Improve your relationships by improving communication Communicating with friends and family who are struggling with mental illness can be challenging. Learn some small changes you can implement that will make a big difference.

1. COMMUNICATION
AND EMPATHY IN
MENTAL ILLNESS
NAMI ANNE ARUNDEL COUNTY

2. EMPATHY
The intimate comprehension of another person’s thoughts
and feelings, without imposing our own judgement or
expectations
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3. DEFENSIVE COPING STRATEGIES
Self-absorption
Irritability
Haughtiness
Controlling/Manipulation
Anger and attack
Rejection of friends and family
Blaming others
Defensiveness
Drug and alcohol abuse
Doing nothing
Resistance to change
Refusing services
Denial
Apathy
Bargaining
Withdrawal
Suspicion
Dependency
Envy
Running away
Refusing medication
Quitting the job
Relapse
Abusive criticism of others
Sleeping
“I don’t want to talk about it”
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Used to Preserve Self-Esteem
in Mental Illness

4. HOW INNER FEELINGS AFFECT BEHAVIOR
Illness Events Feelings & Experiences Behavioral Coping Strategies
First Break: Depression
Fear; loss of control; panic; confusion;
pain
Alerts others of her trouble; gets help
Restoration of Equilibrium
Relief; return of well-being; optimism;
feels confident to resume life plan;
hopeful
“Normalizes” the event; stops
medications due to wellness; dismisses
the problem
Relapse into Mania
Sublime wellness; power; rage; energy;
invincibility
Full denial; accuses others
Coming down from manic attack
Shock; shame; embarrassment and
humiliation; deflation; phobic about
returning to the “scene of the crime”
Starts to withdraw; begins to use
defensive strategies to protect her self-
esteem
Gearing back to keep going does not
prevent another relapse
Loss of confidence; fear of relapse; dread
of discovery and being stigmatized;
fragility; anxiety
Abandons former life plan; isolates
herself from others; hyper-vigilance;
paranoia; attack; another breakdown
Living with chronic illness process
Despair; disappointment; demoralization;
fear of failure; loss of hope; despondency
“gives up”; lets go of life plan and
personal goals; apathy; resignation; “no
gain, no pain”
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5. EMPATHETIC GUIDELINES
1. Don’t Criticize
2. Don’t press, don’t fight, don’t punish
3. If you want to influence behavior effectively, the
best thing to do is ignore negative behavior as
much as you can, and praise positive behavior every
chance you get.
4. Learn to recognize and accept the primary
symptoms, and the residual symptoms, of a
person’s brain disorder.
5. Don’t buy into the stigma all around you
6. Lessen your demand for support from your ill
relative.
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6. EMPATHETIC GUIDELINES
CONTINUED
7. Having made these necessary allowances, treat people
with mental illness, day-to-day, just like anybody else.
8. It is important to encourage independent behavior.
9. It doesn’t help to cling to the past, or dwell on “what
might have been.”
10. Every time our relatives “get better” and show
improvement, for them it means that they are moving
back to a risk position.
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11. Empathy must also extend to each of us, who struggle to understand
and encourage those we love who have mental illness.
12. Families tell us that the most important “grace” one learns in the process of caring
for people with mental illness is forbearance, synonymous with tolerance, charity,
endurance and self-restraint.

7. BASIC COMMUNICATION GUIDELINES
1
Use short, clear direct sentences. Long, involved explanations are difficult for people with mental illness to
handle. They will tune you out.
2
Keep the content of communications simple. Cover only one topic at a time; give only one direction at a
time. Be as concrete as possible.
3
Do what you can to keep the “stimulation level” as low as possible. A loud voice, an insistent manner, making
accusations and criticisms are painfully defeating for anyone who is experiencing the symptoms of mental
illness.
4
If your relative appears withdrawn and uncommunicative, back off for a while. Your communication will have
a better chance of getting the desired response when your relative is calmer and in better contact.
5
Assume that a good deal of everything you say to your ill relative will “fall through the cracks.” You will often
have to repeat instructions and directions. Be patient; you will be rewarded in heaven.
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Be pleasant and firm. If you do not “waffle” or undermine what you are expressing, your relative will not as
readily misinterpret it. Communications are our “boundaries” in dealing with others. Make sure your
boundaries are sturdy and clear.
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8. I-STATEMENT GUIDELINES
Express Negative feelings: “When you
pace in the front yard, I get
uncomfortable. I would feel better if
you would stop that”
Make a Request: I want you to wash up
your dishes. I feel relieved to know the
kitchen will be tidy when I get home
from work”
Give Positive Feedback:” I like your
hair pulled back I’m happy when I see
you taking care of yourself.”
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Helpful to Me When I Want To:
Less is More: Calm, Clear, Concise
Positive Requests
“I would like you to go to the day program. I feel
better when I know you have something to do.”
“I will wait for you to brush your hair so we can
go to town.”
“I would be more comfortable if you wouldn’t
blow smoke in my direction.”

9. I-STATEMENT GUIDELINES
People coping with mental illness are often
intensely self-involved and distracted. Many
times they are not remotely aware of our
feelings and responses. I-Statements get their
attention.
I-Statements announce that we have strong
feelings about some of the things our relative
is doing.
I-Statements also communicate that you are
ready to take the initiative, to bring the issues
out into the open, to stand your ground.
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Points to Remember
I-Statement Practice
I feel _________________
when you ________________

10. LEAP
•Listen
•Empathize
•Agree
•Partner
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11. THANKYOU
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