How to Help a Loved One Seek Help

There is a pile of trash on the table. My friend is sitting across from me, and we eagerly await our morning cup of coffee. I’m sweaty, extremely smelly, and very sandy. The two of us arose before the first light and drove to a tiny beach that sits next to a local marina. We have spent the last two hours digging holes in the sand and then filling them back up again. When fatigue finally set in from the sweltering summer heat of the Florida sun, we decided to call it a morning. I’m of a more opportunistic nature than my friend. I dug around 200 holes, and then immediately filled them in. My friend is older, smarter, and wiser. He is much more selective with his insanity. He probably dug around 75 holes in that two-hour period. All of which he also immediately filled in.

On the breakfast table in front of us, we have the fruits of our labor. All the objects in front of us are metal. I found two bullets that nobody will ever know the story behind. My friend picks one up and says 45 caliber, which could be from anywhere between the early ’50s and late ’70s. I looked across the table enviably at his small cache of coins. He probably has around 15 in total. Two-thirds of them are so damaged and corroded that they will never see circulation again. He picks up a dark black quarter-sized circle and uses an old toothbrush to rub off some of the corrosion. As the date of the quarter slowly appears, he beams across the table at me and shows a big smile.

“1940,” he says quietly.

“Wow, great find!” I reply. The excitement is painted all over my face. I look down at my small pile of various metals which are completely indistinguishable from trash. Most of these objects have been exposed to the corrosive Gulf of Mexico saltwater and the aggressively oxidizing catalyst of sulfur from inner inlet detritus. It will take me hours of cleaning them with various caustic solutions before I can even identify what their long-ago function was. I’m a tad bit jealous of my friend’s extremely valuable 1940 silver quarter. It’s worth approximately $2.10 cents in scrap silver, which is a huge leap up from $025. I eagerly anticipate figuring out what I have found, without setting my expectations too high.

For those of you who don’t know, prior to 1965, the United States Mint used silver in dimes and quarters. The U.S. stopped using silver when the value of scrap silver in the coins exceeded the actual value of the coin. It didn’t take long for speculators and silver hunters to start removing these coins from circulation. As a result, it’s rare to get a dime or quarter dated before 1965 in your local change. As a side note, the United States Mint created a new hobby for numismatic enthusiasts called coin roll hunting. Countless numbers of people go to the bank and request hand-rolled stacks of coins. They sift through hundreds of dollars of dimes, quarters, and half dollars looking for the ones that are silver.

I tried this speculative hobby only once. I had not intended on pursuing this side interest. However, I was depositing a check at the bank when an impulse and whimsy hit me. I decided to give it a whirl. I came home with $200 in rolled half-dollar Kennedys. My loving wife looked at me as if I had completely lost my mind. To this day, we are still finding various pockets of fifty-cent pieces in our house. The majority of these have probably been donated to various school fundraisers, as she won’t let me go into Walmart and pay for something with a bag of fifty-cent pieces. However, if it’s going to a good charity, then my child walks into school with a small bag of change to donate.

Later that night, my four-year-old son became interested in my pile of fifty-cent pieces. He came over to destroy my neatly sorted piles and run his greedy child fingers through mountains of coins. I turned to my wife and saw the scowl on her face.

“Those coins are absolutely filthy,” she said. She was right of course, and I had no reasonable reply.

“Well, on the bright side, they’re too big for him to choke on.” She was less than impressed with this answer, but I could see a microscopic bit of relief on her face.

Within five minutes, I was carrying my son into the bathroom for our nightly rumble that remotely resembled a bath. I was toweling him off and fruitlessly trying to dry his hair when I glanced over to the tub and noticed it was not draining. My son had palmed one of the fifty-cent pieces into the bath with him, slid the drain cover to the side, and crammed the John F. Kennedy coin into the drainpipe. He was absolutely elated with his accomplishment. I felt a sinking feeling in my stomach.

I will spare you the painful details of the next couple of hours and cut immediately to the punchline. The next day, I had to pay a plumber $300 to cut into the wall, open up the drain pipe, get the coin out, and then close everything back up. I didn’t even try to do the math on how many silver pieces I would have needed to find to cover the cost. Needless to say, I didn’t find one silver coin.

Okay, back to the restaurant with my friend.

The waiter arrives with our coffee. My friend and I quickly remove our new treasures from the table and get ready to order. Our behavior is ignored because we’re regulars. We place our orders. He orders fruit to stay healthy. I order extra butter and use my morning labor as a rationalization for why I deserve it.

“So, gonna retire?” I ask. It’s a running joke between the two of us.

“Was your week that bad?” he asks.

“Well, nobody walked into my office this week to tell me how wonderful their life is. You?”

“Not yet,” he replies. “I’m still waiting for the first time somebody calls 911 just to tell us how wonderful their life is going and to thank us for pulling them over on the side of the road to investigate why they were swerving.”

He’s a law enforcement officer. I’m a psychiatrist. It’s amazing how similar our jobs can be and how much they overlap. People seek our help when they are at the lowest points of their lives. It’s a tremendous emotional burden with few rewards.

The morning I just described to you is one of the ways that my friend and I cope with the emotional stress of our jobs. People suffering, in pain, and in distress seek us out. They’re looking for solutions to some of the most difficult problems they will face in their lives. Sometimes, they’re looking for us to wave a magic wand and fix everything in the next 30 to 45 minutes. It’s an honor, for both of us, to be a part of their lives in their time of crisis. It’s a privilege to be of assistance when a person asks for help.

But what about all those people who refuse to ask for help? What about all those family members and loved ones who can’t see how depressed they are? What about our spouses and children who fall to addiction from alcohol or fentanyl? What about our friends whose denial is too great or the euphoria of their high is too strong for them to seek the treatment they need?

“How can I convince my loved one to go for psychiatric help?” the world asks.

The pervasiveness and ubiquitous nature of psychiatric stigma is omnipresent in our society. Some of the cultural ramifications of admitting one is suffering from a psychiatric illness are catastrophic. We have discussed this at length in some of our other discussions, and I won’t repeat them in this one. Needless to say, if you need a refresher on the stigma of psychiatry in society, I know a book you may like.

People don’t want to go to a doctor. People especially don’t want to see a psychiatrist. I’m sure that revelation shocks and amazes you. So, how can you convince a loved one to go for help when they don’t want to go?

The answer to that question is simple. If somebody doesn’t want help, then there is truly nothing you can do to help them. There is ultimately nothing that I can do to help them. I can admit them to a psychiatric unit. I can get court-ordered medications for them. Sometimes, I can even force months-long inpatient treatment. But, if they truly don’t want help, then all these efforts are in vain and they will return back to their previous lifestyles as soon as their freedoms are restored.

So, a better way to phrase the previous question is, “how can I get somebody to go for help when they are scared to but could be open to the idea?”

I’m currently working at an inpatient psychiatric unit. Well over 50% of our patients are brought in by police after the patient has made suicidal statements, gestures, or even attempted to end their lives.

The emergency room has poison control on speed dial. Our patients routinely get checked for Tylenol and aspirin levels even if they deny overdose. The accessibility to these over-the-counter medications is equal only to the damage they can do when used inappropriately. People who are truly trying to end their lives tend to not be too honest about how they have done it.

Thus, I spend a large amount of time trying to convince these people to accept my help. I’m a professional, I have the benefit of case management workers and nursing staff to assist me. I can temporarily suspend people’s civil liberties if needed. With all these advantages, I’m still unable to convince some patients to try a simple antidepressant medication. If I have all of these advantages at my disposal and can still be unsuccessful, then what chance do you have of convincing your loved one to seek psychiatric help?

I try explaining the genetic predisposition for depression. I try to explain to patients that it runs in their family, and they are as much at fault for being depressed as they would be if they had diabetes. I explain to them that taking an antidepressant is no different than taking insulin for diabetics. This tactic typically does not lead to success. I don’t recommend you attempt to explain the genetic physiology of depression to a loved one. They will immediately get on the Internet and find countless websites to contradict whatever you say. People do it to me all the time.

I try explaining to people that I’ve been in the psychiatric field for decades. I explain that I have treated thousands of patients who have presented with similar symptoms. I tout the many successes I have had in the past. I explain the similarities between those cases and their symptoms. Uncommonly are these approaches successful. So, I don’t recommend you try to use personal experiences to convince a loved one to get help.

At times, I even try threatening people. “You just overdosed on 100 Tylenol. You were in the intensive care unit for over a week and damn near killed yourself. You have now been in a psychiatric medical unit for several days against your will, and there is a court order to prevent you from leaving. I have to do my job. I have to see your engagement in treatment before I can safely discharge you. If you want to leave, you need to start this medication.” The results of this explanation are about as successful as the previous two tactics we discussed. So, I don’t recommend you try threatening your loved ones or giving them ultimatums to go get help.

I try education, I try empathizing, I even try threatening. If it is difficult to find success with these emotionally taxing attempts then what can I say to a patient in order to break through their denial?

“George, I know you are highly educated. I respect your opinions and your beliefs. However, you just tried to kill yourself. We have been talking for the last 30 minutes. I have attempted several times and in many different ways to convince you to take an antidepressant medication. I have failed miserably. I only have one more question left for you, what do you have to lose?”

“Excuse me?” he replies.

I stare straight at him and slowly repeat the question. “What do you have to lose?”

“What do I have to lose?” he repeats and looks at me quizzically.

“Yes, what do you have to lose?” I say calmly and then wait.

That uncomfortable silence begins to settle in. He starts to develop the childlike behavior of refusing to speak until I talk first. For him, it is very emotionally uncomfortable. For me, it’s part of the job and part of the process. I’m about as uncomfortable waiting in silence as a grocery clerk is bagging your groceries.

When enough time has passed for George to let the seriousness of the question settle in, I break the silence. I don’t want this to turn into a silent competition. But I do want the therapeutic effect and gravity of the situation to settle in.

“You have tried vitamins, you have tried meditating, you have tried yoga, you have tried exercise, you have changed your diet, and you have spent hours looking up possible solutions on the internet. I’m offering you an extremely safe and simple method. Antidepressants are less dangerous than Tylenol. You cannot overdose on the medication I give you. If you took the entire bottle, the only way you would die would be by choking on the pills. This medication does not have severe side effects. It does not have long-term problems associated with it. You can stop the medication without going through withdrawal. What do you possibly have to lose by trying it for a couple of weeks?”

I pause for a few seconds. “The worst-case scenario is that you try it for a few days, you don’t like it, and you stop it. What do you possibly have to lose?”

“Well,” George replies, “I don’t know. Are you sure it’s not harmful?”

“George, it’s safe. Ten days ago you overdosed on Tylenol and almost killed yourself. Are you seriously asking me this question? Think of the despair you felt when you made the decision to overdose. I’m offering you something that could prevent that feeling from returning. If you’re willing to overdose on 100 Tylenol to solve your problem, then it doesn’t make a damned bit of sense why you wouldn’t be willing to try this medication for a month. You are willing to take 100 pills at one time. I’m asking you to take 30 pills in total over 30 days and give it a try.”

“Huh,” he looks at me with a puzzled face. He’s clearly trying to come up with a good reason why he should say no. He’s battling with the ever-present societal stigma of psychiatric conditions. He’s looking for excuses and rationalizations of a personal nature to refuse me. He cannot come up with anything. “All right, if you’re going to say it like that, then I guess I have to try.”

Addiction

The words you just read were my attempt to have a logical conversation with a semi-logical person. How do you convince an illogical person to go for help? You cannot.

On the inpatient psychiatric unit, I see these completely illogical patients in two different forms. One is from addiction. The other is from psychosis. If you’re trying to convince a loved one to get help for underlying psychotic symptoms, such as schizophrenia, you are in for an uphill battle. Schizophrenia is a catastrophic and crippling disease. Part of having the disease is the patient’s 100% belief in their psychosis. They hear voices that reinforce their paranoia. Anybody who attempts to tell them otherwise can quickly become incorporated in their psychotic delusions. People who try to help become part of the illness.

If you believe that a family member or loved one is suffering from a debilitating underlying psychotic illness, then you will need to seek the help of the legal system to intervene. Community resources are available and can dramatically improve the patient’s quality of life. However, you will be in this for the long haul and for a very bumpy ride. Buckle up, lower your expectations, and accept the small improvements as major successes.

What about alcohol? What about marijuana? What about doctor-prescribed Xanax or Adderall? Millions of Americans suffer from the disease of addiction. It’s a monumental topic and there are amazing resources available. I don’t have an answer on how to convince people with addiction disorders to get treatment. If anybody can discover one, then they will become the richest person in the world. Trying to convince somebody with an addiction problem that they need to quit using drugs or alcohol is impossible.

I will say that again. Trying to convince somebody that does not want to stop using drugs is impossible.

I will say it again. Trying to convince somebody that does not want to stop drinking is impossible.

Until the person suffering from addiction wants to accept treatment, then the person’s life will continue to spiral downwards. The cliché understanding is that the addict has to hit rock bottom. This of course begs the question of what rock bottom is. The cheeky answer is, rock bottom is when you stop digging. Obviously, trying to have a discussion on this with a person suffering from addictions is unsuccessful. The mind of that person may be so significantly clouded that they cannot understand the simple metaphors you’re using.

If you are unfamiliar with the amount of lying, stealing, and manipulation people will use to continue their addiction that I cannot explain to you here. The addicted mind defies all logic, reason, and rationality. To truly understand what the depravity of a full-blown drug/alcohol problem involves, you must either suffer from this condition yourself or care very much for a person who does.

A sober acquaintance of mine with five years of sobriety once said this to me, “I knew that if I kept drinking I would lose my job. I knew that if I kept drinking I would lose my wife. I knew if I kept drinking, I would end up being homeless and living under a bridge. And I was okay with living under a bridge, as long as I could keep drinking.”

A heroin-addicted patient of mine, using approximately $400-$600 a day, once said this to me, “I couldn’t function on that much heroin. I was either high or doing something to allow me to continue to be high. It was the only thing I could think about in life. Do you have any idea what somebody has to do for $3000 a week of heroin, week after week after week?”

Please don’t misunderstand what I’m telling you. Addictions can be treated. Millions of Americans have obtained sobriety. But, not one of these millions of Americans got help for their addiction until they were ready for it. What I’m trying to impress upon you when seeking help for someone is the right mindset. Have realistic expectations for these people, and don’t waste your time on the impossible. Reach for something attainable based on what state the person is in.

If you have a loved one or friend who is battling with addictions but is even slightly open to the possibility of stopping, then get them to the closest alcoholics anonymous/narcotics anonymous meeting ASAP. These are free programs available to anybody who asks for help. The only requirement to attend a meeting is having the desire or thought of desire to quit. Many people go to their first meeting intoxicated or high. They are not judged. They are understood. Many people in that room will have gone through the same process. There is a 12-step program that a sponsor will personally guide your loved one through. They will come to your house if you can’t drive. A list of people will give you their personal cell phone numbers and tell you to call them at any time if you’re struggling. A sponsor will call you and check up on you whether you want them to or not. All of this is free. AA/NA members are from every race and occupation. It effects the very wealthy and the very poor. Everywhere in the world somebody has suffered from addictions and recovered. The disease of addictions is not random. People at these meetings will understand what that person is going through. They will have similar stories and be able to relate.

If you want to help a loved one or family member with an addiction problem then get their ass to NA or AA as soon and as often as you can. Then get your own ass to the closest Al-Anon/Nar-Anon meeting so you get can support.

Dr. Daniel Weinberg, Board-Certified Psychiatrist