How to Tell Someone They Have a Mental Illness Part 1/2

When someone has a mental illness it can be very difficult for them to see it. The very nature of a brain illness is such that the brain itself has a hard time recognizing it. We are often so wrapped up in the symptoms that we can’t see that what we’re really suffering from is an illness and not just a bad day, bad week or bad month. This is to say nothing of anosognosia, the clinical condition wherein people don’t possess the insight necessary to understand that they are sick.

Sometimes Others Can See We Have a Mental Illness

So sometimes the people around us are the ones that realize we’re sick before we do. Sometimes it’s our loved ones that can clearly see a pattern of behavior that goes beyond unusual into pathological.

But if you know someone who you suspect has a mental illness, how do you tell them?

Knowing Someone Has a Mental Illness

First of all, realize that you might be wrong. Even I, with more than a decade’s experience with this disease, could incorrectly identify the disease in others. I am not a doctor and certainly not a diagnostician. Also, loved ones don’t generally have the chance to ask the critical questions that indicate a mental illness – the kind of invasive, personal, rather impolite questions that a doctor would ask.

So you might be wrong. That’s doesn’t mean you shouldn’t say anything, but it’s something you might want to keep in mind.

The Person with a Mental Illness

Conversation About Mental Illness

That being said, even if you’re right you can likely expect the person you suspect to have a mental illness to deny it. We all want to deny we’re sick. It’s human nature. No one wants to admit to any illness let alone a mental illness. In fact, even if the person agrees with you they may still exhibit denial as it’s one of the natural stages of grief and grieving is normal if you’ve just found out you have a serious illness.

Also keep in mind that this person isn’t going to be thinking at their best at this time – they have a brain illness – that’s going to affect how they assimilate information. Be prepared to speak slowly and present simple information, at least at first, until the person gets their bearings. (This doesn’t mean that there’s anything wrong with the person’s intelligence, it just means they are temporarily impaired. It happens.)

Planning for the Conversation

First, get your ducks in a row. Consider for a moment why you think this person has a mental illness. Are these reasons reasonable? How do you know? Have you done your research? I would suggest that if you haven’t done your due diligence and at least looked up the diagnostic criteria for the mental illness then you shouldn’t even be having the discussion in the first place. Without that basic knowledge you’re really shooting in the dark.

Secondly, have specific examples of why you think the person has a mental illness. It’s not enough to say, “you seem sad,” you need to actually have examples ready to back up that idea like, “remember last Tuesday when I found you crying for no reason.”  These concrete examples can help the person with the mental illness really get a grip on what you’re seeing and your perspective. I recommend writing these things down so that in the heat of the conversation, with all the emotions running high, you don’t forget what you want to say.

To be continued: How to have the conversation where you tell someone they have a mental illness

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  1. Sounds like Yr daughter is suffering from an anxiety disorder. I wd focus on that rather than the artwork. Anxiety disorders are serious and highly misunderstood. If yd like more information please contact our office for free information as that is what we specialize in.

  2. Daughter is 25 years old. Beautiful family until she became irritable, isolated and sneaky three years ago. Co-workers turned her in as suicidal when she said she wanted to throw herself in front of a train (which happened to be nearby!). 72-hour hold and a diagnosis of ‘suicidal ideation’. Since then, secretive, angry and short-tempered, intolerant, cruel to her older brother, mean to dad, and isolated. Only got worse.

    8 weeks ago, she left with a girl she met on the Internet. We think she complained to her followers on the web how bad home life is and some predatory peeps talked her into leaving. Girls did not show up on her FB friends and daughter did not show up on theirs. Where did they come from?

    We now find her (online) in a culture which draws fabulous artwork, but always a theme of battles with bizarre weapons, imagining you’re not human, themes of sadness, sorrow and homesick, but no asking for help. The whole culture there seems to be self-affirming each other.

    Daughter cannot cope with the mildest conflict as useful a skill as it would be (one of the purposes of family life) and avoided conflict at all costs just prior to departure. Naturally, this meant refusal to communicate and she has left home and severed all communication.

    Of course, she is not making good decisions. What does she eat? How does she pay rent? Is she being seen by a therapist? She is still posting online artwork of depression, sadness, sorrow, loneliness, homesick and sexual desires.

    Anyone familiar with this culture please write me. What insights would you have?

  3. Hi. Perhaps an ex husband is not the best to diagnose but here goes. My x was diagnosed bi polar 1 four years ago. After the fact, I definitely believe the diagnosis was correct. X denies and actually described bp1 as the least severe of Bp and that it was more in line with PTSD. Refused mess as they made her feel like a zombie. She was raped as a child and never got any support. Well here’s a list of some of her behaviors. So u tell me.
    Chronic credit card fraud and abuse.
    Hitting, screaming and rages.
    Ridiculous highs and lows.
    Drug and alcohol abuse.
    Extreme promiscuity.
    Pathological lying.
    Tried to have own child arrested and charged with kidnapping.
    Disappearing acts.
    Public meltdowns.
    Suicide attempts.
    Multiple personalities.
    Blames everyone, namely me, for everything.
    Can’t hold a job.
    In and out of doctors, hospitals and ERS.
    Alienated all of her children.
    Claims to be the happiest she has ever been.
    Complete chaos in the house.
    Constantly losing things.
    Dozens of started but never finished projects.
    Got pregnant on purpose.
    Constant stress.
    Well, is this mental illness or is she just a shit?

    • Well, considering she was raped as a child and never got any support, I think your ex is right in that she has ptsd. This happens often. The majority of people diagnosed with a severe mental illness have experienced some severe trauma, especially as children. They tend to get worse over time because the injury caused by trauma is never addressed, the patient’s feelings are continuously invalidated because they’re told they have a “brain disease”. The victim of trauma under the our current mental health system becomes more alienated the more their human response to trauma is dismissed as a “brain disease”. Your ex should get herself to a qualified and empathic therapist who will help her heal from past trauma and transcend her current situation. Or perhaps she does have a brain disease, in which case you’ll just have to accept everything she does because it’s completely out of her control, and meds can only do so much.

  4. First off I wqnt to say great blog! I had a quick question which I’d like to ask if you don’t mind.
    I was interested too know how you cesnter yourself and clear your mind prior
    to writing. I have had difficulty clearing mmy mind in getting my thoughts out there.
    I truly do take pleasure in writing but it just seems like the first 10 to 15 minutes are usually wasted
    just trying to figure out how to begin. Any ideas or tips?
    Kudos!

  5. Thank you for this helpful article. A friend’s sister sounds like she may have Borderline Personality Disorder, so I bought the book “Stop Walking on Eggshells” for her, written for the family members of Borderliners. It helped my friend tremendously, but when she broached the topic with her sister, she was met with extreme hostility. If/when it gets bad enough, hopefully, she will open up to the idea that she has a treatable illness.

  6. Another great article and I loved that you mentioned anosognosia. So many people,even mental health professionals don’t know about this fascinating subject. Learning about anosognosia really was a key part of understanding myself :)

    • Hi Victoria,

      You certainly don’t have to, but I would be interested in hearing how it helped you. Did you find your were experiencing it? And what convinced you that you were experiencing it (if you did)?

      Feel free not to respond. I’m not trying to pry.

      – Natasha Tracy

  7. Brain illness – get out of here!

    Also if people ‘have a hard time recognising that they have a ‘brain illness” I would think they would have a hard time recognising that the ECT they just had has damaged their brain!

    • It’s funny how I stumbled onto your website; I was recently writing an article that we all re-examin (not necessarily dismiss) psychiatry.

      Even WITH all the education that shrinks have… at the ned of the day, they too, are human like the rest of us (e.g. eating drinking, sleeping, using bathroom, etc.) and THEY TOO can and do many times make mistakes.

      A common mistake they often make are misdiagnoses.

      Did you know, for example, there co-morbidity is the rule rather than the exception? That many things they observe and judge to be “abnormal” ina consumer does NOT neatly fit into their DSM handbook descriptions.

      Another thing: Consumers HAVE been mistakenly caled “Delusional” when in fact, the things they initially reported to the labeling shrink DID happen, and was later PROVEN! Even if something is not necessarily belived by the examing psychiatrist, if it’s at least POSSIBLE, shouldn’t there be AT LEAST SOME cheklist protocol of criteria a claim has to meet for it to be declared a delusion (for the sake of fairness, justice and responsibility)?
      Especially if the consumer makes claims of being abused or victimized? After all, even the stats confirm that most opeople w/ what is currently deemed mental illness are MORE LIKELY to be VICTIMS of abuse by others than harmful themselves.

      To further support my point, why don’t you google up “The Martha Mitchell” effect? She was a woman who came forward w/ a report that was written off as a delusion… but later was PROEVN correct, and her very life was in danger…. ALL due to a fallible human being’s (shrink’s) biased, human observation.

      In most municipalities, juries are super screened because they don’t want potentially innocent people sent to the can for the faulty belief and bias of someone arbitraily chosen to decide theur fate of freedom or not. Universities and Institues place VERY STRINGENT guidelines on research methodology (usually, the double-bling model) because they, too, recognize that even “highly educated” scientists (as psychiatrists are, btw) CAN BE BIASED and MISTAKEN!!!

      Further… often what constitues a “mental illnes” today, may well be “simply a noticeable difference on the spectrum of human behvior” tomorrow, as homosexuality, back-talking parents(Oppositional defiant disorder), kissing in publicVictorian England) were once considered “disorders”.

      I thank you for the opportunity to allow dissenting viewpoints.

      • Hi Puddytat,

        No argument from me that psychiatrists are people and make mistakes. We all do.

        And as for misdiagnosis, while it is true, it does happen, psychiatry actually has a very low rate when compared to some other specialties. When multiple doctors look at the same person in studies, they almost always come up with the same diagnosis. (Sorry, I don’t have time at the moment to look up the study, but they’ve studied it.)

        Yes, comorbidity is a major issue, no argument here. And it is _usually_ the case that a person with an illness is not a textbook case – but the textbook allows for variation for just that reason. This is commonly understood among doctors in the real world.

        I would never suggest there aren’t stunning examples of mistakes and bad behavior. Of course there are. As there is in any specialty. Every heard of a person who had the wrong leg chopped off in surgery? That would be pretty bad too and it _happens_.

        – Natasha Tracy

  8. This is such solid and sensible advice, thank you.

    I remember one friend finally getting through to me through sheer repetition and persistence. I was absolutely insistent that talk therapists were not for me. My friend got a recommendation and a card from someone else, called and spoke to the therapist and organized with her that I could email rather than call for an appointment (which was heaps less intimidating for me as I have auditory symptoms). After all that effort, I still said no, multiple times. Then one morning after a particularly bad night I found my friend had taped the card to my fridge and in a moment of courage (or desperation?) emailed the psych who turned out to be a really good fit for me.

    Looking back I can’t believe how resistant I was to seeking help. I honestly believed that nobody would ever understand. I thought that if I was honest, they might bin me forever. And deep down I knew I didn’t deserve anyone’s time or attention because they wouldn’t be able to do anything anyway. Thankfully I was wrong.

    One of my oldest and dearest friends is suffering from paranoia at the moment and I am finding that very difficult. It is hard to keep your heart open to someone who is accusing you of horrible things. I’m trying not to take it personally, and trying to find new ways to support her. I am also sometimes taking time out from the relationship for self care. I hope something works eventually because she is so deserving of peace and happiness and I hate to see how she is suffering.

    I am very grateful to you for providing the space for us to talk about these challenging things.

    • Hi Else,

      Many of us are quite resistant to treatment, resistance to admitting to a problem, resistance to change – like most people, I expect.

      And the reasons you cite about not being worthy are deep-seeded for many. And feeling like you’re alone and you’re the only one who feels a certain way? That’s terribly common. If only people understood how common, they would know they _aren’t_ alone. (We never are. There are always people like you out there.)

      Regarding your friend, that is very tough. You’re right to try to maintain perspective and understand that her accusations are not about you. Hopefully the fact that you got help for a problem can be motivation for your friend too. If someone helped you then someone can help your friend through her problems too. Sometimes being a positive example is one of the best things we can be.

      (And good on you for taking time out for self-care. That’s important too.)

      – Natasha Tracy

  9. “remember last Tuesday when I found you crying for no reason.”

    Because crying for no reason *must* be a sign of a brain disease! Yeah, right. I’ve had bouts of weeping for no reason my entire life. Sometimes life is sorrowful. If someone suggested I had a brain disease because of this I’d feel immensely sorry for their shallow intellect.

    I’ve gathered that the gist of this blog is: 1 in 4 people have an neurological disease because they fit a DSM label. If you have any other opinion, you’re a Scientologist or you’re in denial.

    That’s simply extremist and dishonest.

    Sincerely,

    Speak slowly to me! ;-)

    • I don’t think that was the meaning behind that statement. It’s just a suggestion to ease into the conversation to tell someone how you “think” they have a mental illness.

      Crying for no reason doesn’t automatically mean mental illness is involved, you are right. I sometimes cried when I was going through puberty or when I PMS. Hormones can be involved. If you’re going through hard times, though, you’re not crying for no reason…you have a reason.

      The title should be modified, IMO. You can’t know for sure someone has a mental illness. you can only speculate and suggest they seek professional help.

      • Hi Always Sick Chick,

        Nice to see you.

        You are correct that you can never know that a person has a mental illness which is why I put in the whole section about the fact that you can be wrong.

        Titles, FYI, should always be 60 characters or less and that’s not always enough space to specify everything – that’s what the article is for.

        – Natasha

    • HI Emma,

      Crying for no reason is simply an example of something that might give a person pause not that it is a single defining factor of anything. I think that’s pretty clear.

      And yes, of course sometimes life is sorrowful, that’s when you cry _with_a_reason_ which is distinctly different.

      As for the DSM and 1-in-4, I don’t personally find that number to be particularly reasonable I do know that people run with it, however. Bipolar affects approximately 1%, so not one-in-four.

      – Natasha Tracy

      • I personally love the example of ‘remember last Tuesday when I found you crying for no reason?’ I cry without reason all the time when I am hypomanic. My husband actually noticed this early on in my journey with bipolar disorder without having known previously that it was an actual symptom.

        It’s a legitimate observation and a great example for this article.

        Talking to loved ones who may (or may not) be suffering from a mental illness is a courageous act. And the fact that it requires so much courage to do speaks to the extent to which it is still such a highly stigmatized conversation in our society.

        Feeling offended or hurt when a loved one suggests that you may have a mental illness demonstrates how far we have yet to go before these illnesses will be regarded respectfully as the physiological diseases that they are.

        Thanks for contributing so fully to ending the stigma, Natasha.

  10. If we didn’t stigmatize mental illness so that people feel it’s too devastating to even consider the possibility that they or a close loved one could have such a thing, then we could make it easier for all of us to discover our imbalances and find ways to more easily have balanced, productive and happy lives. I was finally diagnosed at age 50 for ADHD, OCD, and possibly Bipolar but because we continue to call them “disorders” no one wants to be labeled “out of order” because that means we’re broken and possibly not fixable. If we focus on the fact that all humans today are imbalanced somehow due to hereditary or environmental influences, then we can work together to make it easier to get back in balance even if it’s a lifelong journey.

    • Hi Donna,

      We call them disorders because they are disorders. We might all be ordered differently but some of it raises to the level of pathological while most of it does not.

      But you are correct that stigma is one of the number one reasons why people don’t get treatment. The second most common reason is fear of treatment. We need to work to reduce both of these factors.

      – Natasha Tracy

    • Hi Nikky44,

      Many people have trouble getting a formal and lasting diagnosis. This is really unfortunate but psychiatric evaluations are tough and some people really fall on the line between one diagnosis and another.

      What I tell people to do is to focus on treatment and getting better. I know it seems like you need an agreed-upon diagnosis for this, but you really don’t, you just need to work with a doctor and find out what treatment works for you.

      We all want to be able to label things, including our problems but if you can get better, then the label doesn’t matter :)

      (FYI, the treatment you respond to may actually confirm your diagnosis one way or another.)

      – Natasha Tracy

      • I have tried at least 10 anti depressants, mood stabilizers, and lithium with 5 different psychiatrist, and since nothing seemed to be working, I have stopped it all since Christmas against medical advise. I don’t feel worse, just the same. That is why I say I might just not have any mental illness.

        • Hi Nikky44,

          I’m sorry to hear that. I notice you didn’t say antipsychotics. Have you tried those? Sometimes they help with illnesses that don’t respond to anything else.

          If you’re intractably depressed there is also ECT, but obviously there are many things to consider with an option like that.

          Have you tried cognitive behavioural therapy or dialectical behaviour therapy? Those can also be very helpful.

          – Natasha

        • I have done psychoanalysis, but never tried CBT. As for anti-psychotics, I’m not sure if i have tried them. I started getting treatment 30 years ago.

          • Hi Nikky44,

            Well, if I were you, I would look into it because new treatments always have a chance to success. I know 30 years seems like, well, forever, but in that time all sorts of new advances have been made and maybe you haven’t tried them all yet :)

            – Natasha Tracy

          • I’ve been struggling with mental illness for 35 of my 45 years and have been on all forms of psych meds since I was 10 years of age. Anti-psychotics could be Thorazine, Haldol, Compazine, Abilify, Risperdal, Seroquel to name a few.

            I’ve done Thorazine, Compazine, Abilify, and Seroquel… I’m not on any now and haven’t been in nearly 3 years. The side effects, to me, outweighed any benefit – but that is me. Your reaction or side effects may not be such that you find anything intolerable or potentially life threatening. Everyone is different in how they handle medication. I am more sensitive, primarily from having taken differing stuff for so many years.

            The Anti-Depressants have not really worked for me, nor have the mood stabilizers (though I have had a love-hate relationship with Lithium from time to time, not on it now though), and I’ve tried the benzodiazepines (ie., Valium, Klonopin, etc..) but the docs will not prescribe those anymore due to an attempted OD several years ago.

            I too, have been off meds for almost a year now. I have a seizure disorder so I take a anti-convulsant which minimally acts as a mood stabilizer. At the moment, it’s not doing much for either condition as I had stopped taking it for some time and have now re-started it about a month ago. I have undergone, nearly, that many years of intensive psychotherapy, both CBT and DBT (since childhood, off and on for long periods of time).

            I wish you luck and hope you find something. Just wanted you to know that there are others out here, who have been in this fight for as long as you, and have been through the trials and tribulations of sorts of the psychiatric stuff for a way long time. So – you are not alone.

          • Murphycat,

            Thank-you for sharing your story. Success stories come in all shapes and sizes and sometimes just continuing to try is an _absolute_success_ story! It’s important that people know that people are like you are out there and surviving, so thank you for your comment.

            – Natasha Tracy

  11. Thank u for this article about how to tell someone they might have a mental illness. Anxious for part 2. Thank u