How to say "you're crazy"?
December 15, 2009 9:08 AM   Subscribe

How do you tell someone that they're "crazy"? I need to help a best friend who is losing his sanity. It's a long story...

About three years ago, in his early twenties, while under a huge deal of pressure in a very stressful job, he started hearing God speaking to him – literally hearing the voice as if it were real. He began to identify as a Christian, and immersed himself deeply in biblical scholarship, Gospel of Thomas, Gnosticism, all that sort of thing. It wasn’t run of the mill born-again stuff; it was obsessive, and a complete and utter break from his previous personality. The signs that something was odd were obvious, but his parents, for reasons I won’t go into, were of no help. His behaviour became more and more erratic, he could not continue working, he got arrested after flipping out on his housemates after God warned him of an impending terrorist attack, he spent a brief period in a mental hospital, came out, got deeper into the stuff, started obsessing about hell, and ended up attempting suicide and was lucky to survive the attempt. I had been living overseas during this time, and was shocked to find out about the whole thing when I got back.
That was two years ago. After this he received the psychiatric treatment he should have had long before, was diagnosed with schizophrenia and started taking medication to control the voices and visions. He started living with his parents again, started receiving a disability pension, and realized that the whole thing had been a symptom of mental illness. He went into a deep depression for about a year. Then he began to recover, returned to university, and it seemed possible that he’d be able to put the whole thing behind him. He was no longer religious.
He graduated from university a bit less than a year ago, and since that time he’s seemed to have his condition under control. He was still living with his parents, taking it easy, half looking for work, began another course and planned to go overseas to live with another relative. He tried dating; he hadn’t had a girlfriend since the whole thing blew up. He seemed to be in a bit of a rut, but at least he wasn’t in danger. If you met him you might not consider him completely “normal” (who is?) but you wouldn’t suspect that he had schizophrenia.
But over the last week I’ve received a couple of calls from him. He sounded perfectly rational, there wasn’t a trace of mania in his voice, but what he was talking about disturbed me. He seems to have a new hobby researching occult symbolism on the internet. He spoke for hours about Egyptian, freemasonic imagery, Babylonian mythology, ancient mystery religions, and said that he had pieced everything together, and uncovered a great secret – basically a magic spell that can lead to life after death. Apparently this secret has been known throughout the ages but because it is being kept secret because it is dangerous and if you do it wrong you will go to hell. Anyway, he has uncovered the magic spell, which he says has given him the feeling of eternal life, physical sensation of power, enlightenment etcetera. He instructed me how to perform this spell myself (the particular details are not important, needless to say it is quite bizarre). But he says he hasn’t discovered the final stages of the spell and is still looking.
I didn’t know what to say. What I wanted to say was – “have you been taking your meds?” But I didn’t want to offend him. I didn’t want to say that his “enlightenment” was just his mental condition resurfacing. I just listened patiently and said, “hmmm… that’s interesting”. The thing is, he talks in the most normal way. He knows he is perfectly sane. And I’m pretty sure he has been taking his meds, but something is still wrong. If I tell him that he’s losing his mind, he’ll just think I’m being an asshole.
It is stressing me out because this guy is my best friend, we’ve been best friends since we were like ten years old. He’s the only friend I’ve kept in contact with since school. And he’s really smart, an excellent guy, who could achieve anything if it wasn’t for this illness. When I recall all the memories of how we grew up together, I just feel totally awful about what it has come to.
So… I don’t really know if there’s an answer to this question, or if anyone has been in the same situation, or what. But I’m at a bit of a loss. He needs help getting back into the real world and piecing his life together again. How do you tell someone that they are “crazy” when they’re obviously not going to believe you?
posted by anonymous to Human Relations (22 answers total) 3 users marked this as a favorite
If he's as good a friend as you claim, if you ask him to please go check in with his psychiatrist/doctor and tell them about his "enlightenment" as a favour to you, perhaps he will.
posted by orange swan at 9:12 AM on December 15, 2009 [2 favorites]

You cannot reason with an insane person. I'm sorry about your friend, but you can't help him regain his sanity. He has a disease - you can't control what he will think, do, or say. And you can't fix him or make him see reason. I might have missed this in your explanation, but is he in treatment?
posted by infodiva at 9:13 AM on December 15, 2009

Well, even if he were sane, you can't control what he will think, do, or say. But still.
posted by infodiva at 9:15 AM on December 15, 2009

What, two years ago, spurred him to recieve treatment? Is he still being seen by someone? If he is, contact the doctor or therapist and tell them what he's been saying and tell them you're concerned for his well-being.
posted by inturnaround at 9:16 AM on December 15, 2009

Medications for schizophrenia can ebb in effectiveness and new medications may need to be tried. You should calmly let your friend know that this may be one of those times.
posted by jessamyn at 9:20 AM on December 15, 2009 [6 favorites]

How about this:

"Hey, I was thinking about that phone call the other day, where you told me all that interesting stuff you've been researching, and that eternal-life spell. You'd want me to tell you if it seemed like you were showing schizophrenic symptoms again, like last time, right? Well, that talk we had set off some alarm bells for me. On the other hand, I'm not a doctor - why don't you make an appointment to talk to your psychiatrist and tell him about this stuff, and get his opinion, just in case."

In my experience, it's not helpful (in fact often detrimental) to argue with him and try to force him see reason and realize that he is delusional. I think the best thing is to avoid contradicting him, and instead suggest that he may be showing symptoms again, and that he might want to see a doctor. I think gentle suggestion is the best tactic.

Don't give up on him though - you don't want him to lose another year of his life to delusion. On the other hand, don't be too overtly persistent - there's the danger that he might include you in his paranoia (assuming he has paranoia), which sucks, and usually means you can't personally help him any more.

You could also call his psychiatrist and confidentially tell him you think something may be up, so he can schedule a "routine" appointment. I would be careful about going behind his back if he has paranoid tendencies, because that kind of thing can make him lose trust fast.

PS: Nicotine withdrawal is commonly associated with increased schizophrenic symptoms - he's not trying to quit smoking, is he?
posted by Salvor Hardin at 9:27 AM on December 15, 2009 [5 favorites]

I am not insane, but I do have a mostly-under-control anxiety disorder. One of my partner's jobs is to keep an eye on me for signs of a flare-up, which are sometimes obvious to other people before they are to me. You've got a clear sign here; he may not be able to hear it, but you ought to say something. I like orange swan's suggestion.
posted by not that girl at 9:29 AM on December 15, 2009

I normally wouldn't suggest going to someone's parents to ask them to check in on their adult child's mental health, but if I were you, that's what I'd do in this situation.
posted by oinopaponton at 9:35 AM on December 15, 2009

If this was my client I would very patiently listen to his delusion about the magic spell he discovered, we covered indulging delusions held by people who are symptomatic of a psychotic disorder previously on Ask Me and you're not hurting him or making anything worse by listening to him and talking to him about his world as he perceives it. This is a great way as a mental health professional to establish a trusting bond with a client because people suffering from delusions are generally very distrustful of people who combat their delusions. To someone who is experiencing psychosis the delusion is very palpable and very real. So I would caution you against combatting his delusion because you're just likely to make your friend agitated if you do; wouldn't you become agitated if people started telling you the things you see and hear actually aren't happening?

However, the point of building this trusting bond would be to reach a point where I can talk to a client about their symptoms without agitating them and gently encourage them to return to treatment. There's nothing wrong with asking your friend if he's been taking his meds, maybe he has a reason why he's not taking them (antipsychotic medications tend to have pretty awful side effects), and you can start to understand why he's making the choices he's making. I would focus on positive things, like bringing up all the acheivements he had and progress he made when he was in treatment and assure him that if he became willing to return to treatment he could get back to that place. I would assure him that it's never too late to start managing his symptoms and turn things around.

I wouldn't expect him to be super receptive to this kind of conversation, and if he's not you can always drop it and attempt to revisit it at another time. If he does return to treatment and get his symptoms under control I would have a talk with him then, also, and let him know how good you think he's doing and let him know how happy it makes you to see him thriving and accomplishing awesome things.
posted by The Straightener at 9:36 AM on December 15, 2009 [11 favorites]

I agree with Orange Swan. Ask him, as a favour to you, to check in. You can't convince him of anything, but he's still sane enough to know that you have his best interests in mind, right?
posted by molecicco at 9:38 AM on December 15, 2009

Seconding not being able to reason with him, in my very limited experience. I've only known a couple honest-to-god clinically diagnosed schizophrenics. The first was a housemate and the second is my wife's cousin who had his first episode 12 years ago and has been very sick ever since. Both of them were less high functioning than your friend, but the basic underlying problem is the same: your logic is completely meaningless. His entire relationship with reality is different than yours. One plus one is blue.

Trying to talk him out of it won't work. Even trying to get him to seek help is going to be a REAL problem. At least with my wife's cousin, it didn't help to ask him to see the situation from an outside perspective. He'd acknowledge that what he was experiencing sounded nuts, but then swear that the voices really were government agents trying to make him look crazy. He was living in a totally different world. Still does, though the meds make it a less scary place for him to live.

If you're really close, first I'd talk to his parents. If they can't help, I'd ask him to go see a doctor not because he's sick, but to help reassure you that he's not. As a favor.

Sorry you're in this situation. It may be that the best you can do is help care for him when things get bad. If you really want to help, I'd try to coordinate efforts with his family. As bad as things are for you, it's gotta be hell for them.
posted by paanta at 9:40 AM on December 15, 2009 [1 favorite]

Oh, my goodness. I had to read this twice to make sure that we weren't friends with the same person. I have a friend whose delusions manifest to a similar, although lesser, extent, also revolving around religion. The last time I spoke to this friend was several months ago, when I told him that I didn't think the prayer he had hit upon to banish the demonic voices from his room was doing the trick, and that he should continue to see his psychiatrist and take his medication (which he wanted to quit doing). He told me that I didn't believe in the power of prayer, and hasn't spoken to me since. I am so glad that he is living with his parents (who are on top of the situation) and in the care of medical professionals, because right now he is entirely irrational and completely unaware of it.

I'm not really sure what advice to give you, other than that a direct confrontation may lose you his friendship. I would make sure that his parents were aware of what is going on (chances are they are), as they are the ones in a position to ensure that he gets treatment.
posted by Wavelet at 9:53 AM on December 15, 2009

I've been in a similar situation with someone close to me, and this is what I found helpful. He trusts you and is not going to hide anything from you, which is good. If you force him to the doctor you run the risk of losing that trust. I think you need a third person in the mix, one who is comfortable expressing concern for him. You and the third friend talk to him together, he presents his case to the skeptical friend. You ask him to talk to the doctor to appease your skeptical friend, so everyone is happy. See what his response is to that.

Barring that, I'd call the parents. The person who I knew who had a psychotic break did so while in college, and his friends eventually called his parents. (Do you know how fucked up things have to be for a bunch of 21 year olds to call one of their moms? They must've been worried to pieces.)

Good luck and PM me if you have any questions.
posted by 8dot3 at 9:55 AM on December 15, 2009

In my experience, it's not helpful (in fact often detrimental) to argue with him and try to force him see reason and realize that he is delusional. I think the best thing is to avoid contradicting him, and instead suggest that he may be showing symptoms again, and that he might want to see a doctor. I think gentle suggestion is the best tactic.

This. I'm not an expert, but I have had to deal with someone like this many times. These are the things that have helped me the most:

- Don't contradict his delusions. They're really completely beside the point anyway -- you don't care if there is or isn't a spell for eternal life, you care about your friend's well-being.
- Don't overstate your case. You're not a doctor, so don't diagnose him or try to guess what kind of treatment he might need. Your goal is to get him to a doctor, not to be one.
- Be as matter-of-fact as possible. Don't beat around the bush, because it will put his guard up. I think Salvor Hardin's suggested wording is excellent.
- If the conversation is freaking him out, just drop it. Let him know, first and last, that you're his friend and that you care for him very much.

There's no guarantee that he'll take this well, and it's perfectly possible that he will think that you're being an asshole. But if he's really your friend, and you're putting his well-being first, you should tell him honestly what you're seeing. It could save him a lot of pain in the long run.
posted by ourobouros at 9:55 AM on December 15, 2009 [1 favorite]

> "What I wanted to say was – “have you been taking your meds?” "

The older I get.. the more often I'm reminded that gut feelings/intuitions are usually right. (In other words = thats what you should have said). Granted, its a little direct/blunt... but sitting there listening to his wild ramblings for long periods of time is not helping. (for a normal person, infatuated with a new hobby or interest, listening to them ramble is perfectly fine if thats part of "getting it out of their system". Your friend is not "getting it out of his system" - sounds like he has a history of "digging his psychosis deeper")... If it were me, I'd use all the conversational skills I could muster to be patient, but more importantly to direct the conversation back towards healthy ground, and help my friend recognize what are healthy thoughts are what are not. I assume you are not his therapist, but many times a phone call to a friend can be very therapeutic if handled correctly. (not implying this responsibility is yours unquestioningly to accept, but if the opportunity presents itself, its an opportunity to help even if that help is directing your friend to revisit his doctor/therapist or re-evaluate his prescription as jessamyn points out.
posted by jmnugent at 10:17 AM on December 15, 2009

Nthing Do NOT Contradict His Delusions, no matter how disturbing, or possibly especially when they're most disturbing. If *gentle* suggestions to talk to his doctor seem to agitate or upset him, drop it.

Talk to his parents! *You* will not be able to help him/get him help; his parents might be.

And the hardest part: If you become a player in his delusions (he remembers conversations with you that you didn't have; he seems to think the relationship is something it's not; voices are telling him bad things about you; etc...) If he starts having delusions centering on you, cut contact with him and call his parents. It may be wisest (and yes, hard) to cut all contact with him until he's stable on his meds again. Keep in touch with his parents/other support system as possible during this time. If you become part of his delusions, *every* interaction can become detrimental.
posted by MuChao at 10:25 AM on December 15, 2009

I am curious about what treatment he has had, as this would affect a response. A lot of people who have been treated for schizophrenia, if they're aware they have the disease, have been given some training in recognizing their own symptoms. Those people are sometimes more receptive to a comment like "From the outsidem this is looking like a symptom of schizophrenia, and is there somebody you can talk to?"
posted by Astro Zombie at 10:47 AM on December 15, 2009

This reminds me quite a bit of a friend of mine. I'm sorry for your friend and that you have to deal with this situation.

What I've been doing for my friend is providing general support. Other mutual friends have been a bit pushier with him and he's drawn away from them. At this point I feel like having someone to talk to is more beneficial for him than having someone else tell him its time for new meds. It seems to help, but I always wonder if I could be doing more. He goes to a support group a couple times a week and says that's amazingly helpful.

Listen to your friend. Ask him how his therapy is going. Don't tell him to go to therapy. If you have a lot of free time you might even want to ask about how he arrived at his theory about the spell. I wouldn't confirm or deny anything he says about it though.
posted by valadil at 11:24 AM on December 15, 2009 [2 favorites]

Can you contact his doctor directly? I'm sure you're a good friend but this sounds out of your depth.
posted by chairface at 11:44 AM on December 15, 2009 [1 favorite]

If you're in the US, how about contacting a local chapter of the National Alliance on Mental Illness (NAMI)? I've never used them personally, but have attended meetings for people affected by a friend of family member's mental illness at a different organization. Even if you don't feel like you need emotional support for your reaction to your friend's illness, it might still be a good way to get suggestions from people who have been in similar situations.
posted by Neely O'Hara at 1:10 PM on December 15, 2009

anonymous: "He knows he is perfectly sane."

A favorite quote of mine goes, "Insane people are always sure that they are fine. It is only the sane people who are willing to admit that they are crazy." Or question their sanity.
posted by IndigoRain at 4:55 PM on December 15, 2009

Hi OP,

So... Anitanita's husband:

The website "" has some excellent advice for family and friends of people with mental illness. basically the advice comes down to this: endorse the emotional content of what your friend is saying, but (here agreeing with Valadil above) neither confirm nor deny the intellectual content of what they have to say. The more you can separate the content of someone's thought from the motivations of why they are choosing to believe it, the more effectively you can talk to someone. Even if you are not a trained therapist, it doesn't take a huge stretch to understand that your friend is desperately seeking a degree of significance and meaning in his life. Perhaps he is just hoping for you to acknowledge that, even if you don't buy into his elaborate "conspiracy theory" of a lost magic spell of immortality, that you appreciate his desire to find meaning in the world.

The nice thing about this approach is that it requires almost nothing of you besides supportive listening. A helpful book for understanding delusions and how common they really are (if you have some time on your hands - it's a good 500 pages), is "Madness Explained" by the British psychologist, Peter Bentall.

And Anitanita:

The only thing I would add is an appreciation of how chilling it *can* feel to be a friend to someone and listen to them 'careen off the road' - discussing topics, perspectives or beliefs that seem entirely incoherent. Whenever I've been in that situation, I feel like don't know what to do because I'm not a trained health professional, and I recognize it comes from both a sadness for my friend's situation and fear for their future.

I just wanted to say that in those moments, I really, really need to remind myself that I am not a trained health professional, I really can't accurately assess how serious their situation is. Like many people, I don't understand mental illness issues very well, and tend to 'come up with some sort of assessment (Oh yeah, Asperbergers.... Yep, he's Bipolar...) based on limited information and bad medical TV shows. That's a lousy way to determine how serious their situation is.

For example, in reading your posting, my first response was all 'sympathetic-ish', "Ohh, that's kind of scary for the OP." and Mr. Anitanita's response was all 'fascinated with human diversity-ish' and thoughtful-ish with a, "Well, you know, there is a really broad spectrum between mental health and mental illness, and you know, it's kind of fascinating, because delusions are so much more common that you might imagine - people with them live rich lives every day. It helps not to marginalize people with 'ooh, pack them off to their shrink forthwith!' language based on fear or ignorance, particularly if their situation isn't violent, etc., etc.". So basically, his response is a lot more informed, a lot more calm, and a lot more generous, than mine.

So my non-health professional response is just to imagine what I would want if I was that friend with the mental health issue- and I think it's just an appreciation that I might be going through a difficult time, that I don't expect you to solve all of my problems, and that any effort on your part to understand what I'm going through it deeply appreciated (regardless of what you can actually do about it). Listen as much as you can (within your boundaries), and encourage your friend to reach out to others, including his psychiatrist, and share his thoughts. You're a good friend to care enough to consider how you can (and can't) help.

And cause you gotta say it: IANAPsychiatrist (Anitanita) and IANYP (Mr. Anitanita).
posted by anitanita at 9:37 PM on December 15, 2009 [3 favorites]

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