I'm not a psych doctor at all, but I do have a patient-viewpoint-driven way to look at mental health. Have you ever met someone who sounded like he or she might be having a mental health problem on the street and wanted to help out? Whether you're passionate about mental health or just looking for a neat and "for real" way to do service in your community, helping mentally ill people to find the right treatment options, CONSENSUALLY, is a project that might be worth your time.
I can't give you a scientifically-backed perspective, and I urge you to use caution and consider running my advice or any of your own ideas by a doctor before you try to talk with someone who is seriously mentally ill and not in treatment that you might meet somewhere for the purpose of trying to help. Nevertheless, I wanted to share some thoughts on what it's like to be mentally ill and unsure of who and what "treatment professionals" and other people you might see when out of touch with reality might be like.
Here are the subjects I'll cover--note, I am not going to cover "how to tell if someone is mentally ill" because I don't know...also, please keep in mind that what I'm sharing is "anecdotal patient experiences," not scientific fact or "broad trends" in mental health...it's just about me:
1 - Substitution ciphers
2 - Friendly vs. evil: "Whom are you working for?"
3 - Your logic is working but your perceptions deceive you.
4 - You still speak English but you've realized it's all a code.
#1: If there were one thing I would tell people who want to talk to mentally ill people to do differently, I would say: Don't try to "learn the mentally ill person's code and talk back to him/her in it." I don't know if anyone actually does that, but I had the sense that people were trying in the past. The top nightmare for mentally ill people who were like me when I was very sick around 15 years ago is: Substitution ciphers, i.e., in spite of any denials you might hear or anticipate, you think that everything stands for something else. For example, I was talking to some EMTs when I was about to be on the way to the mental hospital, and I thought that the "sheriff's office," where one man who was an EMT said that he worked when I asked him, was secretly code for some more sinister government agency. In general, I think I could view that part of my confusion as "major thesaurus trouble"...I viewed various proper nouns and phrases as "essentially the same thing," being used as codes for each other. I had a sort of "database of secret references and associations" in my mind, and I would consult that "database" rapidly to work to understand the secret allusions of what people were saying and what their actions meant, according to me. Anyway, my top piece of advice is: If you are talking to someone who sounds confused, try to speak in a "hint-free and very clear way"...don't act like you know his/her code, because the odds that your guess about the mentally ill person's (likely very complicated) code is correct are close to zero, according to my guess anyway. If you want to interact with someone, do it on a consensual basis, take everything the mentally ill person says at face value, and try to be nice and in particular *interactive*. It is a good idea to ask questions and try to make the person, who might feel lost in a labyrinth of "bot-like spies who talk in code and won't tell you anything," feel like a true conversation is taking place. You can ask questions like "What do you mean by [...]? I'm interested to understand." For me, even though the extreme parts of my big mental health episode only lasted for a few months, I felt very much alone and surrounded mainly by people whose loyalties, affiliations, and identities were hard for me to understand.
#2: I already sort of addressed this, but basically, it can be difficult to tell if someone is on your side when you're very sick. One thing I noticed in the mental hospital was that another patient made a "reassuring gesture" to me one time--extending his hand and arm suddenly to offer me a telephone receiver when I was feeling very agitated--and that helped me calm down. I decided at the time that this other patient was friendly; I didn't analyze, I "perceived and immediately *knew*" who was good or bad, in my mind, based on the "signs" and my quick consultations with my "database" (not that I called it that or was thinking about how to explain my situation) and my conclusions. (I got better quickly with medication--having normal social conversations with people really helped me get stable that time--in case you're wondering, and I was fine and got my sense of reality back fully within a few months...I don't think my case was extremely serious, and I think my out-patient doctor was fairly sure it would turn out OK before what happened happened after I was not on any medications for months.)
#3: One thing you might think about some mentally ill people is, "This person is so illogical." Actually, I think that is mainly not true...given certain basic assumptions that most would find absurd about how the world works, mentally ill people like me could, when very sick, still be characterized as "extremely logical," and constantly adding new (wrong) "axioms" based on perceptions that were completely absurd (that's what it was like for me back then). My understandings of what I saw sounded perfectly reasonable, and if my perceptions had been of things that really did seem like what I interpreted them to be, any rational observer would, I assert, think my conclusions and beliefs were logical. It was like seeing a dog and thinking that it could be concluded that the dog was a secret agent from another country; if it had been, my "narrative" of what was going on would have made perfect sense. My "assumption framework" was the problem; you could say that I was "very lenient" in terms of understanding what things could be interpreted to be. There were "plenty of extremely wild stretches" in terms of my interpretations, but not what I myself would categorize as "my logic and reasoning."
#4: Just one more comment to make about codes...basically, when I was severely mentally ill, it would be safe to say that my understanding of language was that almost nothing meant exactly what I would have said it meant before the episode. That is why I think speaking clearly and in a "hint-free" way might be valuable to patients who are feeling disconnected from the world and trying to understand what people's sentences really mean--i.e., that is how you should talk to such a patient. Probably, if someone had offered to give me an "intensive English grammar, vocabulary, and sentence structure/meaning review course" before my medications kicked in, I would have started to recover even faster. (I recovered fast enough anyway, my point is just that a failure to understand that language is exactly what it was before "it all began" was a major problem for me when I didn't understand things about reality.)
I hope these comment are helpful! It's not about "doing your job"-type professionalism in this post, but if you read my ideas, check them out with an expert if possible, and try to safely help mentally ill people in your community by talking and being safe, then you and I will have both added some more value to global mental health! That is worth doing!
-Philip White (philip...@yahoo.com