Expert: Libby Bonner - 9/12/2007

Question
QUESTION: Over the past 9 months I have been very close with a coworker, a wonderful generous and caring physician.  We quickly became dear friends, spending much time together and having daily long and very intimate conversations, as we are both mid-divorce.  I do know that she has a psychiatrist under whose care she has been for 25 yrs. (she is mid 40's now) I do not know any specifics of her psych history or whether meds are involved. In the past month she has withdrawn completely from me, without explanation or incident.  She has become verbally aggressive, prone to irrational outbursts, paranoid, will not answer the phone to my calls, ignores me completely at work, snaps with little or no provocation.  I did not want to discuss this with her at work, so stopped over at her house yesterday (which has never been an issue before) and asked her if everything was ok, whether I had done anything to upset her, as she hasnt' seemed herself.  She snapped at me and said "I AM FINE. I AM FINE. YOU DID NOTHING. DO NOT TRY TO TAKE CARE OF ME.  GOODBYE."  I confided in a very ethical and honorable coworker my concerns for my friend, and she said that this same exact pattern happened a year ago with another member of the staff.  My friend then emerged from this episode a few months later and acted as though nothing had happened.  My question is this:  How is the best way to be a friend during an episode such as this, do I wait it out and just "be there", (she also has a 5 y.o. daughter  for whom I am concerned) where is the boundary for a friend as far as staying away if that is her demand, etc.  I am  grieving the loss of our friendship, but am much more concerned for her and her daughter. I don't mind being there and standing by during this storm but once it passes I am not willing to ignore the elephant in her livingroom and resume as though nothing happened without some honest discussion about it.  Is this an unfair expectation? Thank you so much for your generosity and kindness in making yourself available for questions.
Kathleen

ANSWER: After many years w/ NAMI and w/ allexperts, your question is a new one....which means it is interesting for me, but that, for you, I have little [no] exact experience to draw on.

I am very sorry about the abrupt loss of this valued friendshiip and the divorce support that was part of it.  

I had been confused about 'same pattern a year ago' but now see that you must mean that your friend abruptly terminated another office friendship w/ a different staff member a year ago, yes??

[I am a little short of time, so want to toss out some questions/comments, some of them rather random....pls write again, and I will also.]


Is that other staff member still employed there?  No way to know how she [the other] felt at the time, or what she may have done or said once order was restored??  If that relationship was never resumed, it may be an indication of what you can expect.  [Ah - but - see below.  YOU can do something about that, perhaps.]

Truly, my deepest concern is:  how is she w/ patients?  Or perhaps she does research or pathology or something???  

How, in fact, is her general demeanor w/ staff and coworkers other than you?  Are there persons w/ whom she must have frequent contact?  What has happened/is happening in those transactions?

Reading very much between the lines:  if she is under psychiatric care, and esp if meds are involved, then I think you can assume this is illness behavior.  Mental illnesses are characterized by relapsing/recovering, over and over.  If she has been around the block many times w/ her illness, as she surely must have been, then she may have learned by now that isolating herself, except at work, is the best way to go....probably best for her quicker  recovery, or maybe even that [she hopes] it is best for the preservation of relationships, in that she protects you from some of her worst and uncontrolled behavior.  [You have likely only seen the tip of the iceberg.]

I do think we're on to something w/ that thought.  I can take it up better later.  But it would bring us to:  what to do re the elephant?  IF you want to continue the relationship, why not let her come out of it and back to you w/o reservation.....and, only after a period of being again genuinely connected, then might you gently ask for a bit of disclosure.

The illness, whatever it may be, is an awful, awful burden to the patient, who also bears the burden of terrible guilt, after the fact, about letting various significant others down.  Huge burdens there.   YOUR burden, if you continue, might be to realize that these withdrawals will be inevitable in the future, and to forgive them completely and whole-heartedly.

Getting help for yourself, re the relationship.  Book:  author is Woolis; title is When someone you love has a mental illness.  It will give you tools that will be helpful when things start to slide; maybe keep you in communication longer and/or better as things start to go.

Also, consider attending a local family support group:  www.nami.org   Depending on where you live, they may or may not have support and it may or may not be good.

Gotta run.   Later.

Wouldn't worry about the daughter as long as there is a grandparent in the picture; not your problem.





---------- FOLLOW-UP ----------

QUESTION: thank you. Unfortunately, she doesn't work in research.  She has been confrontational with other physicians and staff, I saw her strike like a rattlesnake at another doc regarding a case she wasn't even involved in.  You were correct re: another staffmember experienced this a year ago. Unfortunately, that woman is/was much more vulnerable baseline, assumed she must have done something terrible to deserve this shunning, was devastated, and put distance between them to protect herself (as my friend apparantly publicly and viciously berated her in the OR, without cause, repeatedly.) It is clear to me that this is not about me or something I have done. As for how she is with patients, until now my experience of her is as the finest, most dedicated MD I have worked with in 25 years.  What I have seen in the past few weeks is more typical of her jaded, minimally involved peers, not dangerous so far.  I am not comfortable talking with others at work about this because most of what I know is from our personal relationship, not professional and I feel it isn't fair to bring it to the workplace.  I guess I will just remain constant and wait it out, let her make the next move if any.  I would like to try to love her unconditionally, but don't know how well I will do if she chooses to publicly strike out at me as she did her former friend... thank you, Kathleen

Answer
Well.

To clarify, you are right to be mystified or angry now.  But I had thought that she had distanced herself from you at work such that you would/could not become a target during this current episode.  And so my advice for unconditional support supposed that your stance to her, once she is herself again, might be a receptive one, this being the only way to hope to regain/restore the relationship....w/ then my further thought that, at some point after resumption and some normalization, you could make inquiries and require some disclosure.

Now that I see you feel that you remain a possible target at work, I am certainly not recommending loving it and her at this moment and forever, regardless.  More strongly than ever, I do hope you will get the Woolis book.  It would help you to keep from inadvertantly provoking her and/or would give your some language and concepts to deflect and defuse incidents.

She is a surgeon?  She still sees patients in the office and I remain concerned about that.  I was seen by an unmedicated bipolar doc in 2005, a series of three appts.  He was, serially:  hypomanic/manic; depressed [angry/enraged]; and normal.  I think physicians in his practice, and in yours, are failing in their responsibility and exposing themselves to liability.  Even though I understood the situation clearly, having seen him high first, the second appt took some getting over.  [Good reasons why I stuck w/ him, but I have already refused referral to another sub-speciality w/in the practice.]

Anyway, good luck.  You could certainly wash it, at this point, since the momentum of your new relationship has been lost.  And it would take more than you might gain to get sufficiently into mental illness to make any relationship  possible.

It is too bad, but is a common enough, even usual, thing that persons w/ mental illness find themselves w/o friends.  Not guilt-trip time - it's how it is.  I myself would not knowingly enter into full friendship w/ someone w/ mental illness.  Plenty is required of families, and way too much for 'civilian volunteers.'