When mental illness strikes
My personal experience
It was one of those lazy Saturday mornings. Windy, everything moving slowly, struggling to get out of bed. The phone rang. It was my brother. He was calling from Atlanta. His daughter, his only daughter, was behaving strangely. I listened. My heart was pounding. I choked. It sounded like a diagnosis of schizophrenia. This time it was not just another patient. It was my niece. Mental illness has struck the family.
As I listened to both my brother and his wife that morning, I could hear the pain, disbelief, anger and denial. These are normal and natural human reactions and when faced with the diagnosis of any illness most people struggle with these reactions. This time around the emotions were very close. It was family and, in many respects, I too was exhibiting some of these emotions.
I spoke to my niece that morning. It wasn't the same. She was guarded in her responses. I asked the routine questions that I would ask my patients. How are you? Are you hearing voices? Do you feel anyone is out to hurt you? Then I realised that she was hearing voices and was also suspicious and paranoid. Yes, she had become socially withdrawn and there were some changes in her behaviour.
Work through emotions
I realised we needed to act quickly and I had to help my brother and his wife work through their emotions. They were very good. They listened and they respected my advice. This made the process so much easier as often when one is faced with families who are struggling with a 16-year-old diagnosed with a mental disorder, a major challenge we face as mental health providers is that of trying to convince the family that something is indeed wrong. Many families are consumed by denial and sometimes it takes them many years and moving through several psychiatrists before they begin to accept the diagnosis.
That morning, I advised my brother and his wife to take my niece to the doctor. They did this without hesitation and by early afternoon she was admitted to hospital. It was very painful for them. They cried. But they informed all family members and within hours 'the troop' was mobilised as everyone was called into action. They had the full support of family and friends because they were emotionally mature enough to accept the diagnosis and to call on their support system. Far too many persons suffer alone and bear needless burden and pain because they do not want to talk about mental illness in their families.
My niece is improving
I cautioned my brother and his wife to engage the doctors but not to enter into a fight regarding the management of my niece. I advised them to ask questions but not to enter into a confrontation with the health care providers. This is something many patients do and it often becomes counterproductive. I encouraged them as a family to be supportive and not to engage in the blame game.
A week later, I flew to Atlanta to be with my family. We had family meetings. We discussed my niece's illness and her treatment. Of course, I went to see my niece who was very happy to see me. I was touched when she told me, "Uncle, I love you." I knew she was improving.
Lessons from the experience
I have learned some lessons from this experience which I would like to share:
1. Mental illness is common. One in four families is affected.
2. Denial doesn't help. Many people when faced with a diagnosis of mental disorder shift into denial. They minimise the problem and refuse to accept the reality.
3. Seek help early. All studies have shown that the earlier the treatment the better the outcome. Many people would improve faster if family members accept the diagnosis and support the treatment.
4. Don't fight, collaborate. Health care providers are here to help. It is always helpful to collaborate with treatment. Patients and their families should ask questions and seek clarifications, but remember we are here to help, not harm you.
5. Disclosure helps. My brother and his family were open and honest about their daughter's illness. As a result they received the full support of family, friends and from my niece's school community.
I hope this story will help to lift the veil of secrecy, silence and shame around mental illnesses.
Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Dept. Of Community Health and Psychiatry, University of the West Indies, 977-1108; email: firstname.lastname@example.org.