“Empathy is the doorway to understanding” declares Dr. Joyce Burland, a psychologist who is also the mother and sister to individuals with serious mental illness. Midway through the 12 sessions of NAMI’s (National Alliance on Mental Illness) Family to Family course curriculum – which Dr. Burland authored – we teach a class called “Inside Mental Illness”. Indeed, understanding what the illness is like for the person experiencing the illness is key to confronting it successfully.

What happens to people who suddenly have heart attacks, or discover they have a life-threatening illness, or hear they must manage a chronic mental illness for the rest of their lives? Dr. Burland taught us that there are two devastating aspects to this kind of calamity:

“First, people with serious illness lose the protective belief that they are exempt from harm. Secondly, they lose their sense of a predictable and dependable future.”
A serious illness wipes assurance away and dashes the illusion of safety. We are suddenly vulnerable, defenseless, and mortal; the mantle of magical protection gone forever. “Much of our sense of safety and our willingness to take risks in life rests on our belief that serious harm or ‘real trouble’ will never happen to us,” Dr. Burland notes. Losing this belief is the first devastating calamity. It attacks our faith that we can choose the challenges we wish to take on in life.

Individuals stricken with mental illness are forced to confront their own vulnerability, and family members who watch will themselves go through the process too. Recognition dawns that something truly serious and potentially life-changing has occurred. Joyce Burland teaches us that inside mental illness peace of mind is shattered, anxiety takes its place, along with the ever-present fear that life will be swept away by an internal process the individual cannot control. She reminds us that denial is a perfectly normal response to this degree of stress.

The second psychological trauma involved is the loss of a predictable future. Our life goals, plans and expectations are based on our confidence that we will move through life’s stages in a timely, predictable manner. And that we will accomplish the developmental tasks expected at each particular stage.

Serious illness blows the measured timeline right out of the water: the ill young adult sees plans for education, work and marriage disrupted. The ill middle-aged man fears he will lose the “niche” he’s worked so hard to establish for himself and his family. Anger, grief, and rage are the normal response to the frustration of one’s dreams and goals; this is why we often see our ill family member criticize us and withdraw from us. In her workshop, Dr. Burland concluded with guidelines that families can follow to help their relative maintain self-esteem and feel more confident about the tasks of living with mental illness. Here are some:

• Be supportive. People struggling with any sort of mental illness are very vulnerable and cannot defend themselves against direct personal attack. Avoid negative and nagging remarks.
• Praise positive behavior every chance you get. Studies show that if you are positive people will want to perform the behaviors that earn them recognition and approval. Criticism, conflict, and emotional pressure are related to relapse.
• Tell the individual it’s not their fault that they are ill, or that they cannot get out of depression, or that they are not “terrible” for the things they did when they were manic, etc. Such support relieves a lot of guilt and anxiety, even when someone is in denial. Help people learn which of their behaviors are caused by their illness.
• Be very patient in wellness and illness. Realize and acknowledge that getting better and showing improvement means moving into a risk position.  People recovering from mental illness have the awesome task of accepting what has happened to them, finding new meaning in life and constructing a way of living that protects them from becoming ill again.
• The best gift that can be offered is acceptance:Family members and friends can keep the future alive; most people with mental illness do struggle forward and rebuild their lives.  Accept that mental illness is a fact in the life of someone we love, and look ahead with hope to the future.