I recently received an e-mail from someone asking about "how to get someone to counseling." This person knows that I have a history of mental illness, and that I am open about this, and that I am interested in talking to others about it, and was hoping I could help them with someone they care deeply about.
In the interest of sharing my thoughts with anyone whom it could help, I decided that I might share that account here. Eventually, I want to reflect on why I have chosen to be as open as possible about my experiences, even though people over-sharing online gives me the creeps, and I loathe the feeling that I'm acting self-important.
To anonymize the content as much as possible, I've opted for "they/them" as a gender neutral, third person singular pronoun. My middle-school grammar teacher was the amazing James Goodson, and because of him I know that these words are actually plural. Unfortunately, I have no other elegant way of respecting privacy.
Anyway, here's the story:
You asked, "how do you get someone to go to counseling?" There isn't a way to get someone to go to counseling when they don't want to, short of the kind of quasi-kidnapping that I associate with substance abuse interventions. That's probably a bad idea for you, so let's talk about what you can do. Counseling is a great idea, and probably everyone should do some version of talk-therapy, even those people "without any problems" (whatever that might look like). I have a grad-school friend who says that if we were professional athletes, we would of course go to physical therapy, and we would have a physical therapist to keep us healthy. As people using our brains all the time, it seems very reasonable to do the same for our mental health. It must be frustrating for you to see someone in obvious need of help, but unwilling to take the necessary step. It may help you to know a few things.
First: This person is unbelievably lucky to have family who is open to the possibility of their seeking counseling. It's a major hurdle that many people have to get over. Since our families play such a central role in our lives, it stands to reason that any examination of our lives will be wound up with our families. That fact was difficult for my grandparents, who raised me, to accept. They wouldn't go to counseling with my mom, and they wouldn't go with me. There is (sadly) a stigma attached to it, and it's hard to get over that step. So keep up the good work (difficult though it may be) of supporting them!
Second: It may not make sense to you that they don't want to see anyone, but maybe I can help you to understand what it might be like. I am not this person, and everyone's experience is unique and blah blah blah. But I can tell you what it was like for me. This story has helped several of my friends and acquaintances as they or someone they know and care about began treatment for mental health issues. I believe it to be part of my calling to help others by sharing my story with others, so I want you to feel free to share any part of this with any- and every-one whom you think it might encourage. One important qualification is that I mention the medications that did not work for me, but that is a statement about me, not about the medications. They may work very well for others. Everyone's brain chemistry is different, and you kinda have to figure things out by trial and error. Make sure that no one walks away from this story thinking, "oh, that medication is bad." It isn't "bad" -- it just didn't work for this one guy this one time. If a doctor recommends a medication, work with your doctor and see if it helps!
One day in 2002, I started weeping when I saw overcooked broccoli in the cafeteria, and I began to contemplate suicide -- in the abstract (not, "I want to kill myself," but, "I wonder whether that balcony would hold my weight" or "if I killed myself, I wonder which of these assholes who won't even speak to me will cry and pretend to be traumatized, and how long it would take for everyone to get back to their normal lives"). At one point, my cousin came to visit me in my dorm room, and discovered a dozen or so bottles of urine in my closet from when I couldn't even pull myself out of bed to go down the hall to pee, let alone to the dumpster to throw them away afterward. I realized that this was not normal, and that I was not in a good place. Actually, I only realize how bad this sounds now -- years after the fact.
I had always been a little freaked out at the prospect of taking mind altering medication. I was concerned about "turning into a zombie" where my thinking became permanently impaired or that my personality would be so altered that I wouldn't be myself anymore. But nothing impairs one's ability to think clearly as much as being dead. And since I was thinking about killing myself, it seemed that I wasn't permanently attached to being who I was. I figured that death would be a certain end to being myself, and a medicated brain is an unknown. I might be fine, or I might be someone else entirely. If I turned out to be fine, that's a win. If I turned into someone else, it wouldn't be any worse than dying, so it's at least a wash, but it may even be a little better. So I made the decision to pursue medication.
There's a fascinating book about the natural history and philosophy of medication of this kind. It's called Listening to Prozac, and it helped me think through a lot of my concerns about medication. I did most of this thinking after the fact.
In 2002 I began treatment for depression. I was prescribed Zoloft, and started feeling better almost immediately. I took it for just under two years. Eventually I felt well enough that I started to care about side effects. I weaned myself off of the meds, and felt okay for a few months. When I went back on Zoloft, it had less of an effect and the side effects were worse. This is one of the most frustrating parts of the process. It reminds me of how my uncle used to say, "they call it practicing medicine for a reason." That's very true, but I was willing to experiment because it seemed better than nothing.
I began to see a psychiatric specialist, and she prescribed me Wellbutrin. I felt great! I started running a mile every day. I turned in an assignment an entire week early. This was the only time in my entire college career up to that point that I hadn't turned an assignment in late. Then I started yelling and breaking furniture. I got into an argument with Megan about nothing -- because it wasn't actually an argument, it was a manic spell (I believe that it was technically hypomania). It turns out that I did not have clinical depression but bipolar disorder. One way bipolar disorder is frequently diagnosed is iatrogenically: it looks like depression, you give someone an anti-depressant, and they go into a manic episode. This means that they have bipolar disorder. You now have to stop the anti-depressant and put the patient on mood stabilizers. They call it practicing medicine. This is another major source of frustration for many people who have mental illness, mood disorders, or whatever else. It's also very frustrating for the people who love them, because you want the silver bullet that will make everything better. It helps me to remember that the silver bullet exists literally nowhere. If your car makes a funny noise, the mechanic may have to try several things to figure out what it is. And people built cars -- we have the whole instruction manual for cars! We're reverse engineering the manual for our brains. This goes for every thing that is hard: playing a piano, wrestling, painting, writing poetry, public speaking. All of it involves trial and error, and it's almost never a success on the first try. It just feels different when it's your brain. So, if treatment is not an immediate success, don't get discouraged, and don't reject treatment as useless.
After my manic episode, my doctor gave me a prescription for Lamictal. It's used as a mood stabilizer for bipolar disorder and as an anti-epileptic drug to prevent seizures. This was right before I graduated college. When I graduated, I no longer had health insurance, and my job did not have health benefits. I had to pay for it out of pocket, which was $300 per month for a very low dose. The most common dosage would have been over $1000 per month. The good news is that It's now generic, and so only costs 1/10th of that, and Megan's job provides insurance for our family.
This is another major point of frustration for people with this kind of condition. It's expensive to not die. My current medication is great. It works for me, and I have no complaints about it, but I have to take it every single day. If I miss doses, I feel it leave my system, and if I reintroduce it, I feel that too. When the level of the chemical in your blood changes, you start to get side effects. I have forgotten to take it a couple of times, I once ran out for a day and a half, and I once had to stop taking it for three days because I was worried about a possible reaction to it. When your brain chemistry changes, things can get weird. You can feel dizzy or light headed. I get absent-minded, and feel like I'm daydreaming. If I forget my meds at home, I might not be able to drive back from work that afternoon, and I definitely won't be able to do anything productive the next day. There's even a rare, but potentially fatal allergy some people have to the medication. All of this is worth it, though, because the alternative is worse. But in exchange for this risk and expense, I get the most wonderful thing -- I get to be o.k.
In my experience, first personally, as well as through conversation with others, feeling o.k. is actually a challenge for folks with mental illness. I know of several people who were on the same medication that I take. It worked great for them. They had little to no side effects, and they were able to get out of bed and lead normal, healthy lives. They felt perfectly fine, the way a normal healthy person would feel throughout a normal day. Then they suddenly stopped their medication because they claimed not to feel any different. My cousin's ex-girlfriend has the best characterization of mental illness that I've ever heard: "I don't understand why it is that when I take my meds everyone else stops being a bunch of stupid assholes." I share this sentence with everyone I can, because it is so telling about why we don't get help in the first place, and why we sometimes stop doing the very things that are actively helping. It doesn't feel like the problem is with me. I feel exactly the same as I did before I ever got on medication. When someone says something unkind, it might hurt my feelings. When I encounter something unfair, rude, or obnoxious, I might get angry. When someone is behaving in a foolish or unreasonable manner, I get frustrated. And my response is usually in proportion to the stimulus. But somehow, when I swallow these pills, the world becomes more kind, just, and reasonable than it was before. It's truly bizarre.
Early on in my treatment, a college friend asked me if I had forgotten to take my meds that morning. I checked, and sure enough, I hadn't. I asked how he knew, and he said, "you're much more difficult to talk to today." My other friends and family have also assured me that this is the case. But it doesn't feel that way from inside. I know it's the case. But I do not and have not ever felt like it's the case. This is really hard for everyone I know to understand. It's even frustrating for me when I have to interact with others who have the same condition I have. Here's what I tell people to imagine:
I would expect that this might be one of the weirdest experiences of your life. Now if you replace coughing with being in a bad mood, you get an idea of the experience. And being in a bad mood isn't helped by being asked about your bad mood, either. Imagine that you are having the best day ever. You're happy. It's sunny. Birds land on your shoulder and start tweeting Zip-A-Dee-Doo-Da. Then the first person you meet asks, "What's your problem?" Then the next. And the next. How many times would this happen before you start to actually have a problem? The first nineteen years of my life were like a constant whats-your-problem-party. For nearly two decades, now, I have been taking these magic pills with my coffee every morning. Their size, color, and number have changed over the years. But people have stopped being stupid assholes, and they've stopped asking me what my problem is.
I'm afraid that this may sound bleak to you. I hope it doesn't. It doesn't have to be. But you should be prepared for frustration. Getting someone to seek counseling or to try pharmacological treatment is like getting the person at the party to drink a glass of water or take the lozenge. It's a tough sell, and likely frightening and confusing for that person. Fortunately, we've come a long way in the past few decades. In the early days, the anti-depressants were something called MAOIs. If you were taking them and ate blue cheese or dark chocolate or red wine, you would die. But that's an upgrade over being tied to a chair and shocked, or dunked in ice water, or being placed in a hut filled with smoke and having strange things chanted at you to expel the demons. This is the best time there's ever been for fiddling around with your brain chemistry (with appropriate supervision).
It helps an unbelievable amount to have people who are encouraging (not pushy), rather than dismissive of the enterprise. You also have to have a bit of clarity and openness to trying it out. Ultimately you will never be able to convince anyone that they are the one who needs to change. Just imagine if they thought it was you who had the problem -- as hard as it would be to convince you right now is how hard it will be to convince others. I think this is in part because there isn't any one person who needs to change. All of us could use work. But we can do our best to help others to be open to it. I don't know how to tell you to do this, other than patiently and lovingly. When I'm having a hard time, I want nothing more than for Megan to know just the right thing to say and do, and she never quite does, and it's very frustrating for her sometimes. But there isn't any thing that is "just the right thing." And it's not her job to try to do the impossible. It helps when she is concerned and caring enough to put up with me and help me to have some clarity on things.
I did think of one more thing. I have to keep reminding myself of it constantly. Like confessing sins, this sort of realization can only be done by oneself. If performed on another's behalf it is presumptuous to the point of giving offense, and is often counter-productive. So this is something about me, that I can tell, not something to be told to someone else about themselves. It's a joke Grandpa used to tell. Like Woody Allen in the opening of Annie Hall, most of my understanding of the world comes in the form of jokes.
A man's wife calls his cellphone. She tells her husband to be careful coming home - some maniac is driving the wrong way down the interstate. He responds, "It's worse than that. Everyone I've passed on the interstate is driving the wrong way!" When I realized that I'm the husband, I became more willing to try to fix things.
I hope this helps in some way.