Mind Moves / Tony Bates: It was late in the day when he phoned. He sounded worried and concerned as he described how his wife had fallen into a very deep depression and now lay immobilised in bed, unable to speak to me herself.
For some weeks she had been struggling through a dark night, but now her mood had reached a very low point where he wondered if admission to hospital was necessary. He spoke quietly, but his fear for her was palpable, and he hoped I might give them both some direction.
Listening to this man, it struck me how little consideration we give to the crucial role that families and carers play when their loved ones become emotionally distressed or ill. We're inclined to think of a mental health crisis as something that occurs exclusively within someone, as though it has no bearing on the lives of those around him or her.
What is also true is that mental health crises have a profound impact on relationships between people. If we do acknowledge the role of family members in a crisis, it is often in a disparaging way, pointing to them as the cause of the problem. Undoubtedly, there are situations where this judgment has some validity.
However, it ignores and dismisses the vast number of families and carers who are deeply affected by the suffering of "one of their own" and who play a very positive role in supporting that person as they work towards recovery.
My friend in crisis was someone whom I knew to have a very supportive family. She was in the safest of hands, and it was doubtful that any hospital could be more caring of her. She was also working closely with a very fine therapist who had brought her successfully through troubled waters over the past year. In fact, the distress she was experiencing was an inevitable part of her coming to terms with experiences in her life.
It was a tribute to her husband that she felt secure enough to face these memories and work through them. Psychological growth and development can involve periods where we seem to be falling apart, but where we actually come together in ourselves.
We grow as we try to face aspects of ourselves that we have been running from and when we forge a relationship with disowned aspects of our personalities that have remained frozen and undeveloped inside us for years.
Families are understandably distressed by the turmoil they see in a loved one who is caught up in a mental health crisis. They can feel very poorly equipped to judge if that person is going to pull through with their support and patience, or whether a more intensive and protective form of care is required.
It is critical that mental health services appreciate the burden facing families in moments like this and consider ways of supporting and assisting everyone caught up in the crisis. With timely intervention, the need for hospitalisation can be dramatically reduced.
More importantly, crisis intervention can address ruptures in family relationships that can develop at such times, before they become entrenched and destructive. These ruptures often arise as relatives adopt opposing positions on what they regard as being in the best interest of a distressed relative.
Each situation needs to be assessed carefully on its own terms before one can judge what constitutes the most appropriate response. My instinct in regard to the phone call I received was to feel hospitalisation was unwarranted.
I had a number of reasons for reacting this way: I had had a conversation with my friend recently where she sounded very coherent and in control despite the tough times she was describing. From listening to her, I could see there were some good reasons why she was feeling the way she described and I knew she also appreciated this. I knew she had a well-established support system in both her husband and therapist. All of these factors reassured me that no matter what pain she was in, she would survive it and recover. My role, when I received the distress call, was simply to affirm her resources and her resilience.
Had some of these elements not been in place, had she been losing control, perhaps expressing suicidal wishes, and living alone or with limited emotional support, I would have considered a different range of options, including hospitalisation. The critical issue for this family was that they could cope, but they needed someone who believed in them. Their need brought home for me how vital it is that we put in place a range of structures for relatives which recognises their role, appreciates their distress, and supports them when they need it most.
Dr Tony Bates is principal clinical psychologist in St James's Hospital. Any responses to this or other columns by Dr Bates can be e-mailed to: tbates@irish-times.ie.