Learning to ask for help

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 42, a man, and I live in Tucson. I have schizophrenia. I have been stable for the last seven years, which is the longest stretch of my adult life. The single biggest reason for that stability is not a medication or a therapist or a particular technique, although I have all of those. It is that I learned, late, how to ask for help. I want to write about how that skill actually develops, because I had been told to "reach out" my entire adult life and had no idea what that actually meant.

The years I did not ask

I was diagnosed at 22. For the first decade after that, I treated my illness as something I had to manage by myself. I did not tell coworkers. I did not tell roommates. I did not tell most of my friends. I kept my prescriptions hidden in a drawer. When I felt myself slipping, I would double down on willpower. I would tell myself that asking for help was weakness, that everyone else was managing, that I should be too.

In that decade I was hospitalized four times. Every hospitalization was preceded by weeks of silent slipping. Every hospitalization was, in retrospect, a failure not of medication but of communication. By the time I was 32, I had a kind of structural exhaustion that came from running my own life as a one-person military operation against an illness that was bigger than me.

The conversation that changed it

I was discharged from my fourth hospitalization in the spring of my 33rd year. The discharge social worker, a woman who had been doing this for twenty years, sat with me for an hour. She asked me to name three people who knew the full picture of my illness. I named one — my mother. She asked me to name three more I would be willing to tell.

I sat there for a long time. The list, when I made it, was short. My older brother. A college friend who had stayed in touch. My therapist, although she already knew. The social worker said, "By the end of the next month, I want you to tell two of these three people the truth about what just happened to you. Not the cleaned-up version. The real version. Then I want you to ask each of them for one specific small thing. Pick the smallest thing you can think of."

I asked her why specific and small. She said, "Because 'reaching out' is not a thing you can do. Asking for one specific thing is a thing you can do."

The small asks

The first ask I made was to my brother. I told him about the hospitalization. I told him about the two before it. I asked him if he would call me every Sunday at 4 p.m., for fifteen minutes, just to check in. I told him that he did not have to fix anything, just to be on the phone.

He said yes. He has called me every Sunday at 4 p.m. for nine years. The Sundays he has missed because of travel he has rescheduled. The call is not therapy. It is not even particularly substantial. It is a thread.

The second ask I made was to my college friend. I told her about my illness. I asked her if she would be willing to text me once a week — just a "hi" — so that I had a structured non-family contact. She said yes. We have been texting once a week for nine years.

The third ask, which the social worker had not assigned, came a few months later. I asked my therapist if she would be willing to talk on the phone for ten minutes if I called her in a wobble between sessions. She said yes, with limits — the call would be for triage, not therapy. I have used that arrangement maybe five times in nine years. Knowing it exists has prevented many more wobbles than it has caught.

What I learned about how asks work

Specific and small beats general and large

"Be there for me" is not a thing anyone can do. "Call me Sunday at 4 for fifteen minutes" is. The smaller and more specific the ask, the more reliably people can keep it.

Ongoing and structured beats one-time and emergency

The Sunday call from my brother is more useful than any emergency call I could make to him would be, because by the time I would be calling in an emergency I would have lost the bandwidth to call. The structure of the standing call means I never have to ask twice.

Naming the illness lets people meet you where you actually are

Not telling people about my schizophrenia had been protecting them, I told myself. In reality it had been isolating me. Once I started telling a small number of trusted people, my world stopped being a performance. The fatigue of pretending to be a non-ill person was its own drain on my stability.

Asking is a skill, and it gets easier

The first ask was the hardest thing I had done in years. The second was easier. The thirtieth, last week, was a sentence I sent in a text without thinking about it for more than a few seconds. The skill develops the way any skill develops — through reps.

Most people say yes

I had been so afraid people would say no, or judge me, or pull away, that I had assumed the worst. The actual experience has been overwhelmingly the opposite. Most people are honored to be asked. Most people are quietly waiting to be useful. The asking is, often, a gift to them.

The bigger asks

Over the years, the asks have grown. I have asked my brother to be my emergency contact and my psychiatric advance directive proxy. I have asked my upstairs neighbor to check on me if she does not see me for two days. I have asked my employer's HR person, in writing, for an accommodation that lets me work from home one day a week without justifying it. I have asked friends to drive me to medical appointments. I have asked NAMI to connect me with a peer support specialist.

Each of those asks took less courage than the one before, because I had built a track record of asking and surviving the asking.

What asking has done for my stability

• I have not been hospitalized in seven years.
• The wobbles I have had have been caught earlier, by other people noticing things I could not.
• I am less tired. The performance of wellness — the silent self-management — was a constant background drain that I no longer pay.
• My relationships are deeper. People who know the full picture of who I am are the people who can be in my real life.
• I sleep better. The thoughts I used to lie awake holding by myself are now, often, things I have already said out loud to someone.

What I would tell someone who has not started asking yet

• Make a list of the people who already know something is going on with you. The list is usually longer than you think.
• Pick one person on the list. Pick one small, specific, repeatable ask. Make it.
• Wait a week. See how it felt to be helped.
• Pick a second person, a second ask. Make that one.
• If your treatment team is not yet on the list of people you ask things of, start there. Ask for a phone call between appointments. Ask for a written list of side effects. Ask for help reading a confusing letter from your insurance.
• Do not wait for a crisis. The skill builds in the small times.

I will be 42 next month. I am still bad at asking, in the sense that it never feels easy. I am much better at asking, in the sense that I do it anyway. That is, I think, the actual definition of getting better at something.

For more, see coming out of isolation, social connection and schizophrenia, and peer support specialists.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.