Bipolar friend needs help but doesn't want it

July 8, 2011 3:35 PM

How can I convince my bipolar friend to get treatment?

A close friend of mine is bipolar and wholeheartedly believes in a delusional belief system. He fluctuates between that and being totally normal. In the past, before we met, he was committed against his will and abused and traumatized by the system so he doesn't want to go back to a hospital. He also doesn't think he needs help.

He's high-functioning, but what worries me isn't even his belief system but the fact that he seems dysphoric and often talks about harming others or himself, though he never actually has.

He sees himself as highly logical, but there are contradictions in his belief system. If I try to point those out, would it help him see that these beliefs are delusional? It seems like the problem is more the mood of hopelessness than the delusions, yet they influence each other.

posted by anonymous to health & fitness (11 answers total)

If he doesn't think he needs help, he won't get it. If you point out the contradictions, he will become angry. If you think he's going to harm himself or someone else, call 911. Otherwise, be his friend--be patient, be kind, set boundaries for yourself, and maybe--just maybe--he will ask for your help when he's ready.
posted by liketitanic at 3:39 PM on July 8, 2011 [3 favorites]

I am not a mental health professional at all.

Bipolar is a disorder that generally requires medical treatment. What you want to do is well-intentioned, but it's sorta like trying talk therapy with someone with a brain tumor. There is an underlying problem that needs to be addressed before (relatively) rational thought can happen.
posted by the young rope-rider at 4:36 PM on July 8, 2011 [1 favorite]

Oh--and liketitanic is spot-on.
posted by the young rope-rider at 4:37 PM on July 8, 2011

Speaking as someone who has bipolar and has resisted treatment in the past (I'm taking medication now) and someone who has dealt with a bipolar person resistant to treatment, I'll tell you this: Liketitanic hit it dead on. If your friend does not think he needs help, he will not get help, no matter how much you tell him he needs it, no matter how much you beg him, no matter what. He has to want it.

Liketitanic is also right about his delusions. They are a very significant part of his world. If you try to destroy that, he will get angry, possibly even violent if he's talked about being a danger to himself and others (not saying this will happen - saying it is a possibility). Please, do not try to be his therapist.
posted by patheral at 4:48 PM on July 8, 2011

Also, OP, you should feel free to memail me or email me at my username @ gmail. I have been/am where you are with this.
posted by liketitanic at 4:51 PM on July 8, 2011

There are online support groups for friends of people with bipolar (and other mood disorders) that may be helpful for you. Forums (fora?) too.

(And yeah, you can't make your friend go to therapy, and pushing it is probably unwise.)
posted by SMPA at 5:26 PM on July 8, 2011

He fluctuates between that and being totally normal.

What are the behaviors that you believe are hurting him? When he is "totally normal", is he aware of the difference of his behavior and beliefs when he is not? If he's not, perhaps videotaping his problematic actions and showing them to him could educate him. If he is truly totally normal, he may respond to this in a lucid moment and make a plan that others can assist in. If he dismisses it, I'm not sure there's much more you could do.

I completely agree that if he doesn't want help, you can't help him. People only change once the pain of not changing is greater than the pain of changing. For people with severe mental illness, sometimes that greater pain only comes in the form of involuntary commitment or worse, traumatic injury or incarceration. The message that he needs to accept is that this may be waiting for him if he doesn't take action. But only he can do the accepting.

Good luck.
posted by buzzv at 6:02 PM on July 8, 2011

Friend, I worry about you, and I believe there's good therapy and good medication available that could help you be happier and safer. I know you have some baggage, but if and when you're ever ready to get some help, I'll be there for you, especially to make sure you get safe, appropriate treatment. And until then, I'm here for you if you need me, because that's what friends are for.
posted by theora55 at 6:20 PM on July 8, 2011

You are me about two years ago. I directly approached my friend and told him I was worried about him and would like it if he got help. He got defensive and angry, and all but physically removed me from his apartment.

About a year after that, he went to see someone, but only because he wanted to get prescription drugs so he could abuse them. He didn't get them. This made him even more unbalanced.

We had a pretty intense falling out after that (he did some things, that while nigh-unforgivable, he just refused to apologize for). I have no idea what he is doing now.

There is nothing you can do for someone in this situation. This may make you feel bad and utter powerless (as it did for me), but it's something you have to accept.
posted by King Bee at 7:41 PM on July 8, 2011

I was once close to someone very like your friend--he's intelligent and logical but when it comes to his bipolar disorder he just cannot see it, in spite of arrests, commitments, and destroyed relationships with loved ones that have resulted from it. No matter how peculiar or destructive the behavior, he will find a way to rationalize it, and if you don't accept his explanations he gets angry. Like your friend, he had some terrible experiences with the mental health system when he was younger, and they made him intensely resistant to considering any form of treatment.

In my years of dealing with him only two approaches were effective in getting him to approach treatment. The first was when he was highly delusional and not really functioning at all, I managed to sit him down and say, "I can see you're having a hard time. You're kind of freaked out a lot [extreme understatement, of course], you're not really sleeping, you can't do a lot of the things you used to do. Do you remember a few weeks ago, you were able to think more clearly, you seemed so much happier? I've spoken to a doctor who might be able to help you figure out what's going on. You don't have to do anything except talk to him. Would you let me take you to him? If agrees with you that you're fine, I'll take you right back home." He agreed and I took him to a mental hospital for an evaluation. Unfortunately, they decided he needed to be committed, and he never forgave me for this, but I still think it was the right thing to do.

The next time, I did some research into psychiatrists who also practice alternative medicine, and set up a few appointments til he found someone he liked. Although my friend has a horror of psychiatric medication because of his past experiences, he was willing to see a doctor whose approach was more holistic. He's taking, you know, some kind of vitamin supplements now, and I can't vouch for their efficacy, but at least he's seeing somebody regularly, which is a first in his adult life. And she does have the ability to prescribe more traditional psych meds if he starts to go off the rails again, as well as the training to identify the symptoms, I hope.
posted by milk white peacock at 10:33 PM on July 8, 2011 [1 favorite]

The short answer is: you can't. There is little to no help for those who will not help themselves, and even less for those who don't realize they have a problem.

The way to make this a possibility is if you can get his "totally normal" self to recognize the behaviors and thought-patterns of the unhealthy self. Even then, it will be his choice to seek treatment or not.

Assuming he is an adult, and unrelated to you, there's not much else you can do unless he is an immediate threat to himself or others. (And I've known some who can fake, rather well, *not* being a danger when they are [when confronted by professionals/law], so keep that in mind.)

Myself, it took me many years (even after several traumatic events in a row) to even admit that there was something very wrong with me. I was lucky to have some clarity right as I was crossing from "passively" suicidal to "actively" suicidal. NOBODY (my also bipolar mother included) could get through to me until then.

Take care of yourself, set firm boundaries and be there for your friend as much as you can. Feel free to MeMail me.
posted by MuChao at 10:24 AM on July 9, 2011