My 21-year-old was diagnosed with Bipolar I after an extreme manic episode (he was hospitalized). It was a long and difficult few months (awful treatment, bouncing around to different doctors, etc.) during which his mania tapered down, and then turned into a deep black depression, which he is out of now.
No one can persuade him to take medication. Now that he’s feeling normal again, he seems to think that he doesn’t need medication. So no meds, no therapy, no treatment of any kind. And I am quite sure he’s self-medicating with “other” substances. (He lives with us – me/mom, younger brother, step-father.)
Dr. Fink answers…
Based on your description of what your son experienced so far, it’s understandable that he’s reluctant to take medications or seek other forms of therapy. He was hospitalized, which can be dehumanizing; he received inconsistent treatment and bounced around to several doctors, which can be frustrating and discouraging; and then he went from mania to a deep depression, which he may attribute to the treatment he received.
Difficulty with insight into one’s illness is a common component of bipolar disorder in many who suffer with it, but especially in adolescents and younger adults whose brains are still managing numerous developmental tasks and are not particularly skilled at self awareness and self regulation.
Communication is key, but communicating effectively can be very challenging in emotionally charged situations. Confrontation may do more harm than good. You and the rest of the family would probably do well to get some sort of therapy to help you understand what your ill son may be going through and how he’s likely responding internally to what he’s experiencing. Your family may also benefit from learning communications skills that are proven to be effective in situations like this. NAMI Family-to-Family is an excellent resource that has the added benefit of expanding your support network with people who’ve had similar experiences.
You may want to start by re-opening the channels of communication:
- Use “I” statements to express how you feel and what you’re most concerned about.
- Ask your son open-ended questions and really listen to the answers without judgment. For example, after describing one of your concerns, ask him how he feels about it or if he has any ideas on how to alleviate the concern. Overall talk less and listen more.
- Try to empathize with your son by asking follow-up questions to clarify how he feels and then tell him that you understand why he might feel that way. Try to see it from his perspective.
- Set boundaries. If your son is self-medicating, you don’t have to accept that. If you know your son is doing something that’s unacceptable, use an “I” statement to let him know; for example, “I won’t allow you to stay here when you’re drinking alcohol.” Or “I will have to call the police if you continue using illegal substances.”
- Work toward an acceptance of the reality that you cannot control this situation and strive to regulate your own emotional responses to this. He will have to work through a lot on his own, and you will not be able to make him move faster or in a different direction, no matter what you say or do.
Also, as you approach problems, try to pick one problem at a time. Your question describes at least four problems:
- Poor treatment from doctors/therapists.
- Poor understanding of his illness.
- Medication non-compliance.
Choose one. For example, you can’t do anything about the treatment your son received in the past, but it might help your son to hear that this is, unfortunately, a common experience. Most people with bipolar disorder bounce around the system for several years before receiving an accurate diagnosis and effective treatment. When people eventually do receive effective treatment, they feel much better and are better equipped to regain control of their lives.
Also realize that this is a journey for everyone involved and not everyone proceeds along the same path at the same speed. While you may have accepted the diagnosis, it may take your son additional time to accept it and learn to deal with it, and that process usually involves trial and error.
Continue to seek out good help and support for your son and for yourselves – having a network of partners and support people on this journey is a key component to getting through it as successfully as possible.
Photo by Kevin N. Murphy, available under a Creative Commons attribution license.