The Binds that Tie--and Heal

Mental illness brings doubt, confusion and chaos to a family. But a family can heal when it moves beyond their loved one's illness—not away from their loved one.

By Herbert Gravitz, published on March 01, 2001 - last reviewed on December 03, 2008

When I lean back in my chair and think about the Parker family, I know they have changed. Instead of fear, isolation and shame, there is love, connection and meaning. And most important, hope has replaced dread and despair. Millions of families throughout the country suffer just as the Parkers did, but many aren't as fortunate. These families are ignored at best and blamed at worst by a society that doesn't understand their needs. But the Parker family (not their real name) is an example of what can happen.

Our first family meeting took place on a cool November afternoon in my Santa Barbara office. To my left sat Paul Parker, a young man unable to perform his duties as a bookkeeper. He had lost two jobs in one month. In this time, other self-care behaviors had deteriorated as well, making it hard for him to live independently. He had become so increasingly bizarre that he was a concern and embarrassment to his entire family. To my right sat Paul's parents, Tom and Tina. And next to them were their two younger children, 16-year-old Jim and 23-year-old Emma.

Paul has a neurobiological disorder (NBD) and psychiatric illness caused by a brain dysfunction. NBDs currently include major depression, schizophrenia, bipolar disorder and obsessive-compulsive disorder. Although different types of mental illnesses present different challenges, there are similarities in the way these illnesses impact family members and loved ones.

The session unfolded. "You just don't understand, doctor," Paul's father bursted out. "Nobody listens to us, his family. It's not easy dealing with Paul. I hate to say this, but he can be such a burden. My wife and I can't do anything without considering its effect on Paul—and he is 30 years old. Half the time we feel crazy." Tom added, "Paul seems like a stranger to us. It's as though aliens have taken our son and left an impostor."

Almost mindless of the children, Tom and Tina shared the devastation of Paul's illness on their marriage. They were so drained and so angry with each other that they rarely made love, and they seldom went out together. When they did, they argued about Paul. Tom thought that many of Paul's problems were exaggerated and that he was taking advantage of them. Like many mothers, Tina was more protective and accommodating of her son, especially during the early years. These differences led to quarrels in front of the children, which the family dreaded almost as much as Paul's strange and peculiar behavior. Both parents had little compassion left for Paul or each other. Even less time was left for Jim and Emma, because they seemed so normal and caused no problems.

Without warning Jim interrupted, "Not again. Why does Paul get all the attention? I never feel important. You always talk about him." Ignoring her own fears, Emma tried to reassure the family that Paul would be okay. "We've handled Paul's problems before," she pleaded. There were many unspoken feelings, such as the overwhelming responsibility Tom and Tina suffered, the resentment that Emma and Jim felt, as well as the family's guilt, exhaustion and demoralization. And there was a half-wish that Paul would just disappear.

Despite everything, the family loved Paul. They each had powerful—even fierce—loyalties toward him. This was evident when Tom explained: "We brought Paul here, we care what happens, we sit in the waiting room while his life is on the line, and we will take care of Paul when everything is said and done." Paul was important to all of them.

Stopping the Hurt

The family had sought help from other mental health professionals. Paul's parents recounted being blamed for his disorder by several professionals, and they reported feeling confused and helpless. Emma and Jim felt like outcasts; they were ignored by their parents and shunned by their friends. Everyone wanted the hurt to stop. At the very least, the family wanted someone to recognize their pain and say, "This must be very hard for all of you."

The Parkers are not rare or unusual. One in five Americans has a psychiatric disorder at any given time, and half will have one at some point in their lifetime.

More than 100 million Americans have a close family member who suffers from a major mental illness. Of the 10 leading causes of disability, half are psychiatric. By the year 2020, the major cause of disability in the world may be major depression. Further, it has been estimated that only 10 to 20% of those requiring care in the United States receive it in institutions; the rest receive their primary care from the family.

Devoted to their ill member, the family may be the best-kept secret in the arsenal of healing. Yet, family members are considered the support team; they are not known as the stressed and the grieving. These tired mothers and fathers, daughters and sons, husbands and wives deserve attention as well.

Mental illness can weave a web of doubt, confusion and chaos around the family. Unwittingly, the person with mental illness can dominate the entire family through control and fear or helplessness and incapacity. Like a bully, the mental illness bosses the primary sufferer as well as the loved ones. Instability, separation, divorce and abandonment are frequent family outcomes of mental illness.

Under the Influence

I have observed five factors that bind families to the despair of their loved one's illness: stress, trauma, loss, grief and exhaustion. These factors provide a useful framework to understand the underlying structure of the family under the influence.