Helping a Friend Who Refuses Treatment

Reader’s Question

I have a friend and co-worker who I’m concerned about. The problem is that she just will not seek help.

A few weeks ago, after the managers had stressed her out, she broke down in front of me. She was shaking and crying, jabbing her wrists with an ink pen, pulling her hair out, and telling me I was never going to see her again, among all kinds of other disturbing things. I managed to get her calmed down, but it was pretty scary.

She’s in her late 20’s and has been hospitalized for suicidal behavior three times — twice as a teenager and once two years ago.

Anyway, since I know she’s had suicide attempts before, when she said I was never going to see her again it really rattled me. She’s a dear friend and it would be pretty awful to lose her.

When she gets put under pressure, sometimes she gets suicidal, sometimes extremely angry and aggressive, sometimes she’ll vomit or pass out, and she’s told me that sometimes she’ll “shut her body down” when she gets very upset, which I guess means she goes catatonic, or something similar.

I’ve asked her many times to seek help, but she just won’t. She doesn’t trust mental health professionals. She tells me that if she’s honest about how she feels they’ll lock her up for being a suicide risk and she’ll just have to lie her way out. She’s also a single mother and is afraid her kids will be taken away.

Is there any way she can get help without having to risk any of that? Is there some way I can persuade her that getting help is the right thing to do?

Psychologist’s Reply

One of the most difficult things about your position is that there really isn’t a lot you can do for her beyond what you are doing. The behavior you describe your friend as exhibiting — suicidal thoughts, aggressive behavior, vomiting or passing out — is pretty severe, and probably will not be solved via a self-help book or support group. Behavior like that is best dealt with via intensive therapy and maybe some psychopharmacological interventions.

I completely understand your friend’s fears about getting locked up and/or losing her kids, but my concern is more for her children. If getting her calmed down was scary for you, imagine how much more terrifying and difficult such a situation would be for children, particularly if they are very young. You said that she tends to get this way when she is put under pressure, but feeling pressure or stress is something that few of us can avoid, and this is especially true for single parents! Consequently, I have to wonder how often her children are faced with trying to convince their mother not to harm herself, or having to deal with her aggression. Do they have to care for her when she is passed out or catatonic? Who is caring for the children when she is incapable?

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I am aware that some people do not trust mental health professionals, in part because our professional responsibilities require that we take steps to prevent abuse and self-harm. However, I would argue that this very requirement is one reason why we are so necessary. When people are incapable of adequately caring for their children, or are tempted to harm themselves, it is important that there is someone knowledgeable who can help prevent them from becoming their own worst enemies. If your friend can find the right psychologist, they can talk through her fears together and set some boundaries. She won’t need to lie if she begins to get better. However, if your friend cannot help herself, then it is important for everyone, especially her children, that she gets additional help.

It is possible that your friend’s desire to be the best mother she can be may be the impetus she needs to seek help. Oftentimes, people who refuse to help themselves will do it for their children and family. While ideally she would do it for herself, if her kids are what gets your friend through a psychologist’s door, then she can work toward the ideal along the way. Do what you can to convince her, but remember that ultimately, the decision to seek help is hers.