Supporting Loved Ones with Mania or Psychosis

Supporting Loved Ones with Mania or Psychosis

By Brianna Riddlebarger

Having a loved one struggle with severe mental health symptoms can be scary, painful, frustrating, and even confusing. In the case of mania or psychosis (defined as delusions, paranoia, or hallucinations - living in an alternate reality and unable to be convinced otherwise), it can become especially distressing for family members and patients. Mania and psychosis typically respond well to medication intervention - either by targeting it altogether or by reducing intensity of symptoms so that they are easier to manage. Getting help early on is important, but it’s also important to know a few other things when you are watching your loved one in a manic or psychotic state.

1. Avoid personalizing their behavior  

Unfortunately, many individuals do or say things that they deeply regret when going through mania or psychosis. By definition, reason, impulse control, or sensibility becomes lost when these states take over. It’s part of the illness. It’s important to separate this from someone’s morality, character, or identity. While we don’t ever encourage enabling or minimizing unhealthy behaviors, it’s essential to not take what is said/done personally as an attack on you. This is especially difficult when manic anger takes place, or when your loved one is paranoid of you and may accuse you of things that don’t make sense to you. Their reality is distorted and needs to be treated. 

So instead of personalizing it:  a healthy and appropriate response is “He isn’t well and is doing things that are hurtful and irrational. This is his illness and it needs to be treated.”

If it helps, imagine someone who may struggle with blood sugar issues. When their blood sugar drops inappropriately or rapidly, that person will naturally become more irritable, disengaged, or reactive.  The solution isn’t to argue with the person, but to target the blood sugar, and then build skills around when the blood sugar is affected. Similarly, the mania or psychosis has to be targeted, then we build skills around it to support function (in life and relationships). Personalizing their behavior just hinders progress and escalates everyone involved.

2. Avoid demonizing their behavior

Just as mentioned above, separate the illness from their character, morals, and identity. This especially means to avoid labels such as “crazy”, “evil”, “immoral” or anything that stigmatizes their suffering. Demonizing just creates frustration for the patient enduring these symptoms and you! 

It’s tempting to do this when you’ve been hurt, or you simply don’t recognize them for their behavior. But staying objective and regulated will help them also do the same when they are receiving treatment.

3. Don’t try to argue or convince them, or solve core conflicts

By definition, those in a psychosis state are unable to be convinced otherwise of their hallucinations/delusions. Attempting to argue if a hallucination is actually real is fruitless. It can worsen their symptoms because they don’t feel heard or safe, or even start experiencing negative psychosis about you! Psychosis is always worsened when someone is stressed, and arguments or feeling invalidated increases stress. Rather than argue, stick to statements such as “well I don’t see it but I believe that you see it” help them feel heard without you agreeing with the hallucination existing.  Mania by definition is known for being impulsive, unpredictable, or even angry. It’s not helpful to argue with someone in this state. De-escalation skills such as speaking slowly and calmly, open body language, and active listening are essential. 

With either of these states, don’t try to solve major conflicts in your relationship. That will be addressed later when medication and other interventions are involved. Your focus as a loved one is to de-escalate and help them get treatment to stabilize.

4. Hold Boundaries and Expectations

An empathetic and de-escalation approach does not mean you enable or avoid addressing what is going on. Holding boundaries and clear expectations is also important. They just need to be simple and primarily focused on protecting safety and getting your loved one the right treatment. 

Your expectations, boundaries, and reinforcements are critical for your loved one to get medication intervention for any of these symptoms. You hold these expectations out of love and concern for their health because there is illness going on. Just like the loved one of the diabetic patient needs to be clear on diet interventions and taking their diabetic medications regularly to prevent amputation or heart attack - you also need to have this vigilance and concern. To take it further, don’t expect your loved one to always want the treatment. Insight and awareness are often impaired in these conditions, so your insight and clarity is important to helping push them to the right treatment.

Walking through these steps as a loved one can be tricky or overwhelming. This is where getting help with a therapist or case manager is helpful - to guide you and your loved one on a path of healing and consistency. If your loved one is suffering from mania or psychosis symptoms, contact us to receive an evaluation and prompt treatment with family support. 

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