Thursday, 3 May 2012

How to respond to someone with mental illness..... the, 'i love you but i don't know what to say, also this is awkward' guide

Sometimes I wish that everyone could just read each others minds so people wouldn't feel no one understands them, or worry about what they should say.  Then I remember that would be a terrible idea.  But then I wrote this.  It's hard to know what to say or do in some situations, like the death of a friend's family member, unless you've been there yourself.  I sure had no idea what the hell to say so I just clammed up and looked away.  Maybe someone will read this, and feel a little less freaked out next time they come across someone with mental illness.

It's not your job to fix them.
-  First, remember who you are in all of this.  You're not superman.  You're just a friend, someone who loves or cares about this person.  It's okay that you don't know what to do or say.  You aren't meant to.  You aren't meant to fix this, you aren't meant to have answers.  You may not even be able to understand what's happening.  That's okay too.  Fixing, advising or even completely understanding, is not your job.  It's human nature to think we need to be able to help solve a problem, but just stop right there.... take a deep breath.  This is not your job.  You're a friend, not a doctor.  All you have to do is be a friend.  If you try and fix it, or give advice, the reality is it's not likely to work... it's going to stress you out, and stress out your friend.  It's a bad move.  Accept your limitations- don't try to be something you're not.

Be honest.
-  It is totally okay not to have the faintest idea what to say.  You don't know anything about this issue- what it's like, why it happens, what it means.  You're terrified of putting your foot in it and making it worse.  So what DO you say?  Crazy idea....  Tell them exactly that.  Seriously.  Front up.  Make yourself a little vulnerable - they did, so can you.  Tell them you don't know what to say and you're afraid of saying the wrong thing.  If you're freaked out, don't try and hide it- admit it.  Tell them mental illness scares you and you don't know much about it... tell them you don't know how to help.  Tell them you wish you could make things better but you can't.  Being direct and honest is so important... I mean, the alternative is awkward silences and ignoring the elephant in the room.  And ignoring it makes it taboo, something to be ashamed of.  You both deserve better.  So go ahead and tell them that you want to be their friend, but you might need their help in how to do that.

Ask direct questions.....
-  ..... about what you want to know. It's okay for you to be curious.  'Is it okay to ask this', or 'is it okay to talk about that', is a lot better than walking on eggshells.  And for them, just having someone know that something is happening, even if you don't get all the ins-and-outs, is better than going through it completely alone.  It can be cathartic for someone just to say out loud what they're experiencing, just to make it real by telling someone.  Or, they might not want to go there.  Be sensitive but not scared-- don't just barrel in there and ask over-the-top, worst-case-scenario questions like 'are you going to kill yourself' or 'are you going to be put in a hospital', even if that's something you are curious about (unless you have good reason to think that's a current danger).  Your aim is to be supportive and respectful, and sometimes questions like that can sound insulting.  If you want to know things about an illness you don't feel comfortable asking, you're probably better off asking someone else, or reading up from a reputable source on your friend's condition.  But things like, 'do you have a diagnosis', or 'what does that mean', or what 'symtpoms/experiences do you have'-- things like that, they likely do want to talk about, because they're going through them, and having other people know part of it lessens the load.  Give them the opportunity to tell you what they want to.

Talking to them might take some effort.
-  Some mental illnesses, like depression, make you want to hide, isolate yourself, be anti-social, act rebelliously, or otherwise try to distance people around you.  But even though a person might be doing that.... doesn't mean they don't need people to be there.  Don't be scared.  Go up and get their attention, see if they take their earphones out.  Just smile and ask how they're going.  They might really need for someone to ask.  Don't expect they will necessarily come to you.... they might feel like a burden and not want to bother anyone.  They might be rude and act strangely, even lash out, but you'll sense that something's off, and a lot of the time it's them, not you.  They could be going through hell- don't feel burned and give up.  Try again the next time you see them.  Or, it's possible they might not leave you alone-- it's okay to be assertive and tell them you have to go, or you aren't up for talking right now.  A friendship is still a two-way street, but if you're up-front about your own needs and encourage them to do the same, you'll get through this.

Ask more direct questions.....
-  ...... about what you should do.  Let them know you're not just saying that to be polite but that you'd actually like to be there for them.  Likely as not, they might respond with, 'I don't know'.  Or 'eh'.  Sometimes 'I don't know' just means, 'I'm too overwhelmed to think right now, but I'm glad you're here with me and I could really use a hug'.  Or 'eh' means 'Thanks, but if I open my mouth right now I'm going to burst into tears, so maybe if you just sit next to me for a while, that would be good'.  There might be something that they really do need you for, but often they won't know until next Tuesday when they suddenly feel the need to go to the beach, or to watch a dvd with someone, or to eat a lot of chocolate.  Planning ahead is NOT always possible, because mental illness is not always predictable.  A person can be blissfully happy one moment, and overwhelmingly lonely or hopeless the next.  Be flexible, and patient with their inconsistencies.  The simple fact that you care, and that you've reached out, is a big help in itself.  

On the 'asking questions' topic,
Asking them...
-  ..... about what they're going to do........  well this is a little trickier.  It's different for everyone, but often, the future is more uncertain than ever, and they don't know what's going to happen any more than you do.  Don't pressure them to come up with a five year plan (or in some cases, a five minute plan!).  It's okay for them to just get through moment by moment.  Depending on the circumstances, they might be scared and uncertain.... or they might be a veteran at coping with their illness.  Don't have expectations, don't pressure or say they need to do better.  Just be there.

You don't have to understand.
-  You can't know what they're going through, you'll never know what it's like to be them, any more than they know what it's like to be you.  Don't say you do.... it's unhelpful-- and depending on how many times people have said 'I understand' to them that day, they might blow their stack.  Even if you have been through the same mental illness yourself, their experience of it is different.  Two people with depression can have different causes, severities, symptoms, triggers, medications, genetic factors..... to the point that what helps one does not help the other. So if you don't even have experience of mental illness yourself, please don't say you understand.  It sort of diminishes their experience, and makes it seem like it's unimportant.  But don't think this means you can't help or be a friend.  IT'S OK IF YOU DON'T UNDERSTAND.  It's okay that you don't know what SSRIs are or what Cognitive Behavioural Therapy is or what happened when they were six.  Over time, you might talk about these things, and that's great.  But even after years (if it's that sort of illness) friends can still misunderstand or get it wrong.  But you know what?  While it's great to share stuff, and great to talk about stuff..... it's more about them getting it out, than it is about you taking it in.  It's about being there, not getting it.  If they go on about what happened at home last year, or how their auntie has a genetic predisposition to anxiety, and you still don't really get it?  Don't fool yourself that you do get it, but just let them talk.  Remember, ultimately they have to figure this out, and they might do most of the figuring out on their own.  But you're there, listening, and that makes a bigger difference than you know.    

You don't have to give advice.
-  Even trained professional sometimes don't get it right-- people might go to dozens of psychologists, GPs and psychiatrists before they find someone who 'gets it' and is able to really help.  You're not the guru, and they don't have to do what you say, even though you're being very nice and might feel that they should really get that Peruvian Hypnotherapy or that they need to eat only blueberries or that they need to move in with their grandma. or whatever it is.  Don't push.  Suggest, but don't insist (unless of course there's something serious and urgent and you're taking them to a doctor).  Be part of the brainstorming or thinking process, but if they reject your ideas, don't take it personally, and hound them about it.  Ultimately, for something to work, it has to come from them... they have to realise for themselves that it's time to try counselling again, or time to try a different medication, or fly to Nepal to learn yoga on a mountain.  Even if it does turn out that you were right, things have to happen in their own time.  Be patient, and recognise that they might have a better grasp on the situation than you, simply because it's impossible to tell somebody everything, to relate all the complexities and for another person to truly get it.  So just chill, let them make their own mistakes, and let it go.

What you can do to help.
-  Be a friend.  Hang out.  Have fun.  Distract them when they need distraction.  Call them.  Text them for no reason.  Invite them out.  Invite them over to do nothing in particular, just so they won't be alone-- I had a wonderful friend who would have me round and we'd fold washing together, or take me out with her while she bought groceries.  If they aren't getting out of bed, come over and throw on a load of washing.  Ask them around for dinner.  Make a time to go for a walk together, because exercise gives you endorphins, and pick them up.  Just by being around, you're reminding them of the good things in life.  
-  One really helpful thing you can do, is to just let them talk.  Say you don't really understand what they're going through, but you care about them, and you're there. Resist the urge to compare experiences from your life with their experiences of life with mental illness.  Don't go on and on about that time your neighbour's pet died and say you felt 'depressed', just like them.  It's natural to try and relate your own experiences to someone else's in a conversation, but save that normal back-and-forth sharing for another time.  Try just listening, actively, and making them feel heard.  Say stuff like 'what I hear you saying is that...' and repeat back to them the gist of what they said- be like a mirror.  Be sympathetic when they're hurting.  This may sound like hard work, but the thing is?  15 minutes of you really listening, and expressing some care, is going to be more helpful to them than hours of them talking and not feeling like anyone's heard them.  Sometimes quality is better than quantity.  
-  'Common sense' is sometimes far too simplistic when applied to mental illness.  Common sense says 'you shouldn't feel like that' or 'snap out of it'.  But sometimes common sense is helpful.  Any doctor will recommend sleep, healthy eating and exercise.  There are some conditions where these things will not be possible (for example, chronic fatigue nixes normal sleeping patterns and is worsened by exercise) -- things are rarely clear-cut.  But if their condition doesn't directly affect basic health guidelines, go ahead and encourage them to have good sleeping patterns, go to the gym and eat their veges.  

Take care of yourself.
-  Ultimately, whether the person in your life is your spouse or a friend you see every other week, you won't do anyone any favours by wearing yourself out.  Being there for someone, doesn't mean being there all of the time.  Say 'no' when you need to.  If you want to, go ahead and tell them they can call you in the middle of the night--- but if they're someone who starts calling every night, hospitals have free 24hr mental health care lines for more serious cases like self-harm and suicide, and there are lots of free counselling hotlines, even online email services, if they just need to talk.  Even if they're shy and unassuming and hate to make demands of you, if you've got too much to deal with right then, postpone it or delegate.  While some mental illnesses only last a few weeks, others are long-term.  Don't burn yourself out.

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