How Not to Enable Loved Ones with Mental Illness

Saying “no” is essential for checking and preventing negative behaviors.

Posted Oct 13, 2020

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Since being diagnosed with COVID-19, our President’s behavior has provided a textbook example of the consequences of enabling. The inability of the people around him to say “no” has allowed him to become a modern-day Typhoid Mary, exposing Secret Service agents, advisors, aides, and White House staff to the Coronavirus — individuals who all have the capacity to become seriously ill and further spread the disease. 

This lack of respect and sense of entitlement are common characteristics of loved ones whose families have sought guidance from my mental health legal practice. Our strategies to effectively check these traits and ensuing negative behaviors almost always include helping families best say “no” to their loved ones when they can foresee and potentially prevent a negative outcome. To do otherwise often constitutes enabling. 

To illustrate, a person diagnosed with a personality disorder might have regular episodes in which he or she makes demands or relays misinformation incessantly and irresponsibly. It’s not unusual for such individuals to call family members asking for support, often persistently and at odd hours. And it’s not unusual for families to say “yes” against their better judgment.  

I am sympathetic to these families. Saying “no” can be extremely taxing for individuals already burned out from caregiving. They do not have the energy to refuse their loved ones; they’re often anxious, fretful, and sometimes fearful of them; and often they choose to rely on their own misbeliefs about their loved ones’ competencies and intentions.  

But saying “no” is often necessary. It is a crucial step in helping break extremely unhealthy cycles that keep loved ones unwell. Doing so firmly and consistently often requires expert guidance, including such advice as: 

  • Set communication boundaries. Instead of picking up calls and returning texts and emails day and night, family members should determine exactly when and how long they’ll converse with their loved ones. 
  • Eschew harassment and verbal abuse. Except for crisis situations, discussions that devolve into screaming, cursing, threats and other verbal abuses should be brought to an immediate close. Family members can clearly reiterate their behavioral expectations and look to reconnect at a later date. 
  • Remove yourself from the firing line. While family members can find it extremely challenging to encourage positive behaviors among loved ones with a serious mental illness or personality disorder, others can make enormous progress, coming into situations with fresh eyes and no emotional baggage. For example, a case manager can help individuals achieve goals like finding a job, securing an apartment, or completing a drug treatment program. Similarly, a property guardian can manage finances so family members don’t have to field monetary requests. Such changes not only remove a source of significant stress for families, but also allow them to go back to being just mom or dad or sister or brother, fostering a more caring and functional relationship. 
  • Work with your own therapist. Mental health practitioners can provide tremendous help to those with mental illness, but they can also assist their family members. They allow an outlet for their fears and frustrations, provide a means of identifying their enabling behaviors; and offer practical skills to help facilitate change. 

Learning not to be an enabler can take time and energy, but is well worth the effort. We can only hope that someone in the President’s orbit is up for the task.