Caring for mental illness patients: How much risk you can take 照料精神疾病患者之風險評估

I have been learning about psychiatric knowledge for the past eight months. And caretakers’ risk is one of the major topics. There are always caring people in the world. Some are too caring that they thought themselves to be able to take care of mental illness patients. Little did they know that their willingness to back down from their own personality and give in to take care of the needs of mental illness / disordered patients actually reflects their own problem, which is known as co-dependency.

Let’s talk about carers for patients of Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD). These disordered individuals often emotionally abused people around them. The attitude of BPD persons is always blowing hot and cold. From absolute admiration and idealisation, they can devalue you within an unimaginably short time frame. If you take their words seriously, you might risk suffering from Post-traumatic Stress Disorder (PTSD).

Meanwhile, NPD individuals love devaluing others to make themselves feel good. They speak condescendingly, or are always talking incoherently, the receivers of their nonsense could suffer from emotional abuse, which in turn causes the same bad effect in your brain area that experiences physical abuse.

In order to love and care and tolerate patients of these two mental illnesses, you will have to risk losing your sanity as well as physical and psychological health. The situation of the carers could be better if these patients are really committed to seek psychiatric treatment and follow through the programme and focus on self-help for many years to come.

But if they refuse to acknowledge their own problems, it is advisable that you walk away quietly for the sake of your own sanity and safety.

And DO NOT tell them that they have a psychiatric problem.

最近八個月以來一直學習精神學科相關知識，其中一個課題就是照顧者的風險。世上總有人愛心氾濫，以至於以為自己可以照料精神疾病的患者，但是不知道自己願意委屈求全接受有精神狀況的伴侶是因為自己也有狀況，那個狀況叫作「關係依賴成癮」(co-dependency)。

先說照顧邊緣型人格障礙與自戀型人格疾患患者的情況。這兩個精神狀況最常見就是不斷給身邊的人情緒霸凌 (emotional abuse)。邊緣型人格障礙患者常常忽冷忽熱，從完全崇拜你、對你作非常理想化的想像之後變成完全貶低你、說你完全沒有價值。其變化之快，超乎想像。你若真相信這類患者扭曲的想法與言語，你可能會患上創傷後壓力症候群 (PTSD)。

另一方面，自戀型人格疾患的患者最愛貶低別人、抬舉自己。他們言語尖酸刻薄，或者常常語無倫次，對接收者的腦袋中所造成的情緒霸凌效果等同於身體虐待 (physical abuse)。

若要包容、關愛這兩個精神狀況的患者，閣下必須將自己正常且良好的精神與身心靈狀態作為賭注。他們若願意長年就醫而且努力自救，旁人協助他們的情況可能可以好一些。但若他們不願意承認自己的問題，閣下安靜地撤離、確保自身安全，方為上策。至於他們的精神狀況，切記不要告訴他們。