Asks for Advice in Helping a Friend - a Complicated Situation
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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.   

I 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 several occasions.   

I'm 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.   

I 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 side?

 

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. 

Finally, someone 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). 

Unfortunately a 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 situation.

 
Dr. Phelps




Published July, 2008
 

 

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