Family Survival Guide

By Chris Aiken, M.D. | Feb. 06, 2017


“You seem like you’re walking on eggshells,” our family therapist told me with a wise nod. The image of cracked eggs under my bare feet was strangely comforting compared to what our family was really going through. We were living with mental illness, specifically bipolar disorder.

Psychiatrists don’t know enough about how to help families in this situation. I should know—I’m a psychiatrist myself. When mental illness hit my home, I read everything I could. With some trial and (a lot of) error, I found a few principles worth leaning on when someone in your family has a mental illness:

Body Language

There’s a paradox to mood disorders, like bipolar. They make the family anxious, and they make the patient misread that anxiety as anger. This is no one’s fault—it’s due to a faulty switch in the part of the brain that reads faces (the amygdala). The raised eyebrows, tense muscles and pitched voice of anxiety feel like an attack to someone going through mania or depression.

In contrast, body language that conveys warmth, acceptance and compassion has a healing effect on the brain. Calming interactions help stabilize the neurohormones that regulate mood. Families that make frequent empathic comments have higher recovery rates in bipolar. These can include simple empathic statements like, “I see your point” or “I know what you mean,” as well as more specific ones like “It must be hard to go through the motions each day when you’re depressed.”

These gentler emotions are hard to come by during a crisis, so if you’re not feeling it you may need to practice acting the opposite of your emotions. Visualization can help. Just as an athlete imagines the ball going through the goal, picture someone who exudes warmth and calm. A favorite uncle, a minister or an actor like Judd Hirsch or Fred Rogers. You may feel like an actor yourself at first. As they say – “fake it ‘til you make it.”

Nothing’s Wrong, Don’t Fix It

Mental illness doesn’t respond well to ordinary problem-solving. In fact, looking for problems to solve can make the situation worse. Families have much greater success when they give up all that poking and prodding. Look for the positive in your relative—like the progress they’ve made. Notice how they came to dinner, instead of reminding them that they stayed in bed all day. It helps to know the signs/symptoms of mental illness, but it doesn’t help to point them out. Notice the healthy parts of your relative, because what you shine a light on is what will grow.

Of course, you’ll still need to discuss problems, but reserve those for a regular, scheduled family meeting. Without this kind of structure, people can feel as though they are never safe from criticism and attack. During your meeting, use a neutral, “just-the-facts” tone. Avoid discussing people’s intentions or how the illness affects you personally—those are hot-buttons that can quickly spiral into conflict when you’re living with a mood disorder.

Don't Aim for Perfection—Just Improvement

If this advice sounds hard to follow, it’s not. It’s impossible. No one can get it right all the time. Fortunately, it’s usually good enough just to adjust your ratio: Raise the warmth and positivity, and decrease the anger, criticism and tension. When you can’t do that, insert a long pause by going into separate rooms. Make an agreement with your relative to stay apart if either of you get too hot-headed. Decide on a signal for this time-out, like hanging a scarf on the doorknob.

Know Your Limits

The message here is not to just accept everything, rather, it’s that words alone won’t solve your problems. Families need to plan ahead for dangerous or destructive behavior. This involves action, not words. Your relative experiencing mental illness should have a strong voice in the plan. Problems to anticipate include violence, suicidal behavior, substance abuse, overspending and fights that impact children in the home. Hospitalization is not the only solution. Consider temporarily living apart, locking away guns or extra medication and allowing family members to contact the treatment team or come to an appointment.     

These tips are unlikely to lead to dramatic cures, but they do improve the lives of people experiencing bipolar, depression, and schizophrenia. It’s a short list, and Dr. Jim Phelps and I have gathered a few more in our book, Bipolar, Not So Much.

The hard part is sticking to the basics, because grander problem-solving tends to backfire. Recovery is often slow, and it takes patience and some bravery to make it through. The world may accuse you of enabling the illness—and your relative may not thank you either—but you are doing what’s best for your loved one. And don’t forget to reward yourself along the way—you’ll need a healthy dose of warmth and positivity as well.


Chris Aiken, MD, is a psychiatrist and co-author of “Bipolar, Not So Much” (WW Norton, 2017). His work focuses on natural and lifestyle methods that enhance recovery from depression and bipolar. As a psychiatrist, he founded the Mood Treatment Center and serves as an instructor at the Wake Forest University School of Medicine.

thank you!
2/13/2017 4:10:10 PM

Mike Mayer
Pam Hoffman's comments resonate, particularly those of the failed system, which my family member has encountered, and which is far too extensive to address here. I will simply point out that there should be more accountability in the system to do what it purports to do, and that no amount of family education and/or support will make up for that lack. Ditto for the exclusion of family from the care plan. Needs to change.
2/10/2017 5:59:00 PM

Marjie Brinck
good practical tips.
2/7/2017 6:19:17 PM

Very helpful
2/7/2017 6:29:31 AM

Pam Hoffmann
Thank you for an extremely helpful article. As a retired clinical social worker myself, there was far more that I did NOT know than what I thought I did when my son became mentally ill during his college years. While I read as much as I could and improved my dated education, what helped me and my husband the most was a family education series offered through NAMI. Practical ideas, offered in simple language and demonstrated. I loved your statement that your efforts as a parent might seem like enabling and may not be welcome...we did that. I will never regret it, as it eventually brought our son closer to being able to find help for himself. We enjoyed three years of his recovery and being able to see the magnificent man he became. His journey was cut short by a failing system that seemed to want to pigeonhole and leave him to languish, which he would not accept. He died by suicide seven months ago. While we grieve our child, I also understand why he did it. In a burdened system, although parental and/or family support is preferable, no one--not one therapist or psychiatrist-- had any understanding of how to make use of it. Such a tragic state of affairs, particularly ours in which we traveled weekly and monthly from Columbia, SC to Columbus, OH in order to see our son and do what we could to support him in addition to sometimes daily attempts to reach his caregivers who rarely returned calls.
Despite the fact that most therapists and psychiatrists I encountered both in my own work experience as well as my son's treatment did not welcome our involvement on ANY level, I still believe that support of loved ones whoever they may be is preferable to walking the path alone. Thank you for a practical and informative list.
2/6/2017 7:01:57 PM

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