How do you help someone who is spiraling down?

There is someone in my broader family who has been slowly falling apart for years. There's a lot of history there - some PTSD and depression related to sexual trauma over a decade ago, a general lack of 'having it togetherness', some medical issues. She has the education to work in a decent profession, albeit not a particularly well-paying one, but has for one reason or another been unable to capitalize on this education; instead she has been working as a nanny and picking up other odd jobs. During this time she has been apparently unable to establish any semblance of financial stability - she is essentially off the grid, not reporting income and paying in cash for everything and defaulting on some (modest) student loans.

Earlier this year she was thrown out of her parent's home (she is in her 30s) and has been squatting with friends in a rather precarious position since. She seems unable to reverse this slide into greater and greater precariousness, with essentially no safety net now that she is largely estranged from her family. Her full time job was recently axed, and while she may be able to find another position in a similar situation (albeit with substantial financial hardship and turmoil in the interim), it will not dramatically improve her situation. There is also a concern among those close to her that she may have a substance abuse problem, perhaps related to her medical conditions; this has reportedly led to a substantial deterioration in her job performance and already-poor ability to get her shit together.

I have witnessed this from afar - I do not live near her and am in very rare contact (the occasional call/email on a birthday or holiday); we haven't really gotten along for years, though there's more a total lack of compatibility rather than any animosity. But I am worried - her sister has tried to get her help, putting her in touch with organizations that can provide her assistance - her current situation makes her eligible for all sorts of government and private assistance, including housing assistance, food assistance, healthcare, etc. - but she has so far not shown any willingness to engage with these opportunities for relief. Perhaps this is a depression thing, perhaps a pride thing, perhaps who knows what. But it's become very frustrating to watch - she asks her social network for financial assistance, but appears to have no plan or motivation to turn said assistance into a sustainable improvement in her situation rather than a stopgap measure to address an immediate need.

So my question is: What would you do? I'm deeply concerned that she may sink further into substance abuse (if indeed that is an issue) and could become another OD statistic in America. Alternatively, her deep depression could turn suicidal given the precariousness of her situation. Or maybe her health will dramatically deteriorate and in the absence of a support system she might fall apart.

I don't know what to do. Part of me wants to just give her some money to stabilize the situation a bit - while it wouldn't substantially harm my family's finances, a thousand dollars here or there would be a dramatic improvement in her short-term circumstances. Yet I have refrained from doing so because I feel like it would enable her continued inaction on figuring out how to start piecing together her life. In the absence of money, I don't really have a close enough relationship with her to provide any sort of useful prodding or support to move her in a constructive direction; in fact, I bet it would either come off as nagging or condescension. But I fear that in the absence of some constructive change in her life things may get very dark indeed.

There are few good options. They're not close enough to you for some kind of an intervention. They're not going to listen to your advice, even if you spell out exactly what to do in the short-term. Realistically, there's little you can do. If you do want to try something, it's to either convince her parents to bring her back or get her committed for being a threat to herself (assuming that is the case).

If this is mainly a drug issue, lots of research says that addicts do get better eventually, but after a lot of false starts. Just because she hasn't gotten better in the past doesn't mean she won't in the future. This is path with the most long-term potential, but it does entail convincing her parents to put themselves in a precarious mental (if not physical) situation.

If there are serious mental issues to go with the drug issue (which is frequently the case; the causal arrow is hard to pinpoint), being sent to a mental hospital for a few months can get her on the right medicine and off drugs. There's a huge chance of recurrence in this scenario, and she'll be really pissed off at whoever had her committed, but it might be necessary to stabilize the situation (before perhaps having her move back in with her parents).

the easy short term money solution could help, especially if she is falling between the cracks for mental help. but you don't just give out money to family. you setup some sort of reward system. find a place and you'll cover the deposit. find a job and you'll cover groceries till the paycheck arrives. secure an interview then its time for a shopping trip, etc.

"nanny" could mean anything so her actual motivation to work, compared to her motivation to work in her field, is still unknown to us.

The US is obv. very different from Sweden wrt laws (eg. for getting people committed) and support systems. Putting aside medical considerations and studies for a moment, anecdotally, those who make it--in spite of depression, anxiety, PTSD, substance abuse and challenging personality disorders--tend to be those who manage to retain or develop at least one relationship with a dependable and reasonably functioning person. A very good friend, a partner, a good boss, perhaps even a family member. Finding the way back to a "normal" life is a long and slow process and you can fill any one of a large number of different roles in that rehabilitation.

One of the ways in which someone can help, personally, is to be there at the right time to facilitate getting in touch with professionals or make some other positive change. Over and over again, until it sticks. This may require you to spend more time with this person in order to develop a friendship or at least some sort of trusting alliance.

If you don't see yourself trying to become friends with this person, you can nevertheless let them see you're there for them if they need help. That they have, in you, a link to a normal and functioning life, that the door is still open. Concrete ways to do this: get in touch every now and then just to chat or to do something nice. Invite her to low-key and manageable social occasions that don't create too much pressure or strain her budget. Keep offering even if she keeps bailing. Go visit--if she's okay with it--and bring something tasty to share. If she needs help with something specific, eg. a ride somewhere, help figuring out official documents or applying for something or other, you can help with that. When you have a decent relationship and the time is right you can help them find out more about what options there are for getting good help and help them get that help.

Most people with substance abuse do tend to recover with time, but trauma/PTSD, other psychiatric comorbidity, personality disorders and above all the loss of functioning relationships make recovery more difficult and less likely. You'll have to adjust your expectations accordingly and be okay with the possibility that they'll never be able to put their lives together just the way you think it should be. Some people end up leading frustrating, broken lives no matter what you do.

Whatever you do, don't let her feel judged or shunned. It just causes pain and undermines a fragile alliance. Don't let her feel like a project or a charity case.

Don't offer money unless it's for something specific that will keep her life from completely falling apart or help her move forward.

And maintain a healthy distance so that you don't take on the responsibility for her decisions and get frustrated by her repeated failures.

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but she has so far not shown any willingness to engage with these opportunities for relief.

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As harsh as it may sound: As long as she's showing this attitude, she literally cannot be helped. There needs to be at least a spark of willingness to accept help.

Be there, make it clear that you're willing to help and that you're not judging. But she needs to take at least the first step herself.

I think I concur with Aimless here; I think you should not offer her any help besides making yourself available if she really hits rock bottom. Otherwise you indeed run the risk of enabling her in a rejection of dealing with her problems. Because that seems very much what she's doing right now given that she is eligible for all sorts of assistance she's not getting. Your help will be doing little against a descent, and the willingness of your wife to help could very well run out before your family member stops needing it. Once she starts admitting that she has problems, that would be the time to throw your weight behind her recovery.

Keeping in touch and making sure she has a square meal every now and then of course falls well inside of the things you could still do.

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Originally Posted by Aimless

The US is obv. very different from Sweden wrt laws (eg. for getting people committed) and support systems. Putting aside medical considerations and studies for a moment, anecdotally, those who make it--in spite of depression, anxiety, PTSD, substance abuse and challenging personality disorders--tend to be those who manage to retain or develop at least one relationship with a dependable and reasonably functioning person. A very good friend, a partner, a good boss, perhaps even a family member. Finding the way back to a "normal" life is a long and slow process and you can fill any one of a large number of different roles in that rehabilitation.

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I second this part, but I also find it unlikely that a distant relative with little personal history can play this role.

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Originally Posted by Loki

I second this part, but I also find it unlikely that a distant relative with little personal history can play this role.

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The description of the situation seems to imply that closer relatives are giving up. I don't think it matters so much how close they are now, but how reliable he is percieved in the future.

I've been wildly busy for the last week, but I wanted to let y'all know that I appreciate the thoughts. I don't have time to address every one individually, but some general comments:

1. I think the option of getting her committed is a challenging one to orchestrate; nor am I convinced it would help matters. I am (a) not sure there is a substance abuse problem and (b) not sure that the PTSD/depression is sufficient to warrant that kind of intervention. Obviously if I'm wrong on either count I'd feel pretty awful, but I'm far from the closest person and not really able to evaluate this on either metric with any level of certainty. Without such certainty, I'm pretty leery of going down that pathway, especially given that it would irrevocably burn that bridge.

More broadly, I think her mental health, while precarious, is not the only problem here. It's a co-morbidity, if you will, with her general inability to get her shit together that has been a hallmark of her life since she was a teenager.

2. I would rate the chances of her moving back in with her parents (or any other immediate family member) as quite low, absent a real breakdown. Her father hasn't had anything remotely resembling a functional relationship with her for years (and now barely acknowledges her existence) and her mother, while still keeping in touch with her, doesn't seem to have the will to make it happen. Also remember that she is in her mid-30s; moving back in with her parents seems like a step in the wrong direction. She could easily fall back into her old 'coasting' patterns without a very structured intervention that I am frankly doubtful her parents could pull off. They are somewhat dysfunctional themselves and deeply lacking in emotional intelligence; they have not handled anything about this situation well.

3. A lot of the responses might work (sorta) but I live about 1000 miles away so I can't implement most of them. I also have a distant and at times testy relationship with her; we mostly avoid any arguments by only rarely interacting; I typically just use my daughter as an excuse to touch base with her. Her sister lives in the same city and has reached out frequently to try to get her some help (and still has some connection with her), but to little effect. I've instead offered my services to the sister in case she needs help sorting anything out (either logistically or monetarily); she is an eminently reasonable and responsible person who is pretty much the definition of a model citizen, and I have no doubt that if I could help through her, she'd let me know.


I spoke to her last week on a pretext; we had a brief and largely inconsequential interaction, but I implied that I'll increase the frequency with which we talk (using kid as an excuse); I'll try a couple times a month (more would be wildly out of character for me and liable to make her suspicious). Hopefully I can build some sort of rapport even though we have exceedingly little in common. She has secured another job, albeit still nannying at barely adequate pay. I'm hoping that some prodding from the sister can cause her to start sorting out her finances and finding a more stable living situation (and, maybe, getting the mental health help she needs; she has a therapist but clearly that isn't enough). But, honestly, based on past performance, I'm not feeling very optimistic.



One thing about this whole scenario that's got me thinking is how easy it is for people to fall apart. She was raised in a broadly similar environment to her sister, but while her sister is a happily married doctor with a million dollar home, she has essentially nothing. Part of it is probably innate character traits, but maybe bad luck factored in as well - weird family dynamics, sexual trauma leading to PTSD and depression, some health issues, etc. It's a little scary to realize that while most people from relatively decent backgrounds manage to do okay for themselves in life, some people find it incredibly difficult.

Be very careful not to get too invested. I'd like to re-iterate: Unless she herself realizes that she needs help, you won't be able to help her.

Sometimes people actually need to hit rock-bottom.

That may sound callous - but my last ex-girlfriend also has serious issues. I couldn't even attempt to help her before she cut me out of her life. I've made it clear that she may call on me if she really needs help but otherwise I've moved on.

I used the Evelyn Woods speed reading technique, and only scanned first and last paragraphs. But my initial response is....what do you think you can do anyway, and how does it matter to you?

While your motives are commendable, there's really no simple answer for the question you asked. You're asking how far down should someone be
"allowed" to go before 'the authorities' are brought in. Well, Homeland Security would probably like a definitive answer to that question, too.

In essence, there's no single answer to any complex problem. And most problems are complex :(

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Originally Posted by wiggin

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One thing about this whole scenario that's got me thinking is how easy it is for people to fall apart. She was raised in a broadly similar environment to her sister, but while her sister is a happily married doctor with a million dollar home, she has essentially nothing. Part of it is probably innate character traits, but maybe bad luck factored in as well - weird family dynamics, sexual trauma leading to PTSD and depression, some health issues, etc. It's a little scary to realize that while most people from relatively decent backgrounds manage to do okay for themselves in life, some people find it incredibly difficult.

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her sister is a "happily married doctor with a million dollar home", while she has nothing, huh.

Another thing I wondered about, after re-reading your missive....would you feel the same way about a male relative?

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Originally Posted by GGT

Another thing I wondered about, after re-reading your missive....would you feel the same way about a male relative?

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I fail to see why it should matter the gender of the person in question. The trajectory of her life is deeply concerning regardless.

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Originally Posted by wiggin

One thing about this whole scenario that's got me thinking is how easy it is for people to fall apart. She was raised in a broadly similar environment to her sister, but while her sister is a happily married doctor with a million dollar home, she has essentially nothing. Part of it is probably innate character traits, but maybe bad luck factored in as well - weird family dynamics, sexual trauma leading to PTSD and depression, some health issues, etc. It's a little scary to realize that while most people from relatively decent backgrounds manage to do okay for themselves in life, some people find it incredibly difficult.

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It's almost as if the choices people make matter more than their upbringing and starting situation. Don't want to derail the thread - but I've seen this kind of situation a lot with siblings. One sibling is successful and the other is not and it almost always comes down to making really poor decisions even though they both had the same 'start.'

Back on topic, with you a 1000 miles away and not in close contact I really don't see how you can do much good.

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Originally Posted by Lewkowski

It's almost as if the choices people make matter more than their upbringing and starting situation. Don't want to derail the thread - but I've seen this kind of situation a lot with siblings. One sibling is successful and the other is not and it almost always comes down to making really poor decisions even though they both had the same 'start.'

Back on topic, with you a 1000 miles away and not in close contact I really don't see how you can do much good.

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No one's upbringing is identical - even twins. And one could still make the argument that because she is from a relatively comfortable upper-middle class background, it gives her some sort of network and familial safety net that gives her a lot of room to screw up before getting into real trouble. Upbringing matters and the head start you get matter a whole lot.

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Originally Posted by wiggin

No one's upbringing is identical - even twins. And one could still make the argument that because she is from a relatively comfortable upper-middle class background, it gives her some sort of network and familial safety net that gives her a lot of room to screw up before getting into real trouble. Upbringing matters and the head start you get matter a whole lot.

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The familial safety net is helpful but it is still a lesson in the importance of making the right choices in life. You can be born with all the wealth and privilege in the world and still OD in the bathroom at 22 like a piece of gutter trash. To many on this board - people's success in life is almost predestined based on their upbringing when I'd wager to bet every family or friendship circle has stories like the one of your relative. Choice's matter when it comes to the success or failure of a life.

This is just such an extraordinarily stupid tangent in a discussion about a person who's suffered severe sexual trauma and developed ptsd.

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Originally Posted by Aimless

This is just such an extraordinarily stupid tangent in a discussion about a person who's suffered severe sexual trauma and developed ptsd.

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Yes, but wiggin put that trauma on the back burner, ostensibly because people with means have access to psychologists and psychiatrists. (?)

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Originally Posted by Lewkowski

The familial safety net is helpful but it is still a lesson in the importance of making the right choices in life. You can be born with all the wealth and privilege in the world and still OD in the bathroom at 22 like a piece of gutter trash. To many on this board - people's success in life is almost predestined based on their upbringing when I'd wager to bet every family or friendship circle has stories like the one of your relative. Choice's matter when it comes to the success or failure of a life.

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Says the guy who doesn't understand addiction from a medical standpoint, and thinks abstinence = willpower = character. :rolleyes:

Lewk, no one chooses to be abused or addicted.