[Qwerty3758]

Hi,

Recently a friend of mine, George, has been starting to show signs of a personality disorder. A few months ago me and others noticed he was starting to be distant, reclusive and evasive. Then not to long ago we all went out for dinner and we noticed bizarre behavior. He often would go into a daze and stare into nothingness while whispering words to himself (as if talking to someone). He would smile and sometimes laugh when there was nothing amusing. When we would ask him what was funny he would look at us and say nothing or say he wasn't laughing. In addition, we noticed that he was often wearing the same clothes on each occasion. His motor skills were not as sharp as he would have trouble eating simple things such as pasta and his driving became almost dangerous.

Fearing for his well being we contacted family members to express our concern. They brought him to see a doctor and his response was rather indifferent stating he is under stress and emotional issues. We found that diagnosis hard to accept as the signs of something more serious we rather pronounced and we wish him to see a specialist. Unfortunately, he is rather evasive after being brought against his wishes to a doctor in the first place. As friends we are not sure what step we should take next. It seems the family is somewhat in denial and may not be treating it as serious as it is. We want to help him but are not sure of what to do that will help and definitely don't want to do something to make it worse. We've thought of things such as an intervention where we show up and inform him were aware his behavior, in the hopes he might seek help. Problem with this is we're not even sure of what he has and more so how he will react to this situation. None of us have ever dealt with this situation so you can imagine our frustration and somewhat helpless feeling. Therefore, what is the best route?

Any advice would be greatly appreciated.

[costello]

Hi Qwerty:

It sounds like your friend isn't doing very well right now. You've made him and his family aware of your concerns. He's seen a doctor. I'm not sure how you know the doctor was "indifferent," but it seems the doctor didn't feel like there was anything seriously wrong. Sometimes people do act a bit odd during periods of high stress. Even if he's having a psychotic break of some sort, people do sometimes work through episodes. Maybe a wait-and-see approach is best?

You asked what you can do. I think the biggest thing you can do for your friend right now is to be his friend. People with mental illnesses often find themselves abandoned by their friends, and even family. At a very frightening time in their lives they might find themselves with little or no support.

Partly this is because they may do things which anger or scare or confuse the people around them. They may become very difficult to understand to the point that people stop trying to communicate.

People with mental illness also often isolate for a variety of reasons. I think this is probably even truer of schizophrenia than other MI's. People with sz may be very fearful of other people. They may have a profound lack of ability to trust. They may find interactions with other people to be emotionally painful. And they may just feel embarrassed if they've been acting odd.

Ron Bassmann is a psychologist who was dx'd with sz and had several psychotic episodes. He talks about his "old friend Elliot" who stuck with him through the worst of it and was instrumental in helping him with his recovery. Maybe you can be an "Elliot" for your friend. Here's Ron Bassmann's website: A Journey Through Madness and Transformation. He wrote a book called A Fight to Be: A Psychologist's Experience from Both Sides of the Locked Door. He has an interview with Will Hall on Madness Radio: http://www.madnessradio.net/madness-...ogist-survivor.

The second thing you can do is to educate yourself about MI. (For example, schizophrenia is not a personality disorder. ) Personally I would not focus on the standard medical model so much as I would try to see the experience from your friend's point of view. To do that you'll have to talk to people who've gone through it or who are going through it right now - or to read books by such people. They're the experts who can help you understand.

Remember you're not a therapist or a doctor or even a family member. You're a friend. A friend's job is to be there and try to understand with the most compassion he can muster. It's an important role. I wish even one of my son's friends had stuck with him. He has no buddies right now.

I think costello is right. Help him along, but do not try to fix him. That is his job or his families job, I guess. Just be there, it is all you can do, but I think it will be plenty.

[lil-angel-wings]

Originally Posted by costello

Hi Qwerty:

You asked what you can do. I think the biggest thing you can do for your friend right now is to be his friend. People with mental illnesses often find themselves abandoned by their friends, and even family. At a very frightening time in their lives they might find themselves with little or no support.

Partly this is because they may do things which anger or scare or confuse the people around them. They may become very difficult to understand to the point that people stop trying to communicate.

Remember you're not a therapist or a doctor or even a family member. You're a friend. A friend's job is to be there and try to understand with the most compassion he can muster. It's an important role. I wish even one of my son's friends had stuck with him. He has no buddies right now.

I completely agree...people around me dont understand when the words i want to say dont come out right or my behavior seems odd, so they assume that im being miss guided or they just say things that attack me emotionally. It is better to listen to your friend, here all the words, if they are mixed up or seem odd it is probebly because he is trying to tell you something the only way he knows how. So do not be afraid to ask questions, but you have to make them simple. dont go into long drawn out details of this or that. It can be hard to put all the dialoge togethere in your head when you are struggling.

[RunningEagleRuns]

You are a good friend. Good luck! Just support him.

[Qwerty3758]

Thanks for the responses.

I appreciate the the advice and correcting me on a few things. I understand what you're saying but it has become increasingly difficult to contact him. He doesn't answer or return calls, and in the rare instance that he answers he makes up an excuse and says he'll call you back but never does. It's been like this for about 2 weeks (since he was taken to the doctor against his will). He doesn't work or go the school so we're all wondering what he's occupying his time with. We've thought of just showing up at his house but are afraid he reaction might be negative.

We think he might be ashamed of his situation and not want to see us because then he would have to face the reality of what he has. The very last time we saw him he was muttering things to himself, going into almost catatonic states in which we had to constantly distract him to keep him aware. He also mentioned how great god was and that he talks to him sometimes (which you can imagine was particularly frightening). Oddly, he does not display this state when speaking to a stranger as he would all of a sudden strike up a lucid conversation with the waiter at the restaurant. This is why we think his meeting with the doctor cause the doctor to think not much is wrong with him.

Unfortunately, as you said, only the family could act on this but we don't want to stand idly by. It's reaching a point where some of us just want to give up and leave it to them.

[costello]

Originally Posted by Qwerty3758

It's been like this for about 2 weeks (since he was taken to the doctor against his will).

Yeah, this is one of the down sides of forcing treatment on people. They don't trust you afterward.

We've thought of just showing up at his house but are afraid he reaction might be negative.

I would go. Knock on his door and see what happens. You'll get a better idea of what's going on. Personally I'd resist the urge to "call in the troops" and force him back to a hospital or doctor. If he'll let you in, try to assess the situation. Just hang out with him for a while if he'll allow it. Even if he's not saying much, just sit there with him and listen to anything he has to say. In a similar situation, I like to find out if my son is 1) eating, 2) sleeping, and 3) keeping his place relatively clean.

We think he might be ashamed of his situation and not want to see us because then he would have to face the reality of what he has.

Or he could be pissed at you or really paranoid or just lost in his own world or a hundred other things. It's hard to know if you can't talk to him.

last time we saw him he was muttering things to himself, going into almost catatonic states in which we had to constantly distract him to keep him aware.

I'm not sure what you mean by a catatonic state. My son would go inward sometimes. "Attending to internal stimuli" as they say. I don't usually feel the need to distract him. You may just have to train yourself to be comfortable with people who space out and stop interacting with you - sometimes for long periods of time.

He also mentioned how great god was and that he talks to him sometimes (which you can imagine was particularly frightening).

He's talking to God? Or God is talking to him? I wouldn't find that particularly frightening, but I've been at this a long time. It isn't uncommon for people in these kinds of states to experience them as mystical. I suppose you feel frightened because it confirms your fears that he's gone round the bend?

Oddly, he does not display this state when speaking to a stranger as he would all of a sudden strike up a lucid conversation with the waiter at the restaurant.

I would guess he's aware that what he's saying would be perceived as being odd or "crazy." You should be glad he's sharing with you. That indicates trust to me. Don't squander the trust.

This is why we think his meeting with the doctor cause the doctor to think not much is wrong with him.

Yes, and I would say that if he was aware enough and able to interact with the doctor that way, then he may not be as bad off as you think.

Unfortunately, as you said, only the family could act on this but we don't want to stand idly by.

I think you may be surprised at how the little the family can legally do to force your friend into treatment. Unless he's a threat to himself or others, he can't be involuntarily hospitalized - at least in the U.S. You can't just take a family member to the emergency room and say, "He's acting crazy. Take him to the hospital." If he doesn't want to go and denies that he's planning to hurt himself or someone else, they'll just release him.

It's reaching a point where some of us just want to give up and leave it to them.

Yep. That's how it goes. The friends walk away because it's too hard. I'm not faulting or blaming you. Sometimes I think I would have walked away too - if it weren't my son.

I really wish I had an easy answer for you. When my son started acting odd (much like your friend's behavior) in September 2005, I thought I'd just get him to a doctor and everything would be fine. They'd fix him up and put him on his feet, and he'd go on with his life. The reality isn't so easy.

Your friend may come out of this episode in a few weeks or months. If he does, he may or may not have other episodes in time. He may just go on acting eccentric but surviving more or less successfully. Or he may require some kind of mental health intervention. If he does require that, he may go for it willingly or he may have to be forced. He might decide to continue treatment or not. The people around him may be constantly in despair because he "won't take his meds" and he "won't admit he's sick."

In all likelihood he has a very long road ahead of him and will quite likely experience interventions from mental health professionals, some of it helpful, some of it very unhelpful.

I think you need to resist the urge to fix things and put things to right. I understand the impulse. I have to fight it myself. Over time I've learned to mostly let things go the way they're going to go. It's surprising how often things work out okay. Of course, you may have to revise your definition of "okay."

A few questions:

How old is your friend?
Was he functioning "normally" before these new behaviors started?
Has he been taking any illegal drugs or abusing alcohol?
Is he taking any prescription medications, particularly any new prescriptions?
Is he sleeping?
Has he had a life trauma recently - lost his job, ended a relationship, etc?

I hope you don't decide to walk away from this man. He needs people who care about him in his life. My son will descend into a weird world in his own mind if he doesn't have other people around him to pull him back to reality. It sounds like this guy is the same.

To be his friend, though, you'll have to be flexible and open. And you have to be able to distinguish a true emergency from odd behavior. What your friend is doing right now - based on your description - is not an emergency. There's no indication that he or anyone else is in any danger. You have the luxury of time. You don't have to rush anything. If you can just relax with the idea that right now everyone is safe and okay, you can proceed in a more helpful way.

I tend to think that people retreat from reality into their own world because reality looks really, really unattractive. It's scary or painful. In our society we take people who've retreated in this way, and we traumatize them by forcing doctors, hospitals, and medications on them. It's like we're saying, "Yes, you're right. Reality sucks. Let's see how awful we can make it for you. Let's see how much pain and humiliation we can inflict to confirm your idea that the world is a cruel place." Of course, not everyone experiences mental health services this way, but too many do.

I personally think your friend needs a sense of safety.

[Qwerty3758]

How old is your friend? 25

Was he functioning "normally" before these new behaviors started? Yes, but now that we've seen him like this we've been thinking of situations in the past where he'd acted peculiar. We're not sure if we're just reaching though.

Has he been taking any illegal drugs or abusing alcohol? No

Is he taking any prescription medications, particularly any new prescriptions? Not that we know of.

Is he sleeping? He's always had odd sleeping hours. We used to joke he was an insomniac but now his sleeping hours have become unorthodox. Sometimes we'd talk to him at 8pm and he'd say he just woke up. We do know he does sleep a lot.

Has he had a life trauma recently - lost his job, ended a relationship, etc? Well he's had trouble finding a job since graduating from university almost a year ago. This is what we originally thought was the problem before the more serious episodes occurred. Do you think this really could have triggered all this? I mean George did have high expectations after graduation but would not finding a job cause this much of a reaction in him?

[costello]

Originally Posted by Qwerty3758

How old is your friend? 25

That's a pretty standard age for such episodes to start. Maybe a little on the older side for a man. I think it's a better for him that he's having his first episode at an older age. Older age of onset is a predictor of a better chance of recovery. http://en.wikipedia.org/wiki/Prognos...nia#Predictors

Was he functioning "normally" before these new behaviors started? Yes, but now that we've seen him like this we've been thinking of situations in the past where he'd acted peculiar. We're not sure if we're just reaching though.

Yeah, I did that too. Started look back and reevaluating my son's earlier behavior to see if I could find warning signs that I missed.

Sudden onset from previous good functioning is also a good sign, a predictor of better chance of recovery.

Is he sleeping? He's always had odd sleeping hours. We used to joke he was an insomniac but now his sleeping hours have become unorthodox. Sometimes we'd talk to him at 8pm and he'd say he just woke up. We do know he does sleep a lot.

Sleep disturbance is pretty common in these types of situations, and it's something to get under control. It could be that just getting his sleep back to something approximating normal will go a long way toward getting his mind back on track. He may even be getting concerned about it himself and might be willing to get medical care for that.

I would simply ask him point blank if he's sleeping at all and if he's sleeping at night. If he's feeling manic, he may not have actually thought about it. If he's not sleeping, just ask if he thinks a sleeping pill might help. Or a benzodiazepine.

Has he had a life trauma recently - lost his job, ended a relationship, etc? Well he's had trouble finding a job since graduating from university almost a year ago. This is what we originally thought was the problem before the more serious episodes occurred. Do you think this really could have triggered all this? I mean George did have high expectations after graduation but would not finding a job cause this much of a reaction in him?

I absolutely do believe this may be contributing to the problem. My son has had three major episodes. The first was triggered by being fired; the third, by a relationship breaking up. It's not uncommon for a first episode to be preceded by a traumatic life event.

If he had high expectations, it may be a huge blow to his ego that he hasn't found a job. It sounds as if he may have been a very good student? Possibly this is the first serious life challenge he's confronted?

[lil-angel-wings]

costello has lots of good insite and advice

I personally am very able to make people think that I am functioning fine even when im in the middle of an episode... Even my Phychiatrist in the past has not seen that I was in trouble untill I was almost ready for the Hospital, simply because I was covering it up. I had learned to do this as I went for 10 years with out treatment out of fear of being locked up for the rest of my life. So I learned how to stay out of reach of people and when I did interact it was in a way that they saw as normal or slightly strange but nothing that would give them any clue. That is not to say that those very close to me did not know that there was something wrong... it was outsiders.

Sleep disturbance and stress are the two main things that put me in an episode
I am very carful now to get 8 hours of sleep and do everything possible to not have stress in my life. I have been in the Hospital or in some type of intensive treatment almost every two years for the last 20. This has not happened simply for lack of meds as even when I have been on meds I have ended up in a major episode. But the two things i just mentioned sleep and stress are very key factors in the onset of my episodes.

I am aware when things first start to go arie, but as my parinoia and dilusions increase I become less and less aware of what is reality. These things that are happening are very real to me... and after Im stable you can not convince me other wise that what I went through was not real...What I mean is that the situation may have changed, but my memory of it has not and will not change...

again I believe that costello has good advice... I am not the parent of, but the one with. I am however the spouse of and the sister of ones who also suffer from mental illness and I know that just listening and trying to help them figure out what is going on around them and in thier minds is as important to them as them doing this for me...Alot of people who have mental illness are very spiritual...So if your friend is then there is great hope...Have him read or read to him the 23 Psalm over and over again...

God gives strength in weakness... What God gives is good...This is not to be feared...
But if the thoughts are evil then that is not of God...If the voices are evil they are not of God...But faith in God will bring hope so that one can endure the evil that tries to invade the mind.