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Norman M.
Norman M., Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA
Category: Mental Health
Satisfied Customers: 2568
Experience:  ADHP(NC), DEHP(NC), ECP, UKCP Registered.
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My friend appears to be having a psychotic break: he hasnt

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My friend appears to be having a psychotic break: he hasn't slept in a night or two, and according to his fiance, he has been smoking a lot of marijuana and has been texting friends about how he's been communing with the universe, through which communion it has been revealed to him that the universe will come to an end later this year, that he is the son of a demon, and that he has some sort a covenant with some other power that needs to be revealed. He hasn't demonstrated that he is a threat to himself or others, and his fiancee is afraid that calling the police will set him off. What can be done?

NormanM :

Hello, I'm Norman - are you ready to chat?


Hello, Norman. Yes, I am ready.

NormanM :

Great. Can you tellme a little more about your friend - how old is he, and how long has this been going on?


He is 32 years old. Last year he suffered a motorcycle accident in which he experienced head trauma (a subarachnoid hematoma and a subdural hematoma, both of which have subsided). He's dealt with substance issues since, but had recently appeared to be nearly recovered. He had returned to work (he is a lawyer), and other than a drunken episode four weeks ago when being weened off of symbalta and being transitioned onto wellbutrin, he has been apparently all right. However, he stopped taking wellbutrin after this episode because he thought the wellbutrin was making him feel anxious and manic. But until earlier today, he appeared fine. He hasn't seen a therapist or psychiatrist for about two weeks.

NormanM :

Ok - there are two probabilities here. He is clearly delusional and may also be hallucinating, and with that in mind her may be suffering from drug induced psychosis, or he may possibly be ententing the primary phase of schizophrenia.

NormanM :

If the latter, his drug use could be a precipitating factor. However, only his Doc can make an accurate diagnoisis.


I had feared the same. What can we (his friends and his fiancee) do about this tonight, if he is not posing an immediate threat to himself or others? And what do we do tomorrow, etc.?


He has responded with great agitation and agression to the suggestion of being taken to the hospital, and gets upset with his fiancee if she gets too close to him, accusing her of getting in the way of his "covenant." Also, his pupils are very dilated, according to his fiancee.

NormanM :

The main thrust HAS to be is to get him to accept medical help. I have a handout which I give to clients which outlines the best way forward in these situations - would you like me to post it on here for you?


Yes, please.

NormanM :

Ok Please read it, and we can then discuss particulars.



NormanM :

Until someone with a problem accepts that there is a problem, they won’t do anything about solving it. That’s the first hurdle. The second is convincing them that help is available, and that the should accept it.

Sustained gentle persuasion is at least part of the answer. Just being there to listen, and letting the person know that you are there for them may let them build up enough trust inside themselves to begin to deal with it.

You may not to be able to solve their problem, or for that matter understand how they feel, but just listening and letting them talk can be really helpful.

Getting people to open up can be difficult. It has to be done sensitively so that the person does not feel put down or alienated. A gentle approach like ‘It must be difficult feeling as you do. Perhaps we could talk about it? is often the best start.

Choose your time and place carefully if possible so that the person feels as safe and as comfortable as possible.

Try to make sure that the person feels that you are on their side, and try to use ‘open questions’ – ones that don’t allow a simple “Yes” or “No” answer.

Don’t try to give them solutions, because as they open up and talk, the person begins to find their own solutions.

Good beginnings are:

Where – 'Where did that happen?'

When – 'When did you find out……?'

What – 'What else was happening?'

How – 'How did you feel?'

Can you tell me…….

How are you feeling? This helps to get past the bare facts of a situation, and lets people

begin to look at their inner turmoil.

Don’t push hard or try to tell them what they MUST do – give them space and time to talk.

There are some things you can do, and here are some tips:

What you can say that helps:

I’m here for you – you’re not alone.

What causes these thoughts and feelings is a real illness, and it can be treated..

You may not believe it now, but someday, this will pass and you’ll feel differently.

I care about you and want to help, even if I don’t really understand what you are going through right now, how you feel, and what you’re thinking

Don’t ever give up – just hang on one more minute or hour – whatever you can.

You are important to me. Your life is important to me, and to everybody who knows you

I’d like you to tell me what I can do now to help you.

We can get through this together

Don’t say:

Cheer up- it could be worse

Quit worrying about it – you’ll be fine

Your just imagining it, it’s all in your head.

Everybody feels like this sometimes

You’ll just have to help yourself

I’d have thought you would be better by now.

Get over it and snap out of it.

Grow up and act like an adult.

What’s the matter with you anyway?

You’ll also find some helpful information here:

Also the Samaritan’s web site in the UK here is a mine of useful information which will help you, as is the National Suicide Prevention line (in the USA), which you will find here.

Ultimately, of course, a person can be hospitalized against their will, but only under the strictest of circumstances.

The laws of committal vary from State to State, but in general there are broad similarities.

Committal is a legal means of providing individuals with emergency services and temporary detention for mental health evaluation and treatment when required. It can be voluntary or involuntary.

A voluntary committal is when a person 18 years of age or older, or a parent or guardian of a person age 17 or under, applies for admission to a facility for observation, diagnosis or treatment freely and of their own accord

An involuntary committal is when a person is taken to a facility for involuntary examination.

This can only be done when :

There is reason to believe that he or she is mentally ill and because of his or her mental illness

The person has refused voluntary examination and

The person is unable to determine for himself or herself whether examination is necessary and without care or treatment, and the person is likely to suffer from neglect or refuse to care for himself or herself and such refusal could pose a threat of harm to his or her well being;

and there is a substantial likelihood that without care or treatment, the person will cause serious bodily harm to himself, herself or others in the near future as evidenced by recent behavior.

A person may not be detained for more than 72 hours.

A law enforcement officer may take an individual to a facility for evaluation if he has reason to believe that the individual's behavior meets the statutory guidelines for involuntary examination.

If a person is willing to swear in a Petition for Involuntary Examination that he has personally witnessed an individual causing harm to themselves or others, an "ExParte" for an Involuntary Examination can be made.

A person may not be detained for more than 72 hours on primary committal.


These are general guidelines, and you should get legal advice as to what specifically applies in your State.



NormanM :

In the final analysis, if he will not accept help after a few days of persuasion, perhaps his fiance should tell him that if he does not do so, she is going to take a break from the relationship. Just going on as it is is doing him no favor at all.

NormanM :

If all else fails, the commital route may be needed.


I think we may be past the point of convincing that he needs help. He truly believes that his delusions are real. He's been laughing maniacally about his "covenant," his fiancee just told me. He said he "understands everything now." Perhaps she can get to a point where he trusts with the information that has been "revealed to him" by asking open questions, but she is concerned about feeding into his delusion, and what the next steps would be.

NormanM :

If that stage has been reached, then I'm afraid some form of coercion - either by way of an ultimatum about the future of the relationship or by way of commital is going to be necessary. Idon't think there are any other realistic and safeoptions.

NormanM :

Just feeding into delusions as you put it so well is NOT a viable option

NormanM :

If the situation continues he is simply going to get worse. What are yor thoughts?


That sounds right. His fiancee says she'll try to speak with him in the morning (she is exhausted and has to work) and if that doesn't work, she'll go the ulimatum route. As his friend, I'll try to reach out again tomorrow to talk about what's going on with him and his covenant (how he got to that conclusion) and see if any progress is made there. And we'll just hope it doesn't get worse tonight.

NormanM :

I do hope he will accept help. Is there anything else I can help you with today?


No, Norman. You've been very helpful. Thank you. I am hitting the green "Accept" button. Have a good night.

NormanM :

Thank you indeed.

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