Is my friend in need of mental health treatment?
March 6, 2014 6:41 PM   Subscribe

I have a good friend I've known for years. They've always been always been bohemian and eccentric, with a bit of spiritualism. Lately the spiritualism has gone up, but not drastically so ... or nowhere near to the point of people at a New Age store. This is not worrying in itself, but lately they've been acting very bizarre and alienating friends in the process. When confronted the bizarre acts are brushed off as performance arts or jokes. Not immediately, but when pressed.

We are good friends for many years. We'll often have inside non-sequitur jokes. For example, like at a high-end restaurant, wouldn't it be better if they had a drag queen show. Sort of random stuff like that, but funnier in context. Lately she's been trying to make these things actually happen ... like trying to get a bunch of clowns to show up at a restaurant. Or booking a DJ at a bar, which doesn't even have a DJ setup, and not informing the bar. These have been alarming her friends who've noted these "acts" are less about the performance and more about the attention being paid to her. Many have asked straight out if she's gone crazy.

I bring up the New Age philosophy only because it seems to justify anything she does. That things can't go bad because someone read her cards, or because she meditated on it. And that everyone, everywhere thinks her ideas are great. There are exceptions, when people are outright dismissive, but I've seen people warily agree with her ideas and have her turn around and act as if that same person was her biggest cheerleader.

A friend told me her mother was manic depressive and that her behavior reminded her of her mother. However, she's never had a depressive side. It is like all manic all the time. And she seems to know when she's on the brink of being a little too crazy and finding an excuse to tone it down. A good example would be, oh I'm just doing this for my friend's birthday, and I'm only doing this because they love the idea, which would not be the case.

One other data point, they've found a certain actor very attractive and have made comments about them eventually ending up together. This is something I might dryly say, as in George Cloney and I will end up together, we just haven't found the spark. She'll bring up this certain actor every once in a blue moon, but then decided they'd message the actor via Facebook to come to her next "act" ... which is disconcerting, but it doesn't go beyond that. She doesn't exhibit any other behavior I've read about, I don't think she's even seen any of his movies and she does not talk about him very often. But when she does it'll be a quick remark like, "I should go to New York, I might run into him on the street!"

I should say her speech is organized and she doesn't sound crazy. She sleeps normally, doesn't do drugs and drinks in moderation. It is like she was always kind of weird, but now I'm beginning to think she does not have perhaps the same reality the rest of us do.

The breaking point seems to be when she recently lost her job and has no plans other than to perhaps work with the local university to develop a music program (she has no background in music, doesn't read music, etc.). And this is all mentioned once, in passing in all seriousness then never mentioned again.

Sorry for the long post. I will get to the point. Does this sound like classic behavior of someone who needs to get help? How best do I help them, or is this stuff not treatable? Age is late 30s, no kids, never married.
posted by anonymous to Health & Fitness (24 answers total) 2 users marked this as a favorite
Is she hurting herself or her friends? Or starting to develop signs of stalking somebody? If not, backing off might be your best option.
posted by Tsukushi at 7:12 PM on March 6, 2014

I feel that your concerns for your friend's mental health are somewhat valid. Unfortunately, there's very little that you can do other than having a serious heart-to-heart in which you tell your friend that you are genuinely worried for them and suggest that they speak with a professional. Sadly, there is a good chance that this won't go over well. Good luck.
posted by windykites at 7:17 PM on March 6, 2014 [8 favorites]

I'd be worried about a friend who seems to be on a downward spiral. You can't obviously make them do anything, but as a friend you can speak to them privately and bring up your concerns and ask some questions which might put you more at ease.

If she's on a downward spiral, she may have lost her job due to these types of issues interfering with her ability to do her day to day activities at work.

It's hard to get back on track if you lose your job, you lose your friends, you lose your apartment, you lose your card, your bike etc....

As a friend I would try to see if she was doing okay, and if not suggest some options or ever help put her in touch with a support network.
posted by bottlebrushtree at 7:18 PM on March 6, 2014 [2 favorites]

If you read about people in the prodromal phase of psychosis, you might be reminded of your friend. I think it could be worthwhile for her to be examined by someone, not because we can say something is wrong with her, but precisely because we can't. Specifically, it might be worthwhile for her to talk to someone at a clinic which specializes in treating folks with prodromal psychosis. But don't pressure her or harp on something being wrong with her, something that she has to "fix." People have the right to be weird, and they even have the right to be mentally ill, unless they become a danger to someone.
posted by cairdeas at 7:39 PM on March 6, 2014 [6 favorites]

Is my friend in need of mental health treatment?

Maybe? Some people are real-life Manic Pixie Dream Girls (or Guys). Some want to be. Some retreat into this kind of fantasizing because they can't deal with reality. For some people it's a symptom of mental illness. A private conversation along the lines of "Hey, I've noticed you've been getting really kinda out there lately. How are things with you?" and slowly, gently, give her the suggestion of speaking to a professional to at least get evaluated. This may need to happen over several conversations. You know her best; you know what would work.

As an armchair non-psychanything, it sounds to me like she's a) desperate for attention and validation, b) acting incredibly impulsively, c) possibly suffering from some mental illness of which her behaviour is a symptom, d) perhaps invested in the idea of being The Eccentric One, and has had to up the ante to get the same level of "Oh my what did you do" reaction that she used to.

It would also be a good idea to ask her about these incidents. What did she think was going to happen with this unexpected DJ? Who would pay this person for their time? Who was going to explain to the bar what was going on? See if you can gauge how much she is actually thinking things through, how much is magical thinking ("Oh it'll all just work itself out"), and how much is genuine not thinking about the ramifications of her behaviour.

I'm not going to pretend these conversations are going to be easy, or even necessarily productive; I have a friend who doesn't quite go this far, but she does tend to force people into situations that are very difficult for the innocent parties to navigate through. The only thing I have found effective over the past many years is simply not participating, and not giving her any attention when she does this stuff. "I can't believe you did that," delivered in a flat tone with an abrupt change of subject has, slowly, effected some change.

When she announces plans like this, try calling her out on them; "What do you plan on doing when the DJ shows up to play and expects to make money, and the bar owner has no idea they're showing up and tells them to get lost?" Emphasize concepts like planning, and the effects her behaviour has on other people. She might think it's really cool for a bunch of clowns to show up at a restaurant, but what about the people having an anniversary dinner?

Anyway. It sounds like she may be decompensating. None of us here has the training or enough knowledge about her to say either way. Urge her gently to consult a mental health professional (not a card reader, medium, or any other purveyor of woo bullshit. An actual, certified, therapist or psychiatrist) to at least have the conversation about whether something may be wrong; I usually think a pretty solid (if generalized) definition of mental illness is "a mental condition which impacts your ability to live your life in a full, happy, and healthy way." It sounds to me like her formerly Bohemian hijinks are starting to affect her quality of life--you don't mention why she was fired, but if it was this sort of behaviour, her impulses have already caused her harm.

I should say her speech is organized and she doesn't sound crazy.

My speech is organized, yet I suffer from three mental illnesses. I don't 'sound crazy.' If you are concerned that your friend may be suffering from a mental illness, it might be a good idea to take a look at how you think about and respond to mental illness in order to be a more supportive friend. 'Crazy' is not a word with any real utility when it comes to mental illnesses.

Good luck. I hope she's okay, or gets the help she needs.
posted by feckless fecal fear mongering at 7:41 PM on March 6, 2014 [10 favorites]

I see why you have some initial concern. Someone suddenly starting to make those leaps from "cute joke idea" to "LET'S DO THIS!! NO SERIOUSLY" really does strike me as a potential tell for (hypo?)mania. However, manic-type behavior doesn't have to be pathologized unless it's, well, bad. I don't really see much in your post that implies your friend is causing herself problems ("her personality is slightly different from what I like" doesn't really count). My biggest worry would be that this non-troublesome hypomanic behavior could be a warning sign of something genuinely worrisome like bipolar II, down the road. Be there to give her a hand if things do get worse, but don't freak out yet, in case they don't.
posted by threeants at 7:43 PM on March 6, 2014

unless they become a danger to someone.

Or themselves. Out of work and full of harebrained schemes that will guaranteed rebound on her badly? Could be construed as harm to both herself and others.

And derp, I meant to mention hypomania. A couple of my fellow patients last summer had had recent hypomanic episodes and some of this stuff is in the same ballpark.
posted by feckless fecal fear mongering at 7:45 PM on March 6, 2014 [5 favorites]

Out of work and full of harebrained schemes that will guaranteed rebound on her badly? Could be construed as harm to both herself and others.

Yeah, that's kind of one of the thorny issues that's relevant and very important in situations like this - that we're talking about a free adult with civil rights, and the definition of "danger to self" can be stretched very, very far. Far enough to include things that could also be said of most "normal" people. People sometimes feel a bit too comfortable violating the freedoms and rights of the mentally ill, or the suspected mentally ill, or the socially weird, etc. Just another issue that is important for the OP to consider very carefully here.
posted by cairdeas at 7:52 PM on March 6, 2014 [5 favorites]

Your friend's behavior seems to be getting more erratic and less well-connected to reality, your intuition is hollering, and your friend is experiencing negative effects of the behavior(job loss). Have a loving chat expressing concern. Offer help if you feel you can - rides to therapy, couch to sleep on, listening, etc. Talk to mutual friends, and to Friend's family (with caution, as families can be minefields). It's ok to ask someone if they plan to: do something nutty, are using drugs, are feeling inclined to self-harm. Plans for harm to self or others must get immediate action. Your Friend is lucky to have you on their side.
posted by theora55 at 7:55 PM on March 6, 2014 [2 favorites]

Speaking as one of the mentally ill, I'm not talking about violating her rights and freedoms, so please don't paint me with that brush.

She has the right to live her life as she pleases, yes, subject to societal constraints about what she's allowed to do. But the thing about mental illness is that it lies to you, it tells you it's okay to do certain things that, if you were healthy, you would not do.

So I'll grant you that this is something the OP should bear in mind, but everything I'm reading in this question sounds to me like caring about a friend, and not knowing what to do to help her.

Getting a mental health checkup is pretty much always a good idea when there's erratic behaviour. Actually it's probably a good idea for everyone to have a session with a shrink at least once a year but that's probably ranging too far afield for this question.
posted by feckless fecal fear mongering at 7:59 PM on March 6, 2014 [6 favorites]

Mod note: Guys, please don't argue with other commenters. Direct your answers to OP, or email each other privately if you need to talk.
posted by LobsterMitten (staff) at 8:01 PM on March 6, 2014

I don't know that there is anything much you can do here, but I wanted to correct a misapprehension in your post:

A friend told me her mother was manic depressive and that her behavior reminded her of her mother. However, she's never had a depressive side. It is like all manic all the time.

People with bipolar disorder (a more accepted term than "manic depressive" now) can absolutely have manic episodes without the depression. A good friend of mine with bipolar had manic episodes four or five times over a period of as many years before she had her first depressive episode.

Unfortunately, people who only experience mania are less likely to be willing to seek help, because it can feel pretty good.
posted by lollusc at 8:29 PM on March 6, 2014 [2 favorites]

Any chance she's taking prescription drugs? I ask because I know a couple of people who went completely off the rails when taking totally legit prescription psych drugs, as far as I know at the correct doses not abusing them or anything. Justs had a horrible interaction with their personality and brain chemistry in terms of impulse control and judgement. This behavior sounds really similar.
posted by fshgrl at 8:43 PM on March 6, 2014 [9 favorites]

The question about prescription drugs in this day and age is a good one, and I would start there.
posted by jbenben at 8:52 PM on March 6, 2014 [1 favorite]

Are you sure she's not trying to do performance art? Because a lot of the stuff you mention sounds like actual performance art, not like a disturbed person trying to explain away their behavior.

I mean, she could have mental health issues and be trying to do performance art, both. She also could be trying to do performance art but really not doing a good job of it at all.

But this doesn't sound like the types of public meltdowns often swept under the rug in the guise of being an "artist". This sounds like attempts at actual art, however ill conceived and artistically not that interesting.

A lot of artists are narcissists who make everything all about them. It comes with the territory, to an extent. Also, a lot of artists seem like lone wolf kooks who are willing to stand by an idea no matter what other people think of it. When artists who are this way become successful, everyone forgets how annoyingly single-minded and navel-gazey they seemed once upon a time.

With the loss of her job, I'm wondering if she's not trying to reframe all this as "making a career change" and "pursuing her creative goals" rather than just being straight with herself and everyone else that she's having a tough time.

I would back off unless you think she's in danger of hurting herself or others. If you're very, very close and you feel really qualified to weigh in, I would tell her that you're concerned about her and maybe suggest therapy. But I'd do it gingerly and again only if you're very, very close.
posted by Sara C. at 8:55 PM on March 6, 2014 [3 favorites]

I want to second 'back off' and 'people have a right to be weird'. People even have a right to ruin their lives.

If you are concerned she is being foolish, or deluded, you can address her as one (potentially) responsible moral agent to another and attempt to show her why.

(Medical-ization of what are personal and moral life issues can be very, very destructive; mental health professionals are, as a species, dangerously lacking insight and imagination about these matters, in my experience, and come with narrow, rigid, and pointlessly life-distorting agendas.)
posted by bertran at 9:25 PM on March 6, 2014 [5 favorites]

She has the right to live her life as she pleases, yes, subject to societal constraints about what she's allowed to do. But the thing about mental illness is that it lies to you, it tells you it's okay to do certain things that, if you were healthy, you would not do.

Yes. This is how, sometimes, people with backgrounds that ought to prevent it fall through the cracks and find themselves without homes.

How best do I help them,

Watch for signs of harm to self/others and intervene by calling 911 if it comes to it. The standard of "harm" in Missouri, as an e.g., is ""a likelihood of serious physical harm to self or others." There's little room in our society for loved ones to do much, directly, about distal causes of harm, or slow harm.

From CAMH's information page for family and partners of people with bipolar:

How to respond to a person who is manic

Reduce stimulation and noise.
Have brief conversations.
Deal only with immediate issues. Do not try to reason or argue.
Discourage discussing feelings.
Be firm, practical and realistic, without being authoritative.
Do not jump to the person's demands.
Do not get caught up with the person's euphoria, or unrealistic expectations.
Do not try to convince the person that his or her plans are unrealistic.

At the same time, take steps to ensure his or her safety (e.g., removal of car keys or credit cards).

posted by cotton dress sock at 10:06 PM on March 6, 2014 [4 favorites]

I've a very good friend who displays the same behaviour. She has done for as long as I've known her and, from the stories, has always.

While most of the time she's merely annoying, she has behaved extremely. I've only seen her do so in times of lost love. Stalking, in this example.

What your friend is doing is not extreme, just silly and annoying.

When she gets too much, which is often, I take a break from her.
posted by converge at 11:27 PM on March 6, 2014 [1 favorite]

I would say that whether she's going nuts or not, there is reason to worry about her. Maybe she's just a lovable kook, bu I would be freaking out a little, I think. If you can, I'd say sit down with her and tell her you're worried. Stress that, that you are worried. Do whatever you can to avoid making her defensive or dismissive. If she bristles or tries to laugh it off, keep coming back to the worry. Point out some of the ways that what she's doing could harm her. Drive it home that her behavior seems to have changed lately, she's doing stuff that could have a bad effect on her life, and you are scared that she could be in trouble.

If you can frame it that way, so it is clearly coming from a place of love and you are not trying to judge her, maybe she'll listen.

I will say, though, that the celebrity crush thing strikes me as pretty harmless. I don't know, maybe there's something creepy about how she says it, but from what you're saying I don't think it sounds like a big deal.

Good luck. She's fortunate to have a friend who cares this much.
posted by Ursula Hitler at 1:47 AM on March 7, 2014

I'd be worried about her because she's lost her method of supporting herself and she's not really concerned about it. A person living in reality would be making real attempts to fund her lifestyle, even if she views that funding as nothing more than a means to support her performance art. It would take a professional evaluating her, though, to diagnose what is going on.

What can you do? Encourage her to get to a professional and be really honest about what's going on.
posted by SakuraK at 2:42 AM on March 7, 2014 [1 favorite]

I would sit down with her, in a quiet place and be perfectly serious. This is an intervention.

"Chloe, I'm really concerned about you. You've always been charmingly weird and I love you for it, lately your behavior has been very strange, beyond charming and it's scaring me. You've lost your job and you don't seem to have a concrete plan for obtaining a new one. You're staging performance art pieces but you're not really doing it in a constructive way. You're going deeper into spiritualism, believing that everything you're doing is great, and disregarding the upset that you're causing others.

The owners of the bar where you tried to get the DJ to go. The DJ who thought he was having a real gig, and who scheduled his time only to be put in an awkward position. This wasn't performance art or a joke, this was mean to everyone involved and you don't seem to acknowledge how strange and terrible it was.

I love you and I want the best for you. Will you let me accompany you to a mental health assessment? I think that you have an awesome chance to really help yourself and I want to be sure that you take full advantage of it."

You may have to make a decision here, you can stay in your friend's life and watch her go into free-fall, hoping that you'll be around to catch her. Or you can say, "If you don't get help, I don't want to enable this behavior. I love you, but I won't love you to death."

Sometimes, if our friends are bent on self-destruction, there's nothing we can do, and it's better for us to disengage.
posted by Ruthless Bunny at 5:41 AM on March 7, 2014 [5 favorites]

You could frame this in terms of wanting to help her reorganize for job-search and possible career change and leave the "you're acting nuts" out of it.

You state that she is showing up on private property for DJ/Performance Art events, that she is jobless and not doing anything about that, and that she is either deluding herself or lying to others about her interactions with friends. That's just bad behavior and will not end well.

She doesn't have to be mentally ill to be off the rails. Maybe she's just misguided and flailing.

You have a lot if ways to suggest she seek professional help without making her feel judged.

If you have been to some forms of counseling or can enlist someone who could speak from experience, that might be more comfortable for friend.

If she resists, you don't have a lot of options.
posted by Lesser Shrew at 5:52 AM on March 7, 2014 [1 favorite]

RuthlessBunny's advice on how to do an intervention is really good. I have had experiences with psychosis and schizophrenia in friends and loved ones. It's really hard so please do what you feel you can but also take care of yourself.

If it's something like early psychosis or schizophrenia, the earlier she gets help the better. If it is those things, it is treatable, but hard to get people into treatment if they don't agree there's a problem. Usually what ends up happening is the behaviour gets truly out of control and family will have the person assessed against their will. For that to happen though the person has to be a danger to their self or others, and it's more traumatic all around because they lose their right to release their self from care for a few days or longer. I was able to convince a loved one who was having a psychotic episode to let a trusted friend drive them to a mental health facility instead of simply calling the police to be taken in against their will. They understood those were the two options and had previously received mental health care though.

The stress from losing her job could be pushing her further into whatever is causing these strange behaviors, whether it is early stage psychosis, late onset schizophrenia (possible given her sex and age), a hypomanic or manic episode, or just true quirky out there behaviour that is worsened from stress. It's possible she lost her job due to some inappropriate behaviours, if you could find out about that it would be very helpful.

What's good imo is that she is still socializing with her friends, still engaging in conversations, and if she has some delusions they are at least not paranoid from the sounds of it. The research shows that later onsets of these issues is more treatable and less severe usually so that is also good.

1. Talk to her other friends, and ask them kindly not to say things like "are you going crazy" or "what's wrong with you". If she starts to isolate herself and shut down socially it'll be much harder to figure out what's happening and she'll be less likely to agree to talking to anyone who might help her. The more social support she has the better her chances are of accepting any needed help and keeping her stress levels down. If her behaviour is making it hard to enjoy spending time with her in public, you should all try to switch to having a dinner party at someone's house or a smaller venue instead to reduce the awkwardness.
2. I would educate myself about psychosis to be able to watch out better for the signs. This has a lot of good information. In my own experience things were clearly getting into true delusional/psychotic territory when everything that happened in their environment started to have meaning and connection. So license plate numbers of cars driving by were sending messages, the colour of clothing people were wearing was significant, etc. It doesn't sound like your friend is there yet thankfully. However these were men, and apparently men and women can have very different symptoms.
3. Can you help her apply for unemployment benefits, if she is entitled to any? Any help you can give to support her staying housed is very important. Is she opening and reading her mail? Is she paying her bills?
4. Has she had a physical check-up lately? Hormone levels and the thyroid are related to psychosis in women. Ruling that out or even having a mild hormonal issue treated could help.
5. If you are getting a gut sense that she's not going to be able to find and hold a job, that she is simply not able to focus enough in the here and now to carry out a plan to job search and interview it indicates that something with your friend is truly amiss, and you are not wrong to be concerned. Start a log of the dates and situations where you notice she is acting funny (including when she lost her job), this could be necessary for an eventual diagnosis from a mental health professional. Diagnoses are not objective (there is no one test of mania or psychosis), so the more information available the better the chance of her receiving good help.

And thirding that if she resists, there's only so much you can do, you are a wonderful friend for trying to help her.
posted by lafemma at 7:24 AM on March 7, 2014 [2 favorites]

Are you sure that she's not using drugs?

Not everyone who is on drugs slurs their speech or acts totally zonked out, sometimes they can act totally normal except....amplified. A little less grounded in reality.

I lived with someone who had a drug problem. We shared a bedroom, and I still somehow did not realize how bad it was until she was using every day. Instead of joking about doing something silly or crazy like we used to, she would become totally convinced it was a great idea and we had to do it RIGHT NOW. She'd often realize I didn't agree with her and try to convince me it was just a joke, but we both knew it wasn't.

It might be something to keep in mind. I hope your friend gets the help she needs.
posted by inertia at 9:15 AM on March 7, 2014 [4 favorites]

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