Ask HN: How to deal with a serious mental health breakdown?

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I've had a few moments like that, it's not a pleasant thing to be around.

In that kind of mental breakdown, you get addicted to the story you build in your head, where you are special and important and on the verge of something great (but also worthless and doomed).

Healing means giving that up and returning to baseline, and you can't do that for him. Protect yourself first

It's hard to give generic advice but it sounds like calling the crisis team was a good decision.

One thing that generally helps is to get the person talking (and don't offer them advice - listen and help them talk things though themselves).

I've found going for walks with people is good. Can you take him hiking?

Sudden onset mental health problems can have a physical cause. It's very important he have a thorough medical evaluation.

Find the best place that you can to do the eval, and absolutely insist that they do a very detailed workup. A lot of doctors are dismissive of mental health issues. Find a good neurologist, and then push, push, push to get this done.

If you make it happen, you'll be the best friend he could ever have.

As a quick fix, if you don’t think you can help the situation (and there no reason for you feel like you need to fix anything) if the roommate comes back what I might do is take a impromptu vacation, or crash with a friend for a week.

You have alerted his kin and the authorities. You did the right thing.

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Not to this degree, but I would certainly draw the line of assistance if he gets violent or threatening. Someone that is rapidly at that stage toward a close friend is not in a mental state that is salvageable unless you have experience or are a mental health professional. I would personally begin to move possessions of value (sentimental or otherwise) to a safe place like a storage locker, away from any outbursts and look to find an alternative place of residence if things get worse. Probably not the interventionist kind of answer you want to hear, but your priority should be protecting yourself.

Unfortunately when it gets really bad, like this, there is just not much you can do. Calling the crisis team sounds like it was appropriate.

I wish there was some state-sanctioned response in between "please go see a doctor/please take your meds" and "you are now going to be involuntarily committed for possibly forever, hope you like your life getting ruined if it wasn't already". But around here, at least, there is not. Those are your choices, and it is very, very painful.

I recommend he get sober; no drugs or alcohol. Eat plenty and sleep plenty.

He should follow the advice of his doctor however the medical profession tends to treat most psychotic episodes as wholly delusional.

If he denies any validity or even the existence of this episode in order to recover he runs the risk of treading the same path and risking another episode.

There can be insight in these episodes but it requires some recovery to see objectively. I suspect he could know what caused the episode but it may be suppressed into his subconscious.

It's a life's work to integrate. Therapy can help. Meditation can help (with the caveat that if you get serious with practice it can trigger another episode).

Ultimately if I was you I would consider moving out. Depending on how much support he needs in this time it may not be a role you are prepared for or should be expected to take on.

Remind him of his good qualities and it will always be beneficial.

Advice my own. I'm a fallible human being.

I have no expertise in this, but the first thing I would do is to call an expert on the topic that deals with such situations frequently.

Many countries have suicide helplines (both public and private). For example, googling "suicidal friends helpline [yourcountry]" returns for the UK:

https://www.nhs.uk/mental-health/feelings-symptoms-behaviour...

While many of these pages and helplines are targeted at the person going through the breakdown, I imagine they will also advise friends and family, and some pages are targeted specifically for them, for example this result (I have not read the full contents yet):

https://www.rethink.org/advice-and-information/carers-hub/ge...

How old is your friend? It sounds like Schizophrenia. For men it most commonly onsets in their mid 20s to early 30s from what I have heard.

There are good/safe/powerful medicines that can cure most psychotic episodes. Best Wishes to you both.

You're describing a family member of mine to a T. Very intelligent guy, can hold his own against the brightest, charm coming out of ears, creativity overflowing.

He had some paranoid episodes in the past, but we put it down to stress. He was a normal functioning human being 99% of the time, as are we all.

Then it became 90%, and then 80%, and the remaining 20% was full-fledged paranoia.

You'd have to talk him off a cliff almost on a weekly basis to not act rashly on little data. It became difficult to talk once it became clear he was never going to listen.

Once the family became the enemy, he fled from us. Any attempts to bring him back just made him flee further.

I sympathise with your friend's family. There's nothing you can do. If he's not accepting help, then he likely needs to sink further into his delusions/paranoia before he realises what help he needs.

It has to come from him, and not from you. The alternative is sectioning them, and that's something not one of us is prepared to do.

Triggers? There's definitely a genetic aspect to it in our family. There's also ADHD. The use of weed and possibly other drugs as a creative muse. Jealousy might also be a factor.

The most you can do for him is to take care of yourself so that you are the best version of yourself if he reaches out for help. In the meantime, staying in contact and having normal “how’s the weather” conversation is important, so that you are not talking about the serious stuff every time you talk, and so that he doesn’t feel like you are cut off from him. Lastly, Al-Anon is very helpful to folks who have loved ones with mental health issues, not just alcoholism, if I were you I would try that out as well. I have an uncountable number of people in my life who have benefited from various 12 step programs.

I would try to find out if he has recently begun taking antidepressants. I began a regimen last year and had side effects which sound quite similar to this.

Sometimes they are like night a day for people in a good sense. Sometimes they invoke a sort of mania and cause an acute crisis, like it did for me. I eventually learned about ‘suicide crisis syndrome’ and evidently new antidepressant prescriptions are at least somewhat correlated with this state.

Highly intelligent people seem to carry around a mild form of depression called dysthymia, which he might have sought to address with drugs.

Good luck. These things are extremely difficult. I know I was at my absolute worst when I was struggling, and I wouldn’t wish it on anyone (from my side or those who supported me).

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That's a tough call, it's scary because of the surprising nature of it. My first encounter with this was a close friend I'd grown up with and who was also seemingly quite intelligent. He'd had one violent incident in the past involving weed that triggered some kind of psychotic episode that was waiting to happen, and then nothing for many years, until he started down this paranoid pseudo-science veganism and yoga cures all diseases, fasting, breatharianism type direction. Apparently there was more happening that I didn't see, started keeping weapons around, lots of psychedelics. In retrospect, he was almost certainly schizophrenic, ended up attacking someone during a psychotic episode and unfortunately his life ended early and dramatically. After that, some of the signals became harder to ignore, and noticed that another more distant acquaintance started repeating similar things as your friend, except on LinkedIn of all places. Many delusional, spiraling paranoid posts of grandeur (not in the typical weird way everyone does on that platform), describing the government coming to get him after he isolated in the countryside. I think he's fine, but reported him so his reach was limited.

Personally, I'd get out and try to at least temporarily part ways on good terms, not necessarily forever. Depends a lot on vibes. It's tough.

I’ve been in a very similar situation and the advice I’d give myself back then is to seek psychological support for myself from the beginning, preferably a good therapist to help navigate this. It sounds like you’re making solid choices (and the same we made at the time) but you don’t control the outcome of this situation. It was the hardest thing I did in my life, best of luck to you.

What country are you in?

Sometimes actual medical issues can cause psychosis, e.g. UTIs (Urinary Tract Infections) or brain tumors. Getting him into a safe environment was the correct thing to do. If he returns and you don't feel safe then getting yourself into a safe environment is the correct thing to do.

I'm sorry this is happening to you and to your friend. I have some similar experience and want to share some advice I wish I had heard earlier.

It sounds to me like you did the right thing - situations like this can get worse if left unchecked and have serious consequences for the person in question and those around them. I'm not diagnosing your friend - I'm no expert, and various disorders can have those symptoms - but there are resources out there about (e.g.) mood disorders [1] that might give you some perspective and advice.

Treatment can help, and can make a huge difference. Hospitals are unpleasant but can sometimes be the only way for someone who needs treatment to receive it. I am certainly no legal expert, but I think if he was forcibly committed to a hospital and police were involved, he's unlikely to be released without accepting treatment.

You might find it helpful to join a support group for caregivers (e.g. [2]). In my experience it's common for friends as well as family members to attend those. People will offer resources and advice, as well as just sharing their experience, which can provide perspective and help with feeling lost.

Also consider (if you're not already) finding a therapist of your own. People in one of these episodes can push boundaries, say things to you they wouldn't normally mean, and generally be hard to be around while maintaining your own health and boundaries - particularly if you're invested in trying to help them.

[1] https://www.dbsalliance.org/education/ [2] https://www.dbsalliance.org/support/chapters-and-support-gro...

I've seen something similar happen before. If it's severe, then it's out of your hand.

But anecdotally, here's something that's worked for people who are still, for the lack of a better word, sane. So everything from here assumes there is an external (work/people/existential) cause, and not an internal pathology (BPD, Schizo, Brain Tumor). I'm also assuming that both of you have a requisite level of intimacy as friends & that this isn't a drug use problem.

My solution: Take a long walk with him.

I mean a loong walk. Ideally on a quiet night, lasting 5+ hours.

You can't pull someone out of a spiral, but a person can pull themselves out if given enough space & time. Anecdotally, you stay quiet and let the silence build up for the first hour. Eventually, the person starts talking. They'll spend the first couple of hours rambling with only a couple of hints interspersed. Don't pounce on anything, but prod them in the direction of those hints. Soon, they'll start circling around the real issue more aggressively and if you're lucky (FWIW), that's when the levee breaks.

I'd say it's the norm for men to cry at this point. I mean, if it causes a mental breakdown, it's big enough to make them cry. If you reach here, then be very gentle here on out. This person has revealed their softest underbelly. Everything here on out should be unconditional support. Have a seat. It's easier to talk when you're walking, but it is easier to cry seated. Liminal/transitional spaces (train stations, over passes, tiny parks) are the best.

At some point, the tears dry out & some degree of catharsis is achieved. Then, they're ready to walk back again. This is where you can starting looking at optimistic change : how does the person get out of this mess ? Keep this uncomplicated. Give them a simple & optimistic conclusion to cling onto for the next time they spiral. Outline the first step to mark the beginning of a way out. And explicitly give them permission to call you anytime/anywhere if this happens again. If you're lucky, the sun will start rising, the city will begin waking up, and optics of a new-day will give them another soft push toward optimism.

I know this sounds cliche, but cliches are just validation that something has worked for hundreds of years.