Q: Asks for Advice in Helping a Friend - a Complicated Situation
My best friend of 7 years was recently released from a 7 day psychiatric
hospital stay. She was given conflicting diagnoses. She in general
is an overly dramatic person. She landed in the hospital after being
alerted by medical professionals that she was bringing her 4 children constantly
to the doctor for real and imagined illnesses. Her children miss a lot of school
due to pinworms, lice, chronic urinary tract infections, and general poor
health. Her house is very filthy and unhygienic. She has 3 cats that eat off
the tables and counter and she will proceed to feed the children that same
food. I have been called to her house on several occasions because she is
suffering from another "so-called" demonic possession.
recently took her to a pastor who believes in demonic possession. He came to
the same conclusion that I came to. She is faking these episodes in some sort
of attention getting ploy. She insists that she was sexually abused by her
father throughout her childhood. She insists her mother knew of the abuse and
did nothing to stop it. I have met her mother and spoken to her father on
finding the allegations difficult to believe. I would never tell her that
because I feel to do so would cause her greater harm. In the last 2 years she
has babysat a few children. She is now accusing two 9 year old girls, she cared
for, as sexual predators. She called me yesterday and informed me that my 13
year old son is also a sexual predator. I asked her what my son had done to
make her come to this conclusion. She could give me no instances of any sexual
misconduct, but she remained firm in her belief.
When released from the hospital she was put on the medication Zoloft and she
seems to becoming more dramatic and delusional. I love her very much, but I
feel I must keep my distance. She pulled my son aside the other day and
basically accused him of being a sexual predator. My son was extremely confused
and hurt by her words. I cannot tolerate that no matter how much I care for
her. She basically appears to be a very sweet, kind person who uses
passive-aggressiveness as her weapon. ie "I'm only telling you these things
because I'm your friend and I care". She has torn apart her parents and brother
with her delusions, and dramatic attention seeking.
want to help her, yet I must protect my family as well. Please advise me in how
I should proceed. Should I keep my distance or dig in my heels and stand by her
Dear Sandra --
Whatever is going
on here, it is quite complicated. You have made that quite clear. Therefore,
it would be inappropriate for me to give specific recommendations, because there
is too great a risk that I will miss some part of the complexity and therefore
give poor advice.
As I think most
mood experts would agree, much in the story here does not sound like "bipolar
disorder". Only at a considerable stretch of the concept, and perhaps with some
active imagination, might we find these behaviors suggestive of bipolarity. On
the other hand, getting worse on Zoloft is certainly consistent with the current
conception of bipolar disorder. So it might be best to proceed assuming that
there are two things going on: a pattern of behavior which is unacceptable and
potentially quite damaging to others, from which it would seem reasonable --
from your explanation here, at least – to keep your son from further exposure;
and also a possibly treatable mental illness which could account for part of the
problem, perhaps even much of it, but probably not all of it.
Taking her to a
pastor, looking for help, was a very kind thing to do -- especially when dealing
with your friend must be quite difficult at times. While continuing to protect
yourself and your son by maintaining an appropriate level of distance and
separation, if you can manage, it might help her to seek yet further psychiatric
assessments to see if they begin to coalesce around a particular point of view.
For example, if she were to be interviewed by another mental health
professional, would "bipolar disorder" be invoked again?
Of course, this
is tricky. As you know, bipolar disorder has become a controversial diagnosis,
with many people who think that it is being "overdiagnosed". Ironically, we seem
to have reached a stage where a person's diagnosis might depend more on whom
they see, than on what they actually have. That is sad but sometimes true
nowadays. However, when multiple mental health professionals begin to agree,
even if there are one or two contrary opinions, that can begin to suggest that a
particular diagnosis is warranted.
was willing to give your friend Zoloft. And it sounds like she was willing to
take it, at least for a while. One can wonder what might happen if she was
given something like quetiapine, which has antidepressant effects (presumably
the reason she got Zoloft), but also antipsychotic effects. Might her concerns
about "sexual predators" decrease?
(If she did
indeed seem to improve substantially on quetiapine or something like that, that
still does not mean that she has "bipolar disorder". There are other conditions
which can improve, which might also cause a person to have intense beliefs about
"sexual predators" -- such as "posttraumatic stress disorder", caused by sexual
abuse experienced as a child, for example).
medication like quetiapine has substantial short-term and long-term risks, so we
generally do not use it unless we can establish a diagnosis which warrants using
such a medication. Almost a Catch-22 here.
I hope that
something in my reply here may prove useful to you. Good luck with the
Published July, 2008