Too often, we don't get help or identify our problems until we've reached a total breaking point.

When it All Comes Crashing Down: Navigating Crisis

When you or someone close to you goes into crisis it can be the scariest thing to ever happen. You don't know what to do but it seems like someone's life might be at stake or they might get locked up, and everyone around is getting more stressed and panicked. Everyone knows a friend who has been there, or has been there themselves. Someone's personality starts to make strange changes, they're not sleeping or sleeping all day, they lose touch with the people around them, they disappear into their room for days, they have wild energy and outlandish plans, they start to dwell on suicide and hopelessness, they stop eating or taking care of themselves, they start taking risks and being reckless. They become a different person. They're in crisis.

The word "crisis" comes from a root meaning "judgment."

A crisis is a moment of great tension and meeting the unknown. It's a turning point when things can't go on the way they have, and the situation isn't going to hold. Could crisis be an opportunity for breakthrough, not just breakdown? Can we learn about each other and ourselves as a community through crisis? Can we see crisis as an opportunity to judge a situation and ourselves carefully, not just react with panic and confusion or turn things over to the authorities?

Crisis Response Suggestions

1. Working in Teams. If you're trying to help someone in crisis, coordinate with other friends and family to share responsibility and stress. If you're the one going through crisis, reach out to multiple people and swallow your pride. The more good help you can get the easier the process will be and the less you will exhaust your friends.
2. Try not to panic. People in crisis can be made a lot worse if people start reacting with fear, control and anger. Study after study has shown that if you react to someone in crisis with caring, openness, patience, and a relaxed and unhurried attitude, it can really help settle things down. Keep breathing, take time to do things that help you stay in your body like yoga and taking walks, be sure to eat, drink water, and try to get sleep.
3. Be real about what's going on. When people act weird or lose their minds it is easy to overreact. It's also easy to under react. If someone is actually seriously attempting suicide or doing something extremely dangerous like lying down on a busy freeway, getting the police involved might save their life. But if someone picks up a knife and is walking around the kitchen talking about UFO's, don't assume the worst and call the cops. Likewise if someone is cutting themselves, it's usually a way of coping and doesn't always mean they're suicidal (unless they are cutting severely). Sometimes people who are talking about the ideas of death and suicide are in a very dangerous place, but sometimes they may just need to talk about dark, painful feelings that are buried. Use your judgment and ask others for advice. Sometimes you just need to wait out crisis. Sometimes you need to intervene strongly and swiftly if the situation is truly dangerous and someone's life is really falling apart.
4. Listen to the person without judgment. What do they need? What are their feelings? What's going on? What can help? Sometimes we are so scared of someone else's suffering that we forget to ask them how to help. Beware of arguing with someone in crisis, their point of view might be off, but their feelings are real and need to be listened to. (Once they're out of crisis they'll be able to hear you better). If you are in crisis, tell people what you're feeling and what you need. It is so hard to help people who aren't communicating.
5. Lack of sleep is a major cause of crisis. Many people come right out of crisis if they get some sleep, and any hospital will first get you to sleep if you are sleep deprived. If the person hasn't tried Benadryl, herbal or homeopathic remedies from a health food store, hot baths, rich food, exercise, or acupuncture these can be extremely helpful. If someone is really manic and hasn't been sleeping for months, though, none of these may work and you may have to seek out psychiatric drugs to break the cycle.
6. Drugs are also a big cause of crisis. Does someone who takes psych meds regularly suddenly stop? Withdrawal can cause a crisis. Get the person back on their meds (if they want to transition off meds they should do it carefully and slowly, not suddenly) and make sure they are in a safe space. Meds can start working very quickly for some, but for others it can take weeks.
7. Create a sanctuary and meet basic needs. Try to de-dramatize and de-stress the situation as much as possible. Crashing in a different home for a few days can give a person some breathing space and perspective. Perhaps caring friends could come by in shifts to spend time with the person, make good food, play nice music, drag them outside for exercise, spend time listening. Often people feel alone and uncared for in crisis, and if you make an effort to offer them a sanctuary it can mean a lot. Make sure basic needs are met: food, water, sleep, shelter, exercise, if appropriate professional (alternative or psychiatric) attention.
8. Calling the police or hospital shouldn't be the automatic response. Police and hospitals are not saviors. They can even make things worse. When you're out of other options, though, you shouldn't rule them out. Faced with a decision like this, get input from people who have a good head on their shoulders and know about the person. Have other options been tried? Did the hospital help in the past? Are people overreacting? Don't assume that it's always the right thing to do just because it puts everything in the hands of the "authorities." Be realistic, however, when your community has exhausted its capacity to help and there is a risk of real danger. The alternative support networks we need do not exist everywhere that people are in crisis. The most important thing is to keep people alive.

Advance Directives

If you know your crises get bad enough to get you into a hospital, there is a tool you should use called a psychiatric Advance Directive. Basically it's like a Living Will for crisis, it gives you power and self-control over what happens to you when you go into a crisis. If you start to lose your mind and have a hard time speaking for yourself, people will look at your Advance Directive to figure out what to do.

There is an elaborate Advance Directive form at the Bazelon legal center you can use at http://www.bazelon.org/issues/advancedirectives/templates.htm, a more simple one at the Mary Copeland website http://www.mentalhealthrecovery.com/pdfs/crisisplan.pdf, or you can just write a letter and sign it. Write down who you want contacted if you are in crisis and who you don't want contacted, what hospital you prefer to go to, what medications you do and don't want to be given, what health practitioner you want to work with, and any special instructions for supporters, such as "take me out into the woods" or "help me sleep with these herbs or those pills," "feed me kale," or "when you ask me questions, give me a long time to answer, be patient and don't walk away" or ""make sure I can see my pets as soon as possible."

Write your directive up, get it signed by someone and write "˜witness' by their name, and date it. Put copies somewhere that main people know where it is and where to get it (with a therapist or health practitioner, with family, with people close to you, people in any support or activist group you're in). Then when you go into crisis, people can use your directive as a guide on how to respond to the situation, and it can be used to help convince hospitals, doctors, etc to respect your choices on how to be treated. (Directives have some legal weight, but not as much as a living will. Ongoing reforms in mental health law may strengthen the role of directives in the future.)

On Suicide

While it's easy to romanticize certain sides of bipolar disorder, it is a dangerously incomplete picture: if you believe the statistics, 1 in 5 untreated manic-depressives commit suicide. In the medical establishment's opinion, bipolar disorder is a highly lethal disease. Whether or not you choose to see things this way, the stark fact remains that the extremes of bipolar mood swings have driven thousands and thousands of people to kill themselves, and these swings can happen with astounding speed.

There is no accepted theory about why one person who is suicidal ends up doing it and another doesn't. There is no perfect answer to what you should do when someone is suicidal, and no reliable way to prevent someone from killing themselves if they really want to. Suicide is, and will probably always be, a mystery. There are, however, a lot of things that people have learned, things that come from a real sense of caring and love for people who have died or who might die, and truths people have realized when they were at the brink and made their way back. Here are a few we've collected:

1. Feeling suicidal is not giving up on life. Feeling suicidal is being desperate for things to be different. People are holding out for a better person they know they can be and a better life they know they deserve, but they feel totally blocked. Discover what the vision for a better life is, and see how it is only possible to realize it if you stick around to find out what can happen. Turn some of that suicidal energy towards risking change in life. Find out what behavior pattern or life condition you want to kill instead of taking your whole life. Is there a way to change those patterns that you haven't yet tried? Who can you turn to for help changing those patterns?
2. People who are suicidal are often really isolated. They need someone to talk with confidentially on a deep level, someone who is not going to judge them or reject them. Did something happen? What do you need? Be patient with long silences, let the person speak. Let people ask for anything, an errand, food, a place to stay, etc. Often suicidal people really don't want to be honest because they're so ashamed of what they are feeling and it is an incredibly hard thing to admit. Be patient and calm.
3. People need to hear things that might seem obvious, like: You are a good person. Your friendship has helped me. You are a cool person and you have done cool things, even if you can't remember them now. You have loved life and you can love it again. There are ways to make your feelings change and your head start working better. If you kill yourself, nothing in your life will ever change. You will hurt people you love. You will never know what could have happened. Your problems are very real, but there are other ways to deal with them.
4. Suicidal people are often under the sway of a critical voice or belief that lies about who and what they are. It might be the voice of a parent, an abuser, someone who betrayed you, or simply the twisted black version of yourself that depression and madness have put in your brain. Usually this voice is not perceiving reality accurately "” get a reality check from someone close and stop believing these voices. You aren't a "failure," and change isn't impossible. And You Are Not Alone "” Other people have felt pain this deep and terrible, and they have found ways to change their lives and survive. You are not the only one.
5. There are ways to get past this and change your life.