Bipolar is wrecking my family...

[EMSnut45, BSN, RN, EMT-P]

My family is having a crisis, and it all centers around my bipolar sister. I posted a thread probably a year ago about the process of her diagnosis and the S-L-O-W treatment leading to her continued instability. I'll summarize: She is currently 19 years old, and has Bipolar type II (rapid cycling-- like one week she's low, won't get out of bed for days, and the next week she's high, can't sleep, full of energy, spending money, partying with friends, disobeying long-standing house rules) with ADHD. She has been to two different psychologists as well as two different psychiatrists. None of them have been aggressive in treating her. She recently stated that she only feels "normal" 40% of the time. Geez! I can't imagine!

So, my sister disobeyed a house rule, and my mom called her on her cellphone to ask her to please come home to discuss it. Well, she did come home-- to get a pillow and clothes, and storm back out to her car. She is currently living in the local party house-- they owner provides the alcohol to all the minors (yes... the police know about this), the house is FILTHY dirty-- so much so that my sister once said that she doesn't know how someone lives in so much filth, and leaves the front door WIDE OPEN all the time. She states that she is going to pay rent, but once we added up the rent, car insurance, and cellphone bill, she was already in the negative numbers. She doesn't have enough money to pay her car insurance and registration due on March 1st, and frankly, doesn't care.

Her friend, who is barely 17 years old, ran away from home a few weeks ago. Her parents filed a missing persons report, and guess who the police found her with?? Yup, she was driving her friend around to various "hiding spots." Hmm, harboring a minor wouldn't look too good on the record.

Neither would a DUI/DWI-- since she admits to driving drunk, even though "it's just a mile down the road." We found empty liquor bottles in the garage trash, and neither my mom or I drink alcohol.

To top it off, my mom hasn't been able to find a job for the past 6 months, and my entire paycheck from my new-grad job (stressful enough) goes into the family account.

So, if you're still reading, I have a question... Technically, my sister isn't a threat to herself or others, so we can't have her admitted to the hospital unless she WANTS treatment-- which we all know isn't gonna happen cuz she's on top of the world right now. But the stress has got to lessen for my mom and I. I feel myself dropping into a depression from being around it, and I know that my mom isn't going to last too much longer. Dad isn't in the picture (although technically I guess he is because it was his abandoning us that lead to her bipolar-- or so the docs say), and we really don't have a strong support system (both sides of the family sided with my abusive alcoholic father, and won't interact with us). Are there options? Any psych nurses out there who have any ideas? Is there a way to get her back into the hospital if she isn't a threat/won't sign herself in? I guess even hospitalization isn't always the answer unless she wants the help... which she doesn't.

I need a vacation, preferably in the tropics!!

[DirtyBlackSocks]

I sent you a PM with some advice.

Check into her diet, my sister-in-law - who was severely bi-polar - is a completely different person thanks to seeing a nutritionist.

Also, if money is a large problem in the family (it is for everyone) she should be asking her Doctors why she has not been placed on SSDI yet.

On the side of addiction, alcohol abuse, ect. It's just something that shouldn't be tolerated - we had to kick my brother out of the house because he would not conform and wanted to party all day. He straightened himself out shortly there after, when he realized how hard it is in the real world, but that can be a drastic amount of stress to put on some one with a psych disorder.

[Soyrizo]

As far as treatment, no, you can't force her to go unless she wants to. While I understand you want her in a safe, protected place like a hospital, is it possible you can convince her to try a different psychiatrist and possible a therapist to work on cognitive-behavioral techniques? She may be more willing to meet you halfway instead of an all or nothing approach.

Second, look into NAMI, they have resources and support groups for families dealing with mental illness. I am not a psych nurse but I have dealt with a bipolar family member. It is hard to support them and set boundaries like you and your mom are doing, but it sounds like you're doing the best you can. Good luck.

[Kooky Korky, BSN, RN]

I think the fact that your sis is very irresponsible, due to her illness, make her a danger to herself.

See what an attorney or 2 or 3 have to say. Get a social work consult or 2 or 3.

Seems like she could be committed involuntarily to a psych hospital for treatment. Just drive her to the nearest state or county or non-private mental hospital ER and see what they can do. Even if they keep her only a few days, she will have to go before a judge, who will likely commit her for a month more, so she can really get some treatment.

I could be wrong but check it out. You probably already have, but check again.

As for kicking her out, I'd be leery if addiction isn't involved.

[helikias]

Bipolar has a chemical basis. I am puzzled about why her doctors are saying it's the abandonment of her father that led to her bipolar -- that type of thinking is extremely outdated and dangerous. It's a brain disease like schizophrenia; Freud has nothing to do with it.

Sounds to me like her doctors are not the best. (Also, as a side note, I agree with the other poster who discussed nutrition - that needs to be looked into).

You know, it could be that she does not even have bipolar and ADHD -- I mean, it sounds like her doctors might not be that good, so maybe it's time for a second opinion?

Does she have a social worker? Can you get her one in your state? How about clergy?

There's not much you can do, you know. It's a terrible situation ... I think you should go to an ALANON meeting, you need to have a support system of people who have a background in dealing with family issues that involve codependence. I'm NOT saying you are codependent -- it's just that those people will help you so much, you'll feel a lot better.

Best of luck.

[Classof2010]

I don't have any advice, I just wanted to send my thoughts and prayers to you. I am in the same position. My 20 year old brother is bipolar and recently it has been devastating our family. He has party/addiction issues. I'm in my last year of nursing school and know how emotionally draining it is. Remember to take care of yourself first and don't let family issues rule your own life. I know how hard it is, will be thinking good thoughts for you and your sister.:heartbeat:heartbeat:heartbeat

[Soyrizo]

It is really, really common for people with bipolar and other mental illness to abuse alcohol and drugs as a way to self-medicate. Iam not suggesting it's okay and you should ignore boundaries or anything like that, but just try to recognize it is a symptom and not an active choice to hurt your family.

[Meraki]

Bipolar has a chemical basis. I am puzzled about why her doctors are saying it's the abandonment of her father that led to her bipolar -- that type of thinking is extremely outdated and dangerous. It's a brain disease like schizophrenia; Freud has nothing to do with it.

Sounds to me like her doctors are not the best. You know, it could be that she does not even have bipolar and ADHD -- I mean, it sounds like her doctors might not be that good, so maybe it's time for a second opinion?

I wouldn't go so far as to pass judgment on her doctors based on one sentence written without further context. While all mental health has a brain component and is thus neurobiological, environment still plays a large role. Trauma and traumatic stress themselves are in many ways neurobiological as the stress arousal response system impacts brain chemistry. It is still pretty widely accepted in mental health that a traumatic event can precipitate a mental illness. It is possible (and likely) that the person was predisposed to the development of the illness, but it was the stress of the trauma that brought it on, or made it visible. This may have been what her doctors meant. It wasn't the act of her father walking out but the physiological and psychological manner in which her brain processed that event led to the bipolar surfacing. Even once stable on meds, trauma and stress can precipitate further crisis.

I agree with the others that seeking support through NAMI or other organizations that deal with family members with bipolar disorder. They won't be able to change the situation per se but can definitely understand what you are dealing with and what they have tried that has worked and that hasn't and the services and supports available in your area.

It is a vicious cycle as without treatment it is difficult for her to make rational, insightful decisions that would help her get the treatment she needs. I echo the others who said that the substance use is a symptom and an attempt to manage. Where I live you can get involuntary commitment for someone who is unable to care for themselves however you would have to show she was taking significant risks that are putting her safety at risk. Manic phases of bipolar and psychotic episodes definitely can meet this criteria. Talking to local services who work in your area with people with mental illness would be your best bet to find out how likely it is you could do this to get your sister help.

Although she likely doesn't see it, she is fortunate to have you still going to bat for her and trying to get her help. I really hope you are able to find services for her and support for your whole family. All the best.

[EMSnut45, BSN, RN, EMT-P]

It is still pretty widely accepted in mental health that a traumatic event can precipitate a mental illness. It is possible (and likely) that the person was predisposed to the development of the illness, but it was the stress of the trauma that brought it on, or made it visible.

Exactly! You put into words what I couldn't.

I'm going to try to talk to the social worker at work tomorrow. She probably would have some understanding of the state laws on seeking treatment for someone with a mental illness.

I just don't want my sister to ruin her life, and she is certainly on that path. She is still at a point right now where if she started making rational decisions, she could still lead a very successful life and persue her dream career of working with disabled kids. If she continues, I'm afraid she would lose that option (with a police record she couldn't work in the school system), as well as her transportation, roof over her head, and what little reputation she still has. My mom and I love her to pieces and would do anything to help her, but right now she is making irrational decisions that we are unable to support. Geez, it breaks my heart!

[canoehead, BSN, RN]

To a certain point she needs to feel the consequences of her decisions. So she doesn't live by house rules, and she has to find a spot to crash until she apologizes. She doesn't register her car and still drives it, she gets charged. Then when she finally gets the meds in her system she'll become aware of all the negative consequences of not taking her meds.

I think being bipolar must be very hard- who wouldn't want to feel on top of the world? But it gets away from you so fast...that's what she needs to see.

[mammac5]

I have a son who has Bipolar Disorder (and maybe a daughter, too, but she's not seeking treatment and is not diagnosed). The most recent info is that there is a very STRONG genetic predisposition for BD.

However, what really matters is your current situation. The reality is that your sister needs help -- either for treatment of mental illnesss or treatment for substance abuse or BOTH. She's an adult, though, and it doesn't sound like she's expressed a desire to hurt herself or anyone else; she's not going to meet the criteria for a 72-hour involuntary hold. The sad truth is that until your sister reaches her rock bottom (where ever that is for her) there is nothing you can do but pray.

Can your mom and you stand together and repeat the same thing to her every time you have a conversation? "Call us when you decide you are ready to check yourself into treatment and follow through." You love her, obviously, and you feel a responsibility to take care of your mom right now, too. But you do not have the power to force an adult to realize that she's screwed up. Until and unless she realizes it for herself and really wants to get to the root of the problem and deal with it, you are powerless.

I'm so sorry. Trust me, I know how difficult it is to watch someone put themselves through this kind of thing. But there is hope...my son started treatment for BD about 2 1/2 years ago and is doing great. It took a few different tries to find a med and dose that works for him, and it's not been a picnic by any means. But once she decides she wants it, your sister can get better and life a satisfying and productive life.

[mustlovepoodles, RN]

I think the fact that your sis is very irresponsible, due to her illness, make her a danger to herself.

See what an attorney or 2 or 3 have to say. Get a social work consult or 2 or 3.

Seems like she could be committed involuntarily to a psych hospital for treatment. Just drive her to the nearest state or county or non-private mental hospital ER and see what they can do. Even if they keep her only a few days, she will have to go before a judge, who will likely commit her for a month more, so she can really get some treatment.

I could be wrong but check it out. You probably already have, but check again.

As for kicking her out, I'd be leery if addiction isn't involved.

I would highly doubt that any psych hospital is going to commit her involuntarily unless she is suicidal or threatening other people. Insurance has pretty high standards about that. You have to be pretty dysfunctional(and not just making bad decisions) to get admitted. OP, you can always take her there for evaluation and see what they say. A good psych hospital can give you referrals for outpatient treatment if she is unwilling to enter voluntarily.

Frankly, you can't make an adult do what you want them to do. Frustrating, I know. My DS23 has untreated bipolar and he was just miserable to live with. Getting disentangled from him was traumatic for me. But he didn't want to get a job, pay rent, do housework. Didn't want to seek treatment. Basically, we wanted us to provide food & shelter while he played video games all night(or drank) and slept all day. Uh, no, son. That's not how it works. Eventually there was a showdown and he left. Now he lives with a friend somewhere in town and somehow pays his way. Our relationship is somewhat brittle, but you know what? It's better than the stress we were living under before.

It sounds like the whole family could use some help with this. When one family member is sick it impacts everyone. Even if your sister won't seek treatment, I would strongly suggest that you and your mother do. Sometimes it takes some objective third party feedback for us to see what's right in front of us. It make take some therapy to learn how to disengage. Just because she has a mental illness doesn't mean she can hold the whole family hostage. I'm all for helping her but you can't be a door mat, letting her come and go as she pleases, stringing everyone along, dancing to her tune. It's okay to set boundaries, not jsut okay...its necessary. Good luck.