Help me help him
May 22, 2019 1:49 AM   Subscribe

Is there any hope in helping someone get help for mental health issues when they don't see it themselves? (bonus: he is also deep into conspiracy theories)

My roomate/friend/etc is struggling. A lot. While I am not a doctor I am very familiar with mental health struggles, and his behaviour falls very solidly into the realm of depression with other issues adding to it. I am not coming to this conclusion lightly or flippantly. When he falls back into his "dark period" he is demonstrating behaviours such as:
- isolating himself for days (or sometimes weeks) on end, only leaving his bedroom for work.
- behaving rudely, disrespectfully, and curtly towards other people (including his friends and loved ones)
- not sleeping
- not eating/weightloss
- increased use/dependency on alcohol, cigarettes, and cannabis
- having a deeply negative view of others and the world, very quick to assume someone's behaviour was intentional rather than just a simple accident, etc.
- sexual dysfunction

Add to this a deep seated "anti-establishment" sentiment and the belief in multiple conspiracy theories, including that the destruction of the Twin Towers was somehow an "inside job", a rejection of western medicine, and a whole hearted distrust of all pharmacutical companies (and therefore all pharmacuticals/medicines).

He refuses to see a doctor, he refuses to get counselling or therapy of any sort. He thinks he is fine and he thinks his coping skills are just fine, despite the fact that he is hurting those around him and alienating himself from his friends and the rest of the world. I do see him occasionally making efforts to engage with others in a healthy way, but those efforts aren't always successful or well recieved in part because his behaviour during his dark periods can be pretty hurtful and disrespectful, and people's feelings get hurt.

While I am very frustrated and in fact increasingly fed up with his behaviour, I do still care about him and just want him to get help. Are there any techniques or methods that I can use to demonstrate his need for professional help? Anything I can do or say to help him realize how far outside the norm his behaviour is and how much he would benefit from help?
posted by anonymous to Health & Fitness (15 answers total) 7 users marked this as a favorite
Best way I know to help a person understand that unacceptable behaviour is unacceptable is to call them on it whenever it happens.

Suggested script: "I understand that you've been feeling bad, but that's no excuse for making me need to walk on eggshells around you to avoid setting you off, and it's no excuse to neglect your health or your sleep or your nutrition. Sort yourself out and behave like a civilized human being around friends and housemates, or get help. Your call."

There is also nothing wrong with straight-up calling bullshit on bullshit conspiracy theories: "That's bullshit, and if your brain was working properly you'd know it. Get off the weed, go for a walk, eat some salad and don't bring this up again until you're over being fried."

This kind of approach really only works when it comes from good and valued friends. If he doesn't already like you as much as you clearly like him then it will backfire badly. But if he does, it might be enough to get him to pull up his socks when he needs to and break an increasingly self-destructive spiral into just not giving a shit any more. It worked on me.
posted by flabdablet at 2:23 AM on May 22, 2019 [6 favorites]

This is sort of tangential to what you're asking, and I'm not a doctor, but the extreme withdrawal and change in behavior coupled with paranoia/conspiratorial delusion sound like something much deeper than depression. I'm thinking this more along the lines of dementia, a (drug- or trauma-induced?) manic episode, or even something like schizophrenia (again, sloppy uninformed armchair guesses here).

Have you reached out to a support or crisis line for any of these conditions in particular? Might be worth a call, because there are playbooks of how to deal with paranoia and delusional thinking specifically. Something I seem to recall that's recommended for people displaying extreme irrational thinking is to "play along" about the patient's delusions to earn their trust, until one can convince them to visit a doctor (for a physical ailment, for e.g). I found doing this helpful in connecting with a friend who had gone off his schizophrenia medication abruptly and hitchhiked from Atlanta to Philadelphia overnight to live on my couch.
posted by shaademaan at 3:28 AM on May 22, 2019 [10 favorites]

Sometimes, when I've been feeling low, I've ended up lumping the world into two categories - those who are with me, and those who are against me. At those times, someone who came to me with a script like flabdablet's would have ended up in the against-me list, and I probably wouldn't be looking for much further help from that direction. I'd have written them off. Others will experience this differently, but it would be too alienating for me.

I think there are a couple of ways that you could offer something while still staying on your friend's team. First, you can model a calm, balanced, healthy & rational approach to life & its challenges. Just by being an example of someone who has their shit more or less together, and who cares, you're offering a light in the darkness.

Second would be a short and to-the-point script like this example of a "brother check-in", from a group called It Takes Balls To Talk: They're a local group in my area, and they have a lot of resources that are aimed at encouraging men to open up a bit about their own mental health. There's more here:, some of it's targeted towards concerned friends. Maybe there's a similar group in your area too?

Thanks for being a friend who cares, and who can listen. We all need them. Best wishes & good luck to you both.
posted by rd45 at 3:53 AM on May 22, 2019 [3 favorites]

At those times, someone who came to me with a script like flabdablet's would have ended up in the against-me list, and I probably wouldn't be looking for much further help from that direction. I'd have written them off.

Yep. Which is why the direct approach can only work when it comes from people close enough that the subject has already got enough invested in that relationship as not to do that.

Even so, it's the only intervention short of forcibly administering psych drugs that I've ever seen work at all on somebody who was at the time unwilling to seek help for a spiral into self destruction that they did not themselves perceive as being a thing that was actually happening.
posted by flabdablet at 4:08 AM on May 22, 2019 [2 favorites]

In addition to the sound advice above I would strongly consider a plan B for your housing situation, because it's not your job to fix anyone and you need to take your personal well-being into consideration.
posted by aspersioncast at 4:28 AM on May 22, 2019 [20 favorites]

I had this friend, and in retrospect, what I wish I had done is develop crystal clear boundaries and not put up with her abusive behavior even though I understood where it was coming from. You can't save someone who isn't participating in their own salvation, and it enables their bad behavior for you to try -- it gives them something to push against and be a victim in the face of it. Show him what self care looks like by enacting it for yourself. "I love you and I want you to be ok, but this isn't an ok way to treat people."
posted by spindrifter at 4:56 AM on May 22, 2019 [9 favorites]

Yeah I agree with shaademaan and rd45, this is something bigger than depression. I've gone through periods of paranoia and withdrawal and if someone challenges me during a psychotic episode I'll just mark them as "enemy" and move on, ignoring everything they say to me from that point on.

This is not the kind of thing that can be handled by a friend. Try to point him to professionals, then take care of yourself most of all. Hold your own boundaries but don't try to confront him. Say things like, "Hmm, I've never heard that the Twin Towers was an inside job, that sounds like an interesting theory." Tell him your feelings are hurt if he says something rude or mean -- but do NOT at any point accuse him of being crazy or going off the rails. It will just.... not work.
posted by coffeeand at 5:27 AM on May 22, 2019 [1 favorite]

It may be worth trying to see if your city/county/province/country has any sort of mental-health outreach team. I've seen them mostly in larger US cities, so I don't know how universal they are, but it may be worth doing some Googling. (And I'd be happy to help research; if you email the moderators with your location they can post it here, or you can MeMail me.)
posted by lazuli at 6:35 AM on May 22, 2019 [1 favorite]

Obvy we can't diagnose from a paragraph description on a website, but it doesn't sound like schizophrenia to me; it sounds like my brother. Did he get a roommate? He has a case of the bipolar II and he does/is every last thing you described.

I would get out of there with all possible speed because you can't live closely alongside this, in my experience, and also get good sleep and peace of mind. If you can get out of the living situation as gently and low-stressly as possible and without making him feel abandoned, that would be fantastic. Then go over and hang out constantly so that he knows you're there and knows you're his friend. Gently reject conspiracy yack. Gently encourage "healthy choices." He will likely ignore you. If at some point he decides you're the enemy and disengages, try not to point out in your very loudest voice how he's wrong about whatever he's observed about you that means you're a monster; yielding to the urge to scream defensively will likely make the disengagement longer than it might otherwise be.
posted by Don Pepino at 7:26 AM on May 22, 2019 [3 favorites]

So I want to be very clear and upfront about this: there is a way this can be done, but it is literally a several year project. I have never seen it accomplished in under a year. I think it’s important to make a serious assessment about whether you have the time, energy, and investment to engage in a multi year project to get someone to seek help for their issues - meanwhile while probably being treated pretty badly yourself.

Also, people like this can swing on a dime and make your life a living hell. I have experienced this. It’s impor to remember that just because someone has mental health problems and there’s a lot of stigma around that, it doesn’t mean that people can’t harm you because of those problems.
posted by corb at 7:31 AM on May 22, 2019 [1 favorite]

You could talk to a therapist about how to cope with this, and ThereIsHelp, including The National Alliance on Mental Illness (NAMI), which offers a free HelpLine at 1-800-950-NAMI (6264) for information, referrals and support for people living with a mental health condition, family members and caregivers, mental health providers and the public. The NAMI online directory can be searched for local NAMI organizations. It is very difficult to help someone who doesn't want to get help, so please make sure your safety and well-being are the priority.

Also, "having a deeply negative view of others and the world, very quick to assume someone's behaviour was intentional, rather than just a simple accident" is a possible red flag for potential danger that you should be careful about, especially if there are any weapons or violent tendencies that have not been disclosed in this post. Please stay safe.
posted by Little Dawn at 7:34 AM on May 22, 2019 [5 favorites]

This is the script I learned at Mental Health First Aid training.

Haven't watched this no doubt low-budget training video, but we watched a similar roleplay video in the class, and it was pretty helpful.

I second the suggestion of calling a helpline or talking to a professional to get advice. A mental health crisis is a medical emergency and "common sense" approaches (like trying to rationalize with the person) are often counterproductive.
posted by toastedcheese at 9:47 AM on May 22, 2019 [3 favorites]

Whatever approach you ultimately decide to take, you are much more likely to have success at it if you have a strong sense of your own boundaries and worth. AKA "put your own oxygen mask on first.'
posted by PMdixon at 11:16 AM on May 22, 2019 [7 favorites]

You might benefit from a NAMI support group if there is one near where you are. It may be good to have a group of people you can speak with about this situation. The thing my partner found helpful (his son has a serious mental illness and is an adult who lives at home - he's now getting good treatment but was treatment resistant for a long time) was the book I'm Not Sick I Don't Need Help which might be good at looking at. The author has done a TedX talk which I haven't seen but you might want to check that out.

is a possible red flag for potential danger that you should be careful about, especially if there are any weapons or violent tendencies that have not been disclosed in this post. Please stay safe.

Always good to make sure you have a safety plan of some kind in case things take a weird turn quickly. Most people with severe mental illness are more at risk from others than dangerous themselves, but it's worth just being prepared. If there is a local crisis number that you could call who are NOT the cops, that might be a good number to have.
posted by jessamyn at 8:09 PM on May 22, 2019 [1 favorite]

I used to have this friend/roommate. While obviously no one can diagnose from one paragraph and most of us don't have the credentials to diagnose at all, here's what I can offer from my own experience with this.

Your roommate sounds like he is experiencing a very serious mental health issue, possibly something that involves paranoia and/or psychosis, which often goes with conspiracy theory nonsense or religious delusions. The cycle you're describing does sound like it could be bipolar, or it could also be any other condition that cycles - there are cyclic kinds of psychosis, lots of other things. Increased substance use is common here because of the increased stress he is under, but creates a bad feedback loop. Your friend is measuring his functionality in terms of his ability to work, which is something a lot of people with disabilities do: as long as we can hold our jobs, we tell ourselves we're okay no matter what other evidence is present.

Your friend can get help if he decides to do that, but he has to choose it. You cannot make him get help.

I think the suggestions for calling a helpline are good. I would also talk to other people in your shared social circle, because this is a situation where sharing information could be good and it's likely that no one has a full picture but together you can put more of one together, and it's important for you to get the support you need especially while you're still living with him. As also stated above, he is more likely to be vulnerable to abuse than to become a danger to you, but the possibility remains.

My very serious advice to you is to move out as quickly as you can. It is not helping you or him for you to stay, and it's making things hard on you. When you do, you can tell him why and hope he is ready to hear you.
posted by bile and syntax at 9:58 AM on May 23, 2019 [1 favorite]

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