Sample Text from Chapter 3
PROBLEMS FACED BY ADVOCATES
“The first rule is to keep an untroubled spirit. The second is to look things in the face and know them for what they are.”
~ Marcus Aurelius
1. Consumer Relapses
Relapses are usually a part of these illnesses and weaken our health and spirit.
Friends and family can grow tired of listening to us when we are overly consumed by the illness problems. Our world can sometimes be reduced to the person and their illness. There is no reason for us to fall so far at these times because there is help through NAMI. NAMI members will listen, understand and be supportive.
If the relapse is in an early stage and paranoia is beginning to occur, it might help to point out to the consumer, for example, that it is the illness and that the people nearby are not talking about the consumer. Then mention the topics of other conversations that you might be able to hear. Sometimes my daughter will say to me, “I thought the people in the store were talking about me; but that’s just my illness isn’t it?”
If you and the consumer have worked out their usual symptoms of relapse and you have the Crisis Intervention Plan of the medical provider, then put this plan into action if a relapse occurs. The potential exists to stop the relapse early and reverse it. This will hopefully enable the person to move ahead more quickly and without decompensating to the point where they need hospitalization.
2. Consumer Denial of Illness and Refusal to Take Medications
Perhaps denial is a natural early reaction to losing some aspect of your health (mental or physical). Denial gives a person time to consider and adjust to the reality of the alternative—a devastating mental illness. But the longer the denial, the greater the risk of decompensating further and further into the illness to the point of needing hospitalization, committing suicide or getting incarcerated.
It takes both courage and wisdom to know you need help and to seek it. If your friend or family member denies the illness, refuses treatment, and will not accept help, you can:
a. keep trying to get them to go to a medical provider
b. read I am not sick I don’t need help by X. Amador
c. try to open avenues of discussion with questions such as the following:
1. At what point do you want help?
- If you can’t sleep
- If you aren’t eating
- If you feel severely depressed
- If you are isolating
- If your anger gets out of control
- If your paranoia gets out of control
- If you are hearing voices
- If you are losing friends
2. Who do you want help from?
- A private physician or other medical provider (this requires early intervention before a crisis occurs)
- Crisis help at Department of Mental Health
3. Who do you want to take you to get help?
4. How can those of us who love you help you?
- Listen to you without judgment or advice
- Hold you
- Walk with you
- Keep you from harming yourself or others
- Be silent
You can try to get the person to see a family doctor or nurse practitioner for a physical exam because you or they are concerned about their general health. Let the medical provider know ahead of time, preferably with a letter, that you are concerned about, for example, their depression or other symptoms; and ask any questions you have (might he have thyroid problems, etc.).
When the situation is an emergency because you are worried about suicide or violence against others, you may feel that you are willing to risk the consequences of traversing the personal boundary of the ill person. Preferably, you will have already discussed this with the person so they know that if you become worried that they are a danger to themself or others, you love or care enough about them to do whatever it takes to get them help. The part of a person’s brain that would help them make positive health decisions for themself is affected by the illnesses. People in crisis often cannot make informed decisions until they are stabilized, out of crisis, and lucid. You may decide that the alternative of letting the progressive degradation of the illness(es) go unchecked is worse than taking the risk of getting them to help against their will. Too often people wait to get help until the losses are monumental—family and friends, job, health; until violence against self or others is reached; until all remnants of the ill person’s life are shattered. You may not want to wait that long.
Because of the never ending and relentless course of untreated mental disorders, some advocates have successfully used incentives and presented ultimatums to get someone to seek treatment. To watch the daily suffering of someone you love dearly can eventually become unbearable. Incentives from cigarettes to a trip to Bali have been successful in getting someone to seek help, begin medication, and start on their recovery road. With their newfound lucidity, the person is often grateful and continues to choose treatment and recovery for themself, instead of the suffering. Some people have used an ultimatum such as “I love you and am falling into a reactive depression as I watch your suffering increase daily. I don’t think I can handle much more so you/we need to find another place for you to live. If you should decide to choose treatment and recovery, then you can stay.” We all have our limits and we must be honest about them with our family member or friend. Otherwise, we risk damaging our own health and well-being.
If you are unable to help your family member or friend, consider pouring your energy into trying to get services that might someday help them and others. For example, join and work with NAMI in your area and/or try to get local self-help support groups for people with mental illness. Perhaps you can help find a place for the meeting (churches or non-profit facilities); and create a notice for the local paper, or flyers to post at Departments of Mental Health and Social Services and on community or church bulletin boards. In these groups, consumers further along in their recovery can help others find their way to recovery.