Helping Loved Ones With Mental Illness Find Purpose

by William Anixter, MD, with Courtney Kelly

Recall a time when you felt a strong sense of purpose. Whether you sourced meaning from your career, parenting, or something else, there's a good chance you experienced a heightened degree of psychological resilience and well-being during this period, too. Studies have shown that purpose fuels recovery from setbacks, promotes engagement in adaptive behaviors, and contributes to constructive mindsets. These things, in turn, can strengthen senses of purpose, creating positive feedback loops that help power good mental health.

But for those with mental illness, establishing and cultivating a stable sense of purpose can be difficult. Hopelessness is a common symptom experienced by those diagnosed with many types of conditions, including major depression and personality disorders. The persistent dread experienced by those with anxiety or PTSD can make it nearly impossible to envision uplifting possibilities for their lives. And for individuals with conditions such as bipolar disorder or schizophrenia, psychosis poses a significant barrier to connecting with sustainable sources of meaning.

Losing touch with a sense of purpose can further exacerbate symptoms, driving people deeper and deeper into mental health conditions. Fortunately, if you have a loved one caught in this vicious cycle, there are evidence-based steps you can take to help them reconnect with sources of meaning in life.

1. Communicate Candidly and Compassionately

Strong, stable senses of purpose emerge from individuals' core values and are aligned with and supported by their life's goals. If you want to help a loved one establish a secure relationship with a source of meaning in life, the first thing you should do is learn all you can about what matters to them. Though symptoms can make it appear as though nothing really does, open and regular communication can reveal hidden interests or buried proclivities.

To facilitate this kind of open communication, consistently exhibit honesty and non-judgment throughout your interactions with your loved one. Show interest in their perspectives, acknowledge that they are the experts of their own experiences, and avoid trying to force them into viewing things the way you do. At the same time, it's important to remain candid about your perspective, especially when it differs from theirs.

If your loved one suffers from visual hallucinations, do not invalidate their experiences by asserting that they're seeing things. This will erode their trust in you and decrease the chances that they'll share details about their values and goals in life. At the same time, don't lie to your loved one and indicate you can see their hallucinations, too. This will exacerbate symptoms and fuel maladaptive behaviors. Instead, if your loved one expresses seeing something you can't, try responding with some version of, "I believe that you see x, y, or z over there, but I also want to let you know that I don't."

The more your loved one trusts that you won't judge or ridicule their perspectives, the more forthcoming they'll be about their experiences. And the more forthcoming they are, the more information you'll have from which you can glean what matters to them.

2. Observe How Activities Interact with Your Loved One's Symptoms

Once you have an idea of what your loved one cares about, facilitating their engagement in related activities is a great way to strengthen their connection to a sense of purpose. But before you go signing your loved one up for book clubs, volunteer opportunities, or a rec team, pay attention to the way that behaviors and environments influence their symptoms. The last thing you'd want to do is inadvertently condition your loved one to dislike or fear what they might otherwise find gratifying.

Does your loved one appear less agitated than normal in social settings which distract them from distressing emotions? Or do social settings exacerbate their anxiety? Combining your knowledge of what they value with your knowledge of what provides them symptom relief can help you pinpoint activities they'd find not only tolerable, but also enjoyable, and maybe even meaningful.

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3. Remove Barriers Between Your Loved One and Potentially Meaningful Activities

This will also help you identify what prevents your loved one from participating in potentially gratifying activities. Try to remove as much of what stands between them and these pursuits as possible. If your loved one enjoys strength training but is extremely sensitive to noise, the crashing barbells and loud music common in weight rooms may prohibit them from lifting. One way to remove this barrier is to give your loved-one noise-canceling headphones for use at the gym.

For those whose conditions involve intrusive thoughts or auditory hallucinations, minimizing the amount of decisions required for participating in an activity can make it much more accessible. The fewer opportunities for self-criticism, the more self-efficacy your loved one can build while engaging in potentially meaningful pursuits. Try keeping tasks as specific and straightforward as possible: Instead of directing them to "water the plants in the garden," for example, you might give them a 10- or 20-second timer and instruct them to water each plant until they hear the timer go off.

4. Acknowledge Progress and Provide Positive Feedback

Because change happens incrementally, it can often go unnoticed by those in its midst. Helping your loved one recognize when and how they make mental health gains will give them the boost they need to maintain their momentum. Positive feedback builds self-efficacy, and it keeps them focused on the progress they are presently making vs. the progress they have yet to make.

Perhaps your loved one's symptoms are so severe that they've been having a difficult time getting out of bed. Rather than fixate on how they're not engaging in meaningful activities, concentrate on helping them take the first step toward doing so. Then, when they succeed in emerging from their room, reinforce the behavior by praising them for it. This will improve the chances that they repeat the behavior, and after enough repetitions, it will become routine. Once that happens, they'll be ready to take another step toward connecting with their sense of purpose.

5. Facilitate Action in the Absence of Motivation

Behavioral activation is a well-studied and effective approach to treating depression. This practice involves engaging in behaviors that elicit positive emotions or mood states, even when no motivation is present. If your loved one is struggling to get out of bed, attempting to spark internal motivation to do so may be misguided. Better to create structure for your loved one that automates this action so it can be performed whether or not the desire is present. They may not want to get out of bed, but if they feel compelled to by the gravity of routine, the behavior can jump-start motivation in the future.

It is possible to reactivate old neural pathways through behaviors as well. Say your loved one is suffering from anxiety, and their anxiety prevents them from painting, an activity that once brought them joy. Try setting aside time for painting in their daily or weekly routines. Remove any pressure associated with it or barriers preventing them from sitting down at the easel. This might mean starting with a paint-by-numbers project rather than a blank canvas and limiting sessions to 30 minutes. Over time, the actual act of painting can trigger positive associations with the activity and reignite internal motivation to create.

In general, it's important to recognize that your loved one's journey will be non-linear, and that they will encounter setbacks as they make progress toward developing or reconnecting with a sense of purpose. Stay consistent with your support and meet bumps in the road with compassion. All of the practices recommended here rely on the cultivation of a trusting, authentic relationship with your loved one.