I answer this question all the time: “How do I help someone with mental illness who denies their mental illness and won’t accept help?” It’s a constant problem for loved ones. People with mental illness frequently won’t accept their mental illness and won’t accept mental illness help because of it. And, not surprisingly, friends and family members don’t know what to do. If you love someone with a mental illness who won’t accept it, here are some suggestions of what to do.
When a Person Won’t Admit to/Accept a Mental Illness
As some people know, there is a clinical condition where a symptom of a person’s mental illness is that he or she can’t see that he or she has a mental illness. This is known as anosognosia. It’s a real, neurological condition. This is most common in those with schizophrenia but it does happen in bipolar disorder as well. This is important to know as these people are not being “difficult” or “lying” about thinking they have a mental illness but, rather, they just can’t see it. Nonetheless, in time, many people with anosognosia do accept help.
Others may not accept a mental illness simply as a coping mechanism. After all, no one wants to believe they are sick.
Talking to a Person Who Won’t Accept Their Mental Illness
If you or your loved one is in any danger call 9-1-1. Don’t hesitate. The person may hate you now, but his or her life is more important.
Hotlines are an option if you need help but there is no danger. Find hotlines here.
My opinion is that people with mental illness who can’t or won’t see it, need to be talked to with the two ls: logic and love*.
I’m a big logic person so I suppose I’m biased, but I feel that when you’re talking to someone who is being irrational, talking to them emotionally will just inflame the situation. What you need to do is speak with calm logic. You need to say why you think the person has a mental illness and give specific examples. For example, “I know that those with bipolar disorder can express mania with extreme irritation. I think you have been showing this symptom, particularly when you punched a hole in the wall yesterday.”
Another example, “I know that some people with mental illness experience hallucinations. Do you think it’s possible that when you hear voices that aren’t from people, they may be an example of these hallucinations?”
This type of conversion means you must be educated about the mental illness, and it means you need to know the person well enough to give specific, concrete examples. Having this type of conversation in a calm and unemotional manner is hard, I know, but it is possible. And keep in mind that you may have to have this conversation multiple times in order for it to work. Also, picking exactly the right time to have this conversation — such as when the person is being the most rational — is incredibly helpful.
Finally, you need to tell the person this: “I love you. I stand beside you. I will not love you any less, even if you have a mental illness.”
While I know you may think this is obvious, it won’t be to the person with mental illness — trust me.
Getting Mental Illness Help for the Person
Keep in mind, the goal for this conversation is to get the person to agree to help — any kind of help. If the person feels more comfortable with a therapist, start there. If the person will see the family doctor, start there. Obviously, if the person does have a serious mental illness, you want him or her to see a psychiatrist, but that may be something best addressed down the road.
Make sure you offer to take the person to the appointment and offer to even be in the appointment. This can make things less intimidating.
Resources for Those with Loved Ones Why Deny Mental Illness and Won’t Get Mental Illness Help
If you think you’re dealing with a person with psychosis (delusions and/or hallucinations), please read these articles. That is an amazing resource whether the person has schizophrenia or not. There is a lot to know about psychosis, and this will set you off on the right foot.
- Psychosis Education by the British Columbia Schizophrenia Society
This next book is specifically for dealing with those with a serious mental illness who won’t get help.
Yes, this is my book. I believe this book can truly help loved ones understand depression and bipolar disorder — both from a clinical perspective and from a lived perspective. Plus, it has evidence-based information on many treatment options.
This book provides many ways of attempting to convince a person to get counseling.
This is a book by the noteworthy Julie Fast (along with John D. Preston PsyD ABPP). She gives great information about loving someone with bipolar disorder. Even if your partner refuses help, this book may help you understand him or her.
I know that helping someone with a mental illness who just doesn’t want your help is very hard, but honestly, these resources can help. I wish you the best of luck and the best of health.
*Thanks, Kerry.
How do you know that a patient lacks self-awareness, or is unable to acknowledge that he has a mental illness? From what I have read so far, there seems to be no criteria to determine the difference between the lack of self-awareness and a patient simply not knowing what exactly is meant by a specific symptom because he honestly has never experienced it.
Take myself as an example. Last year I was diagnosed with bipolar disorder and was involuntarily hospitalized for approximately three weeks. During my stay, I brought my laptop with me, and I researched what it meant to have bipolar disorder. I researched the symptoms and made an honest effort to self-reflect and determine whether I actually did have those symptoms. One of those symptoms was mania, which is defined as “elated abnormally elevated arousal, affect, and energy level, or “a state of heightened overall activation with enhanced affective expression together with lability of affect.” In order to see if I indeed did exhibit this symptom, I had to look back at my own past and find a personal experience that approximated the conditions defined for mania. If I actually did have mania, then it would be easy to say that indeed I exhibited that symptom, followed by a depressive state. Another symptom of mania is racing thoughts, and at the time, I looked thought that indeed I did experience these. Upon self-reflection, I agreed to the treatment, under the assumption that I did have bipolar disorder.
While I was on the treatment nothing in my subjective experience changed, notwithstanding the induced erectile disfunction and weight gain caused by the medication. I have studied causal reasoning. One axiom in therein states that if you add a cause A, but there is no corresponding effect B, or if there is an effect B, and removing/adding a cause A results in no change in the effect, then it can be reasonably concluded that there is no causal relationship between A and B. My subjective experience is the effect B. The medication, A, was supposed to cause a change in my subjective experience B IF AND ONLY IF the disorder that the medication was supposed to treat was present. But no change in my subjective experience occurred. So the underlying condition purported to exist by the “experts” did not exist after all. Based on this reasoning, I opted to stop taking medication. Despite the nurse’s warnings that stopping would result in a recurrence of mania, nothing happened. My subjective experience was the same before, during, and after the treatment. Either the treatment was ineffective, and only served to make me gain weight and gave me erectile disfunction, or I never had the disorder to begin with.
Perhaps, one would say, my condition was so bad that I could not be aware of it EVEN IF I made an honest effort to observe it in myself. Maybe my subconscious self wanted to prevent my conscious self from being aware of my disorder that it blocked my conscious awareness from being aware of my illness, and only third party observers could see what I did not see. There are two problems with this rebuttal. First, it is unfalsifiable. It would be just as convincing to say that my entire subjective experience is an illusion perpetrated by a deceiving demon, a possibility thought by Descartes. Second, a few months ago, I experienced for the first time in my life the phenomenon of mania and racing thoughts. I was unable to sleep, and stayed up for 24 consecutive hours, and the experience was so self-evidently what was defined as mania that I had no doubt of it being mania. But it only happened once and has not happened prior or since that single day. Prior to that singular event, and I must emphasize the utter uniqueness of that singular event, I did not know what it really meant to have mania because I never actually experienced it. I only surmised that I had experienced it, when in fact I did not, based on an attempt to fit a definition to a collection of subjective events that approximated, but were not equivalent to, the definition. Clearly my subconscious mind was not blocking my conscious awareness. The symptoms were simply not present. I had to convince myself that I did have the symptoms in order to appease the professionals.
It now seems that I was coerced into believing that I had bipolar disorder by professionals who somehow have the exalted ability to read people’s minds. If you add in their institutional authority, their power over you to decide whether you are involuntarily detained or released, their power to observe you and presumptuously make (faulty) inferences about your subjective experience, which strictly speaking is an utter impossibility without having access to a mathematical formula that represents subjective states (presuming that consciousness is a computable quantum field that interacts with biophotons in the brain in which a signature of its history can be determined by it’s objectively/mathematically observable properties), one cannot help but comply with the authorities to simply be let go.
Finally (and this is the most perplexing matter), how can a mental patient possibly have the right to refuse if he, by definition, is unable to reason cogently and unable to make to make decisions, when the right to refuse, by definition, presumes that the patient possesses the ability to reason cogently and the ability to make decisions. In mathematics and logic, we recognize this as a state in which both A and not A are being asserted simultaneously regarding the same individual at the same time. In such a case, we disregard the whole system of propositions (psychiatry is a system of propositions) as utter non-sense.
If this can happen to me, how do you know that you’re not doing this to patients who do have the mental acuity to verbally express their subjective state, especially when you define away his or her ability to even produce credible statements a priori? It is easier to solve a differential equation, or to compute the gravitational force between two masses, than it is to precisely describe one’s own subjective experiences. The brain actively works to hide and disregard facts about the self to the self that the self would find disagreeable. What is presented as the psychiatrist’s care for a patient’s well-being is revealed to be a narcissistic and self-serving desire to simply consider oneself to be better than that patient, so much so that the psychiatrist knows the patient better than the patient knows himself. What psychiatrist would think himself or herself lower status than their patient?
If you truly care, voluntarily commit yourself to a mental institution for a few days. Convince the psychiatrists that you have a certain disorder by exhibiting the symptoms as defined by the DSM. Then, see how difficult it will be to convince those same psychiatrists that you were only feigning those symptoms to gauge their reactions. See how they will say that you have anosognosia. You will know that they are wrong because you knew from the beginning that you were just acting out the symptoms to get the desired effect: their diagnosis of a certain disorder. Of course, you will not do this. How could any rational self-honest human being possibly trust this discipline/industry.
In my experience with my son, when talking to his psychs at a 5270 I mentioned anosognosia-and just got blank looks. Even now, anosognosia is rarely, if ever mentioned in various psych articles. I think this speaks to the Psychiatric/APA/NIMH bureaucratic inertia and fear for careers maybe being rendered meaningless, along with having to actually SPEND MONEY and do real research. In addition, it is only over the past year that I see this cluster of illnesses being more correctly describes as brain disease. (I can proudly say I had a small part in it ranting and pushing on various sites that it was “an organic neurological brain disease” for 4 1/2 years), while there were the usual tepid discussions of “change the name from schizophrenia” to something else to avoid the stigma! Huh.
What do you do if the person is threatening you, showing aggressive tendencies? Often the person is not even willing to listen. Where do you go from that point?
Hi Robin,
I’m sorry you’re experiencing that. Your safety is important. Make sure you take care of that first. Draw clear boundaries that preserve this. Then you may want to only be around the person when others are around. Maybe this means that all the person’s loved ones try to talk to the person at once. This can have pros and cons, but when safety is an issue, options are limited.
And if the person still won’t listen? You may have to live with that fact and deal with the person knowing that.
– Natasha Tracy
i try to stay aware that “crazy” is not a synonym for “bad person,” although the general public seems to confuse the two. lately there’s been media discussion re a prominent politician with whom many disagree — often the conversation turns to what diagnosis he or she would have were he or she tb seen by a psychiatrist. as a mentally ill person, i’m distressed to see this intermingling of terms. you can be a horribly destructive person without being mentally ill; conversely, you can be seriously ill all the while being a valuable member of society.
when someone i know seems to be going off the deep end, my assumption is that sooner or later he or she will hit a point of crisis and seek help. however, if they keep right on going the way they are for years, i figure that’s just the kind of person they are. at some point — esp with family — you have to decide to love someone warts and all, or to avoid them at all costs. of course, family members are like stem cells, you only get so many. if you start writing people off as toxic you may find yourself facing a shortage of loved ones.
Real or not a person’s mental state is who they are. Talking them out of the way they think and perceive reality is something short of brain washing. In fact it is in my opinion. The sensitive emotions of a mentally ill person won’t respond well to the hard truth – you are not like everyone else. Consequently they (we) confine ourselves to minimal worlds of like people or none at all, total isolation. I believe change is possible, but not a total cleansing of the individual self. Some remnant of the mentally ill psyche must remain. Just an opinion. Personally, I find individuals of similar interest to interact with.
I completely agree with you in talking using logic instead of emotion. Having grown up with both of my parents suffering from a mood disorder, I learned the signs and symptoms of depressive and manic episodes at a young age. Whenever I would try to talk to my parents about what I noticed in an emotional manner, they would become agitated and unreceptive but when I would talk to them coming from a logical point of view they were almost always receptive and understanding. This also holds true when I talk to friends about mental illness symptoms I notice.
-Aubri
Just exactly is the legal definition of “mental illness”. This is a highly subjective subject, often just a matter of personal opinion. Catholics think Protestants are “mentally impaired” and Democrats think anyone who votes Republican is “mentally deficient.” Likewise, the gun-grabbing do-gooders have formulated absurd laws allowing liars and spiteful people to accuse others of being “mentally deficient.”
It happens quite often that the accuser is the one who has the mental deficiency, not the accused.
Hi Laurence,
Mental illnesses are, as all illnesses are, defined by doctors. Mental illnesses have nothing to do with being “deficient”, they have to do with an illness in the brain.
And no matter how crazy I, personally, think it is to have voted for Trump, that action does not a mental illness make.
– Natasha Tracy
Mental illnesses are lists of random symptoms in books like the DSM, there is still no concrete biological test for them, and the “symptoms” and “illnesses” are voted on by comittee. If a group of high ranking doctors were to remove cancer from medical textbooks, would it cease to exist? No, it wouldn’t. However, everyone diagnosed with “homosexual orientation disorder” was suddenly “cured” when it was removed from the DSM in the early seventies.
The problem with the help the system offers is that it’s nothing but glib dismissal, drug pushing, and if you’re really unfortunate: psychosurgery or electricity induce brain damage.
call the “get help” rhetoric what it is: coercion to be thrown into the mire of the mental health system.
Hi Mr. Friendly,
That’s bullshit. A cluster of symptoms is always how a disease is defined. Before disease antecedents are understood — guess what they are? Clusters of symptoms.
If you have a mental illness and you don’t want help, that’s your business. Stay sick. It’s no skin off my nose.
But if you have an illness and you want to get better, then you use the tools available. Whining about how the tools are insufficient is not helpful. Using the tools the best way you can is considerably more so.
– Natasha Tracy
so, is homosexuality still an illness. I mean that cluster of symptoms was in the DSM. Diseases dont’ go away if they’re just removed from public reocrd.
The problem is the state decides to force help, involuntary “treatment” for suicide attempts, “assertive treatment orders” for people that don’t want to deal with the barbaric “treatments” foisted on them by people deluded by a misplaced sense of compassion.
The problem is, the “tools” available are blunt implements, being used to try to repair the most complex and poorly understood machine on the planet: the human brain and personality.
But i’ve seen the dismissive attitude you take towads the survivor movement, to you people that were wounded by the “mental health” industry are just an inconvenience.
What the hell are you talking about?
That was an awesome reply. My wife is so sick. I don’t know how to help her. Good riddance Trump; hope I’m not crazy for saying that..