When and How Do You Help Crazy People?

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This article is Part III in a series titled How to Talk to Crazy People.

One time my wife and I took a long ride on a crowded bus. Several rows ahead of us sat a psychotic man. Facing the middle of the bus, he never stopped talking to himself. Except – although I never looked at the man – I listened to every word he said. And soon, he faced toward where I was seated with Mary and spoke directly at me.

When we got off the bus, my wife was livid: “You had to listen to him.”

“I never once looked at him,” I sputtered in defense.

But the man knew I was listening to him.

I had developed rapport with the man during that bus ride. I had more rapport with him than some others who would try to help him, but who never sat and listened to what was on his mind.

…it is important to keep contact with human beings. It’s like a harm reduction program such as needle exchange.-Stanton Peele

This does not always mean that you can help the person – at least in the near term. But it is important to keep contact with human beings. It’s like a harm reduction program such as needle exchange. The client remains addicted to heroin. But, because of the outreach, a bridge for the journey out of addiction has been created.

Let’s return to Charles, the man who had a manic breakdown as described in Part II of this How to Talk to Crazy People series on Pro Talk.

Charles was fortunate to have a sister, Chrisie, who always maintained contact with him. This was surely a trying job. She served this function by listening to Charles when he wanted to talk. And although she wanted to encourage him to take care of himself by eating and sleeping, that didn’t happen.


While I listened to endless rants without judgment, I couldn’t remind him to eat or sleep. First, manic people don’t eat and sleep – at least Charles didn’t. Secondly, my attempts to get him to take care of himself – take meds, stay in the hospital, call his doctor – were met with unveiled irritation, and once outright hostility. He would erupt at my mentioning his mother or children.


…she didn’t try to dissuade Charles from his mania. That is, she didn’t tell him his thinking was disordered or crazy – even his paranoid-sounding thoughts.-Stanton Peele

How frustrating this was to Chrisie, who knew her brother’s love of his children and of the outdoors, of his helpfulness, his underlying sweetness. She wanted to point him back towards this life that had once satisfied him, and that she hoped would satisfy him again. Still, she didn’t try to dissuade Charles from his mania. That is, she didn’t tell him his thinking was disordered or crazy – even his paranoid-sounding thoughts.

Chrisie, not trained as a therapist, did what might be called supportive family therapy. She maintained contact with a crazed person from whom everyone else’s instinct was to recoil and withdraw. She knew that Charles frightened and overwhelmed his family members – including his two children, ex-wife, mother, and an uncle with whom Charles hunted and fished. All were in danger of rejecting Charles, which would only have reinforced his isolation and resentment and prevented him from returning to his functioning state.


I provided a touchstone for both him and his family – I was a protective barrier between them, softening the impact. For Charles, I remained present: I simply witnessed the madness, held his hand via phone while he broke down. I didn’t tell him he was mistaken, that his delusions were delusions. I listened for his own voice coming through, and when I heard him, I’d do my best to remind him of who he is and where he wants to be – without saying “this is where you want to be.”



Practically, I kept track of his whereabouts. He let me know where he was staying, who he was with, etc. He would leave my name at the hospital switchboard, etc. For his family, I let them know that he was all right – alive. Whenever I heard from him, I’d send out a blast, “I heard from him. He’s alive. He’s unwell, but safe.”



I think that his just knowing that he had someone to check in with was enough to keep him tethered, though at times barely. The difference between what I did and what others were doing, I think, is in my desire more to keep him with me than to make him well.



I believe psychosis has to run its course once someone embarks on that journey, and help is being present and waiting it out patiently. The therapeutic work comes after. Or, perhaps, it should have come before.


And Charles did emerge from his mad journey. He eventually went to visit his mother, who due to Chrisie was still in contact with Charles. At his mother’s residence, he returned to his former demeanor and disposition.

Charles is doing well now.

Chrisie found an article which describes a husband’s reaction to his wife’s psychotic episodes, and how they developed a situational, negotiated approach to both her breakdowns and the normal times between them. Working collaboratively with his wife and a psychiatrist, using medications selectively, and creating a lifestyle for his wife that maintained her physical and mental health, the author forged a blueprint for their lives that is called a “Mad Map.”

The Mad Map is a way of recognizing where one is on the continuum, and it traces the way back to that best place.-Stanton Peele

The Mad Map has been developed by the Icarus Project. The Mad Map follows the idea of madness as occurring along a continuum. There is a place where the afflicted person feels best and that is where they want to return. The Mad Map is a way of recognizing where one is on the continuum, and it traces the way back to that best place. These return steps are created in conjunction with the afflicted person during their sane periods. Thus, they have a measure of control even when they are losing it.

Charles’s was a difficult journey. But it was a finite journey, one that didn’t end in death, tragedy, or permanent psychosis and expulsion from humanity.

Thank goodness for Chrisie.

A Final Note on Self-Care: Help for the Helper

Of course, it is important for a helper, like Chrisie, to care for herself. It would do no good for Charles to recover and for her to sink.

Because he was manic, Charles thought he was on top of the world. He would drive recklessly, believing he was somehow charmed, and was seriously injured; he lost his residence. Yet, even though Charles’s world was exploding, he believed that things were going great.

Chrisie, on the other hand, could see all of the danger and denial. She panicked every time the phone rang, fearing bad news – and sometimes it was very bad news (jail, homelessness, a serious car accident). She wished that someone could have given her some guidance in this role, since she had no training for it.

Perhaps mental health practitioners wouldn’t condone what Chrisie did. They would advocate the same tough love that you get in Al-Anon. Perhaps not everyone could cope with playing the role Chrisie did in someone’s life.-Stanton Peele

At first, Chrisie wasn’t sleeping and found it very difficult to balance her life. After a while, however, she regained some of her balance. Chrisie discovered that she needed not to cling to Charles or grasp at what she wanted him to be, to get right with the idea that she couldn’t control anything. This required that she accept that she might actually lose Charles for good. In the beginning, she would lie awake listening for text alerts, even as she was afraid to read them. But she didn’t cut Charles off. Instead she allotted time for him during the day.

Perhaps mental health practitioners wouldn’t condone what Chrisie did. They would advocate the same tough love that you get in Al-Anon. Perhaps not everyone could cope with playing the role Chrisie did in someone’s life.

This post is about keeping our eyes on the humanity of the mentally ill person, keeping him tethered to his life, and creating a bridge for him to return. But it’s just as important to make sure that helpers – friends and family – are given equal care in this scenario. What do they need? What does their maintenance of the relationship with the afflicted person require?

You can’t help someone by damaging yourself.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Rehabs.com. We do believe in healthy dialogue on all topics and we welcome the opinions of our professional contributors.

What Are Your Thoughts on this Topic?

  • http://AddictionMyth.com/ AddictionMyth

    “Tough love” is sometimes used as cover for abuse. However, in some cases it’s completely necessary. Al-Anon says “You didn’t cause it and you can’t cure it.” That’s a good message, but not the requirement that your loved one attend AA/NA before you’ll talk to them again. That’s bad. Tough love in this case means stop paying the cell phone bill or the car payment (even if you think that it’s keeping them alive or you need to do it for ‘peace of mind’). What they call ‘enabling’ in the addiction industry. A little tough love in this case wouldn’t kill them. Even if they scream and cry that it surely will. (Scratch the surface of Charles’ relationship with his mother and you’ll see what I’m talking about.)

  • tarun

    testing

  • anna451

    mythological madness and psychogical prescriptions are a deadly equivalency in these times . psyche requires a certain journey that will be taken according to the wisdom of our body . the icarus project is the only compassionate connection i feel will work long term .this is the 1st time i have seen the project mentioned in a more traditional stream.
    history check ; synanon games were the fore runner of “tough love” tactics.
    i was there……the” square” games for college students in san diego i960’s.. somehow i keep running into synanon nuggets..
    one that surprised me ;synanon has a presence in germany now as a treatment program. .. i am not surprised . but i wish it had died its natural death with chuck diedrich and the rattlesnake. paul morantz has a you tube out that i watched.