I'm very sorry to hear that your friend is experiencing this crisis and the distress it's causing you. I've been through similar episodes before, first with an immediate family member who experienced a months-long manic episode that was later diagnosed as manic bipolar disorder, then a close friend who experienced a drug-induced psychosis which evolved into long-term schizophrenia. I know how hard it is to watch someone you love behave erratically and how powerless it can feel to try and fail to help. Here's what I learned...

The most important thing you can do is take care of yourself. Your own physical and mental health are prerequisites to caring for anyone else and being a part of extreme psychological distress of someone you love takes a huge toll. Lean on whatever practices you already have to stay healthy and content. Remember that what you're witnessing is not your fault and not in your control.

The best way I've found to be supportive are to be present as much or little as I can without compromising my own being. Intervening, escalating, and trying to reason with people in this state seldom has the intended effect and often has the inverse effect. As much as you're able, accept your friend for who they are in this state, listen without judgement, and validate their experience without cosigning it. Stay in touch with their family and close friends and work together to seek medical intervention if they risk the well-being of themself or others.

I'm here if you want to talk about it on a call or over email. Same handle at gmail. Be well and keep reaching out for support.

I would add to this trying to find other people who know your friend and can help. Ideally local, but if he has friends who he trusts that he can talk to over phone/video that works too. Get their connect information. It sounds like this is beyond what any one person can handle on their own, but you are in a unique position to connect him with further resources, in general and during acute crises should they happen.

Also know that 988 is now the nationwide suicide hotline number (in the US), and that you can also use this resource for yourself to deal with your friend's situation. Look up nearby crisis centers and save their info.

Lastly, for me 'take care of yourself' means talking about the situation with trusted friends and family. There can be a tenancy to treat kinds of things as taboo, but open discussion and outside perspective can be extremely helpful.

I like the 988 advice. I'd take it a bit further... consider getting professional help (counselor, therapist, etc.) for yourself as well, at least temporarily.

I see at least two angles where this can be beneficial...

One is getting guidance on how to keep yourself as mentally healthy as possible while going through something so difficult. This is at the heart of the ideas I'm responding to above... you have to stay afloat to have any chance of helping. If you've ever been on a commercial flight, you've heard "Put on your oxygen mask before helping others with their masks." The right professional can be a big help.

Another is that a professional will be able to give you guidance about what you might be able to help your friend with, and things you probably shouldn't try to help with. Professionals have seen a much broader spectrum of situations and have a better idea of where they themselves might be able to help (or not) and where a layperson may be able to help (or not). And they can give you ideas for things to try that might help your friend while exposing you to less risk of harm.

You're taking a smart step by asking for advice. In my experience, a professional often has the best advice.

As someone who has been on the opposite side of this scenario (diagnosed bipolar) the best thing your friend can do is get professional help. Since he’s refusing that, there’s not much you can do other than taking care of yourself and trying to minimize the damage from his episode. You won’t be able to talk him into it. He has to come to the decision that he wants to get better himself.

There’s a good chance he will get worse before he gets better. He may become a danger to you or himself. If he has never been diagnosed with a mental health issue he may blame you for it as you forced a confrontation with reality when you called the crisis line.

If you really wanna play psych nurse (which you will eventually be forced to if you continue living with him while his condition is untreated/unmanaged)start by declaring your home a drug and alcohol free zone. If he has a taste for them he’ll probably go get them on his own anyway, but increasing the barrier to access decreases the risk of other life altering mistakes. Try to make sure he eats enough and stays hydrated.

My recommendation would be to give him an ultimatum: he gets into some kind of treatment or you go your separate ways. It doesn’t have to be psych care. I found going to a support group incredibly helpful when I was first coming to grips with my disorder. Before I found a specific group for bipolar I went to a couple AA meetings even though I wouldn’t call myself an alcoholic. Being with other people and watching them confront their demons can often make it easier to start facing your own.

You are a good friend and it sucks your friend is going through this. But if you are not a trained mental healthcare professional you are not equipped to handle this.

Addressed to GP.

This resonates with my experience. When a friend is having their first manic episode, it’s hard to get them to recognize that and get the help they need. But after the aftermath of a couple manic episodes, my friend wanted to get help. Even when he had a hard time complying with meds, he was able to recognize when he was heading into another manic episode and get help proactively.

My friend’s family do a few things to mitigate some of the bad decisions that a manic episode brings on. 1) the family has location tracking, 2) the family can pause credit cards, 3) the family can take away car keys.

I don’t expect any of those mitigations will be able to be implemented today in your case. But if your friend is currently going through a bad manic episode then they will probably want to prevent future manic episodes from spiraling. Having a conversation about how to achieve that, and having a mutually defined set of warning signs, will help address the problem.

Yeah seconding this advice. If you really want to help someone who struggles with this, long-term help / working them on strategies to avoid escalating mania & exacerbating it in the future is the highest impact form of help.

Don't agonize over how to handle the situation in the moment too much and don't take anything they say seriously or try to make any decisions, just keep them from hurting themselves and try to steer them towards medical help to the best of your abilities.

Sudden onset mental health problems can have a physical cause. It's very important he have a thorough medical evaluation.

Find the best place that you can to do the eval, and absolutely insist that they do a very detailed workup. A lot of doctors are dismissive of mental health issues. Find a good neurologist, and then push, push, push to get this done.

If you make it happen, you'll be the best friend he could ever have.

For adults a lot of this depends on the state/country you reside in.

For example it is generally much harder in california, unless there is a "danger to himself and others" (which the suicide note actually HELPS with).

It is important to start treatment promptly. You did the right thing.

Also, independent of location, many people with mental illness have a corresponding condition called Anosognosia, which is basically a lack of insight into your own condition. It works kind of like denial.

https://en.wikipedia.org/wiki/Anosognosia

A book that can help communicate with someone with mental illness is

I Am Not Sick, I Don't Need Help! by Xavier Amador

(the author's brother had schizophrenia and communicating is challenging, although the book really helps)

You can pass this on to his family. It is really tough to navigate through this if the person is not cooperative.

Does he do experimental work? Something that progresses so rapidly almost makes me think that a chemical used in work could be having an effect. Anything Heavy Metals (Lead, Mercury), that kind of thing.

He does work in a lab with serious compounds, but I have since been told by a member of his crisis team that they know about previous (relatively minor) mental health incidents in his past. I was completely unaware of this, so I am assuming he has dealt with this on his own for a long time, until he was unable to anymore.

I am near certain he is not a drug user either. I have never seen any evidence of this, and in my experience drug addicts are not very good at hiding it when they lose control.

Also, I contacted his work abbout his absense (without details) from my own phone. His colleague (boss?) called me back because they were already concerned about him late last week at work. If they suspected something concerning the work they do, they would have told me or the hospital.

> in my experience drug addicts are not very good at hiding it when they lose control.

Addiction takes a lot of forms and its very likely you know people that are good at hiding it.

I'd spent my childhood around alcoholics and was confident in my ability to see addiction, only to be confronted with someone close to me going off the rails after years of completely hidden amphetamine addiction. Sometimes you really don't know!

> in my experience drug addicts are not very good at hiding it when they lose control

Not sure if it's relevant, but psychedelics (mushrooms) broke a college friend after minimal recreational use. Like, maybe twice, with zero past history of any other controlled substance.

His delusions were similar to what you described. In hindsight, I wasn't qualified to handle his deeply troubled mind.

You did the right thing contacting family and seeking professional help.

If he harms himself, it's not your fault.

got a real mad scientist here, haha.

could it be possible though that prolonged exposure to chemicals excacerbated his preexisting conditions?

Yeah mercury was my first thought too

Stresses can push someone over the edge too. We did just have a US Presidential election.

Thankyou all for your help.

It is becoming clear to me that this is way above my pay grade.

I understand that my non-professional help may even make things worse.

He has agreed to let me visit him in hospital today before he is discharged, but I fear he is not yet in a position to see things clearly for himself.

I will likely have to move.

If they've had a previous episode and have lived with you for 5 years without incident it sounds like they are able to successfully manage whatever underlying issues they have, with the exception of this acute episode.

> I will likely have to move.

Much higher probability then the week before but I wouldn't rush to judgement. You don't want to be a live-in care taker but maybe this crisis was just a manageable bump in the road. Although, don't expect them to be completely back to baseline when they are discharged.

Personally I think OP should move. A housemate relationship isn't a marriage, you don't need to stick with your housemate through thick and thin, and you need a safe home to rest and recover in. Sometimes people going through psychosis can do very strange and unpredictable things; not only is it stressful but it can become dangerous. I'm not saying it will, but at least taking the step of not living with the person seems prudent.

If the situation remains in crisis I completely agree, I just think that may be a premature decision because the roommate has been successfully managing their issues and leading a normal life the last 5-10+ years.

To me there doesn't seem to be much downside. Moving can already be difficult and stressful, but if things get worse or continue to be bad OP will have to deal with that while dealing with the accumulated stress. If things are better for a short period that may be OP's ticket to have some breathing room and get out. If OP does move out, they can still remain friends and have a good relationship. People move all the time for all kinds of reasons.

Don't sugar coat it, he would basically be ending the relationship. It will also force the roommate to figure out a new living situation on top of all the other things: Working on stabilizing, Hospital Bills, Job Loss, dealing with shame/stigma in their friend group. This is part of why these things snowball downward in a positive feedback loop.

If it's going to be a chronic ongoing issue, I agree that OP should move out.

Yeah, the finance thing is what bothers me thinking about OP moving out. I hope his family can help him because if he’s visibly mentally unwell, poor guy is gonna have a hard time finding a new flatmate. It’s just a sad situation and I feel for both of these people.

Please give us an update here if you can! Stand strong.

Unfortunately when it gets really bad, like this, there is just not much you can do. Calling the crisis team sounds like it was appropriate.

I wish there was some state-sanctioned response in between "please go see a doctor/please take your meds" and "you are now going to be involuntarily committed for possibly forever, hope you like your life getting ruined if it wasn't already". But around here, at least, there is not. Those are your choices, and it is very, very painful.

Apparently some regions have crisis intervention teams (e.g. Los Angeles through 988) that can be "hands on" / use limited physical coersion without involving police or going full 5150. Even if they do help in the moment though, what happens after they leave? I agree there's not nearly enough options for support on the 3~12 day timecale.

The most you can do for him is to take care of yourself so that you are the best version of yourself if he reaches out for help. In the meantime, staying in contact and having normal “how’s the weather” conversation is important, so that you are not talking about the serious stuff every time you talk, and so that he doesn’t feel like you are cut off from him. Lastly, Al-Anon is very helpful to folks who have loved ones with mental health issues, not just alcoholism, if I were you I would try that out as well. I have an uncountable number of people in my life who have benefited from various 12 step programs.

It's hard to give generic advice but it sounds like calling the crisis team was a good decision.

One thing that generally helps is to get the person talking (and don't offer them advice - listen and help them talk things though themselves).

I've found going for walks with people is good. Can you take him hiking?

I have no expertise in this, but the first thing I would do is to call an expert on the topic that deals with such situations frequently.

Many countries have suicide helplines (both public and private). For example, googling "suicidal friends helpline [yourcountry]" returns for the UK:

https://www.nhs.uk/mental-health/feelings-symptoms-behaviour...

While many of these pages and helplines are targeted at the person going through the breakdown, I imagine they will also advise friends and family, and some pages are targeted specifically for them, for example this result (I have not read the full contents yet):

https://www.rethink.org/advice-and-information/carers-hub/ge...

> I imagine they will also advise friends and family

They will definitely advise friends and family, although they may not have the proverbial silver bullet.

I'm sorry this is happening to you and to your friend. I have some similar experience and want to share some advice I wish I had heard earlier.

It sounds to me like you did the right thing - situations like this can get worse if left unchecked and have serious consequences for the person in question and those around them. I'm not diagnosing your friend - I'm no expert, and various disorders can have those symptoms - but there are resources out there about (e.g.) mood disorders [1] that might give you some perspective and advice.

Treatment can help, and can make a huge difference. Hospitals are unpleasant but can sometimes be the only way for someone who needs treatment to receive it. I am certainly no legal expert, but I think if he was forcibly committed to a hospital and police were involved, he's unlikely to be released without accepting treatment.

You might find it helpful to join a support group for caregivers (e.g. [2]). In my experience it's common for friends as well as family members to attend those. People will offer resources and advice, as well as just sharing their experience, which can provide perspective and help with feeling lost.

Also consider (if you're not already) finding a therapist of your own. People in one of these episodes can push boundaries, say things to you they wouldn't normally mean, and generally be hard to be around while maintaining your own health and boundaries - particularly if you're invested in trying to help them.

[1] https://www.dbsalliance.org/education/ [2] https://www.dbsalliance.org/support/chapters-and-support-gro...

That is the part I do not understand. I have never agreed with any health professionals to be part of his ongoing care. I suspect his family may have done so, but are abandoning their responsibility?

He had agreed to let me visit him in hospital very shortly, before he is discharged. I intend to make it very clear to the staff that I have not agreed to have any official role in his ongoing help.

You're right, you're not his caregiver, or obliged to be. Sorry if it sounded like I was suggesting that.

I doubt the staff would expect or pressure you to take responsibility for him. If anything you might have trouble getting them to even discuss his case with you - different states vary but in some cases they won't share case details without explicit permission from the patient. (If that sounds frustrating given your first hand experience of his symptoms and their progression - I sympathise.)

The support groups in particular may be useful despite that, just because you mentioned he's a housemate, so he may continue to be in your life. When I attended there were spouses, parents, but also just friends who wanted to help out their friend and understand what they were going through, without adopting responsibility for them.

Violently extracting the man from his home demands sincere apologies. Without that, and if you choose to focus on your own wellbeing as so many suggest, there is no reason for him to trust you, or his own security. Water, food, shelter, clothing, and love are not bargaining chips to get someone to comply with medication, they are necessities and much more fundamental to mental health than pharmaceuticals with indeterminate effects.

To add, I understand GPs story and appreciate them for sharing.

Finding themselves in an unmanageable situation I understand they are not directly at fault for the use of force, but the roommate still deserves an understanding apology from the person close to them who escalated authority.

Since he refuses treatments, I recommend he quit everything except sleep, diet and exercise until he can respond normally to normal conversations, and suggest utilizing motels.

It was the mental health crisis team who made that decision to remove him. I don't think it's fair to blame OP - who presumably called out of concern. If that is your take then you are suggesting that nobody call for help in a mental health crisis for any reason, which I don't think is a valid take.

The straw-man invalid take is not really helpful to a shared living situation. Why not apologize for the consequences of the concern? New events can be a call to renew agreements.

Agree with this - calling the cops on him is a harmful action even if the intention was a positive end result. If this is in the US, you just pointed violent people with firearms at your friend, and asked them to use violence against him. I would never trust someone again who did that to me.

Hang on, op didn’t call the police, they called a crisis team who are trained professionals.

Those professionals, for better or worse, chose to include the police.

we all know cops come with these situations, it's effectively the same thing, it's more that the crisis team came with the cops.

I thought the same thing, why not calling family first and let them provide help...

What country are you in?

Sometimes actual medical issues can cause psychosis, e.g. UTIs (Urinary Tract Infections) or brain tumors. Getting him into a safe environment was the correct thing to do. If he returns and you don't feel safe then getting yourself into a safe environment is the correct thing to do.

Others have rightly warned about taking on too much responsibility for your housemate, but I think there's more room for nuance as to whether becoming nursemaid is 'inevitable' or other such suggestions that it's immediately time to move out or whatever. Other commenters suggesting ultimatums (ultimatums are the worst way to deal with any personal situation imo) or that you'll end up embroiled in being his carer are a bit reactive, or maybe extreme?

That said, if moving out is what you want to do, that is absolutely what you should do, 100%. You don't have to justify anything about that decision to anyone.

If your housemate has been great for 5 years and you've been friends for 10, and if you are happy with your living situation and could see yourself still living there with him when he's stabilised, setting some boundaries around when you will contact his family or the crisis team like 'I will call the crisis team if I see you getting worse over the weekend again' (for example) can help you draw the line of what you can cope with and what you can take on. It can free you of having to make those tough decisions in a crisis again. It doesn't have to be you becoming his carer. Coping with this doesn't necessarily have to blow up your living situation or friendship, though, and I think that there's possibly options to explore for how you move forward and look after yourself than becoming his carer or moving out. Do what is best for you.

Good luck with it, and look after yourself!

I've had a few moments like that, it's not a pleasant thing to be around.

In that kind of mental breakdown, you get addicted to the story you build in your head, where you are special and important and on the verge of something great (but also worthless and doomed).

Healing means giving that up and returning to baseline, and you can't do that for him. Protect yourself first

I've been on the third side of this story -- the emergency responder side. Just wanted to say, thanks for looking out for your friend and housemate and making a difficult decision. No one can truly say whether it was the right or wrong thing to do, that's just not how life works.

But I can say with certainty that I've turned up to situations like you have described, and while it's not a pleasant thing, much worse is turning up because someone has died by suicide. And in that situation it might be someone like me calling his family rather than you. Everyone in that situation wishes they had said, or done something, or seen something, or had the opportunity...

So, though I am entirely uninvolved, thank you.

Get out of this situation ASAP. If he is refusing the treatment he needs leave it to his family. Look after your own well being.

If he's suicidal, he could become homicidal. The first time my family experienced a manic psychological break from a cousin we just stayed in the house with him after a brief psych hospital stay. He then had some sort of further hallucinatory break and he was racing around the house -- literally like a mad man... very heart breaking... We called the cops and had him committed as we really could not take care of him at all and him running around like a crazy man could get _him_ shot by the cops. After he got help, was diagnosed bipolar, and was on his meds, he told us what his hallucinations were and the story in his head was that we were threatening his family -- that will turn most men homicidal, so we were very lucky.

That must be a difficult situation, and you're a good friend for trying to help. I've only had a few brushes with similar mental health issues in friends and family, but in the worst situations it was necessary to get professional help, such as police, hospital, community services. (Police as the last resort.)

This is beyond what any well-wishing friend can be expected to do. I think you need support from other people with experience in the matter. It sounds like your friend needs psychiatric treatment, probably medication. Maybe hospitalization until things are stable.

When people's brains run low on energy (ATP) they start to exhibit 'mental health' symptoms - depression, psychosis, etc. Sometimes a person just needs a better diet and they'll snap out of their spiral.

Chris Palmer MD wrote a book [0] about how he discovered 70+ years of research establishing that mental health conditions are caused by metabolic deficiencies. Dr. Palmer's book documents his patients responding well to a ketogenic diet, but there are plenty of other interventions that can improve metabolism.

[0] Brain Energy - https://brainenergy.com/

Emotional stress is a significant drain on the brain's metabolic outputs (more stress -> more need for ATP).

My friend has the genetic condition where she can't turn the provitamin folic acid into L-methylfolate (vitamin B9). Folate deficiency is associated with alcoholism, but not all mental health conditions are connected to substance use/abuse.

See my comment history. [1] is my somewhat recent comment about the mental health industry, but it's currently flagged/dead so you have to be logged in to see it.

[1] https://news.ycombinator.com/item?id=41417823

Getting seriously involved in changing someone else's life will incur major loss to your own. I'm speaking from several rounds of experience. It's not to be taken lightly and it's not an automatic moral duty. I would strongly argue that your duty is to make a full bodied effort to convince their family that their own is in mortal immediate crisis. If they don't respond to that after it's clearly and emphatically communicate then it's on them. Sadly your friend is almost certainly not going to seek out professional help unless someone intimately intervenes.

I’ve been in a very similar situation and the advice I’d give myself back then is to seek psychological support for myself from the beginning, preferably a good therapist to help navigate this. It sounds like you’re making solid choices (and the same we made at the time) but you don’t control the outcome of this situation. It was the hardest thing I did in my life, best of luck to you.

1) Understand the limits of your ability to help. Your local MHMR may be able to advise.

2) Rule out the obvious - drugs. Very unlikely for an abrupt psychosis without any real history. His family may be able to supply history you are unaware of.

3) Helping people who do not want help (regardless of need) usually does not go well, in the end.

4) Let the professionals do the heavy work - your job is to be a supportive friend.

Look up the book titled "I am not sick I don't need help! How to help someone with mental illness accept treatment" by Xaviar Amador.

In a nutshell, the key is not to insist that your friend recognize that they're paranoid and suffering from delusions. You can't win that battle. Instead, get him to see that he can alleviate some of the immediate problems he's currently encountering (with work, family, doctors, you, etc) by getting an evaluation and medical treatment. In other words, to motivate him to get help, you might have to entertain some of his delusions to a certain degree. You have to play his mental game, until he (hopefully) gets treatment or medication and begins to see things more rationally.

If the two of you are not on speaking terms, find someone that he trusts and is willing to talk to, and get them to try this strategy.

This helped me when I was trying to convince a loved one with severe mental illness to make certain decisions about getting assistance and medical care that they were very resistant to.

Good luck. This is a very difficult and stressful thing to deal with, and as many others have advised, you should consider seeking support for your own mental health as well.

"I'm not sick I don't need help" was a very useful read at one point. A key point I recall is the importance of avoiding taking an adversarial stance and maintaining trust.

I'm sorry this is happening to you and I know all too well how distressing it is to be a compassionate onlooker in an event like this.

Something similar (although likely less severe) happened to my wife in a not too distant past. More or less from one day to the next she started feeling very very unsafe, thought people were after her and conspiring to take away our child. She started writing protective symbols on the walls and doors of our house and felt she was talking to ghosts. I would find her yelling at passersby from our flat window. No one in her life, including me, felt like a safe person anymore.

To me it felt like this foreign power had invaded our life and started ripping everything to shreds. I honestly have never been so stressed in my life.

Luckily we did find our way out of it. My wife was on ADHD medication at the time (dexamfetamine) and we had been going through a rough time our marriage. Covid had just happened and we had a 3yo son. I think by the time she started developing delusions she probably hadn't slept well for months.

Her mother came to live with us for a couple of weeks, we stopped the dexamfetamine and we focused on just making our life as low stress and loving as possible.

I am honestly so grateful that we managed to navigate our way out of this together and that we are fine now. I can't give you much by way of advice. The position you are in is unfair and whatever you do to help your friend is commendable.

One thing I realized is that once the human mind is stressed enough it becomes a sort of runaway nuclear reactor, stuck in a cycle of every more stressful thoughts. The kind of behaviors you will see in that situation are hard to witness, and the best thing you can do as a friend is to provide safety, even when the other person sees the opposite. Living together with this person might not be a workable or safe situation for you or for him, and unfair as it might be you might end up in a position where you have to make this call. Your friend might see this as a betrayal. Be compassionate to yourself and your friend in this moment. Know you are trying to make the best out of an impossible situation. Understand you are not in control and that you are afraid to do the wrong thing and that the fact that you feel this way is what makes you a good friend. Best of luck!

I've seen something similar happen before. If it's severe, then it's out of your hand.

But anecdotally, here's something that's worked for people who are still, for the lack of a better word, sane. So everything from here assumes there is an external (work/people/existential) cause, and not an internal pathology (BPD, Schizo, Brain Tumor). I'm also assuming that both of you have a requisite level of intimacy as friends & that this isn't a drug use problem.

My solution: Take a long walk with him.

I mean a loong walk. Ideally on a quiet night, lasting 5+ hours.

You can't pull someone out of a spiral, but a person can pull themselves out if given enough space & time. Anecdotally, you stay quiet and let the silence build up for the first hour. Eventually, the person starts talking. They'll spend the first couple of hours rambling with only a couple of hints interspersed. Don't pounce on anything, but prod them in the direction of those hints. Soon, they'll start circling around the real issue more aggressively and if you're lucky (FWIW), that's when the levee breaks.

I'd say it's the norm for men to cry at this point. I mean, if it causes a mental breakdown, it's big enough to make them cry. If you reach here, then be very gentle here on out. This person has revealed their softest underbelly. Everything here on out should be unconditional support. Have a seat. It's easier to talk when you're walking, but it is easier to cry seated. Liminal/transitional spaces (train stations, over passes, tiny parks) are the best.

At some point, the tears dry out & some degree of catharsis is achieved. Then, they're ready to walk back again. This is where you can starting looking at optimistic change : how does the person get out of this mess ? Keep this uncomplicated. Give them a simple & optimistic conclusion to cling onto for the next time they spiral. Outline the first step to mark the beginning of a way out. And explicitly give them permission to call you anytime/anywhere if this happens again. If you're lucky, the sun will start rising, the city will begin waking up, and optics of a new-day will give them another soft push toward optimism.

I know this sounds cliche, but cliches are just validation that something has worked for hundreds of years.

This comment is great: I imagine it's what a therapist would do, but therapy is ultimately time-limited and clinical.

Also note that if you are aware enough to be able to introspect (and not in physical danger to self), using ChatGPT for this purpose works really well. You can talk about whatever, and the fact that you're not exposing yourself to another person can help those who are more reserved. Its advice is actually pretty sensible, non-clichéd, and fairly tailored to your situation.

I recommend he get sober; no drugs or alcohol. Eat plenty and sleep plenty.

He should follow the advice of his doctor however the medical profession tends to treat most psychotic episodes as wholly delusional.

If he denies any validity or even the existence of this episode in order to recover he runs the risk of treading the same path and risking another episode.

There can be insight in these episodes but it requires some recovery to see objectively. I suspect he could know what caused the episode but it may be suppressed into his subconscious.

It's a life's work to integrate. Therapy can help. Meditation can help (with the caveat that if you get serious with practice it can trigger another episode).

Ultimately if I was you I would consider moving out. Depending on how much support he needs in this time it may not be a role you are prepared for or should be expected to take on.

Remind him of his good qualities and it will always be beneficial.

Advice my own. I'm a fallible human being.

That's a tough call, it's scary because of the surprising nature of it. My first encounter with this was a close friend I'd grown up with and who was also seemingly quite intelligent. He'd had one violent incident in the past involving weed that triggered some kind of psychotic episode that was waiting to happen, and then nothing for many years, until he started down this paranoid pseudo-science veganism and yoga cures all diseases, fasting, breatharianism type direction. Apparently there was more happening that I didn't see, started keeping weapons around, lots of psychedelics. In retrospect, he was almost certainly schizophrenic, ended up attacking someone during a psychotic episode and unfortunately his life ended early and dramatically. After that, some of the signals became harder to ignore, and noticed that another more distant acquaintance started repeating similar things as your friend, except on LinkedIn of all places. Many delusional, spiraling paranoid posts of grandeur (not in the typical weird way everyone does on that platform), describing the government coming to get him after he isolated in the countryside. I think he's fine, but reported him so his reach was limited.

Personally, I'd get out and try to at least temporarily part ways on good terms, not necessarily forever. Depends a lot on vibes. It's tough.

In the US there just isn't the infrastructure to deal with this. We used to have places people could be committed to against their will so they could get help. The few places like this that are left can't function effectively due to being overloaded and are more like the county jail. Now these people end up homeless or die.

Not to this degree, but I would certainly draw the line of assistance if he gets violent or threatening. Someone that is rapidly at that stage toward a close friend is not in a mental state that is salvageable unless you have experience or are a mental health professional. I would personally begin to move possessions of value (sentimental or otherwise) to a safe place like a storage locker, away from any outbursts and look to find an alternative place of residence if things get worse. Probably not the interventionist kind of answer you want to hear, but your priority should be protecting yourself.

This sounds similar to Schizophrenia although a medical examination is required. Whether your friend is intelligent or not, hallucinations are a medical issue and they can affect anybody as our understanding of the brain is limited.

I’d start looking for a new accommodation or a way to kick him out. As harsh as this sounds, mental health issues are extremely taxing. I’d not be responsible for anyone like that unless it’s very immediate family members.

i have experience with psychotic episodes in my family and partner, and unfortunately professional intervention is the only thing that can actually help. there is absolutely nothing you can do to help him or snap him out of it, all you can do is try to limit what he can get his hands on that he could do any damage with.

as shitty as it is, the best thing you can do is get out of there so he doesn't drag you down with him. you will burn out fast if you try to run around after him and take care of him. i'm not exaggerating when i say that it will ruin you. the only thing worse than dealing with a crazy person is dealing with a crazy person who is smarter than you. you can't help. if things get worse, it wasn't because you "didn't do enough". he needs antipsychotic medication and professional help and you can't provide that.

i hope you both end up being ok.

How old is your friend? It sounds like Schizophrenia. For men it most commonly onsets in their mid 20s to early 30s from what I have heard.

This reads, lightly, like a clinical psychosis situation, presenting a kind of mania with delusion. It can have different diagnoses, of course. As I understand it, there is _almost nothing_ short of medications that will deescalate it. There are people who manage their reality breaks successfully without.

Calling the professionals is 100% the right thing to do. I would also move unless you and he commit to you being a live-in psych nurse. I don't recommend it. I would not break contact, but this is a sharp gap in shared reality that is going to be very dicey to live in the same space next to.

I have lived with a family member with very serious mental illness, and it is no joke. I do not recommend without a major personal commitment.

There are good/safe/powerful medicines that can cure most psychotic episodes. Best Wishes to you both.

As a quick fix, if you don’t think you can help the situation (and there no reason for you feel like you need to fix anything) if the roommate comes back what I might do is take a impromptu vacation, or crash with a friend for a week.

You have alerted his kin and the authorities. You did the right thing.

I've been on both sides of this...

First you need to care of yourself. First and most importantly, your needs emotionally and physically come first, always! Draw those boundaries and fiercely defend them. You can't help anyone else if you're not taken care of.

Second. Every one, married couples, you name it, we are all flying our own planes. You can radio someone and offer assistance, you can offer to lead. But they are flying their own plane. And if you try to fly their plane no one will be flying yours and it will crash.

Your roommate needs to see a doctor. Anxiety, depression, cptsd, whatever is going on.. his brain is doing that because it has worked as a defense mechanism in the past, and because he's still alive his brain is going, 'well keep doing that, it works, see we're not dead." And that's the thing. Your brain doesn't give a shit of your happy or horribly depressed, it is just doing what it has always done to keep you, him, me Alive.

You're roommate would need to be able to step back. You can't change anyone, but you can cheer, coach, and try to lead them a bit. And it sounds like he needs a doc to put him on meds, at least for a little while, so he can step back and look at things from a more objective angle.

So I would ask what's going on, and actively listen. And not to the crazy shit. Ask what's led to it. That you can tell they've got a lot of shit going on and you wanted to make sure they're alright. And actively listen. Don't give advice. Don't interrupt. Just listen, ask a question here or there. And when they finish. If they've shared shit, which they may or may not have. I would talk up my doctor tell them how much they helped me and offer to go with them. "I'll bet he could help you out with... a bit too. So fuck. If you want I'll take a day off and head down with ya. After we can have a fun day like we used to. " something to that effect.

If they're really standoffish or angry and crazy. I would give them a beer, not 6 or 10, and see if they calm down but me just chilling and being mellow if so great. Do the above. If not, I would start to distance myself. And contact our friends and discuss it with them. And if we don't have a circle of friends or if that doesn't work, I'd contact his family and see if they can get him help.

More than likely, he's going to end up having a crazy break down, where he blows up his life. And when that happens, he'll know he needs help. But until then... be a friend but take care of yourself first. And if it's too much. Look into moving.

I really hope this person isn’t a scientist at a frontier AI lab and just made a massive discovery

You're describing a family member of mine to a T. Very intelligent guy, can hold his own against the brightest, charm coming out of ears, creativity overflowing.

He had some paranoid episodes in the past, but we put it down to stress. He was a normal functioning human being 99% of the time, as are we all.

Then it became 90%, and then 80%, and the remaining 20% was full-fledged paranoia.

You'd have to talk him off a cliff almost on a weekly basis to not act rashly on little data. It became difficult to talk once it became clear he was never going to listen.

Once the family became the enemy, he fled from us. Any attempts to bring him back just made him flee further.

I sympathise with your friend's family. There's nothing you can do. If he's not accepting help, then he likely needs to sink further into his delusions/paranoia before he realises what help he needs.

It has to come from him, and not from you. The alternative is sectioning them, and that's something not one of us is prepared to do.

Triggers? There's definitely a genetic aspect to it in our family. There's also ADHD. The use of weed and possibly other drugs as a creative muse. Jealousy might also be a factor.

I would try to find out if he has recently begun taking antidepressants. I began a regimen last year and had side effects which sound quite similar to this.

Sometimes they are like night a day for people in a good sense. Sometimes they invoke a sort of mania and cause an acute crisis, like it did for me. I eventually learned about ‘suicide crisis syndrome’ and evidently new antidepressant prescriptions are at least somewhat correlated with this state.

Highly intelligent people seem to carry around a mild form of depression called dysthymia, which he might have sought to address with drugs.

Good luck. These things are extremely difficult. I know I was at my absolute worst when I was struggling, and I wouldn’t wish it on anyone (from my side or those who supported me).

He is not your responsibility. Protect yourself. Do not put yourself in a dangerous situation. It isn’t worth it.

I would say the treatment needs to be as serious as the problem.

If they are smart and value their brain health, I have found that it sometimes helps to inform someone in a manic episode that prolonged mania (and especially full blown manic psychosis) leads to excitotoxicity and is actually acutely damaging to the brain.

I explain that mania often feels really good! It can feel like "everything is really important and meaningful" all of a sudden, and that "there is a greater truth that they see clearly now". I ask if they think they are experiencing something like that? I ask if they care about limiting potential long term damage to their brain. I try to offer a selection of choices of ways to come down from mania safely: e.g. would you be ok doing a group call with a doctor to discuss ways to limit damage? would you be comfortable taking some seroquel/lithium/GABA-ergic drug with medical supervision? what about trying to get some sleep? etc. Steer clear of stimulants/weed/psychedelics, they usually make mania worse.

Another common effect of mania is tanked working memory, it's very hard to avoid thought loops or stay on a single train of thought for more than a few minutes. If you find discussions sliding backwards or repeating often, help them externalize their working memory on a whiteboard, paper, voice memos, etc. so they can actually think clearly. The relief they experience from lowering working memory load / not having to re-derive every train of thought Memento-style helps a ton to lower combativeness + re-ground them in reality. If you have any experience with high dose psychedelics you can sort of model mania as a similar mental state and "tripsit" them in similar ways.

Keep in mind that even though their working memory is tanked, long-term memory is not, they will likely remember everything you say and do with them, and might take deceit personally for a long time. Set boundaries, prioritize your own health and security, but try to avoid forcing them / lying to them too much, it can backfire and damage real long-term trust.

You have to balance maintaining their trust with the reality that they may try to trick you / forget their own promises. If they agree to be driven to the hospital, discreetly child lock the doors to stop them getting out on the highway if they change their mind. If they agree to try to sleep in their room, make sure they cant climb out a balcony window, etc. they can't be fully trusted to not endanger their own life in this state.

Good luck and thank you for caring enough to help them. Video or write about parts of the experience (privately) and share it with them afterwards, they may appreciate seeing an objective record of what their mania looks like to others, to calibrate against what it feels like internally. If another episode happens in the future, pulling up those notes/videos can help convince them to get help sooner as it can help remind that it's an "episode" that can't last forever.

Diclaimer: I am not a trained professional in this area / this is not medical advice, it's just based on my own experiences / YMMV

Also when in doubt, call 988 (if in the USA). You will be connected with a real person who can help you de-escalate the situation and connect you with non-police resources.

How can you differentiate (as in assess your own state of mind) as to whether a feeling that "there is a greater truth that they see clearly now" is mania or genuine appreciation? Like say you have been depressed for X weeks/months and have been mulling over philosophy/turning ideas in your head.

At some point ideas click and you realize something "obvious" that changes your perspective and you no longer feel as empty as you were before – is that mania indicative of the mind finally "breaking down", or a genuine breakthrough? And for that matter how does the feeling "everything is really important and meaningful" differ from the supposed state of "enlightenment"?

What are some tests you can perform on yourself to assess the difference (between mania/healthy appreciation)? If one is e.g. able to meditate and maintain concentration to a sufficient degree, does that rule out the possibility of mania?

>doing a group call with a doctor to discuss ways to limit damage

What are some non-pharmaceutical ways of doing this?

> How can you differentiate [mania] or genuine appreciation?

If you've done any 5-HT2A drug you'll know the distinct feeling I'm referring to. The telltale sign is that it's always the combo: "everything is really important/meaningful" + bad working memory.

If your working memory is solid and you can actually process long complex thought without reducing it to vibes or simple aphorisms then you're probably not manic. Also important to understand hypomanic != manic != full manic psychosis, they are very different levels of severity. Anything manic or above is very obvious, people around you will be able to tell something is up within 30sec.

> doing a group call with a doctor to discuss ways to limit damage

- sleep

- try keto / limiting sugar, hit or miss but works for some

- holding breath / breathwork (I wouldn't hyperventilate though)

- do things that you'd do to recover if you had a hangover / had just ran a marathon (it's essentially what your brain is doing)

(again I'm not a doctor, fact-check everything yourself)

A perspective different to others in this thread. As someone who has been in your roommate's position before.

Unless he was physically violent to you, you calling the mental health team (and therefore the police) on him escalated this situation. Obviously he would be angry with you, because you essentially had him arrested. His reactivity to this in of itself is not a sign of mental illness. If you put yourself in his shoes, you would be angry or annoyed too.

Additionally, you could have been more descriptive about his behavior. That he believes reality is an illusion is not necessarily a sign of mental illness. For all we know he could have had a glimpse of satori (ironic given your username). That statement about reality is described in countless spiritual and religious texts by people far wiser and more intelligent than either of us.

However, him talking to himself and not sleeping could be a sign of mental illness. Not sleeping itself could even be the cause, and not the effect of mental illness. As in, maybe he stopped sleeping well on the first day, and then the second, and so on, causing this weeklong incident, and sleeping normally would bring everything back to normal. We don't know if this was the case.

If I were you, as a friend, I would apologize for causing him to be arrested and thrown in hospital (even if you don't believe you're at fault or have done anything wrong) and at least let him stay in the house you shared for a couple of months before making any drastic moves like kicking him out. Treat him normally, as you did before this incident. Don't treat him with kid gloves or as a crazy person. This incident could very well be a one off...or it could be the start of long term mental health issues, which can be resolved but would require some more understanding from you. From there on, make a decision about whether you want to continue living with him given what has transpired. You have to be careful about not blowing this one week, or even a couple of days out of proportion and ruining his life and career. Treat it just as an anomaly, don't share what happened with anyone unless you have permission from him.

I'm speaking as someone who's gone through what your roommate has gone through and recovered. A lot of armchair mental health professionals in this thread are providing extremely poor advice here; advice that's only likely to exacerbate what's happened.

For example:

- Kicking him out of the house

Refusing to have him back in the house is basically the same as indefinitely extending his stay at the hospital - possibly one of the worst things you can do from my perspective. Unless he's actively physically violent, which it doesn't sound like he is - why on earth would you refuse to have him back for at least several weeks?

- Breaking off ties with him

Ridiculous, treat him as the friend he has always been to you. There's no need to worry about your safety unless he is actively physically violent to you. If he starts talking about reality, why not humor him out try and understand exactly what he's saying or looking it up?

- Telling his workplace about what happened

You mentioned you phoned his workplace regarding his absence. I hope you kept the details general and didn't tell them about him being hospitalized. That's a decision for him to make later when he is feeling better.

You sound like a good guy. The best thing you can do for him is to keep a level head yourself and be a good friend while maintaining some kind of detachment and distance. The most likely outcome statistically is him recovering - it will just take some time. Just my two cents.

I am very hesitant to add specific details as it involves other real people he was accusing of manipulating him, which I know to be false. By Sunday night my friend was having what appeared to be actual conversations with voices in his head. And they became totally non-sensical to me. It was scary.

I initially told his work only that he wouldn't be in for a week.

I did not discuss specific details with them, but they already sort of knew because his behaviour at work was raising eyebrows late last week.

I went through something similar recently with close friends. One thing we had to do was communicate in plausibly deniable ways that we were predisposed to health conditions. It was extremely difficult to hold down responsibilities.

Look into radio frequency energy.

It’s a stretch but assume it’s an external “leaky” source. Probably don’t assume it’s his fault at all or related to his occupation.

Unfortunately there is little you can do. Be supportive. Don’t discredit him afterwards. History might repeat itself.

Disclaimer: This post isn’t really a joke.

Fair enough, it does sound like he's having some pretty severe mental health problems from those additional details. I care for your friend, if you can relay some of this advice to him when he's feeling better, it would be beneficial.

To echo other people in this thread, you're not responsible for him, but if you have the emotional bandwidth to help out where you can, you can make a difference in his recovery outcomes. It sounds like a lot of pressure, but the more relaxed and detached you are the better it'll be for both of you.

I generally think you were completely right to call the mental health team, but he understandably might still be angry.

I care for your friend, and here are some concrete steps that worked for me, in order of effectiveness.

1. Taking time off work, or even leaving if that's possible

Sounds like workplace tensions caused or exacerbated what he's going through. It's likely his mistrust has spiralled into some kind of paranoia. It's also possible that workplace stress is exhausting and destabilising him. It's best for him to simply take extended leave, or leave the workplace entirely.

2. Avoiding psychiatric labels in favour of therapeutic/psychological labels

Understanding that paranoia develops from suspicion, and suspicion grows from fear, and fear grows from mistrust. To elaborate, it sounds like he's having some kind of conflict where he thinks other people are doing x or y to him, but that's likely just mistrust spiralling out of control. One attitude is to label this paranoia, and as a psychiatric symptom of psychosis/schizoaffective disorders, another attitude is to label it as an extreme version of mistrust. Both are true, but one is more conducive to healing. Basically, if I were your friend, I would avoid internalising any labels he would be taking on during this period, because that can actually reinforce negative outcomes.

3. Eating pure, unprocessed, and heavy foods.

A lot of mania like symptoms are just the result of emotional or mental exhaustion. That causes us to get light headed and start overthinking, and then have an emotional reaction of fear, which causes more overthinking and so on, which can spiral out of control. A simple solution that doesn't involve pharmaceuticals is drinking lots of fresh, spring water, eating tuber and root vegetables like potatos and carrots, and also fatty and greasy foods like cheeses and butter. Basically, natural and whole foods which weigh you down, not things like McDonalds or potato crisps. Drugs are likely going to be necessary for at least a couple of weeks and maybe several months, but longer than this, in my opinion is likely detrimental to the brain's physiology. Your friend sounds quite intelligent, let's keep it that way.

4. Sleeping more

Like I said in my previous response, lack of sleep can cause and exacerbate mental health problems. Sleeping drugs or aids like melatonin may be necessary at this stage, but if not, then natural remedies like camomille tea, a relaxing bath and music would help.

5. Working with a psychologist/therapist, rather than a psychiatrist

This perspective may be polarising, but I believe that psychiatrists are not equipped to help heal severe mental health issues. At best, they are a temporary support that prescribes medication (which is necessary initially for weeks and months). To end up on medication for years and decades, and stuck with a psychiatrist who keeps on prescribing them is a one way road to being a zombie. Instead, in my opinion, working regularly with a psychologist and/or licensed therapist is the best way to recover from so called severe mental health illnesses like bipolar/schizoid disorders. If your friend has the financial means, additionally working with a neurologist once he's more stable (maybe 1 or 2 months from now), would be even better. The neurologist can rule out things like actual physical brain conditions like high cranial pressure, brain tumours and other physiological causes of mental health problems.

6. Spending time in nature during the day, either alone or with a trusted friend

Just sitting or walking around in a park can have extremely outsized benefits for mental health. That means going to as secluded and natural of a place as is practical. If there are no people in the place, that's even better. I experienced it myself, when I walked in a park every day and recovered extremely quickly.

7. Having the intention to surrender to a higher, benevolent power

Your friend is communicating with voices in his head, which is a a big warning sign, from a spiritual, psychiatric and psychology perspective. It could be anything from different parts of his psyche communicating to try and come to a resolution, or it could even be what are called "jinns" or negative spirits in religions like Islam. While many may roll their eyes at the mention of spirits, especially in a more secularly oriented community like Hacker News, this is a possibility. The solution, regardless of what is happening, and regardless of what you (or I) believe is happening, is surrendering to a higher power. It could be surrendering to God, Allah, Buddha, Earth, Universe or the Void. It doesn't matter whether he's atheist, agnostic, religious or spiritual, simply having the internal intention to surrender to a higher power will deliver very rapid healing and peace. If the intention to surrender is genuine (not laced with doubt or skepticism) and comes from a deep place, it will cause an instant effect of peace and relaxation. You can even try this yourself right now to verify it. It definitely did for me. In fact, this last point was the most effective, over everything else I mentioned.

If your friend wants to talk to someone when he's feeling better I'm always available.

I resonate a lot with the last part of this comment. It’s not often I hear reference to djinns, but they certainly have seemed real for me. Your suggestion of surrendering to a higher power, in my case Christ (despite not being Christian), was how I dealt with it. The change in my life trajectory after this event was profound, ultimately it was for the better - I believe that it saved my life.

To give my perspective from having experienced this side as well (did not use the more powerful medications and recovered from the worst part in a bit over two weeks from the time it got distinctly worse with a small residual effect for maybe a couple weeks after that): I agree with this list but would phrase some of them a bit different.

I'll start mentioning that my understanding is that there seem to be a few different types of outwardly similar issues with major differences along with variation within a type and different severity. I was never at danger of suicide and never started a note, though I did vividly imagine suicide at one point. The worst part for me was panic attacks that lasted hours on a few days (suicidal inclination at that time could be deadly as it felt like the end was near in any case, although for me that was not when I imagined suicide). I never use recreational drugs including alcohol (unless you count sugar, which likely you should). I did not hear voices or see people who weren't there but did have a visual oddity during most of the worst times (which clued me in that something was seriously wrong; I wasn't able to make as much use of that insight as I would have hoped but the worst parts happened later when it was much less visible).

I call it brain overheating but it was not just the brain; the rest of my body was overheating as well. I suspect blood brain barrier issues and blood sugar issues during this worse time (but not other times). Adding some oil to my diet seemed like it might have been quite helpful (although jumping to conclusions was a big part of the issue). My memory was both better and worse than usual in some ways; I could pull a bunch of memories to support a theory (at times definitely invented some but mostly real memories I think) while contradictory memories were much harder to recall and dismissed way too easily or worked around in elaborate ways. I started with a theory that felt true (related in some ways to things I worry about but also random) and my brain worked to figure out why it must be true and to fill in details rather than questioning it. I would eventually figure out that the theory was false but then jump to the next one, particularly during the worst couple of days. I don't think someone else engaging much with details of such thoughts is likely to be helpful but gently honest feedback about your overall impression if you do listen can help point the way to reality (I do think there are aspects of reality in the overheated thinking as well but they are covered by the false connections). Writing down what I was thinking was helpful and made it easier to spot the issues later (just don't let anyone else read it). I had strong "universal love" feelings, religious feelings, and paranoia at different times (and maybe combined in some ways).

I would not phrase #7 on this list that way and wasn't similarly magic to me but I do think it helped that when I thought cops were coming for me I was basically OK with that and tried to be ready in a way that would limit the chance of being shot (then eventually the fact that they didn't show up brought me back to reality some). I don't think joining a religion in that state is a good idea and it is a helpful show of love when those who are religious don't try to take advantage of the religious feelings to try to push their religion (clearly not the intent here, I agree with accepting whatever happens being helpful). Getting outside when I was improving is what finally resolved the worst times for me but earlier made it worse (because it worked its way into a theory). To get to that point focusing on a simplified daily routine (and finding some things to do that helped some or at least didn't make things worse) was most helpful for me.

In terms of sleep low dose delayed release melatonin seemed quite helpful to me as well. I would add that it is not just lack of sleep that causes trouble but circadian rhythm as well. Symptoms were distinctly worse for me at night and brighter mornings seemed to help more than cloudy mornings.

Isolation was helpful for me as nearly every interaction I had with others was embarrassing and made things worse. I also accused one person I care about of doing something malicious and feel bad about that. At the same time feeling love from a few people (including the person I accused, who I apologized to fairly quickly) was also helpful. I misinterpreted coincidences as being malicious so I would say isolation is good but avoid permanent decisions until fully recovered if possible since decision making is impaired.

I would characterise surrender and acceptance as very similar. So in your case you accepted the situation, which I would call surrendering to the universe, or to reality. But yes, in no way am I suggesting that one joins a religion or a spiritual faith during a crisis. It's more like, if there is a time to believe in a higher power, even if you've never had any inclination before, it's this kind of situation.

He needs a relationship with a solid professional therapist. That is absolutely number one.

Sounds like he needs parts-informed treatment. Google TIST practitioners. Janina Fisher has an institute with a list of therapists.

USA? The forcibly removed thing.

I'd he had one he'd ask for help on his own. Apart from that, people live their lives the way they do.

In mental hospitals they'll meet other people like them and receive medication, however if it's the right medication is a game of trial and error.

How to deal with it? Let him do his. If he wants to kill himself that's his choice. But he should also get some sleep and leave the building, maybe go for walks and reduce the EM radiation.

That's all I've got.

Write on paper. Get time outside. Lift heavy circles.