The Blog

How You Treat Someone With a Mental Illness

In any case, don't give up on your friends with mental illness. Love, compassion, understanding, empathy, and nudging them to get in touch with their doctor would all be inordinately helpful!
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What if you have a mental illness and you are in the throes of a bad depressive, manic, psychotic (out of touch with reality) episode? And what if your friends have no idea how to respond to this and they are looking for some help as to what they should do, how they should react and how they can help you? Well I have bipolar disorder and when one of my friends asked me how they can help their friends who have a mental illness, the following is what I told them.

When someone is in the hospital for a physical illness, people visit, they send flowers, it's generally acknowledged that this person is ill. There is no "Hush, hush, don't tell anyone about this" going on. In my experience, except for my very devoted boyfriend (now my husband) and my family, no one came to visit me in the hospital. My aunts sent me flowers the first time I was hospitalized. It certainly wasn't as it would have been if I'd gone in for an appendectomy, many of my friends may have visited, many more would have called, and a few may even have sent flowers, chocolates...

Let's ask why it is that things are different in the case of a mental illness. Why? Well if you're getting an appendectomy, your personality doesn't really change, you may be grouchy and a bit frightened, but you are still you. When you are in some phases of bipolar d/o or many times in schizophrenia, you might be the queen of the Amazon (the jungle, not the website!) you might also have the cure to cancer and have evil people trying to kill you to get your cancer cure and take credit for it. In short, your personality does change, and the things you say don't make sense, that makes your friends and others uncomfortable. I understand. If someone I know is very drunk and incoherent, making no sense at all, I cannot speak to them. I know they are making no sense, I know there brain on alcohol is not functioning properly, I know that the next day they won't have any recollection of this strange and weird interaction with me. So I just walk away, unless they need help, then I try and help them.

So, perhaps, like a drunk person whom I don't take seriously, my friends, and even my family, don't really know what to do with me when I am in a severe manic phase and witches from Eastern Europe are trying to destroy my heart with black magic...

In this case, the only thing that helps is to go see my doctor, and increase medication doses so my brain pulls out of mania. Twice in my life the mania was so severe that I was out of touch with reality and I had to be hospitalized, and needed to say in the hospital (30 days, first time and 10 days second time) to get back down to earth and be and function normally.

So friends if you notice your good friend acting erratically, being overly emotional, talking about fantasies as if they were absolutely real, please encourage them to call their doctor. It is at this point that they have lost their insight and have no idea they are not in touch with reality. So, noticing this, as a friend, if you suggest to your ill friend that they call the doctor, this may be just the thing they need. Perhaps even call their doctor on their behalf (don't know if this will work with all the privacy laws, but try anyway.) What your friend needs now is love, sweet love, yes to be sure, but also medical treatment, perhaps hospitalization to get better.

If your friend is in the hospital (psychiatric unit,) visiting them in visiting hours, and flowers, little gifts would be very welcome, just as with anyone in the hospital.

I know when depression strikes me, I become overly emotional, all dark emotions, thinking I am unworthy, unlovable, useless... If my friends tell me that I am wrong in my thinking, if they point out all the wonderful things I've done, all the great ways I am... that all helps, for a while, but depression is relentless, and it will steal your soul. So once again, support, love, understanding (to a degree) is very valuable to the depressed person, but the most important thing is to get them to contact their doctor. The depressed person needs medical intervention, a change in their medicines, or doses.

Just like you cannot cure diabetes with love and affection and understanding and support, you cannot make a person who is in a severe phase of bipolar d/o better with love, affection, and understanding and support.

Please don't misunderstand me, love, affection, understanding, and support are all extremely valuable and very desirable things when someone is ill, physically or mentally. Since understanding is often times lacking about mental illness, since it is difficult to know what is going on in the heads of friends who have a mental illness, patience is also a great virtue. If you try to help someone, and because of their state of mind at the time, they cannot accept your help, be patient, and you never know, the next time you try to help them, they may be very open to and grateful for your help.

So of course love, understanding, acceptance, affection, support, compassion, and most of all patience, are all needed in dealing with friends who are in varying degrees of phases of a mental illness. Compassion is big, the ability to feel or at least try to feel what your ill friend is feeling, walking in their shoes so to speak, will give our friends insight into what the mentally ill person is experiencing. And compassion is not pity, we don't want your pity, we do and surely could use your compassion! And of course, also encouraging them to contact their doctor is of paramount importance.
Also, don't get involved with their delusions, for example when I thought the witch was trying to destroy my heart with black magic, and I told you this, do not become a part of the delusion by telling me you will help me fight the witch. But arguing with me in that phase would have been useless, perhaps empathetically discussing my delusional beliefs would be the thing to do. Saying something like "I understand how frightening this may be, (bait and switch hahaha) how about you give your doctor a call and see if he can help..."

One last thing I'd like to add is that even in a full blown manic phase, I cycled through mania/normal/depressed phases 3-4 times a day. And when I was in my normal phase, I would say to myself and my family "It's happening again, I'm going out of touch with reality again!" So I knew, for parts of the day that it was happening again and that both times, I needed to be hospitalized. So in my normal phase, I actually would have agreed with you and indeed would have called my doctor, and I did call my doctor and tell them what was happening and asked for hospitalization, especially the 2nd time. So it may very well be fruitful to ask your friends who are ill, to get in touch with their doctor, multiple times. You might catch them in a state of mind in which they have a lot of insight and will actually listen to you and call their doctor.

In any case, don't give up on your friends with mental illness. Love, compassion, understanding, empathy, and nudging them to get in touch with their doctor would all be inordinately helpful!


If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.