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Caregiving, Coping and Mental Health

Let’s circle into the life of an urban middle-class Indian nuclear family, consisting of Rama, her mother, her father, and her older sister. Rama’s paternal grandparents live a few streets away, and visit her often. When Rama is twenty three years old, she starts hearing voices that have no basis in reality. She is convinced people are out to get her and is reluctant to leave the house. Her family takes her to the ENT, sure that it’s a simple hearing problem that can be fixed. It is not. She is referred to a psychiatrist, prescribed medication, but beyond this, the family is at odds with how to respond to the situation. What do they say? What will others say? How can they best support her?

Rama is one of many persons with a chronic mental health condition. Rama’s family is one of many confronted with the sudden responsibility of caring for, managing, monitoring, and financing a chronic mental health experience. In India, infrastructures surrounding management of mental health are relatively few and far between, as is societal acceptance of mental health conditions. This adds to the weight of what is called “caregiver burden”. “Even in physical illnesses, there is quite a bit of burden that falls on the caregiver. So you can only imagine how in mental health experiences, since they are not visible to the eye unless it’s a psychotic disorder or a severe mood disorder, negative expressed emotion (i.e., caregivers reacting with hostility, critical comments and/or emotional overinvolvement) is even more prevalent,” says a Clinical Psychologist from Manipal.


So how can family members of patients with mental health experiences best support them, without feeling overwhelmed in the process?


PROBLEM FOCUSED COPING

Problem-focused coping involves identifying the root cause of stress and coming up with logical solutions to combat it. It is effective in instilling a sense of control, and lowering the sense of “burden” a carer feels. Rama’s family can:

· Seek knowledge/ awareness about the person’s mental health experience. Psychoeducation (i.e., providing education and information to those seeking or receiving mental health services) is an important aspect of managing mental health conditions. It is important, for example, for Rama’s family to seek information about Rama’s mental health condition from the psychiatrist or other mental health service providers. What are the symptoms of Rama’s condition? What are the side effects of the medication she is taking? How chronic (i.e., long-term, recurring) or acute (i.e., sudden, severe) is her condition? How much of her behaviors are the function of her mental health condition (the “illness”, which is separate from the “person”), and how can they best monitor and manage it? Are there any low-cost resources in the community that might be useful in managing her condition?

· Monitor adherence to medication.

Rama’s family would play a pivotal role in how faithfully Rama sticks to the prescribed course, and understands the importance of taking her medication (even when she might not want to). As a family, having a set schedule, and delegating responsibility (to various family members) to ensure Rama takes her medication on time is an important way to ensure adequate management of her condition.

· Divide family roles and responsibility.

If all of the caregiver “burden” rests on one person -for instance, Rama’s mother- it can be a lot to handle; in terms of financial, social, and personal stress. Dividing responsibilities (doctor’s visits, ensuring she takes her medication, social support, etc.) among family members not only eases the stress associated with managing a chronic condition, it also fosters a feeling of interdependence and mutual support. Rama’s grandparents or sister could take her to the doctor on days when her father has work.


Rama, too, needs to be included in this plan. Rama needs to be empowered to manage her symptoms (as much as she can), and have a role in the family. Being emotionally over-involved (i.e., doing everything for Rama, including things she can do by herself), and keeping Rama from contributing in any way, does not allow “Rama the person” to grow.


EMOTION FOCUSED COPING

Managing the stress associated with chronic mental health experiences may not be all logic. Depending on the nature of the mental health experience, the family might feel ashamed, blame themselves, or feel overwhelmed. Managing these emotions adaptively, rather than denying Rama’s mental health experience, avoiding thinking about it, or being critical about her condition (“Can’t you see how much we’re doing for you? How could you do this to us?”) is important. What are some strategies to handle this?


· Accept the family member’s mental health experience.

It takes awareness of the nature of the family member’s condition, course, and potential for recovery, to truly accept the family member’s mental health condition.

· Avoid stigmatizing or subscribing to the myths surrounding the family member’s mental health condition.

Rama’s family might subscribe to myths surrounding mental illness, such as seeing Rama’s upbringing as the cause of her mental health condition, or assuming people who spend time with Rama are more susceptible to developing similar symptoms. Such myths are for the most part untrue, and create unnecessary guilt and hostility. These beliefs only undermine Rama’s thought process (“I can’t”, “I shouldn’t”, “I’m incapable”), making her believe that she can’t progress beyond her mental health experience.


· Take one’s own well-being just as seriously as your loved one/ family member’s mental health experience.

Whether this involves committing to a relaxing hobby, seeking social support from people in similar situations (such as a support group), religion, or seeking therapy, it is important to acknowledge and prioritize one’s own well-being, to be of support to others.

Adequate understanding of the patient’s mental health experience and embracing “interdependence” that is characteristic of collectivistic societies is key to family members accepting, and successfully managing their loved ones’ mental health.


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References


Avasthi, A. (2010). Preserve and strengthen family to promote mental health. Indian journal of psychiatry, 52(2), 113.


Chadda, R. K. (2014). Caring for the family caregivers of persons with mental illness. Indian journal of psychiatry, 56(3), 221.


Chadda, R. K., Singh, T. B., & Ganguly, K. K. (2007). Caregiver burden and coping. Social Psychiatry and Psychiatric Epidemiology, 42(11), 923-930.


Raguram, R. D. P. M., Weiss, M. G., Channabasavanna, S. M., & Devins, G. M. (1996). Stigma, depression, and somatization in South India. American Journal of Psychiatry, 153(8), 1043-1049.


Rammohan, A., Rao, K., & Subbakrishna, D. K. (2002). Religious coping and psychological wellbeing in carers of relatives with schizophrenia. Acta Psychiatrica Scandinavica, 105(5), 356-362.

About the Author:

Pooja Sathyanarayanan is a Master’s graduate in Positive Developmental Psychology & Evaluation. She works for a non-profit organization. She is a passionate content writer, developing content that makes psychological research accessible to all audiences. She can be found curling up with a book, walking towards a sunset, or ordering more food than she needs in her spare time.