Tips on Phobia
Weathering the Storm - (Extracts from the book: BDOTI FIL-MALTEMP. Edited by Nora Macelli and Connie Magro. Published by the Mental Health Association and the St Jeanne Antide Foundation, 2015.) Translated by JEAN KILLICK
When you are taking care of a family member with mental health difficulties, you should do your best to obtain information on the condition being faced. It is wise to keep yourself updated on therapy and medication used. It is also very important to keep regular contact with the professionals involved in the treatment. This means that, if you notice any different or alarming change in behaviour, you must contact the patient’s doctor.
This article provides family caregivers with tips on how they should continue the difficult journey of care with more confidence, knowledge and ease. Practical tips provided in this article focus on the following specific mental health problems: Phobia, Depression, OCD, Eating Disorders, Hoarding Mania, Bi-Polar Disorder, Psychosis, Borderline Personality Disorder and Relapse.
Tips on PHOBIA
You should be aware of your limits and those of other family members. You should discuss with your relative the fears and phobias that are affecting his/her life. It is very important not to belittle or put down the experiences and feelings that your relative is suffering.
It is absolutely essential that you obtain professional help on how the patient can be exposed to the thing or situation that he/she fears. This method is called desensitization. It must be done gradually and sensitively, with the advice of professionals. The aim of this therapy is to reduce or eliminate the fears and phobias that are preventing the patient from leading a normal life.
It is most important that you obtain all possible support. This will help you as well as your relative suffering from a phobia. Here are some examples how you can provide better help.
If you have agreed to meet somewhere at a certain time, it is important that you are there a little early or on time, so that your relative will not become needlessly anxious.
It is important that you allow the phobia sufferer to set her or his own pace for recovery, whilst at the same time encouraging her/him to move forward. Your goal is to encourage your relative to remain independent.
During your relative’s recovery period, you should remain positive and show your satisfaction with the progress achieved.
Don’t disparage or comment on issues that your relative cannot change.
You can give the support needed but the sufferer must also try hard while getting professional help with the problems being faced.
It is advisable that you yourself learn methods for relaxing and that you teach your relative to try them too.
Together with your relative, you should try to classify his or her fears, so that you can start working first of all on those that are least ‘fearful’. When your relative feels comfortable and is no longer affected by that particular fear, then work can start on the next fear. Ideally, during this process, you should never raise your voice, but act kindly and patiently to ensure rapid progress. This can also be helped if you continue to encourage your relative to be independent whenever possible.
While you are working hand-in-hand with your relative to overcome his/her fears one by one, he/she needs to be able to see you as a reliable person who can be trusted, someone who does things carefully and reasonably. Allow your relative to set the pace. Do not force him/her to overdo things or go faster than he/she is comfortable with.
It is important that you encourage your relative to be positive on the road to recovery. Praise and encourage him/her, without criticising or putting down. Give as much praise as possible but it is up to the patient to do his/her best to get over negative thoughts and behaviour and develop a more positive life style.
Tips on DEPRESSION
Every illness can lead to depression. It may also be that the depression itself can cause another illness. Depression may occur with chronic illness or some other mental disorder, such as OCD, psychosis, personality disorders, bi-polar or other illness.
Very often, relatives fail to appreciate the suffering of a depressed person. So you must understand that depression is a serious illness. Don’t be a know-it-all and say things to the patient like “Come one, get up”, “You’re so lazy!” “Why are you making such a fuss? Come on, get up and have a shower.” “Everyone has bad moods”. “You’re so spoilt.” You must understand that depression kills off energy; it makes one lethargic; it kills all motivation for working or making something of oneself; it smothers every feeling of health and happiness. You must always avoid criticizing.
As a family caregiver, it is important you realise that the family is the focus of all support and treatment for the patient. Everyone speaks of the beauty of family unity and the support it gives in difficult circumstances. On the other hand, there is sorrow and heartbreak when we do not get the necessary help and support from our family. You must realise that, if you get little help from the rest of the family, there are professionals and organisations that can be your second family; there’s no need to be discouraged.
Here are some other practical suggestions:
Suicide
You should learn the sign-posts of suicide and look out for them. The signs include comments like: “I’m so sick of this world. I don’t want to live anymore.” Other indications may be when the patient shares out his possessions; leaves a letter where it can be seen; draws up a will without ever having mentioned it before. It doesn’t matter if one speaks openly of suicide as this can save their life. Don’t be afraid to ask the patient if he/she is thinking of ending their life. Seek the advice of a professional. One should always bear in mind that you are not guilty of someone else’s suicide. When a cancer spreads, no one feels guilty. In the same way, one should not feel that he/she has caused the suicide.
Tips on OBSESSIVE COMPULSIVE DISORDER (OCD)
Persons who suffer from Obsessive Compulsive Disorder or OCD often involve their family members in their rituals. If we are not careful, it is easy to fall into the reality that they have created and help them in the illusion of the ritual. For example: a member of my family who suffers from paranoia asks me to fix a security camera on the front of the house, because he/she is convinced that many people are against him/her; if I do so, I will be joining in the reality that he/she has created.
Family members usually have uncomfortable and complex feelings. It is important that you learn not to involve yourself in the patient’s obsessions. What can you do?
You can encourage the person with OCD to wear a rubber band around their wrist. Tell them to pull the rubber band every time they feel an obsessive need like washing their hands; checking if the cooker is turned off; checking whether the light is switched off; whether the front door is closed.
You can help by writing on a large sheet of paper the answer to the question that the patient asks over and over again. You can point to the answer and not say anything further.
Disturbed emotions place a huge burden on relationships and affect all aspects of family life. If tension boils over, the hurt caused can be as great as the illness itself. It is important to appreciate that, when we try to stop the compulsion, anxiety increases in the OCD patient. One could sometimes make a joke of the compulsion. For example: “You’ve polished the floor beautifully. But if you carry on polishing it will be like a greasy pole and people will certainly slip.”
I need to learn as much as I can about the illness, so I can be really useful. I should not hide my ignorance with judgemental words that ridicule and put down the OCD patient’s experience. The more I learn about OCD and its treatment, the more I will be able to understand that the compulsive behaviour and obsession are symptoms of the illness itself and not a weak character.
It is important to learn ways to prevent the patient from controlling family life, otherwise the family may collapse. I must learn to communicate openly, clearly and positively. I must be patient and careful not to lose my temper. Above all, I must seek professional help so that I too will know what to do and how to look after myself.
It is important to learn how to help the OCD patient in the treatment programme. If you catch yourself becoming involved in the obsessions through oversight, don’t make a fuss or feel guilty. Forget it and try to keep back.
How do I recognise a new obsession?
When the patient repeats an action many times;
When he/she finds it difficult to finish something because they are obsessing over details;
When he/she starts to arrive late – if it is not usually the case;
When he/she repeatedly asks for reassurance that something has been done correctly;
When he/she starts to save and hoard things needlessly.
Finally, remember that life is a marathon not a leap. Continue to praise the progress made and encourage the patient when things go wrong. Mix humour with love and heartfelt care. Obviously, humour should not ridicule the patient. Above all, take care of yourself. Develop a support network to help you cope. Spend a little time each day in peace and quiet.
Tips on caring for a member of the family with an EATING DISORDER
We know that, when someone in the family develops an eating disorder, you feel disturbed and unable to work things out. You don’t know what to do. Here are a number of steps that you can take to help your relative to be cured and get on with life.
Do not coerce your relative. Try to understand what your role should be. This is the first important step, so that you will not cause the illness to worsen. Don’t try to control what or how much your relative eats. Don’t force them. The eating disorder is a form of control over the sufferer’s life. Therefore, if you try to force your relative, he/she will turn against you and you will become the enemy instead of a dear one who can help.
Your role can be crucial: Even if the person suffering from an eating disorder is receiving professional care, your contribution in the treatment is crucial. Don’t let your behaviour spoil the opportunity to help.
Learn about eating disorders. If you don’t, you will not know what is happening and why.
Don’t be discouraged from communicating with your relative. You should understand that it will become increasingly difficult to communicate. As the person becomes more introverted, the more they will want to be alone, the more sensitive they become to other people’s comments, the more abusive they are. You will understandably feel distraught. Keep in mind that communication is very important. Gently continue your efforts.
Show respect. Show that you understand and feel your relative’s pain. Build a relationship of trust in spite of what they are going through.
Don’t focus on food. Instead of focusing on what or how much food is eaten, the person’s appearance and weight, do your best to listen without judging. Listen to the emotional pain.
Praise: Appreciate the person’s creative potential and praise their personal strengths. Don’t belittle or make them feel worse than they already feel by pointing out their limitations. Give praise where it is due, especially for efforts, gains and accomplishments.
Show and tell the sufferer that you love them. Persist in this because many things are possible through love which has hidden strengths.
Encourage your dear one to seek help so that they can learn to manage their negative emotions.
Avoid discussions on diets or weight problems.
Discuss with them opportunities and sources of help.
Speak openly and sincerely about your own feelings, without making the person feel guilty that you are also suffering. Ask them how you can help.
Be a role model by eating a balanced diet and exercising.
Remember that it’s not your fault. Every time you work to rid yourself of negative emotions and sense of guilt churning inside you, you will be in a better position to act wisely to help your loved one.
Take care of yourself. Don’t obsess about your relative’s eating disorder. By doing that you risk not taking care of yourself or the other members of the family. Look for support for yourself too. You need to be strong to keep the family together.
How you can help during meal times
Ask the to go shopping with you and agree beforehand what to cook for the whole family.
During meal times, agree that none of you will argue about the amount of food on the plate, calories or fat content.
Avoid eating low calorie or diet food in front of the .
Do your best to maintain a positive and happy atmosphere.
Plan some cheerful activity after meals, such as a game or outing which may distract the from vomiting or doing strenuous exercise.
Don’t despair if things go wrong during meal times.
As a family member-carer of a mentally ill person, you can ask for help from the LWIEN service of the St Jeanne Antide Foundation. Phone in for an appointment. The LWIEN family consultations take place on Wednesdays and Fridays in Tarxien throughout the year and twice monthly on Saturdays in Ħaż-Żabbar. Before the appointment, take note of what you wish to discuss – things that worry you, what you think you are doing well, and any questions you would like to ask. It is a good idea to discuss these points with your relative before the appointment.
Remember: “Don’t ponder on what went wrong today but on what can get better tomorrow.” (Helen Keller)
Tips on HOARDING MANIA
How do you help a relative who hoards?
Excessive hoarding will no doubt cause you much frustration. Most family members will probably react negatively when dust and rubbish accumulate around them and they can do nothing about it. It is natural to want to live in a clean and dignified environment without embarrassing anyone, especially when friends and family visit. It is difficult to reason with a person obsessed with hoarding. Your impulse would be to clear the house and get rid of all the accumulated junk. However, this will not solve the problem. It is important to keep in mind that this is a mental disorder that causes a person to be very irrational.
What can you do to help?
Remember: “A good deed strengthens us and inspires others to behave well.” (Plato, 400 BC)
Tips on BI-POLAR DISORDER
Bi-Polar Disorder affects not just the individual but all those around them. Very often, family members suffer as much as the patient. Relatives tend to suffer from extreme stress and isolation as much of their time is dedicated to the sick relative.
What can family members do?
Taking care of a mentally ill person is no easy task and can make us face difficult challenges. However, a saying by Winston Churchill bears repeating: “When you are going through hell, keep on going. Never never never give up.”
Tips on PHYCHOSIS
Psychosis rarely occurs suddenly. What happens is that symptoms start to appear and worsen over a period of months or even years. Amongst the early symptoms one can notice changes in thought processes and feelings which begin to disable a person before the illness worsens and is identified. If diagnosis is carried out at an early stage, there is a good chance that one can overcome the disability and prevent the acute stage of the illness from setting in.
How can you take care of a family member suffering from psychosis?
Love and support are crucial for recovery.
Accept the illness and the difficulties that it brings. If you do not accept it, everything you do will result from lack of understandingand unwise decisions.
Be realistic on what you expect from and from yourself. Otherwise you will give up because the reality will be very different from your expectations. Help to have realistic objectives. For example, if about to sit for exams, do not force to sit for all the exams; discuss with the psychiatrist what would be realistically possible. Depending on the situation, help to apply for an extension of the course or exams.
Don’t go into denial about the problem. Don’t look for excuses. The more you try to deny the facts, the more difficult it will be for you to understand and help. Some people try to avoid the issue by looking for other reasons, such as: “He’s like that because he was bullied at school.” Or “He’s so arrogant and spoiled”
If is young, don’t fuss, over-protect or do everything for because this will only make things much worse and will prevent from developing character. Help to strengthen skills and independence. You may have conflicting feelings about whether you can trust ; remember that must progress at own pace and must be given space to go on in life.
Educate yourself. Learn about the illness and treatment so that that every decision you take is based on good foundations. The more you know about the illness, the better you can manage your life, help to resolve crises and work towards recovery.
Avoid stress. Create a structured environment that supports you.
Couples should work as a team. Go on a course together. Look for help together. Talk and discuss. If you don’t, your efforts will be fragmented.
Don’t nag – the situation will worsen if pressurized. probably already blaming and nagging is the last thing need.
Prepare for special occasions (whether happy or difficult ones), thereby reducing stress and possibly avoiding another attack of psychosis.
Be patient with slow progress!
Encourage and support the treatment.
Check that the treatment is being followed and medication taken. The patient may not be aware of the real situation and may say “You don’t believe that I feel ok. I don’t need to take the pills.” Calmly and patiently, try to convince that cannot abruptly stop taking the medication because symptoms will worsen. Continue to check that medication is being taken; if you notice any worrying side-effects, discuss these with psychiatrist.
Be alert for signs of a relapse. aniawake up shouting fightingarguingsinging at nightshutting himself in his room with headphones on.
Prepare yourself for crisis situationshat should do when a crisis happens
You must understand that you cannot reason or argue with a psychotic patient because the situation will explode into a crisis. Remember that the patient is probably afraid. So, if say (for example) “You want to kill me”, don’t argue .
Try not to be irritated or angry or show this to . Stay calm.
Don’t shout.
Don’t be sarcastic or ridicule . If says: “The police are chasing me”, don’t reply “Of course not! It’s all in your mind. Come on, you don’t need to be afraid.” Don’t say that, because what imagines is real to .
Don’t contradict . Say: “You’re right. You can hear them. Reality can be different. But I understand you.” Or “I know you can see them, but I cannot.”
Try to reduce distractions like television.
Don’t get too close and try to touch .
Avoid looking into eyes for any length of time.
Sit down and ask to sit down too.
Seek professional help, such as the Crisis Intervention Service at Mater Dei hospital. Phone 179 at other times. Phone the social worker from Mount Carmel Hospital assigned to .
Be aware that 30% of psychotic attacks are one-offs. In another 30% of cases, the illness will get worse despite the love, support and treatment provided. Despite this, one must not be discouraged as treatment can control many of the symptoms.
Tips on BORDERLINE PERSONALITY DISORDER and violent behaviour
There is a difference between understanding and accepting feelings, and understanding and accepting behaviour. Violence is not only aggression but results from the person feeling threatened. But violence should never be acceptable.
With medication and support, mentally ill patients who have aggressive tendencies do not present a danger to the general public. If you feel threatened by your relative’s behaviour, don’t dismiss it; protect yourself by leaving and asking for help. In the meantime, do the following:
Avoid touching .
Leave a space between you and .
Don’t get between and the door.
Ensure that there is a building exit you can use.
Talk calmly and softly.
Don’t argue and don’t answer back angrily.
If asks a question, give a brief reply in a reasonable tone. That way the patient will not feel ignored.
Try not to show that you are uncomfortable, nervous or afraid.
Don’t point your finger at , or put your hands at your waist – it look as though you are challenging him.
Don’t move suddenly.
Show himthat you are there to help.
Not every unusual or strange behaviour is violent.
Tips on REPAPSE
How to reduce the risk of relapse
When you feel well, the chemicals in the brain are relatively balanced. Symptoms that lead to a relapse can mess up this chemical balance and cause a relapse. It is important to learn to spot signs of a relapse, so that preventive measures can be taken early on. The best way to prevent this is to take good care of yourself. In addition, there are a number of steps that you can take to avoid the recurrence of the illness. These include continuation of medication prescribed, adopting a positive life style, controlling your environment, and awareness of the symptoms.
It is useful to learn more about the mental illness and medication. Discuss the medication and its effects with professionals in mental health and psychiatry. Search out further written information on diagnosis and treatment. If the medication prescribed is not working, ask about other medicines. Be guided by your doctor so the correct medicine and dosage can be established.
Above all, there must be a strong commitment to taking the medication daily. Although it may not help, be aware that one should never stop the medication without discussing thoroughly with the doctor why one feels the need to change the medication and dosage and what the side effects are. Recognise the early symptoms that warn you of a possible relapse. Remember that the symptoms can be detected right at the start of the relapse.
Take note of any changes you notice, such as strange occurrences at the start of the illness and changes in behaviour that other people have noticed. Remember to stay alert for:
Any symptoms that may appear;
Any new symptoms that occur suddenly;
Any increase in residual symptoms. Residual symptoms are those that lessen but do not disappear totally, despite the medication prescribed. Some remain the same, worsen or never improve.
Take note of early symptoms so that the illness will not recur. Write down the early symptoms so that you can easily spot them and refer immediately to the doctor.
Some early symptoms that you should be on the look out for in your suffedring relative:
Sleepless nights or lack of sleep;
Difficulty in concentrating or paying attention. cannot think as clearly as usual.
One minute are laughing, the next are crying.
Being more forgetful or absentminded than usual.
Hearing voices.
Fear of people, places or things that would not normally frighten .
Excessive anger and more arguments than usual.
Strange reasoning, words and behaviour.
Continuous bad or worried moods
Thinking that people are talking about or laughing
Spending much more money than usual.
It is important to deal with symptoms of a relapse, so that:
Hospital stays may not be necessary – a relapse can be avoided.
Your relative may start and continue to feel well.
They do not regress.
See that they do not shut themselves up!
about any bad news with someone close to you. It doesn’t matter if you need to talk and cry often. This is part of the mind’s natural healing process.
Keep yourself active. Go for walks and take part in other activities. Do housework. Try to do maintenance work around the house to keep your environment clean, attractive and restful. Don’t give up those activities that are part of your normal routine.
Make sure you eat regularly. Eat a mix of fresh fruit and vegetables. If you lose weight rapidly, you will lack vitamins and feel worse.
Avoid drugs (especially Cannabis and alcohol). Don’t try to cheer yourself up with alcohol or drugs as these will make you feel better only for a very short time; later you will feel much worse. These will worsen your mental illness. Illegal drugs and alcohol prevent you from working on your problem. They are also bad for your physical health.
Sleep: try to sleep and wake at regular times.
Don’t be discouraged by thinking that you are the only one suffering mental illness. Be brave – if you are careful, eventually you may be able to overcome the illness. Sometimes, after a mental illness, it is possible for a person to be stronger than before the illness. When you face difficult situations with a positive attitude, you will notice that your relationships have also improved.
Decisions: The more you manage your illness, the stronger your decision-making skills will become and you will be able to initiate changes in your life that possibly you may have avoided making in the past. Make small changes at a pace you can cope with, to avoid needless stress.
Decrease stress: Keep stress levels as low as you can. A lot of stress, even good stress, can cause a relapse. If you feel any new stress, speak to the doctor or to a member of your treatment team. To decrease stress, avoid stressful situations and instead, do something that you like – listen to some music, watch an interesting programme on television, have a shower or bath, write down your thoughts in a diary, go for a long walk, go swimming, talk to a friend or family member, paint, go out into the countryside and take pleasure in the natural beauty around you, do some exercise to relax you.
Control your environment: If you live in a house full of noise that irritates you, see if you can change your environment. Perhaps you can try to live somewhere else on your own. You can ask for help as a family from a family therapist so that you can all learn to live in harmony.
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When you are taking care of a family member with mental health difficulties, you should do your best to obtain information on the condition being faced. It is wise to keep yourself updated on therapy and medication used. It is also very important to keep regular contact with the professionals involved in the treatment. This means that, if you notice any different or alarming change in behaviour, you must contact the patient’s doctor.
This article provides family caregivers with tips on how they should continue the difficult journey of care with more confidence, knowledge and ease. Practical tips provided in this article focus on the following specific mental health problems: Phobia, Depression, OCD, Eating Disorders, Hoarding Mania, Bi-Polar Disorder, Psychosis, Borderline Personality Disorder and Relapse.
Tips on PHOBIA
You should be aware of your limits and those of other family members. You should discuss with your relative the fears and phobias that are affecting his/her life. It is very important not to belittle or put down the experiences and feelings that your relative is suffering.
It is absolutely essential that you obtain professional help on how the patient can be exposed to the thing or situation that he/she fears. This method is called desensitization. It must be done gradually and sensitively, with the advice of professionals. The aim of this therapy is to reduce or eliminate the fears and phobias that are preventing the patient from leading a normal life.
It is most important that you obtain all possible support. This will help you as well as your relative suffering from a phobia. Here are some examples how you can provide better help.
If you have agreed to meet somewhere at a certain time, it is important that you are there a little early or on time, so that your relative will not become needlessly anxious.
It is important that you allow the phobia sufferer to set her or his own pace for recovery, whilst at the same time encouraging her/him to move forward. Your goal is to encourage your relative to remain independent.
During your relative’s recovery period, you should remain positive and show your satisfaction with the progress achieved.
Don’t disparage or comment on issues that your relative cannot change.
You can give the support needed but the sufferer must also try hard while getting professional help with the problems being faced.
It is advisable that you yourself learn methods for relaxing and that you teach your relative to try them too.
Together with your relative, you should try to classify his or her fears, so that you can start working first of all on those that are least ‘fearful’. When your relative feels comfortable and is no longer affected by that particular fear, then work can start on the next fear. Ideally, during this process, you should never raise your voice, but act kindly and patiently to ensure rapid progress. This can also be helped if you continue to encourage your relative to be independent whenever possible.
While you are working hand-in-hand with your relative to overcome his/her fears one by one, he/she needs to be able to see you as a reliable person who can be trusted, someone who does things carefully and reasonably. Allow your relative to set the pace. Do not force him/her to overdo things or go faster than he/she is comfortable with.
It is important that you encourage your relative to be positive on the road to recovery. Praise and encourage him/her, without criticising or putting down. Give as much praise as possible but it is up to the patient to do his/her best to get over negative thoughts and behaviour and develop a more positive life style.
Tips on DEPRESSION
Every illness can lead to depression. It may also be that the depression itself can cause another illness. Depression may occur with chronic illness or some other mental disorder, such as OCD, psychosis, personality disorders, bi-polar or other illness.
Very often, relatives fail to appreciate the suffering of a depressed person. So you must understand that depression is a serious illness. Don’t be a know-it-all and say things to the patient like “Come one, get up”, “You’re so lazy!” “Why are you making such a fuss? Come on, get up and have a shower.” “Everyone has bad moods”. “You’re so spoilt.” You must understand that depression kills off energy; it makes one lethargic; it kills all motivation for working or making something of oneself; it smothers every feeling of health and happiness. You must always avoid criticizing.
As a family caregiver, it is important you realise that the family is the focus of all support and treatment for the patient. Everyone speaks of the beauty of family unity and the support it gives in difficult circumstances. On the other hand, there is sorrow and heartbreak when we do not get the necessary help and support from our family. You must realise that, if you get little help from the rest of the family, there are professionals and organisations that can be your second family; there’s no need to be discouraged.
Here are some other practical suggestions:
- Accept that your relative is suffering from depression.
- Understand that your relative is ill. Empathise and show that you understand that he/she is truly ill and that the illness is making him/her unable to cope.
- Show clearly that you are there for him/her for whatever he/she needs.
- Gently help the patient to agree to seek help and help to make appointments and go with him/her if you are asked.
- Look for more information on the illness. Research appropriate books before you buy any. Speak to professionals and ask them about the authenticity of the author and contents.
- Speak to a professional and continue every time you feel it necessary – it is your right and obligation towards the patient. It’s ok to seek another opinion.
- Encourage the patient to create some structure in his/her life by making a small, manageable plan, so that he/she can do some work at home. Do this lovingly, with kind words.
- Continue to hope and encourage hope. Remember that the majority of depression patients recover. Those that do not recover completely can be much better. Continue to seek help.
- Don’t nag the patient, he may be bothered and start to hate the treatment. You should only say: “This is a treatment. You must have the treatment in order to cure the depression, although it is a hard road.” That’s all!
- Unfortunately, many of us tend to commiserate with words that do not transform into assistance; we use empty words that may further depress and anger the patient. So listen and sympathise. You should not console the patient. Stay close, so that the patient can speak to you openly. Stop whatever you are doing and listen!
- Remember that, when the patient expresses pessimism, anger, frustration and unhappiness, it is the illness that is speaking, not the patient.
- Don’t be offended when the patient tells you “You don’t understand me!” Your reply should be “I know, you are right.” Or: “It’s true that I may not understand exactly what you are going through and what you are feeling. But I am here to help you.” If you contradict him/her, you will only increase the patient’s frustration.
- Don’t patronise the patient. You should not take charge of everything and make him/her feel worse. Don’t overprotect because this is not helpful. Neither should you take over his/life and do everything yourself. That is not help. It would be better to say: “When you are better, you decide. I will support you.”
- You can ask the patient to do something with you; regular walking helps on the road to recovery and reduces the symptoms.
- Don’t expect big improvements. Recovery doesn’t happen overnight.
- Prepare nutritious and light meals.
- Behave gently and lovingly!
- You could suggest that the patient joins a self-help group. Talking about his/her feelings and situations will help on the road to recovery.
Suicide
You should learn the sign-posts of suicide and look out for them. The signs include comments like: “I’m so sick of this world. I don’t want to live anymore.” Other indications may be when the patient shares out his possessions; leaves a letter where it can be seen; draws up a will without ever having mentioned it before. It doesn’t matter if one speaks openly of suicide as this can save their life. Don’t be afraid to ask the patient if he/she is thinking of ending their life. Seek the advice of a professional. One should always bear in mind that you are not guilty of someone else’s suicide. When a cancer spreads, no one feels guilty. In the same way, one should not feel that he/she has caused the suicide.
Tips on OBSESSIVE COMPULSIVE DISORDER (OCD)
Persons who suffer from Obsessive Compulsive Disorder or OCD often involve their family members in their rituals. If we are not careful, it is easy to fall into the reality that they have created and help them in the illusion of the ritual. For example: a member of my family who suffers from paranoia asks me to fix a security camera on the front of the house, because he/she is convinced that many people are against him/her; if I do so, I will be joining in the reality that he/she has created.
Family members usually have uncomfortable and complex feelings. It is important that you learn not to involve yourself in the patient’s obsessions. What can you do?
You can encourage the person with OCD to wear a rubber band around their wrist. Tell them to pull the rubber band every time they feel an obsessive need like washing their hands; checking if the cooker is turned off; checking whether the light is switched off; whether the front door is closed.
You can help by writing on a large sheet of paper the answer to the question that the patient asks over and over again. You can point to the answer and not say anything further.
Disturbed emotions place a huge burden on relationships and affect all aspects of family life. If tension boils over, the hurt caused can be as great as the illness itself. It is important to appreciate that, when we try to stop the compulsion, anxiety increases in the OCD patient. One could sometimes make a joke of the compulsion. For example: “You’ve polished the floor beautifully. But if you carry on polishing it will be like a greasy pole and people will certainly slip.”
I need to learn as much as I can about the illness, so I can be really useful. I should not hide my ignorance with judgemental words that ridicule and put down the OCD patient’s experience. The more I learn about OCD and its treatment, the more I will be able to understand that the compulsive behaviour and obsession are symptoms of the illness itself and not a weak character.
It is important to learn ways to prevent the patient from controlling family life, otherwise the family may collapse. I must learn to communicate openly, clearly and positively. I must be patient and careful not to lose my temper. Above all, I must seek professional help so that I too will know what to do and how to look after myself.
It is important to learn how to help the OCD patient in the treatment programme. If you catch yourself becoming involved in the obsessions through oversight, don’t make a fuss or feel guilty. Forget it and try to keep back.
How do I recognise a new obsession?
When the patient repeats an action many times;
When he/she finds it difficult to finish something because they are obsessing over details;
When he/she starts to arrive late – if it is not usually the case;
When he/she repeatedly asks for reassurance that something has been done correctly;
When he/she starts to save and hoard things needlessly.
Finally, remember that life is a marathon not a leap. Continue to praise the progress made and encourage the patient when things go wrong. Mix humour with love and heartfelt care. Obviously, humour should not ridicule the patient. Above all, take care of yourself. Develop a support network to help you cope. Spend a little time each day in peace and quiet.
Tips on caring for a member of the family with an EATING DISORDER
We know that, when someone in the family develops an eating disorder, you feel disturbed and unable to work things out. You don’t know what to do. Here are a number of steps that you can take to help your relative to be cured and get on with life.
Do not coerce your relative. Try to understand what your role should be. This is the first important step, so that you will not cause the illness to worsen. Don’t try to control what or how much your relative eats. Don’t force them. The eating disorder is a form of control over the sufferer’s life. Therefore, if you try to force your relative, he/she will turn against you and you will become the enemy instead of a dear one who can help.
Your role can be crucial: Even if the person suffering from an eating disorder is receiving professional care, your contribution in the treatment is crucial. Don’t let your behaviour spoil the opportunity to help.
Learn about eating disorders. If you don’t, you will not know what is happening and why.
Don’t be discouraged from communicating with your relative. You should understand that it will become increasingly difficult to communicate. As the person becomes more introverted, the more they will want to be alone, the more sensitive they become to other people’s comments, the more abusive they are. You will understandably feel distraught. Keep in mind that communication is very important. Gently continue your efforts.
Show respect. Show that you understand and feel your relative’s pain. Build a relationship of trust in spite of what they are going through.
Don’t focus on food. Instead of focusing on what or how much food is eaten, the person’s appearance and weight, do your best to listen without judging. Listen to the emotional pain.
Praise: Appreciate the person’s creative potential and praise their personal strengths. Don’t belittle or make them feel worse than they already feel by pointing out their limitations. Give praise where it is due, especially for efforts, gains and accomplishments.
Show and tell the sufferer that you love them. Persist in this because many things are possible through love which has hidden strengths.
Encourage your dear one to seek help so that they can learn to manage their negative emotions.
Avoid discussions on diets or weight problems.
Discuss with them opportunities and sources of help.
Speak openly and sincerely about your own feelings, without making the person feel guilty that you are also suffering. Ask them how you can help.
Be a role model by eating a balanced diet and exercising.
Remember that it’s not your fault. Every time you work to rid yourself of negative emotions and sense of guilt churning inside you, you will be in a better position to act wisely to help your loved one.
Take care of yourself. Don’t obsess about your relative’s eating disorder. By doing that you risk not taking care of yourself or the other members of the family. Look for support for yourself too. You need to be strong to keep the family together.
How you can help during meal times
Ask the to go shopping with you and agree beforehand what to cook for the whole family.
During meal times, agree that none of you will argue about the amount of food on the plate, calories or fat content.
Avoid eating low calorie or diet food in front of the .
Do your best to maintain a positive and happy atmosphere.
Plan some cheerful activity after meals, such as a game or outing which may distract the from vomiting or doing strenuous exercise.
Don’t despair if things go wrong during meal times.
As a family member-carer of a mentally ill person, you can ask for help from the LWIEN service of the St Jeanne Antide Foundation. Phone in for an appointment. The LWIEN family consultations take place on Wednesdays and Fridays in Tarxien throughout the year and twice monthly on Saturdays in Ħaż-Żabbar. Before the appointment, take note of what you wish to discuss – things that worry you, what you think you are doing well, and any questions you would like to ask. It is a good idea to discuss these points with your relative before the appointment.
Remember: “Don’t ponder on what went wrong today but on what can get better tomorrow.” (Helen Keller)
Tips on HOARDING MANIA
How do you help a relative who hoards?
Excessive hoarding will no doubt cause you much frustration. Most family members will probably react negatively when dust and rubbish accumulate around them and they can do nothing about it. It is natural to want to live in a clean and dignified environment without embarrassing anyone, especially when friends and family visit. It is difficult to reason with a person obsessed with hoarding. Your impulse would be to clear the house and get rid of all the accumulated junk. However, this will not solve the problem. It is important to keep in mind that this is a mental disorder that causes a person to be very irrational.
What can you do to help?
- Seek professional help. Don’t think that you can solve the problem on your own. Follow the professional’s advice so that you are all working along the same lines.
- Try to imagine how you would feel in the same situation as the hoarder.
- When you talk to your relative who hoards things, use words that explain and encourage realistic behaviour, such as: “I’m aware that you know this place like the back of your hand. But try to imagine how someone could get to you in an emergency! He would be sure to stumble and hurt himself.” Or: “The neighbours are within their rights to report you to the health authorities. Before things reach that point, wouldn’t it be better if you start to make some changes? Neighbours should be friends, not enemies.”
- Remember that acute hoarders will not accept your criticism. They will be even more stubborn if you make such comments as: “Look at all the junk around you!” or “Who on earth can live in a place like this? You’ve turned the house into a pig-sty.”
- Don’t make fun of their home and the things they cherish. They would think that you are cheapening their value. After all, they already know that you have different opinions about these things.
- Don’t refer to the things hoarded as rubbish or junk. Try to control your facial expression or gestures.
- Don’t try to persuade or force them to make changes in the room or house as this will have the opposite effect.
- Don’t touch the hoarded items without permission. They will be disturbed and upset when they see you moving them.
- Above all: (a) concentrate on safety both for the patient and the rest of the family – particularly fire hazards; (b) then store the items; and (c) finally work to remove the hoarded items.
- Treatment: An acute hoarder doesn’t think his behaviour is a problem. So treatment is a big challenge to all concerned. Everyone needs to participate in the treatment. The hoarder will not succeed on his or her own. You may need to make a plan to ensure that the patient does not continue to hoard. Where animals are concerned, you may need to involve the SPCA in the plan. Intense treatment may lead the person to understand their behaviour and lead a safer life.
Remember: “A good deed strengthens us and inspires others to behave well.” (Plato, 400 BC)
Tips on BI-POLAR DISORDER
Bi-Polar Disorder affects not just the individual but all those around them. Very often, family members suffer as much as the patient. Relatives tend to suffer from extreme stress and isolation as much of their time is dedicated to the sick relative.
What can family members do?
- Read, ask and learn more about the condition.
- Find out what services are available in your area and generally.
- Participate in a support group for family members of mentally ill patients. These groups will provide support that you will need and will help you realize that you are not alone in this difficult situation. The Mental Health Association (Malta), for example, runs an annual course for family caregivers. Many caregivers attend this course more than once.
- Although it may not be easy, it is important to maintain good relations with the sick relative, even when they do not appreciate your support or the sacrifices that you are making.
- Keep in regular contact with the patient’s psychiatrist and keep track of appointments.
- Teach the patient to be as independent as possible.
- Ensure that your relative is taking correct medication. If not, speak to the psychiatrist and check whether it is necessary to register with the MMDNA, so that a nurse could visit the patient at home to give him or her the medication.
- Keep handy a list of important telephone numbers so that you can reach them easily in an emergency.
- Keep communication open with the patient.
- When you are caring for a family member with this condition, it is important that:
- You get enough sleep so that your mind and body are rested and you will not collapse due to tiredness, anxiety and stress.
- Make time for some form of exercise and keep your own appointments and commitments.
- Make sure you have a balanced diet and eat nourishing food.
- Some daily “me” time is necessary – you should not feel guilty for doing this.
- Try to understand the negative emotions that can arise when you are caring for the patient. If you want to rid yourself of negative emotions, make an appointment for yourself with the Emotional Freedom Service of the Foundation.
- Acknowledge the positive things in your life, although these may be small.
- Keep a positive attitude – humour should be an important part of your life.
- Recognise priorities in your life – what is most important?
Taking care of a mentally ill person is no easy task and can make us face difficult challenges. However, a saying by Winston Churchill bears repeating: “When you are going through hell, keep on going. Never never never give up.”
Tips on PHYCHOSIS
Psychosis rarely occurs suddenly. What happens is that symptoms start to appear and worsen over a period of months or even years. Amongst the early symptoms one can notice changes in thought processes and feelings which begin to disable a person before the illness worsens and is identified. If diagnosis is carried out at an early stage, there is a good chance that one can overcome the disability and prevent the acute stage of the illness from setting in.
How can you take care of a family member suffering from psychosis?
Love and support are crucial for recovery.
Accept the illness and the difficulties that it brings. If you do not accept it, everything you do will result from lack of understandingand unwise decisions.
Be realistic on what you expect from and from yourself. Otherwise you will give up because the reality will be very different from your expectations. Help to have realistic objectives. For example, if about to sit for exams, do not force to sit for all the exams; discuss with the psychiatrist what would be realistically possible. Depending on the situation, help to apply for an extension of the course or exams.
Don’t go into denial about the problem. Don’t look for excuses. The more you try to deny the facts, the more difficult it will be for you to understand and help. Some people try to avoid the issue by looking for other reasons, such as: “He’s like that because he was bullied at school.” Or “He’s so arrogant and spoiled”
If is young, don’t fuss, over-protect or do everything for because this will only make things much worse and will prevent from developing character. Help to strengthen skills and independence. You may have conflicting feelings about whether you can trust ; remember that must progress at own pace and must be given space to go on in life.
Educate yourself. Learn about the illness and treatment so that that every decision you take is based on good foundations. The more you know about the illness, the better you can manage your life, help to resolve crises and work towards recovery.
Avoid stress. Create a structured environment that supports you.
Couples should work as a team. Go on a course together. Look for help together. Talk and discuss. If you don’t, your efforts will be fragmented.
Don’t nag – the situation will worsen if pressurized. probably already blaming and nagging is the last thing need.
Prepare for special occasions (whether happy or difficult ones), thereby reducing stress and possibly avoiding another attack of psychosis.
Be patient with slow progress!
Encourage and support the treatment.
Check that the treatment is being followed and medication taken. The patient may not be aware of the real situation and may say “You don’t believe that I feel ok. I don’t need to take the pills.” Calmly and patiently, try to convince that cannot abruptly stop taking the medication because symptoms will worsen. Continue to check that medication is being taken; if you notice any worrying side-effects, discuss these with psychiatrist.
Be alert for signs of a relapse. aniawake up shouting fightingarguingsinging at nightshutting himself in his room with headphones on.
Prepare yourself for crisis situationshat should do when a crisis happens
You must understand that you cannot reason or argue with a psychotic patient because the situation will explode into a crisis. Remember that the patient is probably afraid. So, if say (for example) “You want to kill me”, don’t argue .
Try not to be irritated or angry or show this to . Stay calm.
Don’t shout.
Don’t be sarcastic or ridicule . If says: “The police are chasing me”, don’t reply “Of course not! It’s all in your mind. Come on, you don’t need to be afraid.” Don’t say that, because what imagines is real to .
Don’t contradict . Say: “You’re right. You can hear them. Reality can be different. But I understand you.” Or “I know you can see them, but I cannot.”
Try to reduce distractions like television.
Don’t get too close and try to touch .
Avoid looking into eyes for any length of time.
Sit down and ask to sit down too.
Seek professional help, such as the Crisis Intervention Service at Mater Dei hospital. Phone 179 at other times. Phone the social worker from Mount Carmel Hospital assigned to .
Be aware that 30% of psychotic attacks are one-offs. In another 30% of cases, the illness will get worse despite the love, support and treatment provided. Despite this, one must not be discouraged as treatment can control many of the symptoms.
Tips on BORDERLINE PERSONALITY DISORDER and violent behaviour
There is a difference between understanding and accepting feelings, and understanding and accepting behaviour. Violence is not only aggression but results from the person feeling threatened. But violence should never be acceptable.
With medication and support, mentally ill patients who have aggressive tendencies do not present a danger to the general public. If you feel threatened by your relative’s behaviour, don’t dismiss it; protect yourself by leaving and asking for help. In the meantime, do the following:
Avoid touching .
Leave a space between you and .
Don’t get between and the door.
Ensure that there is a building exit you can use.
Talk calmly and softly.
Don’t argue and don’t answer back angrily.
If asks a question, give a brief reply in a reasonable tone. That way the patient will not feel ignored.
Try not to show that you are uncomfortable, nervous or afraid.
Don’t point your finger at , or put your hands at your waist – it look as though you are challenging him.
Don’t move suddenly.
Show himthat you are there to help.
Not every unusual or strange behaviour is violent.
Tips on REPAPSE
How to reduce the risk of relapse
When you feel well, the chemicals in the brain are relatively balanced. Symptoms that lead to a relapse can mess up this chemical balance and cause a relapse. It is important to learn to spot signs of a relapse, so that preventive measures can be taken early on. The best way to prevent this is to take good care of yourself. In addition, there are a number of steps that you can take to avoid the recurrence of the illness. These include continuation of medication prescribed, adopting a positive life style, controlling your environment, and awareness of the symptoms.
It is useful to learn more about the mental illness and medication. Discuss the medication and its effects with professionals in mental health and psychiatry. Search out further written information on diagnosis and treatment. If the medication prescribed is not working, ask about other medicines. Be guided by your doctor so the correct medicine and dosage can be established.
Above all, there must be a strong commitment to taking the medication daily. Although it may not help, be aware that one should never stop the medication without discussing thoroughly with the doctor why one feels the need to change the medication and dosage and what the side effects are. Recognise the early symptoms that warn you of a possible relapse. Remember that the symptoms can be detected right at the start of the relapse.
Take note of any changes you notice, such as strange occurrences at the start of the illness and changes in behaviour that other people have noticed. Remember to stay alert for:
Any symptoms that may appear;
Any new symptoms that occur suddenly;
Any increase in residual symptoms. Residual symptoms are those that lessen but do not disappear totally, despite the medication prescribed. Some remain the same, worsen or never improve.
Take note of early symptoms so that the illness will not recur. Write down the early symptoms so that you can easily spot them and refer immediately to the doctor.
Some early symptoms that you should be on the look out for in your suffedring relative:
Sleepless nights or lack of sleep;
Difficulty in concentrating or paying attention. cannot think as clearly as usual.
One minute are laughing, the next are crying.
Being more forgetful or absentminded than usual.
Hearing voices.
Fear of people, places or things that would not normally frighten .
Excessive anger and more arguments than usual.
Strange reasoning, words and behaviour.
Continuous bad or worried moods
Thinking that people are talking about or laughing
Spending much more money than usual.
It is important to deal with symptoms of a relapse, so that:
Hospital stays may not be necessary – a relapse can be avoided.
Your relative may start and continue to feel well.
They do not regress.
- lessen the chances of ending up in hospital.
See that they do not shut themselves up!
about any bad news with someone close to you. It doesn’t matter if you need to talk and cry often. This is part of the mind’s natural healing process.
Keep yourself active. Go for walks and take part in other activities. Do housework. Try to do maintenance work around the house to keep your environment clean, attractive and restful. Don’t give up those activities that are part of your normal routine.
Make sure you eat regularly. Eat a mix of fresh fruit and vegetables. If you lose weight rapidly, you will lack vitamins and feel worse.
Avoid drugs (especially Cannabis and alcohol). Don’t try to cheer yourself up with alcohol or drugs as these will make you feel better only for a very short time; later you will feel much worse. These will worsen your mental illness. Illegal drugs and alcohol prevent you from working on your problem. They are also bad for your physical health.
Sleep: try to sleep and wake at regular times.
Don’t be discouraged by thinking that you are the only one suffering mental illness. Be brave – if you are careful, eventually you may be able to overcome the illness. Sometimes, after a mental illness, it is possible for a person to be stronger than before the illness. When you face difficult situations with a positive attitude, you will notice that your relationships have also improved.
Decisions: The more you manage your illness, the stronger your decision-making skills will become and you will be able to initiate changes in your life that possibly you may have avoided making in the past. Make small changes at a pace you can cope with, to avoid needless stress.
Decrease stress: Keep stress levels as low as you can. A lot of stress, even good stress, can cause a relapse. If you feel any new stress, speak to the doctor or to a member of your treatment team. To decrease stress, avoid stressful situations and instead, do something that you like – listen to some music, watch an interesting programme on television, have a shower or bath, write down your thoughts in a diary, go for a long walk, go swimming, talk to a friend or family member, paint, go out into the countryside and take pleasure in the natural beauty around you, do some exercise to relax you.
Control your environment: If you live in a house full of noise that irritates you, see if you can change your environment. Perhaps you can try to live somewhere else on your own. You can ask for help as a family from a family therapist so that you can all learn to live in harmony.
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