The Family’s Emotional Response to Serious Mental Illness

Today, I recall many happy spring and summer holidays spent as a child and young adult with my family of origin – my parents and two brothers and three sisters. I’m thinking of Mother’s Day, Father’s Day, Memorial Day weekend, on through the 4th of July! Traditions and family relationships were part of what made these holidays special.

But there were times when family relationships were strained by events – traumatic events. Sometimes these were times when my father, who had mental illness, was symptomatic and suicidal or had just made a serious attempt. As a young adult in the early 1970’s it became clear to me that the impact of having a parent hospitalized for heart valve surgery differed greatly from the shock of visiting the intensive care unit after a near fatal suicide attempt. Why did the trauma of heart surgery bring us together, optimistically, while the other made us uncomfortable or argumentative or secretive? Why, following a near fatal suicide attempt, did one sibling grieve while another expressed great anger? Why did one stubbornly refuse to talk about the attempt, and another one became insecure in their own life?

I began to resolve many of these questions when I trained to become a NAMI Family to Family Education Program teacher. The training curriculum, developed and written by Joyce Burland, Ph.D., psychologist, introduced those she taught to the family’s stages of emotional reaction to serious mental illness. She underscored that the family’s emotional reaction is challenged by the cycle of onset, crisis, and relapse so unfortunately common in serious mental illness.

I will outline those emotional stages below and try to convey in a small way not only how I was affected, but also how resolving my emotions within each of these stages was healing.

Stage One: Dealing with the catastrophic event. Here we feel overwhelmed and confused. Our sense of emotional intactness may be shattered. It is common to deny or minimize the illness in an attempt to hope against hope that these painful events are not happening, or that they are only a phase – the illness will go away.  We may say or believe “If only we do such and such”, life will be normal again.

I was scared as a child. I remember ambulances. I remember sensing the seriousness and the awkwardness of what was wrong more intently than words could convey. Sometimes the effects of such crises continue throughout life. As a mother, I know my parenting was affected. I was determined I would always be solid for my children. Not only would I be solid, but I must at all costs, be there for them.

Stage Two: Learning to cope— “Going through the mill.” Some of us may be filled with anger, insisting that the ill person should “stop feeling sorry for him or herself” or “snap out of it”. Simultaneously, we worry, feel guilty, and find fault in ourselves or each other. But with passing time, recognition of the seriousness of the illness or crisis/relapse begins to infiltrate. It is clear something major has occurred that has changed our lives’ together. Grief occurs. We mourn the loss of what was and consider the changes and the unknowns in the future.

As a child I tried so hard to behave. As a teenager I was angry and resentful and embarrassed. Love and hate mixed together. Guilt followed. In the years that followed, grief was and is paramount. For some people, grief never ends.

Stage Three: Moving into advocacy/action. With insight and education, some of us are able to gain an empathic sense of what the relative with the mental illness suffers. With empathy comes understanding and acceptance. The illness, or the relapse, is not our fault or their fault. Bad things do happen to good people, even if you and your relative lived life “by the rules”. Parents and spouses become better informed and negotiate the system with more spirit and confidence. We take steps to reduce stigma and discrimination, maybe as we find it close at home, or out in the community or by confronting a system that has failed us.

As I taught in my Family to Family classes, I find the following points are key helps to understanding a family’s emotional response to these catastrophic illnesses.

(1) Our emotional response to critical events in the course of mental illness is a process. The process of coming to acceptance and action is long and ongoing. It is also cyclical. If your loved one experiences a serious setback, you may find you start at the beginning of the emotional cycle again. Back to confusion, fear, and hoping against hope. Back to grief and recognition. Or we may experience a mix of two states, for example, grief and action.

(2) None of the stages’ emotions are “wrong” or “bad”. Again these responses are normal reactions to serious illness and disruptions in our lives.

(3) Different family members are often at different stages. I understood why my siblings had different reactions than I had. We also had conflicts on how to approach the situation. I learned to respect and appreciate my mother in a way I had not before. She was our well parent as well as my dad’s life partner.

For me, the most valuable message was that I learned not to put someone else on my timetable! There is no one right way to go through the process of reconciling our emotional responses. Each person does it in his or her own way. Be gentle with yourself and each other. For my part, I found I needed to forgive myself and my family and my father to go on with a more satisfying life.

Finally, I hope that this description of emotional responses to critical events in serious illness is helpful to you. I hope you find, with me, that there is hope in seeing that we can progress from confusion and pain to acceptance and action.