Medical: Etiquette for the Mentally Ill (from a non-prefessional perspective)

[Oxymoroness]

I have to admit I was really disturbed by a thread that was recently locked. What bothered me so much was that people were suggesting to purposefully frighten a person who had an anxiety disorder.

Now, there are a few things to consider. Yes, some mental illnesses make people extremely difficult to deal with, even to the point where that person can be considered toxic. Some mental illnesses make people so selfish, that they do not care about anyone other than themselves, and "etiquette-proof" — they will never be polite or return courtesies. Sometimes they either don't, or can't take subtle hints. And much of the time normal bounds of etiquette simply do not apply.

That said, there is a kind way to treat even the most toxic mentally-ill person. Granted only rarely there is any appreciation or reward from the mentally-ill person even when he/she realizes that you've been kind despite their rotten treatment of you, but that shouldn't matter. If we know better, than shouldn't we be polite anyway?

Here are my "rules of etiquette" for dealing with someone who is mentally-ill (I am assuming that either the person is not toxic to be around, or cutting them off is not a choice):

1. Do nothing to exacerbate their condition. If they are paranoid, don't lie or play tricks on them. If they have an anxiety disorder, do not purposefully freak them out or scare them. The only exception is if you are their physician and they are voluntarily undergoing treatment.

2. If a third party must deal with them, it is fine to give that person full disclosure on their behavior, but you must also mention their diagnosis. Mental-illness does not make a person "bad" even if their behavior is bad.

3. Do what is necessary in your power and right to keep that person safe. Do not attempt to step on their legal rights unless they are in imminent danger.

4. Preserve what dignity you can for them. They are people too.

5. Even if they drive you crazy, try not to take it out on them. It's not their fault even if it is their problem.

Any others? Thoughts?

[ginlyn32]

If you are the main care-giver:

*Realize that you need to take time for yourself. If you are a Live-In caregiver, this is even MORE important!

*There are several agencies and websites availible to help care-givers.

*Taking time off or even a DAY off does NOT make you a bad person/child/sibling or SO. You have to deal with this every. day. You need time off to mentally recouperate and to restore yourself so you don't burn out.

*Do not hesitate to ask for help from other family members, doctors or other agencies. They are there to help you.

If someone you know is a Main Care-Giver:

*Offer to come over and lend a hand or give them the day off.

*Be supportive.

ginlyn

[Kimblee]

2. If a third party must deal with them, it is fine to give that person full disclosure on their behavior, but you must also mention their diagnosis. Mental-illness does not make a person "bad" even if their behavior is bad.

Oh sweet goldfishies....

Please don't do this unless you know the person is COMFORTABLE with their diagnosis being known. if someone I trusted with knowing about my disease felt the need to tell someone i had NEVER MET that I am ill, i don't think i could ever forgive them.

If i have an occasional lapse, I can explain for myself. Unfortunatly being Mentally Ill is still a huge taboo, and telling a stranger that I'm sick is just as likely to make them think badly of me, as it is to make them more understanding. (Actually, more likely IME)

This idea really scares me.

[hobish]

2. If a third party must deal with them, it is fine to give that person full disclosure on their behavior, but you must also mention their diagnosis. Mental-illness does not make a person "bad" even if their behavior is bad.

Oh sweet goldfishies....

Please don't do this unless you know the person is COMFORTABLE with their diagnosis being known. if someone I trusted with knowing about my disease felt the need to tell someone i had NEVER MET that I am ill, i don't think i could ever forgive them.

If i have an occasional lapse, I can explain for myself. Unfortunatly being Mentally Ill is still a huge taboo, and telling a stranger that I'm sick is just as likely to make them think badly of me, as it is to make them more understanding. (Actually, more likely IME)

This idea really scares me.

Agreed. The person being "dealt with" does have some right to privacy.

[Julep]

2. If a third party must deal with them, it is fine to give that person full disclosure on their behavior, but you must also mention their diagnosis. Mental-illness does not make a person "bad" even if their behavior is bad.

Oh sweet goldfishies....

Please don't do this unless you know the person is COMFORTABLE with their diagnosis being known. if someone I trusted with knowing about my disease felt the need to tell someone i had NEVER MET that I am ill, i don't think i could ever forgive them.

If i have an occasional lapse, I can explain for myself. Unfortunatly being Mentally Ill is still a huge taboo, and telling a stranger that I'm sick is just as likely to make them think badly of me, as it is to make them more understanding. (Actually, more likely IME)

This idea really scares me.

Agreed. The person being "dealt with" does have some right to privacy.

I absolutely agree with and understand not giving out that personal information, but what if the person in question is consistently, reliably difficult in some way. Not necessarily to the point of being dangerous, but perhaps mean or out of line or extremely rude? I've dealt with an individual who I wasn't warned about, and until I'd asked someone, I spent a couple evenings crying because he was rude and mean to me, doing things like pointing out my body flaws and making fun of me in other ways. I later asked a coworker, who said that he was extremely intelligent, thus good at his job, but diagnosed with a mental illness that basically meant you had to ignore this behavior. When a new employee came in, all I said to her was, "Please don't ever listen to anything Bob says about you personally. He will say hurtful things." I guess someone else must have gone into more detail because she came back to me a couple days later, knowing more than I did. But is this a good way to handle it? Or is there a better one?

[Hawkwatcher]

Do not play amateur psychologist.  Unless you are a mental health care specialist trained to evaluate and examine patients, do not suggest that another person is suffering from schizophrenia, clinical depression, or even substance abuse problems.  If that person's behavior is causing you problems, you have a right to address it and demand that it stop.  Offering a diagnosis is not acceptable.

Do not assume all bad behavior is a sign of mental illness.  It is possible to be a nice person and to suffer from mental health issues.  It is also possible to be a sane and to be toxic. 

[Nurvingiel]

Anxiety/depression/SAD sufferer here, appreciating this thread big-time. Most people in my life are pretty understanding, I am very lucky.

*Do be understanding. You don't have to actually understand the mental illness to be understanding, just lend an ear. My husband has trouble understanding anxiety issues sometimes, but he is very understanding.

Don't judge. I automatically distance myself from anyone who says or does things that indicate they are judgemental of any mental illness, whether it's one I have or not. One should avoid judging someone based on an illness, as you never know who is judging you based on your actions.

*Do give helpful advice if you genuinely think it would help. e.g. "I find that when I get worried about something, I make a conscious effort to breathe slowly. I don't know if you've tried that already." Do not ever say, "Cheer up" or that like. I mean, honestly.

* This applies to if someone confides in you.

[aka]

* Think carefully before you express an opinion that people do not need antidepressants or anti-anxiety medication.  There is a high possibility that at least one person with you is or has been taking these drugs and could be hurt.

* Please don't talk about how you went through a single period of sadness or grief but "exercise/diet/meditation/etc" snapped you out of it.  There is a big difference between normal sadness, which everyone experiences in varying degrees due to life events, and chronic and/or major depression.

[Oxymoroness]

2. If a third party must deal with them, it is fine to give that person full disclosure on their behavior, but you must also mention their diagnosis. Mental-illness does not make a person "bad" even if their behavior is bad.

Oh sweet goldfishies....

Please don't do this unless you know the person is COMFORTABLE with their diagnosis being known. if someone I trusted with knowing about my disease felt the need to tell someone i had NEVER MET that I am ill, i don't think i could ever forgive them.

If i have an occasional lapse, I can explain for myself. Unfortunatly being Mentally Ill is still a huge taboo, and telling a stranger that I'm sick is just as likely to make them think badly of me, as it is to make them more understanding. (Actually, more likely IME)

This idea really scares me.

Agreed. The person being "dealt with" does have some right to privacy.

I absolutely agree with and understand not giving out that personal information, but what if the person in question is consistently, reliably difficult in some way. Not necessarily to the point of being dangerous, but perhaps mean or out of line or extremely rude? I've dealt with an individual who I wasn't warned about, and until I'd asked someone, I spent a couple evenings crying because he was rude and mean to me, doing things like pointing out my body flaws and making fun of me in other ways. I later asked a coworker, who said that he was extremely intelligent, thus good at his job, but diagnosed with a mental illness that basically meant you had to ignore this behavior. When a new employee came in, all I said to her was, "Please don't ever listen to anything Bob says about you personally. He will say hurtful things." I guess someone else must have gone into more detail because she came back to me a couple days later, knowing more than I did. But is this a good way to handle it? Or is there a better one?

this actually the scenario I'm referring to. Cronic bad behavior that could otherwise get the person in trouble. By warning about the behavior AND the diagnosis the other person knows it's nothing personal and will give far more latitude. It applies to those who cannot control or self-correct their behavior.

For those who can manage themselves and their behavior of course I wouldn't disclose or recommend disclosing their diagnosis.

Sorry. I should have clarified.

[JoanOfArc]

If the person you are dealing with is talking about suicide, take it seriously.  This is a safety trumps etiquette situation, so you should not hesitate to get them the help they need.  Suicide hot lines are a good place to start.  If the person is seeing a profession, you could also contact them.  They likely are not allowed to speak to you about the person's case, but you can speak to them and they will often take action. 

In addition to not playing armchair psychologist, refer people to competent medical professionals if they confide they are struggling.  If they feel they cannot make the call to a professional, offer to do it for them.  That first phone call can be hard to make. 

If some one is suffering from an eating disorder, do not pressure them about food.  Just eating is not the solution.  It isn't that simple.  They need therapy from a professional who knows a great deal about eating disorders. 

If the ill person tells you they hate their therapist or that he or she is acting unethically, listen to and believe them.  If the person doesn't trust their therapist, therapy is a waste of time.  Sadly, there are bad therapists out there and their are therapist-client relationships that just won't work due to personality conflicts.  Encourage the ill person to find a professional they trust.  Also have them consider the methodology the therapist is working from.  Talk therapy isn't for everyone.  Alternative modalities (by certified professionals), such as art, music or dance therapy may be more helpful  to that person than talk therapy. 

If you are getting too caught up in the ill person's everyday struggles, step back.  It isn't healthy to be ultra-involved.  Take care of yourself.  Be kind and helpful, but remember to keep good boundaries. 

[M-theory]

Try to give unmedicated people credit where credit is due. How impressed would you be if a diabetic could keep their blood sugar 50 points lower through sheer force of will? While bad behaviour is the individual's responsibility no matter what, if someone fighting anxiety with no Ativan manages to stay calm and functional, keep that in mind if they snap at you once in a while.

[Wordgeek]

This is not a matter of etiquette so much as it is a medical issue.  Those of you who are interested in this topic should consult your local mental health authorites or another qualified professional.