16
Jun 25

Explaining Your Teen’s Illness to Siblings

Dad-Explains-to-Son.jpg“It is common for siblings to blame themselves for causing the problem.”

When a teen is mentally struggling, it can be difficult to explain the situation to siblings. Unfortunately, if you conceal the problem, they may imagine all sorts of things. Kids know when something is wrong and they deserve to know what is happening.

Depending upon the age of the child, you can give more or less information. Keep in mind that your child will be listening not only to your words, but also to your tone. They will make note of your body language. It’s important to appear in control of the situation. Answer questions honestly and admit if you do not know something. Be prudent about the details you provide. Your youngsters do not need to know that their brother has been cutting; they do need to know that he is angry or depressed and is being treated by professionals.

It is common for siblings to blame themselves for causing the problem. A sibling may say that they pestered their older brother too much and drove him to depression. Expect this possibility and be prepared to explain that this is not the case. If you think it appropriate and fitting, you can say that you initially blamed yourself too, but that now you know it is a sickness.

I recommend that you tell your child that this is a family matter and that if anyone asks him what is wrong with their sibling to simply say that he or she isn’t feeling well. If they are pressed for more information, they should should refer the person to you.

It is easy to exert all your time and energy on a sick child. Sometimes the sibling feels neglected and will begin acting out; for example, experimenting with drugs. Keep in mind the need for family balance. You will not help your depressed teen by neglecting yourself and everyone else in the family. You may, in fact, prolong the illness if you make it the central part of the family. Sometimes a teen will hold onto an illness if they are getting special attention. Bring home a puzzle and a pizza for your younger children after you have visited your older child in the hospital, or take them to the zoo on Saturday. Establishing a sense of normalcy wherever you can will help everybody, including you.

Handling Sibling Resentment
Your other children may resent their ill sibling for the trouble it may seem to be causing the family. It can be helpful to find a brief, written summary of your teen’s illness. A paragraph or two should be enough; try a website such as NAMI’s Mental Health Conditions. Explain before you hand it to the child that your teen’s illness is medical in nature, even though the symptoms are behavior-based.

If your child remains resentful, ask, “How is this affecting you?” Make sure you understand by rephrasing what you hear and asking if you’ve got it right. Do not argue, explain, or defend. Just listen. Encourage your child to say more because often the good stuff is buried and comes later. Say things like, “I’d like to hear more about that.” When you think your child has told you everything, ask, “Is there anything more?” You can also ask what would help to improve matters. Afterward, thank your child for explaining and say that their feelings matter greatly to you. Avoid making promises at this point. Instead, ask for some time to think about what you’ve heard. Give yourself a day to mull it over and try to see things from the sibling’s point of view. Discuss solutions with your spouse. Then address the matter with your child as soon as possible, preferably within a day or two.

Overloading Siblings With Responsibility
I’ll never forget a chilling scene I witnessed at a family therapy session in the hospital. A large family entered the room, including the twin brother of a teen who had just been admitted for a suicide attempt. Everyone seemed worried, especially the brother of the teen. He told us that he wanted to do everything he could to help his brother. His dad pointed out that since he was closer to his brother than anyone, he would play a key role in his recovery. Then the aunt and uncle took turns voicing their encouragement to the boy, the uncle concluding with, “It’s up to you Ryan. You’re going to have to be the one who saves him.”

The boy’s eyes grew huge with fear. It was too much responsibility for a teenager. The therapist came to the rescue and pointed out that the boy’s top priority should be maintaining his schoolwork and his own mental health, and that “saving” his brother should be a priority for the adult family members and the hired professionals.

My husband and I had to resist the temptation to rely on our teenage son when our second child was hospitalized for depression and suicide ideation. Our son had been in the hospital for depression before and we knew he could offer us some insight. On several occasions, we did ask for his opinion and he helped us, but we always let him know that we were the ones responsible for taking care of his sister. (Just a side note: sometimes a sibling sees things that none of the adults do, so when they speak up, listen.)

Holding your family together can feel tricky at a time like this. Just remember that kids are resilient and forgiving. You’re allowed to make mistakes. Apologize, forgive yourself, and move on.


09
Jun 25

Stabilizing Mania or Psychosis in Your Teen

Teenager“Try not to challenge her. Listen, but keep your comments neutral and non-judgmental.”

It is distressing to see your teen suffering from mania or psychosis. The psychiatrist will make it a top priority to shut down the symptoms, but it may be up to you to get your teen through the days. Hopefully, you can be present throughout this time, even if it means working from home for a while. It is best to provide vigilant supervision since the teen’s behavior may abruptly change and worsen.

Stabilizing Mania

Teens with bipolar disorder often experience mania. The manic teen may have pressured speech in which you cannot interrupt them, or they may pace, not sleep, or carry on about ideas that do not make sense to you. They may overspend or indulge in some other activity to excess.

For now, remove your teen’s access to Facebook, e-mail, or any other media form in which they could write something they later regret. Hide all credit cards and debit cards. Since mania can lead to dangerous behavior, make sure their psychiatrist is monitoring their progress. Follow his orders and record your teen’s behavior every day so that you can give him specific examples of what you are observing. It is easy to forget incidents when you are in the midst of an emotional turmoil. A faithful record can also encourage you when you see that there is improvement.

One of the toughest features of mania is that it often feels good to the patient. For this reason, your teen may resist medicine. Remind them that a crushing depression awaits at the end of mania, if left untreated. Tell them that you are not trying to spoil their good mood but that you want to see their mood leveled out for the sake of their mental health. Try to avoid getting pulled into lengthy, circular discussions that do not lead anywhere. It is okay to say that you need to go do some work for the time being. If your teen wants to talk to you all day, designate a specific time for discussion, such as from three o’clock to four o’clock. If they have a lot going on in their head, encourage them to write about it in a journal. Do not allow your teen to exhaust you.

Managing a Psychotic Episode

Psychosis occurs when a person begins to lose touch with reality. It can include hallucinations (hearing voices, for example) or a delusion (believing that people are out to harm them, for example). It may be a symptom of bipolar disorder or schizophrenia, but it can also occur with depression. It can be brief or it may persist for years.

Some medicines can cause psychosis, so your teen’s doctor will ask for a list of any medicines your teen takes. Street drugs such as LSD and marijuana can cause psychosis. If your teen is paranoid one night and fine the next day, suspect drug use. Talk to them and let them know that if they continue the drug use, the paranoia may worsen and can persist even after the drug use is suspended.

Sometimes a teen becomes psychotic from using illegal drugs and even after they stop the drug, the condition continues and has to be treated with antipsychotic medicine. If your teen seems paranoid for any reason, or if they are saying things that do not make sense, they need to see a psychiatrist. During treatment, the doctor may prescribe an antipsychotic, and he may provide a benzodiazepine like Ativan for short-term use to briefly suppress the psychotic symptoms.

Meanwhile, you will need to deal with your teen, who may be frustrated with the effort to explain to you what is going on because you do not see reality the same way they do. Try not to challenge them. Listen, but keep your comments neutral and non-judgmental. Trying to convince them that they are seeing things wrong will make the condition all the more frustrating, making them feel desperate, misunderstood, and alone. They may decide it is necessary to hide their beliefs from you, and then you will not know if they are still experiencing psychosis.

Although you are listening to your teen, do not encourage them to keep carrying on about their belief. It will only further flame the delusion. Try to keep the environment calm and quiet. Turn off the television, since they may misinterpret what they see and hear. If they try to engage you in their thinking, you may find yourself walking a fine line. Do not indulge the delusion by saying things like, “It’s okay, honey. I’ve put this cross on the door and the aliens won’t be able to get past it.” Maintain a tone of neutral empathy. For example:

Your Teen: There are people out there who want to kill me.
You: I can see that you’re scared.
Your Teen: You don’t believe me, do you?
You: What matters to me is that you feel scared. It must be awful to feel this way.
Your Teen: But you don’t believe me.
You: I sympathize with what you’re going through.  I want to reassure you that your safety and well-being are my top priority right now.
Your Teen: Lock the doors! They’re coming. You don’t understand. Let me explain this to you again…
You: I hear you loud and clear. The doors and windows are locked, just as they always are at night. I know that the world is not always a safe place, so I take sensible precautions to keep our family safe.

Choose your words carefully, avoiding anything that could sound judgmental. Think before you respond. In their confused state, they will not notice any slight hesitations.

If the paranoia persists for months, you may want to make certain accommodations to make your teen feel more comfortable. For example, if they think people are out to kill them, they may not want the garage door open until they are safely inside the car. This is not the same as saying that you agree with the false belief. It is simply a courtesy to make life less stressful for them.

During auditory hallucinations,remember the following:

  • Your own voice will be a source of reassurance. When the voices are at their worst, your loving tone may cut through the nonsense.
  • During a lucid moment, ask your teen to list all the things the voices have said. It may comfort them to realize that the voices always lie.
  • Getting your teen to talk can refocus their attention and make the voices stop. Some people find that singing makes the voices disappear. If they say they will feel silly, sing along with them.
  • Hide anything that could be used as a weapon, including knives in the kitchen or tools in the garage.

Don’t wait until things become out of control. If you feel you are in danger, get out of there and call 911. Explain that your teen is in the midst of a psychotic episode and that you need an ambulance. The police will come too, but they will not arrest your daughter if they are clear on what is happening. Inform them if there is a weapon so that they are not taken by surprise.

If your teen is taken to the hospital, do not despair. Let the professionals take over. Afterward, avoid talking about the things your teen said at their worst. If they did something that now has consequences, such as over-spending, offending someone, or getting into trouble with the law, reassure them that there will be time and opportunity to fix it. For now, it is time to focus on getting well. After your teen is well, it is a good idea to work together on an emergency plan.

Recommended Books:
The First Episode of Psychosis, by Michael T. Compton, M.D., M.P.H. and Beth Broussard, M.P.H., C.H.E.S.
When Someone You Love Has a Mental Illness, by Rebecca Woolis M.E.E.C.