Coping strategies for caregivers: mental health

It was World Suicide Prevention Day yesterday. I’d have written something then, but things got in the way. Anyway, it’s important that people are made more aware of how others think, and react, to things, since everyone has different mental states and experiences. I think the word is Neurodiversity. But knowing more can help stop potentially dangerous situations and states of mind. At least, I hope so. I don’t want to come off as prescriptive here, it’s more just things that are popping into my head and it might not work for everyone. It certainly doesn’t cover the full gamut of mental issues, but it covers some things that I think about. Maybe it’ll be helpful for someone.

*Someone I love is having a nervous breakdown, how do I help?

Well, a nervous breakdown can manifest in a range of different ways. For some, it’s shaking and forcing far too many distractions and cups of coffee as possible in the hopes they can shove the reality of the breakdown away from them. For others, it’s clamming up and slowing down, feeling like stone and not knowing how to move, how to continue on with daily tasks. Others yet it’s a sort of mania that is accompanied by a range of shifting extroverted emotions from anger to enthusiasm. Often the best thing you can do for someone is to be there for them, and not get frustrated by their actions. Reassurance works for a lot of people, but others might prefer you to avoid reassuring and just distract them with things (like, ‘let’s go and cook dinner / go to a football match / do some other thing’). It really depends, but you won’t know unless you try. Avoid doing things that might make the whole thing worse and add extra stress, so definitely don’t bring up a grudge or a problem you’ve been having with them, even if it’s just something as stupid as not putting their dirty underwear in the wash basket. That stuff can wait for later. A person having a breakdown is in a precarious mental state that they can’t fully control and that oftentimes makes their mind race at breakneck pace. It’s something that can make a person feel cast out to sea in a storm, and longing for some firm ground, so you can’t start taking away planks from their raft, and certainly never seek to do so in an attempt to ‘shock’ them into acting normal again. This very rarely works in a positive way; it’s far more likely to exacerbate their nerves and impact recovery time.

*The person I want to support isn’t having a breakdown, but they’re sad about stuff. I want to help but don’t know how.

Asking how they feel usually doesn’t go amiss. Even if they answer disparagingly, it’s really good to check in and give them space to open up. If someone’s depressed they might not feel important enough to bring up how their day was straight off the bat. Even on depressed days, people can see good things, even if it’s a silly thing like a pigeon walking funnily on the sidewalk. A warm smile, accompanied by bringing someone a cup of tea, and showing an interest in how their day was can go a long way in providing space to focus on good things. Or something new, like planning an interesting dinner. The goal isn’t to get rid of the sad feelings, but to provide a space for them to take a backseat while still acknowledging that they exist, which really is the best way to make them abate.

*Okay, so I thought I’d make them a cup of tea but they just can’t make up their mind. What now?

It can be really hard to do decision-making when you’re depressed. It could be that there’s already a whirlwind in your head and you can’t bear adding to it. It could be that everything’s just empty and raising the question of choice seems pointless. It could just be something currently unreachable. So, if the person you want to help looks like they’re struggling to make up their mind, it sometimes helps to reassure them that you’re not going to get mad if they don’t decide quickly, that you decided to do this thing for them and that you don’t mind how long it takes. Make them feel welcome and release the burden of potentially upsetting you from their shoulders. It might also be a good idea to suggest things for them. Like, ‘How about this tea?’ They might sort of nod, and you can take control of the steering wheel, ‘Okay, that sounds good, then. I’m going to make you this, okay?’ And go and do it. If they don’t drink that tea, it’s okay, and you can let them know this too.

*They’re not eating well, and I want to respect their decisions but not hurt them too much.

If you’re taking care of someone you have to do what you can to ensure they’re eating well. Sometimes taking control of the steering wheel in the conversation is necessary again, as your loved one may not be in a place where they can be trusted to take care of themselves going by what they wish or do not wish to do. You should try to get them to eat, or bathe, or dress, but do keep watch for emotional distress. Make sure they are aware that you don’t want to push them, but that you’re concerned for their health. Don’t emotionally compromise them by saying ‘Do it for me’ – this can put undue pressure on their emotional connection to you.

*They’re really responsive to criticism. How do I talk to them about things?

I don’t mean criticism in the ‘my artwork got critiqued’ sort of way. Often, people with aversion to interpersonal criticism can handle work-based criticism because it’s detached, removed from themselves as a person (unless the critic uses ad hominems – insults on a person’s character), but can severely stumble when dealing with people on a relationship level. This is a common feature in avoidant personality disorders (which feature more withdrawal), and also in narcissistic disorders (which feature more extraversion but similar in the hostility towards criticism). It can feel like a double-bind having a relationship with someone with one of these varieties of issues, because you might start to feel afraid of bringing up problems you’re having. But the answer is not to bottle up your problems, nor is it to just bring them up and get stressed at the fallout they suffer each time. There is most definitely a way to talk about things without making a criticism-sensitive person feel on guard. The method differs slightly from person to person, but at its core it revolves around making sure the person knows you’re not trying to make them feel bad, and that it’s not a judgement on them as a person. They may also seek continual reassurance while discussions are going on, even if they might be afraid to ask for this.

People can be sensitive to criticism for a whole host of reasons. Some have been bullied badly, others suffered excessive criticism at a young age while their sense of identity and self-worth was still developing. Others have had traumatic experiences later on in life. Others still have no environmental triggers at all. It’s important to remember as much as you know about this person you’re helping, and using what you know to ensure you don’t repeat any adverse situations they might have been subjected to in the past.

It’s extremely important to remember that if someone suddenly starts to look scared while you’re talking to them about something serious, it’s not necessarily a judgement on your behaviour. Even raising your voice a little in a way that you don’t consider to be threatening might call up connections in their mind of a time this happened before, with someone else, and with less amicable intentions / results. So they’re not trying to make you feel bad, they’re just dealing with stuff, and if you’re more concerned about letting them know how annoying it is that you have to talk a certain way with them, you might want to seriously reconsider how you relate to them entirely.

*I think they want to be alone so I’m not engaging with them.

Sometimes, a person with self-destructive feelings can feel like they’re not worth reaching out to, that they’re not deserving of attention, so they won’t take steps to seek help. One of the worst things a person can do is take this behaviour at its word and give them the cold shoulder. Self-destructive feelings accompanied by a need for human comfort are an anachronistic and difficult mix for the person who’s feeling them. To feel guilty and angry about the fact that you need human contact and love is a cruel mental block to be stuck in, and many times it can only be pushed through to from the other side.

*Well, I tried that, but they’re being rude to me now. They’re still not responding.

It gets tricky when you’re trying to be comforting and the person you’re comforting is still sort of pushing away, or is still unable to break their shell. Sometimes it’s frustrating when you’re trying hard to get through to them and they seem to be shunning you. It can sometimes make you want to lash out and say ‘Well fine, I’m trying but you’re making me feel bad. Fine, go and leave me alone then,’ but please don’t. This only puts more blame and guilt onto the person you’re trying to help. They’ve got a long journey out of self-destructive feelings, and coping strategies that involve hiding themselves away aren’t just going to disappear following one incident of niceness. It takes much, much longer than that.

*But it’s stressing me out, and I need time to myself too. I’m not strong enough.

Very few people are strong enough, but there’s no race here. It’s not about ‘being strong’, it’s about showing that you have empathy, and showing it in a way that is receptive, so that the other person knows they’re in a good enough environment to share it back with you. Sometimes dealing with someone with mental health issues can be taxing, and you really do have to take care of yourself as you do this, but hashing out your feelings with an emotionally compromised person can increase the damage to you both. This isn’t to say you have to baby them. Sometimes it can be appropriate to talk about your feelings, but pick and choose your battles on this one. For many people it may be a bad idea to talk about your feelings that are to do with them, purely because it can exacerbate guilt or self-hatred. For others it may be cathartic, and a way for them to feel more able to open up about their own feelings. But as before, watch for distress cues. I’d err on the side of hashing your issues out with them being a rather risky option. It’s best to find someone who’s in a position to listen to you, and often this person will not be the person you’re trying to help.

If you and the person you’re trying to support are both mentally ill, or just in a bad place, it is a good idea to seek external help for you both. You don’t want to turn things into an echo chamber; you might set up loops that you both can’t get out of.

Setting alone-time for each of you might also be helpful. Even for some dependency disorders, alone time isn’t nearly so bad if you know that someone’s there to pick you up if you are having a crisis or need them. This behaviour can also foster independence.

*The person I’m trying to help actually doesn’t respond to warmth the way I understand it. How do I help them in this case?

There are a host of mental states that mean that people exhibit more detachment from emotion, and not because they’re missing closeness or anything like that. They still have emotions (they’re not robots, and please don’t call them that, it’s hurtful) but they might relate to the whole concept differently to you. This is very different from taking care of someone who might be dependent-avoidant, or from someone who cuts themselves off because they feel they deserve it but secretly want closeness in a very conventional way. In these more distanced cases, it’s important to learn how your loved one relates to others, what values they hold important. It might not be hugs and cups of tea, it might be sitting apart and listening to a forty-minute piano sonata in silence. It might be not talking about it at all. It might be knocking back five shots and not talking about emotions, but sharing a smile. This can get tricky if your emotional needs are more centred around closeness than theirs, because they may say or do things during their recovery process that can sting. It’s best to put yourself in a mental state where you can deal with this (see the above point for tips) because if you don’t you run the risk of frustrating them and damaging their mental state. Someone who reacts more ‘coldly’ than you and who has mental health problems may feel a pressure to perform, and in this it’s not different at all from those with self-confidence issues feeling pressure to respond when they don’t feel brave enough,   It’s not nice to feel like you have to be someone you’re not out of fear of being ‘too mad’ or ‘too broken’ for someone you love to deal with. We care for those we love, we don’t want them to be hurt

*The person I’m trying to help has a disorder that involves fluctuating mental states. How do I do the right thing?

Doing the right thing in every single situation would require near-telepathic abilities, so you have to accept that sometimes you’ll misread a state of mind and do the ‘wrong thing’. It can be incredibly difficult but please don’t give up on them. Seeing someone you love going from warm to cold can be confusing to experience, but all the same it’s going to be far more conflicting in their heads. Whichever state they happen to be in, ultimately they care about the fact that you care, and you still have a relationship to them, so try to foster that relationship in every situation. They might say or do things in one state that they don’t remember in another, but they’ve chosen to associate themselves with you for a reason, so hold on to it. These cases nearly always involve a more bespoke solution that only you can come up with from experience, but remember there is not a catch-all solution. The human mind – both yours and the person you’re caring for – can be surprising.

*The person I’m supporting won’t believe me when I say I care. It’s actually starting to make me sad. How do I convince them?

The thing about mental illness is that it can make a person feel irrational things. It’s the great persuader, and your attempts at persuasion might pale in comparison to this beastie. But it’s also important to remember that a person suffering irrational thoughts can be experiencing cognitive dissonance. Complete belief in irrational thoughts is just one far end of a large spectrum. It’s actually quite common to have something in your mind telling you everyone hates you while the other half of your brain is saying that this is ridiculous and knows that you are loved. So those parts where you tell your loved one that you care and they break down saying that everyone hates them and they want to die? That’s the thing they’re up against saying that. Don’t take it as something against you, rather, help them fight that thing. Be a bulwark against it, something reliable that they can hold on to when it gets real dark. And if it does make you feel sad to constantly hear these things, try not to rub their face in it. It’s probably a good idea to find someone not experiencing mind-altering paranoia to talk to about how you feel on this. Because you have to stay healthy too.

There is no wrong way to feel. This is very important.

And some things can only come about by trying. Sometimes you’ll try and you’ll end up hurting someone more. But if you keep trying different things around this, if you keep on being there for them, it’s extremely likely that you’ll be helping far more than not.

I suppose this all can be distilled down to a few key points.

Ask how people feel. Give them space. Be considerate that they might have different needs than you.

The last one is one I always need reminding of. I forget that people have different needs to me, and sometimes start being overly close to people that really could do without quite that many hugs. It takes time to learn different people’s systems, but it’s so much better to try and make that space than to not. The people who you care about will appreciate it, and they will remember. It might save a life.

Leave a Reply

Your email address will not be published. Required fields are marked *