Home Care for the Mentally Ill?
FOR ten years they had been a happily married couple. The husband had a fine mind and was active in the Christian ministry. But then he began to have lapses of memory, his mind would go blank while giving a Bible talk, and at his job he would get colors mixed up when painting an auto.
Gradually he talked less and less, and before long all he was saying was “No! No! No!” as many as eight times in a row. Then he lapsed into complete silence. But physically he was hyperactive. He would pace the floor from morning to night, and it was a problem to get him to go to bed. After five years he died.
During those years, time and again specialists were consulted, but they said that nothing could be done to reverse his deterioration. A leading New York psychiatrist, who diagnosed him as suffering from a “degenerative, progressive, organic disease,” concluded his diagnosis with these words to the patient’s wife: “May I say at this point that you are an extraordinarily fine person. The sacrifice that you are making to take care of your husband who is a totally helpless individual is unusual. Many people would have had their irresponsible relative in an institution a long time ago.”
Why did his wife decide to take care of her husband at home? Why had she decided against committing him to an institution? Since doctors agreed that no further medical help could improve him, even in an institution, should she commit him? “It would be like throwing your sweetheart away,” is the way she put it. “You marry for better or for worse, don’t you?” She kept showering affection on him, for, said she, “he is like a baby; you cannot communicate intelligently with a baby but he can feel love, and so can my John.”
Institutional Care Not Always a Blessing
Did that veteran New York psychiatrist tell the wife that she was foolish for taking care of her totally helpless husband at home? No, rather, he commended her as “an extraordinarily fine person.” He may have expressed such a view because of an awareness that institutional care of such mental cases often leaves much to be desired.
This fact was highlighted by an experiment in which eight well-educated persons posed as mentally ill. They asked to be admitted to a total of twelve different institutions in various parts of the United States. What did they find? The university psychologist who organized the experiment and was himself one of the experimenters reported that their discoveries were “damning to the institutional system. For instance, four of these pseudo-patients (who kept a daily record) were ignored or slighted by the staff physicians or attendants three fourths of the time when they tried to talk with them.
Among the conclusions reached by these experimenters was that “the consequences to the patients hospitalized in such an environment—the powerlessness, depersonalization, segregation, mortification, and self-labeling—seem to be undoubtedly counter-therapeutic,” that is, tending to make the patients worse rather than helping them to get better.—Medical World News, February 9, 1973.
In an article appearing in Mental Hygiene, January 1969, entitled “Making Chronic Schizophrenics,” two psychologists gave similar testimony. They showed what harm often results to mental patients because of the way they are treated in an institution. Attendants “recurrently humiliate patients and emphasize the low esteem in which they are held.” Some institution employees take the attitude that patients “are essentially different, and what is bad for us is not necessarily bad for them.” Tragically, the way the attendants treated the patients caused the patients to act in the very ways that the attendants claimed they wanted to suppress. It caused the patients themselves to elicit the various punishments they feared most.
According to a very well-known American psychiatrist, use of the electric shock treatment is greatly overdone in mental institutions and so is the use of drugs. In his private practice he tries to keep severely ill patients out of the hospital if possible. Why? Because, as he said, ‘hospitals are places where patients frequently get worse.’
Why Home May Be a Better Place
No doubt there are many sincere and dedicated doctors and staff members in such institutions, so what is wrong? Ever so much! For one thing, institutions often are unable to pay for quality help or are understaffed. And it is just too much to expect that every mental patient will get the sort of sympathetic personal help that he needs.
It seems that many attendants in such places are prone to overlook the fact that a mentally disturbed person is not always and in every respect abnormal. In other words, his course is erratic. In some respects he may be normal all the time and in other respects abnormal just part of the time. He has lucid moments when he is amenable to reason and able to respond to understanding treatment.
Then, too, experience has shown that mental patients are generally more sensitive to the behavior of others than they were in their normal state; this is because of their helplessness. A mental patient needs the care of someone with a steady hand and controlled sympathy, things that he is more likely to find at home than in an institution.
Supporting this position is a report by the World Health Organization: “With the extension of education on psychiatric topics, more and more relatives have developed sufficient insight to be able to tolerate the patient in home surroundings, provided they are given (professional) help. . . . It is not always advisable to admit the patient to a hospital if his family is prepared to maintain him in the close emotional relationship of the home.”
A book on this very subject, Home Care for the Emotionally Ill, by Dr. H. S. Schwartz, underscores the fact that an intelligent and humane family can create a most favorable climate for the recovery of a mental patient. But there is also another factor to consider. What is that?
The Bible shows that mates have obligations toward each other. Further, parents are obliged to care for their children and may have endowed them with a genetic defect that leads to the problem. On the other hand, the Bible lays upon grown children the obligation to care for aged parents. This obligation may well include caring for parents even though they are no longer fully sound in mind.—1 Tim. 5:3-8.
Of course, not every emotionally ill person can be cared for at home. But where it is clear that the patient is not a danger to himself or to others, the home may well be the best place to care for the patient. At home, recovery may well be the quickest and the easiest.
What It Takes
Caring for an emotionally disturbed or ill person at home is no small task. It would be ideal for the patient to have his own room and for the family to have some trained help such as a part-time or full-time nurse. Also, it would be ideal if an understanding and sympathetic physician had the oversight of the patient and could be consulted from time to time. However, many persons have got over a “nervous breakdown” or severe mental depression or other forms of mental or emotional illness in their homes without such ideal circumstances. Other members of the family, however, had to be equal to the challenge.
The member of the family upon whom the chief burden usually falls is the wife or mother, even as in the case noted in the foregoing. She should be mature—mentally, emotionally, spiritually and physically. She must be self-controlled, affectionate and yet not sentimental; she must be able to be firm when there is need and able to put up with trials. What it really calls for is what the Bible terms the “fruitage of the spirit,” such as love, joy and self-control. Above all, much love is needed.—Gal. 5:22, 23; 1 Cor. 13:4-8.
The love must be genuine, unhypocritical, not superficial. There must be genuine interest in the patient’s welfare. The Bible also says that “love covers a multitude of sins.” Love hopes, so hope for the best and appeal to the best in the patient. Have empathy. Treat the patient as you would like to be treated if you were in his shoes.—1 Pet. 4:8; 1:22.
Understanding is also important. As one doctor put it: “The goal . . . is to understand the patient. Everything the therapist says and does should be directed toward that end.” How can you get to understand such a person? By encouraging him to speak.
Further, recognize that mental aberrations are but extreme forms of weaknesses we all have. For example, we all have feelings of guilt at times. But the mental patient may be so overcome with feelings of guilt that he feels hopeless.
Do all you can to build up the patient’s self-respect. Avoid making fun of him. Always give him the opportunity to save face. Where possible, explain away his mistakes. Do not treat him as an inferior, but as though he were normal, which he may well be part of the time. As one of America’s leading psychiatrists put it: “They can be given what they lack; they can be taught and with this new knowledge helped to will differently and do better.” So appeal to the best part of him. Manifest a sense of humor, endeavoring to get him to laugh by making yourself the object of a joke. Laughter releases tension and so is good for mind and body.
Keep in mind that a common basic characteristic of the mentally ill is rebellion. They are often determined to do the opposite of what they are told to do or what they are told not to do. They may resemble children having tantrums, lacking reason and self-control. Prone to be suspicious, they may require an “indirect approach.”
For example, a rebellious patient once went on a rampage, started throwing books around and threatened to punch out the windows. What was to be done? Telling her to stop would merely make her more determined to continue. So her psychiatrist used the indirect approach. He sat on top of the bookcase and kept counting aloud as she dropped one book after another onto the floor. Then he picked up one book and asked her if she had ever read it. He told her of its interesting contents. What were the results of his exercising self-control, using a sympathetic sense of humor and a diverting tactic? He had her helping him put the books back in the bookcase, apologizing for having thrown them about! By similar tactics he diverted a patient standing on a window ledge ready to commit suicide.
The Physical Aspects
The physical aspects also are important, for well has it been said that “good physical care is a gateway to mental health.” A patient should be made as comfortable as possible. Giving attention to his appearance can have a beneficial effect upon him. With firm and loving help you can start an act and lure him to complete it, such as washing, clothing or feeding himself.
If he is prone to sit in a corner by himself all day long, encourage the patient to take walks. Helpful also are massages, even though one may not have any professional training. A prolonged warm bath can help a disturbed patient. Extremely important is proper diet. According to one leading psychiatrist, a proper diet can be the key to treating mental disorders. Especially important are vitamins and minerals found in unrefined foods.
Help from the Bible
In particular, one should apply Bible principles and truths in dealing with a mental patient. The Bible shows that a cheerful heart does good as a medicine. (Prov. 17:22) It also gives the example of how music helped a king who had an emotional problem. Patients who never speak have been known to sing.—1 Sam. 16:14-22.
It is also helpful to encourage the patient by calling to his mind expressions of God’s watchcare over his earthly children. For example: “As a father shows mercy to his sons, Jehovah has shown mercy to those fearing him. For he himself well knows the formation of us, remembering that we are dust.” (Ps. 103:13, 14) And again: “Do not be anxious over anything, but in everything by prayer and supplication along with thanksgiving let your petitions be made known to God; and the peace of God that excels all thought will guard your hearts and your mental powers.” Of course, the ones caring for the mentally ill person also need to strengthen themselves by such scriptures and also by prayer.—Phil. 4:6, 7.
Truly, care for the mentally ill presents a challenge. A knowledge of what is involved should cause any family to weigh the matter carefully before committing a member who is mentally or emotionally disturbed to a mental institution rather than caring for him at home.