Bipolar is wrecking my family...

[EMSnut45]

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!!

[NightOwl0624]

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!

You have my sympathy for what you and your family are going through. I wish you all the best at this very difficult time. I went through it too, so I know exactly how you feel.

I hope you are able to talk to a good social worker. They are the ones who really know how the system works! The big problem is that manic people are not able to make rational decisions, but unfortunately the burden is placed on them because "you can't help someone who doesn't want help". What most people do not understand, is that even when they do want help, it is extremely hard to get that help. In your case, she has already seen 4 professional people who have not helped. That must be frustrating to her as well.

I don't have any specific advice for you, other than to take precautions to protect yourself - do not let this family member ruin your life as well (easier said than done, I know). NAMI is a great resource, at least you will know that you most certainly are not alone!

For what it's worth, this is my very condensed story:

Five years ago:

Family member is behaving more and more irrationally (after starting anti-depressants after many years of mild-moderately severe depression). Wants help, says he is miserable, but can't stop the "addictive" behaviors: spending money, self-medicating, etc. Sees psychiatrist, who "considers" he might be bipolar but wants to play it safe before putting him on a mood stabilizer - keeps switching to different antidepressants. Take him to the hospital twice when behavior intensifies. Released from hospital twice because he is not a "threat", tells him to make appointment with his doctor. Doctor scolds him for being non-compliant. Police find him sitting in his car one day in the middle of a busy street. Escort him to the hospital, comes in as a "car accident". I tell the ER doctor that he is a threat to himself (although in my heart I don't really believe it). Hospital is required to keep him and place him with a sitter. I fill out the "involuntary commitment" papers, but he goes in voluntarily as he is really desperate for help (thank God, didn't have to go before a judge). Dr. at psych hospital immediately diagnoses him as bipolar and puts him on a mood stabilizer.

It did take several weeks for the medication to really take effect, and it did have to be changed due to side effects that were intolerable to him. Dropped the old psychiatrist and found a really good one that found the right combination of meds. Began going to NA meetings, and began repairing damaged relationships and financial problems. Is extremely remorseful, but ready to get on with the rest of his life.

Today:

Family member is 100% compliant, understands his illness, takes reasonably good care of self (watches diet, exercise and sleeping patterns very carefully), and feels better than he ever has in his life. He does very well at his job, has a wonderful family, and is very greatful for getting a "second chance".

Your situation is not hopeless. Sometimes it does have a happy ending.

[chuchie, ADN, BSN, MSN, LPN, APRN, NP]

I'm so sorry for your situation. My brother is bi-polar and his alcoholism makes the highs and lows a nightmare sometimes. There are times that he will make grandoise statements of things he is going to accomplish, which are usually too ambitious for the average person. Then he will go through periods of days where he is just sleeps for hours and can't even bring himself to take a shower. When he was living with my mom his temper tantrums were so severe that some times I had felt it was downright unsafe for her to be in the house with him alone. It is important that you and your mom focus on what is acceptable in the house and what is not, because even if one of you is not enforcing the rules your sister will find away to take advantage of the situation. My mother is the world's biggest pushover and it took her years for her to stand up for herself and finally kick him out. Perhaps you could reach out to others who know that she has been on the decline for a while and ask them to participate on an intervention. Good luck and please don't beat yourself up over the things you can't control.

[shiccy]

The driving drunk thing means that she *is* a danger to herself and others. While this won't allow for a mandatory admit to a hospital / psych rescue, it does mean that if the car is not in her name, then it NEEDS TO BE TAKEN AWAY. She's either going to kill herself, others, or both.

As far as the other information, my prayers go out to you, however I don't have a definite or definitive answer for you. Hopefully somebody else will be able to shed some light on the issue and allow you to get her the help she needs.

[Adele_Michal7, ASN, RN]

I completely feel for you and I went through almost the same exact thing you did (eerie similiarities) when I was in nursing school. I didn't read ANY of the other responses so I don't know or care if I'm being redundant. But, the only thing that led to my sister getting help, sadly enough, was her attempting to commit suicide. It was devastating and she was in the hospital for months. She was released from one too early- against me and my dad's will- only to be put back in days later- (she was put back in because she had a f/u apt with a psychiatrist, who realized how psychotic she still was and wrote a 72 hour eval order because he knew she was a danger to herself and others. The man saved a life by doing that.) It was a very trying time but a blessing in disguise because I don't know that she would have gotten the help she needed if she hadn't tried to harm herself. We had tried everything beforehand.

[IMustBeCrazy]

If she's not suicidal, taking overdoses, harmful to others or such a self care deficit that she a harm to herself (for example so grandiose/delusional she is walking out in the snow in the dead of winter in bare feet), then she is beyond your reach at the moment.

The family needs to start an intervention NOW with her. That means taking the car, cutting off the credit cards, stopping all financial support, taking away the house key or changing the locks, etc. You don't get your lunch for free in this world. It's about tough love and not enabling. If you have even one enabler in the family, she will gravitate quickly toward that person and not learn a thing except manipulation. You can't make her go to treatment/get help, but you can stand firm. Say, "We are DONE. When you go to your doctor's appointment, get on meds, etc, we will be supportive, and not until."

Until she decides to meet up with her life responsibilities, get your family into some counseling sessions. The family is always the last to get help, since they are so focused on the wayward child. That stops now. Help yourselves to be strong and functional, inevitably you will be more of a help for her.

[ck4rn66]

If she's driving under the influence then she is a danger to herself and others. If the police pick her up and don't charge her ask them to take her to the nearest psych facility for an assessment. The counselors there may be able to help her commit to inpatient treatment. Sometimes when facing a night in jail (for DUI) patient's will choose inpatient tx were a comfy bed can be found. If she appears before a judge (for a DUI) you can ask him to mandate psych treatment as a condition for release. Hope this helps and good luck.

[helikias]

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.

I respectfully disagree about the cause of mental illness. I am in the camp that mental illnesses are all nothing but organic brain disorders not influenced by outside events. This is a school of thought that is in the minority, true; but it is being researched and, who knows, it might come out of the "backwoods" someday. Like I said, to each their own opinion; I don't mind somebody disagreeing with me about this.

It seems to me that her doctors can't be THAT good, or her disease would be under control a little better. The sad truth is I have seen more unhelpful psychiatrists than not. It's a field where there's a shortage, so there are not too many to pick from.

Thank you for your viewpoint.

[Whispera, MSN, RN]

I read all the postings and have forgotten alot, but it seems someone mentioned NAMI (National Alliance (for the/of the) Mentally Ill). They have educational groups for family members of people who have mental illnesses, and support groups for both families and those that have the illnesses. They have oodles of information too, and should know what services are available in the community. Try to find one of their groups near you. I think they good give you very valuable information and help.

If there's a psych hospital or psych unit in a hospital near you, they should have information for you too. Good luck to you. My mom had bipolar disorder and it surely pulled my life out of alignment over many decades. My heart goes out to you.

[Jules A, MSN]

First of all please get some support for yourself! If you are old enough consider moving out and focusing on being healthy and independent as you pursue your life goals. I do believe that certain traumatic incidents can trigger a psychotic episode but I also feel that the predisposition is already there. If she is EPd to the emergency department by the police and actively manic hopefully she will end up on the Psych emergency room for an evaluation. In many cases they can convince someone who isn't technically a candidate for certification to sign a voluntary and that buys some time. I wish you and your family well.

[NightOwl0624]

I respectfully disagree about the cause of mental illness. I am in the camp that mental illnesses are all nothing but organic brain disorders not influenced by outside events. This is a school of thought that is in the minority, true; but it is being researched and, who knows, it might come out of the "backwoods" someday. Like I said, to each their own opinion; I don't mind somebody disagreeing with me about this.

It seems to me that her doctors can't be THAT good, or her disease would be under control a little better. The sad truth is I have seen more unhelpful psychiatrists than not. It's a field where there's a shortage, so there are not too many to pick from.

Thank you for your viewpoint.

Non medicated bipolar individuals can have very long periods of "normal", then suddenly shift into a depression or mania.

I don't believe that mental illness is CAUSED by outside events, but certainly a stressful situation can trigger episodes in nonmedicated bipolar individuals, don't you think?

And, just by my casual obsevation, several bipolar people I know did have an extremely stressful event happen to them in their childhood or adolescence: a death of a parent, abandonment, or some type of abuse. I do think with bipolar people it is a combination of the brain and environment.

At least sometimes.

Hmmmm - guess I don't really know either.

[Meraki]

I respectfully disagree about the cause of mental illness. I am in the camp that mental illnesses are all nothing but organic brain disorders not influenced by outside events. This is a school of thought that is in the minority, true; but it is being researched and, who knows, it might come out of the "backwoods" someday. Like I said, to each their own opinion; I don't mind somebody disagreeing with me about this.

It seems to me that her doctors can't be THAT good, or her disease would be under control a little better. The sad truth is I have seen more unhelpful psychiatrists than not. It's a field where there's a shortage, so there are not too many to pick from.

Thank you for your viewpoint.

The problem with putting the responsibility for her ongoing difficulty on her doctor is that if someone refuses help, refuses to take meds and skips appointments, it is difficult for even the best of doctors to get the illness under control. Often it seems to take years of being unwell before outreach or wraparound services kick in for those who are chronically ill and even then it still usually requires some cooperation on the part of the person who is sick. I do agree that some psychiatrists are better than others.

Regarding your belief that all mental illness if solely organic and not influenced by outside events, that is an interesting one! I'm not sure in my many years in psych I've ever encountered anyone who believed it was all or nothing. I believe that stress plays a huge role on both our physical and mental health. Do I believe that stress or trauma causes bipolar disorder - no, do I believe it can be the cause of the manifestation of bipolar disorder - yes. Seeing as I work with people with PTSD - who by definition have a mental illness caused by external events, I obviously don't agree with you! The prevalence of adult psychiatric illness is much higher in populations who have experienced abuse and trauma than in those who haven't. I also have a family member who became mentally ill and spent considerable time hospitalized after witnessing the death of her children. Her illness was definitely precipitated by the event.

I don't mind people disagreeing and maybe this is for another thread as this thread is about support for the OP but I'd be interested in how you explain trauma and stress related illnesses.

To the OP - I'm glad to see so many others who have been through similar voicing their support and sharing their experiences. Hopefully you were able to connect with the social worker and she had some ideas.

[mustlovepoodles, RN]

The driving drunk thing means that she *is* a danger to herself and others. While this won't allow for a mandatory admit to a hospital / psych rescue, it does mean that if the car is not in her name, then it NEEDS TO BE TAKEN AWAY. She's either going to kill herself, others, or both.

.

I wanted to reemphasize this statement. My DS23 is bipolar and unmedicated. As such, he takes risks and has had several significant speeding violations, one for going 85mph in a 25mph school zone at 8:15am! He could have easily killed someone. DH accompanied him to court for that and the judge flat out told him "Get this kid off your insurance. Either take the car away or sign it over to him. If he hits or kills someone they are going to take everything you have--you house, your cars, your retirement. You have a lot to lose and he has nothing. If he kills someone the victims' family is going after YOUR deep pockets, not his." We signed the car over to him shortly after that and required that he get his own insurance.

If you think this was the end of his driving violations, you must not know much about bipolar. He has since then had several more speeding violations which required court appearances and one "speeding with open container" violation. He refused a breathalyzer and if the cop had hauled him in I"m sure he would have blown a 0.25. Instead all he got was points on his license and a fine. I was kinda hoping they'd haul his butt off to jail for a few days. Maybe then he could be forced to get the help he needs.

And to the poster who says the OPs sisters' previous doctors weren't good or she would be in better control. The very nature of bipolar makes it very hard to remain compliant with treatment. You feel bad so you start experimenting with your meds, taking more than you should, mixing with alcohol or benzos. Then you start feeling good, even great, and suddenly you don't even need meds! You can do anything! Who needs doctors? Everyone is just trying to keep me down! Doctors can only do so much with a patient who won't comply.