We all need natural supports to get better when things like psychosis and mania get the upper hand, and caring for your friends and loved ones struggling with serious/severe mental illness (SMI) is imperative to a good prognosis. Here’s advice I would give anyone who’s wondering what to do for that friend in an acute episode, with or without insight into their SMI.
If They Seem to Not Realize They’re Sick
The number one thing to remember, if you take anything from this post, is to not insult the person with an SMI diagnosis. By that I mean, if they are sick and don’t realize it (known as lack of insight, or “Anosognosia“), do not try to convince them or persuade them to take their medication, make them believe they are sick or give them grief for resisting treatment.
Like Alzheimer’s and dementia, the general rule of thumb is to “live in their world.” Unless they are in imminent danger or a risk to themselves or others, be aware they may not realize their sickness, and talk to you as if you understand them, or should understand them.
Sometimes, it’s not so clear whether they understand they’re sick or not. When I was sick, I believed I was healed. I even had my therapist in agreement. But when I became stable, I realized I was sick and needed the medication to remain well. So in my own personal opinion, I think Anosognosia doesn’t have to be a permanent thing.
If They Have Insight
If your loved one recognizes and accepts their diagnosis, this is half the battle. When we are in denial or lack insight and have “Anosognosia” about it, it makes it that much harder to seek treatment. However, if it sounds like they are willing to go the distance to be successful in getting better and back to functioning within normal limits, that is half the battle.
As someone who had anosognosia/lack of insight at one time, I was too proud to admit I had bipolar and then realized the hard way that medication and therapy are answers to the prayers I prayed. God brought me through the chaos and confusion.
I believe God allows hardships and suffering in life because He wants us to be closer to Him through it and after it.
Here are a few practical tips for you to apply in order to help your loved one see as much success and progress as possible:
- Pray about how to express your concerns to your loved one/friend. It can be a tender or volatile thing to approach them, especially when they’re in an episode of mania or psychosis. If they’re not in an acute state and you’re not sure how to address how they’re doing in a face-to-face or phone conversation, you may consider writing a letter to them. You might say something like “It seems like you’re going through a tough spot, but I want you to know I’m thinking of you and here for you.” If you write it though, you have to mean it. You can’t write “I’m here for you” and not be. Make sure you mean what you say, but also say what you mean!
- If they’re not hospitalized, depending on how close your friendship/relationship is, you may monitor their behaviors, check in on them every day, or every other day. Before you do, offer to them that you would like to check back with them daily, or however often. If they’re okay with it, then go ahead. If they’re not okay with it, attempt to be in communication with their caregivers/family/roommates on a regular basis. If they are suspicious, try to explain that you simply want to show you care and are there for them. If you simply cannot or they will not allow you to be in contact with them, pray for them in the meantime.
- Be there to keep them accountable. If they’re especially depressed and suicidal, you may ask them about their thoughts and if they’re planning or thinking of killing themselves. If they are, and you are comfortable talking about that, find out in-depth to what degree they’re thinking/planning. If they have a date and/or method, always contact their mental health provider with them. If they are exhibiting extreme behaviors, call 911. If you’re not comfortable approaching this topic with them, learn more about the ways to talk to someone who is suicidal and help them.
- Remind them of the good times. Putting too much focus and emphasis on the negative or the extreme of an episode can be too overwhelming for anyone. Definitely include talk about positive, happy memories, or great character traits you like and respect in them. Give them room to be themselves, but also try to encourage them that there are more good times to be had in the future.
- If you are a guardian/spouse/close family member, try to see their psychiatrist with this loved one if possible. Let them speak with the doctor first. Never dominate the conversation, but if the doctor asks your opinion, share it. Likewise, if you have concerns, which you probably do because you’re there, ask if you may share them. Be brief, succinct, and factual from your observations alone. No one wants to feel ganged up on because “a lot of the family and others who know so-and-so are concerned.” Don’t speak for anyone but yourself.
Did I leave some out? What other ways have been helpful to someone you know in an acute episode of Serious Mental Illness?
Here are some other posts on my BipolarBrave blog that may give you answers surrounding this topic:
About the Author: Hey there! I’m Katie Dale, familiar with the storms of mental illness, and I blog about my faith and how it has informed my brain-based disorder at KatieRDale.com. I also have a memoir out about my journeys through the psych wards and how I found peace of mind with psych meds (by the grace of God) – you can find it on Amazon here. Come find me and say hi on social media @KatieRDale.
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