I have previously written advice to clinicians on how best to help their patients,1 followed by advice to patients on how best to cope with their psychiatric problems.2 This third in the series provides advice to families on how best to cope with the psychiatric problems of a family member.
In the near future, I will post the fourth and final installment in the series—advice to our society on doing a much better job of helping our mentally ill live safe and productive lives.
My 50 Tips to Families Based on 50 Years of Experience
1. It is completely natural to blame yourselves for the psychiatric troubles of your loved one, but most often it’s neither rational nor helpful.
2. Severe mental disorders have multiple and mysterious causes. Family stress, if involved at all, is usually only a minor contributor. More often, family stress results from, rather than causes, the individual’s psychiatric problem.
3. Feeling irrationally guilty not only hurts the family, it also reduces its ability to see things clearly and provide the optimal combination of supports and limits for the loved one.
4. If the family member has a psychiatric problem that’s only mild and transient, it will likely have little negative impact on the family and may even strengthen family bonds as everyone pulls together.
5. In contrast, psychiatric problems that are severe and persistent can create severe and persistent family stress and conflict and will likely have a profound and sustained impact on the lives of all close family members.
6. How well the family copes with the person’s psychiatric problem usually influences how well he will cope with it. And how well he copes with his problem will reciprocally influence how well the family copes with him and with it.
7. Having a family member with a severe and chronic psychiatric or addiction disorder is probably among the most challenging stresses any family can ever face—just as tough as dealing with chronic medical illness and severe financial problems. Some families get closer; some fall apart; only a few stay the same.
8. Family coping depends not only on the strength and resilience of its individual members, but also how well and consistently they work together and are able to support each other. Family therapy may help improve family coping.
9. Don’t feel you have to hide the family’s psychiatric problem. Societal stigma is rapidly diminishing and increasingly everyone is coming to understand that there is no shame in having a mentally ill loved one.
10. Seeking help earlier rather than later will greatly reduce the severity of symptoms, problematic behaviors, impairment in functioning, risks, burdens, and complications.
11. Be a very well-informed consumer. Learn all you can about the diagnosis; treatment alternatives; insurance coverage; housing; disability; navigating the mental health and medical systems; and how to access social services. Never be shy about asking questions and expect clinicians to have clear, convincing, common sense answers. The internet is a great source of information, but don’t believe everything you read.
12. Family sessions with clinicians are usually vital for the information they can convey to the clinician and the information she can convey to them.
13. Be unembarrassedly honest; open to learning new ways of understanding and relating to your loved one; and to developing new family coping skills.
14. Our society over-treats the worried well and mildly ill, while cruelly neglecting those with severe mental disorders. Be wary of getting too much treatment (especially medication) for problems that would get better on their own; and too little for those that will get much worse in the absence of immediate and thorough attention.
15. Psychiatric medications are not a good first choice if your family member has only mild, transient, and/or expectable symptoms of sadness, grief, anxiety, or stress. There is not a pill for every problem and most problems resolve on their own. Kids, in particular, are being over-medicated after quick and careless evaluations. Be skeptical, be informed, and always ask lots of questions before accepting a psychiatric med.
16. Read carefully my previous blog, "Advice to Patients,"2 in order to learn more about the role of psychotherapy and the uses and misuses of medication in the treatment of psychiatric disorders.
17. Be aware that there are lots of different forms of psychiatric treatment and that no one size fits all.
18. Many treatments have a strong base of supporting evidence, some do not. Whenever possible, evidenced based treatments are preferred.
19. Psychiatric treatments are about as effective (but also as ineffective) as most treatments in the rest of medicine. It makes sense to be optimistic they will help, but don’t expect miracles. Too-good-to-be-true claims for magical results turn out never to be true.
20. Treatment outcomes are very variable and impossible to predict precisely. Most people experience at least partial benefit from psychiatric treatment; some people enjoy a full recovery; a minority have no response at all; and, unfortunately, a few are harmed.
21. Things often go better if your family member allows you to contribute to discussions regarding choice of optimal treatment. Selecting a specific treatment plan among the plausible alternatives depends on the person; the nature of the problem; its severity; preferences; clinician training; availability; and the results of previous serial systematic trials aimed at learning what works best.
22. “No Treatment” may sometimes be the treatment of choice—especially if your family member is experiencing only the normal, expectable problems of everyday living or has had no or bad responses to previous treatment trials.
23. For mild symptoms, watchful waiting; the healing powers of time; stress reduction; and family support may be all that’s needed.
24. In contrast, severe/persistent symptoms require immediate attention. The longer you wait, the harder they may be to treat and the slower and less complete the treatment response.
25. Good clinician/patient match is crucial to good outcome. If possible, have your family member interview several different clinicians before picking the one he and the family are most comfortable with.
26. Try to find non-intrusive ways to promote close adherence to any treatment plan that’s working.
1. Frances A. Advice to Young Psychiatrists From a Very Old One. Psychiatric Times. October 4, 2019. https://www.psychiatrictimes.com/couch-crisis/advice-young-psychiatrists-very-old-one
2. Frances A. Advice to People Who Have Psychiatric Problems. https://www.psychiatrictimes.com/couch-crisis/advice-people-who-have-psychiatric-problems. Psychiatric Times. October 8, 2019.