Families As The Invisible Casualty

Michael Mackniak 0:02

Welcome to Holding It Together Kinda. I'm Michael Makniak. Today we're gonna go inside the four walls of the home. When a loved one struggles with mental illness or a history of trauma, the family really becomes the invisible the invisible casualty of it all. There's a specific kind of grief that we've discussed that comes with watching the person you once knew slipping away. And a specific kind of silence that families keep because they don't know who to tell or who to talk to or how to ask for help, etc. So today I'm joined by Dr. Michelle Sherman. She's a clinical psychologist and the author of Loving Someone with Mental Illness or a History of Trauma. We're gonna go deep into the kind of the raw stuff, right? The resentment, the boundary setting, and how you as caregivers in loved ones can stop being just a bystander and start being the leader of that family team that you've compiled. Dr. Sherman is here and I've been waiting to have this discussion with her for quite a long time. All right, Dr. Michelle Sherman. It's so fine, so good to finally connect this way. You know, we've been back and forth with each other for, I mean, when did your book come out? Over a year ago.

SPEAKER_00 1:34

Yeah, exactly. Yeah, good morning. Thank you for inviting me. I'm very happy to be here.

Michael Mackniak 1:39

I'm thrilled to have you. I and I say this, your book is really good. Your book is the Bible. As far as I'm concerned, I was really happy reading it because it really reaffirmed the things to me, because uh it really goes into a great detail about a lot of things that I think are important that that people talk about. So, loving someone with mental illness uh or a history of trauma, guys. Michelle Sherman and her mom, actually, interestingly, they're a good partner team, wrote it together, and Dr. Sherman is here to talk to us. So I asked my guests, what are you doing now that's got you fired up and stoked and and that you're really excited and passionate about what's what's going on in your life?

SPEAKER_00 2:23

Well, the the honest truth, and feel free to call me Michelle, by the way. The honest truth is I had two nephews who graduated from college last week. So that is the most salient, exciting thing in my personal life that just occurred. Uh, just off celebrating my nephew. So that was very cool.

SPEAKER_01 2:39

Congratulations to all of you.

SPEAKER_00 2:41

Thank you. My my work life. It has been really the ability to connect with people like you, people honestly, internationally, with Canada, the United Kingdom, Australia, connect with people who share this passion for supporting families, including supporting offspring of all ages, who are kind of young caregiver sort of stuff. And in my opinion, not to jump in too quickly here, but in my opinion, in our country, we're not doing a very good job at identifying and supporting offspring. And so being able to learn from other countries is like, wow, cool stuff that they're doing. We have a long ways to go, but it is quite empowering and motivating and energizing to connect with people who are share my passion for doing this work.

Michael Mackniak 3:26

Yeah, no, and I agree with you. And likewise, right? And if you, you know, all these people that you're meeting, certainly send them our way so that so that they can get on with me here to talk to more people and hopefully get the word out to more and more people and grow this thing. Because, you know, like with my care coalition, it's people like you and I and the voice uh and the voices that we can pull together to create this movement to really support in families and people struggling with with mental illnesses in our communities.

SPEAKER_00 3:56

So uh exactly we're all have some kind of a voice in it, you know. Exactly. We're all in this together. So exactly. We're all in this together, finding our own way, our own voice, our own way of contributing, our own resources. Absolutely.

Why Silence And Delay Happen

Michael Mackniak 4:12

Well, okay, so let's start there. I so we're talking about our voices and trying to get our voices out there more and and and the oh, how do you say it? I don't know, it's an honor to be able to do it, but it's a dubious honor in that it's it's it's a struggle. It's like we have we work at it, right? It's it's not something that people are banging down our doors to come and and say to us, wow, tell me more about your awesome topic with mental health. But but more importantly than than what it means to you and me, why do the families in your work and what do you think families are struggling in this silence? Why do they get caught up in that and stay there? Stay in that uh for lack of words, I'm just gonna call it a rut. Why why do they stay there so emphatically?

SPEAKER_00 5:03

I think it's a good question. And I could probably talk the whole hour about that. Um a little interesting because as a psychologist, I'm the person who already they are reaching out to. So I have seen them once they have gotten through that phase of silence. But certainly, if we think about the journey of help seeking, there can be a long period of time for reaching out for any kind of mental health services. I mean, the research on couples therapy shows people wait an average of seven years before reaching out for couples therapy, individual therapy a long time dealing with mental illness. And I think there are lots of reasons. Certainly confusion, not sure what it is, a stigma of all sorts, fear of discrimination. You know, is this going to be on my record? Am I gonna not be able to get a job, not be able to get housing, all of which you know can be consequences, of course. Of access, access is huge. Um, with virtual, of course, it's a little bit better, but insurance coverage, waiting lists, transportation, childcare, services only during the day, fear of being judged by oneself and one and others. I mean, I could go on and on. I think there are tons of reasons.

Michael Mackniak 6:15

Right, not all I think that you, I mean, you nailed 15 of them right off the top of your head. Yeah, and I think that those are all wonderful answers. And you know, we we watch folks sit at the kitchen table while they're drowning, surrounded by chaos in their lives. And their neighbors may not even know what's going on, you know.

SPEAKER_01 6:42

Absolutely.

Michael Mackniak 6:43

And all of the things that you just said are spot on. I can't, I mean, there's there's others we could, as you say, we can't really come up with a lot, unfortunately. You know, unfortunately, there's so many reasons.

SPEAKER_00 6:54

Absolutely.

When Community Supports Lose Funding

SPEAKER_00 6:55

It's hard, and then with the potential changes with the current administration in terms of access to insurance and care and things, I mean it's really terrifying. In my own county, right here, I live in Minnesota. I just literally something going on right now is we have in our state three clubhouses, and two of them just lost funding and are going to close in a month. And it's terrifying. It's it's horrific. It's pretty low cost, actually. Vital service of community and connection and belonging and getting out of the house. I mean, it's so where things are going. I'm an optimistic person, but I am have some concerns about where things are heading with the again, national messages about psychiatric medications, about lots of things that really worry me.

Michael Mackniak 7:40

Uh, sure. We, I mean, we have to be worried. I I mean, you can't be looking at through this lens every single day and not be worried about exactly that. And the clubhouses, so for people who don't know, or sometimes they're called independent centers. It's a place where folks can go who are struggling with mental health issues, and it's a respite place for them. It's a place where they can go and meet other people and they have socials and they have family nights and they have activities, they have job training, budgeting. They they do a lot of these social, a lot of these groups are really, really vital to, as you said, the community. You know, it's like what do they call that? The elder daycare centers that a lot of towns senior centers, yeah. Senior centers, there you go. It's the kind of same, kind of the same thing, and it's just a welcoming environment. And to hear that they're shutting down because they lost funding, uh, it's all money. And the thing that bothers me, and we'll get and we'll move on. I'll just leave it at this is just because you get rid of the money doesn't mean or or or the programs that support the people doesn't mean that the people or the problems go away.

SPEAKER_00 8:50

Oh, so it's just so ass backwards, excuse my French, but it's just it's just I mean, look at deinstitutionalization of what happens, you know. And exactly onto the streets, to the prisons. I mean, uh overwhelmed families who are not prepared. And why should they be, right? They're not mental health professionals. I mean, that's like a classic example of what has transpired.

Michael Mackniak 9:09

Well, and the impact from deinstitutionalization in the Reagan era in the 80s is still being felt by us today.

SPEAKER_01 9:15

Exactly.

Michael Mackniak 9:16

And you know, maybe that pendulum's starting to actually swing the other way given what's going on in our anyway. That's

Ambiguous Loss And Real Acceptance

Michael Mackniak 9:22

another story. One of the things that I do talk about, and I've spoken about with experts in the field, and and and I know that you've come across this, so I want to get your take on it, is the idea that families have to understand, recognize, accept, and do something about the feeling of loss or grief that they undergo when a loved one is diagnosed with a mental illness. One of the things that I that I do know is that some people are not aware of the permanency of mental illness and the and the impact. So one so talk about how we can help families to realize that this isn't really a loss, that it's it's okay to feel the loss and understand what understand better. I mean, one time I I tell the story that I was asked to speak at a NAMI group, and a mom asked me, when's my son going to get over this? When's this gonna be done? And I, you know, I had to tell her that this isn't gonna be done. This is your new normal. How do you how do you address that, not only in your book, but also in your practice and with people that you you see daily or weekly or whatever?

SPEAKER_00 10:35

I'd like to give two answers to that question, please.

Michael Mackniak 10:38

Yes, ma'am.

SPEAKER_00 10:40

Please one is actually, if okay, offering a little different perspective.

SPEAKER_01 10:44

Okay.

SPEAKER_00 10:45

Certainly, I'm a research nerd. Okay, so I'm I'd just like to talk about the the research. And of course, the people who are in contact with me tend to be the ones who are struggling more. But the research has been pretty clear. Let's look at psychosis, perhaps one of the more not that all mental illnesses, of course, aren't difficult, but you know, an obvious one with pretty significant struggles. The research tells us about the a third, a third, a third. A third do have a chronic, very significant, relapsing, very poor course. A third maybe continue to have symptoms, but you know, are able to have some meaningful quality of life. And a third actually do have some remittance or improvement of symptoms. So actually, I don't say, in I strongly encourage the trainees that I teach to not say it's going to be really bad forever, your child's gone forever. Because actually, I don't believe that in the research doesn't show that. Furthermore, even with the people who do have this really chronic course, I talk and believe strongly in the concept of recovery, and not a recovery meaning alcohol and drug recovery, but recovery meaning even with symptoms, people can have a life of meaning and purpose. Okay, whatever that means to them. So actually, I don't paint a picture of doom and glue in your destined forever to have you know horrible symptoms and sort of stuff. But actually, there are many people living with this illness, whatever it would be, who actually can lead a life of meaning and purpose, and that's actually available to all. So that's point number one. Point number two, in terms of ambiguous loss, yes, Pauline Boss, a family social scientist right here at the University of Minnesota, five minutes from my house, actually, uh coined this term originally with POWs, MIAs, and dementia. So that sense of having your partner or your loved one there, but not there. And so the loss that can be experienced surrounding that. I think it is a concept many people don't think about and don't understand until you kind of explain it to them. But then often when they do understand it, it can be very helpful because it's like, yeah, this is not the child that I thought I was going to raise, my hopes and dreams of them going to college, perhaps getting married, having children, all this sort of stuff may not be their future, may not be their reality. And so the pain surrounding acknowledging that and realizing that at least right now this is not the path that you and perhaps they had hoped absolutely can be a loss. And so yeah, I do have a whole chapter on that in my book and acknowledging the loss and embracing acceptance and what acceptance really means. Acceptance doesn't mean that you like it necessarily, acceptance doesn't mean that they're not going to change and grow because certainly we hope that they will. But but right now, realizing the reality and working to be present with where they are right now, that can absolutely be a loss.

Michael Mackniak 13:39

And sure. And I one thing that I did like to, I mean, I guess I like a lot of what you said, but one thing that jumped out on me that when you talked about the third, the third and the third, it's important caveat that you put on there, because I use it a lot myself, where you say people with mental illness are not lost to us, they have a new normal, let's call it, and they are very capable in most circumstances, I would say, to live a meaningful life, as you said. And here's the quote, according to what that means to them, right? And and that's what it's really all about, anyways, isn't it?

SPEAKER_00 14:17

For everybody raising right, and all of us are not, exactly.

Michael Mackniak 14:21

Yeah, I mean, if if your kid is, you know, you perceive your kid as a loser, but they feel really fulfilled because they're able to do their art and they can express themselves or whatever, you know. Geez, wouldn't we all like to be able to do what we love or to to live the life that we love for ourselves, not for what everybody else thinks we should be living?

SPEAKER_00 14:44

And we all have different limitations in some way, maybe for some people, economic, maybe physical health problems and mental health problems, maybe uh limited opportunities due to racism or whatever else. I mean, we all have things that that struggle that can be hard for us. And so, how within those things do we create and define our own meaning? Or I have a autoimmune disease, and so I can't do some of the things that I'd like to do, but I can still create a life of a great deal of meaning within that illness that I have of this autoimmune disease.

Michael Mackniak 15:14

Yeah, well, and and kudos to you because you brought out, I love your pushback to my question because you're right. It doesn't have to be all about grief. I I do I do think that there's a sense of loss, and some people feel, and again, I I guess that's the important thing. Some people, it's not all people, feel like, oh, should I have done something different?

SPEAKER_00 15:34

Oh, absolutely.

Michael Mackniak 15:35

You know, should I am I raising, you know, is it something I fed them when they were little that caused, you know.

SPEAKER_00 15:41

And I total agreement with you that that that is not helpful, and we absolutely want to destigmatize and provide education. Absolutely. I just also I mean, you know, me and my company is seeds of hope. So I'm all about instilling hope. Honestly, I'm not gonna pull any punches with you, but I'm also about instilling hope. And furthermore, even when people are having really significant struggles, looking for moments. It can be a moment that you're able to just sit and have a two-minute conversation or a sweet exchange of a meme, or go on a little walk together, or watch a funny movie together, looking for those moments. Because after all, isn't that what it's all about anyway?

Michael Mackniak 16:18

Yeah, right. I mean, it's yeah, baby steps, right? And what you appreciate and take away can be completely different and meaningful in a different way. Yeah, and that's a really good way to look at it. And I'm sorry that I hadn't brought it up to my people before that because you're absolutely right, and I should think of it more in that regard rather than harping on the negative of it all the time, the you know, the resentment and the grief and the disappointment and things along those lines.

SPEAKER_00 16:44

But that's all real, that's all absolutely real. I need to I sit with families with all those feelings and then acknowledge and honor and talk about how to cope and manage them, and you know, the other stuff as well. The hope, the empowerment, the what can you do? You know, what was it in your locus of control that that you can do to take care of yourself uh as well as to support your loved one without that's a lot of what I try to get across to people is to be able to take care of themselves too.

Hope For Them And Hope For You

Michael Mackniak 17:12

Um it was interesting. We were I was trying to put together, this is a few years ago. I was trying to put together a package of materials for folks out there in the community, and you know, trying to get a nutshell word of what it is that we offer through this work that that I do. Uh and I asked my my my right hand and left hand man both happen to be women, right hand Sarah, left hand Angela. I said to them, independent of each other, what is it that we offer in in our nonprofit and in the work and the message that that that I deliver that you think is most important to people? And you know, I was thinking they were gonna come up with a product or something along this one, independent of each other. They both said hope. Hope, hope, hope. So it's just something that really resonates within at least within your field, because they're they're also in the clinical realm.

SPEAKER_00 18:04

So absolutely. It's it's essential. At times it's hard. You know, I I was talking to a friend actually who's got a loved one with very significant mental illness, and talking about this idea of hope. And I think it's a a challenging one because they say, Michelle, you know, you've not you've not lived this with me, the repeated hospitalizations and the manic behavior, the suicidal behavior, whatever else. It's like sometimes it's hard to have hope for them. And which I honor, and I say, and you can have hope for yourself. Focus on creating and continuing to have a life of hope for yourself, even if sometimes it's hard to have hope for them. Because as we know, for many serious mental illnesses, relapsing is a normal part of the illness. And so it's like, yeah, they're doing well now, they're on the same medication, they got in this clubhouse, whatever else, and and then the clubhouse loses funding, or you know, their doctor retires or moves or loses insurance coverage or whatever else. So it's like, and by nature of the illness, at times there can be triggers or things that are hard to anticipate. So focusing on the now, focusing on what you can have hope about for yourself.

Michael Mackniak 19:11

You're always looking for that other shoe to drop, right?

SPEAKER_00 19:14

Right.

Making The Most Of Psychiatry Visits

Michael Mackniak 19:17

A lot of it is warranted, but some of it's just like, you know, it's kind of like I guess I listen to sports radio a lot, and it's like that's that's what Met fans seem to go through, you know. I don't know, I'm not a Met fan, but that's not so how can families, when they are talking to you as as their clinician, as their physician, okay.

SPEAKER_00 19:39

I'm not a physician, but yeah.

Michael Mackniak 19:43

How can they give you a better snapshot in your meetings with them to tell you? I mean, you know, we talk about this a lot too. A doctor is seeing a patient, i.e., family member, for 15 minutes. They go home, they've got 23 hours and 45 minutes left that they are dealing with their real life. How do you recommend to our families, the the families, caregivers of folks with severe mental illness, that you write about in your book? How do you love them? How do you and how do I best present what my family's going through to my doctor, to to Dr. Sherman?

SPEAKER_00 20:19

So am I, I would like to clarify, am I saying to the patient's doctor or to your doctor? Because those are kind of two different things.

Michael Mackniak 20:28

No, to the patient's doctor.

SPEAKER_00 20:29

So the patient's doctor like you're going along with them to their psychiatry appointment or something. Yeah, yeah. Okay. So first and foremost, I think the family's job is actually at first to let your patient lead. You know, let your loved one lead because at times family members take over for them and talk. Now, of course, we absolutely know. At times we'll call patient, not love that term, but for ease of conversation, patients may not be forthcoming, they may not remember, they may not be great historians due to the nature of the illness, maybe concurrent substance abuse, all sorts of stuff. So at times, obviously, we know that that happens. Shame, embarrassment, okay, not taking my pills, whatever else. So the family members sitting there saying, hmm, you know what to do. It depends a lot on the clinician in terms of their ability to, readiness to desire to engage families. So it's a lot about forming that relationship. I've seen at times families not helpfully kind of go off on, you know, 20-minute kind of rant sort of stuff that the clinician frankly doesn't have time for. You know, really in these med management checks, sadly, for everyone, it can be literally 15 minutes forward, calling in the refills, checking on side effects, getting symptom, checking suicidality, all this sort of stuff. So it's really, really hard. And so for families, I think the biggest recommendation I have is preparation before you go into that appointment. Put a note on your phone, read a little shooter. Paper, what are the three or four top things I want the doctor to know? Okay. It can be advisable, I think, for the family member to talk to the loved one before. Say, I'd really like to tell Dr. Smith about that you're really not sleeping well. Is that okay with you to kind of get there by it? They they may or I may not, you know, be willing to go there, but what are the main points that I want them to know? Certainly major issues of things like are they taking their medications, you know, is is huge. Sudden abuse, of course, is huge. And absolutely any concern about violence, suicidal harm of you know, objects or things like that, any of those sorts of things are incredibly important. And I think sticking with as much as possible and some of the data points, the facts rather than long stories. And this is very hard for families, which is why I prefaced my answer by saying, and you families need your own support as well, because this is not your therapy as much as you'd like it to be, and you have lots of big emotions and feelings and worries and stuff like that. This isn't the time for that. Okay, this is not your medical appointment. That's why it's imperative for families to connect with things like NAMI or their own psychologists or things like that, that they have other places that they can feel heard and connected and seen. So I also appoint, prepare, connect with your loved one, get their permission, and give data and facts that you know, as you're able.

Michael Mackniak 23:26

Yeah, I and no one's I think those are all invaluable. And you know, look what do they call that? The shameless plug. You know, that's what the journal that I designed is supposed to help them to do is to track what's been going, bring that to your doctor so he can look at this and say, oh, in real time, this is what was going on in the home. And that's the invaluable information.

SPEAKER_01 23:46

Exactly. Exactly.

Michael Mackniak 23:48

What what one of the things that that I think people are frustrated with is that understanding or the the the perceived lack of understanding that we are a vital and valuable asset to you, Doctor? Yeah, ask us for information, respect us in what we do outside of your four walls. Yeah. Let's be part of a team. And how can people become more strategically if need be? But how can they make themselves more accepted and more valued as part of that team?

unknown 24:24

Yeah.

SPEAKER_00 24:25

It's a great question. It's a hard question. I think respecting the boundaries that the provider sets is important. Again, as we were just saying, if you kind of go off for a half an hour on a highly emotional sort of thing, you're probably going to frustrate the provider. Not that they hopefully don't have empathy and things like that for you, but even things like showing up in a spirit of gratitude for what they're doing, honoring how they're trying to help that your loved one. You know, it's not like you are indebted to them, but certainly expressing gratitude, I think, goes a long way in helping the provider feel like you're really, you're really caring. The other, the other thing that I empower families to do, particularly if they're concerned that their loved one may have a strong negative reaction to what they're saying if they're in the appointment, is although I wouldn't suggest medical messages necessarily, because of course the loved one can read that, but you can drop off a note, you can leave a message, you can ask the doctor to call you. Now, depending on whether or not you have release information as an attorney, you're obviously very aware of that, can limit what you're going to say. But I think there are other ways to put information into the system. They may or may not respond to you, but use your voice in other sorts of ways. Even with that, however, I think if you write a 10-page long essay, they're probably not going to read it all. So again, bullets, point main points, one page, you know, that's it. And then thank you for reading this. I appreciate your care. I want you to know that I want to be here and part of the team. So verbally, you know, saying that, and I appreciate your taking time to read it. So it's like providing input in a way that they can actually digest, express gratitude, and continue to show up, such that when my brother is there, my the doctor always knows that I'm there with them. So this is I am part of the team and I want to continue to be part of the team.

Michael Mackniak 26:16

Those are three major points. Gratitude, yeah, digestible nuggets, consistency.

SPEAKER_00 26:23

Exactly.

Michael Mackniak 26:24

Huge points. Yeah, exactly. Yeah. Absolutely. I appreciate that because that really is a good synopsis for folks. Because as I say, unfortunately, the squeaky wheel, i.e., the irate talkative, over-the-top pressured speech parent does not get the grease in this mental health system. They say, thank you very much, but I'm gonna have to talk to the patient alone, you know.

SPEAKER_00 26:51

Exactly.

Michael Mackniak 26:51

And it's easy, it's easy to do that when you are that off-the-hook representative.

SPEAKER_00 26:57

Of course, because it's distressing. You're upset. It's understandable, like, doctor, don't you understand? Because my son looks very perfect here. He's sitting here happily well grooming arrows, but he doesn't shower for two weeks between what I'm saying, etc., etc. It's really, really, really hard. So I get it, which is why, again, you need your own therapist who understands your mental illness. You need your own non-group or whatever else, a place where you can feel seen and understood. Because your loved ones, doctor appointments are not the place.

Communication Starts With Relationship

Michael Mackniak 27:24

Let's talk about that relationship between that family caregiver and the person with the illness. And I want to talk about it on a bunch of levels. But yeah, first thing is communication.

SPEAKER_01 27:37

Yeah.

Michael Mackniak 27:37

Right. You know, everything's falling apart around us.

SPEAKER_01 27:41

Yeah.

Michael Mackniak 27:42

Son, daughter. This this is not tenable within our family, you know. Uh you haven't showered in two weeks, your room is a disaster area. It's starting to smell. It's not fair to the rest of the people in this house. How do you how do you how do you how do you recommend that people engage in these conversations and and be listened to and listen, actively listen? And what's your advice to people on those skills?

unknown 28:08

Yeah.

Care Navigator Journal Break

Michael Mackniak 28:12

We'll get back to our conversation in just a minute, but I want to take a second to talk about something that many of us in this community deal with every single day, and that's the mental load of caregiving. If you're like me, your brain is probably filled with appointment dates, medication schedules, and a never-ending list of questions for doctors. It's exhausting trying to keep it all in your head while also trying to show up emotionally for the person you love. That's exactly why the team at the Care Coalition created the Care Navigator Journal. This is not just another notebook. It's a tool specifically designed to help you to stay organized and more importantly, to help you feel a little more in control when things start feeling really chaotic. It gives you a dedicated space to track medical updates, manage daily tasks, and even process your own thoughts. Imagine such a thing. Your well-being matters just as much as the person that you're caring for. If you're feeling overwhelmed and looking for a way to stay organized, I highly recommend picking one up. You can find it right now at www.carecoalition.org slash holding it together. Again, that's carecoalition.org slash holding it together. It's a small way to start holding it all together, one page at a time. All right, let's get back to the show.

Listening Skills That Actually Land

SPEAKER_00 29:43

To me, although I have a whole chapter on communication in my book, okay. So certainly I can get into the minutia of that, but I'd like to actually take it a layer even deeper.

Michael Mackniak 29:52

Okay.

SPEAKER_00 29:53

To me, it's all about relationship. Because if let's say it's my son, if my son all that he hears is my griping and grabbing and criticizing and things like that, no matter what I say, he's not he's gonna tune me out and feel that I'm just being a J E R K and not want to listen and not talk to me. So if we're talking about the fact that he hasn't showered, if talk he's not taking medications, talk about, hey, let's go to you know, your sister's birthday party today, if if we're not in sync in relationship, it kind of doesn't matter what I what I say. So, what do I mean by relationship? Emphasizing relationship. It is even looking for small moments or ways of connection, of being present, even things like, will your loved one allow you? Just kind of, even if it's stinky, you know, be in the room with them a little bit, grab a book, you know, do whatever else, and just I want to be with you, I want to be present with you. Can I just kind of show up with you? Listening, listening, listening. How are you doing today? Would you be willing just to go on a walk with me or come out and let's have breakfast together at the table or whatever else? Trying to make yourself available in a non-judgy, critical sort of way. Because the first thing that is, in my opinion, essential for considering behavior change and leveraging a relationship is connection. And they are most likely feeling probably not only a lot of symptoms, but feeling really judged and embarrassed. Okay. And aware that you're probably thinking, oh my gosh, this is horrible. And so until we can help them see us as families, as people who aren't going to judge and shame and criticize them, but but want to connect with them, that's the first step.

Michael Mackniak 31:32

And and I think that that's important because we talk about this concept of active listening. Active listening is so important. So and it is.

unknown 31:39

Yeah.

Michael Mackniak 31:40

But active listening could be really bad too if you are an eye roller like me, or you wear your, you know, you I cannot, I cannot keep my facial expressions in my inward thoughts are outwardly expressed on my face when I'm I just I know it about myself and I just have to embrace it. So anyway, so active listening is is imperative, but good active listening, right? And good feedback and uh practicing the techniques of communication in a positive way, I think are really important.

SPEAKER_00 32:16

And listening. I mean, starting off with, you know, I don't know if you talk much with your uh folks about the leap skills, amateurs, you know, listen, empathize, accept, partner, that sort of thing is like we don't get to the you should do this, you should do that, until we really listen and connect. And so to me, in terms of communication, the biggest place is listening and listening for what's important to them. You know, maybe sharing whenever is really not that important to them, but they really want to get this new music, or they really want to be able to get a new guitar or something like that. You know, it's like what really matters to them and engage in that world, or even maybe a video game. I'm not a big fan of video games, but even you know, could I play this video game with you or something, entering into their world, not their psychotic world, but entering into what matters to them. That, like, oh, you care, asking questions, not in an intrusive, overly intensive sort of way. But it's like working on that relationship to me is primary, is key because that's to leverage anything. Dr. Amador, as you may know, talks about his brother who had a very serious schizophrenia, and he tried all the communication skills. He tried to get him to yell and scream and bargain and mad and cry and all the sort of stuff. So none of it worked. What did work and actually got his brother to eventually take medication was relationship with her. So his brother eventually did take medications for his psychosis, not because he thought he wanted him or needed him. He had huge anosygnosia, but because his brother he cared about his relationship with his brother. That's where I'm talking about. Is it's all about relationship.

Michael Mackniak 33:51

That's heartwarming.

SPEAKER_00 33:52

That that that can I think it's true. I think it's true. I think it's common.

The Siblings We Keep Missing

Michael Mackniak 33:57

What do you think about I think I think that one thing that we overlook and that we need to talk more about and study more about, frankly, yeah, is the impact that it has on the other kids in the house. And and and I, you know, it just made me think as a parent or even as a sibling, you can go in there and say, you know, hey, I know how this is impacting you. Let's talk about how it's impacting us, and then that's how it's impacting me. Or whatever listening skills you you recogn, you know, leap is a great is a great acronym. But I think that that I think that those kids, the other kids, need to be spoken to as well. And and um and talk about that for a second, about that.

SPEAKER_00 34:42

I think siblings are very, very commonly invisible in these families. We have a huge, huge way to go. Uh, when we talk about children, I think about two different kinds. I think about offspring. Okay, so if hypothetically my husband was dealing with bipolar disorder, and we have children, so think about them, as well as again, if my 21-year-old daughter is the motorpsychosis, how are my other kids kind of managing it? So I think they're related, but they're two different things. I think if we talk about them collectively, there tends to be a huge amount of the same issues and emotions we talked about at the beginning of our session today of embarrassment, shame, confusion, not wanting to have friends over, unpredictability. Of course, with younger children, you know, is this my future? Or actually, that is with all children, but am I going to catch it? Is it contagious? Am I going to be like that someday? I mean, there are so many fears. The embarrassment, the anger, the loss, as we've talked about. This isn't the relationship with my sibling, with my parents, with my family that I wanted to have. All sorts of emotions. I think other countries are doing a much better job at trying to help identify these young people who often get into parentified roles in terms of doing caregiving and things like that. Other countries are doing really a much better job at this. So we've got a long way to go. Other countries even have laws. Like, for example, in October 2025, in the United Kingdom, they just passed a law that whenever a parent is involuntarily admitted to a psychiatric hospital for mental health purposes, they are now required to identify if their offspring, if they're children, and assess how the children are doing and connect with resources as appropriate. Our country does nothing like that. And you may think, oh, Michelle, that's no big deal. But if there's, and you're an attorney, you know this, if there are laws, it can help leverage money.

Michael Mackniak 36:39

Right. Yeah. Well, it used to be able to. We hope that that that pendulum comes back.

SPEAKER_00 36:44

Yeah, absolutely. But it's at least a step in the right direction.

Michael Mackniak 36:47

I think that's a wonderful law.

SPEAKER_00 36:48

I do too. I do too. At this point, children are very often invisible. Um, and we know nature and nurture, they're at considerably higher risk of mental health problems themselves. A 2025 meta-analysis, no, excuse me, 2023 meta-analysis of I think over 60,000 young people from lots of different countries, found that having a parent with mental illness, the rates are actually quite high, whether or not the offspring will develop mental illness. So it was for parental bipolar disorder and parental depression, it's a 50% chance that an offspring will develop some form of mental illness, not necessarily the same one their parent has, but 50% over 50%. And for parental psychosis, it's about a little less than 20%. So we these children we know are at higher risk for developmental health problems. And we also know the science of prevention. Science tells us there are some things that we can do to help these children perhaps prevent the developmental illness themselves, or equip them with tools and skills for coping so they have a better and healthier journey. I'm very passionate about this and the distress that our country, and even including NAMI, actually, is not very focused or interested in offspring or siblings, which makes me very sad and frustrated.

Michael Mackniak 38:04

No, I I agree wholeheartedly there with that one. And yeah, I'll just leave it at that. I am really interested in the the the kids. And one of the things that interests me, especially about the data that you just cited, is that we're not saying, or I'm not saying, I don't know if you if you have the data to back to to disprove what I'm about to say, but uh the data that you just said about 50% or more dealing with with the depressions, etc., or the less than 20% having the psychosis. To me, that speaks to what one of the things that's really interesting. Work is trauma-related work. One of the because that doesn't speak necessarily to genetics. I mean, we'll always say, Oh, the apple doesn't fall far from the tree, but it's it's not the genetics that's causing this, it's more of the trauma and growing up in an environment, I think, that's that stimulates or if you're predisposed to anything, it might trigger something. But I but I really believe that being put into this this pressure cooker, this uh of life and the lessons and things you have to react to causes other forms of or manifestations of whatever illness this may be. Is that right, wrong, somewhere in the middle?

SPEAKER_00 39:24

I actually strongly believe that it's both. Okay, there's a very strong genetic component in terms of increased risk. You just look at the family histories and things like that. So, yes, there's a very strong genetic component in terms of decreased risk. There absolutely is nurture as well, and so many contextual factors that this conversation needs to be put in. Then the context of culture, I was in the context of family violence, the context of comorbid substance abuse, all these other sorts of things that affect the child's experience. I, if we look at the data, frankly, and if we look at certainly my clinical experience, most children do well. So I do not want to have a doom and gloom sort of view. It's like most children are resilient, perhaps due to their own inner strength, perhaps the parent and or other family members support, perhaps community, church, neighbors, support groups, whatever else. So I would like to for sure emphasize that although children are at considerably higher risk, it's not 100%. You know, when I present this data to some families, they're like, oh, you mean half don't develop some sort of mental illness? It's like, yeah, so it's not universal. Many children do do well. And the diagnosis of mental illness is not uh necessarily a doom and gloom thing that we have a lot of evidence-based treatments for many mental health uh conditions. And as mentioned earlier, even if they do develop mental illness, they can absolutely still have recovery and a life of meaning. So I don't want to say it as a doom and gloom sort of stuff, but yes, absolutely, it's both nature and nurture. And there can be many protective factors that children can have inherently or that we can help them with. I absolutely want to be able to at least briefly mention that in addition to my mom and I writing loving someone with a mental illness or history of trauma, you mentioned, we also have been writing for 20 years books for teenagers.

Michael Mackniak 41:14

Oh, really? Great.

SPEAKER_00 41:16

For teens whose parents have the mental illness PTSD or actually had military deployment. We're really humbled that our first book for parent for teens whose parents had military had PTSD was actually picked up by the National Guard, and boxes were sent to all National Guard units across the country.

SPEAKER_01 41:33

Oh, wow.

SPEAKER_00 41:33

Speaking to the absence of resources for these kids, okay. So just last year we actually released a second edition of our book for teenagers called I'm Not Alone, a Teen's Guide to Living with a Parent Who has a mental illness or history of trauma. To the best of our knowledge, it is the only nonfiction book written for these young people. And it's very interactive with stories and activities, reflection questions, uh, stories from children who have lived experience. And so we really hope that this can be a resource to help children be seen. We we've been humbled that it's been now being translated and used in some other countries. And a psychiatric nurse in Iceland was saying she's starting to use it with uh some of her teenagers. And she told us the story of this young girl who had been in the kind of her support group for a while. And when this nurse, psychiatric nurse gave her the book, she's like, Finally, a book for me.

SPEAKER_01 42:27

Oh, really? Yeah.

SPEAKER_00 42:28

What we hope is like there aren't resources for these kids. They're again invisible in things. And so we hope that it's the second edition of our book called I'm Not Alone. And again, we have a whole section on there about managing my own risk because we're I'm honest. I say, Yeah, you are at higher risk, and there's stuff you can do about it.

Michael Mackniak 42:46

Hmm. Yeah, that's interesting. That's great stuff because kids are getting smarter, man.

SPEAKER_00 42:53

Yeah, they're more mental health literate, although a lot of what's being said is inaccurate.

Michael Mackniak 42:58

Oh, yeah.

SPEAKER_00 42:58

Well, YouTube and all the sort of stuff. So yeah, it's tricky.

Red Lines, Safety, And Self Care

Michael Mackniak 43:03

I know that you have a limited time, and I want to make sure that we touch on this because you know the very real issue that we're talking about this communication aspect. You talk about the red lines and the boundaries that that people need to have. Um, so I want to talk, I want you to talk a little bit about that, but I also want you to talk about what do you do when your red lines and your boundaries are being constantly breached? What do you do when you are trying to maintain boundaries in acute moments of psychosis or during a floridly psychotic episode? I think those are, you know, people listening are being like, Yeah, yeah, I'd love to be this, this wonderful genteel provider, family member, etc. But sometimes it's hitting the fan and I gotta react in real time. What the hell do I do? Doctor, help me. What do I do?

SPEAKER_00 43:56

No, it's incredibly true. And I'm also a realist, and again, talking. About data, we do know that most people with mental illness are not violent, absolutely. However, in the context of psychosis, in the context of acute substance use, they are at higher risk. And who is more often to be the recipient of this is family members or friends or people who are in close contact. So we need to be honest and say the risk of violence is something that some family members experience. At the time when their loved one is really in acute crisis, that is not a time to try to do these communication skills or things like that. It is paramount at that time that you, your children, your pets, remove yourself from the situation. Don't tell your loved one to leave. No, they're going to even get more angry than you. It's time for you to actually get yourself safe. That is most important at the time. If it involves calling a crisis team, calling 988, calling 911, uh, calling your doctor's office, his or her doctor's office, whatever else. But but that is absolutely the time that your own safety is paramount. And I mean physical and emotional safety. Thinking about where you might be able to go, who might be able to be supportive to you, what you may want to grab to be comforting if you have a young child grab their blanket or whatever else. If it is a regular sort of situation, maybe even having a purse or a bag or something that's kind of repaired if you need to get away quickly. A go back. Yeah, exactly. But it's absolutely imperative that family members take care of themselves first. There are clear, clear lines. Now, when you say kind of red lines, it gets trickier because every family has their own boundary that works for them. Some, for example, will say no drugs, no weed in the house, period. Some people say you absolutely have to shower at least every other day, you know, whatever else, you know, for fanity. Okay, again, people have different roles. No, no judgment, you got to figure out for yourself. But finding ways to express those and then be really consistent with those and figuring out the consequences is is hard. And again, we're back to consistency being a key thing. If we take it to the extreme, a huge challenge that many families struggle with is crap, Michelle. You know, it's the middle of December. I'm here in Minneapolis, there's snow everywhere. I'm telling them they have to leave. Where are they gonna go? I don't want them to be homeless. Have you seen the movie No One Cares About Crazy People?

Michael Mackniak 46:25

No.

SPEAKER_00 46:25

Oh, yeah, it's going all around the country. Actually, just played here in Minneapolis a couple days ago. It's sold out movie theater, which is awesome. It is all about people living with severe mental illness and our communities, lack of response. They talk a lot about the family impact. It'll actually be available on Apple in approximately about a month. No one cares about crazy people. It's a very poignant movie, and the reason I'm mentioning it now is it it shows the struggle of families. It shows people living in a homeless sort of situation and them talking to themselves and having all these struggles. It's incredibly hard to set these limits. And so families vary in this, but your own safety, your own psychological and physical well-being are are imperative because you can't help them if you're not able to take good care of yourself. But it's super hard. Super hard. Super when especially when community supports are crumbling. You know, it's like where where can they go? There are no beds or whatever else. There are no psych units, there are no, you know, shelter sorts of beds. It's incredibly hard.

Michael Mackniak 47:30

Well, it's an it's incredibly hard because you there, I mean, we talk about setting boundaries, and and there's boundaries that we set, and that that word can mean different things. I mean, boundary, yeah, you're not allowed to bring your pot and your your drugs into my house. That's a boundary. Meanwhile, you also have this what I would call like the clinical boundary for lack of a better term. Okay, I'm a parent, I love my my child. I'm gonna let them walk all over me. And and those bound, you know, you have to be able to set those those non-defined boundaries as well. And I think you touched on that uh pretty nicely because it's not okay to beat you up all the time and and and you taking it as the caregiver because you're afraid to upset the apple cart. Well, that up cart is upset, man. It's it is upset, and I think that another thing that people worry about is they worry I'm gonna if I leave, he's gonna destroy the house. And what I would say to that is, you know, it's better they destroy the house than destroy you or a life or but you know, right?

SPEAKER_00 48:41

Right, absolutely, absolutely, and it's real. I understand when people are hearing voices telling them to do X, Y, and Z. It's super, super hard. This is a complicated issue, and I don't think there's a clear answer. You should do this, you should do this, other than I do believe it's important to protect your own safety.

Michael Mackniak 48:58

Yeah, and you said it, but if you're not there to bounce back the next day, yeah, nobody's I mean, nobody's gonna do the job you do.

SPEAKER_00 49:06

Right, exactly. And that's a huge, unpaid, overwhelming, confusing, often isolating and lonely job. Um, so it totally is. So then an essential aspect of needing to do whatever fills your soul, not only setting the boundaries, but taking that time to if for if, for example, someone finds meaning in being in nature, if they enjoy spiritual activities, if they enjoy regular going to the gym, if they enjoy their book club, you know, whatever. I don't care what it is. They like going and playing hand racquetball with their friends, you know, whatever it is, you gotta do that stuff, even if you feel guilty. And I believe, frankly, and I teach families, it's okay to disappoint your loved ones sometimes.

Michael Mackniak 49:47

Yeah. Actually, they disappoint you, you could disappoint them.

SPEAKER_00 49:51

Exactly. And if you don't, then you're not going to be able to continue to show up in the way that you want to. So prioritizing your own needs is incredibly important.

Michael Mackniak 50:01

Right. And and this the word that you use, this isolation, this isolated feeling, this loneliness, right?

SPEAKER_00 50:07

That's why we have podcasts. That's why we have support groups, you know, things like that are so so important.

Michael Mackniak 50:12

Well, and I and I really try to impress upon people in this podcast, and the the point of this podcast is that I don't have the answers, but I can certainly let you know that you're not alone and feeling these ways. And you're not, you know, and and to have you here to re-emphasize those points. And be and you've done this in a scholarly fashion. In your book, by the way, people that listen will know this is the highest praise I can give. I can hear your voice coming through your book. It's like I'm talking, having a conversation when I read it. Now, uh, you touch on so many points that are so near and dear to my heart, so it was such an easy read for me. Other people may, you know, truth be told, it's like with everything, but your book really goes through in a real good, laid out, nicely fashion, just the way to address the a lot of the topics, a lot of the conversations that I have here you have in your book.

SPEAKER_00 51:10

Well, thank you so much. I'm glad that it really resonates with you. We hope so. And we intentionally had that little guide at the beginning. So it's not like you have to read every chapter in a row. It's like, okay, I'm worried about limit setting, or I'm worried about parenting, I'm worried about talking to my kids. You just skip to the chapter that you want to, and they're all exercises and activities. It's not just boring research text. So we hope that people find it accessible. Yeah, that's from your kind words. And I really enjoyed being with you today. I just want to say thank you so much for the opportunity. I appreciate you allowing me to share different opinions and perspectives, as well as so much that we are totally aligned and really in agreement upon. So thank you for all you're doing to reach out to people and help people hold it together and keep the journey in mental illness. So thank you for the opportunity.

Michael Mackniak 51:54

Yes. Well, loving someone with mental illness or history of trauma, Dr. Michelle Sherman, thank you for being here and we will certainly talk, continue our dialogue.

SPEAKER_00 52:05

Excellent. Thank you very much.

Practical Takeaways And Closing

Michael Mackniak 52:13

Well, as usual, our conversation is a huge reminder to you all that you don't have to be carrying the weight of a diagnosis all by yourselves. Dr. Sherman, you know, her tools uh around boundary setting and family engagement really give us a cool, a nice map to move from just surviving the day-to-day um activities or life to actually strategizing a way through it all. So if you feel like you're losing the person you love or if you've been keeping your family struggle a secret, it's okay to say it out loud, and that's why you're here. That's why you should be joining our care coalition. It's okay to admit that it's hard. It's okay to ask um help for yourself, not just for your loved one. Right? Take one piece of what we talked about today. Maybe it's a boundary, maybe it's calling a friend, um, you know, put something into practice to help yourself out. These small nuggets we talked about, this showing up with gratitude that we talked about. So thank you all again for being here. And we're all just out here, just kinda holding it together. And I'm gonna see you next time.