F*ck Feelings (45 page)

Perhaps your hope is that once he's “in treatment,” even if he feels coerced and reluctant, something about the shrink or treatment process will grab him, change his mind, and allow him to be helped. Then he won't just forgive you for pushing, he'll thank you for your lifesaving heroics.

Unfortunately, treatment for mental illness is the same as for medical problems and usually requires patients to be actively motivated. Push too hard, and she won't be thanking you, just ignoring you out of frustration and even rage; if you're trying to help a relative, you'll have an actual family feud on your hands.

The problem is that if someone enters talk therapy reluctantly, they wait
for it to do something
to
them rather than
for
them, passively complying rather than getting involved and doing the homework. If she complies with medication prescriptions, she will quickly object to side effects and stop taking them before they might be effective. If your goal is to show her that treatment can save her, her goal then is to show you that treatment won't work, and she will usually succeed.

There are exceptional circumstances, however, when forcing someone to get help may be worthwhile, and there are other circumstances when advising someone to get help may pay off in the long run, even if your advice is ignored for the time being. Knowing those circumstances, and accepting the limits on your ability to get people to accept treatment, will make you much more effective than if your philosophy is to push hard whenever you see someone who needs help.

Exceptional circumstances always exist when you think someone might hurt themselves or someone else; that's the only time that the police and mental health clinicians have the power to put someone in a mental hospital against their will and keep them there for what is usually a short stay. Even then, it's up to a judge to review the case and decide whether the risk of harm is severe enough to force them to stay there and accept treatment. If there's a risk of harm, you should know what you need to observe and do to start the ball rolling on a commitment evaluation.

(Please note: in most Western countries, the days of having someone hauled off and involuntarily and indefinitely committed to a white-tiled asylum ended long ago; the laws have changed dramatically in favor of preventing unnecessary commitment, and almost all of the long-term state hospitals have been demolished or turned into fancy condos.)

Adolescents who have never been treated sometimes respond well when they're forced to try it, so if you know what treatment he's had before, and have leverage, you can sometimes get an adolescent to get the help he really wants but has been too angry to accept.

In any case, you can learn how to sell people on the advantages of getting help and even covertly offer some ad hoc therapy yourself without bullying or implying she should do it to make you happy. First,
however, you must learn to control your helplessness so you don't wind up expressing anger or fear.

While it's usually impossible to make someone get help, it isn't always, and learning how to describe treatment as a valuable choice, rather than a punishment or obligation, is your best approach. Aim to teach someone, not control them, and she may make the right choice on her own.

Among the wishes people express are:

• To get someone help before they hurt themselves, lose their jobs, and drive their families away

• To get someone to see what his symptoms are doing to him

• To stop addictive, self-destructive behavior

• To prove to someone that treatment won't fail this time

Here are three examples:

My father has been depressed and irritable for the past two years, since my mother died, but he won't get help. He was always a gruff guy, but my mom would balance him out and reveal his lovable side. Now he's just a miserable bastard. I think he might even admit to himself that he's
become unbearable—that's part of why he's miserable, maybe—but when I bring up the idea of talking to someone, he just says that therapy is gay and shrinks are lying crooks. Meanwhile, he has driven some of his friends away and my kids dread visiting him. My goal is to get him to get help.

My girlfriend admits that she's depressed, but she insists that there's no point in getting treatment because it's never helped her in the past. Her parents first sent her to a therapist when she was eight, and even after getting treatment off and on for years, it didn't change anything. She only agreed to go back to therapy as a condition for being readmitted to college after dropping out, but it had no impact. I keep catching her crying and I see the cuts on her arms, but if therapy isn't an option, I feel totally helpless. She can be so smart and sensitive and fun when she's not depressed, so I know she can feel better, but she insists she's powerless to change her moods. My goal is to figure out why therapy doesn't help and find something that will, because if I can't help her, I don't know if she'll survive, let alone if our relationship will.

I don't think my brother has ever gotten the help he needs. He has been in and out of hospitals for the past ten years with multiple diagnoses—depression, psychotic depression, schizophrenia—and he's had years of therapy and many medications, but nothing seems to work, and nobody can say definitively what's wrong. Now he's suicidal again, but I don't know if he's on any medication, or been prescribed meds and is just not taking them, or even if he has a therapist at the moment. I just know that I can't force him to get one or take his pills, and that he's gotten so good at hiding things from me, even the crazy thoughts he's probably having, that if he's determined to die, I can't do anything to stop him. My goal is to figure out where he can find someone who can really help him and then make him get an appointment and stay alive.

Since mental illness is in so many ways a total mystery, it's odd that people assume that it can always be solved with treatment. Total mysteries don't
have absolute solutions, so if treatment doesn't work, the answer isn't always to keep looking for new treatments, but to look beyond treatment entirely.

After all, some of those in great distress may have already given treatment a good try with no (or not enough) results, and others may believe they're the only sane person and everyone around them needs professional help. You can't close your investigation and push someone who is unwilling into treatment if it's already clear that it isn't going to help.

On the other hand, if you think someone is in danger but too sick to take care of himself, then that's not a mystery, just a nightmare, and you may decide he needs to be hospitalized regardless of whether he agrees. The only question is whether someone is likely to hurt himself, and if the answer is yes, then close your investigation and ask the real police to come running.

In short, don't be afraid to get creative and use your own judgment. If you can gather a little information and ask yourself a few simple questions, you'll often know whether treatment is worth pushing and how hard to push, or whether you need to turn your inquiries elsewhere.

If someone you love is suffering from depression and loss, it's natural to urge them to get help with their grief. If that depression has turned them into a nasty Asshole, however, urging them to do anything will just allow them to give that grief to you.

To paraphrase the old saying, if you can't get the nouveau Asshole to go to therapy, the therapy must come to the Asshole. Make like a therapist yourself and find a positive way to describe his negative behavior and what it's doing.

After all, your advice and encouragement are perhaps as valuable as anything a therapist could offer. Very often, therapists are in no position to observe how a patient behaves with other people and only know what their patients tell them. You may be in a much better position to observe the problem and give particularly relevant advice.

As such, you could say his irritability, which he used to express in a way that was funny and warm, now drives people away, including
those he obviously loves and who love him. You wonder if he sees the problem and, if so, whether there's anything you can do to help. You can think of several promising possibilities, beginning with a talk with his regular doctor about a variety of treatments. That way, you cover all the bases any counselor would, only you don't get paid for the referral.

Like any decent therapist, don't promise that he'll feel better. Indeed, he may feel worse, in the short run, if he stops being mean. Instead, promise him that he'll have better relationships in the long run and like himself more.

Protect yourself by limiting your exposure to uncontrolled irritability, making it clear that you're stepping away reluctantly and not punitively while respecting his decision and conveying confidence in your own view. You may never get him to get treatment, or get everything possible out of your excellent amateur treatment, but you'll know you've given him a respectful, positive push and done all you could.

When someone declares that treatment for depression hasn't worked and isn't worth pursuing, you're right to wonder if she's really tried every reasonable option or if irrational pessimism is controlling her. At that point, try to learn enough about possible treatment options to judge for yourself.

If you think there are treatments she hasn't tried, tell her your opinion and see how she responds. If she's too fed up with treatment to listen, don't feel responsible for getting her to change or you'll go from being her pleasant partner to her overbearing parent in record time.

Instead, accepting the fact that change is highly unlikely, ask yourself whether she has a problem with negative, rigid thinking in other areas of her life. Then decide how much it's likely to affect your relationship if you spend more time together and what kind of limits, if any, to put on your relationship.

Announce your limits in a positive way. Let her know that you respect her ability to tolerate depression, but you think her treatment decisions are too negative and have deprived her of opportunities for help. You
can accept a partner who has depression, but you can't accept someone who doesn't take good care of herself. If she can't accept
that
, you know you've done your best and can move on.

If someone you love is very sick and might be at risk of suicide, don't distract yourself by blaming the failure of prior treatment. Like all illnesses, there are forms of mental illness for which modern treatment, no matter how well done, is inadequate. Forget the past and do what's necessary now.

Ask yourself whether you've heard him talk about death, murder, or escaping unbearable pain, or seen him running into traffic or grabbing extra pills “by accident.” If you have, tell it to the police and then to the nice emergency room shrink who will decide whether or not to lock him up. Don't worry about whether he'll blame you for stealing his freedom and giving him nightmares; just do the right thing and make sure he lives to be angry at you another day.

If something bad happens, don't focus on who's to blame. Respect the fact that severe mental illness is tough to live with and value the many ways you and others have tried to help. Some people say that suicide is a result of cowardice or failure on the part of loved ones to act, but those people are, to use the clinical term, fucking idiots; there's is no such thing as failure when you continue to love and care for someone who is desperately ill and has lost much of his original personality. There's no such thing as cowardice when someone bravely fights a disease just by getting out of bed every day, even if they eventually can't do it anymore.

Never assume that treatment is the solution when all the clues point elsewhere. Give yourself the opportunity to decide for yourself whether additional treatment is likely to help, whether it will ever be accepted, and whether you're morally obliged to call the cops if it isn't.

You may feel like you're trapped in an impossible enigma, but in reality, some solutions are impossible and some mysteries can't be solved. Still, helpless feelings need never stop you from doing everything you think is necessary to help out and find answers, even if they aren't the ones you were originally looking for.

Here's what you wish for and can't have:

• The ability to scare people into doing what's necessary to help themselves, since reason doesn't work

• The power to make treatment work if they reluctantly agree to try it

• Relief from fears of what will happen if he doesn't get help

• The ability to retain his trust while you tell him what he doesn't want to hear

Here's what you can aim for and actually achieve:

• Trust your own assessment of the quality of a person's treatment decisions

• Urge better decision making without becoming negative or emotional

• Ask the police and emergency room doctors to take over decision making when you decide it's necessary

Here's how you can do it:

• Ask about wishes to die, give up, kill, ingest, or punish

• Urge someone to consider what she wants treatment for, rather than what she wishes treatment would have done for her

• Gather information about past treatments to determine whether this one has something new to offer