General /

Sometimes I’m asked to teach on how to talk with a person with a diagnosis of a mental illness. My reaction is to say “treat them like an individual”. It’s difficult to respond without sounding flippant and I realize the request is sincere. Unfortunately, the question negates the fact that a person with a mental illness is a person, with fears, desires, strengths and weaknesses, like everyone else. The symptoms of a mental illness will vary, with some days better than others, not unlike symptoms of a medical illness. Often when people think of an individual with a mental illness they think of a stereotype, a person out of touch with reality, unpredictable and violent. A more accurate picture is a person who is isolated, self conscious, trying hard to be inconspicuous. Often the person is isolated and lonely because their experience is one of being persecuted, taken advantage of, ridiculed, judged, hurt emotionally and sometimes physically. Many individuals experience hallucinations even when they receive appropriate treatment, and have simply learned to live with the symptoms without talking about them, fearing that if they do they may be involuntarily committed to an inpatient facility. Individuals with a mental illness often live in fear and in poverty finding it difficult to find and maintain employment because they appear different to employers and peers.

The media has projected negative images of individuals with a mental illness which are stigmatizing. Not There exist people that do cruel and evil things but not due to a mental illness. Sometimes those are simply unkind and cruel people.

The truth is that the behavior of a person is more often shaped by the way they are treated. My personal and professional experience has been that even when a person is actively delusional and or hallucinating, that person did not become aggressive or violent until someone tried to physically and or emotionally control them, and that reaction seems human, not a symptom of a mental illness. I’ve heard it said by individuals diagnosed with a mental illness, “The problem is not us, it’s you and the way you react to us”. There is a certain amount of truth in that statement. All of us are inclined to react to people based on the way we are approached by them. If you interact with a person in an aggressive and controlling manner, you can reasonably expect an angry and defensive response.

Human beings are often afraid of behaviors that are unfamiliar or unusual even when they are not harmful. Often the reaction to someone who acts different is to try to control the person and make them conform to our expectations. If instead of controlling we try to understand the differences and behave in a non-judgmental manner, it can evoke a very different response. This concept is explored in the RCT training event in the Mandt System.
If the other individual exhibits symptoms of fear or insecurity, our approach should be to reassure, help the person feel safe and feel that we are not a threat to them. This can occur not only by the words we choose to use, but also by our demeanor as we convey that message.

If the individual displays anger, which often comes from fear, we can soften our tone of voice, speak more lowly and quietly and tell the person, “You seem upset. I’m not sure why. Help me understand why and tell me how I can help you feel more comfortable”.

If the person shares information involving hallucinations or delusions, be honest in your response, “I am not hearing, seeing or feeling the same as you” rather than trying to “humor” the person by playing along with the delusion or hallucination. Be friendly, kind and empathetic rather than accusatory and controlling.

Recently I was approached in front of my house by a neighbor, someone I had interacted with only once previously. On that previous occasion she had alerted the police of a burglar alarm going off in my home and insisted they investigated. I was out of town at the time and she related this to me when I returned. It took considerable time and effort to clarify with the police and her that I did not have an alarm system and refused to pay the charge for the investigation. Rather than showing my annoyance, I thanked her for watching out for my home. While she clearly appeared confused and anxious the brief conversation was not unpleasant. When she approached me this second time, it was clear from her body language and facial expression that she was once again very anxious. She shared that she was hearing something that made her afraid. She feared that neighbors were watching her and someone was trying to hurt her. I reassured her that I’ve lived in the neighborhood many years and we have good neighbors who are often quite helpful, don’t interfere and that they were not trying to hurt her. I let her know I did not hear what disturbed her. She explained she had financial problems and had received threatening notices from bill collectors. She was physically ill, unable to work and in debt. She worried that neighbors were enlisted to spy on her. Again I shared my experience with our neighbors was very different and gave examples. We stood on her porch and talked for 45 minutes. She had insight that her anxiety was not typical, was possibly internal, and perhaps not based in reality. We discussed techniques to help her relax with breathing exercises, visualization and journaling. As a social worker she was familiar with the techniques. She invited me into her home, but I declined as I had already delayed my departure for an appt. We agreed we would talk another time, but meanwhile she would use some of those techniques to soothe herself. She seemed somewhat less anxious and reassured about the neighbors.

When I returned a week later, the coroner and police were at her home. She had died, cause and time of death unknown but apparently of “natural causes”. I regret that I did not do more for her when I had the chance. I am reassured that her two brief encounters with me were reassuring and pleasant and that at least for that brief period she felt safer.
How do you talk to a person with a mental illness? The same as anyone else.

If the person is delusional, gently reflect back your reality.
If the person is angry, give them space and try to understand where the anger comes from.
If the person is frightened, try to reassure and help them feel safe.
If the person is happy rejoice with them.
If the person is lonely, be a friend.

Be empathetic and treat the person the way you would want to be treated under similar circumstances.

Aaryce Hayes – COO The Mandt System