Stigma, stress, and support
I have frequently found myself in the crosshairs between the needs of a person suffering from major mental illness and the exhaustion, anxiety and frustration experienced by the loved-one caring for them.
It is difficult for clinicians to navigate this terrain, speaking to the immense difficulty of the family members themselves. I have found that most of the roadblocks in moving forward is lack of understanding of mental health issues and the immense societal stigma and ignorance that accompany them. Family members caring for the chronically mentally ill need psychotherapeutic support themselves, both because of the stress that is always a side effect of caring for the loved one, and the family dynamics that are brought to light in a patient’s treatment.
Mental health symptoms are reinforced, and sometimes caused, by early dysfunctional experiences in the family. This could be what we call “Big T” trauma (molestation, domestic violence, addiction) or “Little T” trauma (emotional neglect, coldness). So when a caregiver is in the depths of caring for a loved one with mental illness, or the identified patient (IP), these often unresolved parts of their history are brought to the light, causing stress for the caregiver themselves.
However, the response of the caregiver is often to buckle down and ignore their own emotions and focus on the IP, either because they do not want to cope with the problems in the family system that have been brushed under the carpet, or they compare themselves to the IP and come to the conclusion that their needs pale in comparison.
This is reinforced by societal stigma against mental illness and lack of understanding it engenders. This could be a whole article in and of itself — but it should be noted this greatly compounds a caregiver’s ability to address their own needs.
Hopefully, when a caregiver finds themselves involved in the mental health system caring for their IP, they will encounter a seasoned and resourceful clinician who can help steer the conversation towards a more holistic understanding of the problem and address the needs of the caregivers. However, this is likely not to happen in our current healthcare environment, where turnover and high volume often result in lack of nuanced care.
As a caregiver, you know what I’m talking about. You’re here because you know that you have to seek support yourself. Armed with this knowledge, I encourage caregivers to seek counseling themselves, either in the context of the IP’s treatment or on their own. In addition, there are many support groups specifically for family members coping with another’s mental illness, shown at the bottom of this article. It can be immensely healing to speak about these struggles with others in the same position. You can connect with other caregivers of people with mental illness here on the forums.
Psychoeducation is an immensely important component. Psychoeducation refers to the information given to the mentally ill and their family to help empower them and deal with the symptoms in the most optimal way. I have seen the power of this basic and essential tool firsthand many times. While hearing a diagnosis or prognosis can sometimes be shocking and troubling, more often than not family members and patients are relieved and experience it as a concrete way to move forward.
As a therapist, I see a main facet of my role as explaining diagnoses and helping patients and family’s process them, with an emphasis on the fact that they are “working” and highly subjective, and designed to help facilitate treatment, not define the person. For example, a patient is suffering from depression, not depressed. It’s just like how if you have cancer people say you are suffering from cancer, not that you’re cancerous.
Also essential to this is the way the problem is communicated. Mental health issues can be difficult to treat from the perspective of the clinician, patient, and family because of its abstract quality. I cannot give you a blood test to determine you have depression. However, I can affirm to patients that their symptoms are real, a disease, and not just “in their head.” Most of the time they are highly treatable with good outcomes, and this is equally important for the caregiver.