Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Sunday, February 06, 2011
You Need Help!
Sometimes in my real life it becomes obvious that a friend or acquaintance is having a problem. Either they are wearing obvious signs of mental illness or they just show signs of being 'stuck' in life or, worse, of moving backwards. Often they don't see it. I suppose there is the outsider's vantage point of making a judgment that may reflect my own value system and not their reality: to me, I may see someone who has family and job and connections who sees leaving those things as a healthy escape and their withdrawal as a good kind of comfort with keeping their own company. Usually these aren't my close friends, but what do you do when you notice that someone in your life is changing and might possibly benefit from help?
In general, I've found that "You need help" is not helpful. People hear this as an insult, not as a kind suggestion from a concerned friend. And from a psychiatrist friend it may be worse and easier to blow off---shrinks think everyone's crazy, they push drugs, they think everyone needs therapy, they see the world in a skewed way (at least this is how the commercial runs).
So I wondered: how do people let their friends know they need help in a way that inspires them to get it in the absence of a crisis? If you're in treatment because someone else suggested it, what enabled you to hear the suggestion without being wounded or insulted?
Subscribe to: Post Comments (Atom)
I do not have any friends--well, one (obviously, I need help :)). But I once told my mother that she needed therapy. You don't tell a narcissist that she needs therapy; she will then deny that anything is wrong with her and let you know that it's all your fault. My children--well, my daughter knows she needs help, but has no money; my son needs help, but he thinks he's perfect (see narcissist); and my third son & I conquered his OCD together. When he seemed to be heading towards a life of cutting, I seemed to stop it by reminding him how un-fun it was to get over the OCD, so why did he want to give himself another mental illness? and we got through it. I need help too, especially given that until a few months ago, I planned to off myself, but that went away when I quit my evil job, so now I'm too poor to get help. So I think that I wouldn't bother telling someone else that they need help when I am incapable of getting it myself. Help is expensive.
First, I offer to help, to listen, to care. Then if it appears they need more, I start to offer suggestions of people more qualified than myself.
If I start off witht he offer it inevitably ends up as them percieving me telling them to get help.
Honestly, I've got 2 years before I get my bachelors in psych, then 2-2 1/2 years before masters ..who knows how long before PhD ..afraid to do the math (I'll be 50 before I get masters!) and the more I learn the less willing I am to offer actual advice ... but it seems the friends want more ...at the point where I think I know just enough to be truly dangerous. So listening is what I'm doing most of these days.
There was a very good sequence of events leading up to me getting help, and the whole experience happened because people told me I needed to get help.
I started showing signs of depression and a concerned friend approached me and said that he was worried, and noticed I was showing the same symptoms his wife was showing when she was depressed. He told me that he would let me wait it out and experiment but if I went on too long he would make sure I got the help I needed.
The biggest thing that made this interaction positive is that he understood I had not let go of the false hope that I would wake up the next day and be happy again. He understood that, and didn't try to take that false hope away from me. Instead he waited for me to prove myself wrong. A week later he noticed I was having a terrible day and said straight out, you're depressed and need to get help.
I brushed him off but the idea of getting help was at least starting to grow on me
After a few weeks I still wasn't fully convinced I needed help until one day after school I burst into tears in a different friends arms and he pulled me off to the side and told me to promise him I'd get help. I told him I couldn't promise anything because I was afraid to go anywhere near a therapist's office. The conversation was left at that, but I stewed over it for another week and finally went to see someone.
Best. Decision. Ever.
Also- even though every time someone brought up to me that I needed to get help, I brushed them off like there was no way. but each time it was brought up made me warm up to the idea a lot more even though I didn't say it.
Its a minefield! but just being around and talking about my own everyday life challenges can start a helpful dialogue.
Simple explanations of symptoms as opposed to advice. The only advice i usually give when asked is who to got to for help.
After that it's more 'being around' with soup, a hug and encouragement to stay with the therapeutic process.
Sometimes end up having to 'translate' professional advice but keep encouraging them to refer back to their health professional and clarify things.
But above all remembering that all of the above or certain parts of it may have to be done via someone other than me, someone who is not a 'shrink'
Jude, please know that many communities have resources that can provide you with counseling for very low cost or for free. If your county has a local mental health association, they might be able to help you find some affordable help. Likewise, a local suicide hotline might have some referrals. Or even if you called a clinic that you can't afford - they might be able to help you find one that you can. Check your local Catholic Charities as well...they often offer counseling (non-religious, despite the organization).
Its quite a risky matter IMHO.
Friends might not apretiate you being a therapist to them.
EG how do you tell a friend that she's sliding a slippery slope to Annorexia ?
Especialy when she is convinced that she's "huge"
This is a difficult dance to do, and its worse if you are a mental health professional because the friend will right away be thinking that you are evaluating them professionally. A minefield to be sure. The only thing one can do is be supportive and offer personal experiences; saying things like "when I had X problem, I really got a lot of help by doing Y" and "sometimes people need help to understand their experiences and make better choices and when I was going through X it was immensely helpful to get an opinion of a third party...I have a colleague that I could recommend that really understands this problem if you would be open to talking to them, it might help" Those kinds of statements plant a "seed" that hopefully will germinate into action. Any more than that, and you will put the person off.
Sometimes,it becomes obvious that one's shrink is suffering from obvious signs of mental illness.....
This really does happen. If you point it out you risk being lectured about transference.
I have a different perspective as a patient. I don't think I can "get people to seek help". When I discover that someone is a lot crazier than I thought and is trying to heavily use me for support and aid beyond the normal limits of friendship, I exit the relationship. I have already "been there and done that" trying to give to bottomless pits of need who just drag me down too. I want to be able to have limits on the relationship without being given the guilt treatment. I want to share good times, not just shoulder someone's burden. It is not that I am unsympathetic, but I need to protect myself from unrealistic demands. (It IS sunny here by the way!)
I don't have any good advice, but I can say that coming out of inpatient hospital treatment, I found it highly annoying when mere acquaintances or inlaws I see once a year would send me notes and cards telling me that they were glad "You got the help you needed." These people didn't even really know me and they certainly didn't understand the chemical and genetic factors at play during my manic episode. Honestly, I felt like they were speaking about their own families and merely directing it at me. And, rankly, whatever they have to say as far as treatment, I think I'd consider doing the opposite. Ultimately, it has to come from within.
First of all, I think that any relationship that is strong enough for you to be this honest, will probably survive the offense, if it is taken that way- otherwise, you probably overstepped your bounds too soon. All I know is, a few months ago things got really bad for me, and my mom suggested I try anti-anxiety medications. I didn't, and freaked a little that she thought things had gotten that bad, but what it did for me is show me that things needed to change, if it was bad enough for my family to be worried. So I prayed and sought out other kinds of help and am doing better. My mom's concern for me resonated with me. If a coworker I didn't know well had tried the same tactic, I might have been affronted and scurried back into my shell and never talked honestly with them about those things again. I think it is better to approach the truth IN LOVE and ask forgiveness later if needed than hold back and regret not helping when my help could still be heard.
Also, a lot of it comes down to what kind of friend you are in the first place. If your friendship is built on convenience, dependency, or personal material gain, rather than on true caring, than you will come across as judgemental and callous. But if you have successfully communicated your esteem to a close friend, I think you can't go wrong, even if they get angry or upset in the short term, because they know your motive. They may think you are wrong about them, but they will appreciate that you cared, and chances are that they will weigh your words seriously for some time.
nobody has ever noticed when something is really wrong with me, unless i was intentionally acting out (like as a teenager). i turn to people around me and tell them what is going on, instead. and i seek help on my own, sometimes with their support. i am ultra-hyper-aware of the goings-on inside my brain.
when ithink someone else needs help, i tell them i am worried about them and talk about how therapy etc. has helped me. i don't sit them down and push an intervention on them - instead i spend time observing the situation and trying to get on their side before i start discussing any potential treatment.
this can take several conversations before i start talking about therapy. sometimes i even approach it indirectly by discussing my concerns with other people who are closer to the individual. it can occasionally help a person to snap out of a depression just by knowing that other people are concerned.
i have a family member who has bipolar disorder and we had to take a different approach in one situation. pre-diagnosis, she had a meltdown that made us concerned for her safety (and ours). we insisted that she seek help before we would continue to see her as a family.
i guess that every situation is a little different, depending on the relationship of the people involved, and the coping abilities of the friend or family member who wants to help.
I received therapy for depression and PTSD following an abusive childhood, but did not do so until I was completely out of options and on the verge of suicide. People had told me that I needed help, but I didn't listen to them because, at the time, I thought therapy was for weaklings (and here I am in med school thinking I might become a psychiatrist!). I wish I had gone much sooner.
Though no one was able to get through to me, I've found some success getting through to a close childhood friend who endured similar circumstances to my own. My initial attempts, talking to him about my experiences and expressing concern for his depressed state was not what did the trick. He was convinced after I gave him a book on child abuse and how it affects adult survivors. After reading it, he saw that he wasn't alone, wasn't a freak, and was not by any means a weakling. Somehow seeing it in print, officially, was more convincing than anything I could have told him. He's on his 3rd counseling session and optimistic about treatment. I think that in retrospect, if someone had handed me the same book 5 years ago I would have sought treatment sooner too.
I suffered from depression and PTSD following an abusive childhood. For two years I refused to see treatment, thinking it was for weak people, that I was just "bad" for not being able to fix myself. Though many people told me to get help, I was not interested in what they had to say. I was on the verge of suicide by the time I sought treatment, and discovered what a gift therapy can be (little did I know 5 years later I'd be in med school seriously considering psychiatry!).
Though no one got through to me, I recently had success in helping a close friend who had a similar problem. I tried telling him about how therapy worked for me and how I was concerned about him sinking into depression, but nothing I said helped. Finally, I gave him a book that I read during therapy about children of parents with borderline personality disorder (Surviving a Borderline Parent). Reading about how adult survivors learned to cope, and how abusive parents are not so rare, he came to realize that he was not alone and not a freak. He became open to seeing a therapist and trying to work through his issues. I'm pleased to say that he's doing well. I wish that someone had given me the same book earlier, because I think that I would have been more open to therapy if I had seen it in writing, too.
Take that as you will. :)
Post a Comment