In recent years, there has been a decline in the stigmatization of mental health. At the same time, there have been more frequent conversations around what mental health issues are and how to best support someone who has mental health issues. National Alliance on Mental Illness (NAMI) is an organization that offers support and guidance for people who struggle with mental health issues, and their families and friends. Here are a few of their suggestions from the organization’s “Tips for How to Help a Person with Mental Illness” article on how to speak with someone who suffers from mental health issues.

• Speak to them in a calm, relaxed manner

• Be respectful, compassionate and empathetic by using reflective language 

• Be a good listener

• Try to avoid telling them to just pray about it or advise on what they need to do

• Avoid talking at them too rapidly or loudly

Notice that the recommendations are common to how many of us wish to be spoken to when we are in conversations. NAMI states that one out of five people live with a diagnosed mental illness. What isn’t explicitly stated is that everyone experiences debilitating events in their lives. Where there is divergence is in how each of us cope with those events. That is dependent on factors such as our natural personality and personal belief system, our formative years, and our perception of events. 

Everyone has experienced trauma in some form, whether it was bullying, losing a best friend to another friend, losing a loved one, war, abuse, family dysfunction or something else. How we respond to these events is guided by factors such as the degree of severity of the events, when they occurred, our natural personality, the implicit and explicit training on how to behave during our formative years, and how we think about the events. All of these factors then intersect with the natural, biological responses embedded in our systems as well.

When mental health issues are viewed as coping skills and neurobiology in action, behaviors and thought patterns make sense in that they developed in response to (perceived) threats to our physical, mental, emotional and spiritual equilibrium. This does not mean that the coping skills are healthy. For example, when someone thinks they see their abusive perpetrator on the streets, they can go into the fight-flight-freeze responses. This may come in the form of attacking that person (fight), suddenly running away (flight), dissociating and not being able to focus (flight), or standing still unable to move (freeze). When someone is feeling emotionally overwhelmed and the system interprets this overwhelm as a threat to the survival of the person, cutting themselves may feel like an appropriate response to alleviate the overwhelming emotions or thoughts by turning the emotional and mental anguish into a more easily definable, manageable pain. 

There is now a deeper understanding of people with mental health issues through the continued development of the psychology field in conjunction with the science of neurobiology. This is resulting in more effective methods for guiding people into healthier lifestyles. Internal Family Systems is a relatively new clinical method to heal mental and emotional wounds. Richard Schwartz, who is the creator of this method, posits that we all have a “multiplicity of the mind” (Treating Complex Trauma with Internal Family Systems workshop, 2018). Each of us contains a core self and three main types of internal parts: “exiles” who carry the wounds, “firefighters” who operate to stop the pain, and “managers” who prevent the wounds from getting triggered. All parts are welcome, have good intentions and seek relief. Yet, as with every family, sometimes the parts clash in an internal conflict that comes out in seemingly irrational behaviors or statements. What may seem to anyone outside the person to be irrational behavior makes sense when viewed as an internal “family” struggle. 

The following examples offer another way to view it. In cartoons, the internal conflict is sometimes shown as the devil on one shoulder and the angel on the other with the character caught in the middle. The Pixar movie, Inside Out, demonstrates a more sophisticated version of this, capturing how each character has internal conversations as they are navigating external conversations. This is in each of us, with the only difference being how differentiated or cohesive our internal systems are. If we understand how complex each of us is, and that we are all operating from a place of desiring healing and no pain, we can become more compassionate and are able to engage in more effective dialogue. 

One practical approach to irrational thought patterns or behaviors is to ask open-ended questions starting with how or what. Questions starting with these words tend to generate a less defensive response than why questions. What and how questions also need to be coupled with a non-judgmental tone of voice. When we ask ourselves or other people questions in order to understand actions or ideas, it is important to keep in mind the difference between criticism and judgment. Criticism asks a person to examine their behaviors and ideas in order to come to greater understanding or change. Judgment engenders no understanding or change. 

Think of the difference between these two questions and see which one you would prefer to answer 

• “Why did you do/say that?”

• “What led you to that behavior/idea?” or

“How did you come to that conclusion?”

The first statement infers a judgmental tone that decreases reflection and personal responsibility, and increases defensiveness. The second tends to generate a critical tone that increases reflection and personal responsibility, and decreases defensiveness. Of course, these are generalized statements because someone whose “firefighter” is active is going to respond defensively no matter what. But understanding that we are talking with the “firefighter” can change how we interact with them, and change the outcome of the conversation.

Overall, communication is a complex system and mistakes will be made. Taking personal responsibility for the part we play when a conversation goes wrong can make a huge difference in how the relationship changes and progresses. There is no one way to do this. There is no direct “right” or “wrong” way to do this. All we can do is remain as compassionate, flexible, open and present as possible in the available conversational moments.

Rebecca Schoenewolf, LMHC, LPC, RMT, holds a master's degree in holistic counseling, and is a Reiki Master and teacher in both Usui and Holy Fire Reiki. She has private practices in Danbury and Brookfield. She can be reached at 203-826-2558, or visit her on Psychology Today or at RSHolisticServices.com.