The Shame of Stigma

by Elin Widdifield

shameLast week in a book group I facilitated, the topic of “shame” was raised during discussion of author Wally Lamb’s latest novel, We Are Water. One of the main characters, Annie Oh, had been sexually abused as a child. Her shame was wrapped up in guilt and loss, and as a foster child, she received no professional help. She no doubt felt confused, angry, and she lived in a tangled web of shame and secrecy. For years, her anger festered, expressed in her “outsider art” and by abusing her son. Shame, guilt, and secrets caused darkness and deep troubles in Annie Oh’s family.

What is shame? Merriam-Webster defines shame as: A feeling of guilt, regret, or sadness that you have because you know you have done something wrong. Ability to feel guilt, regret, or embarrassment, dishonor or disgrace

From the Oxford Dictionary we can add: A painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior. (Emphasis in bold is mine.)

Shame can be useful for enforcing behaviors that keep individuals and others safe in a society. We want criminals to feel shame for socially unacceptable actions. Unfortunately, many criminals are sociopaths, incapable of feeling empathy, guilt, or shame, which can create frustration for those of us who do experience and respond to these emotions and/or have been a crime victim. Most all of us have felt shame at some point in our lives, perhaps as a child, when learning society’s code of ethics from elders. Sadly, some, like Lamb’s Annie Oh character, carry an undeserved burden of shame throughout life.

​T​he Oxford Dictionary says, shame is a distress caused by the consciousness of wrong or foolish behavior. What is perplexing, and not included in the Oxford or Webster definition, is that too often people feel shame for events out of their control, such as being abused as a child or born with a brain that is wired for a mental illness.

What does shame do? Shame isolates, leads to secrecy and to hiding one’s truth. Shame denies one the ability to make honest appraisal of oneself, one’s life. Shame is the foundation of stigma and most devastatingly results in a reluctance to acknowledge illness and/or seek treatment.

How many times has the media squawked bafflement that an individual who has caused their own death or harm to others had lived with undiagnosed or untreated mental illness? “How could a person or their loved ones ignore obvious symptoms of mental illness,” they ask?

Rarely is a person promoted in their job after they’ve revealed their history with mental illness, even if their work had been stellar…

For those of us who have a loved one living with a mental illness (most of whom are NOT a danger to others), it is not surprising a person fails to seek treatment, or that loved ones weren’t successful in enforcing treatment. Our society feeds the stigma of mental illness with its solid diet of… yes, shame. Rarely is a person praised for their hard work of addressing their mental illness and undergoing treatment. It’s usually discussed in hushed tones. Rarely is a person promoted in their job after they’ve revealed their history with mental illness, even if their work had been stellar, and this despite the long list of highly successful individuals living with brain disorders.

How can we help to detangle this mess of shame, guilt, and secrecy, and diminish stigma?

We can speak about brain disorders openly in the same way we speak about physical disorders. Caregivers, family members, and loved ones must speak up about needing support. Those looking from the outside see no crutches, casts, or blood. Yet, in the home, loved ones are subject to the ill person’s extreme behavioral changes that cause chaos in all the lives around him. Loved ones must change plans as quickly as they are made; they often seem distracted and are overwhelmed. But those looking in from the outside don’t know the truth unless it is spoken about.

Starting a conversation about the impact of a loved one’s brain disorder on our family, and more broadly, our society, is not always comfortable. We still encounter a tone-deafness about mental illness. Recently, when talking about interviewing people all over the country for Behind the wall, a man interjected, “You mean you found crazies all over the country?” I bit my tongue and, after a beat and a breath, I continued my effort to share information about mental illness. Some will back away, because this illness has nothing to do with them or their family. And that’s​ okay. Fortunately, in our experience, most people to whom we speak about Behind the Wall do understand or want to learn about brain disorders.

For the sake of our neighbors, friends, and because of the prevalence of mental illness across the globe, we continue to share what we know about brain disorders in an effort to reduce stigma and encourage individuals to seek treatment. Speaking openly, without shame, is beneficial for a whole society. We can have stronger and safer communities when our citizens who live with mental illness are not afraid to be diagnosed and treated. National Alliance on Mental Illness (NAMI) states the importance of encouraging quality (evidence based) treatment in terms anyone can relate to:

​The human and economic toll is enormous yet often hidden. Untreated mental illnesses in the U.S. cost more than $100 billion a year in lost productivity… Local hospitals and clinics must cope with associated chronic physical diseases. Schools have to open more special education classes. Courts and jails handle a large number of individuals who suffer from untreated mental illnesses. Suicide ranks among the top fifteen most common killers in the U.S. (in the top three among young people), and 90 percent of cases can be attributed to mental illness.

Our society must take responsibility to learn symptoms of an active mental illness. Those of us with experience, and who understand the illness, can lead this effort. An effective step in this endeavor is to demand in our communities that law enforcement, first responders, educators, and anyone else interfacing with the public are properly trained to recognize symptoms of brain disorders and learn how to interact with a person in mental health crisis. ​Brain disorders cause people to behave in odd ways. No doubt. A person with a mental illness may respond to his own inner processes, which may include frightening voices or paranoid beliefs. Atypical brain activity caused by the illness may be reflected an appearance of “not being all there,” and his responses are unpredictable to outsiders. Understanding brain disorders requires respecting that the input affecting his brain processes is unknowable and that his responses to these inputs influence behaviors that are odd and possibly frightening to an outside observer, or family member. These are behaviors of untreated mental illness, or of a person who has experienced a relapse.

We can all play a part in identifying misplaced shame for an illness that wasn’t chosen by the ill person and the foolish behavior symptomatic of the illness is out of one’s control. We can all do our part to reduce stigma so that people will seek and receive treatment.

We can stop assuming that living with mental illness equates to an inability to hold down a job and living a fulfilling life. Most people who are treated for serious mental illness live full and meaningful lives.

Our faith communities and workplace can be inclusive by understanding that the illness has symptoms that should not be conflated with a person’s character, or behaviors when they are well. We can support a person who lives with mental illness by providing a route for skill-building and work experience.

We can support caregivers of people living with mental illness by simply listening, taking a walk, or having coffee together.

There are many organizations whose mission it is to support individuals and families of those living with mental illness and to address stigma. Among the many, check out:

www.BringChange2Mind.org

www.healthyplace.org

www.activeminds.org

www.behindthewallstories.com

www.SZmagazine.com

www.thekennedyforum.org

As always, your comments are most welcome:

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Parenting in a Tornado

We are pleased to have this contribution from guest blogger, L. M., whose daughter lives with bipolar and borderline personality disorder, and substance use. The illness began to manifest when her daughter approached adolescence and continued into early adulthood.

Parenting a child during a mental illness is like being in the midst of a tornado. At first you have this beautiful person; an angelic child who gives you more joy than you’ve ever experienced. Life is beautiful through her eyes. Then one day, you feel a breeze approaching. It’s not unexpected although at times, it approaches in unexpected gusts.

Of Oz of Cyclonically

“Of Oz of Cyclonically” courtesy of artist Sean R. Selders. Prints available at: http://www.angelfire.com/nj/TornadoScapes

It doesn’t feel unordinary. Perhaps changing patterns in the weather as the seasons shift. Then the breeze evolves into a wind. A steady, increasingly fierce wind. The wind starts swirling. You are swept up inside of it without a warning. You try to find your way out. But each gust pushes you in a different direction. Soon you lose your way. You doubt the path you should take to break free. Your confidence is shaken. Your compass is broken. You ask for directions but the answers are varied and jumbled. You find yourself running in circles wondering how to escape. But there is no escape. And the circle closes in. Finally, you manage to find a break in the force of the wind. You lift your head, wondering how you got swept up. What caused it? When did it all happen? Was it my fault? You look behind at the debris. The damage is immense and widespread. Your head is still swirling. How can you pick up all the pieces? And what will fit back together when you do? The form you had envisioned can’t take shape. It no longer exists. What to do next?  Change the pieces. Make them clay. Let the clay be the new day. It may change every day. It may change every hour. You learn to accept the volatility, the constant morphing of a life you once thought was a straight line, a fixed object. And you observe. You listen. You learn. The tornado swirls, but you step aside. You let it be. Let it unfold on its term without being swallowed in the center. it’s the only way.

As always, comments are welcome:


Breathing

Our guest blogger tells us how challenging it is to live “in the moment”.

Photograph courtesy of Robert Cutten

Photograph courtesy Robert Cutten, 2013 http://www.bobcutten.com

I hold my breath waiting. Panic stuck in my throat, wondering if this is beginning of another crisis my son is creating. Is he going to experiment and lower with his meds and become manic? Will it be like the time he became manic and paranoid?

That time, after alerting the police that the CIA was watching him, he threw out all his trophies, awards, photos, well-written essays, things representing highlights from his past, from before he became ill. Later, I was able to retrieve most things, buried deeply in the garbage and sludge-covered. He packed the essentials: a gallon of sterile water, one change of clothes, sketchbook, a few dollars and not much more. He set out to live on the streets so the CIA couldn’t study him. My two sisters and I drove down every street downtown, tracing the path to his familiar haunts, hunting him down as if he were a runaway puppy.

We found him, euphoric, ready to enter the homeless shelter. He admitted he hadn’t slept in a week and needed help.

The chaos he has created in the past stems from his decision to walk into a bar and drink a beer, and his distorted notion that he is a ‘normal guy’ who can drink a beer. One beer, and be fine. But for him, one beer leads to a weeklong, or months-long binge, blackouts, ruined relationships, lost job, failed college semester, and all this followed by shame and guilt, and the long haul of putting it all back together again.

So, I would hold my breath waiting, knowing what had been built could all fall apart. In one beer.

But while holding my breath, I forget the gratitude for the previous three years of calm and serenity his recovery has brought to our family. I forget gratitude for the hard work and day-to-day struggle that is his, just to live a meaningful life with solid relationships, work, and balance in his life. I forget how much work he does to earn a moment of joy, and happy family moments.


It’s not healthy to stop my life, become paralyzed in fear…


It’s not healthy to stop my life, become paralyzed in fear; I know this. And I’m not fun company. I’ve watched my husband sleep, eat well, go to the gym, work, and put his worry into neat compartments that only occasionally leak out. I will never know how he has been able to do this, but we are all different.

At the Al Anon meetings they tell me to let go and live my own life. Of course I know this is what one should do, but letting go and taking care of myself requires more discipline than holding my breath. Taking care of myself, over worrying for my child, is not natural for mothers.

But how long can a person hold their breath?

I came to realize that I cannot continue to live this way, starving myself of oxygen, denying myself my own life. I need to be strong for that moment he reaches out, asking for help. I needed to change, and it can only come from me.

I found a therapist who knows about addictions and mental illness. She helped me grieve the loss of my son, the easy son I once had; the son who won trophies, wrote essays, and had healthy relationships. To allay my fear and angst, I began to meditate, sometimes a walking meditation on the beach, or in the woods. Exercise and sports had always been a part of my life and it was time to incorporate these activities back into my life. I needed to live more consciously, beginning with eating well, not mindlessly consuming a pint of cookie dough ice cream in one sorrowful sitting.

The most difficult part for me was becoming social again. I had lost relationships during the chaotic times of my son’s illness. Let’s face it, people don’t understand, and I wasn’t fun to be with anyway. I made new friends who are also in the club of knowing mental illness and addiction. These friends could hear what I was saying without flinching or pitying. I don’t want pity.

What has helped give me perspective and insight is being well informed. I read and learned everything I could about the dually diagnosed, those with serious mental illness and substance use disorders. I found my local NAMI to be most helpful, especially the Family-to-Family class that my husband and I attended together. I found support and community there too. I also called upon my faith, that faith I had felt abandoned me during the hard times.

I feel connected to my son, and this is key. Feeling connected to our son gives us the best chance that he will turn to us when he is failing. It’s the best hope we can have. Feeling connected enables me, ironically, to let go a little more. Knowing that he is aware that we will always support his recovery and never judge his journey is the best insurance that he WILL turn to us on his own volition. Because ultimately, his recovery must come from him. I now recognize that holding my breath or living in fear will not give him tools to manage his illness.

How we stay connected is by expressing our deep appreciation of his strengths and struggles, and telling him frequently how much we respect his hard work. Believe me, I want to keep him in a bubble to protect him. But I don’t pity him or coddle. I support his efforts. I’ve learned the importance of letting go and allowing him to make his own choices and decisions, because I won’t be around forever to protect him. I enjoy his humor, his new quirkiness, and his artistic passions. There are many things I want for him but he may not want these things for himself. I’ve worked on learning to stay quiet, enjoy the moment, and find gratitude. I am grateful he’s alive and has integrated into his community, and is moving forward in his own way with his own volition.

Sometimes, I slip, and find I am holding my breath: after learning he’d “had a beer with friends,” or one recent night when he didn’t return home. The difference now is that I recognize when I am not living in this moment, but rather flashing back to the chaos of the past, and worrying about things that may or may not ever happen. My physical health is much better when I live mindfully, with balance, and joy. Every day offers the chance to find joy. I sound like a bumper sticker. A few years ago those sayings evoked anger rather than peace for me. I don’t want to be in this club of parents whose children struggle with a dual diagnosis. I want to be a parent of an adult child whose biggest problem is finding the right career, or breaking up with his girlfriend, or learning to budget his money.

But this is where I am in this moment.

Your comments are always welcome:


How Social Media Made Us Feel Media Awkward.

Social-MarketingSo, this is awkward.
My sister, Elin, and I set out to put a collection of stories together to help other parents and the extended family members learn to manage and advocate for a loved one who lives with serious mental illness. It was borne out of our own need; we wanted these stories for ourselves, to help us better support our loved one who had been recently diagnosed.

The editing process for our Behind the Wall collection was at times challenging. The gravity of the subject matter was palpable and honorably representing the stories and the storyteller, at times, daunting. These are difficult stories to tell and hear, and we felt it important not to sugarcoat. There were times one or both of us had to step away from the emotional intensity. We were confronted with our own relationship to the ideas and realities of mental illness, and how it affects our loved one, each other, and ourselves.

What kept us on task was thinking of the parents who told us after being interviewed that they considered the project important and earnestly hoped their story could help someone else—someone who was feeling isolated and scared as they’d once been. In the end, we received much more than we gave, much more than what we could ever have anticipated. We met inspiring parents who showed us how to be better, more compassionate human beings.

The Behind the Wall collection began five years ago from the time of this writing. As we rounded the corner and saw our collection taking the form of something we felt useful, we recognized that we had more to say—insights we had learned from parents but that didn’t quite fit the story collection format. That’s when we began writing our blog.

The blog turned out to be a good thing. It helped us to continue processing concepts for coping and living with having serious mental illness in the family. And, as luck would have it, when we talked to agents about our book they said, “You’ve got to have a platform! Social media! Blog!”

We thought, “Good for us! For once, we’re following the rules of the game!” Besides the blog, we had also begun using Facebook and Twitter to connect with others who are serious about talking about this important issue. Through social media we learned about many organizations doing good work to support individuals living with mental illness and their families. We learned that social media can be useful!

Our primary motivation for our story collection, blog, and social media has always been to share useful information we learn. We are doing whatever we can to spread the word about the importance of supporting those who live with serious mental illness, and supporting their caregiver/advocate and loved ones. We wanted to participate in spreading the word about the harmful effect of stigma and how it delays treatment, which in turn impacts recovery.

Because every individual’s mental illness manifests uniquely, and there is no “cure” for brain disorders, we never have, or ever will, advocate for a miracle treatment or standard “it’ll fix anything” treatment. While we may describe a particular evidence based treatment that has helped others, we do not advocate a particular medication or the decision to take NO medication.

So, imagine our surprise when we were accused of shilling/helping to promote a company via social media that advocates quitting doctor prescribed medications in place of vitamin supplements. Um. That was awkward.

We’re not saying that this protocol is recommended OR NOT recommended.


Our responses to those we follow on social media are responses to particular statements, or tweets, for example, not endorsements of said tweeter’s whole philosophical stance. 


Our responses to those we follow on social media are responses to particular statements, or tweets, for example, not endorsements of said tweeter’s whole philosophical stance. Advice/comments we advance are those echoed by the many experienced parents we have interviewed. Our goal has always been to bring stories to the forefront because there is tremendous healing in knowing others are living similar stories.

We forward information that includes such things as new clinical studies or literature that may be interesting and useful to others but that are from reputable sources. Because we’ve been keeping pace with the current literature, we can vet it for those new to the journey of managing mental illness, or we may learn about a new study that advances the treatment of mental illness and we want to share it.

That said, while we will not offer advice on treatments, there are a few recommendations we always stand by. And here they are:

  1. Regular exercise is good for everyone.
  2. Everyone benefits from a healthy, nutritious diet.
  3. Treatment sought for mental illness and/ or substance use should be evidence-based, and this means by a reputable source.
  4. When diagnosed with any illness, one should learn as much as possible from reputable sources.
  5. Obtain second opinions. Preferably more.
  6. If a “cure” seems simple, or one that “is being kept from the public by some large entity”, beware. If something is too good to be true, it is not true.
  7. Trust your gut.
  8. If you have been diagnosed with a serious illness, enlist a trustworthy advocate who doesn’t tell you everything will be okay, but who is willing to follow evidence based guidelines for your care when you are unable to advocate for yourself. If you are the caregiver, don’t say everything will be okay, but instead do your homework and understand the illness as well as you can.

 There it is.

We welcome comments.


A little help here?

Albert Seuss, by Mark Abercrombie

Albert Seuss, by Mark Abercrombie

Being in public, even just standing in the grocery store line with her adult son, used to be embarrassing for Annie. Her adult son can’t be still. He’ll start bobbing his head. His body is jittery. He could easily be mistaken for a tweaker. She shrugs. “You get used to it,” she says. And he’s done worse.

Having a child who lives with mental illness feels sort of like being the parent who carries a newborn and two toddlers with head colds on the plane for a red-eye, only more extreme. Nobody wants to be near that mess, and everyone has an opinion. Also, there’s a lot of glaring.

In the stares and clucking of distaste that parents of atypical children often absorb, there seems to be a less than subliminal message that these parents chose this messy life and if they only desired things to be different, it could be so. As if these parents are weak. But parents of children with mental illness did not choose this club. Their child didn’t either. There are coping skills to be learned, but like those toddlers on a plane, you cannot control air pressure, or sinus pain, or always fix whatever is bothering them.

A person who lives with mental illness sometimes displays odd behaviors. A person with an injured leg may walk funny for a while and it’s the same for an injured brain; it’s not so odd when you think about it in that way, Right? What’s distinctly different is that a child’s mental illness challenges the stamina of parental love like nothing else. That’s in addition to judgment from others. Rebecca, one of our Behind the Wall parents, explained how excruciating it could be when her daughter, Stella, accused Rebecca that she was not her real mother. Stella’s father, Dan, recounts discomfiting conversations with Stella about the chip in her head. But for Stella, who heard voices clearly and sensed smells that others did not, the chip theory didn’t seem so far-fetched. It did make sense to her because her brain was feeding her different signals than what others know to be reality.

Simply spending time with a person who is experiencing a manic episode and/or psychosis presents challenges. It’s not easy. Depending on where a person is on the spectrum of recovery, there are frequent lapses in logical thinking that sometimes lead to risky behaviors and self-harm. Once, Annie’s son broke into a store after hours. He busted the door, got in, then realized he didn’t know what he was doing and left. He didn’t steal anything but damaged the door. His actions didn’t make sense.

Sometimes there are scenes. Ugly scenes. Jennifer, who lives with bipolar and borderline personality disorder, had developed a history of rages and alcohol use by the time she’d reached high-school age. This behavior was never permitted or condoned by her parents. In one incident, Jennifer had been drinking and was raging and throwing things at her boyfriend’s house. Her boyfriend’s parents banned Jennifer. Sadly, they must have also spread the word that she was out of control and it was about bad parenting. Jennifer’s sister, who had never been part of any such incident, was banned from spending time with the family that lived next door to the boyfriend. A loved one’s illness leaks into all aspects of family life.


As one Behind the Wall parent says, most people don’t know what it’s like to have a loved one who lives with mental illness. Good for them. 


Only those who’ve parented a child who lives with serious mental illness can truly understand the challenges involved and the breadth of behaviors that arise because of the illness. Even for these parents, there is much experience required to distinguish between typical bad behaviors versus behaviors driven by the illness. They can’t possibly always get it right.

Parents of children who live with serious mental illness, like those beleaguered ones getting on a plane, aren’t asking for anything more than a little understanding. As one Behind the Wall parent says, most people don’t know what it’s like to have a loved one who lives with mental illness. Good for them. Living with a serious mental illness and being a parent/advocate has challenges that can only be fully understood by others living a similar experience.

Parents whose children live with mental illness aren’t asking anyone to sidle up to their chaos. These parents are also past wishing to be well-liked because major concerns are about keeping their child safe and stable. Parents aren’t asking for solutions, or agreement, or sympathy. Pity is not wanted. Just please don’t judge. And if one were so inclined, even a small gesture of support and kindness goes far for a parent enduring a journey where parental love is infinitely tested.

 

As always, your feedback is welcome.


Why a fear of labels can cause more damage than calling it like it is.

I just say, ‘he has schizophrenia.’You know, it is what it is!

poppy

Throughout the process of creating our collection of stories for our Behind the Wall project, most parents we interviewed had already passed through the hurdle of acceptance, or as one very astute parent clarified, she’d reached “radical acceptance”. (See post entitled, “Radical Acceptance” dated June 26, 2013.) Most of the parents we interviewed were living in the fluid state of “What do we do now?” And in the same way a yogi practices yoga, rather than ever fully mastering it, these parents practice the daily inhale/exhale of living with grief while also caring for one’s own well being. We’ve said it many times before: these parents are inspiring.

During one interview, however, a parent described her child’s illness without offering to share the psychiatrist’s diagnosis, insisting instead, “We don’t use labels.”

The stigma attached to serious mental illness is detrimental to those diagnosed and their loved ones. “We don’t use labels” means, “We won’t really say what the illness is because I don’t think my child can handle knowing it and neither can I. I don’t want others treating her differently.” This way of thinking is not uncommon when parents first learn their child’s diagnosis.

A diagnosis of a serious mental illness such as bipolar, schizoaffective disorder, schizophrenia, or serious depression, often comes after challenging chaos and endangering incidents. Frequently, the most accurate diagnosis is preceded by several near misses. Settling on a correct diagnosis can be a complicated process. So when a parent hears, “Serious mental illness,” it makes sense to wonder, “Is that really it? Are we jumping to conclusions?”

These are sentiments many Behind the Wall parents harbored while moving toward acceptance. After her son was diagnosed, Bianca would sometimes think, “Schizophrenia? Maybe he’s just having a bad day. Maybe he just smoked too much weed.” Or, she’d say, “Maybe it’s bipolar. Because bipolar is more socially acceptable than schizophrenia!” All the while, she knew her son was very ill.

But not addressing the illness directly inhibits acceptance by loved ones, the caregiver, and most critically the ill person. An individual living with serious mental illness simply cannot reach recovery without accepting the diagnosis and treatment required to effectively manage the illness. Maybe a parent refuses to “label” because she doesn’t want her child to believe he is flawed or less of a person. One may fear the child will use the diagnosis as a crutch or excuse. A parent doesn’t want her child to be treated “differently.”

Life is more difficult with any untreated illness. 

Here’s something to consider: a person living with untreated mental illness already knows she is different in some way. Life is more difficult with any untreated illness. And those who are in recovery almost always recognize the importance of owning their illness and calling it what it is: a challenging, incurable condition that was not caused as consequence of their own doing.

And while society and the media are still slow to come around to speaking accurately about mental illness, when a person’s immediate community accepts the illness without confluence of inferiority, so will the diagnosed individual. When loved ones rally to support a lifestyle conducive to managing the illness, that is, treats him (differently) with perhaps more compassion and understanding, his life gets better the same way a person managing diabetes must be supported in his lifestyle requirements.

 it is what it is

Decades ago, our mother reminded us, that a person would never announce his cancer diagnosis, likely because it was a death sentence. Also, it was terribly impolite. But today there are good treatments and website pages where a person announces his illness, his stage of recovery, and welcomes supportive posts from loved ones. Even money for healthcare is accepted. As it should be.

Today, serious mental illnesses can be managed too. There are set backs. But those who have the best chance for recovery are those who own the illness, accept the diagnosis and treatment. As it should be.

Let’s talk about mental illness in a real way. There is hope. It’s a serious illness that needs proper due.

 

Your comments are welome.


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.