ask dr-robert

You can put this on your web site or not but I REALLY need some help. we are both in england UK and from my email address u can tell I'm called James but its best if I don't say her name.

my girlfriend is a shy girl, keeps to herself and is very closed. she rarely speaks to people when at school (she is 14). I thought it was because she's not accepted and has been left on her own. since making an effort to know her and now going out with her she has told me why she's like that. She says she has a voice in her head, that sometimes controls her, it tells her things like she is ugly, fat, worthless, no point living. she told me how she's attempted suicide because of it and is being treated for depression but wont tell anyone about the voice because they will think she's crazy.

she's trusted me that I wont tell anyone and she wont go to see or talk to anyone about it. she's said she fully expects to live with this for the rest of her life since she's had it for 4 years.

To me its obvious she needs help but I cant get her to talk to anyone about it. I don't want to push too hard because its obvious she's not stable mentally with thoughts of suicide. I have no idea what it would be diagnosed as (treated as) and I've probably not told you enough for that but if you can give advice on a way to get her more open to talk about it with a professional, she's scared they will take her away. Anything I can do to help her not think suicidal, help her to talk about it to someone who can actually help please tell me. I'm reluctant to tell her family or tell a psychologist without her knowing as I'm trusted and the only person she's told the whole time, I don't want to do it and it be the thing to push her over the edge. what do I do to help her?

James

p.s. a link to a web site, anything you can do to help. thanks for reading that and I hope you can reply



Dear James,

Thank you for writing. If you will have a look at my reply to the question about formal thought disorder, you will understand that your girlfriend's hearing that voice in her head is one of the classic symptoms of schizophrenia.

Your girlfriend is in a a terribly dangerous situation. Since she already feels suicidal, she may tire of the voice at any time, and, just because she cannot stand hearing it any longer, she might decide to go through with suicide. Or, the voice could instruct her to kill herself, or, even worse, some else. Once someone is schizophrenic to this extent, any slight connection to a shared, consensual reality may be broken at any time, leaving that person totally isolated in a way that most normal people cannot understand and completely uncontrolled by ordinary social norms.

I do understand your reluctance to break trust with her, and I also understand her fear that she would be "taken away" if someone in authority were to learn about her condition. Sadly, at this point, this unfortunate person is ill enough that hiding her condition from competent caregivers is not a viable option. To do so any longer is to continue risking her life, as well as the safety of anyone with whom she comes into contact. Further, schizophrenia is a progressive disease, which, if left untreated, almost always becomes worse, eventually becoming resistant to any kind of treatment whatsoever. In other words, without treatment, your girlfriend will almost certainly get much worse, eventually needing permanent custodial care. With treatment, the schizophrenia might come under control, allowing for a relatively normal life.

Now, while your girlfriend still maintains some connection to reality, is the time to act. If possible, you should speak with your friend and ask her to get the advice of a trained professional--perhaps the person who already treats her for depression. If she is unwilling to do this, it becomes, in my professional opinion, your ethical duty, both as her friend and as a member of society, to see that she gets proper treatment immediately regardless of her or your feelings about it. If she declines to take your advice, you should meet with her present doctor, and tell all.

I am sure this will feel difficult, but you can tell yourself that you will be helping her by reporting this if necessary, and that if you continued to collude with her in hiding her condition you would be doing her a great disservice since without immediate help she will end up either dead of suicide or much more mentally ill.

Sorry, but that's the way it is. Please do the right thing.

Be well.





Dear Doc Robert

Thank you very much for the reply which was much quicker than I thought it would be. I am taking your advice, I hope this will end well.

extremely grateful,

James



Dear James-- I moved your question to the top of my list because it seemed so urgent. I am glad that you are choosing to follow my advice. It is the only thing to do in a case like this, and I think in your heart you knew that even before writing to me.

I understand that going against her wishes could seem like a betrayal of your girlfriend, but it is not. Because she is mentally ill, her wishes are working against her own best interest, and that is why she needs you to help her in this way. Assuring that she will receive the treatment she needs is the loving thing to do, and, if she gets the right kind of help, you will be saving her a lot of suffering in the long run.

I join you in wishing that things work out for the best.

Do not hesitate to write if I can help you further.

Be well,

RS