Interventions and helping my best friend
March 15, 2015 2:43 PM   Subscribe

My best friend, who historically suffers from depression, is spiraling out of control. We live together. We just moved out to Portland together. I need advice on interventions - I think he needs to see a psychologist, (or a psychiatrist?) but I have no idea how to tell him that.

He's been on-again-off-again depressed for years, but I've never seen him this bad.

We moved out here 2 months ago, and he started seeing a guy he met on grindr. They hung out for a few weeks, went on a few dates, and then they stopped seeing each other. This CRUSHED my bff. Like, it seems like he's going through a major divorce, not a low-time-investment breakup.

Meanwhile, he's been drinking. Ridiculous amounts. Like, 6-10 stiff cocktails a day. He wakes up still slurring his speech, and by noon he's demanding cocktails. He has always been a drinker, but never this intense, and I have told him that his body needs him to cool it on the alcohol.

This has been going on for about 2 weeks now, and it doesn't seem to be abating. He's taken "days off", like today, but that just means he's ultra depressed and holes up in the basement watching netflix.

A few other snowflakes... while he doesn't have anger issues, he does get very angry and emotional when he drives. He is very binary: people are either amazing or idiots. He overthinks things: he recently spent two whole days composing a simple 4 word text response. He is a performer, and a fantastic one - he is his most comfortable on a stage. He is obviously gay, and I'm straight, and we have a very brotherly relationship, and we have been this close for many years.

He lately has been talking a lot about the importance of suicide prevention, which I think is his way of talking about suicidal thoughts. I am extremely certain that he would not try suicide, because he is very rational about the importance of suicide prevention, but I think having these conversations are his way of letting off steam.

I think he needs to see a psychologist, to work out his headspace and why he lets other humans affect him so much. I've mentioned this, but it comes across as off-handed and he doesn't follow up in the conversation. He is very cognizant that he is acting crazy, but how can we start to heal him?
posted by special agent conrad uno to Health & Fitness (19 answers total) 3 users marked this as a favorite
 
First off, you need to back off the "we" shit. I realize your intentions are good but in the middle of depression the "we" shit can hurt the person more than help. Yes, you can help and yes, you can be supportive. However he's got to own this and want to deal with it.

Look up local resources on NAMI for him and tell him what you've found...he has to want to do the work though.
posted by fluffy battle kitten at 3:13 PM on March 15, 2015 [4 favorites]


Given that he's talking about suicide, if it were me I'd call the local mental health crisis line. For Multnomah County it's 503.988.4888 (or 800.716.9769), and that page lists the numbers for neighboring counties as well.
The Mental Health Call Center is staffed 24 hours a day, seven days a week by a highly-educated, well-trained staff. The call center offers

Crisis Counseling by phone, with translation services for non-English speakers
24/7 mobile crisis outreach for in-person assessment
Referral to low-cost or sliding-scale agencies
Help finding mental health providers, including those who have culturally linguistically specific services
Information about non-crisis community resources
They should be able to help talk you, or him, through some options, including immediate intervention if he is more actively suicidal than he's told you or referrals to other agencies if he doesn't need immediate crisis help.

He may be "rational" about suicide prevention, but drinking heavily tends to undermine one's ability to think rationally, and researching suicide prevention can be a way of discovering which suicide methods are less preventable. I don't want to scare you, but your description would make me want to put this person in front of a trained professional, or at least on the phone with a trained professional, as soon as possible.
posted by jaguar at 3:14 PM on March 15, 2015 [7 favorites]


I think you need to sit him down and make a little announcement that you want to talk to him about something serious. Just the act of designating it as a Serious Talk should make it clear that you're not just casually suggesting he get some help. Then give him the talk, and put as much conviction into it as you can. Stress that you are worried, and list some of the ways his behavior is destructive and out of character. Tell him about some of your worries, where you think he might be headed if he doesn't pull out of this. Be prepared for some potential pushback, and do what you can to counter any of his objections.
posted by Ursula Hitler at 3:18 PM on March 15, 2015 [4 favorites]


And if for whatever reason those numbers don't work, you can always call the National Suicide Prevention Hotline at 1 (800) 273-8255, and you should be automatically connected to the closest crisis center in your area based on your area code.
posted by jaguar at 3:19 PM on March 15, 2015 [1 favorite]


You aren't going to be able to make him get help or even make him want to get help. The best you can do is say "I'm concerned about you. These are the things that worry me. What can I do to help? Are you willing to talk to someone in a professional capacity?"

by noon he's demanding cocktails

Who's buying the alcohol? If it's you, stop. Get it all out of the house. Making people get help is nigh impossible but there are tangible things you can do so as not to enable him.

What about the "days off", is he skipping work? Or just hibernating? Can you ask him to shut off Netflix and go for a walk with you? This is a lousy time of year for the PNW but getting out of the basement and getting even a little exercise might help things along.

And definitely, the people at the Multnomah County Crisis line are great. Avail yourself of that resource even just to say "This is what I'm seeing. How concerned should I be? What can I do to help?" And make sure that number is posted in the house in case he decides to ask for help. Good luck.
posted by Beti at 3:23 PM on March 15, 2015 [2 favorites]


Also, keep in mind that depression is a big fat liar and the lies it puts forth aren't rational. So the stuff he says out loud may not make good sense because his brain is bombarding him with really loud intrusive lies.
posted by fluffy battle kitten at 3:30 PM on March 15, 2015 [1 favorite]


"days off" means days off from drinking. Like today - he isn't drinking today.

I should state, demanding cocktails at noon doesn't mean having them. It's not affecting his work performance. It's just surprising to me - if I were that drunk the night before, the mere thought of ethanol would make me nauseous.

I don't mean to turn this into a referendum on his drinking, which I do think is a problem. But I think it's a separate problem, and largely stemming from his depression.

Thank you all, very sincerely, for your advice.
posted by special agent conrad uno at 3:35 PM on March 15, 2015


Frankness and directness delivered with tact, love, and concern are the way to go. Part of what's great about this is that you're sharing yourself honestly. You don't have to learn "the right way" to say this stuff.

Say something like "I'm really concerned about you, and it worries me a lot. It seems to me that this recent breakup was like a straw that broke the camel's back type thing! You're drinking so much more than you used to, and when you don't drink you're so depressed that I'm worried that you might hurt or even kill yourself. I don't know how to help you, and it's making me frantic -- I've been asking people how to help you see a professional to talk about how you're doing. I don't want to offend you - I don't think you're "crazy!" I'm just really hoping you can get some help because it is making me so sad to watch how much you're suffering. When I've mentioned this to you before you kind of brush it off. And that makes me feel so helpless and een more frantic because I really think you need this and I want to be your friend but I don't know how to help you"

I'm just taking what you've said and putting it into a statement you can say to him. Be simple, clear - don't worry about beating about the bush - you're his friend and he needs to hear about your concerns, in my opinion. There are some terrific therapists in Portland - memail me if you want some recommendations.
posted by jasper411 at 3:38 PM on March 15, 2015 [5 favorites]


The drinking may cause him to have feelings or to have feelings other than pain. The drinking definitely isn't a helper regardless of how the two tie together.
posted by fluffy battle kitten at 3:38 PM on March 15, 2015


The drinking must stop. It's a necessary, but not sufficient, first step towards getting his shit together. It engenders so much self-loathing that progress against depression is pretty much impossible. Then he can see a therapist and discuss treatment options. Good luck.
posted by Johnny Wallflower at 3:46 PM on March 15, 2015


Consider your limits and boundaries. Living with someone with untreated mental illness is crazy making. Make your case, but if your friend chooses not to get treatment you might reasonably choose to spend a whole lot less time with him as a result. Put yourself first and be well.
posted by crazycanuck at 3:57 PM on March 15, 2015 [3 favorites]


Buy daylight lamps, Portland is rainy, and cloudy, get vitamin D supplements. Portland is dark enough to push ome borderline depressed people, over the edge.
posted by Oyéah at 5:25 PM on March 15, 2015


Something that various shrinks tried to tell me, but I would not listen, is that heavy drinking makes the depression much worse. In my case, to the point of making it untreatable.
My personal experience is that the drinking relived the symptoms - *while I was drinking/drunk*, but that it came back worse than ever the next morning. It just got continually worse until I put down the bottle. I ended up much past where your friend is now.
I still have depression, but it is very mild and easily treated.
I'd wager any mental health professional is going to say the same thing.
posted by rudd135 at 5:29 PM on March 15, 2015 [1 favorite]


Why not just say "I'm really worried about you. I'm scared that you're going to get upset by my just saying this, but I think you're not doing as well as you could be."

Be honest.
posted by BadgerDoctor at 7:16 PM on March 15, 2015 [3 favorites]


A frank conversation about your fears sounds good. Does he have any other friends you could turn to for support in this? (Maybe his parents?)
posted by Going To Maine at 8:53 PM on March 15, 2015


The drinking isn't necessarily the problem, but it is a sign that he's self-medicating. At some level, he knows that he's in more distress than he can deal with on his own, and he's trying to deal with it by drinking. It's a pretty common response when alcohol is a socially-acceptable, easily-available drug which is actually encouraged (to an extent) in situations like break-ups.

It's really easy for us to say he needs to stop drinking, and yes, he does. But coming out and saying "you need to stop drinking" isn't going to get very far right now because probably right now, that's the thing that he thinks is helping him cope at all. So I don't think that targeting the drinking will really help. It might help if he can recognise that his coping mechanisms aren't actually increasing his cope.

So maybe you could say something along the lines of: "So hey, I've noticed that you still seem pretty upset by this breakup. It seems like you're trying to distract yourself from your feelings. Binge-watching Netflix and drinking a lot can be good distractions for a little while, but it doesn't really seem to be helping you feel better now. I'm getting really worried about you and I figure there's got to be some better ways to help you feel better. Can we talk about it?" If he's good with that, then you can gently but firmly suggest things like seeing a professional, contacting the Mental Health Call Centre that jaguar suggested, etc.
posted by Athanassiel at 10:57 PM on March 15, 2015


I am totally not an expert, but I think you're getting good advice here. Just be direct and real and honest, and tell him what you've said here. You don't have to pretend to be a different kind of person when you have that conversation (like, suddenly being a Just Say No person), and it's okay if it's a little messy and weird. Jasper411's script is good.

And I want to say: your description makes me wonder if your friend might be bipolar. That's essentially depression mixed with high-energy periods, during which the person seems irritable, blame-y, reckless and grandiose. Lots of performers are bipolar. It's dangerous mostly because of the recklessness, which often manifests in ways related to sex/drugs/alcohol/money.

I have a friend who's bipolar. FWIW he tells me that the most useful thing I can do is to give him direct feedback on his behaviour, because his own perceptions are skewed. It doesn't help him, he says, for me to worry silently, or to say things intended to be reassuring or supportive. What helps is for me to say things like "wow, your drinking is way up lately" or "holy crap you were rude last night at dinner" or whatever is true. A good friend, my friend says, doesn't watch somebody drive a bus off a cliff and pretend everything is okay.
posted by Susan PG at 11:41 PM on March 15, 2015


Like jaguar said, I think this is a crisis, and I think you need to call in the outside help. You aren't going to be able to fix this for your friend, however supportive you are. Carry on being supportive and trying to talk to him about it and coming up with healthy things to do etc, but get in touch with the mental health crisis line asap.
posted by glasseyes at 3:27 AM on March 16, 2015


I have BPD/some bi-polar II tendencies and this sounds like me at my worst. During tough times I am a mess and it's hard to help me because being defensive is a big part of my illness. I also have to help myself and it doesn't sound like he's in a position to do that.
I echo the above commenters, get in touch with the suicide helpline. He's hit rock bottom and you need someone experienced in this kind of thing to help you. You can't do this alone. Mental illness is a very serious and complicated thing and you can't put all the pressure to help him on your shoulders alone.
posted by shesbenevolent at 12:19 PM on March 16, 2015


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