Learn why people deny their mental illness and how to handle your mentally ill relative's anger and your feelings of guilt associated with the mental illness.

Why people resist accepting they are mentally ill and resist taking psychiatric medications

People resist accepting that they are mentally ill because:

1. They are experiencing denial---a common first reaction to shocking or bad news such as a death or the diagnosis of a seriously disabling illness.

2. They are in pain due to the social stigma associated with mental illness. The implications for the future are also painful and involve:
   • grieving the loss of some of their dreams and the ability to have normal lives
   • lowering their expectations for what they will have in their lives
   • accepting the need for long-term treatment

3. They are experiencing a symptom of the illness, in one of several ways:

   • continued, massive denial of problems a primitive defense mechanism to preserve the fragile sense of self-esteem that ill people have
   • delusional thinking, poor judgment, or poor reality testing

People resist taking psychiatric medication because:

1. The side effects can be upsetting and unpleasant.
2. It may mean admitting that they have a mental illness.
3. It may feel like they are being controlled by an outside force. It can trigger issues people have about loss of power and control in their lives.
4. Reducing symptoms, and thus seeing the limitations of their lives, can be more painful than being lost in psychosis. Many people in manic episodes prefer that high-energy state to the lower-energy one they feel on medication.

Handling your mentally ill relative's anger

If you are both angry and fear losing control, it is best to separate, protecting everyone from injury. If your relative is angry and you are not:

1. Remain as calm as you can; talk slowly and clearly.
2. Stay in control. Either hide your fear, as it may cause the situation to escalate, or tell the person directly his or her anger is frightening you.
3. Do not approach or touch the person without his or her request or permission to do so.
4. Allow the person on avenue of escape.
5. Do not give in to all demands; keep limits and consequences clear.
6. Try to determine whether the anger is completely irrational and thus a symptom of the illness, or if there is a real cause that you can validate.
7. Do not argue irrational ideas.
8. Acknowledge the person's feelings and express your willingness to try to understand what the person is experiencing.
9. Help your relative figure out what to do next.
10. Protect yourself and others from injury; some outbursts cannot be prevented or stopped.

If angry outbursts are a recurring problem, wait until everyone is calm and then brainstorm acceptable ways in which the person can handle angry feelings and remain in control. These might include:

1. being clear and direct at the time of minor annoyances; so the anger doesn't get bottled up and explode
2. venting some energy via exercise, hitting something safe (a pillow), or yelling in a secluded
3. leaving the situation or taking some time out to write in a journal or count to oneself
4. taking an additional dose of medication, if prescribed