How to Calm and Care for a Relative in a Manic State

Recently, an unspeakably tragic incident occurred in Chongqing: an emotionally overwrought young mother threw her young child from a high-rise building, killing the child on the spot. Before the incident, the mother was completely in a manic state. Videos circulating online show that people on the scene were hoarsely pleading with her not to hurt her child, but the demented mother, heedless of everything, still threw the child down.

Public discussion of this incident has been intense. Although I cannot know the details of this young mother, judging from my many years of professional experience, she was most likely in a manic state at the time, and her behavior was clearly abnormal. Moreover, as the folk saying goes: "When the rapeseed flowers are yellow, the madmen are busy." Every spring, when the rapeseed flowers bloom, common mental illnesses such as schizophrenia and bipolar disorder all enter a high-incidence period.

In medicine there is a kind of suicide that extends to immediate family members called "extended suicide," also called "mercy killing of family." It occurs when some mentally ill patients, on being provoked, fall into a state of panic and agitation, despair of the future, feel hopeless and under heavy pressure, and have a strong suicidal urge, determined to escape their suffering by killing themselves. But thinking that their loved ones are also in "pain" while alive, in order to spare their relatives pain and misfortune they often kill their parents, children or spouse and then kill themselves.

Whether the young mother in Chongqing committed an "extended suicide" awaits careful professional assessment. But this tragic event in her family is a microcosm of the countless families in our society tormented by mental illness. The total prevalence of mental illness has already exceeded 10% of the population; some statistics put it around 12%, others around 15%–17%.

Mental illnesses vary in severity. A minority of mentally ill patients enter states of panic or mania; when in such a state they can easily cause great harm to others or themselves, and in severe cases may self-harm, commit suicide or harm their relatives. At such times, family members should handle things calmly, avoid inflaming the patient's emotions, and provide as much companionship and care as possible.

When necessary, call the police and arrange hospitalization tactfully. For example, send messages by phone to absent relatives or friends (avoiding calling the police on the spot and provoking the patient), asking them to help call the police, so the officers can come and help take the patient to a mental health center for treatment. Usually, when a patient is in a manic state, he will not cooperate in going to the hospital to seek a doctor's help, and family members can hardly force him to go; the hospital has no authority to take the patient to a mental health center. In most parts of our country, at present only the police can carry out this task. So the work of police officers is actually very hard; many of the things they handle every day are thorny, and we should understand them more.

When a patient is manic, family members should calm down and recognize that their beloved relative is in a state of mental derangement. Do not use any words or behavior to provoke them, and above all do not argue or confront them. No matter how ugly the patient's words, or how much they misunderstand the family's intentions, family members should not explain or argue. The patient may also have frenzied, destructive acts, such as smashing objects around the house; at such times, do not engage in violent confrontation either, but hide away knives and other things that could cause injury as far as possible, and move underage children out of the home.

If a family member is not normally a cool-headed person and is easily emotional, the situation may well escalate into terrible consequences. At such times, ask other family members for help, and avoid leaving two emotional people together.

The best strategy for family members is to accept the patient's emotions, acknowledge what the patient feels at that moment, and express understanding and sympathy. For example, when the patient accuses the family of hurting them, at such moments family members should not rush to defend themselves; they may say to the patient: "I know you are suffering right now. If I were you, I would also feel hurt by these things. I'm sorry, it is my fault."

Usually, people in a manic or panicky state are under heavy mental pressure and negative emotion; they feel their life is a mess and their heart is in turmoil—indeed much of the panic comes from imagination rather than fact, but under the sway of emotion they have temporarily lost the ability to check reality. At such times, it is futile for family members to try, through communication, to make the patient see that what they imagine does not exist; only by accepting and understanding them can they be soothed as quickly as possible and led out of the extreme emotion.

At such times, any arguing, criticizing, blaming or judging is irrational. Only by empathizing as much as possible, expressing sympathy, and listening to them can they be calmed somewhat. When necessary, use medication (mood stabilizers such as lithium carbonate or olanzapine) to bring the patient down.

A person's emotions are like an interval on a number line: different people's emotions lie in different ranges. Emotionally stable people may range between -1 and +1; those with somewhat intense emotions may range between -5 and +5; others range between -10 and +10. Most people find it hard to understand why a few people's emotions are so intense, but we can imagine several times over what we ourselves feel when most joyful or most sorrowful, and then we can understand the inner world of those relatives with severe emotionality.

Everyone's brain structure is different, so the amplitude of emotional fluctuation differs too. If we do not slap all kinds of moral labels on other people, we can better understand and sympathize with the mental torment they suffer. In fact, the highly sensitive people I have encountered yearn more than anything to be like normal people, not sunk in extreme emotions they cannot escape; it is just that their brains, when ill, are completely out of control and beyond their own command.

The general public in our country is currently basically illiterate when it comes to psychiatry; many may themselves be deeply suffering from mental illness (about 40% are tormented by anxiety, and about 20% by long-term depression) yet know nothing about it. Mental illnesses, like physical ones, have a physiological basis and need a doctor's help and treatment; they are far from being as simple as the patient "just not thinking right." Most people are trapped in the misconception that they can talk the patient into "looking on the bright side," and find it hard to give their ill relatives effective help, so tragedies like this recur again and again.