A. According to the National Institute of Mental Health, women are more likely to experience depression, generalized anxiety disorder and eating disorders, and are also more likely to attempt suicide. Researchers believe some of the reasons may be that women experience greater hormonal shifts, and they are also more likely to be victims of sexual and physical abuse than men. Many experts are also quick to point out that women are more likely to seek help than men, which can result in higher numbers of female mental health issues being reported. Men are more likely to abuse alcohol and drugs or suffer from antisocial personality disorders. And while they attempt suicide less often than women, they have a higher suicide rate (due to more completed/successful) suicides. We also go into more detail about this in chapter three of BEHIND HAPPY FACES.

A. It’s a common misconception that all women can talk easily and comfortably about their feelings. The media floods us with images of women routinely chatting on about the most intimate things in their personal lives, as if there’s nothing to it. So when it comes to mental health issues, you’d think that if this were the case, women must have it easier, right? Wrong. Deep emotions can be just as difficult for women to share as it is for many men. Don’t assume that women never feel that they have to keep their innermost feelings to themselves. Many of them do.

Some women are raised to believe that they shouldn’t discuss their deepest emotions, because they need to sacrifice for their families. Other women aren’t taken seriously when they do express emotions, and frankly, a lot of women don’t like to talk about how they feel. However, on the whole, women do seem to express emotions more than men. It is generally more socially acceptable for women to do so. Men do express emotion, but it’s usually in certain acceptable contexts like sports, death, marriage or other scenarios. As most people know, men are often more comfortable expressing their emotions to a female friend or girlfriend, but more and more guys are learning to “hug it out” and talk to each other as well. The way someone is raised can also play a role in how they deal with emotion, regardless of their gender.

A. One of the most common things we ran into when we would tell people we were writing a book about mental health issues is people who said they typically don’t talk about such things at all-that it wasn’t really considered acceptable in their community or culture. African-Americans, Latinos, Asians, Arabs, Native Americans, Caucasians-people of nearly every race and ethnicity will often say this. So many people are convinced that nobody in their particular community talks about mental issues. But the truth is, problems with mental health affect all of us in every community-and nearly everyone has a hard time talking about them.

So does race have an impact with regard to mental health? In some senses, no. Mental health is an issue for everybody, everywhere. But in some ways, race does come into play. A lack of research, advocacy, and minority mental health professionals can make it harder for some minorities to find the help they need. Typically, when people seek help, they prefer to work with someone from a similar race, gender, or class. So minorities may feel that they are at somewhat of a disadvantage, since there are not as many of them currently represented in the mental health field. This could be a significant reason why some minorities don’t seek mental health care.

Advocacy organizations, personal stories, and books written by and for minorities are growing, especially in the past decade as more people become aware of the urgency of mental health issues. While this growth is definitely a positive step forward, there is still a major lack of resources and awareness that is hard to miss. In 2004, Ross went to hear Tupac Shakur’s mother, Afeni Shakur, speak at the signing of her new book. Someone in the audience asked Afeni if she thought that reviving the Black Panthers would be a good idea. (Afeni was a former member.) She calmly smiled and responded by saying that she felt the most important thing anyone could do is to start going into the high schools and middle schools in minority communities and talking about mental health issues. She said that when she was growing up, it was almost unimaginable for someone to commit suicide, but yet six of Tupac’s friends have killed themselves, and she hears more stories like this every day.

Talking about suicide, depression, bipolar disorder, or simply about mental health is hard for anybody-regardless of where you were born, where your parents were born, what language you speak, or what faith you practice. But these things are a fact of life, so being able to talk to someone about how you feel is always the first step toward getting help. And keep in mind that there are a great number of mental health professionals out there ready and willing to help you, so if you know you need to speak to someone, try not to let concerns about race or ethnicity stand in your way. Everyone has equal rights-when it comes to taking charge of our mental health.

A. Living in poverty sucks. No matter how you slice it, when you’re struggling to find enough money to buy a loaf of bread, it’s hard to focus on mental problems, even if you have them and can no longer function.

The high cost of mental health care is a huge barrier for many people. Middle and lower class families feel this the most, even when both parents work. It can be difficult to afford an insurance policy - many of which don’t even cover mental health costs.

CHERYL
Cheryl, a Chinese-American, is recovering from an eating disorder.

My mother has suffered from paranoid schizophrenia with obsessive compulsive tendencies for thirty years. I have binge eating disorder. However, living in a lower-middle class family with only my father working and no insurance made it almost impossible for either of us to seek proper help. It was only in the past couple of years with the expansion of the mental health system that we’ve been fortunate enough to find treatment.

It was an individual responsibility of mine to research all of my possibilities for finding psychological help for the uninsured and to be honest, it was a daunting task. I continued to search endlessly on the Internet and by making phone calls. But it was well worth the effort. It took me weeks to find someone who could help us, but I did. I was able to find a Chinese speaking psychiatrist for my mother and a clinic that specified in eating disorders. They also had a sliding scale for the uninsured.

Cheryl managed to find help for herself and her mother, but her story is hardly typical. When it comes to mental health care, insurance policies with thorough mental health coverage are hard to find. Often you’ll find that the right medication isn’t covered, you’re limited to a certain list of therapists, and none of them may even live in your area, etc. Dealing with the frustration is almost enough to cause a mental disorder! Meanwhile, your environment and the stress of your finances mixed with other factors can be stressful enough to trigger related disorders. If you’re dealing with substance abuse and can’t find help, for example, you could start to experience depression.

Cheryl had to overcome a lot of challenges to find help. Luckily, she was willing to educate herself on these issues. She searched to find what she and her family could do to find treatment. Since she lives in Queens, New York, there were more options available to her than there might have been if she had lived in a smaller town. Fortunately, there are more community resources springing up all over the country. The treatment may not be the best, but help is coming-and it’s certainly better than struggling on your own. And if you’re in college, you have a counseling center with two to eight free visits and insurance offered by the school. Getting help shouldn’t be nearly the fight it was for Cheryl.

When you are living in a lower class community, sometimes it pays to be creative when dealing with mental health issues. A shining example of how poor communities can sometimes heal is shown in the documentary film, Rize. In the movie, filmmaker David La Chappelle documents a dance phenomenon from South Central Los Angeles called “krumping.” While it has become infamous in music videos, most people are unaware of its origin. The form of dance became an escape for young people growing up in the extremely poor areas of Watts and other Los Angeles neighborhoods. At the Los Angeles Film Festival, one of the dancers eloquently described what krumping meant to him. He told the audience that young people in his neighborhood have to deal with shootings, gangs, not having parents, alcohol, drugs, and a lot of other issues. He said it’s easy to slip up and not see a way out because there aren’t any positive examples for them. He then explained that krumping is a way out for him. It’s an expression and a way to let go of all of the BS he has to deal with on a daily basis. In his neighborhood the choice is to either join a gang or dance, and he chooses to dance.

Scenes from the movie show groups of young people having something like emotional breakdowns as they dance for the first time, and the positive effect from the community appears to be overwhelming. Now, this is not to say that you can just dance your depression or bipolar disorder away, but it does show that no matter what your financial situation is, young people can be resilient and search to find a positive way to cope with their problems.

Chapter 3 pages 92-95

A. One of the most important steps in seeking help is really wanting to. A lot of times people realize that they’re not themselves and emotions in them have changed so much that they don’t know what to do. They feel hopeless, isolated, angry, scared, frustrated and a whole host of other thoughts run through their head as they wonder if they’ll ever be able to go back to life the way it was or even worse if anyone even cares. If you’re in this place in life know that it can get better. It may take a long time, longer than you would ever want, but it is possible and becomes even more possible when you seek help.
If you’re in high school seeking help can be a little tricky, because you usually aren’t over eighteen. The first step is to talk to a counselor at your school. You may not want to for a whole host of reasons: the counselor is too old, doesn’t get it, will tell my parents, will kick me out of school, or I don’t want the school to know about my issue. But if you’re feeling bad enough to ask for help, how can it hurt to at least give your counselor a chance? You can also ask him or her if there is someone else you can see. A counselor will definitely tell your parents what is happening if you are a threat to yourself or others. If you’re not a threat to anyone, then you can ask what the counselor will share with your parents or whoever. Every school and state can have different policies.

In most cases you will need your parent’s permission to talk to a mental health professional other than the school counselor. If your parents don’t want you to seek help, then you can talk to your counselor about your options. You also always have hotlines, websites, local mental health groups, and other resources which are listed at the end of this book.

If you are in college, then you should know that this is one of the easiest places to seek help in your life. That doesn’t mean it’s simple or that you won’t have any complications or won’t have to fight to get the treatment you need. The counselor to student ratio is still 1 to 1,697, although some smaller schools have better ratios. But chances are you have health insurance from your college or your parents, so that should be covered. You should also have a counseling center on campus that either refers people to professionals off campus or can help you right away. Almost all campuses offer between two to eight free visits at their counseling center. You don’t need your parents’ permission, but if you are going to use their insurance, then you want to check with your counseling center to see if the charge will show up as a visit to the wellness center or a visit for counseling. Outside of that no one else needs to know. If you are going to seek help, then the time is now. What are you waiting for?

Before you seek help, you should definitely educate yourself on your rights. There is a lot of fear out there about what to expect and what can happen to information about your mental health. No one can legally share your information with other people on campus. It should all be confidential. You should not be kicked out of school unless you are a threat to yourself or others. And if that is the case, the school will be more likely to accept you again when you are healthy if you tried to seek help before things got too bad. If they have to ask you to leave, some schools are not as open to bringing you back. Every college has a different policy so check with them first.

When you approach your school’s counseling center, you shouldn’t have to wait two-three weeks to be seen, and if you do, you can ask to be referred to someone off campus. But of course, it’s impossible for us to tell you the policies of each school and state, so please check with your counseling center to confirm their policies.

You are taking a huge step by seeking help. If you want the best outcome, it’s even better to go a step further. Educate yourself. Make sure that you know what’s going on within you, what can happen to you if you don’t follow your treatment program, and lastly, your rights. After that, you can start to work on all of the other issues. Remember, when you first start to talk about these problems, it can seem impossible to stop crying or find the words. It will take time, and it does get better, but not unless you begin the process and equip yourself with the emotional tools needed to build a better life. Again, the first step is finding the courage to seek help.

Chapter 4 pages 106-108

A. The diagnosis is critical. And to some extent, having the right diagnosis can be empowering. It identifies what’s wrong so you can learn more about yourself, trace your family’s history, and maybe even meet some like-minded people who are experiencing similar things. But the diagnosis is something that needs to be kept in perspective. It’s only a step in the right direction. It is by no means the end of your problems.

If anything, the diagnosis is the beginning of what for some people can be a life-long process of learning about your disorder and taking care of yourself. Think about it this way: if you tore all of the ligaments in your knee and broke your kneecap, the doctor wouldn’t say: “Okay, you have no knee left. But the good news is we got the right diagnosis, so please go back out and do what you want to do. Run, swim, bike. Like I said, we got the right diagnosis. It’s all downhill from here.” The doctor wouldn’t say anything close to this. You would have to go through surgery and months of painful physical rehab before you could even use your knee again. And even after it healed you would always run the risk of it blowing out on you.

Well, guess what? Your brain is just as much a part of your body as your knee, and when you get a diagnosis of a mental disorder, it’s only a starting place. You still need to determine what works best for you. It could take months or years of effort to learn what will keep you healthy. And just like your knee, your brain can always have blowouts or relapses. Traumatic evens like the death of someone you love, a divorce, a breakup, or physical or sexual abuse can make a mental disorder resurface. And sometimes disorders can reappear even when it seems like everything’s going fine.

Sometimes finding the right diagnosis can be extremely difficult because health issues in your physical body can cause problems that mimic mental health issues. There is an inextricable link between your physical and mental health. If you are having a serious problem finding a mental health diagnosis that defines your problem, you may want to get a checkup on your physical health as well.

Chapter 4 109-111

A. The most important thing you can do if you are ever placed on medication is to learn as much as you can about the medication. A lot of people put their heads down and walk out of the office feeling ashamed that they need anything to help them and don’t ask enough questions. You need to know what this medication is going to do to you, what the side effects are, if there are things you can do outside of the medications to help the treatment and everything else about the medication. This will help you learn more about your treatment and begin to make you an expert on the medication you may need for a long time or with extreme disorders for life.

Medication is important, but it won’t do all the work. You should also ask your doctor if there are things you can do outside of your medications to help manage your disorder. Research shows the most effective form of treatment for mental disorders is medication and therapy, but very few people know that and even fewer receive both. Some people think, “If I just take my pills, then my problems will go away.” However, this is not true for everyone.

Medications can be extremely effective in raising or stabilizing your mood, helping you focus, lessening anxiety, or reducing psychotic symptoms. Some people will respond to medication right away and be able to function the way they used to. Others may need to try different combinations over years and years before they find something. And still others may never find the perfect medications to help them. But no matter what the situation, the meds are there to help you in various ways, so you can work on other parts of the disorder.

If someone took blood pressure pills for her heart, then drank alcohol, smoked cigarettes, didn’t exercise, ate crappy food, and didn’t do anything outside of the meds to help, then she would run the risk of dying a lot sooner. If you (or anyone you know) is taking medication for a problem with your brain and you don’t talk about it, you don’t work on it, or worse, you drink, do drugs, or hurt yourself, then you are not going to deal with the disorders nearly as well as you could.

We always hear stories from people saying their medication makes them shake, causes acne, massive weight gain, or a list of other really hurtful side effects. If these things are happening to you then you need to talk to your doctor about the side effects and what you can do to limit them or remove them. It could mean switching medications or lowering a dosage, but you need to communicate clearly with your doctor on what you don’t like.

ALSO IF YOU ARE DRINKING, DOING DRUGS, HAVING RAMPANT SEXUAL ESCAPADES OR OTHER POSSIBLE DESTRCUTIVE BEHAVIOR THEN YOUR MEDICATION WILL NOT WORK. You need to give medication time to work and you need to make efforts outside of it to help it work. We know how hard it can be to be the sober one at the party and we constantly hear that weed can mellow someone more than their meds, but you need to think about the consequences of delaying a healthy way to treat these problems.

A.

• Go to the counseling center as soon as you get to campus to start scheduling appointments and learn what they offer.
• Check in with the Disabilities Services Office to see if there are any special arrangements you can make to help you with your academic work. If there is no Disabilities Services Office, check with the Dean of Students, Residence Life or Housing Departments for other arrangements.
• If your counseling center can only see you for a certain period of time, find out what your options are, how many visits you get, and what you can do to supplement those visits.
• Know where you can get your medications.
• Talk to the mental health professional who you’ve been seeing and learn how you can contact him or her if you need to.
• Find resources in the community if the counseling center can’t help you.
• Call your insurance company and ask them what they cover and don’t cover.
• Most importantly, prepare yourself for the change of college. Know that change can trigger a relapse or cause you to have difficulty adjusting to your treatment.
• Recognize your warning signs and adjust your lifestyle.
• If you have to leave college, know it is okay. You can come back or you can take another life path. Having to leave for a while is not the end of the road.

A. Once you have a diagnosis learning how to understand that side of you can be extremely challenging. A lot of people find themselves in a situation where they don’t want to tell their friends, because they want to be normal, don’t know how to talk to their parents or can’t talk to their parents and end up only discussing how they feel about having a disorder with their doctors. That can really lead to being more uncomfortable with the diagnosis.
One of the most important things you can do to feel more comfortable is talk to people close you about how you feel about your diagnosis. It’s great that you can talk to your therapist about your innermost thoughts and feelings. But it’s also really important to have a support group of friends or even just one friend that you talk to about these issues. It can take a long time for you to be able to talk about anything deep in your life. It’s hard to open up to other people, and you may be afraid. But talking to a friend, family member, partner, or someone you see on a regular basis outside of your therapist can really help when you are in therapy.

You should know that if you are able to start this process, it can only help. However, it should be with people you trust, people who are close to you, and people who care about you.

A. If your family is not there to support you, it’s important to remember that you still deserve to have people in your life who care about you and want to help you. You’ll just have to look harder for them.

• Friends. Find friends who will be close to you, support you, and not leave at the first sign of trouble (like when you have a bad day). Friends can help fill the hole left by your family.
• A good relationship. Some people are able to build a healthy relationship and break out of the negative coping mechanisms that life with their families has taught them. The relationship can also help fill the hole.
• Mental health professionals. You may have no one to talk to. Not a friend. Not a partner. No one at all. It may just be you and your psychologist, therapist, doctor, psychiatrist, or other professional. And this is okay. You may feel isolated, but as you work through your issues, you may find it easier to make and maintain meaningful friendships.
• Support groups. Another great way to have understanding and support are open support groups. They can help you identify certain problems in your life, while also making connections to other like-minded people.
• Education. Books, websites, brochures, or anything about your disorder can help you better understand what is happening to you and what you can do about it.
• Spirituality. A belief in something larger than yourself-whether it is your religion, faith, or just an overall connection to humanity-can help.
• Music. A lot of people find music to be a release when they don’t have the words, don’t have the time, or just don’t know what to say or do. However, be careful in your choice of music - it can help you release a lot of emotions, but at some point, for some people, particular kinds of music can reinforce negative feelings.
• Healthy lifestyle choices. This may be the most important component when trying to break out of the damage your family dynamic created.

It may never be possible to open a relationship with your parents or get them to understand your problems. This lack of understanding can feel like rejection and can hurt more than anything in the world. But remember that you don’t need to give up either.

• Talk about your level of emotional distress in terms they can relate to and understand. Remember to consider your audience. Seek to communicate on their level.
• Discuss the link between your behavior and your emotions. You’ve tried other “quick fixes” and they have failed to work.
• Mental illness is a biological disease. You are not pretending to feel miserable. This is not something that will go away on its own.
• Make analogies to other diseases. Focus on the ones that you can’t see but are potentially life-threatening if left untreated, such as diabetes and heart disease.
• You are aware of the stigma that is associated with having a mental issue and you are prepared to deal with it. The stigma is hardly an issue compared to the level of pain you constantly feel.
• Your mental disorder is not a reflection on their parenting. You do not see it as their fault. If anything, if you had their support, you would feel safer and more focused on healing.
• Having a mental disorder does not mean that you are “crazy.”
• Many famous people have had mental disorders and have been successfully treated.
• Mental disorders are treatable and can be improved within a relatively short time frame, the specifics of which will depend on your disorder.

A.

• Educate yourself on the disorder. Learn the warning signs. Know the symptoms. The more you know about the disorder, the easier it will be to recognize it if you ever start to experience it.
• Ask questions. Does anyone else in the family have this disorder? What disorders do they have? Did anyone commit suicide? Education from books is one thing, but hearing stories and how people coped can be even more helpful.
• Research treatments plans. What plan is most effective for the disorder in question? For most disorders, research shows a combination of therapy and medication may work best.
• Talk about your feelings. Discuss your thoughts and feelings about the disorder with someone you trust. Don’t suppress your emotions. They will only come out sideways, which usually results in unhealthy behaviors. Take control of your feelings before they start to control you.
• Be selective. You don’t need everyone to know or understand that your parent has a mental disorder. After you educate yourself, you may see that this is a health issue, but unfortunately not everyone will agree with you. We would love to change everyone’s view on mental disorders, but it will be better for you to be careful about who you tell. First make sure the people closest to you are on your team and care about the intricacies of your life.
• Come to terms with your past. Mental disorders can cause very specific family dynamics to take hold. They can change or reverse roles, so suddenly you’re the parent (and your mom’s acting like the child). Do everything you can to learn about families who have suffered from the disorder. Many people say that they will never repeat the same mistakes their parents made, but how will they know (or keep themselves from repeating the behavior) if they never understand what it is?
• Be aware of yourself. If you start experiencing the disorder on any level, seek help immediately. The earlier you get into treatment, the faster you can return to a sense of normalcy.
• Embrace your individuality. Just because someone in your family has a problem does not mean that you are fated to follow in those footsteps. With some disorders (like substance abuse), you have a choice. And the more you learn about the disorder, the better prepared you will be to chart your own future.

A. Caring about a brother or sister can go much deeper than just caring about a friend. This person shares your DNA. They’re a part of you, intrinsically linked to you. It’s natural to want to help them. Here are some suggestions:

• Don’t blame your sibling or parents for the disorder.
• Have patience as the symptoms can get better or get worse. It takes time for each person to find stability. Don’t be ashamed that someone in your family is suffering.
• Try to accept your sibling and the disorder. It will be better for both of you.
• Don’t feel guilty about needing attention. The focus can’t always be on the person with the disorder.
• Try not to be offended if your sibling takes his or her emotions out on you. Sometimes it’s easier to take things out on people we love. But remember to stick up for yourself and let him or her know it’s not acceptable to treat anyone negatively.
• Don’t be afraid to talk to your sibling about his or her disorder.
• Talk to people you trust about how you feel about your sibling’s disorder.
• Know that you can’t be your sibling’s therapist, but you can be his or her friend.
• Understand that you may have to help your sibling for a while. Even so, he or she should be accountable. Just because a sibling has a disorder does not grant him or her a free “get out of jail” card.

A. Telling a friend that you have a mental disorder can be hard on many levels. It can bring up many of your insecurities and vulnerabilities. Will this person understand you? Judge you? Or make fun of you? Even worse, will she abandon you? We depend on our friends for so many things. It may feel easier to stay silent rather than risk losing the relationship. But then aren’t you living a lie? We can’t expose the depth of our souls to everyone; that’s not realistic. But you need to tell your close friends about your emotions. Your feelings are a major part of you, especially if you have a mental disorder.

Finding the words can be equally challenging. Something traumatic can happen so quickly, and at first you may not know who to trust.

ALISON
Alison’s brother died by suicide.

For me, it was extremely difficult to reach out to my friends. They were incredibly supportive; many came home from college and otherwise sent cards and phone messages, but I didn’t know how to share what I was feeling with them. I remember thinking, too, that I would never wish this pain on anyone, so I didn’t want to share the pain I felt so they would have to feel it too. For about six months, I kept it in.

I learned how to open up and I started grieving. My friends became my grieving board: friends at college and ones from home, who opened me up and allowed me to take care of myself as opposed to everyone else, as I had been doing. They have continued to be the most open, enlightened, understanding group of people I have ever met. They admitted that they didn’t know what I was going through, but they let me talk and wanted to hear what I had to say.

It’s normal to fear your friends’ judgments. It’s also normal to expect them to judge you. But often that fear isn’t even real. It’s imagined. In some ways it can be easier to think this way - no one will get you, so why even try? Now you don’t have to take a risk or bring up a topic you’re uncomfortable with. You can just stay silent. But if you act this way, you’re not giving your friends a chance to be there for you. Maybe they won’t judge you. Maybe they’ll be like Alison’s friends. They could help you make peace with your issues. You’ll never know unless you try.

It probably feels better to be miserable and lonely - and safe - than to risk sharing your emotions and feeling like an idiot. But here’s the deal. Everyone has problems - maybe not as dire as yours, but if you continue to live in your own bubble, you’ll never know.

Alison became closer to her friends and developed deeper bonds with them because she was able to share her feelings with them. Like Alison, you need to give your friends a chance and see what kind of people they really are.

It’s very disappointing when your friends don’t understand you. But even then, there’s hope.

MARTHA
Martha was diagnosed with depression. One of her friends had a hard time understanding what she was going through.

We stopped talking as frequently because I felt like I had to take care of her feelings, and I’m guessing that she felt at a loss as to how to relate to me in my depressive state.

I wasn’t happy with the lack of understanding and felt I should reach out to Shirley. I told Shirley that I was taking an antidepressant for my depression. Shirley told me she didn’t believe depression was real, that I could snap out of it if I wanted to. I was devastated. I know it’s hard for people who haven’t experienced the severity of a mental disorder to understand its emotional complexity. I also felt that Shirley’s comment had nothing to do with me as much as it was a reflection of her own belief system.

I told Shirley that I was not making a choice to be depressed, and that if I could, I certainly would not be choosing to feel so terrible all of the time. Why wouldn’t I want to feel good? I asked her to consider my mother who is diagnosed with paranoid schizophrenia, and who has suffered from depression and has been on medication most of her adult life. Is she just “choosing” to feel bad?”

At first, Shirley was silent. She finally said, “Half the time I don’t know exactly what to say to you about this stuff.”

In that moment, I realized it was Shirley’s limitations about what to do that made our friendship awkward. Getting angry wouldn’t change a thing. I explained to Shirley that she didn’t have to know how to say anything about depression; all she had to do was listen attentively and offer compassion. Shirley told me she would try and we are still friends to this day.

Not everyone is going to know how or possess the skills to deal with the extreme states of these disorders. But often we just need someone to listen. We need to know someone cares about us and support us. Our true friends can do this. And this is another reason to learn about your disorder: so you can explain it to people who are close to you.

CLARENCE
Clarence came to understand what a friend with bipolar disorder was dealing with.

I had never experienced depression or any mental disorder, so when my friend started going through a lot of changes, I really just thought they wanted attention or were making it up. It took me a while to realize that someone would have to want attention really badly to make up the things he was doing and there had to be something a lot more serious going on. That’s when I started to believe he had bipolar disorder.

You may wish that your friend could take away your pain. When they can’t fix you, it’s common to think, “No one knows what to do for me.” This can make you feel empty and hopeless. But remember, no one can read your mind. It’s impossible for them to know how to help you unless you tell them. The more educated and confident you become, the better you will be able to handle situations and friends who want to help you, but don’t know how to help you.

A. The absolute best thing you can do is sit down and talk to a mental health professional, counselor or someone in your area that you can talk to for an hour to hour and a half about your friend, their history, changes in their lives, family situation and every other factor going into their problem to figure out what you can do and where they can go. Beyond that here are some other helpful tips:

• Turn Confrontation into Conversation, When you approach a friend about mental health issues, it can quickly turn into a confrontation. You’re almost sure to hear, “I’m fine. You don’t get it. Leave me alone.” Here’s what you have to focus on in these situations - take a deep breath and think about how to turn the confrontation into a conversation.
• Help a Friend Feel Comfortable. Your friend may be defensive because he thinks you’re judging him. You can quickly change this by reminding him you’re on the same team. You care about him. You’re not there to argue; you’re there to help. You miss him, and you want to be there for him. Offer to go to therapy with him. He may decline your offer, but it might help him feel more comfortable.
• Discuss the Reasons. Refer back to Chapter Two, which discusses the most common reasons people don’t seek help. Reread the chapter with your friend in mind. Does your friend feel weak? Stupid? Afraid you will call her crazy? These are some of the questions to consider when you want to start a conversation.
• Approach You Friend in a Familiar Way. Think about how you used to enjoy spending time together. Did you watch TV? Shoot hoops? Sometimes people say they want to approach a friend, so they take him for a walk. But here’s the thing: if you’ve never gone for a walk with your friend before, then this is not the time to start. Think about it. You’re doing something that you’ve never done, while also discussing the person’s deepest, darkest issues. It’ll feel anything but natural. If you’re worried about a friend you have known for a long time, then doing something you used to do together is a good option. Maybe you went for coffee, played sports, or did something healthy to relieve your stress. This is a good place to start the conversation.
• Talk Face-to-Face. For most people today, interactivity is like oxygen. Instant messaging is an essential part of life. It’s an easy, fast way to communicate. You can talk about anything. Even the tough stuff. It’s non-confrontational confrontation. You can argue with someone over IM while they sit ten feet away from you in the same room It’s often more comfortable than actually taking to the person, especially if you’re mad. Avoidance only takes a click. But if you are using instant message or texting to deal with emotional problems with your friend, she doesn’t have to reply. If you post on her profile, she doesn’t have to publish it. You can play these games forever. Where will it get you? Be the bigger person. Talk to your friend - face to face. You’ll have a much better chance of resolving your issue - or getting her to open up.
• You Can’t Be a Therapist Or Psychologist - What you absolutely cannot do, no matter how much you love your friend, is be a therapist or psychologist. You can’t diagnose his problems, recommend treatment, or give him medication. And this is true no matter how much you think you know about his disorder. It’s natural to want to heal him, but the best way to help your friend is to support and empower him as he comes to terms with his illness and resumes his life.
• You Cannot Help Someone Unless the Person Wants Help - Regardless of the severity of your friend’s disorder, if she doesn’t want help there is nothing you can do. Trust us on this. You should still follow the suggestions outlined in this book and try to open the door, but you cannot control the outcome. You cannot control how your friend responds to your attempts to help her. This should not stop you from trying; it’s just a lesson in life. You cannot control anyone but yourself.
• Take Care of Yourself Too. When dealing with a friend who has a mental disorder or any difficult situation, you also have to take responsibility for your own health. If your friend is locked in a downward spiral, do what you need to do to protect yourself. Talk to someone you trust and get the support you need. Before you know it, these problems can suck you into the undertow. Take care of yourself first.
• Remember That Caring About Your Friend Can’t Make Your Friend Care About Herself. This may sound crazy, but bear with us. When someone has a lot of self-hate, it’s almost impossible for him to receive love. You tell him you love him, but it doesn’t register. It can’t. He, like many others who feel this way, sees no reason why you would. Until he learns to love himself, he can only see his flaws and faults. This should not keep you from expressing your affection; just know what you’re up against. But don’t lose your faith in him. Maybe you can help him see himself through your eyes. And, of course, encourage him to seek professional help as well.

Sometimes it’s too painful to stay in a friendship with someone who doesn’t see a way out and continues to destroy himself. If he was a friend who helped you get out of a destructive pattern and then slipped back into his problem, you may feel compelled to stay. You care about him on every level imaginable, and it hurts to see him this way. But if it gets to the point where the friendship is no longer healthy for you, then you may need to distance yourself. At this point, you will have tried everything you can and the nature of the friendship has changed so much that it is no longer close to the friendship you remember. It can be the most painful decision to make, but you may have to end the friendship. If it comes to this, let him know the door is always open should he choose to rekindle your friendship.

A. The Jed Foundation offers this advice (adapted from the American Association of Suicidology) when dealing with a suicidal friend.

• Don’t try to manage the situation alone. It is often best to include others in helping someone at risk for suicide.
• Be aware - learn the risk factors and warning signs for suicide and where to get help.
• Be direct - talk openly and matter-of-factly about suicide, what you have observed, and what your concerns are regarding his/her well-being.
• Be willing to listen - allow expression of feelings, accept the feelings, and be patient.
• Be non-judgmental - don’t debate whether suicide is right or wrong or whether the person’s feelings are good or bad; don’t give a lecture on the value of life.
• Be available - show interest, understanding, and support.
• Don’t dare him/her to do it.
• Don’t act shocked.
• Don’t ask “why.”
• Don’t be sworn to secrecy.
• Offer hope that alternatives are available - but don’t offer reassurances that any one alternative will turn things around.
• Take action - remove lethal means of self-harm such as pills, ropes, and alcohol or other drugs.
• Get help from others with more experience and expertise.
• Be actively involved in encouraging the person to see a mental health professional.
• Don’t leave the person alone until help is available.

Individuals contemplating suicide often don’t believe that they can be helped, so you may have to be active and persistent in helping them to get the help they need. And, after helping a friend during a mental health crisis, be aware of how you may have been affected emotionally and seek the necessary support for yourself.

A. Plain and simple, breakups suck. To say they’re painful is a serious understatement. It doesn’t just hurt. It’s like someone reached into your chest and pulled out your heart. It feels brutal, like life can’t get any worse. You walk around, oozing from the inside out. Everything aches. And there’s no end in sight.

If you have a mental disorder, your recovery from a breakup can be harder to manage. For some people who have already been diagnosed with any type of mental disorder, a change like a breakup can cause an episode to reoccur. Or it can bring a mental disorder that you’ve been refusing to acknowledge to a breaking point, forcing you to deal with it.

It’s completely natural to be in pain after a breakup, but for some, that pain will go a step further and become depression. In order to be diagnosed with depression, you have to exhibit the following symptoms for two to three weeks:

1. A persistent sad, anxious or empty mood
2. Decreased energy, feeling constantly tired
3. Not finding pleasure in anything
4. Loss of sex drive
5. Difficulty concentrating or making decisions
6. Insomnia, waking up too early or oversleeping
7. Weight gain or loss
8. Feelings of guilt, worthlessness, helplessness
9. Excessive crying
10. Thoughts of death or suicide

It’s important to distinguish between feeling “depressed” and suffering from “depression.” There is a real difference between the two. When you feel depressed there’s a cause-you had a bad day, you just got some bad news. It’s painful and you’re unhappy, but as time passes, you feel better. Depression is something different. It lasts for weeks or longer and it isn’t always tied to a single piece of bad news or a difficult day. Time passes but you don’t heal. You can’t make yourself feel better. You need help. The best way to determine whether or not you have depression is to go to a mental health professional and explain your situation.

A.

• Have the support of your friends and family. You need someone you can talk to about the experience and to process your feelings.
• Try to talk to your boyfriend or girlfriend about this in a natural way. Don’t assault them with it.
• Don’t say negative things about yourself when you address the situation. Be confident. Hold yourself in a positive light.
• Be honest. Speak straightforwardly about your disorder or what you have been through.
• Don’t panic if the first reaction is negative. Realize that when someone hears this for the first time, it may be shocking. His response may be a gut reaction, and not a reflection of how he will feel once he’s given it some thought - or how he may feel about it in the future.
• Be willing to educate your partner about your disorder. Most mental disorders have a high treatment rate. It may or may not impact your relationship.
• Be clear about how your disorder or experience may change the relationship - or not. Tell your partner what you may need from her. But don’t expect too much at first. She may need time to process this new information.
• Let your partner know you did not choose to have a mental disorder. You are not seeking attention. You are doing everything you can to be healthy, which is why you are telling the person you love.
• Be open to questions about the disorder and the experience.
• Give the person time. And REMAIN CONFIDENT. Do not make him or her the key to your happiness or future. You were fine before this person, and you’ll be okay if it doesn’t work out.
• Be prepared for any kind of reaction. The person may not be able to handle it. He could flip out. Call you every name imaginable and reinforce your worst fears. Or he might calmly thank you for being honest and then let you know he wants out of the relationship. He could ask for time. Or he could completely understand and open up a new level of the relationship.

All of these reactions make sense, but you have to stay strong in the belief that someone who really loves you will accept you for who you are. If someone can’t handle the news of your mental disorder, your relationship probably didn’t have much of a future anyway. That may be hard to hear when someone leaves or hurts you because of something out of your control, like a mental disorder. Hopefully, you have support from friends, family, or at least someone who can be there to help you after someone abandons you.

It can be hard to regain stability and quite a shock when you experience such a loss. As we have stressed throughout this book, it can also lead to a relapse with a disorder, so whenever you’re faced with a dramatic situation like this, don’t do it on your own. Talk to a mental health professional, your friends, and family, and take every step possible to avoid going through another major episode. Also remember that breakups can be for the best. They can even be a good way for you to learn more about yourself and what you really need in a relationship. Of course it doesn’t feel like that right after you’ve heard, “I don’t think we should see each other any more.” But if you give it time and get the help you need, you’ll survive and eventually move on.

A. Leaving someone you love is a big decision - it’s nothing to take lightly. Talking about your situation will enable you to make a sound choice about what to do. If you hear comments from your partner like, “I will die if you leave,” you need to know that your partner’s life is not your responsibility. When someone takes his or her life, there is a lot more going on than just a tumultuous relationship. You cannot - under any circumstances - take the blame.

JOSÉ
José was nineteen and was afraid about what would happen to his girlfriend if they broke up.

My girlfriend and I were about to separate for good. She said she would kill herself if we broke up. I didn’t know what to do. I didn’t want her to die, but I didn’t want to be in the relationship anymore. We went on like this for months. Finally, I went to see a counselor on campus and we worked out what was best for me while also protecting her. But let me tell you, it wasn’t easy. I never would have gotten through it without the help of the counselor.

Breakups are powerful events in a person’s life. Of all the requests Ross receives to speak at a high school or college, the number one reason is a students’ suicide - which, not surprisingly, is usually tied to a breakup. And it typically goes something like this: boy meets girl; they fall in love; girl dumps boy; boy takes his own life. Ninety percent of all people who take their own lives have a mental disorder that already exists along with the suicidal thoughts. Most experts agree that a breakup is never solely responsible for a suicide. It’s profoundly more complicated than that. If someone is filled with self-hate and shame, a relationship may be the only positive thing in his or her life-but that still doesn’t mean a breakup caused the person’s suicide. The break-up didn’t create the feelings of self-hate, and the relationship could not have fixed or changed those feelings. A person who breaks up with someone who kills himself is not responsible for that person’s death.

That said, if you are dating someone who continually talks about killing him or herself - and who has a plan - then you must tell someone you trust. If the person has a plan, then you must take action. Devising a plan is typically the last step someone takes before taking his or her own life. If you are ever in this scenario, call a suicide hotline immediately and find out what you can do. We included a few in the back of the book.

(It’s also important to note that not every person who attempts to take his or her own life will have a plan or discuss any possible plans. The ground rule for anytime you feel someone may be experiencing any type of mental disorder-whether the person is suicidal or not-is to encourage them to seek help.)

A. Everyone should work with a professional to find what treatment works best for them and in order to do that effectively we don’t promote one form of treatment over another. The most effective form of treatment for severe mental disorders is medication with therapy. There are a lot of different types of treatment out there and while it may be frustrating for people as they take the time to find a treatment that works they should never give up. We encourage you to work with a mental health professional to find what works best for you and don’t be afraid to find it. Also remember that part of treatment is making healthy lifestyle decisions and developing positive relationships outside of your treatment.

A. Ok well to be honest anyone who is hurting themselves or exposing themselves on a level that some people may feel is for attention still needs help in some ways. The reason we are educating people on mental health issues is because we want people to understand that these disorders are treatable, they are things you can deal with and they don’t have to inhibit people the rest of their lives. Being unhealthy or not functioning is never cool. If you aren’t sure whether your friend or this person is doing or saying these things because they want attention, then you should talk to a counselor or mental health professional in your community and tell them everything you know. It is better to be educated on these issues.

A. One way to look at this would be what would you say to a friend who just diagnosed with diabetes, cancer or a heart problem? You would want to know where it comes from, how it feels to be diagnosed and what they will have to do manage it. In some ways a diagnosis of a mental disorder is very similar. Tell them you will be there for them and care about them. Ask them if there is anything you can do for them and try to keep the person doing things they enjoy. Also remind them they will feel better again. You may want to ask the person if mental disorders are in their family or what led to them being diagnosed, what the mental health professionals said to them about their diagnosis and what they need to do as part of their treatment. The major difference between other health issues and a mental disorder is that there isn’t as much shame in a broken leg. When asking someone about their mental disorder keep in mind that they may not be comfortable talking about anything at first and it may take time for them to open up about everything. In the meantime you can educate yourself on whatever the disorder is and let them know you are there for them if they ever do want to talk. The more comfortable a person becomes talking to friends and family members may lead to more comfort when they talk to a mental health professional in therapy.

A. The short answer to this question is no. There is a strong biological link of mental disorders being passed down through families. Much like when someone in your family has a heart problem or cancer other family members may be at greater risk for developing those problems, but there is no guarantee. The best thing to do if someone in your family does have a mental disorder is to educate yourself on all of the warning signs and what the disorder is. That way if you ever start to experience any of the warning signs you can recognize them and seek help quicker. Early intervention is the key. Learning about the disorder may also help you be able to talk to your family member or look out for other family members who may also be at risk. It is also important to mention that you can experience a mental disorder even if there is no history of mental disorders in your family. Oftentimes alcoholism, drug abuse and other destructive behaviors can mask a mental disorder, so if you have no diagnoses of a mental disorder, but these other problems are in your family that is important to know as well.

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