“I am the prophet Elijah. Shave your head and come to me.” The words over the phone would have been disturbing to hear from anyone but the fact that they came from someone I knew and loved was frightening and caused me to fear for his safety. He was clearly out of his mind. What could I do? I saw only one option. I called the police on my friend.
I had known him for years. He had his quirks and idiosyncrasies and had made more than his share of foolish financial decisions but I had never thought him to be mentally ill. It was when the strange calls and Facebook messages started coming that I knew he was in real trouble.
It began with his impulsive decision to move in with a woman he had just met. He was an avowed Christian and the decision was against all he said he believed in. For him to make such a choice after only a few dates was deeply concerning. It was during that conversation telling me about his new found love that I realized something was seriously wrong. He wasn't making any sense.
His speech was fast and pressured and he darted from one topic to the next. His attitude toward me was unusual as well. He had always respected me and often come to me for advice but in this conversation he had elevated himself to the role of counselor. He repeatedly tried to tell me what was wrong with my life, what to do and where I was off course. The change in demeanor was drastic. It seemed his view of himself had expanded overnight. Halfway into the conversation it dawned on me. He had bipolar disease and he was manic.
When people enter the manic phase of bipolar disease it is almost impossible to reach them. The chemical imbalance in the brain leads to grandiosity, a sense of superiority that makes receiving counsel or advice from others impossible. In his case his grandiosity included hyperspirituality. He claimed that God was speaking to him and giving him remarkable insights that he had to share with me.
I begged him to get help, but he would not, could not, listen. Within a few days he was fully psychotic and standing on the top of his still moving and driverless car yelling at the world to repent. In a very proud Facebook message to me he described how he fled from the police and ran to a church parking lot before being taken into custody. He was placed on a psychiatric hold, but he somehow escaped from the facility and holed up in a local hotel. It was from the hotel that he sent me the message claiming to be the prophet Elijah.
It was months before I heard from him again. He was significantly better but still displayed some of the signs of the disease. He was hypomanic, overly focused on competing in sports and showing poor judgment in finances. I asked if he was still taking his medications. He wasn’t. I asked if his psychiatrist had made the decision to stop the medications. He hadn’t. My friend had decided on his own that he no longer needed the medication. I looked him in the eye and told him as seriously as I could, “You have a mental illness. Your thinking is broken. You don’t get to make this decision. See a psychiatrist and do what he tells you. Period.” He promised he would, but he didn’t.
We don’t talk anymore. In my mind there is nothing to say. I find it hard to engage in small talk when the most important thing in his life, his mental health, is not being addressed. I am like a broken record to him, saying the same thing over and over, “See a psychiatrist, see a psychiatrist.” I mourn the loss of relationship but must accept there is nothing I can do.
I recently had a patient come in who was eerily similar. I had seen him three years earlier and diagnosed him with bipolar disease in the hypomanic stages. Remarkably, I was able to get him to see a psychiatrist. One he started to feel better he took himself off of all of his medications. When he came back to see me it was for a skin condition. He was quite surprised when I declined to treat the skin problem until he saw a psychiatrist. I told him what I tell all of my patients who refuse my recommendations, that bad medical care was not an option.
“You can get bad medical care all over town but you can’t get it here, " I said, "In this office we do what is best for you.” As I had with my friend a few years ago I explained that he could not allow broken thinking to guide him in making decisions about his health. Because of his disease he needed to listen to an expert who had his best interests at heart. I reminded him that although he felt normal now, once the disease turned into the manic phase he would be unable to listen to medical advice. He had to see a psychiatrist.
When I think of these stories I think about how we all do this to varying degrees. We place way too much confidence in our ability to figure things out. Our marriages can be falling apart, we can be struggling at work, battling to stay sober or dealing with anger but we don’t seek counsel from those who can help us. We think we can do it on our own and we trust our own broken thinking to guide us. How foolish we are.
It takes incredible effort and humility to ask for help but that is the path to success and health. I came to grips with this myself 5 years ago when anxiety disorder and panic attacks invaded my life. I swallowed my pride and went to see a psychiatrist. I remember how freeing it was to say, “Tell me what to do.” It was hard to trust and put myself in someone else’s hands but it was necessary and it was a turning point for me.
Would that we all learn this lesson. Often the road to wellness begins by simply asking for help.