Caring for the mentally challenged: Guide for loved ones

As a caregiver or as a mental health professional we would like to think that our responses to an individual, suffering from mental illness are supportive and encouraging. But, is our expression of emotions just reactions to circumstances or a pattern of responses hidden in the matrix of our family structure? And what if our expressions are causing relapse in the name of being supportive? Answer to this, lies in the area of ‘Expressed Emotions’, which refers to the attitude of caregivers towards the person with mental illness. 

To understand them, let's take a minute to reflect on our possible responses towards individuals suffering from mental illness: Imagine this being said in an increased tone, volume, and tempo.

“How many times to tell you to take bath regularly? Since the time you were born we’ve always suffered. We are paying so much for your treatment, why aren’t you taking medications? You are just too lazy to get up and go to work... You are acting as if you are sick...You never listen to us…”OR

“It's all because of my (caregiver) negligence, I should have been more strict with him ...I shouldn’t have gotten married in the first place...etc”

In order to understand the above-mentioned pattern of communication, a medical sociologist named George Brown in the 1950s was curious to understand what made individuals who suffered from Schizophrenia relapse after them being symptomatically stable and recovered functionally with their long hospitalization and antipsychotic medications.

Thus, his curiosity culminated in a study where he and his colleagues observed that the predictor of relapse and readmission of the patients, we're dependent on the type of home that they were discharged to. Thus, in his seminal paper “The discovery of expressed emotion: Induction or deduction?” He mentioned five concepts of expressed emotions which include critical comments, hostility, emotional over-involvement, positive remarks, and warmth.

All the former three concepts are concluded based on the caregiver’s use of tone and the language used to convey their feelings, similar to that of the above-mentioned example, which reflects high expressed emotions. 

So how can we as a caregiver or mental health professional contribute in lowering the expressed emotions? Some of the ways are as follows, 

• Firstly, expression of warmth and positive regard by appreciating the little efforts made by the individual suffering from any mental illness in his/her day to day functioning, along with stating positives and being part of their coping journey. 
• Secondly, understanding what the individual with mental illness is going through, by gathering all the factual information about the illness. And most importantly attributing the person’s symptoms to illness rather than minimizing or blaming oneself. Thus, psychoeducation is one of the most important aspects to lower expressed emotions among caregivers and mental health professionals. 
• Thirdly, family interventions with respect to training in communication patterns are proven to be an effective treatment option in facilitating movement from high to low expressed emotions. Thus, seeking therapeutic intervention can be beneficial, as it lowers the risk of relapse. 

To conclude, in recent years, studies have shown promising evidence with respect to impact of expressed emotions in many mental and behavioral disorders. Though, the concept has deeper notions attached to it, simple steps can be taken to make the individual suffering from mental illness less dependent and more in-charge of his/her own life. 

“There is hope, even when your brain tells you there isn't.”

― John Green, Turtles All the Way Down 

Ms. Shilpa Nagaraj

Clinical Psychologist 

Cadabams Group