How Do You Help A Loved One Who Is Struggling But Doesn't Want Help?

New York Times Best Selling Author By Terri Cheney
New York Times Best Selling Author
Terri Cheney is the author of the New York Times bestseller Manic: A Memoir. Formerly a successful entertainment attorney, Terri now devotes her advocacy skills to the cause of destigmatizing mental illness.
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When I was a litigation attorney, I had to learn to think fast on my feet. Courts are no place to dither; judges have zero tolerance for hesitation. As a result, I can usually improvise my way through question-and-answer sessions at readings and lectures. It helps that growing older has made me humbler than I used to be. I can now say, "I'm sorry; I don't know the answer to that" without dissolving into a puddle of shame. 

There's one question that I consider my nemesis, though. The one I most dread to hear but always gets asked is How do you help someone who doesn't want help?

The trouble with this question. 

The question is inevitably preceded by a very sad story about a loved one's continuing fall from grace, the devastating impact it's having on all those around them, and their inexplicable refusal to take medication, go to therapy, or even acknowledge that anything is wrong. 

I can tell who's going to ask the question almost before they speak—frustration is written across their faces. They have tried everything, yet they're hoping against hope that I'll have an answer. 

I wish to God I did. I wish I could provide the magic words that would instantly deliver a happy ending. Instead, I've learned to come clean. You know what? I say. That's the hardest question I'm ever asked, and it breaks my heart every time I hear it. I don't have an answer, but I have some suggestions.

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So, how do you help someone who doesn't want help?

I tell them about the National Alliance on Mental Illness and the International Bipolar Foundation. Both are terrific organizations that can help families and friends of loved ones with mental illness. When that response feels too clinical, I share my personal thoughts about this problem:

1. Take care of yourself first.

Always remember the airplane scenario (clichés exist for a reason). When the oxygen mask drops, you have to put on your own before assisting anyone else. It makes total sense: When you can't breathe, you can't help. 

So many of us forget this in crisis, when others are screaming loud in our ears. We let our own needs dangle, unattended, while we try to solve other people's lives. The result: Nobody survives. 

The harsh reality is, dealing with someone in denial can be exhausting. You've got to take care of yourself first, or you're no good to anyone else.

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2. Recognize the other person's fear.

Recognize the tremendous fear that lies beneath a refusal to seek help. In most cases I can almost guarantee that the person knows, at some repressed level, that something is wrong with him or her. He doesn't dare lift his head aboveground for fear of what he might see—and the even greater fear that there won't be a way out. 

3. Know about anosognosia.

People who suffer from anosognosia aren't simply in denial about their illness. They don't even realize they're ill. 

Anosognosia means lack of insight or awareness, and it's most common in individuals with schizophrenia and schizoaffective disorder, although it's not limited to them. Doctors have determined, in many cases, it may be caused by actual changes to the brain structure.

I bring it to your attention—and to the attention of as many law enforcement personnel as I can—because I think it might engender a better understanding of why some mentally ill people just don't seem to get it. Maybe they can't.

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4. Find common ground.

Acknowledge what you share with the person in denial, however disparate your situations may seem on the surface. After all, we all use denial as a defense mechanism from time to time. 

Realizing you have some common ground may lessen the agonizing bewilderment you feel when you look at the other person. This last point, subtle as it may sound, has made all the difference in the world to me. For years, I was one of those intransigent people who refused to admit to myself or others that I needed help. 

Bottom line.

When I finally acknowledged that I was in trouble, I didn't suddenly become more lovable or easier to fix—I was just easier to understand. I wasn't an enigma anymore, a problem that couldn't and wouldn't be solved. I was human, fallible, and therefore just like the people who were trying to help me. Bridges slowly began to be built. The great divide grew narrower at last. It taught me an essential lesson, which is all I can pass on to others now: Empathy reaches where sympathy can't.

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