How can I help my friend get help for suspected mental illness?

January 10, 2013 1:05 PM

I'm sure that my friend (who lives cross-country) is dealing with un-diagnosed untreated mental illness. I'm 99% sure it's bipolar disorder, based on lots of information and evidence. I don't want this thread to be about diagnosing, but rather about how to help (I think we can agree that the steps I should take to help would be largely the same regardless of what he's grappling with, right?).

He's desperately unhappy and freely admits this to me -- detailing many things that make him angry and anguished in different phases of his life (relationship with parents, relationship with longtime girlfriend, his job, etc).

To me (having dealt with depression myself) it's obvious that this underlying issue is causing or at least exacerbating all of these things he's dealing with. I've said this to him many times, and pointed out that even if he gets away from all these problems (ie breaks up with girlfriend, quits job, moves out, etc) that the underlying issue will remain and eventually negatively affect his future life as well -- that these things don't just go away (and that the very fact that he wants to sort of run away from everything is a pretty good indicator that something's up). Sometimes he agrees with me on this and sometimes he doesn't.

He's 32 and estimates he's been dealing with this for at least 8 or 10 years. He has a family history of mental illness. For a long time he self-medicated with alcohol, but stopped drinking a few years back. I don't know how he self-medicates/deals with things now and I worry because it seems like things are deteriorating lately (to the point where I'm making this post).

We've had many emotional conversations where one day he'll agree that he needs help or treatment and then the next day he'll deny it. We'll set up a plan or timetable to work on planning stuff out and then it will fall through. I'll offer help and he'll accept it and then turn it down later. He's even commented to me how he's sabotaging himself and this getting-help process. Mental illness has a strong stigma for him (I think due to family history) and he will go on about how dealing with this means admitting that he's broken or powerless and the idea makes him distraught.

He's an extremely bright and logical guy and definitely realizes that there is a problem that needs to be addressed. But the logic seems to fall apart whenever it comes to taking concrete steps.

Why can he admit that he needs help and then not get help? How can I best support and help him from a distance? I'm happy to go and be with him if it would help, as I have a flexible job and can travel. General as well as concrete recommendations/steps, resources I can look at, and any advice at all would be really appreciated! Have any of you gone through a similar situation? Am I missing something obvious? Thank you so much for your time and willingness to share!

Please feel free to email. Throwaway email: helpmehelpmyfriend @ gmail.com

posted by anonymous to human relations (7 answers total)

IME, you can gently suggest that people see a doctor, but they won't until they want to. Perhaps on one of the days where your friend is more open to seeking treatment, you can make a doctor's appointment for him and get him to agree to allow you to travel to see him and accompany him to the doctor. Sometimes a little bit of "I'll be letting someone else down if I don't do this" can provide a bit of extra push.
posted by wierdo at 1:09 PM on January 10

Sorry if this is a dumb question, but have you tried saying "I really want to help you. What can I do that would help? I could even come out there if that would help?" What does he say?
posted by salvia at 1:09 PM on January 10 [2 favorites]

Perhaps the reason he's not seeking help is because he's getting exactly what he wants right now — a sympathetic listener who has no power to make him change his behavior. I'd consider pulling back. Give him a little warning, but tell him that you're not going to be his therapist-by-proxy anymore. It's not fair to either of you.
posted by roger ackroyd at 1:12 PM on January 10 [8 favorites]

You can do this, I have done it, but be prepared to totally write him off as a friend. You have to be pretty alarmed about his behavior to do what I'm about to recommend.

I knew a guy and he was always perpetually depressed and miserable. He would hang out in Chat all day, loudly moping to anyone who would listen. He'd write purple prose in his blog, moaning about people he hated, his horrible life, etc. I always just figured him for one of those drama-dudes. One day he wrote something in his blog and it spooked me. Seemed a bit too Columbine for my taste. I called the Jr. College where he attended and spoke to security. I gave them the URL, told them his name, mentioned a few of his classes and interests and then I said, "Look, I'm all the way on the other side of the country, whether or not you do anything about this is on you, I'm just concerned. You know how to find him, do what you will with this information."

BOY was he pissed. Apparently they sent a couple of cops out to his house to talk to him. I guess they thought things were cool because he didn't get committed or anything. But at least I did something. And it worked, so far as I know, he's still around. What I hope was that he finally snapped awake and recognized that what he was doing online was scary enough to the outside world that he either needed to get help, or knock that shit off.
posted by Ruthless Bunny at 1:38 PM on January 10 [3 favorites]

I agree with roger. Your friend gets distressed about his life, the stress builds up and he is just about to do something about it so he reaches out to you, makes plans, and as soon as he has made plans he feels he is taking action. His stress goes down, he thinks "things aren't that bad, I can handle this on my own.". He continues in the status quo until his distress grows, he reaches out to you, he vents, he makes plans, he feels better, doesn't follow through, things stay the same.

I think you can give people maybe two or three passes at this cycle but anything past that then makes the person who is the vent part of the problem. Clearly he needs to be at a really distressing level of stress before he will reach out for the professional help he needs. In the parlance of AA, he needs to hit rock bottom.

You are caught in the same cycle. You are concerned for him, you offer solutions, you feel better that there is agreement on next steps and when that falls apart you don't then get angry at him? Tell him no more complaining until you see action? No, you listen to the next time he is upset, suggest options and feel better because you are sure "this time" he will follow through. So you can see how he is stuck in the same pattern as you and emphasize.

You need to step back and let him face the consequences of his decisions. You can explain why and keep the lines of communication open but refuse to talk about his mental health except for the concrete actions he has taken and cheerlead actions, not promises.
posted by saucysault at 2:06 PM on January 10 [2 favorites]

I don't want this thread to be about diagnosing, but rather about how to help (I think we can agree that the steps I should take to help would be largely the same regardless of what he's grappling with, right?).

Wrong. You are not a doctor or a psychologist. Neither are most of us. In fact, your entire post reads to me like a case of codependency.

To me (having dealt with depression myself) it's obvious that this underlying issue is causing or at least exacerbating all of these things he's dealing with.

To a man with a hammer, all things are nails.

Why can he admit that he needs help and then not get help?

He is getting "help" – from you. Whether that's the right kind of help or not is a different story. If you are continuing to help him and nothing's getting better, it may well not be the right kind of help.

And if I sounded harsh before, I'm all for friends helping friends. If one can sort out their life with the help of loved ones and chosen family, so be it. But there are limitations to that. If you are helping, and he is not getting better, he needs a different kind of help.

How can I best support and help him from a distance?

Put firm boundaries in place. Mainly living your own happy life and be a real friend, not a "helping" friend. In my (limited) experience on this matter, if someone is spiralling downward and refuses to help themselves, a real friend sits them down and says:

"Look mate, you're fucked right now. You're on a bad path. You need to sort yourself out. I'm not going to go there with you. You sort yourself out, and I'll be here with open arms when you come back."

Because friendship is about meeting the needs of both people. What need of yours is he meeting right now? How is he being a friend to you? By allowing you to help him? Please reference above PDF on co-dependency if that is the case. What are you getting out of this friendship?

That is important because if you are listening to him – letting him make plans and break them – you are enabling him. You're sitting far away, and as long as you and he do your dance, he may well assume he's alright. When it sounds like he is not alright.

I'm happy to go and be with him if it would help, as I have a flexible job and can travel.

That may work. If you make that journey to deliver him to a therapist, and then come home and get on with your life.

Have any of you gone through a similar situation?

Yes. It's frustrating, but the reality is that people make their own choices. Despite all the care and love and attention in the world, people choose shit paths. It happens.

But sometimes the best thing you can do is point them in the right direction and wish them good luck. You listening and engaging may be preventing him from hitting bottom – really realising the shit state he is in. If your situation is anything like mine was, you strategise. You commiserate. You try and make him laugh. You assure him. You play out a drama that just repeats. Sometimes the story is getting brighter. Sometimes it's getting darker. But it never really goes anywhere. It just kind of sits there and goes in circles.

And subtly, perhaps without you even noticing, it affects you. It plugs into you in a certain way, and you're almost trapped in it. Thinking this is normal. This is what friendship is. I would be surprised if this wasn't affecting you more than you think it is.

Am I missing something obvious?

You seriously need to think about your role in this, and if you are enabling this person. It's a startling revelation for a lot of people, but you may have poor boundaries. People with poor boundaries attract other people with poor boundaries. Have a google and take a test about personal boundaries. Read some stories about it. Be aware of the boundaries of other people.

Then compare them to your own, and see if you have boundary problems. Because you very well may have boundary problems. And if you do, you are probably not helping either of you at the moment. It's very nice that you care, but you have to care in the right way. You have to take care of yourself first. You have to make sure you are being a friend, and not a caretaker.
posted by nickrussell at 4:25 PM on January 10 [2 favorites]

You could take a look at You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling. I've heard good things about it from other mental health professionals.
posted by OmieWise at 6:35 AM on January 11