Stress is at the foundation of the family experience of mental illness. There is constant tension, dread and worry because the illness can strike at any time. It's common for family members "to walk on eggshells." The Parkers liken the atmosphere to a pressure cooker and the possibility of the ill loved one "going off the deep end" looms. Stress accumulates and leads to psychosomatic illness. Tom has high blood pressure, while Tina suffers ulcers.
Trauma also lies at the core of the family's experience. It can erode members' beliefs about control, safety, meaning and their own value. While victims of NBDs rarely assault others physically, they do assault with words, and their words can pull apart the family. Another form of trauma is "witness trauma," where the family watches helplessly as loved ones are tortured by their symptoms. This type of family atmosphere can often induce the development of traumatic symptoms like invasive thoughts, distancing and physical disorders. The result can be traumatic stress or posttraumatic stress disorder. Much of the family's despair results from trying to manage and control what it cannot. Knowing when to intervene is one of most difficult lessons a family must learn.
Loss lies at the very nature of family life. Family members report losses in their personal, social, spiritual and economic lives. They suffer losses in privacy, freedom, security and even dignity. "What we miss most is a normal life," said Mrs. Parker. "We have lost being just an ordinary family." The family may be the only place where we cannot be replaced. So it can be devastating if we cannot have effective family relationships.
Grief occurs from this steady diet of loss. Family members can go through protracted grieving, which often goes undiagnosed or untreated. Grieving centers around what life will not be. "It's as if we are in a funeral that never ends," said Tom. Grieving can become compounded because our culture does not sufficiently acknowledge and legitimize the grief of those under the influence of mental illness. A lack of appropriate entitlement can follow. "I really have no right to feel bad. Paul is the one who is ill," said Tom. Therefore, mourning fails to occur, preventing acceptance and integration of loss.
Exhaustion is the natural result of living in such an atmosphere. The family becomes an endless emotional and monetary resource, and must frequently monitor the concerns, issues and problems of the ill loved one. Worry, preoccupation, anxiety and depression can leave the family drained—emotionally, physically, spiritually, economically. Tina summarized it, "There's no rest." Tom added, "We can't even get a good night's sleep; we lie awake wondering what Paul is doing. This is 24 hours a day, 365 days a year."
Leaving It to Fate
Living in an environment of chronic stress, trauma, loss, grief and fatigue can also lead other family members to their own parallel disorder. Parallel disorders of family members are also known as secondary or vicarious traumatization. The family members can develop symptoms including denial, minimization, enabling, high tolerance for inappropriate behavior, confusion and doubt, guilt and depression, and other physical and emotional problems.
Other terms include learned helplessness, which occurs when family members find that their actions are futile; depression fallout, the consequence of living in close proximity to a loved one's despair; and compassion fatigue, burnout that comes from intimate relationships when family members believe they cannot help their loved one and are unable to disengage from the illness long enough to get restored. "I'm just too tired to care," said Tina.
The symptoms of families under the influence of NBDs can be devastating, but they are also very treatable. Research consistently shows that four elements lead to healing: information, coping skills, support and love.
Healing begins with an accurate diagnosis; from there core issues can be confronted. The family moves beyond their loved one's illness—not away from their loved one.
In response to pain, the family can learn to develop a disciplined approach to dealing with their situations. Tina, for example, has embraced spirituality and has learned to ask herself, "What is the lesson that I am supposed to learn in this very moment?" Tom adds, "When I gave up caring about what was supposed to be, I got back my footing and now have something to offer Paul other than my temper."
To create a new life, the Parkers made five key transitions that facilitated healing. Although not every family member made all of these shifts, most family members made enough of them to change their lives. First, to transform the way they thought and felt, they shifted from denial to awareness. When the reality of the illness was confronted and accepted, healing began. The second transition was a shift in focus from the mentally ill person to attention to self. This shift requires the establishment of healthy boundaries. The third transition was moving from isolation to support. Facing the problems of living with mental illness is too difficult to do alone. Family members worked within a framework of love. This makes it easier to relate to the illness with distance and perspective. The fourth change is family members learning to respond to the person instead of the illness itself.
The fifth and final shift toward healing occurs when members find personal meaning in their situation. This elevates the personal, private and limited stories of the family to a much larger and more heroic level. This shift doesn't change what happened or even take the hurt away, it just makes people feel less alone and more empowered. It creates choices and new possibilities.
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