# MHApps Take Control – Relationships – Importance Of People And Relationships In Recovery – Isolation Integration Withdrawal

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- Relationships One of the first things that begin to disintegrate when people experience mental ill health are relationships. When people feel ill or are having an off day (depending on how severe it is) they frequently withdraw into themselves.
  This means a lot of different things: a ring in sick to work, cancelling an evening out. If the feeling continues or deepens, people don’t go out unless they have to, and if they see someone they know across the road, they might avoid them. As the feelings of being down, or miserable develop, the phone will not be answered or if it is, the response will be unfriendly and short, even with close family and friends. Sometimes people will spend the day watching television, grunting at the world, and finally, we go to bed, cover our head and won’t talk until we are ready. We have all done the above at some stage in our lives and made excuses for ourselves. We were sick or we were not feeling great. We get a little sympathy, we recover and everyone is happy again. No harm done, that’s life.

- When a person withdraws for long periods of time and there appears to be no good reason for it, the sympathy, understanding and acceptance can wear thin.

- Relationships are based on a lot of things. We all make judgements about people consciously and unconsciously, good and bad for all sorts of reasons. It has been said that 95% of what we think about a person is decided within the first five minutes of meeting them. Communication happens in different ways, body language, the expression on our faces, eye contact, clothes and of course talking. Understanding how we are seen by other people can be very important in building and maintaining relationships. If a person is not happy with themselves, or is only interested in themselves, other people will instinctively see this. So, having a good self-image is half the battle in being able to relate to others.
  Like everything else, we have to take a bit of responsibility and perhaps step outside our comfort zone. Feeling isolated and friendless is a very common experience for people with mental ill health and it is a very difficult place to live your life. What some people forget though is that not every person you meet is going to be “best friend for life” material. A daily trip to the local shop to buy a paper, a few words with the person behind the counter, can be the start of a small but precious strand of inclusion.

- Being involved with groups, support groups, for example can connect you in a general way to other people, a casual place where you can be yourself and share, talk, or be silent without feeling out of place.

- “We didn’t know what to do when we went in to visit him in the hospital. He was just staring into space. He went from being talkative and energetic, always rushing around the place to just sitting on the chair in the hospital looking at the TV and not watching it. He was smoking 60 cigarettes a day, eating massive amounts of junk food; crisps, chocolate, washed down with litres of coke. He looked as if he swelled up and put on three stone, Christ we thought, what have we done to him, the supposed cure seemed worse then the mental illness.”

- Medication is a very thorny subject. Compliance is a word heard often in this context. Most people who are diagnosed with a significant mental illness are prescribed medication. All the medications have side effects. Some people are particularly sensitive to the side effects and have to cope with very real discomfort and disturbance to their bodies, while at the same time experiencing a lot, some, or no relief from the symptoms of their mental illness. Getting the balance right can be a long process for some people. Many speak of the medication as if it were worse than the mental health problem it is prescribed to treat. Does the benefit of taking the medication outweigh the consequences of not taking it? As we know, medication works fully for some people, works fairly well for some people and appears to work hardly at all for another group. Research suggests that people want and need a lot of explanation and information about the purpose, side effects and results of the medication they are prescribed.

- The most important ingredient to keep a relationship going is talking, communicating.

- Family relationships are much the same. We will get on better with some of our family than we do with others. That is normal. We do, however, need to make the extra effort to take part in things, in our own way. Be willing to step out of your comfort zone to help a family member or friend or just to meet up with them.
  We need to appreciate and understand who we are before we can have good relationships with others. Casual friends will come and go, but longterm ones need work.

- The three biggest barriers to forming or maintaining a relationship are isolation, isolation, isolation.

- When we are in a situation of pain, suffering or hurt, there is a tendency to withdraw into our worst self. That is, the quiet, lonely, scared, angry or withdrawn self. All ties are cut with the outer world and we become small, seeking ways to feel safe.
  Other people do not know what is going on and react accordingly. They become fed up with the behaviour and drift away or become angry. People can become totally isolated, and in a very short period of time lose the confidence to form or maintain relationships.
  The most important ingredient to keep a relationship going is talking, communicating. Whether it is with a friend, a family member or just someone you meet occasionally. Tell people what is going on for you. Ask them about themselves. Keep in touch, text, telephone, write.
  Display understanding, and show interest. Let people know that you want what is best for them. Celebrate their successes and listen during their hard times.

- “Our job a lot of the time involves making sure the patient takes the prescribed medication and follows all aspects of the care plan, so they are stabilised and able to be sent home. There is always somebody else waiting to come in. We sometimes enlist the relatives to try to ensure the patient is compliant with their medication when they go home. We know how difficult it is to make sure someone takes the meds when they do not see the benefit of it.”

- “Don’t be talking to me about the medication, it was a constant battle. We tried cajoling, threatening, bribing and sweet talking, cursing and one time I stood on my head; all to no avail, or maybe it might work for a while. Eventually we said please yourself take it if you want. She didn’t, and we spent another 8 hours of our life in the A and E.
  We got little support from the so-called professionals. We didn’t know what the medications were for; we didn’t know the side effects. Looking back now we wondered why we didn’t ask someone, but in reality we know we gave all power over to the consultant. We believed medication alone would solve all difficulties. One of the things we have learned is that when a person within the family becomes unwell the whole family becomes unwell as a result, and we all needed to recover together.”

- “As a doctor, I am very well aware of the complex reactions a patient can experience as a result of taking medication. The medication prescribed for mental illness is strong. It is also working on the brain in a general way. It can and does affect many functions of the brain, not just the ones we may want it to. Psychiatrists are nearly always dealing with symptoms only. By that I mean we cannot be sure what the cause is. Most medical conditions can be accurately diagnosed by tests or biopsies, or other tools. We are listening to the patient, using our judgement and experience to assess and decide what we believe the main problem is, and how best to manage the presenting set of symptoms. Anti psychotic medication is the main treatment available at the moment. People react to it in very different ways. They are also trying to live with sometimes very challenging symptoms. Medication should be only one part of the treatment. A multi disciplinary team provides a wide range of professional skills and interventions, which are all part of the treatment package, so to speak. Colleagues work with patients in different ways, providing different perspectives. The expertise of the whole team is utilised to develop a plan.”

- Feeling less sluggish I make my way to the clinic looking at all the happy well-washed faces going about their business. Well I like to think they are happy because if they are not, where does that leave me and what hope have I got. My community mental health nurse is there, although I have never met her in the community, only in the day hospital. She asks, as I knew she would, “yes” I answer.
  “Ok wait there; he will see you in a minute”. I always think; if Beckett was in a psychiatric hospital he would call his play “Waiting for Doctor”. I am called in. A big head of hair motions me to sit down with a wave of the hand. Another doctor I do not know. He never looks up, reading my file he asks me the same questions all over again, why the hell can’t he look at the file he looks so busy reading. He asks, “how are you”? Fine I say. He asks, “are you taking your medication”? “Yes” I answer for the umpteenth time, “ok then see you in six months”.”

- “Medication is the bain of my life. Everywhere I go or anything I do is somehow clouded by the obligation I have to prescribed medication. For example, I open my eyes in the morning (well 11.30am, my morning) and the first thing I see on my bedside is medication. My first action is to try and swallow, but my mouth is too dry. Although better than when I was on different medication and I awoke with my face stuck to the pillow as a result of the “overproduction of salvia” I think they said, a side effect. Anyway, I make my way to the bathroom shuffling, barely registering what the outside temperature is; I take a fist of meds with a glass of water swallowing each one with difficulty as a result of my dry mouth. Every time I take the meds I am reminded of my mental state. I used to fantasise that if I did not take my meds I wouldn’t have this problem, as I would just forget about it. I go down to breakfast, my mother, is there I answer before she asks, “yes I have taken my meds”. I meet my father, he looks at me, and I know the look, I say, “yes I have”.”

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