We sing in church, “Will you let me be your servant, let me be as Christ to you? Pray that I may have the grace to let you be my servant too.” As hurting human beings, we all need to give and receive friendship, prayer, and support. When the person we befriend has a serious mental illness, a unique element enters our friendship. As a person with schizophrenia, a chronic illness that I have wrestled with since young adulthood, I have been on both the giving and receiving end of faithful friendship. Such treasured companionship has eased my suffering and enriched my life.
Here are nine dimensions that may enrich your friendship with a person who lives with mental illness:
A person with mental illness is a person first, before they are an ill person. I prefer to say that I live with the illness of schizophrenia rather than to say I am a schizophrenic. Accepting that we have a mental illness is a long journey because it is part of the nature of the illness to deny that we are actually ill. The book I Am Not Sick, I Don’t Need Help
, by Xavier Amador, declares this common belief in its title. As part of your ongoing prayers for your friend, you might pray for insight into the illness. Pray also for the stigma attached to mental illness to be replaced by understanding, and for better treatment and eventual cure.
Margalea Warner and her friend Kristen Peterson.
- Mental illness distorts thinking in cruel ways. People with schizophrenia may hear voices shouting at them that they are bad people and deserve to die. Somehow, the voices never say kind things about the people they torment. People with depression may not hear voices outside their head, but in their minds, they hear over and over that they are worthless and unloved. It is a vicious cycle and a hard one to stop without help.
A friend in crisis called me saying she had strong urges to hurt herself because she was convinced that she was such a bad person. I did everything I could to help her think more clearly and kindly. I reminded her of the times she had been a good friend to me and of the contributions she made as a volunteer. I tried to help her be in the present moment, encouraging her to eat toast, pet her cats, play her instruments, and in this way to eventually get past the urge. You may find other creative ways to help your friend to perceive reality in a more accurate and kind way.
The confusion of distorted thinking can affect people’s understanding of God, making them think God hates them or has abandoned them. It is incredibly painful to think this way. Repeat to your friend over and over the affirmation that she is a beloved child of God. One friend ended every letter she wrote me, “God loves you and so do I.”
Margalea holding the Woman of Courage award she received from United Way of Johnson County for facing her illness with courage and humor.
- Set flexible boundaries with your friend. Let him know good times to reach you by phone and, likewise, the times of day phone calls are not welcome. Communicating by email is often a good option because your friend can email you at three in the morning and you can respond the next day.
Also, let your friend know how often you will check your email and try to be consistent about it. Emails do not have to be lengthy on your part. For your friend, writing out a long email about what is going on can be part of the healing process.
How to handle times when your friend is suicidal is an important boundary concern. I think most people with mental illness have moments when we are tempted to end our lives. We lose sight of the hope of each new day and long for relief from the grinding pain of symptoms and distorted reality. If your friend tells you of a plan to end her life, you must communicate that urgently to health professionals. Your friend may need to be hospitalized. Over the course of your friendship, as you and your friend build trust, your friend may need hospitalization less often and for shorter periods.
- Help the one you are journeying with to develop structure in her life. A gentle selfdiscipline, even just getting out of bed before noon, showering and eating breakfast, adds helpful structure. Many mental health consumers are on disability and must limit the hours they work in order to retain needed benefits, but they can still volunteer, pursue a hobby, or exercise. Setting a date to go for a walk with your friend gives a reason to get up in the morning.
- Speaking of exercise, physical activity is important in anyone’s life but especially to those taking psychiatric medications that can cause voracious appetite and weight gain. After I started the atypical antipsychotic clozapine, I gained a considerable amount of weight almost overnight. I joined Weight Watchers. With encouragement and support from leaders and fellow members, I dropped the weight, and I have kept it off. Share healthy meals with your friend and go for walks together. Affirm your friend’s inner beauty. Let him know you believe he can learn healthy new habits.
- One symptom of mental illness can be anger. Your friend may lash out at the very people whose support and affection she needs the most. This is destructive to her support system. Encourage your friend to take a deep breath and pause before saying hurtful words. It is not easy, but try to model patience and unconditional acceptance.
Help your friend direct anger at the illness rather than the people who care about him. Tell your friend, “I’d like to help you use your anger to fight symptoms and self destructive impulses.” Your friend may have good reason to be angry at insurance companies or Medicare for denying coverage of a medication he relies on or a dosage he needs. Walk beside your friend in this and advocate in whatever way you can.
Ultimately, your friend may need to express anger at God. God can take it! If you read the Bible with your friend, turn together to the book of Job. Job was not afraid to ask God hard questions about the reason for his suffering. God answers Job’s questions with a larger question. “Who has put wisdom in the inward parts, or given understanding to the mind?” (Job 38:36) We may not ever know all the answers but we can pray for wisdom and understanding.
- Realize that your friend needs support from a variety of sources. A good place to start is to see if there is an affiliate of the National Alliance on Mental Illness (NAMI) in your area. Look for a listing in your phone book or visit the NAMI website.
- Another support that can be meaningful to people with mental illness is the international program known as Compeer. People receiving mental health services are paired up with a friend to spend at least four hours a month together. My Compeer match and I get together for coffee or lunch, shopping at secondhand stores, attending plays or movies, and just hanging out. Studies have shown consumers with friends have better overall health and quality of life. I have learned that my white cell count, which we monitor closely because of the medicine I take, is often healthier after spending time with a friend. What a difference a friend makes!
- Finally, don’t be afraid to laugh with your friend. Laughter is a wonderful gift. And face it, life is pretty funny sometimes. While you cannot cure the person with mental illness who you walk beside, you can give hope for recovery. You can give forgiveness. You can be yourself. These are true gifts.
Margalea Warner worships at First Mennonite Church in Iowa City, IA. She is active in the National Alliance on Mental Illness and a founding board member of Compeer of Johnson County. This article was first posted in 2009.