The Invisible Struggle: A Guide to Supporting People Who Need Help But Don't Know It
A summary of a fascinating conversation my dear friend Dr. Shokooh Miry as she educated my physician colleagues.
Mental health challenges often wear masks of normalcy, hiding behind successful careers, social media smiles, and daily routines that seem perfectly intact. After a revealing conversation with a seasoned psychologist, I've distilled insights that can help any of us recognize and compassionately respond to the invisible struggles around us.
Think of mental health awareness like having a blind spot while driving—the person affected literally cannot see what others might observe. This isn't about intelligence or weakness; it's about how our brains protect us from painful realities, sometimes at the cost of our own wellbeing.
/BORDERLINE
Imagine living in an emotional house where the temperature swings wildly between freezing and scorching, with no reliable thermostat. People with borderline personality disorder experience relationships through this lens of emotional extremes. Here's what you need to know:
The Reframing Strategy: Instead of suggesting "you need therapy," try positioning support as "learning to deal with difficult people in your life." This removes shame and positions them as gaining skills rather than fixing flaws. About 25% of effective therapy actually focuses on managing relationships with others—validating their experience that relationships are genuinely challenging.
Their Pain as Motivation: Unlike other conditions, the intense emotional suffering that characterizes borderline personality disorder often becomes the very fuel for seeking help. When someone experiences emotional pain acutely, they're more likely to pursue relief.
Self understanding makes world understanding.
/THE NARCISSISTIC PUZZLE
Working with someone who has narcissistic traits is like trying to fill a bucket with a hole in the bottom—no amount of validation ever seems enough. This presents unique challenges:
The Empathy Building Approach: Research supports focusing on developing empathy rather than confronting the narcissistic behavior directly. Think of it as teaching someone to see through others' eyes rather than demanding they stop looking in mirrors.
Radical Acceptance: This means accepting that you will never fully satisfy someone with narcissistic tendencies. It's not about giving up; it's about protecting your own emotional resources while maintaining realistic expectations.
Ripple Effects: Children of narcissistic parents often develop their own mental health challenges—depression, anxiety, low self-esteem, and eating disorders. Understanding this generational impact helps us support not just the individual, but their family system.
Harm Reduction: Sometimes focusing on peripheral issues like substance abuse can create positive changes even when the core personality patterns remain unchanged.
/THE DIGITAL AGE COMPLICATION
Our relationship with technology has become as complex as our relationships with people. Mental health professionals now routinely explore three critical areas:
Secret Behaviors: Everyone has behaviors they hide from others. Creating space for these disclosures—whether it's excessive gaming, shopping, or other compulsive behaviors—opens pathways to understanding and healing.
Digital Boundaries: The relationship between phone usage and anxiety, avoidance, and sleep problems is profound. Physical separation from devices, especially at night, often produces immediate improvements in mental wellbeing.
The Pornography Question: Rather than asking "if" someone uses pornography, effective clinicians ask "how often." This assumes reality and removes shame from the conversation.
/STRATEGIES FOR COMPASSION
Validation Before Education: Like building a bridge, you need a solid foundation of understanding before you can help someone cross to new perspectives. Validate their experience before suggesting changes.
Assume Rather Than Ask: Instead of "Do you ever feel anxious?" try "When you feel anxious, what helps?" This subtle shift removes the possibility of denial and opens conversation.
The Weight Question: "Is there anything weighing heavily on you?" often unlocks conversations that direct questions cannot. It acknowledges struggle without demanding specific admissions.
Normalizing Humanity: Reminding someone that everyone struggles with behaviors they wish they could change removes the isolation that often prevents people from seeking help.
Effective support requires holding two truths simultaneously: people can change, and people deserve acceptance as they are right now. This isn't contradictory—it's the foundation of compassionate growth.
Think of it like tending a garden. You water and nurture plants while accepting that growth happens in its own time and way. You can't force a flower to bloom faster by pulling on its petals.
Perhaps most importantly, understand that your role isn't to fix or save anyone. Your job is to be consistently present, authentically caring, and appropriately boundaried. Sometimes the most helpful thing you can do is simply witness someone's struggle without trying to solve it.
Wealth, success, and outward stability don't immunize anyone from mental health challenges. That colleague with the perfect LinkedIn profile, that friend who seems to have it all together, that family member who never complains—they might be fighting battles you cannot see.
Supporting someone who doesn't know they need help requires patience, consistency, and often professional guidance. Your role isn't to diagnose or treat, but to create conditions where healing becomes possible—through understanding, acceptance, and gentle encouragement toward professional support when appropriate.
Remember, you cannot control whether someone seeks help, accepts reality, or changes their behavior. You can only control your own response—how you show up, how you set boundaries, and how you maintain your own emotional wellbeing in the process.
The invisible struggles are all around us. By developing these skills and perspectives, we become part of creating a world where seeking help feels safe, normal, and supported rather than shameful or frightening.
In the end, the greatest gift we can offer someone struggling in ways they don't recognize is our consistent presence—not as fixers or judges, but as fellow travelers who understand that life's journey includes valleys as well as peaks. Sometimes, that steady presence becomes the first step toward their own recognition that help might be worth seeking.
Thank you to Dr. Shokooh Miry, PsyD for inspiring me to write this.
Stay curious,
Jordan
Again, yet another fantastic article. Thank you Jordan!