On this website, I have often posted about mental illness. I’ll keep posting about it, too. Why? Because it is an important, not-discussed-enough, and poorly solved topic that has profound impacts in and out of medicine. It’s also one of the two key areas lacking formal teaching in medical training (Wealth and wellness). Yet, despite my desire to make this a more publicly discussed issue, I was recently seen as making a mental health stigma of someone in my life. Gotta love feeling like a hypocrite.
See, we have a small group of about ten people we meet with weekly. One of them, we can call him Bobby, was clearly starting to show signs of a mental break with reality. He was seeing lights and hearing voices that others weren’t. Bobby started talking about a secret service job he was taking. He also thought people were watching him.
It really was the whole nine yards. This was tough because, each week that we met, his symptoms seemed to get worse with more and more red flags becoming apparent.
Honesty. A set up for Stigma?
I often ask people who want my opinion on something a question in return. [It should surprise no one that I use the Socratic method… I was a philosophy major after all.]
For example, when a resident asks me, “How did that procedure go? What can I work on?” The following is the most likely response out of my mouth, “Do you really want to know my opinion? I will tell you, but I am going to be brutally honest.” This comes with a risk and a reward.
The risk? I might tell you something that no one else will, but that is honest and open. This may be offensive to you if you don’t like constructive criticism. The reward? When I give someone my opinion, they know I really mean it. So, when I say “job well done” you don’t have to wonder if I am just saying something to make my residents feel better.
The most common application of this is in my family life. I don’t tell my wife or kids what they want to hear, I tell them the truth. When my wife asks me how she looks in something and I look at her and tell her that she is beautiful, guess what? She has absolute confidence that she looks stunning. And, truth be told, I married up. My wife is a saint. In every way, she is what makes our life work. And she is gorgeous. That makes it easy to be honest. I am thankful for that every day.
Unfortunately, with Bobby’s situation, this was the first time that I realized that my brutal honesty might be a problem when it came to wanting to help others.
Back to Bobby
Each week we were finding out more information about Bobby and his situation. Unfortunately, this was given to us in piecemeal fashion. We were told that the leaders of the small group or someone with prior experience with his situation would be talking to Bobby. After all, he clearly needed to get some professional help.
Weeks went by and further details began to emerge. We were told that the last time this happened a couple years back, he had a loaded gun available to him in his home that he asked someone to take from him. This time it wasn’t clear if the gun was in his possession or someone else’s.
This now placed my wife and I in a precarious situation for two reasons. The first is obvious, we didn’t know the full extent of Bobby’s history or what he was capable of in terms of his mental illness. He had a gun (maybe)? That was a big problem.
The second problem, which is less obvious but was actually the bigger problem, is that it became impossible for me to talk to Bobby because of that brutal honesty I mentioned earlier.
I suck at pretending, and that’s all we had been doing. Pretending nothing was wrong. If he was complaining of chest pain with a history of cardiac bypass or stents, I am sure we would not have been just sitting there each week waiting for something to happen.
Where does his help come from?
As the details emerged, I knew that he needed help. [Unfortunately, I don’t stop being a doctor when I go home.] That said, it wasn’t my responsibility (or my expertise) to get Bobby help. I was told others would do it, but now four to six weeks had gone by with very little happening.
Bobby was set to meet with a friend who had worked with him when he had his mental health crisis a couple years prior. However, Bobby kept dodging the meetings. Yet every week, like clockwork, Bobby would show up for our weekly small group meetings.
I alluded to this earlier, but just because I am blunt and honest doesn’t mean I offer my opinion freely. Blunt does not equal “giant ass hole.” It means I am honest when asked.
That said, if something is wrong I’m more than happy to be the one to speak up if no one else will. [Yup, you guessed it. My wife loves this about me…] The situation had become a moral obligation to me. In my mind I could either sit through small group pretending nothing was wrong and trust the leadership of the small group to do what they said they were going to do. Or I could speak up and talk to Bobby. What would you do in this spot?
Stigmatizing or Not?
We were faced with an uncomfortable situation. Now that things had peaked, should we go to the next meeting or not?
The first week we had this conundrum the whole group was cancelled. The second week, the leaders decided it was best to continue to meet so that we could show Bobby love and support him through this. That said, Bobby was in an alternate reality and didn’t think he needed help at all.
My wife and I thought and prayed about it. We then decided not to go to small group that week until Bobby received some real concrete help from the leaders who promised it.
Unfortunately, this led the leaders of the group (who we have known for the better part of ten years) to think that we might be stigmatizing Bobby for his mental illness.
What did we learn?
The interesting thing to me in this whole situation was how two different couples could act out of love for someone (Bobby, in this case) and do two completely different things. The leaders loved Bobby by continuing to meet so that Bobby felt included and supported. They didn’t want him to be stigmatized. I think this was crucial for Bobby, and I respected their decision entirely.
My wife and I decided not to go to the meetings because we felt that Bobby really needed help, and he wasn’t getting it. It was also impossible at this point to sit a room and pretend everything was fine and not say anything. We also felt that by going we might not help Bobby at all.
In fact, we feared that we might hurt his chances of getting help. Because, unbeknownst to him, Bobby had an intervention scheduled to occur the very next day.
Fortunately, Bobby ended up going to the meeting. He is in the process of getting the help he needs, though the mental health system in our country (like the main health care system) is broken.
So, it is going to take some time… but at least the steps are being taken. And Bobby now knows that many of us are concerned, which means we don’t have to pretend anymore.
Have you had a tough situation like this? Does anyone you know or love struggle with major mental health problems? How do you love and support them while also making sure they get help? Leave a comment below.