Immature pot head or actual illness?
January 9, 2014 5:00 PM   Subscribe

I am really good friends with a woman who has schizophrenia. I am having a hard time understanding traits she has and whether or not they are her illness or just her quirks. And if I should help her with the things she wants help with?

First off she is completely aware of her "craziness" (her words not mine). She is under a doctor's care. Has community nurses that ensure she receives her medication and is willingly wanting her medication. She sometimes says things that are illogical but recognizes that they are. She hears voices and says they try to torture her but she says she has trained them not to and doesn't let it bother her anymore. So for all intents and purposes she has it under control and is doing pretty well.

She is sweet and tender hearted and caring of her friends. Just an all around great woman.

However there are things that she does that confuse me and I do not know if it is just her personality or her illness. Forgive me if it turns out any of this is buying into the stigma of mental illness. I have suffered from depression since I was five so am usually pretty aware of it but have no experience with this illness.

BTW NAMI doesn't exist in my country and the local similar organization of the CMHA does not run any groups on anything here and just runs a Clubhouse where she is a regular and I would feel it being an invasion of her privacy to ask people that are her mentors and friends about her.

She smokes a hell of a lot of pot. I have no problem with pot use. Do it myself and find it fun. But it is the only time I ever see her excited when there is some around and she is going to get some. When she is off it or tries to quit for a few days she says her energy gets too crazy and she gets too happy. I just see it as her being more engaged with people - more talkative - more alive. Frankly, I like her more when she is not high but am leery to say it in case there is real proof that pot use does benefit her condition. She says she wants to quit but the being too happy bothers her.

She is completely disorganized. She lives independently. Pays her rent. But can't seem to do things like keep a clean apartment or pay her bills. She will if given motivation by me and friends but can't find it herself. She says she wants to change this but never learned how and no one will tell her. She implies that there is some secret to being an adult that people keep from her and it upsets her. Which results in her asking me to help her remember to pay her bills and then lying to me when she doesn't out of fear of disappointing me and shame.

She believes that emotions for herself are bad and that she is lame for caring about people. She has kind of a flat affect that I recognize from my depression.

She complains that certain nurses aren't as good as others at giving her her injection but when I suggest she ask for the nurse who is best she says she doesn't want to hurt their feelings. She doesn't know what medication she is on but is afraid to cause a fuss and ask. She wants to be able to go to her doctor by herself instead of having a nurse who says nothing sit in with her because she talks to her doctor more when they aren't there but she thinks it will hurt the nurse's feelings. She has side effects from her med that she wants to ask about but feels they are too embarrassing to ask.

She wants to change her life and improve it but when I tell her that she could get a rehab therapist she says she has is too shy.

She sometimes says things that she knows are "crazy" and has told me I can say they are to her but when I do she gets very upset that I don't believe her.

When talking to people who do not have a mental illness she gets a very little girl voice.

Basically I am trying to figure out if she's just a shy immature pot addict or if these are symptoms of schizophrenia and if her pot use is a real way of managing her feelings. Also if she tells me to tell her when something she says is "crazy" and then gets upset when I do so... What do I say?

More and more I am feeling like I have to be the one to teach her these things that she wants and as a friend I don't mind but I don't have the training to tell if it is her disease that makes her this way or just her personality. She basically seems stuck in the age range of a teenager. Is this a common symptom? And should I keep encouraging her to be the person she says she wants to be but gets upset she can't find the code to?

She feels comfortable asking me for help but I don't know if that's responsible for me to do so or if I am going to make things worse if something happens like I move out of town, etc...
posted by kanata to Health & Fitness (14 answers total) 2 users marked this as a favorite
Also I fully understand it is not my job or responsibility and that I have the option of saying no but I care about her and feel the system is treating her like a child and just am curious if there is a reason why they do this...
posted by kanata at 5:05 PM on January 9, 2014

I am not a doctor but FWIW every single doctor I have ever seen (I too have a mood disorder and use pot regularly) has mentioned that marijuana can exacerbate conditions such as Bipolar, Schizophrenia and Anxiety.

The things you've mentioned about her and her behavior do not strike me as entirely Schizophrenia -- her behavior seems more indicative of Bipolar. If that is possibly something she suffers from, self-medicating with pot to combat mania episodes (ie: feeling too happy, speaking/moving quickly, racing/disjointed thoughts) is pretty common.
posted by stubbehtail at 5:22 PM on January 9, 2014 [4 favorites]

"Basically I am trying to figure out if she's just a shy immature pot addict or if these are symptoms of schizophrenia"

I'm sorry if this is not that helpful, and if it doesn't answer your more specific questions, but I'm not sure that it has to be either of those things.

Rather perhaps it's part of her life and who she is, part of that is being schizophrenic, but that doesn't mean it has to be a "symptom of schizophrenia" that is shared by others. Meaning it can be related to it, but maybe the only way to understand it would be by her entire life experience which is completely unique, and of course is an interaction with her personality.

I definitely don't think there is anything wrong with your trying to help her (I don't think that you're "enabling" her if that's the worry). And it doesn't surprise me that she speaks in a little girl voice at times, or that she thinks there's a "secret" to being an adult. Not because I think these are "symptoms of schizophrenia" but is probably a result of being someone who can not function in the same way or at the same level that others can. This is going to have an effect on the development of her personality and her views. In other words, I doubt she's an "immature pot head".

Of course the more you "help her to help herself", insofar as she can, rather than just merely helping her, is better.
posted by Blitz at 5:24 PM on January 9, 2014 [2 favorites]

Basically I am trying to figure out if she's just a shy immature pot addict or if these are symptoms of schizophrenia and if her pot use is a real way of managing her feelings.

My hunch is that it's a little bit of column A and a little bit of column B. Part of what makes schizophrenia so disruptive is its onset time--your friend probably spent most of her teens and twenties getting her illness under control, and is relatively new to navigating life as an independent adult with adult relationships.

I guess the bigger question is, does it really make a difference? You're her friend, not her social worker. She seems to have settled into a groove in life, and while you might not totally like or approve of it, it seems to be working OK for her. I'd focus on addressing the stuff that directly affects your friendship--like the fights over whether and how you can say things she says are "crazy". Pick a time relatively removed from any such incident, and say something like "hey, you've told me before that you'd rather I say something if I think your schizophrenia is distorting your perception of things, but every time I have, it seems to cause a fight between us. Is there something about how I'm bringing it up or when that I could change to prevent that?"

The only other thing that I'd specifically try to resolve is the bill-paying thing, since that really does pose a clear threat to her ability to maintain her safety and independence (though, again, it's something that she may need professional intervention on if this is really an intractable problem for her.) It is sort of curious that she can manage with rent but not with bills, so I'd try to help her pin down exactly what the difference is in those two, and see if there's a way to make paying bills more like rent--maybe do them at the same time? Or if she drops off the rent in her building but has to mail the bills, maybe make up stamped envelopes ahead of time (or do online payment, if that's an option)? Or it might be some problem surrounding math/money management, since rent is usually fixed month-to-month and bills can vary?
posted by kagredon at 5:55 PM on January 9, 2014 [8 favorites]

Realistically, she needs way more help than you can give her. I have a few thoughts that might be useful, though.

In the past I've given people tips on how to get what they want when they're too scared to ask for it - leaving voice mail messages at 3am, sending faxes, handing over a list of things you want to say when you get to your appointment, giving your provider authorization to speak to a friend or family member, etc. I find this to be the most helpful (for my own well-being) thing to say when people push back with "I'm too shy." You may want to try that.

Here in the US, by the way, there are lots of services specifically designed to help those with psychiatric disabilities with the "doesn't remember to pay bills" and "can't get the apartment clean" issues. Those are called the instrumental activities of daily living, and getting services for that usually goes through places who get money from healthcare-related budgets (if I ever need to sign up for one, which I might, the agency I would be going through gets their money from Medicaid.) That'd be something to arrange through a social worker, basically.

And, as far as the "you can tell me" but then getting upset: bring it up the next time she is not upset (and is not saying things that contradict your understanding of reality.) Use words like "I want to help you and let you know when you say things like that, but you haven't responded well in the past. Do you want me to keep trying?" Personally I give them about two or three trips through the cycle before I just stop trying to point this stuff out to them. At a certain point it stops mattering whether they're doing it on purpose, or being an immature brat, or whatever - I simply am not going to do it anymore, no matter what the "real" explanation is.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:56 PM on January 9, 2014 [4 favorites]

People aren't just individual traits. I like to use the analogy that people are a BUNCH of traits, whizzed up in a blender: most of the time, you can't separate out individual components of them. They're just... THEM. I've known drug users, the mentally ill, and people who were both of these things, and their behavior has always been just an interconnected mish-mosh, rather than moments of "ahhh, that's the heroin talking!" or "that is SO bipolar right there!"
posted by julthumbscrew at 6:40 PM on January 9, 2014

CHMA offers caseworkers that specifically work one one one with people teaching them adult coping skills. The clubhouses are good but are not meant to help with bill-paying. Although, my first thought when you said that was an issue was that I assume she is not fully employed and/or on ODSP (or equivalent) is that is probably doesn't not have the income for covering her bills AND living a happy life (money to socialise, eat healthy, pot).
posted by saucysault at 6:51 PM on January 9, 2014

It sounds like she's built a lot of coping mechanisms for herself so that she can manage the day-to-day reality of her disease. In that sense, it's kind of a chicken -> egg situation: one happens because of the other, but the latter probably exacerbates the former even as it mitigates some of the effects. (Which, let's face it, we all do regardless of mental illness.)

We have a friend with (untreated) schizophrenia who uses pot to self-medicate. He probably would have developed the disease anyway, but his "break" apparently coincided with a particularly heavy period of pot use. As mentioned above, pot really does a number on a lot of people with schizophrenia.

Other things, like being upset that someone may or may not be sharing the "key to being adult," sound more closely tied in with the paranoia. For a lot of people, this paranoia starts with a lot of actual facts and events, but the brain just goes way past what you and I might consider a logical conclusion, just trying to make sense of it all. Our friend, for example, worked for a pizza place owned by some Iranian guys. Unfortunately, he was set off to some degree by 9/11, and he started thinking that his employers were terrorists who were out to get him. His main evidence was that he would see these guys all over town, and he'd assume they were following him. Well... of course he saw them all over town. They were PIZZA GUYS. So a lot of paranoia that seems far-fetched often has a very plausible root.

I think that's what has struck me the most: the amount of logic and interpretive extrapolation that goes into the delusions. This person is clearly living with the effects of a disease, but when you get down to it a lot of the delusions start to make a bit more sense.

That's another difficulty: when you get close to someone like this, you spend a lot of time trying to figure out how much disbelief you're able to suspend or suppress around this person. At some point, they have almost certainly been taken advantage of in some way that threatens their security. (SO many people with severe and persistent mental illness are victimized, injured or killed.) Even if you're trying your hardest to reach out to them and do what's right, they will put up protective walls -- and rightly so. You're threatening to disrupt the careful system that lets them function. Eventually, if you want to get past those walls you may have to just let certain things fall by the wayside. And if you get really REALLY close, you may find yourself drawn into some of the delusions yourself, because you're so used to simply trying to keep the peace.

This is not at all meant to discourage you from being this woman's friend, or trying to help her. But she likely has very strong reasons why she acts the way she does. If you think about it, she probably has so little in her life that she can control on her own, these things are doubly important to her.

You sound like a kind and thoughtful friend. Proceed with compassion and genuine interest for who she is and what she can offer, not just trying to minimize a collection of symptoms or quirks she sometimes exhibits.

What's really important for our friend is being engaged, playing music, all that. That's something we can help with. Schizophrenia takes you inside your head; being a friend can get you out of your head for a bit. But as friends, it's not our responsibility to keep him on the path.

Regardless of mental illness: would you be friends with someone if you knew you couldn't change them? That's what you have to ask.
posted by Madamina at 6:59 PM on January 9, 2014 [6 favorites]

Totally anecdotal comment that may or may not be relevant or helpful:
I have a friend who is both bipolar and schizophrenic, and medical marijuana has made a huge difference in his life, for multiple reasons. Because it works, and he doesn't have to hide it, he's no longer seeking multiple ways to self-medicate - and thus staying away from the scary stuff like heroin. He's also creating new relationships and rebuilding damaged ones, and I wouldn't have thought that possible.

So, I've known him since he was in his early teens, and spent most of our adult lives praying I wouldn't be attending his funeral anytime soon... instead, these last 6-7 years, his life has settled down, he met his (now) wife, and I'm just amazed. He'll never be perfectly "normal", but he's certainly surviving, and in better circumstances than he spent the years between 15 and 35.

So... your (and your friend's) mileage may vary, but in at least one case, it's been a blessing.
posted by stormyteal at 7:37 PM on January 9, 2014 [5 favorites]

Thanks for the perspectives. I never thought she might be at the maturity level of when her illness first kicked in and this missed out on the growing up experience that most people her age experience through trial and error.

I guess what I really want to understand is how can I help her advocate for what she says she wants... more help... more self confidence... and is that something that is commonly hard for people with schizophrenia even though she is well put together in every other aspect.

She's complained to me before that her life sucks and all she does is smoke pot. She wants to change but doesn't know how.

I have seen how her nurses seem to treat her as a child. They have her housed. The clubhouse is her landlord so she is reminded by them to give them her rent in cash. They come to her place and give her her medication but don't reach out to help her with any other options. They call her Kiddo and she hates it and she seems to not know how to ask even for that to stop.

Since I have no experience with schizophrenia I am leery to push her to advocate for herself in making the mental health system help her the way she wants in case there is some reason why they are not doing it. And I am unsure why they do not see it as they know she gets her phone cut off on a regular basis and why.

So I guess that's why I was asking... Would they see her as just a schizophrenic disorganized person and are choosing to not help further because it would unstabilizer her? Or are they seeing her as a pot head and not worth help?

I accept her for who she is and care for her and will bring up how she wants me to respond to her odd thinking again as was suggested...or just let it go.

I know I can't help her as much as she wants or needs but I would like to empower her to try to ask for it... And I am just trying to figure out if it is her immaturity and shyness and pot life style that is stopping her and probably something I could give her pointers on (make lists... don't leave your pot all over the place when the nurses come... practice speaking authoritatively) or if it is something common in the schizophrenia diagnosis that gets in her way and the mental health people are doing it for a reason that wouldn't seem apparent to someone with no experience with it.

Basically I want to help her become the person she wants to become and am not sure if it is the schizophrenia that is stopping her from asking for what she needs or the wake n' bake lifestyle. I never thought it could be both.
posted by kanata at 9:55 PM on January 9, 2014 [1 favorite]

One thing you might want to do is ask her to accompany her to the doctor or in dealing with the nurses to advocate for her. You can be the "bad-guy" and ask for the nurse who gives the good injection, or request that the nurse leave the room so that your friend can speak to the doctor alone. Show your friend that it's no big deal and that nurses have bigger fish to fry than to worry about what patients think about them.

Another thing is when you hear her say something that is self-defeating or silly or in other ways indicitive of disordered thinking, you can say, "That's not true, that's your disease talking."

For example, she says, "The elves are keeping me from learning how to be an adult." You can reply, "That's not true. Nothing is physically keeping you from learning how to be an adult. I am here and I'll help, as will X and Y. I do need to hear from you that you WANT to be an adult, rather than giving it lip service. Why don't you tell me how learning adult skills can help your life." Having her actually explain why paying bills on time is a good thing, may help her process it, and absorb it and then do it.

As for the pot, since paranoia is a side-effect of pot usage, I'm thinking it's contra-indicated for her condition. Due to the nature of the drug, it's not easily measured, so the differing amounts she gets from day-to-day can't be calibrated to her other medications.

If she "gets too happy" then that's a sign that whatever medication she's on isn't doing a good job of leveling her moods, and it should be discussed with her doctors.

Pot is obsuring a lot of issues, and the sooner she gets off of it, the sooner her doctors can see how the prescribed medications are working, or are not working. Psych meds are a hassle to get right, smoking will only exacerbate the process, if not downright inturrupt it.
posted by Ruthless Bunny at 6:23 AM on January 10, 2014

To come at this from another angle ask yourself how many people you know who'd like to make a meaningful change in their life and are unable to do it without the added challenges of substance use and schizophrenia. I know tons of people who would like to lose weight, go back to school, or be more assertive and are unable to for whatever reason.

I think expecting your friend to change meaningfully even with your help is unlikely.

However, you can still be supportive and caring.

Friend: I wish xyz.
You: That would be awesome. Let me know if I can help.

Then let it go unless she specifically asks you to do something.
posted by MadMadam at 10:31 AM on January 10, 2014 [2 favorites]

What do I do when she specifically asks me to do something and I realize it is something she needs more help with and she recognizes that to and wants it but because of the way the system is set up I can't come to appointments with her and help her ask for it? It frustrates her and me...

I guess I should let it go and work on my not feeling I need to help her as much as I do. This question probably says more about me than her. It just hurts to sit and watch someone in pain striving to change their life and not knowing how but not actually being able to help much because they are an adult and I think the system is failing them and because I am not a relative I cannot help.

It hurts to have to say to a dear friend I don't know how you can get help.

Sorry. Thread sitting and using this as my own therapy apparently.

Thanks for all your kind responses.
posted by kanata at 11:41 AM on January 10, 2014

because I am not a relative I cannot help

My husband is a long term client of the mental health system in Ontario and being a relative has not helped at all. I do not have access to his diagnosis', treatments, appointments etc even though he wants me to be involved, I am completely financially supporting him, I have been directed by his health care team what I "must do" (including things that had I done them, would have given custody of our children to CAS, put me in a physically unsafe living situation, and cost me my job while probably leading to his death due to their misdiagnosis that I kept telling them was wrong) and doing full-time care-taking on a day to day basis as well as handling all his paperwork etc.

The mental health system is set up in a counter-intuitive way. "Clients" are given lip service that they empowered to make their own decisions and in charge of their health when for many it is too overwhelming a task (it is overwhelming for mentally stable people too!) and thus they are told what to do by the doctor du jour who has only cursory information about the complexities of their personal situation. And if following the doctor's orders meant their health/living situation worsened, well, then they were doing something wrong because the health care team NEVER makes a mistake.

If you want to help your friend as an advocate with appointments, ask for her permission and then go. Butt in, ask the questions she has expressed to you in the past. Being a relative gives you no special powers; many of us just force ourselves into the conversation because we can see the damage that is done by people "just doing their job" versus us, the ones that live day to day with someone struggling and not getting the proper care.
posted by saucysault at 8:45 AM on January 13, 2014

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