By Max E. Guttman, LCSW
Socialization is particularly important for the emotional well-being of people with serious mental illness (SMI). This is true for several reasons. When people maintain their connections with others, they are more likely to be tuned in to the world around them, given that social expectations require attention, commitment and concentration. For people with SMI, social interaction can stabilize mood, help them to feel grounded and connected to others and allow them to feel more engaged in their recovery process.
Isolation is one of the most gut-wrenching aspects of having a mental health condition: people need support, but they may simultaneously push away support because of their symptoms. While the specific benefits of socialization for each diagnosis are unclear, the unwavering need for people with mental health conditions to develop and cultivate meaningful, supportive and organic connections is as clear as day.
When my psychosis began, I was isolated, ostracized and abandoned by friends. When my symptoms became apparent, I was in my final semester of college. My friends, who had become accustomed to the person they had known for three years, were confused and alarmed. As my psychosis worsened, I became moody and paranoid — which was troubling to anyone who knew me and observed the radical changes in my thinking and behavior.
For so many people with active psychosis symptoms, this is the outcome. Those dealing with psychosis may seem strange; perhaps engaging in bizarre behavior or have altered speech. People may also exhibit ill-timed and drastic changes in their disposition.
This state, which can be "scary" or "strange" to some, is the point at which people experiencing psychosis need stabilization, peer connection and another organic support best cultivated by good health. The added burden of social disconnection and isolation is one reason these mental health conditions are so severe, difficult to "bounce back" from and dangerous. We feel increasingly isolated and misunderstood as we endure these confusing and hazardous states.
My behavior years ago was so alarming to my friends that my roommate telephoned my family one evening, believing I had a plan to poison his food. As my psychosis worsened, the ability to care for myself was completely diminished. My isolation from friends, and difficulty engaging in adequate self-care, meant I had no support to lean on when I ran into issues on campus. No longer surrounded by friends, I had no one to troubleshoot what was an increasingly extensive list of problems. As a result, the issues became too overwhelming and complicated to address, given my increasing level of confusion from psychosis.
People with psychosis benefit from support: the more support, the more people available to bounce ideas off of and discuss issues productively. As problems begin to mount and symptoms worsen, the need for additional support is increasingly critical. When we include others in our worldview, our perception of reality expands. The communicated experience of others contributes to the way we come to understand our world. The additional perspective is essential for people disturbed by fear and paranoia. Counsel from a friend or relative unpacking irrational beliefs is soothing and reassuring when someone is in distress from psychosis.
Socialization can also be tricky for people living with affective and mood disorders. For example, trying to socialize in a manic state often leads to serious social consequences. During mania, people may appear elated, sharing grandiose ideas and speaking rapidly, all while trying to keep up with their thoughts, most of which seem more brilliant than the next.
I have experienced this first-hand. I have also observed it with friends battling mood disorders; I know how difficult it is to maintain healthy connections with friends. When friends fixate on your welfare out of concern for your well-being, they spend more time watching over you than connecting with you in a meaningful way. Support from peers becomes tricky when mutual support takes a back seat to a friend in the throes of mania.
Scholars must research how specific mental health symptoms can be alleviated by social interactions, kinship networks, family support and other socialized mediums enriching our lives and offering conditions supporting a healthy lifestyle. Perhaps the social landscape can be mapped out charted, and better understood by researchers evaluating support and the prognosis of people with severe mental health conditions.
In doing so, research can offer clinicians working with people with severe mental health conditions recommendations and other suggestions on re-working and re-patterning their social world to best promote a healthy space for their recovery. Additionally, clinicians might be able to identify and mark protective factors more quickly and leave their patients or peers in a better position when they regain their independence.
The mental health system speaks so fondly of socialization, but currently, it does little to support those engaged in the process.
This is a problem for everyone involved in the recovery process. Clinicians need to provide psychoeducation to the friends and relatives of those with a diagnosis, not just the patient, to honestly expect results that will have a lasting impact on the life of those in recovery. Friends, relatives and other social connections without psychoeducation, even with good intentions, can negatively impact the recovery process or put the diagnosed person at risk of relapse or worsening symptoms. Providing recovery-focused attitudes about what to expect from someone with a specific diagnosis regarding their capacity to socialize and access social support is even more critical.
Socializing is a skill set that's multifaceted and not quite as simple as telling someone to "make a friend." We must teach realistic expectations and skillsets targeting specific disorders and courses of treatment to improve outcomes. Preparing all support systems with an accurate clinical picture might make the difference for those trying to move forward in their recovery.
Max E. Guttman is a Licensed Clinical Social Worker, mental health therapist and disability rights advocate. He has worked in various systems of care in New York State as a clinician and peer. Max is also the Editor-In-Chief of Mental Health Affairs, a website for the mental health prosumer.
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