Having worked at the Ensemble treatment center I had the opportunity to learn about many clients and their illnesses. Perhaps I can help you to understand the illness from a client’s perspective.  The first thing I learned before I could help was that I had to understand. To understand the person I had to suspend my judgment and enter into a trusting relationship in order to really communicate. 

As you know, most clients suffer. They may differ in how they suffer or what ways they suffer, but they suffer. Most sufferers fear judgments and they are often judging themselves the most harshly.  Many clients become fragile and may tend to read judgment into statements that are not intended to be that way. An environment of trust has to be built so that they won’t feel judged. Statements like the following can hurt:  that’s silly; really???; that’s not true; you’re stupid if you think that; no one is following you; the radio is not talking to you, etc. These kinds of statements do not reflect your understanding of your loved one’s reality.  The client who feels fragile will begin to distrust you and that will start to close the door to communication. Sometimes it is reassuring to say that I see that you believe this but I do not share that reality.

 Most often the ill individual feels misunderstood by family members.   In addition, they suffer so much they can’t think about how others around them feel.  For instance those suffering from depression have days, weeks, (months or years) of not wanting to wash themselves because the effort to clean is so enormous that it overwhelms them. Depression causes a lack of energy that may make the limbs too heavy to move. Some become habituated to their own smells. Those with Obsessive Compulsive Disorder can take hours to do their rituals: for example, they have to use the bathroom in the middle of the night or prefer not to at all if family members complain of the amount of time or amount of water being used. Complaints cause stress which will exacerbate the problem.

When a person is not in reality they can still communicate their fears and thoughts. Being out of reality is often scary for them: either experiencing voices from inside themselves, hallucinations, or having thoughts of being persecuted. Some of these experiences are not threatening; others are negative, bizarre and/or hurtful. I have learned that I take for granted my brain’s good functioning. So much goes on automatically that it is difficult for many of us to understand when one process does not work or stops working. One fascinating instance occurred while I was driving with a client who had schizophrenia. She became overwhelmed visually. She told me that everything appeared to fly at her. We do not realize that we have screeners in our brain to filter information until we see someone whose screeners do not work. In the past she had full blown panic attacks because of the fear it generated. This problem made her agoraphobic and she refused to leave her home unless accompanied. Her family members saw the problems that this situation created.  Her solutions did not look logical to them.

Many times, family members rely on logic to discuss different issues. There are instances when this will work and times when it will not. I found that some people cannot receive painful information and they may become defensive or switch into their delusions.  One time I had a client who was upset because he was not getting invited for any interviews. He had applied for many jobs in person. His disheveled appearance plus odor were part of who he was.  I suggested that self care was needed in the restaurant business; he felt threatened and he became paranoid.  He felt others were looking at him and he said he wanted to hurt someone. Logic in this case did not work and in fact caused an unforeseeable problem.

This example leads into the whole area of distorted thoughts.  At some point clients can become frustrated with themselves and others because of their faulting thinking. For people with borderline personality disorder it may take a long time to realize that some event that happened is not the other person’s fault but it is a product of their own thinking. Learning to check and verify their impressions is a skill that many have to learn. Learning to understand a person with borderline personality disorder is difficult. They fear abandonment by those closest. At times this feels to them that they are empty or there is an empty hole in their center that they have to fill, possibly with food or impulsive acts for love, gambling and even anger temporarily fills it. When they learn to love themselves the hole starts to fill up and they can move on.

Often borderline individuals hate themselves, their needs and behaviors and it takes long term therapy to help them.  Family members may see their fear of abandonment as unreal or exaggerated because they do express their love. It is the cognitive distortions that are hard to explain to the ill person that their feelings or assumptions are wrong. Unfortunately their fear of abandonment or self loathing cause many problems in relationships of all kinds. Their family life suffers as well as their work life. Logic can not explain why someone likes you one time and hates you the next until you learn what triggers the emotions of your loved one. 

Frankly, it is very hard to understand why someone is always engaged in behaviors that are harmful to themselves, especially when they do not understand it themselves. Encouraging the ill one to see that they are hurting themselves or to realize that they do not like how they have acted is the beginning of the healing process for all clients of all types.  A family member can help them to identify things that are not going well. A person does not need a diagnosis to say that they are suffering and they need help to change.

People who have mental illnesses are also aware of what they have lost because of the illness. They can feel like they have lost their future. They can feel that they were never a good person and that they had no right to a good life. They are aware of their inabilities and losses of abilities. People with schizophrenia’s cognitive abilities can diminish over time. Young men with schizophrenia know that their friends have moved on in ways they have not. They struggle to finish school and get jobs. Learning to live with the emotional roller coaster supersedes finding girlfriends and making plans for the future. Also women have been discouraged from having children because some drugs they take pose problems for proper child development.  Every person is unique in their experience. It is important to listen and understand; some people are resilient and others may need supportive therapy.

Mental health workers know that for now the solutions involve medications and/or psychotherapy. But we will not feel like guinea pigs trying all the drugs and getting all the weird side effects. We will not have to summon our courage once again to face yet another drug failure (it takes about 3 months to really see how a drug is working).  Some clients fear that they will never find the right treatment and then what? Being “Sick“ means having more than enough internal fortitude, having strength to avoid the stigmas and expectations of society.  What is wrong with finding pleasure, and feeling stable? Does the definition of a man or woman mean working or having a family? The first priority to the loved one is to help them feel stable and loved, then productive in their own way. Can they be valued for who they are and not what they should be? I believe so.