How to help a friend?
September 26, 2018 10:09 AM   Subscribe

How to interact with a friend suffering from a psychotic break?

A friend has had a complete psychotic break two weeks ago (the second of her adult life). She is currently in a facility. Two things:

1. Her husband, also a friend, does not currently want her having visitors however she got access to a phone yesterday and called a different friend saying how surprised and sad she is that no one has come to see her. How do I/we balance these contrasting desires?

2. If I do go and see her how do I interact? Do I tell her that her fantasies and voices are not real? Do I just play along? Is there a healthy way to interact?
posted by Cosine to Human Relations (13 answers total) 3 users marked this as a favorite
1. Can you talk to him about why?

2. "That's interesting" and "Hmmm, wow" and change the topic.
posted by DarlingBri at 10:10 AM on September 26, 2018

1. I would definitely ask about this and if he knows of ways you can show her you are thinking of her if this directive is coming from her treatment team.

2. Empathize with the emotion behind those delusions. "That sounds really upsetting/frightening/interesting." Don't get involved in a debate, it feels very, very real to her now. When possible change the topic.
posted by goggie at 10:14 AM on September 26, 2018 [10 favorites]

You can't logic a person out of psychosis and trying just makes your relationship worse. On the other hand, you don't need to agree. The best is to focus on what makes you friends, not on her current symptoms. If she insists on talking about fantasies and voices, you can either make neutral noises or you can sympathize with her emotional response ("sounds scary"). You don't need to play along and act as if it is factually true but you can respect that this is her experience. The best you can do is to encourage her to engage in her treatment and not discharge early, before the meds have had a chance to take effect. But mostly just be a friend and talk about your usual outside interests.
posted by metahawk at 10:19 AM on September 26, 2018 [13 favorites]

Do talk with her husband and try to figure out where he’s coming from. Is this just what he thinks is best, is it treatment team advice, is she going back and forth on whether she wants visitors and he’s trying to balance her conflicting requests? Maybe she can have care packages. (If so, ask what you can and can’t send, each facility will have its own rules.)

It is generally not recommended to confront a delusional person about their delusions. Distract, defer, empathize with the feeling without engaging with the specific delusion. She’s got a treatment team for this; you don’t have to do it. You can be emotional support, bringing cheer and news and gifts and encouragement and changes of topic as needed.
posted by Stacey at 11:11 AM on September 26, 2018 [3 favorites]

Just wanted to say it is SUPER thoughtful of you to seek answers to these questions in advance of your visit. You are a GOOD friend.

Also, I know psychosis and dementia are completely different animals, but I've found deflecting, changing the subject and empathizing with the emotions involved -- if not validating the delusions -- are excellent techniques in dealing with my mother, who suffers from dementia. I believe they are definitely indicated with your situation.

Best wishes for you and your friend.
posted by DrAstroZoom at 11:40 AM on September 26, 2018 [5 favorites]

Thank you DrA, I never considered the connection to dementia, I spent the final years of my MIL's life learning to stop correcting her mistakes about date/time/happenings and just go with it, I guess this situation can probably be dealt with in a similar way.
posted by Cosine at 11:45 AM on September 26, 2018 [3 favorites]

I would see if the health care professionals treating her have any guidance on both questions.
posted by Candleman at 12:43 PM on September 26, 2018

Nthing that the professionals' treating her word should have priority over her husband's ...and his isolating her from her friends is a huge red flag. Has he pulled this before?
posted by brujita at 2:02 PM on September 26, 2018 [1 favorite]

The husband (and wife actually) is an exceptional human being, honestly, after 20 years I know few better people, no risk there. I think he is just doing what he thinks is protecting her from the affect of other input on her fantasies, the friends who are going to talk with him tonight are people he really trusts so that part of the question may be ok by tomorrow.
posted by Cosine at 2:18 PM on September 26, 2018

Do I tell her that her fantasies and voices are not real? Do I just play along? Is there a healthy way to interact?

Nope. Generally speaking is to find way to empathize without getting into the truth value of what they are saying. Sometimes just a casual "Uh huh" or something is fine. I have a family member who goes through occasional psychosis episodes and that is always the advice given by NAMI etc. You might want to talk to the husband and see if he wants to go to a NAMI support group with you (they are exceptionally good for family and friends of people having mental health issues and are often really good for giving people "something to do" during a crisis) and maybe you can talk there. Best of luck to your friend.
posted by jessamyn at 3:09 PM on September 26, 2018 [2 favorites]

If you visit, call the facility and ask if you can bring fresh adult coloring books, markers, and individually wrapped hard candies. I've been in the nut hut a few times for suicide attempts and there's not much to do besides color but the markers are always running dry. And the patients who had candy used it to make friends. (Individually wrapped hard candies is the only food gift most places allow.) If you bring or send flowers make sure they're in an unbreakable plastic vase.
posted by Jacqueline at 10:06 AM on September 27, 2018

Also I would totally err on the side of respecting her wishes over her husband's. If she wants visitors then visit. It hurts a lot when it's visitation time and nobody comes to see you. Especially when everyone else talks about their own visits later during group.

Her husband is probably either embarrassed or making incorrect assumptions about what would help her.
posted by Jacqueline at 10:10 AM on September 27, 2018 [1 favorite]

Other good gifts if she's going to be there a while: memory foam slippers, flip-flops for the shower, a nice soft fuzzy sweatshirt, paperback books with relatively upbeat nonfiction topics or fictional plots.

But always check with the facility first because some restrictions are not intuitive (e.g., no large hardback books because a previous patient used those as weapons once).
posted by Jacqueline at 10:15 AM on September 27, 2018

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