How do Irish families deal with mental distress?

When Zita McMahon heard that the eldest of her four children had been diagnosed with depression after a breakdown last March, her first reaction was that she wished it was anything but that.

“If she had diabetes or asthma I would have said, ‘Oh well, that’s a shame but she can live a normal life with any of those.’ So I had a quick talk with myself and said, ‘This is an illness and you are going to have to deal with it, as if it was diabetes or asthma.’”

It is an attitude that has shaped the approach ever since of both Zita and her daughter, Jill (22), to the condition. They believe that being as open and upfront about it as they would be if it was a physical illness not only helps Jill in her recovery but can also contribute to the destigmatising of mental health issues.

In many ways the diagnosis came as a relief: Jill no longer thought she was going mad and Zita, a teacher, was able to acknowledge the problem she had known “deep down” was affecting her daughter.

Likewise, Jill’s sister, who is close in age, had sensed something wasn’t right and she was told straight away.

While early discussions on the illness were conducted out of earshot of Jill’s younger brothers, aged 15 and 16, Zita soon saw they needed to be in on it as well.

“I just told them straight: ‘She has depression, there will be medication that will help her. It will take a while to sort out her doses and in the meantime we will just be patient and understanding with her.’”

When they asked what they could do to help, Zita replied: “Well, she responds well to hugs.”

A few days later, sitting around the dinner table at home in Co Clare, one of the brothers turned to his sister and said: “Well Jill, how was the depression today?”

The matter-of-factness, putting it out there in the open just as if she had a head cold, was exactly what Jill needed.

“It made me laugh and feel better,” Jill recalls. She knew depression was new to everybody in the family but was reassured by the sense that they would get through it together.

Some of Zita’s friends thought she shouldn’t be going around talking about it, as it might backfire on Jill when, say, looking for a job.

"I found that interesting but it didn't put me off," says Zita. Jill found a similar mixed response among friends, particularly when she started to write about it in her blog, salessmilesandstyles.blogspot.ie.

'Unbelievable' reaction
Overall, she says she has had an "unbelievable" reaction to the blog and some friends were able to open up to her about how they had been going through something similar.

“If this helps just one person, we will feel we are doing something right,” says Jill.

On the face of it everything was going extremely well for Jill six months ago. She had graduated with a degree in journalism and Irish from Dublin City University, went straight into a job at the university's Irish department, had a lovely place to live and plenty of friends around. Yet, she felt she was not coping well with "adult life".

“I knew there was something wrong – it was a kind of mist.” She was very tired, couldn’t concentrate, felt breathless and anxious and didn’t know why.

“I was trying not to wallow in it – walking an hour to work every day and trying to snap out of it.” She was cranky with housemates and cleaned manically, “trying to control my surroundings because I could not control my own head”.

However, she thinks it came as a shock to people when she did have a breakdown. “I cried for three hours non-stop one night.”

There was no trigger and she had no idea why she felt so sad. “I had an impending sense of something bad going to happen.”

A cousin helped Jill get home, where she felt safer back with the family and was able to go to see her old GP who diagnosed depression straight away.

After about two weeks she was able to return to work in Dublin and has recently started studying for a Masters in digital humanities and culture. Now if she has a down day, she texts Zita just to let her know, on the basis of a problem shared.

“I think you can isolate yourself easily when you are trying to be independent and deal with it yourself.”

Christine Fitzgerald did exactly that when she was struggling with depression as a teenage mother in Limerick.

"I was only 18 and came from a family of 12 and had very good parents but I told nobody and just hoped and prayed it would go away. It didn't; it just escalated over the next six years."

Felt like a burden
She was so ashamed, felt like a burden and could come up with hundreds of reasons why her husband and children would be better off without her.

“It is not necessarily wanting to die, it is just wanting to stop the pain,” she stresses. Yet, despite her mental turmoil, she says she functioned very well as a mother.

The turning point came when she was admitted to a psychiatric hospital. “The secret was out.”

It was Christine’s mother who realised her daughter would need ongoing support once she came out of hospital and suggested she go along to a local meeting of the community mental health organisation Grow.

“It is one of the best moves I ever made,” she says.

“Grow is not just a place people go and talk about their problems, but you are encouraged through the Grow programme to do something about your problems.”

She likens it to a self-development course. “You learn the skills to pick yourself back up, or to maintain your mental health.”

While it took her a couple of years to get back on her feet she has never returned to that darkest of places and has been able to come off medication.

Now Grow’s national co-ordinator, Christine, recites one of the organisation’s sayings: “Each person’s recovery aids the transformation of the world,” adding: “I always think of my children when I read that because I cannot even begin to imagine how their life would have turned out if I had remained sick.”

Ripple effect
When the focus is on an individual with mental health problems, the ripple effect on the family around them is sometimes forgotten.

Those loved ones can play a huge part in the ill person’s recovery but they need to protect their own mental health at the same time.

As the director of services at St Patrick's Hospital in Dublin, Tom Maher, points out: "We see the patient for appointments or, for an average of 30 days if they are inpatients, really everything after that has to be the support of the family."

It’s a tall order, particularly if family relationships have been bruised or fractured in the preceding months or years before the mental health issue was diagnosed and treated.

“You will often find that people who have a mental health problem will start distancing themselves from significant others,” says Maher.

“One of our jobs is not only to deal with the person themselves but to re-establish those close relationships.”

That can be particularly problematic if the person undergoing treatment does not want staff to have contact with the family, as the hospital has to respect his/her right to confidentiality.

Pieta House, which offers free counselling to those who are in suicidal distress or engaging in self-harm, is unusual in that it allows family members to make an appointment for somebody they are worried about.

“We know a lot of the people don’t know whether they want to live or die, so the chances are they are not going to pick up the phone themselves,” says Cindy O’Connor, chief operating officer at Pieta House.

Last year, Pieta House saw 2,736 clients – up from the 70 seen during its first year of operation in 2006 – and 22 per cent of those were aged under 18.

While people of all ages and backgrounds come in for counselling, the largest client group is aged between 26 and 44.

Knowing how difficult it is to get men to access services, staff were surprised that, within that group, there was little difference between the numbers of men and women seen.

Third-party system
When they dug deeper into the data, they found it was mostly women who called to set up appointments and it convinced them of the importance of having this "third-party" system.

Although this sometimes results in “no-shows”, once the family gets the affected individual into Pieta House, says O’Connor, “they see it is a really nurturing environment to come into. The process of engagement is very, very high for us.”

Apart from therapy for the individual, Pieta House offers support for family members. Sometimes parents of, say a young person self-harming, just need a once-off information session about appropriate and inappropriate ways to respond, says O’Connor.

“A lot of the time they are frightened and afraid to put any boundaries in place in case the child may self-harm again, whereas boundaries are the one thing that contains the child and makes them feel safe,” she explains. They also have to be careful they are not “rewarding” the behaviour either.

If a husband and father is feeling suicidal and has made a couple of attempts, the whole family is obviously upset, but they may be feeling angry with him too and overwhelmed themselves.

One-to-one counselling
There is no right or wrong way to feel, she stresses, and family members can avail of up to 10 one-on-one counselling sessions.

“We give them space to explore how difficult it can be but how to stay connected to the person who is distressed.”

People who are concerned about the mental wellbeing of a family member should look at the frequency, intensity and duration of that individual's low mood when considering if it is something they need to be alarmed about, advises Dr Claire Hayes, clinical director of the depression support organisation Aware.

It is normal for all of us to experience tough times, stresses Hayes who is concerned that there is widespread panic that if a person is experiencing mood disorders, they are regarded as depressed and likely to attempt suicide.

“People are now linking suicide with depression massively. That is becoming a dangerous, self-fulfilling prophecy,” she warns.

“Just because people think they are better off dead, does not mean they are suicidal. That is a key thing for people to know.”

However, it is very important for family members to know how to respond.

After acknowledging the distressed person’s feelings, it is important to focus on what they might do about them, rather than just telling them they will feel better soon.

She also recommends not telling people to think positively. “The pressure on all of us to think positively has generated depression,” she argues.

Whether it is a child, partner or some other family member who is distressed, Hayes's mantra for the best approach to take is: "It is okay to experience difficulties but what are you going to do about it?" We always have options.

swayman@irishtimes.com

What should we tell the children?
“Mommy is a little bit sick, but she will get better,” is something US writer Therese Borchard has been saying a lot recently to her 10-year-old daughter Katherine at home in Maryland.

Having been raised by a mother with depression and now rearing two children herself while coping with the illness, Borchard blogs on mental health and has written several books, including What Does Depressed Mean: A Guidebook for Children with a Depressed Loved One (Abbey Press).

With her own children, Katherine and David (12), she says she compares it to something they will understand, like a broken leg.

“I say that my head is in a cast like the broken leg, and is healing,” she tells The Irish Times.

And she summarises the other things she makes sure to say to them regularly: "I'm just sick, that's all"; "You are not to blame"; "People who are depressed cry, but the crying has nothing to do with you".

“I am getting better; Depression can be fixed (treated)!”

“Don’t take anything personally. Depressed people can act strangely but that has nothing to do with you”; “You are still very loved.”

Parents attending St Patrick’s Hospital in Dublin are advised to be open and honest about their illness and explain it to children in age-appropriate terms.

It can be very frightening for them if their mother or father suddenly disappears and nobody is saying much about it.

“We don’t give children enough credit for their understanding,” says the hospital’s director of services, Tom Maher.

“What often happens is they kind of understand.

“They hear adults talking in hushed tones and if they are not told what the actual issues are, their imagination runs wild and it causes a level of distress that isn’t necessary.”

Service users are encouraged to have their children brought in, using the child-friendly visiting area, The Wishing Well, that has been opened at the hospital.

“Once the children see their parents, they become very reassured,” he adds.

“What we are trying to do, particularly with children, is to destigmatise mental health.”