How to help a person having a manic+paranoid episode?
April 22, 2020 6:00 AM   Subscribe

A close friend is having a very paranoid episode -- hasn't eaten, hasn't slept -- and is currently in stay-at-home mode, alone. The people who live closest to them are wrapped up in the paranoid conspiracy thoughts in a way that makes me think it would not be helpful for them to check up on this person. They also live in a city with a very high prevalence of CV19. As far as I know this is the first time this kind of episode has happened. Does anybody have any advice on how to help? Resources?
posted by mojopiano to Human Relations (9 answers total) 2 users marked this as a favorite
Since resources vary so much by location, it would be super useful if you could name the city, or at the very least a vague location.
posted by cooker girl at 6:03 AM on April 22, 2020

Response by poster: This is in New Orleans.
posted by mojopiano at 6:08 AM on April 22, 2020

Here is some information from the local NAMI chapter that may be relevant. Scroll down to suggestions for pandemic era mental health crisis response. You can also request a welfare check.
posted by crunchy potato at 7:12 AM on April 22, 2020 [1 favorite]

A welfare check is usually done by police which might freak your friend out more. How old is this friend? If your friend is young and otherwise healthy they can go a few days without sleep and food but lack of both will exacerbate any mental health issues. My mother and my cousin both had schizophrenia with paranoia and there was no reasoning with them. I hope this is not what your friend has.
posted by mareli at 7:37 AM on April 22, 2020 [1 favorite]

Response by poster: Yeah, the welfare check is something that I think may escalate the problem more than help.

I'm looking over the NAMI information to see if maybe a phone call with somebody could be something good for this person, if even possible.

If anybody has experience dealing with this - I wonder how much I need to go along with the conspiracy while also directing them to confront contradictions? I've done some basic googling but I don't see a lot there.

Thanks for the help so far.
posted by mojopiano at 8:06 AM on April 22, 2020

Best answer: I think a call from the cops or NAMI will be harmful for most paranoid people, unless they believe one of those groups to be trustworthy. I'm taking a class related to this from an academic perspective, so I'm not a counselor, but my understanding is there is not one solution that works for everyone. Here's the basics though:

What absolutely does not work past a very early point is trying to argue with them about facts and prove them wrong. This will antagonize them and most conspiracy theories are set up so anyone disagreeing with them strongly will be painted as part of the conspiracy. You cannot rationally change their mind by having better evidence, and you need to stay part of their psychological trusted "in group" to have a chance of helping them

A lot of the time people pick a paranoid theory to believe in to help deal with some anxiety in their life, so it's not at all surprising someone would start now. One approach is to help reassure them about that core anxiety, that will make them need the theory less and they may just get bored with it. Another reason people believe in theories is to gain unity with a social group, so you can either try to be closer to them to help meet that need, or you can subtly point out conflicts between their values and the rest of the conspiracy community that might make them distance themselves. The last thing that can work is to spread doubt about the theory itself: don't tell them the theory is wrong or appear to be an attacker, instead pretend to not know anything about it and express your doubt about specific aspects only after they tell you it themselves but remain open to the theory as a whole. The goal is to make them apply the same distrust towards the people who spread the theory that they apply to the government or whoever the theory is about. This can be hard to pull off so it's also fine to just try and work on the social and anxiety motives and give them a chance to distance on their own. But your instincts are correct: they are looking for enemies right now and it is easy to end up as one
posted by JZig at 9:27 AM on April 22, 2020 [6 favorites]

Response by poster: Thanks for the help.
posted by mojopiano at 10:34 AM on April 22, 2020

My BIL has a psychiatric break a few weeks ago and was experiencing basically this exact situation in a different city. It has been hell for my sister. I would also be wary of asking the cops to do a wellness check due to paranoia. My BIL believed the cops and my sister were plotting to murder him. What helped was:
-my sister contacted BIL's living parent. Living parent broke quarantine to come to their city. The living parent went to the local courthouse and got a Court Order issued to hospitalize BIL. Living parent is now BIL's power of attorney.
- Using Court Order, Living Parent coordinated with local cops and BIL's friends and my sister to calmly persuade BIL to go with cops to psych ward.
-BIL was hospitalized for maximum amount of days before he got a fever and
-BIL tested positive for COVID19 which he may have contracted in the cop car or in the psych ward ER.
-BIL came home and sis took care of him. He was medication at this point but was still manic. He was extremely sick for 10 days. Now, he's intubated at the hospital.

Long story short, this needs to be a coordinated effort with people who have the legal means to assist getting your friend as much help as possibly available (family or spouse). From what I understand, due to the coronavirus, a lot of psych wards are wary of bringing people into their wards. I would also be wary, given what has happened to my BIL, but he absolutely, absolutely needed to be committed.

My BIL (not actually technically married to my sister but as good as is) was totally out of control, so it does take an enormous effort to institute help for someone in that position- if such help is even available or being offered at this time.

Just offering this as a person who experienced something like this directly from the sidelines. Hope it helps.
posted by erattacorrige at 12:10 PM on April 22, 2020 [2 favorites]

Response by poster: Thanks for sharing your experience. So sorry for your family :( That's pretty much my biggest fear, short of self-harm.

I think the person in question is deeply sleeping so hopefully will have a good conversation later tonight and won't have to take drastic welfare measures that may escalate the situation, but this has been really helpful so thanks everybody.
posted by mojopiano at 3:23 PM on April 22, 2020

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