Supporting Mentally Ill Loved One

C. Alec Pollard, Ph.D., is Founding Director of the Center for OCD and Anxiety-Related Disorders at Saint Louis Behavioral Medicine Institute and Professor Emeritus of Family and Community Medicine at Saint Louis University School of Medicine. He is a licensed psychologist who works with a range of obsessive-compulsive and anxiety-related disorders, with a special interest in obstacles that might inhibit the pursuit of recovery or interfere with effective participation in treatment. He is on the Scientific and Clinical Advisory Board of the International OCD Foundation and chairs the organization’s Training Subcommittee, including a national training initiative called the Behavior Therapy Training Institute. Dr. Pollard is former chair of the Clinical Advisory Board of the Anxiety and Depression Association of America and has authored over 100 publications, including 3 books – “The Agoraphobia Workbook, Dying of Embarrassment: Help for Social Anxiety & Phobia,” and “When a Loved One Won’t Seek Mental Health Treatment: How to Promote Recovery and Reclaim Your Family’s Well-Being.”

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the “Inside Bipolar” podcast with Dr. Nicole Washington.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hey everyone and welcome to the podcast. I’m your host Gabe Howard. Calling into the show today we have Dr. Alec Pollard. Dr. Pollard is the former chair of the clinical advisory board of the Anxiety and Depression Association of America, and he also wrote three books, including, “When a Loved One Won’t Seek Mental Health Treatment: How to Promote Recovery and Reclaim Your Family’s Well-Being.” I also want to give a great big thank you to Evernorth Health Services for providing funding for this episode. Dr. Pollard, welcome to the podcast.

C. Alec Pollard, PhD: Well, thank you for having me, Gabe. I really appreciate it.

Gabe Howard: It is my absolute pleasure for you to be here today. I’m really looking forward to this conversation, because it’s not surprising that people who are caring for someone with a mental health issue or a mental illness will experience a lot of anxiety and depression. Now, what is surprising is how little help there seems to be available for caregivers. Now, today, we’re going to be discussing how to take care of yourself and combat burnout when you are in that caregiver role. But Dr. Pollard, for many caregivers, even stopping for a moment to think that they might be experiencing burnout feels disloyal. They think to themselves, how can I justify taking time for myself when that is time that I am not spending on my loved one and my loved one is going through so much? How can I make this about me? It really seems like they internalize this as selfishness.

C. Alec Pollard, PhD: Oh, they absolutely do. And it’s very, very common now. Certainly not everyone, but an awful lot of caregivers think about now, their caregivers. So they see themselves as the person who is providing the care. And a caregiver, again, could be a spouse. It could be a son or a daughter of a parent, could be a parent. So it can go in all directions within the family. But that that person is often so focused on the individual who’s been diagnosed with some kind of mental illness, that they don’t feel that it’s appropriate to think about themselves. And and that’s really a form of really toxic thinking because and I’m going to start with an analogy that will sort of set the tone for.

Gabe Howard: I love that, I love that analogies are the best.

C. Alec Pollard, PhD: Well most of our listeners have probably been on an airplane. And when the flight attendant comes out, this is not what the flight attendant says. In the case of emergency, make sure you put the mask on the child first. Even if you’re passing out in the process of doing it. They don’t say that. They say put your mask on first before you try to help your loved one put their mask on. And there’s a point about that. That is that we’re not robots. We’re human beings, and we have feelings, and we have energy levels that not all are not always there. We have moods that are not always there. We’re human. And now I haven’t inspected all of your listeners, but I’m going to go out on a limb and think they’re mostly human. Uhm.

Gabe Howard: I’ve gotta believe they are.

C. Alec Pollard, PhD: I don’t know what your marketplace is among robots. Maybe? Maybe you’re big with them? I don’t know, but given that you’re a human being out there, you have your own needs. And sometimes you mean. Well, but you’re actually ignoring the very things that you’re trying to provide to your loved one. And so it is. Absolutely. And there’s if we have time today, we can go over some of the myths that that caregivers may hold, that actually keep them from taking care of themselves?

Gabe Howard: I think that would be a beautiful place to start.

C. Alec Pollard, PhD: Well, okay. So. And getting the help might be making a phone call to get therapy for yourself. Or it could be reading a book about self-care and self-compassion, or just on your own thinking about how to improve your psychological well-being. Whatever it is, the reluctance to pursue those things has to do sometimes with myths like, if I take care of myself, I’m being selfish. For example and as if actually nurturing yourself would be selfish. It’s self-oriented. But somehow the word selfish becomes this pejorative term that means you shouldn’t do it. And again, we’ll come back to this a lot. The more you don’t take care of yourself, the worse you are at taking care of others. Another myth is if I take care of myself, it takes energy away from me taking care of my loved one. Again, false. No. It gives you more energy, greater well-being to be able to handle your loved one and. And all the stress that comes with that. More effectively. There’s also, well, what if my loved one gets mad at me? In other words, if I’m not available while I go take yoga? They might get mad at me or whatever. They might. But that’s not in your control. What’s in your control is whether you take care of yourself, and you’ll be able to handle whatever anger you get by taking care of yourself. You’ll be in a better place to do that. And I would say this, that in in our book, we talk about how to present these changes in your behavior that end up taking care of you, how to present it in a way to your loved one, to the person you’re taking care of in a way that is good for everyone. It’s it’s about I want I want to treat you better because it’s going to come a shock. This is a shock to your listeners.

Gabe Howard: All right, hit me, hit me, hit me.

C. Alec Pollard, PhD: You ready?

Gabe Howard: Yep, yep, ready.

C. Alec Pollard, PhD: Occasionally, caregivers get testy.

C. Alec Pollard, PhD: I know. No, no. I know.

Gabe Howard: They have their own emotions?

C. Alec Pollard, PhD: It’s it’s a shock. This is why everybody’s tuning in to get this latest news. Yeah, they maybe are. Don’t behave in ways that maybe later they think. Hmm, I should have said that differently. Or they get a little cranky. They do whatever they, in fact, are being human because you cannot give, give, give and not eventually start to burn out. And that’s our whole message here is taking care of yourself, because you actually become not only you’re taking care of yourself, you’re going to handle the person you’re taking care of more effectively. You’ll be less cranky. You’ll be able to say things with a calm voice. You’ll be able to be strategic in how you deal with that person rather than blow off steam or lose it because you can’t take it anymore. And then you say things you have to come back and apologize for. So, all of this is about the betterment of the entire family system. Everybody benefits from everybody taking care of themselves.

Gabe Howard: I think the driving force behind this is that if the caregiver lets their guard down, even for a moment, even to take care of themselves, that something bad will happen and that that bad thing cannot be overcome. You know, they’re worried about arrest and death and self-harm and suicide and,

C. Alec Pollard, PhD: Right.

Gabe Howard: You know, the outcomes of psychosis. And I really think that’s the driving force that even though they will admit that they’re not 100%, a 50% caregiver is better than no caregiver.

C. Alec Pollard, PhD: Yes. But that’s not your only choice, is it? You could have a 50% caregiver, or maybe even 75 or 80% caregiver, if you change the way you think about things. In our book, we have five steps that we outline for caregivers. And the very first step speaks to what you just said. Crisis. Prepare for crises. Prepare for the things that often keep you locked in to doing things that burn you out. For example, very commonly, if you try to take care of yourself, depending on what it is. But some of the things you do may be experienced, even if you’ve dealt with it diplomatically and effectively and said things the right way, the the individual may see it as a threat. So if and we’re just going to pick on yoga today, so.

Gabe Howard: Yeah. Yeah. Yoga. Yoga is terrible.

C. Alec Pollard, PhD: Yeah, yeah.

Gabe Howard: Yoga is terrible. [Laughter]

C. Alec Pollard, PhD: Poor yoga. I love yoga, but some of my best friends are yogis. Anyway, so you go to yoga class and your loved one says I think if you go, I don’t know if I can handle it by myself alone and and hinting maybe at suicide or self-harm. That scares the family member. Right. So now they cancel their yoga date or whatever. And the thing is that that locks them back into what we call the family trap, where everyone is sort of trapped around the one person’s mental illness. And so, instead, prepare for crises. There are ways, effective ways to deal with crises that don’t reinforce them for future events, but deal with it and get to the safety of the everybody in the family depending on what the crisis behavior is, get that taken care of as quickly and swiftly as possible, with as little discussion or innuendo or all the things that pulls people into these traps. But you definitely have to have a plan for how you’re going to do what you’re going to do in the face of some crisis behavior that your loved one might exhibit temporarily. What we find is if you’re consistent, you do it right. That fades as the individual with the mental illness begins to see, oh, she comes back feeling better. She’s not yelling at me as much or whatever it is. So everybody wins with this mindset.

Gabe Howard: Hi, listeners. Your host, Gabe Howard here. And I want to let you know about a fantastic free resource I recently learned about. If you or someone you know is struggling, or even just wants to learn more about mental health, check out the Anxiety and Depression Association of America’s website at ADAA.org. The ADAA has tons of free resources and even a Find Your Therapist tool to help you find support close to home. Their website again is ADAA.org. That’s ADAA.org.

Gabe Howard: Funding for this episode was provided by Evernorth Health Services. And we’re back speaking with Dr. Alec Pollard discussing how caregivers can avoid burnout. Let’s talk about symptomology. What are the symptoms of caregiver burnout? So if a listener is on the fence and they’re like, well, am I showing the symptoms or am I just complaining?

C. Alec Pollard, PhD: The number one thing is resentment. And it’s very hard for some caregivers to acknowledge resentment because they think somehow that’s a betrayal, that that they shouldn’t feel resentful that they’re doing all these things for their loved one. After all, it is my loved one. As if again, that would be true for robots as far as research has shown that robots do not feel resentful when they take care of loved ones, but humans do. And so in our work with families, we really have to encourage them sometimes to be honest about how they feel, and to not judge the feeling or try to talk it away because that’s their signal. Because if they’re resentful, I’m telling you this. If they’re complaining, they’re resentful. So how does resentment get expressed? Crankiness, negative statements, lecturing, whatever. These are all things that we call minimizing for those who are read the literature. You may have heard the term expressed hostility, but these are the things we do to change the person with the mental illness to demand change lectures, yelling, guilting, whatever it is. It can even be positive. It could be coaching them and trying to cheer them up. But those things, those things can lead you into a trap because the recipient of that behavior is not happy to have this behavior. Usually it will be met with equal hostility, even greater. And then you have family conflict.

Gabe Howard: One of the words that keeps coming up over and over again whenever you do any research on caregiver burnout is resentment and doing harm. And I think that to the average caregiver, they’re like, well, how could me being present and trying and doing my best ever cause harm? Can we delve into that a little bit? Because I, I know that caregivers don’t set out to make mistakes or set out to cause harm, but I

C. Alec Pollard, PhD: No.

Gabe Howard: Also know that it happens a lot in the mental health community. Patients, people living with severe and persistent mental illness are constantly reporting that they feel abused or neglected by people who I see as well-intentioned, hardworking and loving caregivers. And I’m that makes it difficult for me because I’m I’m seeing both sides. So you’ve mentioned resentment and you’ve mentioned causing harm. Let’s really delve into that.

C. Alec Pollard, PhD: Okay. And and I cannot stress this enough that the person, the person with the mental illness. That person didn’t ask to have a mental illness. There’s no shaming or judgment. They’re behaving the way they know to behave. It may be dysfunctional, but that’s what they know. The family members are in the same boat. Nobody taught families. I didn’t have this course in high school how to deal with someone with an illness or psychiatric impairment. Did you have it? I didn’t.

Gabe Howard: No, no, nobody taught me. Of course I went to high school in the in the 80s, but I don’t think it’s great in 2025. But it was really, really bad in the 80s and 90s.

C. Alec Pollard, PhD: Yeah. So we had those courses in the 70s and 60s. We stopped them in the 80s because we knew you were coming through.

Gabe Howard: Yeah, I knew it.

C. Alec Pollard, PhD: We didn’t.

Gabe Howard: I knew that it had to do with me. I knew it! [Laughter]

C. Alec Pollard, PhD: We didn’t want you. Didn’t want you to have it. Because if you knew all this, then you wouldn’t have invited me. But.

Gabe Howard: Right, right.

C. Alec Pollard, PhD: So. So any rate it’s really important to understand that people are behaving how they know to behave. They don’t know another way or they do it. And even if they knew another way, there, there are barriers standing in their way even after that. So we understand there’s no judgment here. If you I use the analogy of if you’re standing in a tornado, your hair will get messed up. You’re not doing anything wrong except standing in the tornado. Now, it’s a terrible analogy because for me to use. Because I’m bald. But anyway, for most people, their hair would get messed up. So what does that mean, exactly? It means that there are some things that are almost inevitable under certain circumstances, because people are reacting to reactions to reactions. So when you have someone who who needs your assistance, for example, the natural inclination is to help. That’s a good thing. I’m not going to stand up here and say, oh, you shouldn’t be helping these people. Yes you should. I mean, you should at least consider that option. The problem is that if they’re helping and the person is not meeting them halfway, not trying to get better, and maybe assumes that that is their entitlement, not really appreciative of it.

C. Alec Pollard, PhD: Then it starts to set up this dynamic that almost always will lead to people being burned out.

Gabe Howard: I know that we’re almost out of time, but I want to ask, is it even reasonable to think that you can combat caregiver burnout? Isn’t this just the inevitability of caregiving that you are going to burn out?

C. Alec Pollard, PhD: Not burnout. Are you going to be stressed? Yes, there is going to be some burden with caregiving, even if the recipient of the care is completely cooperative, appreciative and thankful. But what’s more often the case is that the recipient of the care is not always thankful, appreciative, and cooperative. They are often become after years of being accommodated entitled. And so that that ends up being something that is more likely to lead to burnout. But there’s hope. Because if there are ways that you can take care of yourself better maybe not perfectly, but certainly better if you do it right, if you do it a step at a time. Okay. Dare I say, if you buy our book? All right. There, I said it. Blatant self-promotion. But we go through all the steps of how to escape from the family trap, how to take care of yourself. And before we even get to how to deal differently with the the person with the mental illness, we talk about taking care of yourself and getting, for example, valued activities back into your life that maybe you’ve neglected. Dropping off some of those accommodations that are really particularly stressful for you. You don’t have to do it all at once. So it’s overwhelming for the family member. For the loved one, you can do it steps at a time that are manageable. But no, burnout is not inevitable. Stress is, but not burnout. You can improve the quality of your life if you take the right steps.

Gabe Howard: Dr. Pollard, thank you so much for being here. Now your book, “When a Loved One Won’t Seek Mental Health Treatment: How to Promote Recovery and Reclaim Your Family’s Well-Being” is available wherever books are sold. Where can folks find you online?

Gabe Howard: Wonderful. Thank you again, Dr. Pollard.

C. Alec Pollard, PhD: My pleasure.

Gabe Howard: All right. I want to give a special thank you to Evernorth Health Services for providing the funding for this episode. And of course, a big thank you to all of you, our listeners. My name is Gabe Howard, and I’m an award winning public speaker, and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can grab a signed copy with free show swag or learn more about me just by heading over to my website, gabehoward.com. You can also follow me on Instagram or TikTok @AskABipolar. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And listen. Can you do me a favor? Recommend the show. Share us on social media. Share us in a support group. Send somebody a text message. Sharing the show with the people you know is how we’re going to grow. I will see everybody next time on Inside Mental Health.

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