When we hear the term ‘carer’, there is a risk of imagining someone wearing nurse’s overalls and counting out medication. In fact, caring for someone with a mental illness is often a lot simpler than that. Caring for someone with a mental illness can mean going round to their house for a cup of tea and a chat, meeting them for lunch or just sending a text asking how they are doing on that particular day.
How do I help someone who is mentally ill?
Nowadays we have a good understanding of the variety of different mental health issues, and although a clear diagnosis is fundamental in receiving the correct treatment, in my experience many mental illnesses often share common traits. They are like complex webs intertwining and overlapping. Although I have specifically experienced Depression, Anxiety and Body Dysmorphic Disorder, within those three diagnoses I have had Agoraphobic, Socio-phobic and Obsessive-Compulsive tendencies, so I feel able to comment on how to care for someone with these issues specifically, but also on more general tips which can be applicable in any situation.
Whack-A-Mole
I often find that dealing with a complex range of issues results in trying to have a game of Whack-A-Mole in your mind. Once you feel as though you have overcome one aspect of your mental illness, another one pops up. For example, to get out of a depressive episode and slowly transition to a functioning human again, it is necessary to keep yourself clean, feed yourself, and go outside. So, I would drag myself out of bed and train myself to care for myself again. After a couple of days I started to feel a bit better, so I faced up to my reflection, did my make up and wore an outfit that I feel comfortable in, and I was able to go outside. My Depression was under control. My Body Dysmorphia was under control. I felt good! But wait, there comes the anxiety. There is the trembling hands, the nervousness in my voice, the sweating and paranoia if anyone looks at me.
And when I overcome that, it’s hard to escape the feeling that there’s always something else around the corner.
It’s an exhausting cycle, but ten years down the line and you just sort of get used to it.
“Get a grip! You’re bound to feel rubbish sat in bed all day!”
Knowing someone who is experiencing a depressive episode can be very distressing. If you haven’t experienced Depression yourself, it can probably be quite frustrating too. Considering that being that low is scary and confusing for the person experiencing it, there is a good chance that they will have difficulty articulating their thoughts and feelings or communicating normally. Next time you ask them what’s wrong or why they are sad and they reply with an “I don’t know”, be patient and aware that you don’t need to know. They don’t even need to know. All you both need to know is how to deal with these low feelings. There is a risk of saying well intentioned but very unhelpful things in this situation, and the following phrases and their ilk should be avoided at all cost:
“Why are you so sad all the time? Don’t be sad.”
“There’s nothing to cry about!”
“Just get out of bed it’s not hard!
“You’re not depressed, you’re just feeling low.”
It is so important to not diminish or undermine the feelings of someone with depression – it does not help the situation in the slightest. Being depressed is like being in a black hole, and at that moment you feel like you are never going to be able to get out. It’s physically draining, too. Your body can feel so heavy and lethargic, and your head is constantly aching from the poisonous thoughts inside of it. So, maybe they do need more rest than someone without depression. Maybe if for a while they sleep a lot, and the only exercise they get is shuffling between their bed and the sofa, let them be. Sometimes you need to let them just be, and if that’s against their recovery plan then just improvise for that day. Instead of yelling at them to get dressed, go outside, and function like a normal human being, maybe whack the kettle on, pop on a film and join in on their day of duvet-dwelling. Sometimes just company is enough to get through the day.
That’s another thing to be conscious of: taking life day by day, if not hour by hour or minute by minute. Depressive episodes can be unpredictable; they can make us afraid of the future and spoil day-to-day plans. I’m not saying tread on eggshells around somebody who is depressed, but try not to overwhelm them with grand ideas when their main objective is just to get through each day until the episode is over. And that is something that you can remind them – the episode won’t last forever, things will get better and it won’t always be like this.
“Just chill out, yeah?”
Stress is a normal part of life, as is mild anxiety leading up to a stressful situation. However, the extent to which Anxiety can consume you is not comparable. The irrational fear and terror that wakes you up in the middle of the night, when you become too paralysed by worry to leave the house, when you become so petrified that your body launches you into a panic attack… These are most certainly not normal parts of life and should not be undermined by phrases such as “Oh, you’re just a little worrier, aren’t ya?”
Anxiety can manifest in many different forms. The sources of people’s anxiety can differ greatly, and sometimes there may not even be a specific trigger. If you know someone who has anxiety, you need to get to know the Anxiety as well as the person. Anxiety can make someone feel as though they have no control over it, so compartmentalising it into a separate entity is often a good idea. Make friends with the Anxiety, and try to understand when and where it will appear. Then, both you and the person suffering anxiety can anticipate when Anxiety will join you, and take preemptive measures to postpone the visit or facilitate its stay.
One of the most difficult things is to deal with Anxiety in secret, as the physical symptoms are more likely to be exacerbated. They can be overwhelming – I don’t think most people realise just how taxing on your physique a mental illness can be. These symptoms can range from sweating, trembling, speech difficulties, irregular breathing, blushing, rashes, a racing heartbeat, muscle tension, nausea, stomach pain, chest pains and often result in panic attacks.
“You look fine, stop fishing for compliments!”
Being a Body Dysmorphia sufferer, it is difficult for me to provide a correct description of the disorder, as its nature is one of distortion. In my opinion, I have a heightened sensitivity to the dimensions of my body, the volume of space which I inhabit and I am unable to leave the house without making sure certain habits and rituals regarding my appearance are completed to a reasonable standard. This of course can be mistaken for vanity, when in fact a body dysmorphic is anything but vain. From my experience, the extensive measures are taken in order to protect society from having to witness something so horrific, so unimaginably deformed and just outright sickening as my appearance. I know I’ll never be “pretty”, but I can at least try to become less ugly and disgusting. However, a medical professional will offer a different opinion. Apparently Body Dysmorphic Disorder is when a person becomes excessively preoccupied with an ‘imaginary’ perception of themselves. I admit that I’m not fully ready to agree with this yet, and I probably won’t be for a very long time.
BDD is a condition very closely linked with more well-known illnesses such as Obsessive Compulsive Disorder and Anorexia Nervosa. It can also harbour other ailments such as Compulsive Skin Picking or Trichotillomania, the former which I have experienced.
I guess the key with caring for someone with BDD is patience. My boyfriend now knows that if it takes six outfit changes before I can leave the house, then the result would be more pleasant for the both of us than if he forced me to leave the house in one of the first five outfits. He, along with most of my friends and family, knows that the majority of compliments or comments around my appearance have been trained to be filtered from my consciousness, so telling me that I’m not ugly is like talking to a brick wall, and your compliment on how my hair looks today will be greeted with nothing more than a superficial smile.
To overcome Body Dysmorphia, cognitive-behavioural psychotherapy is recommended. It is not a quick fix, and it will take a lot of time to undo the conditioning that you’ve given to your brain. But patience is key. BDD is a very specific condition, and thus needs very specific care. Exposure therapy which is designed by both the therapist and the patient is an efficient way for the body dysmorphic to overcome certain fears and break certain compulsions. Some may seem almost bizarre to you, for example, a highly anxiety-provoking situation could be going to the corner shop without a full face of make-up. For some people this is nothing but an ordinary day to day task, but for someone who has BDD, this can be terrifying. It goes without saying to never judge, or undermine these achievements. Maybe you can become familiar with the situations and tasks that need to be carried out as part of their exposure therapy, and even do some together.
Regardless of the medical terminology given to any mental health issue, there are some general rules which apply:
Help them to help themselves
Feelings of low self worth are common amongst mental illnesses, so it’s not surprising that someone may need coercing in order to get help. They may think that they don’t deserve help, that they are being punished or maybe they just physically don’t have the energy to search for help. It is important to be in contact with medical professionals during a period of mental illness, just as it would be for any physical illness. Like diabetics need insulin on a daily basis, people with mental health troubles often need medication to help correct the chemical imbalances in their brain. Getting in touch with a GP is a good starting point, and then referrals can be made if necessary.
You don’t have to understand
You’re not a psychiatrist, and nor am I. We’re average humans who try with the best of our capabilities to comprehend the complexity of the human brain. Trying to single-handedly “fix” someone with a mental health issue can be frustrating for you and for them, so start small. You can start by seeing what they might be in immediate need of – a drink, some food, a hug? Just being a good friend and reminding them they’re still human can be comforting to someone who feels alienated by their mental illness.
Be aware of triggers
A trigger for someone with a mental illness can be something that seems ordinary and mundane to you, but could induce an episode for the person. Making yourself aware of these triggers means you can avoid them for the safety of your friend, at least until their therapy is at a level where they can overcome their fears and anxieties. Another issue, which I believe to be quite a serious one, is how society accepts certain vocabulary to be spoken which is actually very insensitive. For example, remember when you had so much work to do that you just wanted to “top yourself”? Or that awkward encounter with an old friend that made you “want to die”? Or how about when that man was going “schizo” at you and your friends? And is that song really “depressing”?
Just like society has tackled inappropriate and derogatory terms regarding race and sexuality, terms relating to mental illness should be treated with care.
I hope this helps, and that by talking more openly about mental health we can raise awareness and eradicate the stigma once and for all.
