Loving the Family Member with Mental Illness

When thinking back on my time as a counselor and art therapist in a community mental health setting, I distinctly remember dreading the “PLC” or “Planning and Linking Conference” with clients’ families. We would meet in a room: the client, the client’s family, and another of one of our staff, to discuss the client’s progress and goals with their support network. I remember these meetings at times being awkward, as each individual came with differing expectations. I would be ready with my optimistic smile and list of progress that the client was making, while the client’s mom would be ready to share how her son still doesn’t leave his room or talk to her, and is this program even working? The client would often sit quietly, looking uncomfortable with the incongruity of perspectives in the room.

I realized later on, the difference between myself and the family members essentially boiled down to familiarity. I saw clients at work, where I was paid to work with them, and then I went home and had my own separate life. Alternately, the client’s families saw them every day, saw them at their worst, and had a history of hurt and disappointments to sort through. Even though they loved their mentally ill family member, it was frustrating for them when progress did not come quickly or not at all. It is hard to be objective and detached when watching a son or daughter sit in a room all day with no motivation to do anything; it is painful to see a mother relapse into substance use, only to be disappointed yet again after a period of sobriety. 

If you find yourself trying to cope with a family member’s mental illness or substance abuse, it can be an extremely difficult and arduous process. You may feel tired, cynical, and may even have difficulty liking your family member on some days. You may wonder if God hears your prayers for your loved ones, and wonder if things will ever change. These are all normal responses. However, there are some shifts in perspective we can implement that can help us in this process. They are not going to “fix” our loved one’s mental illness, but may help us as we seek to love our family member well as we walk alongside them. 

1. Adjust your expectations of the individual. 

It can be extremely frustrating to see an individual who once functioned in the workplace and society to now sit in a room, doing nothing, saying nothing, with no motivation to participate in the world. You may feel anger, and wonder why they are so lazy when you know that they are capable of contributing or you may feel embarrassed when they act socially inappropriate. However, mental illness is complex, and oftentimes, social inappropriateness, lack of motivation or inability to experience pleasure (also termed avolition and anhedonia) are symptoms of the mental illness and brain dysfunction. You may find yourself less frustrated if you lower your expectations of the person and realize that they simply may not be able to function at their full capacity at this time.

2. Celebrate small successes. 

It can be easy to focus in on all the things the individual is doing “wrong,” like “they are not acting appropriately,” or “He still doesn’t look for a job.” However, once we create realistic expectations, we might be able to better celebrate small victories, even if these simply include the individual showering regularly or being able to engage in a reality-based conversation. Focusing on strengths is a key part of psychiatric rehabilitation, as well as encouraging the individual to utilize those strengths to reach their rehabilitative goals.

3. Seek to show grace.

Just as we enjoy being shown grace by others, seek as much as you can to show grace to your loved one. There might be years of disappointments and hurts, especially if the individual has had periods of psychosis or substance abuse. It might be helpful to remember that God continually shows us grace upon grace when we sin, so how much more can we show grace to others? This can be difficult, especially if we are used to focusing in on the individual’s shortcomings, or if the individual has been hurtful to us without repentance, so we can pray for the Holy Spirit to help us to grow in grace and love for the individual. 

4. Seek to forgive.

Similarly to showing grace, forgiving the individual with mental illness can be very difficult, as the individual often has no concept of how much they may have truly hurt you. They may never ask for forgiveness for the chaos they caused during a manic episode or the times you have visited them at the hospital or the money you paid for their therapy. They may never apologize for the names they called you when they were unwell. There may be a high and thick wall between you and the individual that you feel can never be broken. However, the Holy Spirit is ready and able to help you forgive that person, both to help the relationship but also for your own mental health. Bitterness can only distance you from your loved one and it can even make you depressed. 

5. Embrace structure if possible.

Structure can be especially helpful for individuals who may be distracted by hearing voices, seeing things, or feeling depressed or anxious. If you have small chores that you need help with, invite the individual to engage in the activity and help you with it. There are also day programs available that can give individuals structure and peer support. The individual might claim they don’t need a program or that they don’t want to go, but you and your support network can encourage the individual to attend, especially after a visit to a program and possibly meeting other peers while there. Also, encourage the individual to participate in church events, especially if your church is a welcoming environment for individuals of all abilities.    

Just a note about encouraging the individual to engage with social activities: If you find yourself anxious about your loved one behaving inappropriately or saying inappropriate things, it might be helpful to give someone a head’s up about the situation and your anxiety. You could explain, “He can be very talkative in his manic episodes and sometimes distractible.”  People are actually more understanding than you would imagine and often your loved one’s behaviors are more embarrassing to you than they really are. Try not to let your anxiety about social settings impede with getting the individual out into the community. 

6. Have a support network and a plan for crisis. 

It is imperative that you have people on your team to support you. If a loved one becomes psychotic or a danger to themselves or others, having a team, either a spouse, sibling, or support group, can help you get through that period. It is also helpful to plan ahead for a crisis situation. There are several “Crisis Plan” worksheets available online where the individual can write down diagnosis, medications, doctors’ phone numbers, triggers, and things that help the individual to feel better. 

Holding Every Thought Captive

“We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.” 2 Corinthians 10:5

“As a man thinks, so is he.” Proverbs 23:7

“And be not conformed to this age, but be transformed by the renewing of your mind, for your proving what is the will of God—the good, and acceptable, and perfect.” Romans 12:2

During my senior year of college, I had to create a senior exhibition art piece. I cut strips of tracing paper and wove them together over a wire frame to create a gown made out of paper. My goal of the exhibit was to depict how we as humans are more than our thoughts, although we give our thoughts more power over us than they deserve to have. I used the material of strips of paper to depict thoughts, to show how fragile and temporary our thoughts are, but how when woven together, these same thoughts can become a whole powerful being. Our thoughts are just thoughts, but when we don’t regulate them or hold them to God’s truth, those same thoughts can affect our entire being. 

In the field of mental health, Cognitive Behavioral Therapy (CBT) is an evidence based practice that has been shown to help individuals with varying mental illnesses. Dr. Aaron Beck, the creator of CBT, taught that thoughts affect our feelings, which in turn affect how we behave. However, Scripture has taught, long before Dr. Beck, that we are to hold our thoughts captive to the truth of God’s Word and who He is. Despite the command to hold every thought captive, most of us rarely stop to examine our thought life, and are actually unaware as to how keenly if affects how we feel and how we act. 

One key to holding our thoughts captive is to simply stop and examine them, or in CBT lingo, “Catch the thought.” We are often too busy to do this. Here’s an example: You might be getting ready to go to a social outing but are feeling increasingly anxious. In your state of anxiety, you shout at your husband and raise your voice in frustration at the child who has mismatched socks on. If you were to stop in this situation, you could “catch” or identify some thoughts that contributed to feelings of anxiety. One thought might include, “People at this social function will judge me or dislike me,” or, “I’m going to see such-and-such a person and I really don’t like that person and how she talks to me.” In the moment of getting the family out the door, you might not even be aware of these thoughts but rather just caught up in feelings of anxiety. Catching our thoughts is a process that takes practice, and over time, we may find that there are certain thoughts that come up often in our lives. 

Another key to holding our thoughts captive is to “check the thought.” We want to ask ourselves if a specific thought is true, or ask if we have evidence that this thought is actually correct. And if it is in fact correct, is it also helpful to us? Does it bring us closer to God or farther from God and His character? If we find ourselves jumping to an untrue assumption, are there alternate explanations for this situation? In the situation above, if we examine the thought, “People at this function will judge me,” we would have to admit that we do not know this to be true. Even if there might be one person there who makes you feel small, is it helpful to generalize them into the entire group of people who you will encounter? This thought is simply not helpful. For the thought about the condescending person you’d rather avoid, are there other ways to think about this person? Identify any of their positive qualities, or consider if perhaps they might talk to you in a condescending tone in an attempt to feel better about themselves.

The third key to holding our thoughts captive is to “correct the thought.” Dr. Beck would argue that with time and therapy, we can correct our thoughts. However, we cannot truly do this without the help of the Holy Spirit working within us. Even so, it is definitely an act that we need to continually cultivate and practice! So how do we correct our thoughts? Well, Scripture tells us to “renew our minds” (Romans 12:2, Ephesians 4:23) and “think on that which is true, noble, right and pure” (Philippians 4:8). We must continually bring our thoughts back to Christ and His work of redemption. We need to be in the Scripture daily and in prayer. The more we are immersed in God’s Word and in communication with Him through prayer, the more we will be able to identify lies from the devil in the form of untrue and unkind thoughts. We should also be part of a fellowship of believers, who encourage us in the faith, remind us of truths when we are weak, and point us back to Scripture when we embrace untrue thoughts. 

Our thoughts are just thoughts, but they can have so much power if left unchecked. We have so many thoughts in a given day but they do not have to define us. Our identity is found in Christ and we can keep going back to this truth, day after day after day.