3 MIN READ | Mental Health

Maxwell Guttman, LCSW

How to Understand Friends Who Have Mental Illness?

Cite This
Maxwell Guttman, LCSW, (2022, October 17). How to Understand Friends Who Have Mental Illness?. Psychreg on Mental Health. https://www.psychreg.org/understand-friends-mental-illness/
Reading Time: 3 minutes

Mentally ill people make horrible friends. I know my previous statement sounds like a gross, offensive over generalisation. I am a person living with a significant mental health disorder. Given all my exposure to treatment programs throughout my recovery, I have a great deal of time in mental health settings. I’ve met people with all different shades of mental health conditions. Many of these people I met in treatment or working later became incorporated into my social circle

Big mistake

Socialisation for people with mental health disorders is critical to their recovery and overall health. However, being friends with a person with a mental health disorder is challenging, if not hazardous, scary, and altogether disappointing.

There is a saying that warns against having expectations with friendsPeople warn against it. When it comes to having a mentally ill friend, have zero expectations for the friend ‘ship’ to sail right because it will be a bumpy, turbulent ride.

That sounds more difficult than it read. Having an unpredictable friendship, where the parameters and boundaries shift daily, isn’t exactly a walk in the park. If you don’t suffer from a mental health disorder, from what I observe from relatively healthy people, it is that they take some comfort in having a life that isn’t chaotic.

Most people don’t thrive off being shocked or like having their head turn, if not spin when it comes to their everyday interpersonal life. People want stability, or as they say, my profession, to be ‘stable. ‘ But when you are friends with a person in constant freefall, be prepared to give your support around the clock, probably overtime.

Depending on the diagnosis, mentally ill people can differ much further from the ‘norm’ than you might think. Whenever I expected one behaviour or emotion from a friend, I observed something far more extreme and intense than I had first anticipated.

Interpersonal waters are even more difficult to weather, and often, unclear when to pull the plug and disengage socially. Never underestimate the magnitude or intensity of a person’s display. I am mentioning this because you might need to exit someday quickly; I have and fast.

When I say normal, I mean behaviour that is generally socially acceptable. Because I suffer from a disorder and my training as a mental health therapist, I see the same pathology play out in interpersonal dysfunction. The dysfunction can be rooted in any number of issues at work.

After all, some people have multiple problems and are even more challenging to get along with or maintain a friendship. Between the stress of managing a pre-existing mental health issue and interpersonal conflict, friendships with mentally ill people can be a recipe for long verbal sparring sessions and over-the-top, emotionally driven verbal sparring.

I can’t count the number of times my phone rang ad infinite because someone with a mental illness was trying to reach me obsessively to clear for a little bit of verbal reassurance or to ‘talk it out until reaching a calmer headspace.

Let’s break it down into clinical terms first. Picture the moodiest friend you know. Now, take their ups and downs, and intensify the sadness or mania by ten times what you’ve seen. Have you ever had a conversation with someone truly manic? Try understanding what the person is saying.

Speech and being so pressured, it becomes almost impossible to communicate. Now picture your depressed friend. They are too sad or withdrawn to return a phone call or engage in quality face-to-face time. I suppose it is hard to qualify or evaluate the friendliness of a friend without being subjective. I value face-to-face time and being emotional, if not physically present.

I also appreciate mutual support, respect, and kindness. Mentally ill people will violate, willfully and purposefully, each of these qualifiers and even attend with an entirely new way of failing to meet your needs.

Sorry, I’m not upset with you. I’m just depressed’. So says my friend with bipolar depression. After cancelling on me fifty or so times, my friend was able to hang out, ending a period of extended self-isolation and withdrawal. Sitting down at dinner with her, I expected to enjoy catching up and having good wholesome fun.

Instead, sitting across from me was a tired, sad, angry woman who was bitter about her illness. She spent most of our time together projecting her sadness onto the world ‘the human race is a virus’.

I still remember feeling depressed hearing her speak, asking why I even asked her to hang out. She justified the recent tragic events in the world today as the price humanity pays for being a ‘self-destructive parasite.’ Her metaphor was enough to make me lose my stomach over what was a delicious dish in front of me.

My friend isn’t too complicated and is mild on the disorder spectrum. Now imagine someone manic, grandiose, self-important, etc. the list can go on and on, and so can the quality and magnitude of a display or interaction that went wrong when someone loses behavioural control.

I’ve experienced this firsthand and have had to walk out of meals during dinner when a friend lost control and began accusing me of putting roaches in her food and trying to sabotage her book deal for the manuscript she is still writing.


Maxwell Guttman, LCSW teaches social work at Fordham University. He is also a mental health correspondent for Psychreg.

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