OPINION - Supporting family through mental illness

Carol and I felt an overwhelming sense of despair and desperation when our, then 14-year-old, daughter Lizzie became severely ill with anorexia nervosa, requiring an emergency admission to hospital. Carol was a trained teacher, and I was a former research psychologist, but nothing prepares you for the devastating feeling of helplessness when mental ill-health affects your own family.

nothing prepares you for the devastating feeling of helplessness when mental ill-health affects your own family.

Thankfully, over time, Lizzie journeyed through to recovery, got to medical school, and is now a happy, healthy, doctor. Lizzie says that she will be forever grateful for the clinicians who helped her, but what really made the difference was the family-based self-help that we were able to provide for her.

Helping our children to build a mentally healthy life is not easy, and there are no simple solutions, but I hope that these three short reflections might help you, whatever your situation.

1. Be discerning about diagnoses.

Parents/carers are understandably shocked by the latest statistics which show that 20% of children are probably mentally unwell (NHS Digital, 2023) with many more either developing mental ill-health or at risk of developing it.

Naturally, if our child shows signs of mental ill-health, we feel that we must ‘get a diagnosis’. Certainly, it is always important to talk with the doctor, who can manage risk and provide a pathway to treatment. And it is well established that early intervention is valuable for a full and sustained recovery. But ‘getting a diagnosis’ is not a magic solution, it brings its own challenges.

We may then feel that it is now the responsibility of clinicians to fix the problem, just like they would if they diagnosed appendicitis or a broken leg. And therefore, we might expect to watch passively from the side-lines, missing the opportunity for effective family-based self-help which can be so valuable in recovery from mental ill-health. Our child, also, may experience their own sense of impotence, as they are labelled with what can feel like a permanent condition. Sadly, on social media, an increasing number of young people list their diagnoses, such as ‘OCD’ ‘Anxiety’ ‘Bipolar’ etc, as if they are permanent descriptions which now define them.

'getting a diagnosis’ is not a magic solution, it brings its own challenges.

Early in Lizzie’s recovery journey my wife and I decided that we would never describe her as ‘an anorexic’. She was Lizzie, a unique and beautiful person. Yes, she was living through an eating disorder, but there was much more to her than just this ill-health, and she had a whole life ahead of her. The diagnosis was indeed helpful in providing a pathway to treatment, but it should not define her.

2. Be confident in your capacity.

Increasingly, research shows the value of self-help for mental health, especially within a context where family members have been equipped with the skills to provide appropriate support. As the UK Government’s Green Paper Transforming Children and Young People’s Mental Health Provision puts it: ‘The evidence highlights the important role of the family in ensuring successful interventions, with parental involvement improving the outcomes of many interventions.’

Some of the key skills that Carol and I learned as we supported Lizzie through the illness were how to ask open questions and use reflective listening. By being ‘curious rather than furious’ as the eating disorder drastically altered Lizzie’s behaviour, we were gradually able to gain insight into what the anorexia felt like for her. We began to understand the intense anxiety and guilt she experienced when she faced food or couldn’t exercise. Over time, we discovered how we could use non-directive coaching skills to help her refocus her mind upon her life goals.

I couldn’t make her well again, but I could keep us all together in the boat.

That wasn’t easy for me, particularly, because I am naturally a ‘Mr Fix-it’ kind of person. I like to get things done, and make things happen – quickly. But there is nothing quick about a recovery journey.

In the early days I had an image in my mind. It felt as if the family was in a rowing boat, struggling against the current of a fast-flowing river, to get to a place called ‘Lizzie is well again’. And I felt that my role, as the Dad, was to get us there. So, I was rowing really hard, and so was Carol and other family members. Then I looked round, and there was Lizzie rowing in the opposite direction. So, I got frustrated, even furious. But one day I suddenly realised that I had got the wrong goal. My job was not to ‘get us up the river to that place where Lizzie is well again’. Only she could do that. My role was to keep us all together in the boat. So that we could encourage her, support her, and help her as she made progress on her recovery journey. I couldn’t make her well again, but I could keep us all together in the boat.

So, I changed from leading her on, to cheering her on. I couldn’t fight the illness for her. I had to love her, believe in her, and help her to believe in herself again. It was Lizzie who had the lead role in fighting this illness. I was just a supporting actor. But I had a vital role to play.

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3. Hold on to hope.

When Lizzie was very ill, Carol and I often felt like we were in a dark tunnel with no hope. In fact, the tunnel felt so long and dark that we were tempted to despair that it was in fact a cave with no exit. But the evidence shows that ‘hope for recovery’ is a significant factor that helps people on a journey through mental ill-health. So, how do we maintain hope when we feel despair?

Each individual has their own journey into and out of mental ill-health.

True stories of other people’s recovery journeys can help, which is why Lizzie wrote her story in her book ‘Life Hurts: a doctor’s personal journey through anorexia’. However, we must remember that every person is different. Each individual has their own journey into and out of mental ill-health.

It can be hard for the person who is mentally unwell to hold on to any sense of hope, to believe that they ever could recover. But if their family can hold on to that hope, and can communicate it appropriately, then this can help their recovery journey. Certainly, for Carol and myself, as we supported Lizzie, we regularly told her that we believed in her, that we had confidence that she could overcome this ill-health. And, gradually, that helped her to develop the confidence to believe it herself.

Personally, we were helped by the fact that we are Christians, as is Lizzie. That does not mean that one has to be a Christian to recover from mental ill-health. The evidence is clear that all people, of all faiths and none, can recover from mental ill-health. And it is important to note that what I say now, in the rest of this opinion piece, is from my personal perspective, not in my role as a Director of Family Mental Wealth, which is not a faith-based organisation (it is funded by the government and collaborates with many academic and clinical centres of excellence across the country).

But there is a growing body of research into the mental health benefits of spirituality and faith. For example, regarding eating disorders, a systematic review of 22 research studies (Akrawi et al, 2015) concluded that: ‘strong and internalised religious beliefs coupled with having a secure and satisfying relationship with God were associated with lower levels of disordered eating, psychopathology, and body image concern’.

'I have come that they may have life and have it to the full.'

Certainly, in Lizzie’s case, there were significant steps forward in her recovery journey when I helped her to see the illness through the eyes of her faith, as she describes in her book where she recounts a time when she was very ill in hospital:

‘Dad always carried a Bible in his jacket pocket and, as he sat on the bed, he would ask me if I wanted to read some of it with him and to pray. I always said yes, and one of those readings was another little insight for me. Dad read from John’s Gospel (chapter 10) in which Jesus said, ‘’The thief comes only to steal and kill and destroy; I have come that they may have life and have it to the full.’’ I recall, after he read that verse, how he stopped and read it again, slowly and thoughtfully. We talked about it for quite a while and I remember it dawning on me that anorexia was like a thief, stealing my happiness and killing my joy. That night I wrote in my diary: ‘‘I must stop, otherwise the thief will destroy my life. This is not fair. God and my family love me and that’s all that matters.’’’

From Life Hurts: a doctor’s personal journey through anorexia by Dr Elizabeth McNaught (MD Publishing, 2017)

That moment was not an instant recovery, but it was one step along the journey. There were many more years and many more struggles through which Lizzie travelled. A recovery journey is often long and winding. But, for me and Carol, holding onto the faith expressed in the Bible helped us immensely through that long and painful time.

‘Weeping may stay for the night, but rejoicing comes in morning.’

For me, I found Psalm 30 a particular help. It contains a great promise: ‘Weeping may stay for the night, but rejoicing comes in morning.’ I wrestled with that promise in the darkest times of Lizzie’s illness. I kept asking God when that morning of rejoicing would come. But, as Lizzie gradually progressed through the illness, I discovered that I should not be living for one sudden morning of great joy. Rather there were many mornings of small joys. I learned to be thankful for each one. I celebrated each little step along her recovery journey. And I held on to the faith that there was hope and a future.

Nick Pollard is co-founder of Family Mental Wealth, a social enterprise set up to support others, going through similar situations, to build their mental health and wellbeing through family-based self-help.