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July 5, 2011 5:22 PM   Subscribe

My number 1 may be suffering from psychotic break. What do I do here?

My boyfriend of 18 months has had what I can only describe as a "psychotic break". He's always been extremely harmless, and there is nothing indicating otherwise. He has become delusonal and its really upseting me. He has built up this internal value system within the past 3 weeks, and because he is able to validate every assumption with himself, its perfect. What I'm saying is that you can't tell him that he's incorrect about something. He doesn't believe it, and just ignores it.

At first, I thought he was being a jerk. After a LOT of incidents, I realized there is some mental illness behind it. And it just happened. For instance, today I brought him his eggs, and they were "cold". I was told that they were cold because I didn't want him to have hot eggs. I was about to hit him with the frying pan when I remembered he said the exact same thing at Borders when the salesguy didn't have the graphic novel he was looking for. It just seemed like a nerdy joke, and all 3 of us laughed at the time. But thinking about it now, it was done in the same manner. He REALLY believes in what he is saying. I would have just thought that maybe he's being a jerk. But he's lost all emotion in his face. He's never happy, laughing, or even funny. Its just that sad serious voice.

My problem isn't knowing what numbers to call, its in how to get him to go to the doctor. He's had problems with depression in the past, but he believe's he's fine now. How can I convince him to get help? He's resistant to "seeing someone" who may be able to help him. And I'm wondering if he should see a MD or a PHD here?
posted by anonymous to Health & Fitness (12 answers total) 5 users marked this as a favorite
YOU CANNOT CONVINCE A CRAZY PERSON THEY ARE CRAZY! I know, because I've been there. All you can do is tell him how he is making you feel and that you will have to step away if he can't see how much it is hurting you and your relationship.

You can also find resources for him, as in a therapist or a psychiatrist. If he is threatening violence though, either to you or to himself, you should call 911.

Never come from a place of "you do this, or you say that," but always how his actions impact you.

My suggestion is to get him to see a therapist first. I would actually suggest you going to see a therapist and talking it out with them to see what you should do or how you can help.

18 months is really not that long though, so if you aren't in it for the long haul or are not sure if you are, cut and run now because it's gonna get worse until he admits there's something wrong and genuinely wants to get help.
posted by TheBones at 5:29 PM on July 5, 2011 [6 favorites]

I'm so sorry, but while I understand why you've made this question anonymous, this is a terrible anonymous question. The small degree anyone here is going to be able to help you requires much more information than you've provided. How old is the boyfriend? Where are you living? What is the insurance situation? Is he on any medication? Does he have a GP or internist?
posted by DarlingBri at 5:36 PM on July 5, 2011 [2 favorites]

Did you edit something out accidentally? This...
For instance, today I brought him his eggs, and they were "cold". I was told that they were cold because I didn't want him to have hot eggs. I was about to hit him with the frying pan when I remembered he said the exact same thing at Borders when the salesguy didn't have the graphic novel he was looking for. It just seemed like a nerdy joke, and all 3 of us laughed at the time. But thinking about it now, it was done in the same manner. He REALLY believes in what he is saying. really unclear. You haven't quoted his irrational statements. You haven't illustrated any delusions. Consider having a mod fill in some details.
posted by jon1270 at 5:38 PM on July 5, 2011 [10 favorites]

TheBones is right -- you can't really talk somebody out of a delusion -- for him this is his reality. You will need to do a lot of "I" statements about how it is affecting you. Here's a good powerpoint from Mental Health First Aid on how to help someone with psychosis. Here's a video that illustrates the MHFA way of responding. The situation in the video sounds like the psychosis is more advanced, but it's a good illustration of the various steps. It might give you some ideas.

If at any time you feel that he is at risk of harming himself or someone else, you need to call 911. You can call and ask for a "psych evaluation." They will come out and take him to the ER. This does NOT mean that they will keep him, but he will at least be evaluated.

Also, I would recommend that you call your local NAMI office and see if they can give you more ideas and local resources.

Good luck.
posted by la petite marie at 5:41 PM on July 5, 2011 [4 favorites]

jon1270, I read it as "I brought my boyfriend eggs and he told me they were cold. He said they were cold because, and I quote, 'You don't want me to have hot eggs.' He said something similar to a salesguy at Borders the other day, 'You don't want me to have that graphic novel.' He REALLY believes what he is saying."
posted by cooker girl at 6:28 PM on July 5, 2011 [2 favorites]

The "losing all emotion in his face" thing is called a "flat affect. It's not a good sign. The attributing of incorrect values to other people's motivations from unrelated events ("you want my eggs to be cold") is also not a good sign I believe that's called magical thinking . None of your examples of course when taken individually are indicative of anything but if indeed this is a daily occurrence and is a distinct break from his normal behavior over time - well you may want to take a look at this

You should have him see a good psychiatrist - that's someone with an MD - not just a family counselor or therapist.

You should also resign yourself that he will not likely want to go. In that case it's unlikely you can do anything about it because the early stages of certain mental illnesses are not obvious to the person who is exhibiting symptoms because their thinking has been compromised. In such a case you may have to be prepared to leave yourself if friends and family can not convince him to seek help.
posted by Poet_Lariat at 6:37 PM on July 5, 2011 [3 favorites]

Cooker girl: I read it as...

I think you're right about the eggs; I somehow missed a phrase in there that helps it make more sense than I initially thought. Still, the bit about whatever happened at Borders is unclear to me. She also says "all 3 of us laughed at the time," and then 2 sentences later says, "He's never happy, laughing, or even funny." There's so little here to work with.
posted by jon1270 at 6:49 PM on July 5, 2011 [3 favorites]

Presumably in the context he also told this salesperson at the bookstore that he was denying him this graphic novel because he (the salesperson) didn't want him to have it, which is obviously not rational. The point seems to be, he may think people (including loved ones and strangers) are persecuting him for reasons unknown.

I've never been delusional but I certainly have needed professional help with my mind and I'll tell you very frankly that the only thing that got me there was when it was very clearly down to that or my relationship ending. Ultimatums are sometimes necessary and they sometimes work.
posted by nanojath at 7:01 PM on July 5, 2011

Is he on any kind of medication? If so, has the dosage been changed recently? Even meds for non-psych problems can cause behavioral changes. Is he using drugs, or smoking a lot of pot? Does he have a doctor? Are you living together? Is he sleeping normally?

Do you have any contact with his family? Can you turn to them for help? Do you have close mutual friends? Have you talked to them?

You must be really scared, I'm glad you've reached out to us, but you really also need to get more help than we can offer. I hope you get some help and support from people in your community, you shouldn't try to deal with this by yourself.
posted by mareli at 7:22 PM on July 5, 2011 [1 favorite]

The answer to "MD or PhD?" is "Whichever one he's more likely to go to." Reach out to his family, too. This is probably not the first time this has happened to him.

There is probably little that you can do to convince him to get treatment. Which is a shame, because it means that you will have to leave him, for your own safety and sanity. Either now, when things are relatively stable, or six months from now, when the situation has gotten worse than you can imagine.

I know this sounds harsh, and it is. But that doesn't make it less true.

Try to get him to seek help, but if he refuses: cut your losses. This is a situation where you really have to focus on taking care of yourself first.

It's like they say on the plane: in case of explosive cabin decompression, don your own oxygen mask before assisting others.
posted by ErikaB at 8:50 PM on July 5, 2011

"... He's had problems with depression in the past, but he believe's he's fine now. ..."

If he's been under care in the past, and was medicated, you should be aware that certain drugs given to control depression, or other drugs given as adjuncts to the normal anti-depressive medications to help control depression when the primary drugs don't work as well as expected, can simply "stop working" even if they are continuing to be taken. The result is often a significant short term change in thinking, somewhat similar to going off medication entirely, over a period of as little as a few days, to 2 or 3 weeks, and sometimes accompanied by drug side effects.

If he's gone off medication recently, perhaps you could still find an old pill bottle, or some other record, that will yield a prescribing doctor's name. You have nothing to lose by contacting such a doctor directly, and describing your #1's flat affect, changed thinking, and odd speech, but the doctor will have ethical limits as to what they can tell you about previous treatments. Still, on behalf of a patient or former patient they believe to be in crisis, a treating physician or psychologist can often open doors to rapid intake treatment short of the usual standards for involuntary admission, which is, roughly, in most states of the U.S. "presenting as a danger to themselves or others."

If he won't take your word alone that he should see a doctor, could you enlist the help of other friends, family members, clergy, employers, or other significant persons in his life, to make the same recommendation? A person seeking help voluntarily has more options for community based care than a person who has become sick enough to truly represent a danger to himself or others, and who must be involuntarily hospitalized.
posted by paulsc at 9:50 PM on July 5, 2011 [1 favorite]

I'm so sorry this is happening ... I went through something similar with a boyfriend long ago, and it ended badly. Legally, you can't force him to get help unless he's a danger to himself or others. So you have to do your best to persuade him to seek treatment, which won't be easy if he doesn't believe he's sick.

I would give the same advice that paulsc said above. If you can find out who the prescribing doctor was, try to get in touch with them. Try to get friends/family to talk to him if he won't listen to you. Take a very, very gentle approach. If he's having paranoid delusions, it will be hard to convince him that you're acting in his best interests.

As to your question (MD vs PhD) you want to see an MD bcs they can prescribe medication. A psychiatrist would be best.

Good luck to you. Just do the best you can; these situations are extremely difficult.
posted by phoenix_rising at 6:27 AM on July 6, 2011

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