How to deal with the mentally ill

Brendy

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I've been meaning to post a thread on how to deal with a mentally ill poster for some time. My experience here gave me insight on how to help someone who is suffering delusions. I want to suggest an outline of how to approach this situation. I am hoping any future person suffering from psychosis while benefit from a better response.

First off, for those who don't know I suffer from schizophrenia. My experience in pychosis was very similar to other people who suffer from this disability. I will use my first thread as an example. The opening post is here: http://www.internationalskeptics.com/forums/showthread.php?t=108989

Please refrain from posting on that thread and instead post here.

I offer some do's and don'ts.

Do:

Realize that these delusions and hallucinations seem completely real to them. There minds will only question it if you take the right approach with them.

Confront the delusions head on. Ask for scientific explainations for the paranormal events this person is experiencing. Ask for biological methods for things like telepathy, which is a very common delusion. Try to prove the delusions false.

Reinforce the idea how unlikely it is that everyone is lieing to them. People didn't become psychiatrists to hurt people. The doctors are trying to help them. A hospital is a much better alternative than going deeper into psychosis.

Point to all the overwhelming research showing mental illnesses exist. This is important because a common delusion is that it's all a lie and instead these sick people are actually gifted.

Be sure to tell them that there is nothing wrong with being mentally ill. It just makes them different.

Point to stories, books, and other media where people tell their experiences with mental illnesses. This is very important.

Along that same line show how medication has helped some people almost fully recover from psychosis. If they have tried medication with no change, tell them that not all the medicines work for every person. Personally only one out the four medications i have tried improved my symptoms. Encourage them to talk to their doctor about trying something else.

Tell them to be very open with a doctor. Tell the doctor everything. Don't lie to them for fear of what might happen to you.

Dont:

Refrain from troll accusations. I know some people are liars, but I also think it is pretty obvious when someone is mentally ill because their delusions are much more abstract and even ridiculous than every day woo.

Refrain from make jokes at this person's expense. They are being tortured by their own minds and don't need to be made fun of. Also if you make a joke the OP will most likely not seriously consider your input and thus you will not help change their minds.

Don't get fustrated by continued denial that they are sick. The ill mind will not allow the delusions to disappear in a flash. It is a slow process.



Feel free to add your own do's and don'ts or any other advice. I may add more as I think of them.

Overall my experience in my first thread was a good one and an important step in my recovery. However I thought there was room for improvement.
 
Brendy, this is very good advice for dealing with people who are mentally ill, but I do have one comment.

It is very hard, if not impossible, to accurately diagnose someone over the Internet. Most posters here are not doctors, psychiatrists, or the like. In addition, many people who need help do not believe this themselves.

Yes, in an ideal forum, no one would make fun of any person's posts. This is not an ideal forum, and there are times when people will come across as ill when they aren't, or come across as healthy when they aren't.

Your suggestions are very sensible, but I would be uncomfortable with people here trying to determine who actually needs help and who does not.
 
Your suggestions are very sensible, but I would be uncomfortable with people here trying to determine who actually needs help and who does not.
Absolutely. I am not a psychologist and I do not have the proper qualifications to determine whether another member is delusional and mentally ill. I don't think even a psychologist can make that determination based on internet forum activity. Brendy, I have known a number of individuals with various mental health issues and you are to be commended for taking a proactive role in the treatment of that illness. I've seen more than a few people come through here posting some pretty nutty stuff but whether that person really believed what they were say or simply derived satisfaction with getting people to believe they did I couldn't always say. I think the best advice is that if you think another member really is delusional to not do anything to exacerbate those delusions.
 
I think this is good advice for dealing with almost anyone, mentally ill or not. So we don't need to be able to diagnose someone to show some politeness.

But of course there are some SOBs who don't show any sign of mental illness, yet they provoke, insult and troll. They may also deserve a better treatment, but unfortunately we are not their mom.
 
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If you wouldn't think so loudly at the supermarket checkout line maybe everyone wouldn't know your business.

Claim whatever disability you want but your failure to take my advice and tell that girl you had brain cancer and were going do die a virgin was gold. I gave you 'A' material and you didn't use it.

It's 'B' material and below for you from now on until you show some gumption.
 
Brendy...

I have a few questions...

If you are schizophrenic...How do you know this is reality...?

How do you know and can be sure, that all those people cannot read your mind...?

Maybe they are now making you believe that they cannot read your mind to keep you quiet...so you don't actually discover the truth about them...?

DB
 
DB,

You're just jealous that the voices aren't talking to you anymore and stuck you in this reality.




Boo
 
great advice.

I do work with a UFO site.

I don't try to diagnose anyone, but some people are clearly delusional. A few people are simply joking and it's quite easy to see the difference between the really ill and the joksters. Still, I often suggest (with good results!) that if what they think has happened to them HAS happened, then they at least need a psychiatrist or therapy of some sort because they have PTSD. They can buy that they have trauma from being abducted, and despite what we see on cable tv, almost all real therapists and psychiatrists are NOT going to feed into the delusions of the "abductee".

I've had people thank me because they have had everything from a small brain tumor to serious mental illness diagnosed. It's interesting what medication can DO. One person is ill from a brain injury due to a car accident. Simply having a doctor explain what was happening in his brain helped him so much. Instead of fearing being abducted, he wrote to me, "when the aliens show up I just ignore them".

The thing is that people can be helped, but all we can do here is be kind... or try to figure out some way to get them to find help. But Sherlock Holmes once quoted a minister (sorry forgot name) ... "There but for the Grace of God go I". Even if you are an atheist... it's always important to remember, sometimes it's just luck that you aren't in those shoes.
 
Brendy,
that is a great post. I imagine that it takes a lot of strength to come forward like that.
:)
 
One interesting suggestion is that during psychosis the brain loses the ability to distinguish between internally generated and externally generated information. This leads to the feeling that motor commands sent to the muscles are coming from somewhere else, or that thoughts are external voices, images real objects etc. Hence delusions often involve the feeling of one's movements or thoughts being controlled by someone else.
We can all experience confusion over the source of motor movements to a degree (e.g. the idiomotor effect). People without diagnosed mental illness may also hallucinate from time to time. Even though the diagnosis of psychosis is made using categorical criteria (illness present or absent), dimensional accounts (delusional thinking as a dimension that varies along a continuum in the general population) seem more convincing.
I think it was Ramachandran who had an interesting suggestion that during a psychotic episode, a person should laugh when they tickle themself, because they don't recognise the motor commands behind the tickling as being internally generated.
 
I've been meaning to post a thread on how to deal with a mentally ill poster for some time. My experience here gave me insight on how to help someone who is suffering delusions. I want to suggest an outline of how to approach this situation. I am hoping any future person suffering from psychosis while benefit from a better response.

First off, for those who don't know I suffer from schizophrenia. My experience in pychosis was very similar to other people who suffer from this disability. I will use my first thread as an example. The opening post is here: http://www.internationalskeptics.com/forums/showthread.php?t=108989

Please refrain from posting on that thread and instead post here.
Hi Brendy! I can't6 remember if I posted in your base thread, and while you have a personal perspective on living with your mental illness, I have a different POV when it comes to dealing with thought disorders in other people.

(I live with Major Depression (Reoccurring) and OCD, I was also a mental health outreach worker for ten years, a DV counselor for three, and a crisis intervention counselor for 1.5 years.)
I offer some do's and don'ts.

Do:

Realize that these delusions and hallucinations seem completely real to them. There minds will only question it if you take the right approach with them.
And sometimes not even then, if I told most people that the sum rose in the west they would be upset with me. It works best if you earn the person trust and soft sell it. Not in terms of the delusions but of the distress that most people living with psychosis experience.
Confront the delusions head on. Ask for scientific explainations for the paranormal events this person is experiencing. Ask for biological methods for things like telepathy, which is a very common delusion. Try to prove the delusions false.
I never found that to be helpful. It does not build rapport and trust.
Reinforce the idea how unlikely it is that everyone is lieing to them. People didn't become psychiatrists to hurt people. The doctors are trying to help them. A hospital is a much better alternative than going deeper into psychosis.
Community services are better than the hospital. A bulletin board is not a good place for intervention. I never found confronting delusions to be helpful. Encourage people to get good professional help.
Point to all the overwhelming research showing mental illnesses exist. This is important because a common delusion is that it's all a lie and instead these sick people are actually gifted.
It is a very delicate process, usually the person has some distress over other symptoms and that becomes the point of contact and rapport.
Be sure to tell them that there is nothing wrong with being mentally ill. It just makes them different.
Ordinary people living with an extraordinary issue. I agree, focus on the symptoms that distress them, like lack of sleep. recovery, especially in the Boston Model is a real thing. But you build that trusting relationship first.
Point to stories, books, and other media where people tell their experiences with mental illnesses. This is very important.
Most people are aware of the more stigmatizing elements, but there are good sources, Living with Schizophrenia by Torrey ( a minimum of misinformation) and Fred Freese of case Western (a really, really cool guy.)
Along that same line show how medication has helped some people almost fully recover from psychosis. If they have tried medication with no change, tell them that not all the medicines work for every person. Personally only one out the four medications I have tried improved my symptoms. Encourage them to talk to their doctor about trying something else.
And finding other helping professionals who can help them communicate with the doctor and nurses.

Most people don't understand that effective treatment often takes years. I responded to the first medicine, I have a friend who took about four years to find an effective treatment.
Self medication with alcohol and street drugs is real problem as well.
Tell them to be very open with a doctor. Tell the doctor everything. Don't lie to them for fear of what might happen to you.
Well, people who know that nobody else thinks like them have trust issues, often doctors don't help.
Dont:

Refrain from troll accusations. I know some people are liars, but I also think it is pretty obvious when someone is mentally ill because their delusions are much more abstract and even ridiculous than every day woo.
I disagree.
Refrain from make jokes at this person's expense. They are being tortured by their own minds and don't need to be made fun of. Also if you make a joke the OP will most likely not seriously consider your input and thus you will not help change their minds.
I agree, but this forum is not a supportive environment, and there are people who come here to stir things up.
Don't get fustrated by continued denial that they are sick. The ill mind will not allow the delusions to disappear in a flash. It is a slow process.
It is a matter of trust, most of the people I worked with wanted to be healthy, and it was a matter of trust and patience.
Feel free to add your own do's and don'ts or any other advice. I may add more as I think of them.

Overall my experience in my first thread was a good one and an important step in my recovery. However I thought there was room for improvement.


Well, the JREF is what it is, your advice is wonderful, but this place is what it is.
 
I really like the overall message of respect for those struggling with mental illness in your advice, but I have to agree with other posters who say that this sort of thing gets very tricky online. How do we really know if the person is mentally ill? What if the poster is perfectly healthy but enjoys typing odd things to get a rise out of people? Formally, anyway, very specific DSM-IV-TR (Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision; APA, 2000) criteria must be met before anyone can be said to suffer from some form of mental pathology, and only licensed clinical psychologists or board certified psychiatrists are in the position to make those kinds of decisions. Of course, we may suspect that a poster may be ill, but there are also a lot of otherwise healthy people out there who (a) troll for fights/reactions or (b) genuinely hold beliefs that may strike others as bizarre.

Do: <snip> Confront the delusions head on. Ask for scientific explainations for the paranormal events this person is experiencing. Ask for biological methods for things like telepathy, which is a very common delusion. Try to prove the delusions false. <snip>

In a person-to-person context, this could actually prove dangerous in certain contexts. I wouldn't recommend that anyone here who knows someone who is schizophrenic just go and do this as a default. Informed clinical judgment is crucial, and direct confrontation is not always the way to go when dealing with certain forms of pathology up close and personal. Online, this is again tricky for the reason I mentioned previously.
 
I don't think an online persona can be accurately rated for much of anything.
It's too easy and too common to just be a smart-ass for any number of reasons, and pretend to be anything, because the readers can't get the cues face-to-face encounters provide.
The dedicated dippys with 1000s of posts all of the same fashion which show a consistent pattern of dippyness can be expected to be dippy in real life, but the occasional drive-by posters who fling woo or whatever, difficult to say.
In real life, I will avoid people with problems like this.
 
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Brendy,
that is a great post. I imagine that it takes a lot of strength to come forward like that.
:)

I agree with GnaGnaMan (who has an AWESOME screen name, by the way... and welcome!).

It isn't everyone who can struggle with the issue you have and manage to come out of it with honesty, perspective and the courage to share your ideas...

I'm glad you're here, Brendy.
 
I, too, am glad you are here, Brendy, and I congratulate you on your willingness to discuss a serious problem. Thank you for posting.

Gayle
 
I also think it is pretty obvious when someone is mentally ill because their delusions are much more abstract and even ridiculous than every day woo.

Perhaps, yet how do we define what a delusion is exactly? I remember once reading a definition of "delusion" that said that it is an "irrational belief not supported by empirical evidence" provided that is not a belief generally accepted in one's culture (eg. religion).

So, belief in non-existent beings is not considered delusional if almost everyone else in your culture believes also. In our western society, it is okay to believe in god but it's not okay to believe in leprechauns (yet neither exist)! Mental illness is too subjective to be considered "pretty obvious"...
 
Perhaps, yet how do we define what a delusion is exactly? I remember once reading a definition of "delusion" that said that it is an "irrational belief not supported by empirical evidence" provided that is not a belief generally accepted in one's culture (eg. religion)"...

More precisely, delusions are falsely held beliefs that remain uninfluenced and uncorrected by reason and contradictory evidence. They are characterized in mental health as being either bizarre (as in schizophrenia) or nonbizarre (as in delusional disorder). Bizarre delusions are "clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual's belief that a stranger has removed his or her internal organs and replaced them with someone else's organs without leaving any wounds or scars)." (DSM-IV-TR; APA, 2000; p. 324). In contrast, non-bizarre delusions could conceivably occur within the bounds of reality, although they typically can be shown to be false (e.g., being poisoned or loved by a celebrity).

So, belief in non-existent beings is not considered delusional if almost everyone else in your culture believes also. In our western society, it is okay to believe in god but it's not okay to believe in leprechauns (yet neither exist)! Mental illness is too subjective to be considered "pretty obvious"...

Well, yes and no. You are correct that there is a definite "statistical consensus" element to mental illness in the sense that different cultures determine different things to be delusional or non-delusional (and, interestingly, bizarre vs. non-bizarre for an even finer distinction). It also gets quite whimsical within Western soceity when we start doing things like diagnosing folie à deux (shared delusional disorder between 2 people) and beyond (folie à trois, folie à quatre, folie à famille), but then, somewhere, there's an arbitrary line where we stop and say, "well, I guess we can't label it as pathology anymore!" because of a group consensus. This seems to me like a classic argumentum ad populum fallacy in clinical psychology.

However, mental illness can be fairly obvious in the technical sense of whether or not it is connected to functional disturbances in personal, occupational, and social spheres and/or psychological distress. So this extends beyond just having beliefs that may be considered odd.
 

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