Often, when we think of mental illness, we visualize the individual’s suffering, however, when the individual is supported by family, the family becomes an unconscious and invisible sufferer. Yet, family members are considered the support team; their suffering and stress are rarely recognised. These tired mothers and fathers, daughters and sons, husbands and wives deserve attention as well. If we review the impact worldwide, in countries like India for instance, family is the key resource in the care of patients with mental illness due to their traditions and population volume. What is more, in Chinese society, Pearson and Lam, 2002 observed that “in countries with low-income levels and numerous existential stressors, changes in family structure may make the caregiving burden even more onerous”. (Avasthi, A., 2010)

Equally, when we focus on mental health symptoms in regards to family impact, it can weave a web of doubt, confusion and chaos. Unwittingly, the person with mental illness can dominate the entire family through control and fear or helplessness and incapacity. Like a bully, mental illness bosses the primary sufferer as well as their loved ones. Instability, separation, divorce and abandonment are frequent family outcomes of mental illness.


The five factors that bind families to the despair of their loved one’s illness are stress, trauma, grieving, loss and exhaustion.

Stress is at the foundation of the family experience of mental illness. There is constant tension, dread and worry because the illness can strike anytime. It’s common for family members “to walk on eggshells”.

Another form of trauma is “witness trauma“, where the family watches helplessly as loved ones are tortured by their symptoms. This type of family atmosphere can often induce the development of traumatic symptoms like invasive thoughts, distancing and physical disorders. The result can be traumatic stress or posttraumatic stress disorder. Much of the family’s despair results from trying to manage and control what it cannot. Knowing when to intervene is one of the most difficult lessons a family must learn.

Grief occurs from this steady diet of loss. Family members can go through protracted grieving, which often goes undiagnosed or untreated. Grieving centres around what life will not be.

Loss lies in the very nature of family life. Family members report losses in their personal, social, spiritual and economic lives. They suffer losses in privacy, freedom, security and even dignity.

Exhaustion is the natural result of living in such an atmosphere. The family becomes an endless emotional and monetary resource, and must frequently monitor the concerns, issues and problems of the ill loved one.

Other symptoms can be worry, preoccupation, anxiety and depression and can leave the family drained emotionally, physically, spiritually, and economically. The family members can develop symptoms including denial, minimization, enabling, high tolerance for inappropriate behaviour, confusion and doubt, guilt and depression, and other physical and emotional problems.

What can families do?

In response to pain, the family can learn to develop a disciplined approach to dealing with their situation.

First, they can transform the way they think and feel and move from denial to awareness. When the reality of the illness is confronted and accepted, healing begins.

The second transition is a shift in focus from the mentally ill person to attending to self. This shift requires the establishment of healthy boundaries.

The third transition is moving from isolation to support. Facing the problems of living with mental illness is too difficult to do alone. Family members need to work within a framework of love. This makes it easier to relate to the illness with distance and perspective.

The fourth change is family members learning to respond to the person instead of the illness itself.

The fifth and final shift toward healing occurs when members find personal meaning in their situation. This elevates the personal, private and limited stories of the family to a much larger and more heroic level. This shift doesn’t change what happened or even take the hurt away, it just makes people feel less alone and more empowered. It creates choices and new possibilities. Staff, H. (2021, December 22)


Early therapeutic interventions, including family interventions, should focus on expanding training to patients and key relatives about wellness recovery, skills training, and task sharing of household and self-care chores.

Access to better treatment for patients is very important. This includes medications, psychosocial interventions and rehabilitation services. Caregivers need to be supported through active programs of support and guidance rather than being left in the lurch.

More attention needs to be given to the mental health and well-being of family caregivers by developing a locally applicable theory of rehabilitation, testing interventions in each country or region according to tradition and seeing if they can be applied. (Avasthi, A., 2010)


Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry. 2010 Apr;52(2):113-26. doi: 10.4103/0019-5545.64582. PMID: 20838498; PMCID: PMC2927880.

Pearson V, Lam PC. Family Interventions in Mental Illness: International Perspectives. In: Lefley HP, Johnson DL, editors. On their own: caregivers in Guangzhou, China. Westport, CT: Praeger; 2002. pp. 171–83.

Staff, H. (2021). The Effect of Mental Illness on the Family Relationship, HealthyPlace.

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