Denial: When mental illness first strikes, family members may deny the person has a continuing illness. During the acute episode, family members will be alarmed by what is happening to their loved one. When the episode is over and the family member returns home, everyone will feel a tremendous sense of relief. All involved want to put this painful time in the past and focus on the future. Many times, particularly when the illness is a new phenomenon in the family, everyone may believe that since the person is now doing very well, symptomatic behavior will never return. They may also look for other answers, hoping that the symptoms were caused by some other physical problem or external stressors that can be removed.
Sometimes, after some family members understood the reality of the illness, others do not. Those who do accept the truth find that they must protect the ill person from those who do not and who blame and denigrate the ill person for unacceptable behavior and lack of achievement. Obviously, this leads to tension within the family, and isolation and loss of meaningful relationships with those who are not supportive of the ill person.
Stigma: When all members of the family have the knowledge to deal with mental illness, the family is often reluctant to discuss the issue of their family member with others because they do not know how people will react. After all, myths and misconception surround mental illness. For many, even their closest friends may not understand. For example, the sister of a young man with schizophrenia pointed out that when a friend's brother had cancer, all his friends were supportive and understanding; but, when she told a few, close friends that her brother has paranoid schizophrenia, they said little and implied that something must be very wrong in her family to cause this illness. Family members may become reluctant to invite anyone to the home because the ill person can be unpredictable or is unable to handle the disruption and heightened stimulation of a number of people in the house. Furthermore, family members may be anxious about leaving the ill person at home alone. They are concerned about what can happen. The result is they go out separately or not at all.
The result of the stigma in so many areas of daily life is that the family becomes more and more withdrawn. When others do not accept the reality of mental illness, families have little choice but to withdraw from previous relationships, both to protect themselves and their loved one. They are unwilling to take any more risks of being hurt and rejected.
Frustration, Helplessness and Anxiety: It is difficult for anyone to deal with strange thinking and bizarre and unpredictable behavior. Imagine what it must be for families of people with mental illness. It is bewildering, frightening and exhausting. Even when the person is stabilized on medication, the apathy and lack of motivation can be frustrating. A mother mentions how her daughter, when asked to put her clothes in the closet, looked at the freshly pressed blouses for over an hour before making a move to hang them up. What was a matter of routine for this young woman in the past, now seemed to take an inordinate amount of time. Even though the parent knew it was not so, she had to fight the feeling that her daughter was deliberately not doing this one, small task. Family members may have trouble understanding any difficulties the person is having, or they may tell themselves that the person will "snap out of it" if given time, support and encouragement.
Exhaustion and Burnout: Often, families become worn out and discouraged dealing with a loved one who has a mental illness. Having gone down many dead-end streets in an attempt to find assistance, they may be hesitant to try another approach for fear of another failure. They may begin to feel unable to cope with living with an ill person who must be constantly cared for. Hopefully they can develop a plan to allow each family member to take responsibility for different tasks and/or to trade off times of primary responsibility. But often, they feel trapped and exhausted by the stress of the daily struggle, especially if there is only one family member.
Grief: One of the greatest difficulties for families in accepting any life altering illness of a loved one is dealing with a changed future and expectations. The grief is particularly acute for families where a loved one has a mental illness. This illness impairs the person's ability to function and participate in the normal activities of daily life, and that impairment can be ongoing. Families struggle with accepting the realities of this illness. Families grieve for what might have been and find it difficult to focus on the possibilities that remain for their loved one. But, working through their grief allows them to accept what has happened and to move on.
Need for Personal Time and to Develop Personal Resources: If family members deteriorate due to stress and overwork, it can result in the ill family member having no ongoing support system. Therefore, families must be reminded that they should keep themselves physically, mentally and spiritually healthy. Granting this can be very difficult when coping with their ill family member. However, it can be a tremendous relief for families to realize that their needs should not be ignored. They should continually be reminded that it is necessary to take time for themselves, despite the demands of assisting their family member.
