How far are we responsible for the decisions we make in life? A theologian tries to make sense of a secular friend’s struggle with repeated episodes of psychosis

Last month I received a sane-­seeming email from my friend Max. My heart lifted briefly then sank back. So he is out. I had helped to get him sectioned a few months earlier. Good news – very good news – but only if … a lot of things.
A week later, I helped him to move into a new flat. I reported this to Hugh, one of our old mutual friends (we were all at school together). He wondered why I was still ­bothering to try to help him. He politely implied that I was naive to think that anything would be different this time. I wanted to reply that Max is still Max, underneath it all – funny and clever and honest (sort of), and this time it seems that he is genuinely trying to face up to the magnitude of the mess he has made. But I didn’t say this. Being positive feels ­inadequate. The stakes are too high for normal optimism. For this is not a matter of someone getting back on his feet. His feet don’t work. His old personality is not a safe abode he can return to and build from. His old personality is a slippery slope to his madness. He must fundamentally change, and urgently. How do you get that across to an old friend? It sounds a bit … unfriendly.

What’s his story? He has, for the last 14 years, had long spells of psychosis, seemingly triggered by extensive drug use. He regularly smoked cannabis from his late-teens; his first psychotic episode was in his early thirties – he is now 48. But before the psychosis struck he wasn’t a complete waster. He got a good degree, and a further degree, and then began a promising career, but the stresses of office politics contributed to his first collapse into psychosis. His father died, and some difficult family issues returned to haunt him. He tried to get his life back on track, but the double whammy of addiction and psychosis was too much: it ruined his career, his relationships, everything. During his periods of sanity, he tried to mend ­relationships and to restart his career, but his demons returned, and he slipped back to ranty madness, berating his old friends, or ex-friends, with cod-philosophy, theories that proved he was never mentally ill but the victim of a conspiracy.