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    Welcome to Holland

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    One of the things families of the mentally ill run into is a lack of understanding from friends and other family members.  While they often express sorrow and compassion, it’s clear from their words and actions that they don’t really have an understanding of the situation.   It’s not because they’re bad people; it’s simply because they have no frame of reference.  At the same time, it’s hard for us to explain our experience to them in a way they can understand.

    The best description I’ve ever read of what life is like for the families of the mentally ill is a 1987, essay written by Emily Perl Kingley.  She wrote it to comfort parents of disabled children, but it expresses well what families of the mentally ill go through when their loved one is diagnosed.  It is entitled Welcome to Holland.
    I am often asked to describe the experience of raising a child with a disability – to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It’s like this……


    When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting.


    After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, “Welcome to Holland.”


    “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.”


    But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay.


    The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place.


    So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.


    It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around…. and you begin to notice that Holland has windmills….and Holland has tulips. Holland even has Rembrandts.


    But everyone you know is busy coming and going from Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.”
    And the pain of that will never, ever, ever, ever go away… because the loss of that dream is a very very significant loss.


    But… if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things … about Holland.

    Copycat Craziness

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    I’m taking yet another divergence from my plan to describe my story to talk about an issue caregivers of the mentally ill face, but no one talks about. This is something I’ve observed in my son, and other parents I’ve talked to have seen a similar phenomenon in their own mentally ill children. This is the phenomenon of what I’ve termed copycat craziness.

    What do I mean by copycat craziness? It is the tendency of some with a mental illness to adopt behaviors they see in other mentally ill people., particularly behaviors of a self-destructive variety that they have never shown a tendency for in the past. The more shocking or disturbing the behavior, the more likely it is to be adopted. This is especially true with young people who have been in either an acute care or residential treatment setting for a period of time, though no doubt it also occurs in adults.

    Let me illustrate. My son was diagnosed with bipolar disorder in late 2007, on the occasion of his first hospitalization. Up to then he had not tried to harm himself physically; all of his physical aggression was against us or our things (especially the walls of our house). During his second hospitalizations, however, he met some female patients who practiced cutting. Ever since, he has practiced cutting whenever he was in the midst of a depressive phase. He has not cut himself so much as to require stitches, but he has taken great pleasure in telling us–and other teens in the neighborhood–what he’s done. On the one hand, it’s a way of feeling better; on the other it’s a way of striking out. But the point is that he would never have started cutting if he had never heard about it from someone who practiced cutting in the first place.

    So many of the behaviors our young people exhibit may have been adopted from someone they talked to about their own problems. A girl has problems with depression; she talks to another girl who says when she feels depressed, she cuts herself and she feels better. The other girl figures she has nothing to loose, so she starts cutting and, lo and behold, she feels better–but only for a time, so she keeps cutting. When her parents find out, they are of course concerned so they get her into therapy–for the cutting. The depression that started the entire thing is overlooked, at least initially. So if the therapy works, and she stops cutting, she may adopt another form of coping–drugs, alcohol, sexual promiscuity, etc–that she heard from another friend who suffers from depression.

    This is why, in my opinion, group therapy settings for young adults may wind up doing more harm than good. As part of the natural process of growing up, teens look more to their peers for support and affirmation than to adults, particularly their parents. They want to fit in to whatever group they find themselves; to do that, they will adopt some of the behaviors and attitudes they see in those they want to emulate. Mentally ill teens are no different. If they encounter other teens like them in a group situation, either outpatient therapy or a hospital setting, they will begin to see the behavior of their peers as normative. In order to fit in, they will adopt the behaviors and attitudes they see their peers exhibiting. Instead of helping, the therapeutic setting may make a bad situation worst.

    So what is the solution? I believe, as much as possible, the mentally ill–especially teens–should not be treated in a group setting. Unless the illness is acute and it is necessary for either the patient’s safety, or the safety of their loved ones, hospitalization should be avoided. The negative effects will take a while to overcome–if they ever are.

    But what is one to do if a teen has begun to copy behaviors they’ve learned about from others in therapy? This is difficult, because once a person adopts a behavior it becomes part of all the other issues stemming from their illness. I’m not even sure I have any real advice about how to do this. One thing I would ask you to keep in mind as you approach these issues, however, is the verse in Paul’s Epistle to the Romans that the title of my blog comes from:

    Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.(Romans 12:2, English Standard Version).

    By adopting the behaviors they’ve seen in others, the mentally ill are conforming to “the world,” or a particular manifestation of it–the “world” of mental illness. Just as Christians are called to be “in” the world, but not “of” the world, so the mentally ill person in our lives should be discouraged from being part of the world of mental illness. They should be encouraged to renew their minds, difficult as this may be for them. Instead of copying behaviors and adopting attitudes that are negative and self-destructive, they should be encouraged to seek that which is positive and life-affirming.

    I am not trying to say that group therapy and hospitalization is never called for. As I’ve already said, sometimes hospitalization is unavoidable, and for some group therapy can be useful. But I don’t think we do ourselves or our mentally ill loved ones any good if we don’t address the negative aspects of these. I’ll continue to look at these issues in subsequent posts.