One of the symptoms of bipolar disorder is a lack of insight – an inability (not unwillingness) to notice a significant shift in one’s own mood or behavior. This happens most often during acute mood episodes – manic or depressed – but can be part of the bigger picture of living with the illness. Family members agonize over how to help someone who doesn’t want help, and they sometimes watch helplessly as the illness destroys their loved one’s life.
If the person is at risk of harming herself or someone else, the doctor may have to hospitalize her against her will. This, of course, is a confrontation that coerces the patient into treatment. But what about the individual whose symptoms are destructive but not acutely at risk of suicide or aggression? What about spending all the family money, committing serial infidelities, or not going to work for months? What is a family to do when the person cannot see the difficulties and cannot seek help themselves?
Psychiatrists and psychologists have no clear cut solution or approach to dealing with situations such as these. Every case is different. Following are some suggestions on how to proceed.
If your loved one with bipolar is already connected to a treatment team, contact the team leader (your loved one’s psychiatrist, psychologist, or social worker) or another mental health professional on the team and inform the person of the situation and of your concerns. The team will usually try to work with the family and other loved ones to re-engage the person into care.
If your loved one’s healthcare providers say they cannot speak with you, that may be true, but they can listen and take action on the information and insight you provide.
Contact a mental health professional (a psychiatrist, psychologist, or social worker) on your own to obtain guidance. You have nothing to lose by getting more information from professionals. In addition, you may need counseling yourself to deal with the trauma these situations often cause.
Contact a local chapter of NAMI (National Alliance on Mental Illness) or DBSA (Depression and Bipolar Support Alliance). These are great resources to learn how other families have navigated this journey and to get information about the mental healthcare system in your area.
Through local support groups, you may also discover other potential resources, such as employer mental health programs or community agencies that may be able to step in.
Your loved one is doing the best he can – what he thinks he needs to be doing to be okay. Lack of insight and poor judgment are part of their illness. Thinking and decision making are impaired – especially during acute episodes.
Trying to get someone to just “change his mind” and “listen to reason” when the mind is being held hostage by the mood disorder doesn’t work very well or at all. Entering the conversation with the idea that the person can simply change his mind when he really can’t merely leads to frustration, distress, and resentment.
The person with bipolar does not have good control over his emotional responses, so fairly or not, it is incumbent upon loved ones and caregivers to regulate their own responses carefully. Triggering an angry or hopeless response in someone will not be productive and may make things worse.
Sadly, sometimes loved ones can only watch and remain available to mobilize help or support as soon as the person with bipolar disorder has even the slightest change of heart.
You may need to make decisions about your own health and well being based on untreated bipolar symptoms. Be clear and firm about the steps you will need to take to preserve your health and well being if your loved one does not agree to treatment, but do this in as non-confrontational a manner as possible.
Presenting consequences in confrontational and/or angry terms – essentially cornering the person you are trying to help – will be no more effective than presenting your terms in a more conciliatory manner. Anyone who feels cornered will not be able to make the best decisions, so don’t expect your loved one with bipolar to be different in this regard.
Caution: If you decide to stage a formal intervention of some sort to try to force or coerce someone into care, always involve a mental health professional. If your loved one tends to become angry or overwhelmed, a confrontational intervention can become dangerous and do more harm than good.
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Last reviewed: 1 Jun 2010