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wundayatta's avatar

What can you do to help someone in denial recognize that they have a problem?

Asked by wundayatta (58357 points ) September 1st, 2009

One of the big problems in mental health is that people won’t comply with drug regimens or any other treatment protocols if they don’t believe they are ill. I know this is true for bipolar disorder, and I guess it is true in other disorders.

This is also a problem with alcoholics or other addicts. Many people don’t think their drinking or drugging is a problem. Yet those around them are feeling adverse consequences—negative changes in behavior that is caused by the addiction.

Do you have any ideas about what other people can do to help a person recognize that they have a problem? This recognition is crucial if a person is going to be committed to working on getting better. Do you have any positive experiences with this problem? Could you describe the situation and what you did that worked?

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28 Answers

Judi's avatar

You really can’t do anything except to stop covering for them. A wife who picks up her husband off the floor and cleans up his his barf helps him avoid the consequences of his choices.
All you can do is wait for them to hit bottom and be there to support them when their ready for change.

AC's avatar

The very brief suggestion is:

Firstly I would stress the importance of the person understanding that my observations are non judgemental and that I only have a positive intention for them. I would then discuss my observations.

Secondly I would discuss that I understood that however disruptive their behaviours might seem that I knew they were only there to get a positive result for the person displaying them.

Thirdly I would try to explore what these behaviours were trying to achieve for the person – or what they were trying to help them avoid.

Fourth – I would support the individual to explore alternative more appropriate methods of achieving the same benefit.

If people have more options without feeling attacked they are more likely to consider changing their behaviour.

Ultimately if the person is receptive you have a starting point. If they are not you could always start with discussing what positive benefit they get from not discussing it (ie not having to face their behaviours/fears for example) and take it from there.

You can’t force a person to change but you can be supportive and non judgemental.

The choice is theirs, I would just try to show them they have more choices than they think.

AC

Bri_L's avatar

That is a hard question. It is so much about what works for them. What will turn on that “light bulb” of clarity. And that is such an individual thing.

For me it was the understanding that not everyone felt the way I did. And that it wasn’t my fault. Once I realized that I thought “well screw this, lets take this on!”

Buttonstc's avatar

The old theory was that an addict had to hit bottom ( as a result of the consequences of their actions piling up) before they would be “ready” to consider getting help.

The problem with that approach is that they died before reaching “bottom”

Current methodology is more focused on “raising the bottom” so that help is accessed sooner.

The best way to do this is with an intervention involving the family and friends who care about them. This is what her family did with Betty Ford.

Some people consult with a trained interventionist; while others just organize themselves. In a nutshell, it involves a combination of lov

Buttonstc's avatar

Dang iPhone. Sorry about that.

It’s a combination of loving and factual confrontation in a united way. This is combined with a listing of consequences and an offer of immediate treatment.

Even tho TV can be a vast wasteland of junk at times, one exception is a program on A and E network called INTERVENTION which provides a good cross section of all different addictions and I believe also bi-polar if I’m not mistaken.

I’m sure there is a lot of info online about intervention as well. It has saved many lives.

Judi's avatar

@Buttonstc I’m glad I’m not the only one whit the iPhone issues!

Darwin's avatar

I wish I knew. Then my son would be willing to take his meds.

Bri_L's avatar

I think that often the issue is comprehension is difficult when your in the situation. I think sometimes when you can liken it to something that the person can grasp and understand and utilize that as a means of teaching by association it enables the person to disassociate the troubled feelings that may prohibit them from making progress.

CMaz's avatar

Usuallly you have to hit the bottom, before you can climb out.

AC's avatar

@Darwin makes a very valid point for me. Being able to disassociate allows for a less emotive observation to be made. If a person can see and have empathy for “another person” and then make the association between themselves and the “other” it sometimes gives them the ability to view themselves with more compassion and hope.

With regard to hitting rock bottom before you can climb up I’m not sure that’s an absolute.

That refers to a persons response to change – away from or towards.

Towards people will focus on moving towards their goal and can start at any point, once they decide to. The hard part is deciding.

Away from people tend to move away from pain when it becomes unbearable. The problem with this style and addictions is that the substance numbs the pain and so defers the motivation to change. Hence why it takes until rock bottom when there is nothing but pain and change seems a viable option.

So, you don’t always have to reach rock bottom but I suspect it is more common to do so before seeing profound change.

AC

Buttonstc's avatar

The main problem with just letting someone hit bottom is that for some the bottom becomes death, especially for addicts.

Bri_L's avatar

I don’t subscribe to the idea that you have to hit bottom before you can climb out. That suggests that the problems are all external and that is not the case. Even if it were, I have read nothing that has convinced me it is a benefit or necessary to allow it to happen.

CMaz's avatar

“nothing that has convinced me it is a benefit or necessary to allow it to happen.”

Not beneficial. Except we learn from our mistakes.
But, seem to be human nature (pride) to avoid facing the truth till you have no other option.

rooeytoo's avatar

Hit bottom is a nebulous term. The bottom can be at any level, depends upon the perception of the addict what the bottom is.

I don’t know what words to say, but the people around the addict or alcoholic or whatever, have to remember the 3 c’s – I didn’t cause, I can’t control it and I sure can’t cure it.

The afflicted individual has to want to stop. I really think alanon helps to teach you what not to do and how to keep the focus on yourself. I didn’t stay there long but long enough to see that there was a lot I could do for me and not much at all I could do the the other.

Bri_L's avatar

But to learn from our mistakes we have to have the right mental capacity and frame of mind. If the issue is part chemical then there will likely not be a way for that to happen alone.

I also think there is a difference between OCD and Bipolor disorder and alcoholism. That is not to put one over the other in severity. That is just to point out that I believe they need to be approached differently.

dpworkin's avatar

Denial, in the classic sense, is a defense. That implies that there is some source of terrible pain or anxiety against which this person’s psyche is building a safety wall.

Once you understand that fundamentally, he or she must be actively suffering, you can reframe the way you look at his or her behavior, and perhaps assist the person in getting some help.

YARNLADY's avatar

After several months of reading the different opinions on Fluther, I have changed my point of view about “helping” people who don’t want to be helped. Adults need to be allowed to choose their own path, and if that leads to self-destruction, who are we to tell them they can’t be there?

dpworkin's avatar

@YARNLADY I’m glad I don’t depend upon you for emotional succor. God forbid you need aid yourself one day, and all your friends assume your attitude.

YARNLADY's avatar

@pdworkin I am available for help for anyone and everyone who askes for it. I expected a response like yours, but I am talking about adults who do not want help. I will not force them to live the life I think they should live.

Buttonstc's avatar

@Bri
You are right that there are significant differences. The original question has addiction and mental illness both mentioned and I wasn’t sure which one the Q wanted to focus upon.

I should most likely clarify that my remarks were directed at dealing primarily with addicts.

And even if an intervention is done, it is still up to the person themselves to respond. Intervention certainly can’t force them. The best it can do is to focus upon the issue and hope that it provides a moment of clarity for the addict to realize how many really do love and care. Hope that this provides the impetus to seek treatment.

Mental illness is another subject altogether.

YARNLADY's avatar

I think @AC said it best. If you are working with an underage person, it is much harder, because the parent needs to take a stronger role in seeing that the child is taken care of. My brother was placed in a residential care facility from age 16 through 18 and they supervised his meds 24/7.

For a parent who is hoping to convince the child to continue his own care when he becomes an adult, the prospect becomes much more difficult. There are several parent support groups to help in this trying time, and they are much easier to find with the internet than they were before this wonderful resource became available.

hungryhungryhortence's avatar

The best thing I found was to feel the difference for myself between when I was drugged up against pain and how I felt and acted when relieved of pain without drugs. I imagine it would similar for a lot of people troubled by different substances- let them experience something positive and phenomenal without the drugs and see how interested they are in pursuing it.

As far as continuing meds, lots of people feel so good that they want to go off of them and then crash badly. I thought it was part of the prescriptions and drug therapy for doctors to be telling people ahead of time to expect these feelings and to be very careful with upswings. Kids are smart and open to learning new things, shouldn’t take but a few times crashing for them to figure out remaining consistent gets the best results out of most things.

hearkat's avatar

Denial happens in other aspects of health care too… every day I see patients whose families have nagged for years for them to get a hearing test. We don’t like to admit our flaws and frailties.

Sometimes I will point out to the family that by repeating and shouting, they are ‘enabling’ the person so they can stay convinced that they don’t need a hearing aid. I try to use humor to help them laugh at themselves for being so stubborn to refuse help.

As for mental health and addiction, it is a subject I know too well. My ex-husband was in denial even after I told him to get sober or get out, and still after he lost visitation until he completed a rehab program. I don’t know if reality ever sunk in… since his liver gave out on him nearly 11 years ago.

I had a subsequent long-term relationship with a man who was not an addict, but he had deep wounds from childhood abuse. He was very introspective, and always said that he could figure his own problems out, all the while he was dependent on me. I’d point out that he obviously hadn’t figured it out, since he was having so many problems, but he didn’t want to hear it, so I stopped trying. Last I heard he had moved several states away, but his 2 kids are still in this area. So it seems nothing sunk in with him, either.

I agree that the best way is to let the person deal with the consequences of their own choices. I see things that I would have done differently in hindsight, and I’ve also applied this as a parent. Consequences are life’s greatest teacher; all the lessons I’ve learned were taught the hard way.

wundayatta's avatar

@Buttonstc What makes mental illness so different? It sounds to me like denial of an illness is pretty much the same thing as denial of alcoholism.

Buttonstc's avatar

@daloon

I guess a lot would depend upon the type of mental illness.

Dealing with addicts is fairly straightforward as the main problem is denial.

Some mental illnesses carry with it a much higher degree of disordered thinking. Trying to reason with a severe schizophrenic can be almost impossible if they are unable to distinguish your voice from the imaginary ones which torment them so.

Also one of my best friends from my college age till now is a couple where the husband is severely bi-polar and there were times in the past ( fortunately not recently) where his wife couldn’t even get him out of bed when severely depressed. And when he was severely manic there was just no reasoning with him at all.

And this is a guy who graduated from Annapolis so obviously had a very logical mind to begin with when not clouded by the severity of chemical imbalance. But most of that was way back when. That’s when treatment for this was in it’s infancy. Once he got stabilized on Lithium and whatever else he really didn’t require a whole lot of convincing to stay on the meds as they eventually had six kids and he was a very devoted and caring Father.

But my main point in recounting that is to illustrate the severity of disordered thinking that accompanies some forms of mental illness which is different in essence from the addict who has that singleness of craving for whatever his substance is and the denial used to support his quest. Apart from that one single aspect, the rest of the reasoning ability is usually within normal limits.

The type of disordered thinking that accompanies the chemical imbalances of some types of mental illness can be much more diffuse and complex.

It’s a little hard to explain but I hope that clarifies what I meant a bit.

wundayatta's avatar

In my experience, the denial for bipolar folk comes primarily in two ways. First, they like their manias so much that they don’t want to lose them, so they deny they have a problem. Even if they admit to themselves they have a problem, they think they don’t need to fix it when manic, and they think it is impossible to fix when depressed.

Second, they won’t admit to mental illness because of the stigma attached to it. They may believe they can handle it on their own, so they don’t need help. They may also not believe it is a condition treatable with drugs. Or they may not believe drugs are anything more than a crutch or a placebo.

In either case, it sounds to me as if it is quite similar to the way alcoholics behave and think.

Schizophrenics may not be all that different. Many bipolar folk get paranoid or have delusions or hallucinations. It can be difficult to separate schizophrenia from bipolar disorder. The drugs that treat them can be similar. I’m not sure their “disordered thinking” is that much different from that of a person who is having a manic episode. They might believe that people who are trying to help them are really trying to hurt them, but that’s still denial, and still similar to denial about other conditions. There’s nothing that different except, perhaps, the excuses they use.

Maharet's avatar

Many moons ago I once called a man who ran a recovery center. He was a nice Christian man and the center was run by his church. I was pretty desperate since I was about 23 years old and my mother had been “out” as an alcoholic since I was 11.

Wanna know what this lovely man said when I pleaded with him for help?

“I can’t help you. She has to come on her own. If she’s not here on her own, we won’t take her.” He then proceeded to hang up on me. I was hurt and so angry, but I came to realize something. I had to start living my own life.

Here’s the thing no one can help you help your loved ones understand that they have a problem. It’s no ones responsibility but their own. What you can do is open your mouth and let everyone around them know they have a very serious problem.

I told my mothers entire family and we will discuss it here and there, sometimes in front of her. She might admit she has a problem or deny it. It depends on her mood, but she stopped getting as drunk at family events. I don’t bother speaking to her when she’s drunk because you can’t have a conversation with a drunk. She’s also learned the hard way only to approach me when she’s sober. My stance on the whole thing is you can be a drunk/addict/bipolar all you want, just don’t do it around me because I won’t be there. It hurts too much after so many years. I’m 36 now.

So try the intervention approach if it’ll make you feel better. Talk to them about their problem. Tell them you will be there if they need you to a degree, but when you’re done doing all the things you can for them and when you see it made no difference don’t feel bad. You did what you could and you can’t do anymore. You might feel like you can, but you can’t. Of course that’s the childs perspective growing up with an alcoholic parent.

If I were a parent dealing with a child…phew…that’s a whole different ball of wax isn’t it? I guess I don’t know…

little8632g's avatar

You cannot show them. They either already know or they need to hit bottom. Its that simple.

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