Help with schizophrenic friend
April 5, 2005 1:04 PM   Subscribe

Looking for advice on helping out a schizophrenic friend.

I have a buddy, "J", who's always been a little 'crazy' as it were. Lots of storys about UFOs, the FBI, collapsing the wave function, harmonic oscilators, etcetera. On the other hand, he's a really fun guy, good friend, and brilliant scientist (x-ray crystalography, structural biology, heavy stuff). This past weekend, my friends and I took him up skiing with us and he was acting extra bizarre, barely eating or sleeping, rambling on a mile-a-minute, reporting all sorts of bizarre sightings of spirits and UFOs. When we decided it was time to go home, he decided to stay at the ski hill, where in the past he has been quite capable of taking care of himself, as he has a lot of friends there. Before we could convince him otherwise, he disappeared and there was nothing more we could do about it.

Now, two days later, I've spoken with his boss who is also generous enough to let him live with him and his family. J contacted him from halfway between the ski hill and home, a little scratched up apparently, looking for a ride home. His boss is seriously shooken up about this. He's genuinely concerned for his family and for J. He's not sure if he'll be able to contact J's family or if they'll be any help, and he certainly doesn't want to turn him over to the state.

Basically, I'm curious what other people's experiences might have been in similar situations. All of my experiences with J lead me to believe that he suffers from classical paranoid schizophrenia, and he was in the middle of a heavy episode this weekend. How do people with this condition cope, and how do their friends and family cope?
posted by garethspor to Health & Fitness (14 answers total) 2 users marked this as a favorite
Can't help you much, but I'm about to start reading a first person non-fiction account of a schizophrenic - Operators and Things: Inner Life of a Schizophrenic. Supposed to be good.
posted by Gyan at 1:17 PM on April 5, 2005

a closish friend may be schizo (life is a bit more complicated than that, i suspect, but at least one doctor has diagnosed him as such).
drugs seem to help, a bit, but it's difficult to balance the gains and the side effects.
really, there's not much to do - that i know of - except continue to love and help them. avoid running after short term solutions, pace yourself, be tolerant. if there's someone particularly close to them, they may be taking a lot of the load. try help them. realise that, horrible cliche though it sounds, part of what makes them an exhausting pain in the neck, at times, and can break your heart, is also what makes them so cool.
posted by andrew cooke at 1:20 PM on April 5, 2005

andrew cooke has good advice. On a side note, I'd say from your description that J was a bit more manic than schizophrenic, particularly in the later stages of a mania there can be a lot of psychosis involved. This may be just because of what you chose to describe, though.

You don't say a lot about treatment and if J is diagnosed with anything etc etc. Unfortunately anti-psychotic meds are not much good for what we would call negative symptoms, such as the delusions you describe. They do better with positive symptoms, like hallucinations; but they aren't always that good there either. If your friend is suffering from mania, mood stabilizers actually do a good job controlling mania, although they tend to make people dull and unreponsive in general. In other words, their mechanism of action is general rather than specific to the mania. For that reason, and for reasons of paranoia, weight gain etc etc, it can be very difficult for people to want to take these medications. This can be a real source of frustration for people who love them and want to help them, as it can seem like willful disregard for what is best for them. But as someone in that position, you have to remember that the meds make people feel like zombies a lot of the time, and many many people diagnosed with schizophrenia or bipolar disorder would rather feel alive and fucked up than feel like a zombie.
posted by OmieWise at 1:38 PM on April 5, 2005

We have a relative who is classically paranoid schizophrenic. A good resource for friends and family is a book called Surviving Schizophrenia, by Torrey. There's a fair amount to dislike about the book, including its snide, know-it-all tone, but having said that, it's a *very* helpful resource to families and friends who don't know quite what to think or do about their schizophrenic friend/relative. What's best is for these folks to find a good niche they can do well in. Sometimes, however, things happen that upset the equilibrium and/or the condition worsens over time.

You and the members of your community will probably notice that there are certain circumstances that are easier for your friend to handle, and others that are quite stressful. For example, many people who have schizophrenia have a *really* hard time in situations where there are lots of interpersonal demands. It's not surprising to me that your friend decompensated in the midst of a small group activity, as such things have lots of implied and explicit interpersonal demands. Basically, try to discourage participation in activities that exacerbate his symptoms.

Some of the newer meds seem to be quite helpful, if your friend would consider seeing a psychiatrist.
posted by jasper411 at 1:40 PM on April 5, 2005

Does the fact that you've had so much contact with J in the past when he was acting strangely mean that you've discussed his behaviour with him?
It's all well and good to humor him and make allowances etc but I guess if it was my friend I would be observing to see whether this behaviour was changing sufficiently that it was adversely affecting his ability to lead a normal life. Such things as missing work/meals/showers and any other factors indicating a progression would alert me to a problem for which some intervention might be called for.
If you have his confidence and/or he's in a stage where he's listening to you (or someone else relatively close to him) perhaps it would be best if he could be directed towards a Doctor so that he can be assessed.
Many people with psychiatric problems lead otherwise normal lives with some medication of course.

But to specifically answer your question, someone who has some progressive illness of this type are going to become progressively burdensome on their close family/friends - I would think that they will live continually stressful lives, not knowing what will happen next, fearing for the safety of J as well perhaps as themselves.

Facing irrationality with rationality (love, assistance, covering mistakes/work problems etc) isn't necessarily going to work. An assessment of some sort is the best course of action that you could urge/instigate/recommend, I would think.

On preview....I don't necessarily disagree with advice above - but everyone will have a better understanding if an assessment is made. And I'd be hesitant about writing off medication without professional advice anyway.
posted by peacay at 1:44 PM on April 5, 2005

Good advice everyone, unfortunately I can't imagine my friend admitting that anything is wrong with him rather than the universe around him. And considering that much of his ranting this weekend concerned his skepticism with westerm medicine and the pharmacutical corporations, I couldn't imagine him seeking psychological conseling or ever taking any medications.

Peacay: I consider him a good friend, although I don't have that much close contact with him, and have not until today, discussed his condition with those that he lives with. I've always heard his crazy stories of UFOs and such, which basically I thought were pretty cool, but I had not experienced him when he was conjuring these things up. So this weekend was the first time I started to understand it being part of a serious condition.

Omiewise: It could be that he would be diagnosed as manic, and manic certainly described his actions all weekend. I am not at all experienced in making diagnoses like this and schizophrenia certainly described many of his behaviors as well.
posted by garethspor at 1:52 PM on April 5, 2005

just wanted to add that, while the approach peacay describes seems pretty common - people want to help, and it's obvious something is wrong - forcing someone to go to psychiatrists, doctors, whatever, doesn't seem to be very productive in my (limited) experience (and even if you have the best of intentions, it's surprising how easy the slip is from helping to forcing). it makes other people feel better, for a while - because "something is being done" - but in the long term can just make the person in question more isolated and unhappier.

also, if you're a colleague at work (not clear to me), one thing you can do is help protect his ass. it sounds like he has a cool boss. is there anything you can do for the boss that would help make life easier? if you can help make the boss's life better, he's more likely to keep supporting this guy, and a job is a great thing to have - not just for the money, but also the structure it gives to life, the self respect, the company, etc. since he's also providing accomodation for this friend, it sounds like the boss is not just a saint, but also a good candidate for receiving any help you can think of.

good luck!
posted by andrew cooke at 2:12 PM on April 5, 2005

It's a good observation, garethspor. Our relative just got heightened paranoia in response to repeated suggestions that he get medication. All that talk just played right into his delusions of being controlled. And the fact that his neighbors were freaked out about him just upped the ante even further.

Omniwise's point is good too - meds may help with some things, but not with others, and there's often a trial and error period as the docs mess with the dosages, combinations, and side effects. If someone is convinced that there's nothing wrong with him, that trial and error stuff is sure to set him over the edge. If you're looking for some more info, the National Alliance for the Mentally Ill might be a good place to start, though some people with psychiatric disabilities find them rather patronizing and condescending to them.

I think straight talk is important, but it should have lots of "I" statements in it - like, "I don't know how to respond when you said xyz," or "I don't know what to make of it when you talk about UFOs - I guess we just don't understand things the same way." rather than "You're acting bizarre - you should see a doctor."
posted by jasper411 at 2:18 PM on April 5, 2005

Point taken about possible difficulties getting J to go to a Doctor and acceptance of standard types of care.
Nevertheless, it will always be the case that if there is significant danger to himself or others then forced intervention would be indicated (I'm not trying to be pessimistic - just trying to reinforce what would be ajudged as a 'line in the sand' kind of thing)

But I wonder what's available in your community - these situations are not uncommon and in 2005 it might be the case that an informal coffee lounge visit or similar might be arranged (surreptitiously) with a community psych professional?? You/his family/anyone else who is going to be on board as frontline support to J ought to yourselves have a chat with the local psych. crew - online stuff is ok but talking things through with knowledgeable people can be dually beneficial - support and advice.
posted by peacay at 2:41 PM on April 5, 2005

Oh....getting J assessed is important on many levels but one basic thing is - so that a diagnosis can be made. That can't be readily done online obviously but the benefit of this is that a prognosis can be made and some appreciation of the likely future can be guesstimated and discussed with those close to J. It may be well and good symptomatically addressing needs as they arise, but with a decent knowledge base from which to work, people in J's life will know what to look for, signs of possible progression, what better ways perhaps there are to 'handle' him and when/what type of intervention might be recommended. IANAD but I've worked in Psych.
posted by peacay at 2:51 PM on April 5, 2005

Once again only basing off of what you shared here and IANA shrink but it sounds like pretty classic manic depression.

A great resource and community to help dealing with such things is the the Icarus Project. It was started by folks who have had their fair share of experience in dealing with manic depression.
posted by lips at 2:54 PM on April 5, 2005

and just in case you don't have time to fully browse the above site, here is a good essay from one of the founders of the site
posted by lips at 3:00 PM on April 5, 2005

I don't think there's enough information here to venture a guess at the diagnosis or even the right way to proceed.

I would suggest, however, that if your friend is in fact actively paranoid and/or hallucinating, as seems to be the case, that it's important to remember how frightening and unpleasant this is for the person involved. The amount of mental suffering that a real schizophrenic person can experience is nearly unlimited, it seems to me. Medicines can help; a brief period of involuntary commitment to give the medicines a chance to do their thing can help too.

But it sounds like your friend's relatively high-functioning. This can be a blessing, as it keeps the person in contact with the world the rest of us live in; but it can also be a barrier to effective treatment, as the person will be terrified of losing that tenuous link (via commitment to an institution, stigma, what have you.)

I have no special advice; I would recommend only that, as you care about your friend and as you are able, be present in his life right now. Listen, be supportive, encourage healthy thoughts and behaviors, discourage the other kind, and don't abandon him when he tries to push you away. One good friend who is willing to do this is worth 10,000 pills or doctors, in this doctor's opinion.
posted by ikkyu2 at 3:20 PM on April 5, 2005

intelligent crazy people are the most difficult. They will always keep you guessing, and they are clever at fighting for their own autonomy. They will frustrate merely average mental health professionals, who will likely seek to drug them into complacency (to protect their own egos).

They will straighten up for periods, and fend for themselves. Then weeee, its off the deep end again. Maybe they manage without being dangerous to anyone. Most likely they are very afraid, and they fear their fear will betray their problem, so they work hard to hide it.

When does a prison have no walls? When its a drug that kills your personality. Its so easy to conclude, its better to be free and insane than imprisoned in your own body, your brain chained to a molecule.

Involuntary hospitalization? That's for CRAZY people! And once inside, one has to ask, will they listen to you at all? Or will they assume you're crazy, and therefore you have no valid points to offer. Take your drugs and shut up or we'll tie you down and force them into you.

What's a little wild craziness, compared to that?
posted by Goofyy at 2:28 AM on April 6, 2005

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