Mental Health

The mental health crisis is everyone's problem to solve together.

Cultural approach to mental health

Mental health is a hot topic these days. Everyone seems to be diagnosing everyone else, regardless of their knowledge about mental illness. Mass shootings, domestic terrorism, sexual violence/harassment, and hate crimes have everyone scrambling for answers. These are important conversations we should have been having all along. To blame mental illness on all of these issues that are a complex mix of history, culture, politics, gender, race, and socioeconomics is dangerously naïve.

The tendency of culture to blame mental illness for everything bad that happens, especially mass shootings, not only distracts from the hard work of solving the problem, but it perpetuates the generational Shame Cycle of mental illness. Instead of encouraging people to seek help when they are suffering, our culture reinforces the notion that mental illness is a shameful secret to keep hidden.

Research has proven time and again that those who suffer from mental illness are much more likely to be victims of crime than to commit one. To categorize evil as mental illness perpetuates an unfair stereotype about those who suffer from mental illness, while absolving perpetrators of responsibility.

For an in-depth analysis of the relationship between gun violence and mental illness, I encourage you to read the report Mass Shootings and Gun Violence published by the American Psychiatric Association and authored by James L. Knoll, M.D. and George D. Annas M.D., M.P.H.

A history lesson

Historically, society’s response to mental illness has been to pretend it doesn’t exist. Mentally ill people were (and in many cases still are) an embarrassment to their families; a source of profound disappointment. This disappointment often led parents and spouses to take their anger out on the mentally ill person with verbal or physical abuse or neglect.

Well-intentioned, loving families, knowing the way society might treat a mentally ill child, would go to great lengths to hide a child’s struggles from the world. Families with a history of mental illness are usually caught in intense Shame Cycles.

Mentally ill people were (and still are) taken advantage of, used by others for selfish gains, or institutionalized. Often they were horrifically abused in the very institutions where they were placed to “care” for them. Mentally ill people are highly susceptible to sexual violence and abuse.

There is a high correlation between homelessness and mental illness. It is estimated that as much as one-third of America’s homeless population suffers from serious mental illness, including schizophrenia, schizoaffective disorder, bipolar disorder, or major depression.

This does not include those who suffer from undiagnosed disorders such as mild or moderate depression and borderline personality disorder, in which illness is not as noticeable but just as damaging to a person’s ability to cope with the rigors of life.

Although we are starting to have conversations about mental illness, there remains an enormous stigma around mental health diagnosis and mental healthcare. Even “normal” people who seek therapy are often stigmatized. (Are any of us really normal? What does that even mean?)

Men in particular are shamed for considering counseling, either by others or by themselves, since they have been culturalized to believe that talking about feelings and being overwhelmed by life is a sign of “weakness.” Women too may avoid seeking mental health care as they compete in a man’s world, or if they have men in their lives who “don’t believe in” therapy.

Many health insurance plans still do not cover mental healthcare as a standard benefit. In circumstances where the primary breadwinner in a family refuses to pay for therapy and treatment, entire families suffer needlessly due to the generational stigma against mental healthcare.

Removing the stigma

When we encounter an obviously mentally ill person on the street, what is our gut response? Disgust? Fear? Condemnation? Revulsion? There are few among us who immediately jump to compassion as our first response.

We may feel like we are being respectful by quietly accepting the odd behaviors of a mentally ill person, particularly if the behavior “isn’t hurting anyone.” By ignoring someone’s struggle with mental health issues, we are actually telling the person that this thing they have no control over is something to be ashamed of, a secret to be hidden. A “don’t ask/don’t tell” policy is never healthy.

If someone has cancer, or multiple sclerosis, or a nasty head cold, we don’t quietly drop our eyes and pretend the person isn’t sick. We ask how we can help.  This same approach needs to be applied to the mentally ill.  We need to sit down with loved ones who are struggling with mental health issues and say, “I love you. How can I help?”

There are so many more resources available today than in generations past. There is no excuse anymore to silently suffer with mental illness in yourself or your family.

Mental illness is hereditary

Multiple studies have confirmed that a predisposition to mental illness is passed through families via their DNA. Understanding this can help remove the stigma of mental illness as a character failing on the part of the individual. Just as cancer risk is passed genetically, so too is depression, bipolar disorder, and other mental health disorders.

And just as all people with the genetic predisposition to cancer don’t get the disease, not everyone who has a genetic possibility of mental illness will actually become mentally ill. Mental illness can lie dormant for several generations before striking again, making it hard to trace.

Of course, there are environmental forces involved as well. Just as smoking increases your likelihood of getting cancer, or eating a high-carbohydrate diet increases your risk for diabetes, so too does living with high rates of emotional stress increase your chances of suffering mental illness.

Accountability: compassion vs. enabling

Let me be clear… A mental illness diagnosis does not absolve a person of responsibility. It does, however, provide valuable information both to the individual as well as those around him or her that could help when addressing maladaptive, toxic, and/or dangerous behaviors. It’s difficult to solve a problem we don’t even understand.

With proper treatment, most people with mental illness can live fulfilling, healthy lives if given the chance.

Let’s distinguish a clear difference between compassion and enabling. Compassion is loving someone through their distress, in spite of their struggles and shortcomings. Enabling is allowing yourself to be used by another person because you feel sorry for him. Compassion is at the heart of love. Nothing good comes from enabling.

Enabling is an insult to another’s intelligence. When we enable someone, we are telling him that we don’t believe he is able to take charge of his own life. We enable others as much for our own selfish desire to feel needed as we do from a desire to help.

If a person is struggling to care for her own needs, family members and friends should set very clear boundaries about how they are willing to help. A trained mental healthcare team can help family members discern what is a need for the mentally ill person, and what is a want, based on the patient’s fear of independence and the family’s desire to feel needed.

The world is a scary place for even the healthiest people. Without a proper diagnosis, those with mental illness don’t understand why they can’t seem to “get it together,” which breeds a Shame Cycle that often drags down everyone around them.

People who suffer from undiagnosed mental illness are often supported emotionally and/or financially by family members who are ashamed of their behavior or in denial that there is a problem. Unfortunately, many mentally ill people learn early on how to manipulate others into caring for their needs as a survival skill. They believe their own delusions because no one has ever held them accountable. They feel justified in treating others poorly, because nobody ever expected any more from them.

By enabling a mentally ill person, we are giving him permission to behave erratically and violently towards himself and other people.

If a mentally ill person is going to learn to cope with life, he must be taught how to meet his own needs. This cannot happen if someone else is constantly stepping in whenever he is faced with any kind of challenge. As with all people, those suffering from mental illness need to develop confidence in their own abilities. This can only come with practice and the firm, loving, gentle guidance of people who believe in them.

Families need to stop being ashamed of mental illness. Society must stop ignoring the existence of diseases of the mind. If we won’t even have the discussion, then we are missing an invaluable opportunity for emotional healing.

Are you mentally ill?

During the years I was redefining love I was continually asking my therapist: “Am I crazy?” Of course, crazy is not a term therapists use. It is a derogatory term that does not bring healing. What I was really looking for was whether I showed any signs of mental illness.

We are so culturalized to believe that any kind of negative emotion means we are “losing it” that we doubt our own sanity even when we are simply experiencing the normal ups and downs of life. Sometimes life is hard, people!

Then again, if you are continually feeling emotionally off balance, it’s worth looking into. To be truly accountable, we must be willing to explore all possibilities. There is no sense suffering in silence when there is so much help available.

A great time to reach out for support from a therapist is when you are trying to extract yourself from toxic relationships or a Shame Cycle. Often toxic people have mental health struggles of their own. When I was sorting through my toxic relationships, I found the objective assessment of a trained counselor very helpful. I would ask my therapist routinely if I handled a situation appropriately or how I could have handled things differently.

Only a trained mental healthcare professional can make an accurate diagnosis of mental illness. Be careful not to be an armchair psychotherapist to yourself or others. If you have concerns about your own mental health, or that of a loved one, seek professional help.

Deal with your anger

Dealing with a mentally ill person can be extremely challenging, particularly if it is someone in your immediate family. Sometimes it may feel impossible to love the person at all.

Children who grow up with a mentally ill parent enter the world with a skewed definition of relationships and the world around them. They are taught maladaptive life skills from their earliest days. Even adults who enter into romantic partnerships with mentally ill people will, over time, begin to view the world through the eyes of their unhealthy partner.

When a person is finally removed from the situation the first emotion felt is often anger – anger at the other person for causing so much pain, and anger at oneself for putting up with it.

Before we can redefine love, we need to address our anger. If you are feeling angry, you are unable to make healthy decisions about where you end and the other person begins. Be mindful of your feelings, love yourself through it, and get real about your own and the other person’s shortcomings.

Is it her fault she’s mentally ill? No. But nobody has a right to treat you with disrespect.

Is it your fault she’s mentally ill? No. But it isn’t your job to clean up after her every time she acts out. Nor should you have to silently endure mistreatment because the other person has a mental illness.

How is your silence helping the situation? Are either of you happy? Are either of you growing? It’s time to make a change.

Change the dynamic

A major part of redefining love is deciding with whom we want to share our whole selves. There is only so much of us to go around. Emotionally healthy people choose to share their whole selves with those who respect their boundaries, because their boundaries are essentially who they are.

In some cases, we must make the hard choice to end relationships with mentally ill people. And sometimes, we just want to change the dynamic so it is less invasive and unhealthy for ourselves and others in our lives.

Changing the dynamic of relationships with mentally ill people is often difficult. Because the person is not mentally well, he or she will likely react irrationally to the relationship changing, compounding the anger of the person trying to make the change.

Remember as you begin redefining love that a mentally ill person is likely terrified. If you are close to the person, you probably have a codependent relationship. Perhaps you are his biggest enabler, the crutch he’s leaned on for years. When that crutch is removed, inevitably he will fall down. Who wants to fall down?

The tough business of setting boundaries

In the case of a mentally ill person, intervention by trained mental healthcare practitioners is crucial. Both you and the other person are going to need a lot of support. It isn’t fair to yank the rug out from under someone without trying to place cushions to catch her fall.

Notice I said trying to place cushions. You can’t force someone to accept help if she just isn’t willing. Nor can you rescue someone who doesn’t want to be saved. With the help of a trained mental healthcare professional, slowly begin the process of setting boundaries and holding yourself and the other person accountable. Expect bumps and serious discomfort for both of you. Nobody said this was going to be easy.

Remember that setting boundaries is an act of love. You are communicating to the other person that you love him enough to share your whole self, and you love yourself enough to take care of your own emotional needs.

Unfortunately, mentally ill people often struggle with understanding that other people are separate from themselves. The sad fact is the person may never respect your boundaries. Set boundaries anyway. Be consistent and be brave. Seek relationships with people who support you. Make healthy connections outside of the Shame Cycle from which you are attempting to break free.

It is difficult to watch someone self-destruct. You will be tempted to come to his rescue like you always used to do. Remind yourself that the person will never learn to trust himself if you are always cleaning up his messes. He deserves a chance to fail as much as anyone else. Hopefully, he has accepted help from the mental healthcare system.

What if?…

As you begin to change the dynamic of your relationship with a mentally ill person, your mind will run through every worst-case scenario. What if she turns the rest of the family against me? What if the whole world thinks I’m selfish for taking a stand? What if he harms himself or someone else?

As for people turning against you… If you are a part of a deeply enmeshed and dysfunctional family and you are the only one willing to address the elephant in the room, there is very likely going to be some pushback from other family members. That pushback may come in the form of open criticism, but in many cases you will simply be ignored.

Take note of how this feels. Because somewhere underneath all the chaos she’s creating, this is how the mentally ill person has felt her entire life. She is constantly generating drama so that people will notice that she needs help. Use this awareness to help you feel compassion for her.

Mentally ill people can be very intimidating. Everyone is so accustomed to walking on eggshells that the notion of taking a stand is unfathomable. This is why having a therapist is so important. When you’re feeling insecure or tempted to back down, your therapist will remind you that you are on the right track. Focus on seeking out support from others separate from the situation. Make your own family.

If you feel that someone is a danger to himself or others do not violate your own boundaries and run back to the relationship. Call 911. If the person is truly dangerous, you will have performed a public service. If the threat was made to test your boundaries, he’ll know you mean business. If someone doesn’t want 911 called on him, he shouldn’t make threats about safety. Lesson learned.

In many cases, our worst fears are never realized. What if, when finally left to fend for him or herself, the mentally ill person surprises everyone and flourishes? If you hadn’t made the choice to step back and set some healthy boundaries, you would never have known what he or she was capable of.

Personal safety

Most people with mental illness are not dangerous. Those who are dangerous are more likely to do self-harm or to lash out in frustration or fear towards a specific individual. Try to separate the individual from his or her illness. When a mentally ill person behaves dangerously, it is their illness talking. It is a cry for help.

Trust your gut. If you feel unsafe, get out of the situation. Remember that redefining love is about accountability and setting boundaries. Sometimes, we must love people from a distance. There are people trained to deal with mental illness. Utilize their expertise. Seek their guidance. And above all, keep yourself and others safe.

Redefining love for the mentally ill

Once we have redefined love, setting boundaries and holding others accountable becomes a lot less scary. Even though the other person may still not see it that way, within yourself you know that you are sharing your whole, honest self with the other person. And you don’t have to be angry or aggressive about it because you are sharing an act of love.

There are always going to be people who are harder to love than others. Love may not be the first emotion you feel when you encounter a mentally ill person. Sometimes it may take days to come to a place of love for someone who behaves so erratically. But it is so incredibly worth it. Love feels a lot better than disgust, bitterness, and despair.

In a world with so much pain and discord, it’s easy to wonder how just one person can make a difference. By creating emotionally healthy environments in our own families, we are making the world a safer, happier place.

If there is mental illness in your life, whether it is a serious case or a more subtle personality disorder, you could change the world by holding yourself and the other person accountable, setting boundaries, and helping the mentally ill person learn to rely on him or herself to navigate life in a healthy way.

If you don’t have mentally ill people in your life, you can help by removing the stigma from mental healthcare. You can love others who are different, who act out, who seem strange or make you uncomfortable. You can offer love and support to friends who are struggling with a relationship with a mentally ill person.

When we redefine love, we hold ourselves accountable for our own discomfort and judgment of others, and we hold others accountable for their own healing. We take responsibility for our own mental health and seek the help we need to ensure we are not generating Shame Cycles. We offer safe environments for people to admit their struggles. We remove the shame associated with mental illness. We set loving boundaries, and we maintain them.

Take the lovex3 challenge!❤x3

Copyright © Redefining Love 2018.

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Annas, George D., M.D., M.P.H. and James L. Knoll IV, M.D. 2016. Mass Shootings and Mental Illness. American Psychiatric Association Publishing.

Asher, Jules. March 1, 2013. Five Major Mental Disorders Share Genetic Roots. National Institutes of Health.

Desmarais, Sarah L. PhD, Kevin S. Douglas PhD, Kevin J. Grimm PhD, Kiersten L. Johnson MS, Marvin S. Swartz MD, and Richard A. Van Dorn PhD. November 12, 2014. Community Violence Perpetration and Victimization Among Adults With Mental Illnesses. American Journal of Public Health.

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Kamaradova, Dana Klara Latalova, and Jan Prasko. July 29, 2014. Perspectives on perceived stigma and self-stigma in adult male patients with depression. Neuropsychiatric Disease and Treatment, 10: 1399-1405.

The Treatment Advocacy Center. July 25, 2014. How Many People With Serious Mental Illness Are Homeless?

The author of Redefining Love is not a licensed mental healthcare professional. The information included on this site is for general informational purposes only. For mental health questions or concerns, please reach out to a licensed mental healthcare professional.