This article was not supposed to begin this way. But after the massacre in Newtown, Conn., last Friday, its opening paragraphs screamed for revision.
The subject of Dr. Mark S. Komrad’s new book, “You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling” (Hazelden, 2012), was important before Friday’s tragedies, but its message has never felt more chillingly relevant than it does now, as all of America is reeling with disbelief, horror and grief over the senseless murders of 20 young children and six adults at an elementary school in a quiet New England town.
The murderer, a 20-year-old male who first killed his mother in their home and then proceeded to Sandy Hook Elementary School, where he killed students and teachers before turning a gun on himself, was clearly in need of psychiatric help. Treatment might have saved his victims, as well as his life.
Why didn’t he receive it?
How do you tell a person you love he or she needs psychiatric help?
Almost all of us have been in this situation at one time or another, and many of us have been clueless about how to approach it. But we no longer can afford to hide behind our uncertainty to avoid confronting the mental illness we recognize in our friends and relatives. In “You Need Help,” Komrad, a Towson psychiatrist, provides readers with the tools and information to deal with this common, yet critical, dilemma.
In the 1990s, Komrad hosted a popular call-in radio show called “Komrad on Call.” On the program, which was nationally broadcast for four years, he answered callers’ questions about mental health issues.
“My most frequent call was the one that went, ‘My mother/spouse/adult child is having emotional troubles, and they are way beyond my ability to help. How do I talk to them?’” he said.
But it was not only the callers to his radio program who alerted Komrad that this was a common concern, he also noticed it among patients in his private practice and even in social situations.
“In a nutshell,” said Komrad, “I wrote the book to tap into the unused power of people’s relationships to both support and maneuver people to get into treatment.”
“You Need Help” begins by helping friends and family members (“allies”) recognize when a mental health situation has become unmanageable and requires the intervention of a professional. When an individual’s emotional problems begin to affect his everyday functioning, and certainly if he becomes a danger to himself or others, it is time to get professional help, the book explains.
There are many reasons why psychologically troubled individuals may require support, persuasion and even coercion to accept help, Komrad said. Some of these include our American culture and its emphasis on self-reliance and self-determination, denial and its more serious cousin agnosognosia (the absence of insight). Despite the strides that have been made in recent years, mental illness still carries a societal stigma. Widespread misunderstandings about how mental health professionals work — often absorbed through the media — contribute to the reluctance to seek professional intervention. Additionally, said Komrad, our society’s civil rights tradition sometimes works against family members trying to secure help (in the form of inpatient hospitalization or mandated treatment) for their loved ones. Finally, Komrad said, “We are a Maalox culture. We want relief in a moment. In fact, the trajectory of recovery is long. People don’t want to invest time in therapy.”
In “You Need Help” Komrad addresses the obstacles that prevent friends and family members from discussing treatment. The most common obstacle is the fear that confronting the problem will anger him or her and result in the loss of a relationship. Although Komrad acknowledged that a loved one’s mental illness is a “delicate topic,” he urged allies to pursue the conversation anyway. And if the conversation goes poorly the first time, keep at it.
“Don’t give up. There are many different approaches to try,” he said.
Among the approaches Komrad has recommended is coercion. The doctor has come to believe that harnessing the power of a relationship to force a loved one into treatment, especially as a last resort, is fair game. He provides various techniques of “applying leverage,” which he contends is ultimately in the disturbed individual’s best interest.
“You Need Help” also provides vital information on how allies can locate the resources they need. By providing step-by-step instructions on how to handle almost every situation that may arise, Komrad prepares allies to manage the interpersonal, as well as the bureaucratic, struggles they likely will encounter.
With a frankly personal forward by Rosalyn Carter and heartfelt quotations by Bruce Springsteen, Carrie Fisher, Patrick J. Kennedy and James Baldwin, readers confronting the issue of mental illness in themselves or their family members will find they are in good company.
For more information or to order “You Need Help,” visit http://www.youneedhelpbook.com.