No One Said This Was Easy: Managing Enduring Conflict in Mental Illness

Presentation by Dr. Frank J. Pieri, MD
Review by Martha Cooke

Last Tuesday I attended the information evening event for NAMI Santa Fe at Camino Alire. My goal was to keep up to date with a current topic and this from the UNM School of Medicine presented by an associate professor of psychiatry, to Dr Frank Pieri. The title of the talk was, Psychotic Disorders; Insight, Compliance, Acceptance: Dealing with Enduring Conflict.

As a family member it was most useful to  gain insight into the topic of psychotic disorders and in particular, dealing with enduring conflict.    My family faces conflict as a part of the process of living with cyclical symptoms of bipolar disorder. Conflicts are presented to us in a spectrum of critical circumstances that can affect housing or independence on one hand or the crisis of estrangement and decompensation on the other.   Family members who have no previous experience with the symptoms of mental illness risk giving up on an individual who will suffer from  estrangement and lack of support.

In our hour together the Dr. covered a lot of ground.  Any single related topic that was brought up such as the six faces of conflict or the specific characteristics of enduring conflict would warrant an evening’s discussion.  But I learned that enduring conflict has many underlying characteristics that add to the difficulty of a conflict that was more complex than I had originally perceived.

We know that the nature of psychosis and the necessity for medical compliance makes the process of conflict complicated and difficult. But Dr Pieri suggested:

  • We must approach situations with hopefulness, optimism and a will to make things better, but with realism and a an awareness that the situation will only improve slowly and with many setbacks.
  • We need to act confidently and at least decisively on the basis of the information and choices we have but with the knowledge that that we don’t really know all that is involved.
  • We need to embrace conviction and beliefs to move forward while at the same time recognize that these beliefs are not based on absolute truth and that opposite beliefs and convictions have to be considered.

It is always helpful to take an overwhelming topic and break it down into parts to better understand how everyone is effected. I won’t attempt to interpret the definition of enduring conflict as it was presented. But I will share the Dr’s information regarding managing enduring conflict with sustainability factors that provides some baselines to strive for for everyone, including families or clinicians:

Sustainability Factors

  • Developing resources

  • Maintaining Energy

  • Maintaining Emotions

  • Encapsulating the Conflict

  • Maintaining safety( personal, physical, and psychological)

Dr Pieri also offered some good information about managing conflict with a model to consider for dealing with the long term enduring conflict:

Staying with Conflict: A Strategic Approach to Ongoing Disputes. Bernard Mayer, 2009

A model developed by a Conflict Specialist to apply to long standing seemingly unsolvable issues.