Email: how to help someone with bipolar disorder or other mental illness.

I got this email from Agatha (that’s not her real name).

Hi JT! How’s everything going for you? I’ve been following your blog fairly consistently, and it looks like you’ve been having fun with a wide variety of skeptical shennanigans. We miss you here in [name of state]!

Through all of your blog posts, the ones I enjoy reading about the most are your posts on mental illness. They have helped me become more open and understanding to my loved ones who are affected, and helped clarify several misunderstandings and questions for me.

I was wondering though- you talk a lot about how to relate to people with mental illness, and how to be supportive throughout their recovery/treatment. However, you don’t talk much about what to do when the individual with a mental illness doesn’t appear to want to get better. Do you have any perspective or advice on this?

My sister has been diagnosed with Bipolar disorder, and has several other symptoms that suggest she may be suffering from a combination of illnesses. I would find it much easier to support her if she seemed to be making an effort to get better, but instead she seems to use her disorder as a tool to get what she wants. She’ll do something rude and/or manipulative, but when confronted she’ll act like she has no control. She seems to love the attention from playing off of her mental illnesses. Is there a way to be supportive and help someone get better when they are using their illness as a weapon?

Sending many virtual hugs your way *hugs*

Thanks for reaching out to me on this, Agatha. The first thing I want to say is that because mental illness is an invisible disability, it’s very easy to emulate.  Some people who crave attention, but who are not really sick, can use it as an excuse.  This is unfortunate because it keeps that person from learning accountability and it creates and sustains the very dangerous idea that everybody with a mental illness is a faker.  If you conclude that this describes your sister, I’d give her a very firm lecture on the damage her behavior does to others.

Now, as for how to help someone who is really sick, my friend Lauren wrote her account of helping me get better, which I strongly recommend reading.  It very accurately describes the tribulations that can come with helping someone get better.

The more I thought about my experiences, however, the sadder I got. Helping JT through his dark times wasn’t fun. In fact, it was a lot less than fun, it was pretty fucking shitty. I want to tell all of you to run out there and help those who need it no matter the cost but the truth is that it’s damned difficult.

One of the many downsides of the various mental illnesses is that many of them warp our thinking to convince us that we are not sick.  Or they convince us that if we are sick that it’s better this way.  For me it was a gradual path.  I first had to accept I was sick (er, my friends had to convince me I was sick) and then I had to realize that things would be better if I got help.  The former was the less difficult of the two, and I suspect it will be with your sister.

The greatest things you can do is to be there and to tell them the truth.  They will try to push you away either so they can be alone or to self-fulfill their sordid prophecy that they cannot be loved.  If that is what your sister is doing, condemn the behavior.  Let your sister know that she is better than that.  When she says she has no control, tie her down with, “but you wish you had control, right?”  When she agrees, show her your research on what treatment can do and hold her feet to the fire when she waffles (and she will).

It takes a lot of insistence to get a sick person to the doctor (and sometimes it takes so much that you can’t realistically be expected to do it anymore).  I’d recommend getting more of her friends involved for when somebody needs a break.

Ultimately though, the goal is the same with someone with a mental illness as with any other sick person: to get them treated, which means convincing them to go to the doctor.  Say you’ll go with them.  Say you’ll drive.  Say you won’t judge them (or that you’ll even judge them positively for having the strength to go).  The excuses you’ll hear will be “I don’t want to occupy a doctor with my silly problems” or “I’ll be fine, I just need to satisfy __________ criteria” (in my case it was “lose five more pounds”).  Be firm and tell them that they’re not ok, and that doctors don’t exist to just treat the most sick people.  If what they’re going through wasn’t a sickness worthy of treatment then treatments for mental illness wouldn’t exist.

But they do, and whether it’s through therapy, medication, or both, this is how people get better.  You need to get them to a doctor and go from there, and you get them to a doctor by staying on the points I’ve highlighted above and not coming off of them.

Good luck, Agatha.

About JT Eberhard

When not defending the planet from inevitable apocalypse at the rotting hands of the undead, JT is a writer and public speaker about atheism, gay rights, and more. He spent two and a half years with the Secular Student Alliance as their first high school organizer. During that time he built the SSA’s high school program and oversaw the development of groups nationwide. JT is also the co-founder of the popular Skepticon conference and served as the events lead organizer during its first three years.

  • http://researchtobedone.wordpress.com ResearchToBeDone

    “One of the many downsides of the various mental illnesses is that many of them warp our thinking to convince us that we are not sick. Or they convince us that if we are sick that it’s better this way.”

    This is absolutely true in my experience. Some of the most important things I’ve had to learn in dealing with depression have been that the depressed brain is *incredibly* adept at making up stories about why you’re depressed that have nothing to do with reality, and that, in a general sense, being depressed, or miserable in general is not like getting a correct answer on a test—if World Misery averages to 57 misery points per person, and you yourself are exactly 57 points miserable, there is no prize. Because misery is not about truth.

    That first step: going from, “it is right that I feel this way, because X”, to “feeling this way is a problem”, is just a first step, but it is an absolutely vital one.

  • Kate Donovan

    While I don’t have much experience in getting friends specifically to doctors, I wrote (with the help of other friends and commenters) a four part ‘Friend Manual’ for friends of people with mental illness. It starts here:
    [Incoming linkspam]
    http://freethoughtblogs.com/ashleymiller/2012/09/19/the-friend-manual-part-i/
    http://freethoughtblogs.com/ashleymiller/2012/09/20/the-friend-manual-part-ii/
    http://freethoughtblogs.com/ashleymiller/2012/09/24/the-friend-manual-part-iii/
    http://freethoughtblogs.com/ashleymiller/2012/09/25/the-friend-manual-part-iv/
    That you are writing to JT at all is spectacular. It already makes you an amazing friend. As someone who relies on people like you, thank you. Thank you.

    Also, I have no idea if you’re on a college campus or not, but most counseling centers will take friends of people-in-need-of-therapy. It’s a horribly stressful position to be in, and they can help you and give you an outlet.

  • Emily

    This is really well thought out, getting someone help can be exhausting an incredibly frustrating, esspically when the person seems to not want to get better.
    From my own experinces with dealing with my bipolar, it can be a lot easier to shut out the idea of getting better. Set backs during treatment and not meeig expectations of your peers can be crushing. This coupled with people who treat you as disabled and unable to be helped, makes it seem very tempting to just sink into the disorder and make it your whole life. The attention can seem validting and abusing the diganosis can seem so easy because it lowers people’s expectations of you (which works well when you have none for yourself because you feel like a lost cause).
    Getting help is hard, but ultimently worth it.

  • Anonymous

    (is it possible and ok to be anonymous for this? I hope it is)

    “I first had to accept I was sick (er, my friends had to convince me I was sick) and then I had to realize that things would be better if I got help.”

    This really struck a chord with me. I live with a friend who is depressed. She has admitted that she is depressed, alright, but she refuses to accept professional help. Most of the time she insists that she is working on this in her own way (by hiding away in her room…), but every now and then she admits that she is terrified of professional help. A while ago now, I decided to make it serious, because she really needs help. I cajoled, I blackmailed, I pressured, said I’d go with her… All that happened was that we were fighting all the time and I got really worried that maybe I was wrong to push her so. I don’t know how to get her to find help. I don’t know how to help her. I don’t know how to get her to come out.

    I don’t really know where I am going with this. I guess I could do with some advice as to how to get someone to get help, but mostly I worry that she will never accept any help. I am not sure what to think about that.

    • John Horstman

      As someone with type 2 bipolar disorder who resisted treatment for years, I will say that it is difficult to impossible to actually force someone into treatment. The person absolutely needs to want to get better – if ze doesn’t, you might be able to coerce hir to see a therapist /psychiatrist, but you will not be able to get hir to do the work necessary (even down to just staying on top of a medication regimen) to actually get better. The person in question needs to 1) want to get better and 2) see that as at all possible.

      You say of your roommate that “every now and then she admits that she is terrified of professional help”. It sounds like she does acknowledge at some level that she has a problem and actually does want to get better, but has some reason she doesn’t want therapy. Addressing that reason sounds like your next step.

      Is she terrified that she’ll change? She will if treatment is successful: remind her that change – for the better! – is, in fact, the point. That’s what getting better means.

      Is she uncomfortable opening up? Therapists (good ones) have ways to address this themselves, so just convincing her to see a therapist at all (get her to agree to try just two or three sessions, perhaps by promising to stop bringing it up if she gives it an honest effort and doesn’t like it) might be able to address this.

      Has she had bad experiences with therapists in the past? That was a big one for me – I wasn’t abused (though that can happen – it’s uncommon though, and no reason to bring it up and scare her), but the therapists I saw as a child when I first started developing problems probably did more harm than good, as they had no idea how to relate to me as an extremely intelligent child with an anti-normative view of many social conventions. The way I overcame the disincentive of bad past experiences with therapy was to remind myself (and be consistently reminded) that the therapists were working for ME, I was ultimately in control of the sessions, and I didn’t have to keep seeing anyone who wasn’t working. Also, reminders that it can sometimes take a while to find a therapist/psychiatrist who’s a good fit (socio-cultural outlook is important but often elided from descriptions; I can’t be helped by, say, religious, Republican therapists because they have no fucking clue how I see and relate to my physical environment, my cultural environment, and other people) are helpful: just because the first one or two or eight therapists don’t work doesn’t mean help is impossible. I recommend taking the first session to interview a therapist; they need to get background information on one and one’s symptoms, but far more important is getting information on them, as someone to whom one doesn’t relate and who doesn’t understand one’s worldview isn’t going to be helpful.

      Without more and more detailed information about her behavior and the conversations you’ve had, I’m not sure how many other specifics I can offer. I know one thing that would bother me is people not accepting the legitimacy of what I was feeling or my psychological limitations when they couldn’t understand them. If I say that I cannot make myself get out of bed, I really mean it; I often desperately wanted to do so, but I could not – my depressed phases would sometimes manifest as a literal inability to exercise agency, and in a hyper-individualistic culture like ours that takes agency to be a defining aspect of personhood and identity, this inability made the fear of judgement from even sympathetic persons terrifying. It’s also generally impossible to explain the experience of mental illness to healthy people, because we lack the language to do so, and people lack the experience to connect to the things we do have words for. For example, for a healthy person, if one is hungry, one has something to eat. When in a depressed phase, I would sometimes not eat for days; I’d be starving, but unable to to actually take the action to get myself food. I think that’s almost impossible for someone who has never experienced the phenomenon to imagine – not being unable to decide or a lack of wanting things, but an inability to translate those desires and decisions into action. The closest analogy I can come up with is paralysis, though that’s not strictly accurate, as one may be able to self-motivate to do some things but not others. So, I guess my only other general advice is to keep in mind that sometimes what someone with a mental illness is saying will make no sense to you or seem impossible. Just accept those things as true (unless directly contradicted by some evidence) and work within that framework.

      • Anonymous

        Hey, thanks for that. You have given me a lot to think about. I can answer the first thing (the reason for resisting therapy) quite easily: she feels that she is holding things together now and that going to therapy will mean breaking it all open, thus not being able to cope anymore. That fear runs very deep – it doesn’t respond to logic.

        I will need to really keep that agency thing in mind, because I do tend to think ‘if you would only get out of bed and go for a walk, things would be better’, for example. And I find it hard to realise that she can’t get herself to eat. These things are so … normal to me.

    • Kodie

      I’ve tried to take care of, on two separate occasions, two separate people, who emerged with symptoms. One already had a diagnosis, but he had been managed with therapy and medicine for a long time and I naively thought that was that, and I wouldn’t have anything to worry about. In both cases, their parents had to do all the helping and kind of shut me out, which was shitty of them to do. Yeah, I’m not trained, I didn’t go to all the meetings, but that doesn’t mean I don’t care or want to learn and be a part of this person’s life. But they team-managed it like a business. In these cases, both had needed hospitalization and sign up for on-going programs and disability insurance.

      Anyway, don’t go it alone. Think about it – the person going through it is trying to go it alone and can’t manage. Don’t be a martyr, involve other people, the person’s family if you can. I tried to act as though the person was just acting weird and didn’t want to do anything drastic, but that had an enormous negative effect on my life as it became more and more clear that there was more going on in their head than I could do anything about. I am not the best equipped for it as I need help too. It’s easy to get resentful, as the person should just have the same sense you do and do what’s good for them, just like they would go to get a cast if they broke their arm or take a pill to get rid of a sour stomach. I’ve had bad experience with therapy, and would probably say the same thing. I get in positive productive moments and feel like that will last and most of the time felt like if people around me cared, they would be there instead of telling me to go talk to a stranger, but I don’t have depression either, and most of the people in my life understand that sometimes people need therapy that means they don’t have to do anything – or I “look ok” so what’s the problem. Mania particularly feels great to the manic person and makes them resist treatment, if I understand correctly, which is what I was dealing with – a really fun guy who wanted to do lots of fun stuff and then turn on me week to week with focused anger most hurtful. When they get pissed at you, well when he got pissed at me, I felt like – hurt like a regular girlfriend like he was a right-minded boyfriend saying true things, but I wanted to wash my hands of it. It’s also just like an abusive relationship – how much of what was happening was excused because he’s ill and how much can be attributed to he’s bad news and I should get away? Essentially, his mom and his sister made that decision for both of us like we were teenagers, infantilizing him and demonizing me, and the prior relationship was the same. After the first time around, I never wanted to deal with that again (heartlessly), so the next guy says he’s on medication like it’s a done deal, but it’s never done forever. I took care of him because I cared about him no matter what, and it’s the right thing to do, but it’s not just so easy as getting them to a doctor so both your lives can go back to normal.

      When someone is sick, how do you decide? You have you to take care of, and if this person needs a lot of help, or what they need you to do is read their mind or something, that’s what it feels like. I am hooked up with therapy but that’s not all I need help with. I can name it – I need help making a schedule and sticking to it; I need help feeling confident enough to pretend I’m well enough to go back to work without crying in the toilet every day, or worse, right in front of everyone; I need help pulling together all my paperwork, forms, agencies, etc.; and it would be super if someone could help me organize my apartment. Without all this, I am prone to feel anxious and overwhelmed and evasive while everyone thinks I’m hunky-dory because I see a therapist for an hour a week and I can act like I’m ok so I don’t bring everybody down, but it really takes a lot out of me. Don’t do it alone.

      • Anonymous

        Don’t go it alone is very, very good advice, thank you. I absolutely suck it at, but you are right. Also with regards to the resentfulness and also with regards to keeping an eye on my own needs. I think those two go hand in hand, actually. I over-extend myself, because I want to help, and then I get resentful, because I have over-extended myself. I don’t want to be resentful, because I love my friend. It’s tricky.

  • Molly Anderson

    Ive been sick for quite awhil i see a therapist and a phys doctor i had a hard time finding a doctor that
    would take me they would always say they could not help me i have been in the hospital 4 times no
    help its like going into a motel for rest. i think my doctors are getting sick of me when i go to a family
    doctor they never want to help me they always say i need to go to my phys doctor for meds and stuff they
    cant help. i had real high blood pressure that day i went to the doctor and she never did or said anthing
    the next day i had a bloody nose. i get so depressed i cry alot i cut real bad i hate myself i dont get
    along with people if they say something wrong to me it turns me into someone other than myself and
    i just go off on them. i cant stop it. my family refuses to go anywhere with me so i dont leave the house
    that much. i dont sleep at night i hear alot of voices in my head all the time telling me to do stuff and
    bad things about my self that depresses me even more. the doctors dont understand this they say i
    should just ignore the voices or tell them to go away its easier said than done. i blow up anymore all
    the time at everyone i get so mad and cant control it and it scares me. i have blackouts where i dont
    remember things. i take alot of meds and they dont help. im so tired………………………

  • am

    “If you conclude that this describes your sister, I’d give her a very firm lecture on the damage her behavior does to others.”

    If her sister’s been diagnosed with a mental illness, it’s not the e-mailer’s place to accuse her of faking a disorder and ruining things for “others.” How would you feel if in the midst of a dealing with your mental illness someone very close to you suggested you were faking it and lectured you about the damage to other people you might cause? As someone with a mental illness who also has close family members with mental illnesses (who can often be difficult or manipulative), I know I would be devastated and my relatives would be incredibly upset.

    I’ve found that when it comes to my family members, using some techniques from cognitive-behavioral therapy can help . I found using David Burns’ idea of disarming by finding SOME truth in what the person is saying and empathizing really improved things between us. (http://www.relationshipsincorporated.com/Websites/relationshipsinc/files/Content/2324859/Effective%20Communication%20Skills.pdf)

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