To see it is to believe it, right? But what if you do not know what you are looking at? What if you do not know what you are looking for? Understanding a person suffering with a mental illness can be challenging and overwhelming; it is difficult to understand them, and difficult to communicate with them. But what do you do when you are faced with something difficult? You try to understand it, it is like untying a knot, you find the ends of the thread first and work your way through. To begin, you will get an idea of what it means to be a mentally healthy person. Then you will learn about the signs and symptoms of two specific mental illnesses, Bipolar Disorder and Schizophrenia, so that you can gain a deeper understanding of each illness and its uniqueness. After each description of these diseases will be techniques of how to interact and communicate with a person suffering from the symptoms of these diseases.
What makes a person mentally healthy?
Adrienne Dill Linton, who put together the book Introduction to Medical-Surgical Nursing, defines a mentally healthy person as “a person who is a living being with physical, cognitive, emotional, behavioral, and social dimensions who interacts with the environment to achieve a chosen life purpose” (1272). Healthy, self-actualized individuals have an accurate perception of reality, they have an ability to accept oneself and others (Linton 1273). A mentally healthy person can be spontaneous, they can solve problems, essentially a mentally healthy person can adapt to change. There is a need for privacy and a need for independence. A mentally healthy person can express themselves emotionally. This person has a frequency of happy moments in their life that produce a sense of worth, hope, and love of life. They identify with humankind, can maintain satisfactory relationships, they have a sense of ethics and they have some sense of resistance to conformity (Linton 1273). This definition and explanation is meant to give you a baseline of what makes a person mentally healthy and self-actualized. Now we will begin to explore how mental illness varies from this baseline.
What is Bipolar Disorder?
In the book, PN Mental Health Nursing, Bipolar Disorder is described as a mood disorder with recurrent episodes of depression and mania (Sommer et al. 107). Mania is psychotic, paranoid, and/or bizarre behavior. Psychotic behavior can be better explained by simply saying that one has a disconnection from reality. A person demonstrating paranoid behavior may think that everyone is out to get them. To be manic is to have a labile or easily changed mood with euphoria, agitation and irritability (Sommer et al. 109). A person going through a manic episode, has mood changes easily and quickly without rhyme or reason. This person is restless and wants to get going even if they don’t know where they are going or what they are doing. Interference or criticism of what a manic person’s chosen task is can cause increased agitation and irritability. During a manic episode there is an increase in talking and activity and flight of ideas (Sommer et al. 109). This basically means that there is rapid, continuous speech with sudden and frequent topic change. A person going through a manic episode has a disconnection from reality in the fact that they have a grandiose view of self and their abilities, they think of themselves as godlike. In the book The Bipolar Disorder Survival Guide, author David J. Miklowitz explains grandiosity as feeling superior to everyone else and believing that only very special people can understand them (24). There is a high level of impulsivity that comes with a manic episode, like spending money and giving away money or possessions (Sommer et al. 109). This can be confused with generosity but the two couldn’t be more different. Generosity describes a person who is prepared to give more than is strictly necessary or expected while impulsivity describes a lack of self-control.
The depressive part of bipolar disorder is a flat, blunted, labile affect (Sommer et al. 109). A flat affect means the facial expression never changes, a blunted affect means there is a narrow range of normal expressions and labile affect means an easily changing facial expression. This person going through a depressive episode experiences tearfulness or crying and lack of energy. Francis Mark Mondimore, the author of Bipolar Disorder: A Guide For Patients And Families, describes some of the symptoms of the depressive part of bipolar disorder as having a loss of pleasure and lack of interest in activities, hobbies, sexual activity, and states that this person may have physical reports of discomfort or pain (18). A person with bipolar disorder who is experiencing a depressive episode may not be able to make sense of why they are feeling so low, there may not be a clear reason why they can’t stop crying. Keep in mind what they are feeling is real to them, and it is important to have empathy but not sympathy. To have empathy is to have an ability to understand and share the feeling of another. Sympathy is a feeling of pity and sadness for someone else’s misfortune; it’s not helpful to the person who is suffering. Many people compare bipolar disorder to riding a roller coaster. During a manic episode, people often confuse confidence with grandiosity, spontaneity with bizarre behavior, sensitivity with intolerance of criticism…it is important to know that there is a difference. Confidence is a feeling of self-assurance coming from an appreciation of one’s own abilities or qualities whereas grandiosity is an unrealistic sense of superiority. Spontaneity is sudden inner impulse or inclination without premeditation or external stimulus versus bizarre behavior which is behavior that is not appropriate to the current circumstances. Sensitivity is being easily offended or hurt but intolerance of criticism is a firm unwillingness to accept any perspectives or thoughts that are different from one’s own.
Walking through a manic episode.
When a person with Bipolar Disorder, is going through a manic episode, it may appear that they are going 100 miles a minute, that they are in a hurry and can’t focus. So first, be aware of your surroundings; noise, TV, music, background chatter, other people in the vicinity can escalate this person’s behavior (Sommer et al. 110). Think of these factors as stimulants, this person does not need to be stimulated anymore, so quiet the surrounding areas down or take this person somewhere that is quiet. Use a calm voice, to not use inflection or a tone when you speak, give short responses and short explanations (Sommer et al. 110). Set limits, do not let yourself be manipulated (Sommer et al. 110). “A person in a true manic state usually will not stop moving, and does not eat, drink, or sleep. This can become a medical emergency” (Sommer et al. 111). “Mania is an abnormally elevated mood that usually requires hospitalization, hypomania is a less severe episode of mania that lasts at least 4 days accompanied by three to four finding of mania. Hospitalization is not required, and the person is less impaired. Mixed episode is a manic episode and a major depressive episode being experience simultaneously, the person has marked impairment in functioning and can require admission to an acute care mental health facility to prevent self-harm or other directed violence” (Sommer et al. 107) The best thing one can do for a person suffering from a manic episode is to get them professional help. If the person in question is diagnosed with Bipolar Disorder and they are experiencing a manic episode the best thing to do for them is to get them to a hospital where medical professionals are prepared to assess them.
The downside of Bipolar Disorder
Now, when a person with Bipolar Disorder is going through a depressive episode, the most serious concern here is suicide. If this person speaks of suicide, ask them if they have a plan. A good rule of thumb is if anyone ever mentions, or hints at suicide when they speak to you, always ask them if they have a plan? If yes, then ask them what their plan is? For example, if they plan on shooting themselves, do they have a gun at home? The reason you want to ask these questions is that you want to know if they have the means to kill themselves and you want to prevent self-harm (Linton 1298). This conversation may be uncomfortable, overwhelming and scary, but these questions may be necessary if you ever find yourself in this position. Use calm, slow, steady speech when talking to this person, this person may not respond immediately so be patient. Do not ask direct questions but rather make observations (Sommer et al. 100). Direct questions can cause stress and seem like an attack. Say “I noticed you didn’t eat today” rather then “did you eat today?” or “why didn’t you eat today?”. Never ask “why” questions, they can come off as accusatory. Make time to be with this person even if they do not speak, it shows you are available and builds trust. Sometimes you must accept silence. Silence can be therapeutic; it is important that you feel comfortable with silence because silence enables the person before you to consider their own thoughts as well as what you are communicating to them (Linton 1285). You may notice that there are some similarities between Bipolar Disorder and Schizophrenia, and you may use the similar communication techniques for both.
A person is diagnosed with Schizophrenia then they have psychotic thinking or behavior (Sommer et al. 116). A person suffering with schizophrenia has thoughts that are disconnected from reality and it shows in their behavior. “School, work, self-care, and interpersonal relationships are significantly impaired” (Sommer et al. 116). “They display bizarre behavior patterns characterized by strange body movements and odd facial expressions, use languages that is impossible to understand, or groom themselves in unusual ways” says Richard S.E. Keefe and Philip D. Harvey in the book Understanding Schizophrenia: A Guide to the New Research on Causes and Treatment(18). This disease is characterized by its symptoms and this disease has symptoms that are separated as being positive or negative. Positive symptoms are a manifestation of things that are not normally present, think of positive symptoms as extra characteristics which are the most easily identified symptoms such as hallucinations, delusions, alterations in speech, bizarre behavior such as walking backward constantly (Sommer et al. 117). Negative symptoms are the absence of things that are normally present, think negative symptoms as “missing.” These symptoms are more difficult to understand. A schizophrenic person’s affect is usually blunted or flat, inability to speak or have thoughts; this person may sit with you but only mumble or respond vaguely to questions. There is a lack of energy, a lack of pleasure or joy, and lack of motivation in activities and hygiene (Sommer et al. 117). Problems with thinking make it very difficult for a person suffering with this disease to live independently. Disordered thinking, inability to make decisions, poor problem-solving ability, difficulty concentrating to perform tasks, memory deficits (long-term memory, working memory such as inability to follow directions to find an address) are examples of what make being independent and schizophrenic difficult (Sommer et al. 117). Emotional manifestations are hopelessness and suicidal ideation. Hope is the one of the most vital emotions we possess; it is a feeling of expectation and desire for something to happen, it’s a wish, an aspiration, a daydream, an ambition. When you lose all hope, when you lose every daydream of a better life or a better day, when you lose all expectations or ambition, it can be devastating, you may ask yourself what is there left to live for. Hopelessness is deadly.
Navigating the minefield that is Schizophrenia.
Schizophrenia is difficult in its own way because in this scenario you are dealing with someone who is hallucinating and/or having delusions. Hallucinations can take the form of hearing voices, seeing things, smelling odors, tasting things, or feeling bodily sensations that are not there. According to Sommer et al., “Delusions are false fixed beliefs that cannot be corrected by reasoning and are usually bizarre” (116). An example of a delusion would be a person believing that they are giving birth to a dinosaur. This person is not actually giving birth to a dinosaur, but to them, it is real. A Schizophrenic person who is suffering with hallucinations might hear voices or feel ants crawling on their skin. If you are faced with someone who is struggling with schizophrenia and experiencing hallucinations or delusions, do not argue and do not agree with them. This person suffering from hallucination or delusions believes they are just as real as a mentally healthy person believing that the sky is blue. To them, it is a rational and matter of fact thought. If they say they hear voices that are telling them to kill themselves you would say “I don’t hear anything, but that sounds scary” and try to provide safety to prevent them from causing harm to themselves or others. How do you keep this person safe? Seek professional help, call 911. Be genuine and empathetic in all communications with this person. Reorient them to reality and focus conversations on reality-based topics.
One day, you may find yourself facing someone you care about who is suffering from the symptoms of Schizophrenia or Bipolar Disorder. You may find yourself wanting to help them, but not knowing where to start or what to say. Take a step back and remind yourself that this person communicates differently. Do they use words? Yes, but they are telling you something with their behavior as well. Observe the person before you, are they mumbling? Does it sound like they are talking to someone who is not there? Are they focused on you? Or are they focused on something else? Does it look like they are looking at someone or something that is not there? Do they seem panicked? Do they seem lethargic? Asking yourself questions like these will be helpful in determining how to communicate with a person diagnosed with a mental illness who is experiencing an episode. In any scenario, be available, listen, clarify, share observations, be genuine and be prepared for silence. If you find yourself perplexed by the issues that come with helping someone who is diagnosed with a mental illness you can reach out to various advocacy groups such as Mental Health America or the National Alliance on Mental Illness.
Websites for mental health
Keefe, Richard S. E., and Philip D. Harvey. Understanding Schizophrenia: A Guide to the New Research on Causes and Treatment. Free Press, 1994.
Linton, Adrianne Dill. Introduction to Medical-Surgical Nursing. 6th ed., Elsevier Saunders, 2016.
Miklowitz, David Jay. The Bipolar Disorder Survival Guide What You and Your Family Need to Know. Guilford Press, 2002.
Mondimore, Francis Mark. Bipolar Disorder: A Guide for Patients and Families. Johns Hopkins University Press, 1999.
Sommer, Sherry, et al. PN Mental Health Nursing. 9.0 ed., Assessment Technologies Institute, LLC., 2014.