The dangers of “coddling” a child who lives with serious mental illness. Five ways to be supportive instead.

My biggest mistake was trying to fix everything for him. He never learned how to do it on his own.

"Big Boy" courtesy of artist Mark Abercrombie

“Big Boy” courtesy of artist Mark Abercrombie

This is what a mother of an adult son who lives with serious anxiety and depression now says. From an early age, Jonathan* seemed more sensitive than other kids. During adolescent and teen years he showed symptoms of anxiety and depression. His mother tried to resolve issues for him because mothers want to make things better. But in doing so, she’d give him the solution rather than allow him to make his own way through problems. She did the heavy lifting to get him out of his darkness. She’d say, “Let’s go for a walk.” Or, “How about I take you somewhere.” “Maybe we should watch a movie.” In other cases, she’d shield him from potentially difficult situations. She tried to rescue him. “That was my mistake,” she now admits.

… finding the fine line between being protective and supportive versus coddling for an overly sensitive or atypical child can be shifty. 

Protecting a child from physical harm and nurturing through difficult emotional benchmarks are givens in a mother’s job description. But finding the fine line between being protective and supportive versus coddling for an overly sensitive or atypical child can be shifty. Parents we interviewed for Behind the Wall described atypical children who almost always had real limitations in social and school settings caused by anxiety or over-sensitivity. Sadly, it is not uncommon for a spouse or the child’s other parent to disagree about where the line of competency exists, creating friction in the home and between family members resentful of “special treatment”. Disagreement between parents about a child’s competency can have devastating consequences. Expectations that are too high can be overwhelming and unduly stressful. Low expectations send the message that parents lack confidence in their child. An awareness that parents are disputing one’s competence can also create guilt and self-esteem issues.

Madeline Levine, psychologist and author of The Price of Privilege and Teach Your Children Well advises, “Never do for a child what he can do for himself”. This includes navigating on one’s own through difficult emotional territory with support from parents. A parents’ job is to prepare a child to live successfully in the world. Experience is truly the best teacher, and parents are uniquely qualified to provide such opportunities for trying new physical, mental, and emotional challenges. Coddling, by definition, prevents experience and important failures from which one learns. Being supportive means presenting a child with choices and allowing him to gracefully fail and succeed at his own pace along the path he chooses.

For a person who lives with mental illness, though, the line of competency can shift day-to-day, sometimes hour-to-hour depending on the person’s current state of recovery. Sometimes, that line moves backwards.

Here are ways our Behind the Wall parents show support and avoid coddling:

Be honest. Being honest with a loved one about her mental illness and her current state of recovery is the crucial first step toward her recovery. Being well informed by credible sources about the diagnosis and seeking evidence based treatments are necessary for recovery. Ultimately, a person cannot reach recovery without moving toward it on his own volition, which may require professional motivational help. Managing an illness successfully requires knowing facts. Shielding facts in an effort to protect another from the stigma of mental illness only serves to obfuscate the path to recovery.

Give your child responsibilities. Everyone needs responsibilities. Having a goal each day fosters success over time, even if on some days the goal cannot be reached. As one Behind the Wall parent says, even though her son was not yet able to live on his own, he wasn’t broken; he could still clean his dishes. It just may take a little longer for him to remember to do it. As Dan says of expectations for his daughter who lives with schizophrenia, she is responsible for living the best way she can. All of us owe ourselves the self-respect to work every day toward learning better management of one’s own health; for a person living with mental illness it is certainly more challenging than most and often means taking medications and recognizing when treatments are not working. A person may do better one day than others, and may even fail, but everyone has the responsibility to try again. And loved ones must provide support everyday without judgment or criticism.

Teach strategies rather than provide solutions. Keep an ongoing dialogue. A person living with a brain disorder may not always be capable of rational or logical thinking. Sometimes, a person may believe that loved ones or even non-existent people are trying to inflict harm. There is no amount of rational talking that can convince a person who is experiencing psychosis otherwise.

But that doesn’t mean a parent or trusted loved one shouldn’t keep trying to show—by asking questions, for example—how to logically work through paranoid or disjointed reasoning. When her son is experiencing psychosis, Bianca points out behaviors and symptoms that indicate irrational thinking, and helps him to see he is not well. When doing well, she describes the behaviors that reflect failing mental health. She will tell him, “When you were in the shower for six hours, that was not healthy.” She will ask him, “When you’re not doing well, what are some things you can do?” A constant dialogue about recognizing symptoms of one’s worsening illness may be helpful to a person who is in the long and difficult process of learning to manage his own illness. Bianca encourages her son to take a daily inventory of symptoms and think about what has worked for him in the past and what he can do in the future. More than once, Bianca’s son checked himself into the hospital.

Provide an escape plan for potentially stressful situations instead of not trying at all. Along the lines of teaching strategies, avoiding any situations that may have potential for stress can limit an individual’s engagement with community and chances to develop new skills. But stressful situations without an escape strategy can have devastating consequences for a person living with mental illness. Sometimes, social events are unavoidable, or an individual desires to try a new experience. Discussing an escape plan in advance empowers an individual with agency to determine when a situation becomes overwhelming and to act upon it. Planning ahead develops problem-solving skills for managing the ever-changing limitations of one’s mental illness. Behind the Wall father, Dan, encouraged his daughter to pursue a demanding education while emphasizing the always-available option to drop a class should she begin to feel overwhelmed. Bianca, a Behind the Wall mother whose son lives with schizophrenia, prepared her son in advance of attending a wedding. If the crowd became too much for him, she explained, it was acceptable for him to go outside and take a walk or go home. Now, when they go out to dinner, he gets up and goes outside if he needs the escape and nobody is concerned, critical, or judgmental.

Failures are memorable lessons, and with support from a team, a failure can be a safe learning experience. 

Welcome failures as opportunities to learn and never be judgmental. Perhaps the most difficult guideline to follow when parenting any child, but especially one who lives with persistent mental illness, is allowing for failure. A person with brain disorders frequently faces situations in which “failing” may pose lethal risk. Failure to manage one’s illness can lead to a psychotic episode, possibly resulting in self-harm or victimization. Assertive Community Treatment (ACT), an evidence-based treatment, provides people with mental illness a safe environment to try new life skills. Failures are memorable lessons, and with support from a team, a failure can be a safe learning experience. One example of ACT service is “supported employment” in which a person’s employer and case manager work in cooperation to increase the employee’s success. The case manager facilitates understanding between employer and employee, assists in working through obstacles and potential job challenges such as communication problems, stressful hours, or short-term memory deficits common for individuals with brain disorders. ACT provides similar support for college students managing communications with instructors and stressful course loads, for example. By providing well-trained advocates to teach and reinforce practical life skills and strategies, ACT decreases day-to-day logistical load for families who are hesitant to allow an adult child to fail.

By the time Jonathan, whose mother admitted she had not allowed her son to fail, reached his early twenties, an age by which he could have begun to understand how to manage his illness, he continued to experience increasingly severe and unmanaged anxiety and depression. He was not progressing in life as he thought he should. He sought help from an uninformed practitioner who did not offer talk therapy but prescribed marijuana** for severe anxiety, which over time, compounded his issues. Though one of Jonathan’s parents is a physician, he refused to listen to advice from either of them. Fortunately, Jonathan finally recognized his anxiety and depression was debilitating and he had not acquired effective tools to manage his illness. He agreed to seek treatment from a doctor recommended by his parents and his life has been improving.

*Names and identities are changed to protect anonymity of the (usually adult) children of Behind the Wall parents

 

**Studies show that marijuana use is “…potentially dangerous for people with mental illness.”

From National Alliance on Mental Illness web site (www.nami.org):

The overwhelming consensus from mental health professionals is that marijuana is not helpful—and potentially dangerous—for people with mental illness. Using marijuana can directly worsen symptoms of anxiety, depression or schizophrenia through its actions on the brain. People who smoke marijuana are also less likely to actively participate in their treatment—missing more appointments and having more difficulty with medication-adherence—than people who abstain from using this drug.

The relationship between marijuana and psychotic illness, specifically schizophrenia, has been studied for many years and is receiving increasing publicity in the mainstream media. Certainly not all people who smoke marijuana will develop schizophrenia, but people who are at risk of developing this illness—including individuals with close family relatives that have severe mental illness—will be more likely to experience psychosis if they are using marijuana. In this population of individuals, people who regularly smoke marijuana are diagnosed with schizophrenia at a younger age, hospitalized more frequently for their illness and are less likely to experience complete recovery even with high quality treatment. This is particularly concerning, as approximately one-third of people in America with schizophrenia regularly abuse marijuana.

From the Royal College of Psychiatrists website (www.rc.ac.uk):

There is growing evidence that people with serious mental illness, including depression and psychosis, are more likely to use cannabis or have used it for long periods of time in the past.  Regular use of the drug has appeared to double the risk of developing a psychotic episode or long-term schizophrenia. However, does cannabis cause depression and schizophrenia or do people with these disorders use it as a medication?

Over the past few years, research has strongly suggested that there is a clear link between early cannabis use and later mental health problems in those with a genetic vulnerability – and that there is a particular issue with the use of cannabis by adolescents.

 

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Advice to a Parent Whose Child was Recently Diagnosed with Mental Illness: Part Two out of 100.

Truth What we learned from parents through our interviews for Behind The Wall is that parents and their child often have difficulty accepting a diagnosis of serious mental illness.

Sometimes the diagnosis comes with the mixed feelings of relief—for having a name for what it is that makes the ill person feel unwell, and also grief for what the illness portends. And because of the stigma of mental illness, even the most well-informed individual may choose to deny the diagnosis for a deep desire for it to be untrue. Most people understand to some degree that a mental illness diagnosis signifies a life with challenges, and for some, unnecessary shame.

But parents we interviewed can attest there is no shame in mental illness. A person with mental illness may have challenges but they are capable of living a full life, finding happiness, stability, and fulfillment. They are capable of meeting expectations, provided these are realistic.

How does one get there? As one mother put it, “As soon as I accepted it, my son’s life got better.” This is good advice for any parent.  In life, most of us have learned that an obstacle cannot be overcome without identifying what it is, exactly, to be overcome.

When a friend of mine learned her newborn was diagnosed with Down syndrome, she was filled with grief. She hadn’t expected to have a child who would have such profound challenges. But years later, she and her husband stood before his classroom on parent night and explained their son had a syndrome, and yes he looks different, and please explain it to your child because that will make it more comfortable for everyone. There is nothing to hide, nothing to be ashamed about. And what she has observed is that the children whose parents are open about the boy’s challenges are the ones who are most accepting and, well, friendly towards him.

Well, Down syndrome is not mental illness. And maybe the rest of society has a more difficult time understanding mental illness. But the example is apt in this regard: being honest and informed with your child and those in your child’s life can help him or her accept the illness and manage it better. Being honest with yourself, as a parent, can help you be more direct in finding the best treatments and solutions to the difficult day-to-day challenges. Bianca, a parent we interviewed told us that when someone asks her why her son is not attending college or a colleague asks about her son, she now just says, “He’s been diagnosed with schizophrenia.” She says, “Let them deal with it!”

What parents need, and often want when their child has been recently diagnosed with a serious mental illness —any illness– is honesty. Reality.

Since we couldn’t say it any better, here’s Kerri’s advice. She’s the parent of a young man in his late twenties who was first diagnosed with mental illness at the age of twelve.

To a parent whose child has been recently diagnosed I would never say, “Oh, it’s going to be fine, don’t worry.” I would be empathetic. I would say, “This is hard. I remember when Thomas…” I would draw upon when Thomas was first diagnosed. “I was devastated. It was hard. Take it one day at a time. Time will tell.”

I would give advice on what to do: “Make sure you have a good psychiatrist with whom you can communicate well, somebody you can trust. You need support. These are the things you should be doing. I hope you can come back to our support group next month. Do you have good friends there for you?”

I would give tangible advice on how to take care of himself or herself as a parent, make sure they have the information they need. If there is a good book for them, I would lend it. Websites, articles. I might even say, now that I know more about the medication piece, “Medication is really tricky…if you are ever concerned that your child is either over-medicated or on the wrong medication, you should watch for these signs…”

I would give concrete advice. I would never be like, “Oh, don’t worry. It’s all going to be great, wonderful. I’m sure your son or daughter will overcome this.”  I wouldn’t go there. I’d be in the here and now. I would never, ever say anything negative because I would never want to discourage a parent. I mean, there’s always hope and there are some people who do fine.

 

And what do parents of children diagnosed with serious mental illness want from the rest of us? To listen. To understand that parenting for them is different, poses more challenges than most parents have. They need us expect them to be late to things, not be able to show up sometimes. But most of all, they need people to be there for them.

More from our amazing super-parents to come…

 

As always, we are interested in your comments:


Welcome

BEHINDtheWALL

By Mary Widdifield

My mother once told me, there was a time when people wouldn’t say the “c” word in polite company. Cancer, that is. Perhaps it was because in those days, there was little hope for recovery. But now people discuss their  battle with cancer or whatever illness it may be, openly and often vividly.

Not so much the case for those diagnosed with serious mental illness or for the caregivers and loved ones of individuals living with mental illness. Yet, as with other illnesses, there is hope. But this is not common knowledge because of the stigma around mental illness.

Through our work interviewing parents for our collection of stories entitled, Behind The Wall: The True Story of Mental Illness as Told by Parents, my sister and co-editor, Elin Abercrombie, and I learned there is a whole other subset of high level parenting in our society. These are quiet heroes who have bravely told us their stories, experiences that are not typically conveyed in polite company.

I hope to bring more topics bubbling to the surface for my readers, covering the things hidden behind the wall within the subjects of parenting, family life, and the general human condition. Mostly serious, sometimes less so. Sometimes, there will be guest bloggers who have experiences to share. But always there will be brutal honesty…

Thanks for visiting.

We welcome comments!