My best friend appears to be sliding into psychosis. Who and how should I approach in order to help him out? I know IANAD and YANAD - but I need less info on diagnosis and more info/personal experiences/stories about reaching out to someone who has a undiagnosed mental illness in order to help them.
In order to help you guys get a real grasp of my friend's situation, I'm gonna give you some background history, and then a record of some of the very disturbing encounters I've had with him recently. Then I'll finally get around to elaborating on my question of how to handle this situation - who to talk to, what to say, how to approach, all that. I would really appreciate it if anyone who has personal stories or experiences with this sort of situation would share with me, as I'm totally at a loss as to how to proceed.
- Also, I know very similar questions have been asked in the past, but I'm looking for something other than the normal "get him to a doctor" response. I want more than anything to get him there - it's how that I'm confused about.
The person in question, let's call him S. I have been best friends with S since the third grade, so we have been extremely close and known each other extremely well for a long time. S. currently lives about an hour's drive from me, where he attends a different university. However, we see each other almost every week, and a whole lot more during breaks. We're both in our early 20s and male.
About a year and a half ago, S. got heavy into LSD. At first it was every weekend, and then he started using it during the school week, even going to class while tripping. This lasted for about a semester, before his source dried up and LSD had lost its novelty. I know he also has taken a lot of mushrooms, as well as some more exotic stuff like DMT, MDMA. During this same time period, his very serious relationship with his long-term girlfriend (one of his first partners) dissolved after she decided to go for his roommate instead. This messed him up a whole lot in the head, but it seemed after awhile as if he got over it. It's only now that I'm realizing maybe the shock and trauma didn't dissipate so easily.
I mention all this because it was about 6 months after this intense period of drug use that he started to change - a lot.
Symptoms/Signs of Illness
First example: One night it was I, S., my girlfriend and S's roommate, hanging out. We were just sitting around, sipping beers and listening to new music. I noticed that S. was very, very withdrawn and couldn't be coaxed to start any sort of conversation, and had to basically be forced to say anything about anything. This is when I started to worry, and this is when things got progressively more disturbing. We continued to chat about music for the rest of the night (we being my girlfriend, S's roommate and I) and shyed away from trying too hard to incorporate S into the discussion. However, after awhile, S began to become more and more agitated, and would burst into our conversations with remarks like "Why do you guys always have to talk about me in front of my face?" & "Why do you keep insulting and criticizing me, when I'm right here?" etc. I.e. He was interpreting everything we said, which was merely mundane music trivia, as attacks, affronts and comments about him. We told him each time "We're not talking about you at all, we're talking about [this musical act]" but he would just looked confused, suspicious and then finally would say "Oh....ok."
This type of thing has happened occasionally since, but not with the intensity of that first time (i.e. he'll interpret one or two comments or conversations this way, but won't keep insisting on it the whole night after we explain to him what we're actually talking about.)
I went to visit him last weekend, and upon arriving he seemed pretty OK. However, as the night wore on, and we sat around talking (he really didn't feel like leaving his house, even though no one else was home and there was nothing to do, and we were supposed to be meeting people downtown), things started to get weird again. Finally, he told me "I want to tell you something." He went on to explain that when he'd been walking around downtown recently, he had started to notice strange connections between everyone and everything around him. For instance, he would hear one person talking on their cellphone on his side of the street, and then would immediately notice how a person across the street, also on their cellphone, would start talking about what the first person had been speaking about.
He said everyone he met was subtly influencing each other, and that he was the only one who could notice this. Even stranger, he said that he could tell in such small and subtle things such as a change in someone's posture, or small movements of their hands, heads, or the direction they were walking in, that the person in question had heard all of the other people's conversations and was acting in response to these conversations.
Example: A person who heard another person, further down the street talking on their cellphone, would shift their feet as a sign that they were in on the conversation, and this shift itself was a message or a sign that could be interpreted. Sometimes these messages were directed to the voice on the phone, other times, to S. himself. S. said he had experienced this a lot recently, and that it was a new phenomenon.
Even more chilling than all of this (which was so disturbing I had goosebumps for half an hour afterwards) was S's face and demeanor as he told me all this. Completely cold, inexpressive, flat. This flat affect isn't restricted to when he is telling of his strange experiences, however - ever since he started to change, S. has had an increasingly flat affect speaking or doing anything. I've seen maybe one or two smiles in as many months. And while he's always been just a little quiet, in this time period he has stopped initiating conversations completely, and will only reply when absolutely necessary or when he has been continually goaded by those around him to answer.
His performance in school has also drastically gotten worse. In school together, we were two of the brightest kids in our school. And while earlier in college, he was bored with the material and smoking a moderately unhealthy amount of marijuana, he still managed to do very well, even in courses he had no interest in. However, recently, he has completely given up on attending class or doing any coursework, and as a result has failed quite a few courses and this has caused his graduation to be pushed back an entire semester.
1) S definitely shows signs of having ideas of reference
- both when he has conversations with friends (when he thinks they are covertly attacking him) and when he is out in world (when he sees all human activity around him as holding some secret, significant meaning, and all of these activities seem to be interconnected and influencing each other)
2) He also definitely has a blunted/flat affect & poverty of speech
3) I believe it is very possible that the voices he claims to hear when walking down the street (especially when the owner of that voice is supposed to be a voice on a cellphone across or a block or two down the street from him) are audio hallucinations, but it's hard to be sure. Problem is, if he has been hearing voices, I believe that he would probably try to hide that from me.
4) He has become increasingly socially withdrawn and isolated, and his school and work lives have suffered as a result, not to mention his friendships.
All of this leads me to conclude (although IANAD) that there is a good chance he is developing symptoms of schizophrenia. Considering the amount of LSD he used prior to this period, and the emotional turmoil he was going through at the time, I think this might have contributed to bringing what was previously a latent condition to the surface.
So finally, to elaborate on my question: How should I handle this situation? I love S. dearly, he has always been my best friend, and he's an amazing person and an amazing musician. Watching him slowly fall into a very deep hole is killing me, and on an even more basic level, I really miss having a connection with him. He's just not there anymore really, most of the time.
My problem is that I think confronting him, or even politely and suavely suggesting that he see someone, would bring about a very violent rejection. Considering how he is already paranoid in conversations about completely innocent topics, I can't imagine my telling him that I'm afraid he has a mental illness would turn out too well. I just don't know who else to go to - his parents? I'm just afraid to make the wrong move because I really want him to get help and I don't want to make him shut me out.
He is capable of acting semi-normally for periods of time (although if you knew him before this period you could immediately tell something is off) so I'm afraid of broaching the subject, because although I've seen enough to totally convince me that he's at serious risk, I think it's possible that he could mask his symptoms and hide what's going on for a couple more months at least. Which would be pretty bad regardless, but I also know that he has continued to use mushrooms and excessive amounts of marijuana, and I'm afraid those things, if he continues to use them regularly, will only make his condition deteriorate more.
So what should I do? Try to talk to him about it, despite the high chance that he'll disregard all I'm saying and possibly cut the ties between us? Try to talk to his parents, despite the fact that he probably acts relatively normal around them (or so I imagine), and then risk the chance of him denying everything to them and then, once again, cutting me off? Or try to meet with him with several more of our friends, because I'm only one of many who have noticed the changes he has undergone recently? None of the above? Something else? Nothing at all?
I care about this guy a lot so I want to help him the best way I can, I've just never had an experience like this, and don't know how to handle it. I have lots of experience with mental illness (personal experience and otherwise) but this is the first time (and hopefully the only time) I've had to basically watch a friend slowly drown in his illness without knowing what to do to save him.