There is something about NAMI’s patronizing view of the mentally ill that really irks me. For a bit of fun, I took a Q and A from its Ask the Psychiatric Pharmacist section and thought, what if this were an obese person they are talking about? Everybody knows that you can’t make another person lose weight. They have to do it themselves, for their own personal reasons. It’s the patronizing attitude that bothers me more than the good intentions. This approach may work with your friends, but it still presumptously assumes that the patient is incapable of making his own decisions for his own reasons. (NAMI does assume the person is incapable of making their own decisions because NAMI believes in agnosognosia, the inabilty to recognize that you are mentally ill!)
So, below is Q and A #14, to which I have copied almost verbatim, but substituted fat/obese for mental illness, diet for medications, FATSO for NAMI. I left in the special case they plead for bipolar and schizophrenia.
As yourself as you are reading this, if this approach will really work if you try it on your friend. I’d say, you’ve just lost a friend.
Original question: Someone I really care about has mental illness but repeatedly stops taking his medication and his symptoms come back. Sometimes my friend has to be hospitalized. How can I help him? (My thought: Why is this question being directed to a pharmacist in the first place?)
Rephrased question:
Someone I really care about is immensely obese but repeatedly stops dieting and he gains it all back. How can I help him?
PHARMACIST’S response: One answer is to let the fat person know that he can always count on your love and friendship, but his best chances of losing weight will occur when he accepts that proper diet is crucial to his recovery. Sometimes one can help persons struggling with fat (especially those with bipolar or schizophrenia) decide for themselves which is worse – the short periods of time without the donut and the side effects, followed by the inevitable re-emergence of the fat (often piling on more fat than before)….. or, the steadier, prolonged times of skinny living (or at least more manageable fat) while staying with the diet and coping with the hunger. In a recent study, a researcher and colleagues have shown that higher rates of non-compliance with diets were associated with relapse between 6 and 18 months following a previous binge.
Simply relapsing can help some of those suffering with obesity to be more compliant with their diet. To them, relapsing means “hitting rock bottom”, and they will be more motivated to change whatever they can to ensure a better recovery. Others may not be prepared, and will be more difficult to reach. For these people, consistent support and patience are important to maintain.
Another valuable action you can take is to tell your friend about FATSO. There may be a FATSO group in the community in which he lives. You could take him to a FATSO meeting. Show him how to get on the FATSO website and navigate to the different sections available (“Inform Yourself,” “Find Support,” and “Take Action”). Being an informed consumer will help him understand not only more about his illness but also about the important role dieting can have in controlling his symptoms (in his case, obesity).
It’s very important that your friend knows you will be there to help him when his over-eating gets troublesome. Your support in helping him stay on his diet will benefit him greatly.
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