Caregivers: When to Push and When to Show Extra Compassion

NOV. 13, 2017

By Stephanie and Andrew Downing


Marriage is difficult for anyone, but it’s even more challenging when you add in the complications of mental illness. My husband, Andrew, has schizophrenia. We’ve lived together for nearly 15 years and we’ve found success as a married couple, but our journey has been filled with many obstacles.

Beyond my relationship with Andrew, I am also a mental health practitioner. Whether I’m caring for someone with schizophrenia or depression, I often walk the narrow, unforgiving line of when to push and when to administer a large helping of mercy. Though challenging people to improve their quality of life is risky, if we don't, those who are struggling may continue to struggle.

People have asked me so many times when and how to encourage, or push, someone struggling with a mental illness. Here is what has worked for me:

Practice Compassion and Mercy First

An act of mercy starts with an open mind and a sensitive, understanding voice while communicating. I constantly challenge myself to see the bigger picture and put aside my own frustrations, so I don’t come across as judgmental or abrasive. As this type of personality can prevent an empathetic viewpoint. If I am open about my own problems around my husband, he might be more willing to talk about his own struggles.

Assess Symptoms

To push someone successfully, knowing when symptoms are flaring is helpful. Phone calls, text messaging or other forms of digital communication can make it difficult to assess symptoms. Body language and word choice, comparatively, offer a wealth of information. For example, anxiety can cause a person’s body to twitch and tighten.

Show Love During Confrontation

Unfortunately, caregivers often have to challenge struggling individuals during difficult times. Waiting for peaceful moments or willing ears is not always an option. That's where the art of confrontation and mercy merge into one cohesive act of love. However, yelling or speaking from a platform of self-assumed intelligence, pride, anger or bitterness typically results in a negative outcome. People tend to respond well to a loving presentation of information that reinforces equality.

Build Relationships That Foster Equality

Healthy relationships start with the understanding that mental health conditions have labels, but those labels don’t represent the person. Treat your loved one as a person who is equal to you, not as a lesser person because they have mental illness. If their relationship with you isn’t built on mutual respect and admiration, it will be very difficult for them to grow or be challenged by you.

With all this said, keep in mind that no one has absolute control over another human beings’ actions. Caregivers must let go at times to remain healthy themselves. Holding on to bitterness or regret can cause a caregiver emotional turmoil.

Expect to make mistakes as you grow into your role as caretaker. Though I have often felt guilty for making his life harder with my pushing, Andrew often tells me he may have been lost to a permanent state of delusion without our relationship. I know that my presence in his life has challenged him to be the best he knows how to be. Never give up on the person you love, and try to remember the immense challenges that a person with a mental health condition faces each day.


Stephanie and Andrew Downing are the authors of “Marriage and Schizophrenia: Eyes on the Prize.” You can learn how Stephanie failed and succeeded at pushing Andrew to be his best through the immense challenges presented by schizophrenia. 


DEC, 30, 2017 06:33:56 PM
Lynn Cansler
My mother has undiagnosed mental illness. She won't leave the house or seek any medical treatment. She's going blind but blames it on the lights. Now dad is in the hospital and she won't accept that he needs a walker and a ramp installed at the house. She will fight the installation of the ramp because it disrupts her rigid routine. She has a difficult time with small changes and now we have a huge change to deal with. Prayers are needed.

DEC, 28, 2017 01:15:31 PM
Sharon Seng
My adult daughter has been suffering from anxiety all her life, but it has gotten worse in the last decade. She has become seriously depressed, and now agoraphobic since her fiance, and a best friend have died, she suffered a broken leg, and lost job her job because of it. We moved her to PA to be closer to us and have finally gotten her SS and Medicare, and a nurse practioner who is helping her, but she needs counseling and a psychiatrist. She will not go to the hospital. She just went on a crazy spending spree and is in debt that is going to affect her SS. We don't know what to do. Any advice?

DEC, 14, 2017 01:38:05 PM
Martha Moet
Also a caretaker for my 42 yr. son suffering with paranoid schizophrenia for 17 yrs in our home. The heart break continues on. He was 2 weeks from his 24th Birthday. He took medication off and on for about 14 yrs. Side affects adds to his suffering. He has lost almost all of his teeth due to constant acid reflux.. He used to tell me what the threatening voices screamed at him and the frightening visions of demons hurting him. I have a mellow voice and seldom raise it. But my husband yells at him with a downgrading loud voice making demands of him which he can't comprehend. The last few months my son will not come out of us room when my husband is home. I have suffered with severe depression for 40 years.

DEC, 02, 2017 08:01:34 PM
Joanna walker
My 30 year old son who has bipolar 1 has been living with my husband and me for 6 years. Prior to that, he took us to hell and back, with threats, nasty abusive behavior, homelessness and jail. We were lucky that an anti-psychotic medication worked for him, and he got insight. We try not to push too much, and we’ve stopped being critical. We encourage him as much as we can, and overlook a messy room or dishes left on the table. I try talk about what he is interested in -mostly video games and anime. I watch with him and hang out with him so he doesnt feel so isolated. We are lucky that he is med compliant and likes his therapist, psychiatrist and coach. We wanted him to go back to school, and every semester I would put the catalogs at his seat at the kitchen table, with little comment. Two years ago, after saying no so many times, he agreed to take an adult education program to become a computer tech. Now, after doing an internship, he is looking for a full time job. My message is:be patient. I hope you will have some successes soon. Have hope that things will get better, because without hope they surely never will.

DEC, 02, 2017 03:20:14 PM
My 28 year old son has a diagnosis of schizo-affect disorder . He was diagnosed ten years ago. Has been working off and on for the last 2 years and is still living with us. He has no money skills and is constantly asking us for money. Knowing when to deny him is hard. He so wants to be on his own which we would love to see but he can't see the need to budget his money. I continue to go to family support groups to help me deal with this . Mental illness consumes our days and nights.

DEC, 01, 2017 02:28:05 AM
Denise Alexander
Thank you.

DEC, 01, 2017 02:27:04 AM
Denise Alexander
I have been looking for a chapter or support group in Tacoma WA. Our son 24 is bi polar. Can you help us connect with any caregiving support? Denise Alexander

NOV, 30, 2017 11:00:27 PM
Claudia Hauri
Ann.....the best explanation I, as a nurse practitioner have for taking meds is: Schizophrenia, Bi-polar, depression is like any other disease /health diabtetes, high BP. You need to take a medicine every day to help stabilize. This said, the stigma of mental illness might be reduced. Hopefully there are no more Nurse Rachets!

NOV, 30, 2017 03:37:26 PM
Diane Weaver
My late husband had bipolar disorder II, which was well-controlled by medication during the last ten years of his life. I, too, had the struggle of what to overlook and what to address -- as a loving peer.He died in 2009, and in remembering him -- missing him each and every day -- I choose to remember only him and not the often-hurtful symptoms of the illness. I had extra motivation from the fact that he supported me so well when I had Stage III Breast Cancer when I was 40 years old and our children were 1 and 4 years old! When the Bipolar Disorder flared up after that, (and after I received excellent education and support from NAMI Family-to-Family) I could gently remind myself that he had supported my struggle against breast cancer. This made me glad to be able to support him in his struggle against bipolar disorder.

NOV, 28, 2017 11:40:48 PM
I too am trying to get help for my son. All I keep hearing is there are no resource

NOV, 27, 2017 07:17:39 PM
My 48 yr old son had his 1st "Psychotic Episode" when he was 22 yrs old. Since then, he has been mostly unmedicated, in jails, institutions and homeless for long periods of time. He has traveled the country while delusional, paranoid, and all that goes along with being Schizophrenic. He has been in group homes., etc., only to walk away.
Currently, my son lives with me. It's winter and I thought that I could handle having him with me. As most mothers, I want to help keep my son alive. It doesn't appear that I am doing a very good job. He can barely put a sentence together. I have become the emotionally abused parent, however when possible I have him court committed. He has been hospitalized 3 times in the last 3 months. The last time, he was kept for 12 days. Not barely long enough for him to be stabilized. I'm anxious most of the time, and wonder what the stress is doing to my body.

NOV, 27, 2017 06:06:15 PM
Glenda Woodard
Hello All, As we all well know this disease have so many different levels. It wasn't hard to get lots of support from my home State of CT including SSDI supplemented with State income. Now retired and moved to SC the laws here for disability/mentally challenge is so unrealistic. We are now faced with no medical insurance because my son currently switched to his father's benefits of $1200 a month placing him about $8 over the guidelines he does not qualify for anything. Not to mention we now have to pay for his meds and 1 out 10 cost $1200 discounted price. So now there will be no money for rent, other meds needed, electricity, phone, or food. The counselling support here is something to be desired.

NOV, 27, 2017 01:12:51 PM
Hi,I needed all that information. Now its time for seeking housing for resting.My son gets very irretiable when he tries to find suitable work His baby mothers persists him that hes alright? How can mom show better Love to help him get better,and take care of him without the problems of the babies mom pursing G hes not doing any better,cause we/he has not our own .

NOV, 20, 2017 03:31:54 PM
Ann Fedele
I like to find out how other "caregivers" be it your spouse, child, parent and so on. I have a 32 yr old son with Schizophrenia, when he was about 22 yr old, he has just started and Stopped taking medication since Jan 2017. He is now on another medication and is so much more like himself, I'm hoping to keep on him this time and instead of stopping meds I told him that the Dr can add another med or increase or decrease his !! I would love some advice on how to encourage him or be more demanding of the taking of meds ?? IDK ?? I feel like I walk on egg shells when dealing with this darn illness.. I've been reading and doing most of what I learned about talking to him and being positive around him, but not overbearing. Sorry I'm rambling . I would appreciate any advise or experience you all may have for me... Good Luck All,

NOV, 17, 2017 06:31:29 PM
SteveAnn Bourgeois
I am currently working to get my son approved for SSDI, he is dual diagnosed and in residential treatment. I learned so much when my husband and I attended the 12 week Family to Family class. We have been suffering silently for about 10 years and suddenly realized we were not alone any longer.

NOV, 17, 2017 02:42:30 PM
Arelative of mine is needing care since Feb 2017.hes diagnosed Acqire Brain Injury .JUSTyesterday I felt like I needed a short break a day ortwo for me .IT Really takes a whole village of support to care for someone so I have to give thanks to HOME Instead my family support the big and little that you do.BEEN WORKING ON finding him housing I do pay attention to his denial of going to any facility.

NOV, 14, 2017 09:10:05 AM
Bill Coussons
Great educational tool...

NOV, 13, 2017 11:21:01 PM
Elsie Virginia Ruiz
Informative and inspiring.

NOV, 13, 2017 06:47:16 PM
Lizanne Corbit
This is a wrestle that so many people struggle with. I love that you say "expect to make mistakes" -- it's OK! Taking on the role of caretaker is never easy and it comes with a lot of weight. Just as you're being easy and supportive of those you're caring for you have to show yourself the same understanding.

NOV, 13, 2017 05:29:22 PM
Kerry Gimbel
Thank you. I am currently trying to help my son who is struggling with mental illness and addiction. I think the time has come to let go for a bit but it is heartbreaking.

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