by Scott Haltzman, M.D.

One of my favorite cartoons was something I found almost 20 years ago in a New Yorker magazine. In the first panel of this drawing , we see a boy in a lake, frantically waiving his arms in the air as his dog looks on. The boy yells, “Lassie! Get help!!” In the second panel, we see Lassie lying on a psychiatrist’s couch, pouring out the contents of her heart to a bespectacled doctor who’s sitting across from her taking notes!

It’s funny how the ever-obedient Lassie follows Timmy’s command to seek help for her own problems (even when, obviously, Timmy wanted the help for himself). When you suspect a friend or family member is having a hard time, you may also feel like shouting, “Get help!” But will that person be as obedient as Lassie?

If someone were drowning, had broken a leg or were suddenly unable to breathe, that person probably would welcome your help with open arms. But if the same person were to suffer an emotional problem, there’s a good chance your recommendations for finding help would at best be brushed aside and at worst cause the person never to want to talk to you again. In fact, many people are so anxious about recommending emotional help for their friends and family that they sometimes put it off until it’s too late.

WHY THEY WON’T GET HELP
There are many reasons people with psychological issues may be resistant to recognizing when there’s a problem.

1. Despite all the advances in modern medicine, there is still quite a stigma associated with mental illness. People often feel that such problems are a sign of emotional or spiritual weakness. They don’t appreciate that many mental illnesses are considered biological illnesses with genetic causes.
2. Whereas a broken leg or bleeding problem is obvious, you can’t see mental illness in any way that easily reveals what the problem is. To add to the complexity of the issue, even trained professionals don’t have standard laboratory tests to prove that someone has a mental illness.
3. Often the illness itself robs a person of the ability to know when he or she is mentally ill. For example, a depressed person may assume he deserves his depression because of the “bad” things he’s done, or a schizophrenic person may think the voices she hears are real and not see how her mind plays tricks on her.
4. Denial is a frequent symptom of some psychological problems, such as substance abuse or pathological (out of control) gambling. In other words, saying, “I don’t have a problem,” is part of the disease.

Remember, your involvement and support can save a life! Here are some common behavioral health problems and short courses on ways to deal with them.

WHAT TO SAY (AND NOT TO)
Because the person you care about may not see a problem, you might have to point it out.

Gulp! Who wants to be the one who has to tell her best friend or loved one he may be mentally unstable?! Like it or not, the responsibility may lie on your shoulders, or at least you may have to consider the possibility that you’ve got to speak up.

There are no hard and fast rules for helping a loved one seek care for emotional problems. In the following sections, I will talk about how to address specific kinds of mental health issues, but here are some general dos and don’ts that will help make the discussion more manageable for everyone involved.

DO point out your observations, such as, “I’ve noticed you’ve been acting differently lately.”
DON’T accuse or point fingers, such as, “You’re not the person I married anymore!”

DO turn to other people in your life for support when you prepare to talk to your loved one.
DON’T gather many people together for a Jerry Springer style intervention. It may further alienate the important person in your life. (See the sidebar for more on this.)

DO see the discussion as an opportunity to work together to help your friend.
DON’T see the interaction as a confrontation.

DO let the person know how important he or she is to you and how much his or her well-being means to you.
DON’T give ultimatums, like, “If you don’t go for help, I’m out of here!” (If you actually do fear for your own well-being because of your loved one’s behavior, you may have to leave. But simply threatening this action rarely shifts people into change.)

DEPRESSION
Often, depression is associated with social withdrawal and all kinds of negative thinking. When people are depressed, they can feel helpless and sometimes believe they’re to blame for their suffering.

Avoid trying hard to brighten the mood by joking around. Also, tough love, such as, “Pull yourself up by the bootstraps,” doesn’t work so well. Your best bet is to remind your friend you have faith in him and believe there is a brighter future ahead.

Because depression robs people of momentum, it may be up to you to schedule an appointment with a therapist or psychiatrist. And that’s perfectly all right.

PSYCHOSIS
This is a condition in which someone loses touch with reality. It’s generally associated with schizophrenia but often seen in bipolar disorder or depression. Sometimes a person’s beliefs can become so distorted that she believes she’s being poisoned or spied on. In these cases, it’s often fruitless to try to talk the person into seeing reality your way.

If your loved one is already on medications, check in to see if she’s taking them as prescribed, and coordinate follow-up care with the psychiatrist. If she’s not already in treatment, forget negotiating. It’s time to call the doctor. Even if she says she’ll never forgive you for calling, it’s still important to get help. In time, you’ll be forgiven.

SUBSTANCE ABUSE
With alcoholism and other substance abuse (even pathological gambling or pornography addiction), one of the main features is the tendency either to blame others for your problems or to deny that a problem exists.

It’s a complete waste of time to attempt to debate someone who doesn’t want to confront his problem. It’s better to present your evidence directly: “Chris, I think your drinking is getting in the way of work.” If Chris is open to talking, then you can start a dialogue. If, instead, Chris defends or denies, simply reinforce that you’re available to talk later and walk away.

Sometimes a substance abuser’s activities may represent a danger to you or others in your household. If that’s the case, you may need to ask or force—by police if necessary— that person to leave until he gets treatment. Remember that there are good treatment options for substance abuse problems, including Alcoholic Anonymous , Narcotics Anonymous and medications. There are also support organizations for you, such as Al-Anon and Alateen.

SELF-DESTRUCTIVE BEHAVIOR
Sometimes a person doesn’t have to have a full-fledged addiction to need psychological help. People who smoke, overeat, or neglect their hygiene or personal safety have problems everyone else can see. And odds are, they know they have the problem. I ask all my patients who smoke whether they realize it’s dangerous, and so far every single one has said yes. Obese people know they’re obese. Nail biters know they have no nails. Domestic-violence victims know they’re living in danger.

So if all these folks know that there’s a problem why don’t they just stop? Because they can’t. Call it addiction; call it self-punishment; call it bad habits; call it lack of self-esteem. The problem is, you don’t know what to call it because it’s a professional’s job to figure it out. And that’s where the person you care about should be looking for answers. By “professional,” I mean nutritionist, general physician, therapist or physical trainer.

Because your friend can recognize the problem, approach your efforts to help in a collaborative way, by saying, “I know you’ve been having a hard time managing your ______. Is there any way I can help you get it under control?”

If behavioral changes are necessary, consider the fact that, in a supportive effort, you might also have to start an exercise regime or quit smoking. Pitch in and make solving the problem teamwork.

Part of caring about loved ones is knowing when they’re having trouble, and part of being an important component in their lives is sometimes stepping forward and help them see when they need help. If you act lovingly and respectfully, you can make your relationship grow even stronger.

Board-certified psychiatrist SCOTT HALTZMAN, M.D., is co-author of The Secrets of Happily Married Women: How to Get More out of Your Relationship by Doing Less ; an assistant professor at Brown University; and medical director of NRI Community Services , a behavioral-health organization in Woonsocket, R.I.

Last updated and/or approved: June 2008
Original article appeared in July/August 2008 issue.

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