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Mental Health

Friends Behavior of Concern...Mental Illness

12/10/2009

Question:

Im just sending an email in regards to my friend with some questions. She is now 27 but grew up in an extremely abusive environment. Around the time she was 10 she became very withdrawed and depressed and alternated back to herself to a normal to hyper mood. Lately well for the past few years she has completley not been herself. Mean, hateful, depressed, nearly getting fired from all her jobs.Absolutely hating everyone. I mention to her that she has something wrong mentally, but she denies it. She sways back in forth with saying she knows she needs medication then to saying that it would show weakness and that she doesnt need medication. Im worried bc she gets homicidal thoughts at times, but thankfully has never acted out. Also at younger years, starting around 7 years old to about 15 tried to commit suidicide several time and her parents did nothing about it. The mood swings are horrible and almost uncontrolable. Will be fine then just bust out in uncontrollable tears. Cannot keep any relationships longer than a few months because of the mood swings and withdraws back into a shell and scared of everyone. Also says at times shes not sure if she feels what she thinks she feels and really confused. Are these symptoms typical from the happiness hyperness and meanness to depressed and violent thoughts normal? I know the violent thoughts are bad as she was ready to stab her mother in the neck with scissors and smash her dogs head against the wall corner. Her dog is her world so when she told me these things, I kind of freaked out. Im not sure what to do. What or how should I convince her that she really needs to seek help? I know at one point during juvenile years she was court ordered to see a therapist, but fought it till they finally gave her her way. I`m very scared for my friend. Could this be bi polar or something else? Many people has said to her that she was bipolar and she gets very angry over it. Please help me find a way to help her. I do know she refuses medication for almost everything. Please help me with ideas.

Answer:

Well, I would certainly agree that your friend has some significant mental and emotional problems.  It is difficult because when you care for someone, you want him or her to be healthy and happy, but what can you, as a friend do?

Unfortunately, your problem is one that physicians and health care professionals also deal with.  If someone is ill, mentally or physically, but chooses NOT to seek treatment or do anything about it, both the law and ethics do not allow us to force that person to get treatment.  The only exception is when there is a significant immediate risk to the person's or to another person's life (such as when a person makes real, meaningful suicidal and homicidal threats or takes action on those threats.)  In that situation, the law may be called, and they may force an evaluation, and possibly even an involuntary treatment.

What you can do as a friend is to be supportive.  When your friend thinks about seeing a counselor or doctor, be ready right then with appointment information, names and addresses.  Be encouraging to her desires to be healthier and happier.  Reassure her that mental illness is NOT a weakness of mind or spirit, but a real disease.  Ask your friend if she got a serious disease like diabetes or an infection if she would get treatment.  If she would, then tell her that mental illness is every bit as real and as serious as either of those diseases, and that with treatment, people do get better!  Just like with other chronic diseases, however, treatment often needs to be ongoing for a long period of time.

The other thing for a friend to consider is whether he or she is "enabling" the friend to avoid treatment.  If your friend had diabetes, and asked you to buy her a coke and a donut, you would probably say no, knowing that it would be bad for her diabetes.  The same thing needs to happen here.  People with mental illness may ask friends to lie for them if they miss work or do not keep a promise, to give them money or food because they have spent their money on unhealthy things or make it easier for them to live without dealing with their illness.  It is hard to do, but you want to support your friend, but not enable her in her disease.

Thank you for visiting NetWellness and good luck.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati