How mental health care affects family

“A distant relative has been caring for a mentally ill mother for close to a year now but her neighbours suspect she is herself too running into some sort of psychosocial disorder. How possible is that?”

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A few weeks ago, two young men brought their father for evaluation of what was becoming a serious family problem. At the age of 74, the man who had previously been a shopkeeper, managing his affairs well over many years had become progressively forgetful. He was losing keys, was rude to his customers and was losing money often, accusing his family of theft. He had recently been noticed to be aggressive towards his wife, sometimes accusing her of having affairs with the church minister. This was the straw that broke the camel’s back because this was a perfect couple.

The mother of two boys had put her life on hold to look after her husband as she had promised to do on her wedding day. She had vowed to be by his side in sickness and in health. It was clear that her husband was no longer able to look after his affairs and seemed very depressed and irritable most of the time.

He did not know what day of the week it was and sometimes asked to be taken to church on days such as Thursdays or Fridays.

On account of increasing disability, the boys lamented that their mother had neglected herself, and spent most of her time caring for her husband of 55 years. She did not go to church herself, she ate badly and hardly slept. She became isolated and no longer belonged to the local community. It was clear that she was herself becoming progressively depressed and lonely.

Following a period of evaluation and detailed history taking, it became clear that the man in question was suffering from Alzheimer's disease, which is the commonest cause of dementia. This is itself a mental illness that is caused by the gradual damage and deterioration of brain cells due to some changes in the nature of the proteins of the organ. It is common among the elderly all over the world and is a cause of much concern to care givers who often, as in the case of your relative, succumb to mental illness.

In consultation with the family plans around managing the old one included strategies for giving him medication that would reduce the progression of the Alzheimer's disease, but most crucially putting in place a support system for the wife who was herself clearly in danger of developing a mental illness. This is a component of care that is often forgotten by some doctors and families.

In her case, a helper was found and she was given opportunities to take time off to go to church as well as time for her own personal wellbeing without guilt. She reconnected with her sisters and her Chama and soon blossomed and was a better carer for her husband.

At the other extreme of life, we recently saw a mother of a 20-year-old girl who had developed schizophrenia while attending university. She as a single parent who had invested all the material and emotional resources she had, to give her only child, a life that was better than hers.

The onset of the illness had been gradual and the girl had initially presented with difficulties attending her computer classes, her moods had changed, and she frequently fought with her classmates over trivial things. She started to complain that she was hearing voices talking ill about her and also believed that teachers were in some way interfering with her thinking process using X rays. Her behaviour was clear evidence that something was wrong.

Following examination, it was clear that she had a schizophrenic illness that required treatment. Her mother who worked as a banker suddenly stopped work and became engrossed and deeply involved in the management of her daughter. In all respects her life stopped. Her relationship with her boyfriend deteriorated severely and in time, it was clear that she had herself developed a depressive illness. Instead of one, we had as in your case two patients, neither of which could support the other.

As you can see from these two stories caring for a person with a mental illness (or physical illness) can itself predispose to the development of different types of mental disorders including depression.

It is for this reason that we always recommend that the carer also be careful to make sure that they maintain their own mental health. It is true that you cannot be a good carer if you are not well yourself.