Dear Portia: How Do You Stay Sane with a Mentally Ill Person?

Dear Portia,

How do you deal with toxic or mentally ill people who have harmful behaviors and stay sane? You have no choice but to deal with them—they’re your family or your boss. How do you get them to seek the help they need? Or, to understand they have an issue?


Dear JP,

I know a woman who really lost it after having a baby. For those living with her, it was obvious she was struggling, but not obvious how to change that. She had panic attacks during bedtime, started sobbing in the middle of the night when her baby woke up, and a few times lost her temper, screaming at the top of her lungs, with both her husband and her new baby. When her husband suggested solutions, she waved them all away, sure that any change in their routine would bring everything crashing down.

She really needed help. But for the life of her she could not see that help would be at all helpful.

That woman was me.

It wasn’t until a few years later, after a friend mentioned that anxiety and rage were symptoms of post-partum depression, did I connect the dots and realize I’d been mentally ill.

It shocked me that I didn’t see my illness on my own. After all, I’d been depressed before, my old therapist told me to watch out for PPD, and I’d seen someone suffering with it up close. I still didn’t recognize the signs when it was me.

Realizing the source of that blackness brought both relief (I wasn’t simply a terrible person) and pain (I could not believe the hell I’d put myself and my family through when I could have gotten help for a treatable illness).

My husband and I have come a long way since then; I feel sure that were I to experience depression again, we’d both be better equipped to recognize and handle it. Still, within the funhouse of mental illness, it’s really hard to see straight.

That brings me to your question.

It’s hard to live with people who are mentally ill, or work with them, or be partnered to them. However, it’s completely impossible to make change or see their illness unless they’re willing to do so.

Change comes from inside. Period.

The best and only sane strategy for dealing with people with untreated (or poorly managed) mental illness is to focus your efforts on what you have control over. Which is you.

I’d say it’s a three-part process.

Accept That the Mentally Ill Person Is Doing Their Best.

Mentally ill people are doing their best when they don’t take their meds, lose their jobs, or abuse you.

That’s not to say their behavior is okay. It’s just all they are capable of in that moment. Their fears and pathologies are controlling them, and not the other way around. Given the current universe, they are not able to change.

It sounds like a terrible thing to accept this. Or maybe it sounds Pollyannaish. (It’s weird that something can be harsh and Pollyannaish at once.)

Brené Brown introduced me to the “doing their best” concept in Rising Strong. The bottom line, she says, is that when you accept the person is truly doing their best, you cease wishing with magical fairy dust powers that they will become different. You stop thinking that if they tried a little harder (or you tried a little harder) the behavior would change.

Nope. No magic-fairy dust powers. Just reality: their behavior sucks, and it’s not okay, and it’s not going to change for the foreseeable future.

Decide with Brutal Honesty What You Can’t Live With

This part is hard.

You figure out what you value most: is it preserving your own mental health? Saying no to verbal abuse? Financial survival?

And then, given your values, you decide on deal breakers—say triggering panic attacks, or physical violence, or adultery, or whatever. What values or boundaries are sacrosanct? Which are more flexible?

I’d recommend going through this with a therapist if at all possible to help you see clearly. Dealing with mental illness, especially in one’s family of origin, tends to make it hard to make wise choices.

I’ll give you a for-instance.

In one of my relationships, anything deeper than surface-level interactions hurts. I don’t have any official diagnoses for that person, but I suspect one that’s very hard to treat. That person is genuinely doing the best they can, but it’s not okay that their best messes with my head.

After a great deal of therapy and honest attempts to improve the relationship, I realized one day that I was done trying to make things better. The cost was simply too high.

However, completely cutting the person out of my life conflicted with other deeply held values. So even though it felt awkward and messy and uncomfortable, I chose to keep seeing that person, as long as they didn’t violate important boundaries.

It’s not an easy balance, but it has turned out that I can manage the difficulties of being around them because I know why I choose to do so. Though they haven’t addressed underlying issues, they have risen to the challenge of respecting my boundaries, which is actually quite lovely to witness. Being in relationship isn’t perfect for either of us, but it’s bearable, and most importantly, it allows me to live with integrity.

This brings us to the last step.

Communicate Your Boundaries Kindly and Firmly

Not long ago in a conversation with someone, um, troubled, I realized what their responses reminded me of: a toddler. Three-year-olds are masters at pressing buttons, trying to manipulate you, and all kinds of nonsense. I mean, they’re three.

Unfortunately, a lot of us never mature past early childhood, probably because of trauma or poor parenting. Grown-ups end up whining and throwing adult-sized tantrums. It’s awful.

Elizabeth Pantley, one of my favorite parenting authors, describes how to deal with toddlers: be kind but firm. Give clear choices, and be willing to say no.

So if you decide, for instance, that you’ll can’t live with three am phone calls from a mentally ill sibling, you tell them so directly: “Brian, I want to be present for you, but I need rest. I will only answer phone calls after 8 am, and before 11 pm.”

If Brian calls outside those times, you don’t answer the phone (if you know it’s him) or when you pick up, you remind him of the boundary, and hang up without discussion.

You don’t argue. You don’t explain or apologize or shame or engage. Hello, goodbye, click.

This becomes a lot easier to do if you’ve done step one: assume they are doing the very best they can. If that’s the case, making changes is up to you.

It’s not helpful for a mentally ill person to have unlimited scope for their pathology. It’s not laudable to keep unhealthy family systems running like clockwork in order to “keep the peace”. Instead, be a kind-but-firm pain-in-the-ass about respect and dignity. It’s warrior work.

One last thing: the “kind” part is incredibly important. Accept the person for who they are. Treat them with empathy. Try to put their awful antics into perspective: they probably have very good reasons for reacting the way they do—not excuses, but reasons: trauma, or brain chemistry, or overwhelming fear. Try not to take their nonsense personally, just as you don’t take a three-year-old’s meltdown personally. Maybe they need a (figurative) nap.

Don’t punish them or shame them with your choices. Make boundaries out of necessity and deep love for yourself, not because the person needs a comeuppance.

Trying to punish people poisons you from the inside. I don’t recommend it.

All This Stuff Is Hard

It’s hard. It takes time, wisdom, and terribly awkward conversations. For many of us (like me) it might be impossible without therapy. It’s a lot easier to avoid, appease, vacillate, shame, or punish.

So be kind to yourself, too. It’s okay to be bewildered, make mistakes, or go slowly. It’s okay to be angry that all of this hard work is necessary in the first place. It’s okay to grieve that Brian is a crappy brother.

But also, keep things in perspective. A lot of people are running around with untreated mental disorders (or dysfunction that might as well be a mental disorder). Such illnesses run in families; they’re also produced by our violent, oppressive culture.

I loved a recent New York Times article about choosing whom to marry. In it, the author said, “In a wiser, more self-aware society than our own, a standard question on any early dinner date would be: ‘And how are you crazy?’”

We should all stay humble about our own brand of crazy, and compassionate about the crazy others put us through. Instead of explaining it away or putting up with endless fallout, we should stand tall and minimize the amount of crazy we participate in.

Heather Caliri
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