The schizophrenic who refuses to take their medication, the person with OCD who won't admit there is anything wrong... why do so many mentally ill people refuse help?
The right professional help and strong family support are necessary, but not a panacea, for people with mental health issues, writes psychotherapist Stella O'Malley
It is only when you love a person who has a mental illness that you realise how hard it is to help someone who doesn't want to be helped. It's all too easy for others to assume that all that needs to happen is for the person with the mental illness to get the right help but, sadly, professional help is often no more and no less than one vital step on the long road to recovery.
Life is hard and life is messy and mental illness is even harder and messier and, if we are to really begin to confront the truth of mental illness, then we need to examine our tendency to hope that there is a solution, somewhere out there, to these problems of living.
Because there is no solution.
Today there are millions of people all over the world trying to rescue their loved ones from the ravages of their mental illness. However, their efforts are often pointless as, even though some people's lives can be significantly improved by a combination of the right professional help and support from a loving family and loyal friends, the heavy lifting usually needs to be done by the person with the illness.
Nancy Tucker, in her extraordinary book The Time In Between: A Memoir of Hunger and Hope, articulates perfectly the complex relationship between the client and the therapy and how, ultimately, the mentally ill person has to do most of the work: "The Right Therapist helped me because, after a certain point, she couldn't help me. She could support me; scaffold me; offer me succour - but she couldn't do it for me. She could hold my Empty Child when my arms were not yet strong enough, but she could not offer the self-care; self-acceptance; self-love it craved. She could be by my side as I struck the demons down, but it could not be her wielding the sword.
"The realisation that I had found the best ally I could hope for, and that the battle was still mine and mine alone, somehow gave me permission to stop searching for a Magic Cure. It rid me of excuses; put the responsibility squarely back on my shoulders. It was uncomfortable. It was hard. But it was Right.
"After years of side-stepping, ducking and diving, I finally had to put my head down and make the change."
If a person can find it within themselves to pinpoint a way to emerge from the pain and the horror of mental illness stronger and better, then everything becomes easier.
However, some people never manage to move beyond their mental illness and seem forever hamstrung by the constrictions of their condition. This is why a progressive society needs to help the vulnerable people who aren't able to help themselves.
My best friend in life became homeless and died after he refused help from everyone who loved him and from the many professionals who tried to help him.
This lovely, kind, intelligent man refused support from his friends and family - he had a long-standing invitation to come and live with me - he left a series of rehab facilities, he stopped going to his doctor who was always prepared to go above and beyond his duty and instead he lived outside in the cold and the rain where he could attend to his addictions without sermons, without well-meaning advice and without motivational speeches.
Years before he became a homeless addict, he said he sometimes felt jealous of the homeless because they were free to just drink their drink or take their drugs and there was no mental agony of trying to get better; they had given up and just succumbed to the illness. Some 10 years later, he took this very road.
The agony of watching a loved one press the self-destruct button for the millionth time is almost impossible to describe. Of course the families and friends of people who have mental illness are just like everyone else - sometimes we are magnificent, sometimes we are adequate and sometimes we are petty and mean-minded.
Very often, there is one member of the family that wears themselves out in a valiant but vain bid to save the ill person from themselves. These helpers can easily fall into becoming enablers and they usually need to seek good professional support too as they often end up just as ill as the person they are trying to rescue.
But why do so many mentally ill people refuse help? Why do so many mentally ill people cling to their illnesses and behave in an extraordinarily self-destructive manner despite thousands of offers of help?
Psychology is a relatively new science - it wasn't all that long ago that doctors were drilling holes into skulls, using leeches or even exorcism as a way to handle mental problems.
We have thankfully come a long way since then, and yet we still don't know enough about anxiety, addiction, OCD, depression or many, many other illnesses for mental health practitioners to be able to give a confident prognosis about how the illness will play out. An integral part of many mental illnesses makes many sufferers resist treatment and this resistance can make their loved ones feel devastated with frustration.
Whether it is the schizophrenic who refuses to take their medication, the person with OCD who refuses to admit there is anything wrong or the person who suffers from panic attacks whose life is now confined to their bedroom; family, friends, psychotherapists and doctors can turn cartwheels in their bid to help and still, after all that effort, there might be no discernible change in the ill person's symptoms.
The weight of disappointment is often overwhelming for the people who are trying to help while the heavy weight of everyone else's expectations is equally burdensome for the person who is trying to recover.
It has been argued that our commitment to helping ourselves and others can depend on our "locus of control". When a person has an internal locus of control they believe that they can influence and shape the events in their lives. On the other hand, a person with an external locus of control believes that outside forces dictate their lives.
These other forces might be their family, their doctor, their medication, the government, God or even their finances or their job. A person with a high external locus of control will tend to believe that their recovery is dependent upon them finding the right therapist or the right medication or sufficient family support person while a person with a high internal locus of control will be more likely to take the approach that they need to dig deep and find for themselves the strategies that are most helpful.
The problem is that when mental illness strikes, most people cast around looking for someone to blame.
The sufferer, the family or the deficient mental health services are most often in the firing line but sometimes it is not appropriate to blame anyone - indeed we would often be better off blaming mother nature and this bewildering universe for all the attendant mental pain that comes with mental illness. Because we seem to be still swinging from the trees when it comes to knowing what to do when a person is resistant to treatment.
This is why, when we love someone with mental illness, we need to make sure that we find the strength deep within ourselves to learn how to cope. We need endless patience, endless sympathy, endless tolerance and we need to try to balance all this with good humour and a light touch so that the joy of life doesn't get submerged by the illness.
Of course it is completely impossible to do all that and so we fail, endlessly, every single day. But that's okay - as the poet Philip Larkin reminds us, "What will survive of us is love". We don't necessarily have to behave perfectly just because someone is sick. Instead we can be just who we are.
Mental illness is so profoundly difficult for everyone involved that the more it can be viewed as a tragedy for everyone - perhaps like a natural disaster that leaves destruction in its wake - the more likely we are to build a community that supports the vulnerable and the less likely we will be to point the finger of blame at everyone else.
Because there is no one we can blame for mental illness; we can't blame the person who has to bear the illness - they never asked to be susceptible to it - nor can we blame the parents, because then we need to blame their parents before that, and their parents before that and on and on. Nor can we blame the doctors as they are doing their best and they are as fallibly human as the rest of us.
The ancient art of mindfulness advises us to be a 'compassionate mess'; if we can practice compassion; self-compassion and other-compassion and if we accept that our lives will be messy and yet we still have some joy in our lives, then we will be alright. And, in this world, being alright is really very good indeed.
Stella O'Malley's new book, Fragile - Why we Feel More Stressed, Anxious and Overwhelmed Than Ever, and What We Can Do About it, published by Gill, £12.99
Name has been changed to protect anonymity