[theaussiestew]

Fair enough, it does sound like he's having some pretty severe mental health problems from those additional details. I care for your friend, if you can relay some of this advice to him when he's feeling better, it would be beneficial.

To echo other people in this thread, you're not responsible for him, but if you have the emotional bandwidth to help out where you can, you can make a difference in his recovery outcomes. It sounds like a lot of pressure, but the more relaxed and detached you are the better it'll be for both of you.

I generally think you were completely right to call the mental health team, but he understandably might still be angry.

I care for your friend, and here are some concrete steps that worked for me, in order of effectiveness.

1. Taking time off work, or even leaving if that's possible

Sounds like workplace tensions caused or exacerbated what he's going through. It's likely his mistrust has spiralled into some kind of paranoia. It's also possible that workplace stress is exhausting and destabilising him. It's best for him to simply take extended leave, or leave the workplace entirely.

2. Avoiding psychiatric labels in favour of therapeutic/psychological labels

Understanding that paranoia develops from suspicion, and suspicion grows from fear, and fear grows from mistrust. To elaborate, it sounds like he's having some kind of conflict where he thinks other people are doing x or y to him, but that's likely just mistrust spiralling out of control. One attitude is to label this paranoia, and as a psychiatric symptom of psychosis/schizoaffective disorders, another attitude is to label it as an extreme version of mistrust. Both are true, but one is more conducive to healing. Basically, if I were your friend, I would avoid internalising any labels he would be taking on during this period, because that can actually reinforce negative outcomes.

3. Eating pure, unprocessed, and heavy foods.

A lot of mania like symptoms are just the result of emotional or mental exhaustion. That causes us to get light headed and start overthinking, and then have an emotional reaction of fear, which causes more overthinking and so on, which can spiral out of control. A simple solution that doesn't involve pharmaceuticals is drinking lots of fresh, spring water, eating tuber and root vegetables like potatos and carrots, and also fatty and greasy foods like cheeses and butter. Basically, natural and whole foods which weigh you down, not things like McDonalds or potato crisps. Drugs are likely going to be necessary for at least a couple of weeks and maybe several months, but longer than this, in my opinion is likely detrimental to the brain's physiology. Your friend sounds quite intelligent, let's keep it that way.

4. Sleeping more

Like I said in my previous response, lack of sleep can cause and exacerbate mental health problems. Sleeping drugs or aids like melatonin may be necessary at this stage, but if not, then natural remedies like camomille tea, a relaxing bath and music would help.

5. Working with a psychologist/therapist, rather than a psychiatrist

This perspective may be polarising, but I believe that psychiatrists are not equipped to help heal severe mental health issues. At best, they are a temporary support that prescribes medication (which is necessary initially for weeks and months). To end up on medication for years and decades, and stuck with a psychiatrist who keeps on prescribing them is a one way road to being a zombie. Instead, in my opinion, working regularly with a psychologist and/or licensed therapist is the best way to recover from so called severe mental health illnesses like bipolar/schizoid disorders. If your friend has the financial means, additionally working with a neurologist once he's more stable (maybe 1 or 2 months from now), would be even better. The neurologist can rule out things like actual physical brain conditions like high cranial pressure, brain tumours and other physiological causes of mental health problems.

6. Spending time in nature during the day, either alone or with a trusted friend

Just sitting or walking around in a park can have extremely outsized benefits for mental health. That means going to as secluded and natural of a place as is practical. If there are no people in the place, that's even better. I experienced it myself, when I walked in a park every day and recovered extremely quickly.

7. Having the intention to surrender to a higher, benevolent power

Your friend is communicating with voices in his head, which is a a big warning sign, from a spiritual, psychiatric and psychology perspective. It could be anything from different parts of his psyche communicating to try and come to a resolution, or it could even be what are called "jinns" or negative spirits in religions like Islam. While many may roll their eyes at the mention of spirits, especially in a more secularly oriented community like Hacker News, this is a possibility. The solution, regardless of what is happening, and regardless of what you (or I) believe is happening, is surrendering to a higher power. It could be surrendering to God, Allah, Buddha, Earth, Universe or the Void. It doesn't matter whether he's atheist, agnostic, religious or spiritual, simply having the internal intention to surrender to a higher power will deliver very rapid healing and peace. If the intention to surrender is genuine (not laced with doubt or skepticism) and comes from a deep place, it will cause an instant effect of peace and relaxation. You can even try this yourself right now to verify it. It definitely did for me. In fact, this last point was the most effective, over everything else I mentioned.

If your friend wants to talk to someone when he's feeling better I'm always available.

[ost-ing]

I resonate a lot with the last part of this comment. It’s not often I hear reference to djinns, but they certainly have seemed real for me. Your suggestion of surrendering to a higher power, in my case Christ (despite not being Christian), was how I dealt with it. The change in my life trajectory after this event was profound, ultimately it was for the better - I believe that it saved my life.

[throw8qoh]

To give my perspective from having experienced this side as well (did not use the more powerful medications and recovered from the worst part in a bit over two weeks from the time it got distinctly worse with a small residual effect for maybe a couple weeks after that): I agree with this list but would phrase some of them a bit different.

I'll start mentioning that my understanding is that there seem to be a few different types of outwardly similar issues with major differences along with variation within a type and different severity. I was never at danger of suicide and never started a note, though I did vividly imagine suicide at one point. The worst part for me was panic attacks that lasted hours on a few days (suicidal inclination at that time could be deadly as it felt like the end was near in any case, although for me that was not when I imagined suicide). I never use recreational drugs including alcohol (unless you count sugar, which likely you should). I did not hear voices or see people who weren't there but did have a visual oddity during most of the worst times (which clued me in that something was seriously wrong; I wasn't able to make as much use of that insight as I would have hoped but the worst parts happened later when it was much less visible).

I call it brain overheating but it was not just the brain; the rest of my body was overheating as well. I suspect blood brain barrier issues and blood sugar issues during this worse time (but not other times). Adding some oil to my diet seemed like it might have been quite helpful (although jumping to conclusions was a big part of the issue). My memory was both better and worse than usual in some ways; I could pull a bunch of memories to support a theory (at times definitely invented some but mostly real memories I think) while contradictory memories were much harder to recall and dismissed way too easily or worked around in elaborate ways. I started with a theory that felt true (related in some ways to things I worry about but also random) and my brain worked to figure out why it must be true and to fill in details rather than questioning it. I would eventually figure out that the theory was false but then jump to the next one, particularly during the worst couple of days. I don't think someone else engaging much with details of such thoughts is likely to be helpful but gently honest feedback about your overall impression if you do listen can help point the way to reality (I do think there are aspects of reality in the overheated thinking as well but they are covered by the false connections). Writing down what I was thinking was helpful and made it easier to spot the issues later (just don't let anyone else read it). I had strong "universal love" feelings, religious feelings, and paranoia at different times (and maybe combined in some ways).

I would not phrase #7 on this list that way and wasn't similarly magic to me but I do think it helped that when I thought cops were coming for me I was basically OK with that and tried to be ready in a way that would limit the chance of being shot (then eventually the fact that they didn't show up brought me back to reality some). I don't think joining a religion in that state is a good idea and it is a helpful show of love when those who are religious don't try to take advantage of the religious feelings to try to push their religion (clearly not the intent here, I agree with accepting whatever happens being helpful). Getting outside when I was improving is what finally resolved the worst times for me but earlier made it worse (because it worked its way into a theory). To get to that point focusing on a simplified daily routine (and finding some things to do that helped some or at least didn't make things worse) was most helpful for me.

In terms of sleep low dose delayed release melatonin seemed quite helpful to me as well. I would add that it is not just lack of sleep that causes trouble but circadian rhythm as well. Symptoms were distinctly worse for me at night and brighter mornings seemed to help more than cloudy mornings.

Isolation was helpful for me as nearly every interaction I had with others was embarrassing and made things worse. I also accused one person I care about of doing something malicious and feel bad about that. At the same time feeling love from a few people (including the person I accused, who I apologized to fairly quickly) was also helpful. I misinterpreted coincidences as being malicious so I would say isolation is good but avoid permanent decisions until fully recovered if possible since decision making is impaired.

[theaussiestew]

I would characterise surrender and acceptance as very similar. So in your case you accepted the situation, which I would call surrendering to the universe, or to reality. But yes, in no way am I suggesting that one joins a religion or a spiritual faith during a crisis. It's more like, if there is a time to believe in a higher power, even if you've never had any inclination before, it's this kind of situation.