Helping a friend with bipolar disorder

March 30, 2005 2:10 PM

I think my ex-boyfriend may be bipolar. He refuses to admit that, or seek help. His mother and I are both worried, and both want to help, but we don't know what to do. Does anyone have any experience convincing someone to seek help?

We recently broke up, and his behavior was so surreal and out-of-character that I can't help but think he's not psychological healthy -- he yelled at me for being upset about my mother's death, for example, saying that "other people have problems, too" (she just died a week ago; we're not talking some should-be-over-it-by-now drama); he twisted every innocuous thing I had done recently into some sort of symbol of how much I hated him, etc. He's also been totally consumed by online poker lately, staying up till 4am and then getting back up at 8am to play more (thankfully, he hasn't lost much money at it -- that I know of). He's said he feels worthless, that he fucks everything up, that everyone's against him (including his mother, who was simply trying to get him to get some therapy, which she offered to pay for -- and now he's refusing to even speak to her). He's quit his job, has no income, and now that I've moved out, has nowhere to live. He's not really doing anything to fix any of this.

Given how he's treated me, I'm wary of even talking to him again. I have been emailing with his mother, though, because I felt like someone should at least know how he's been behaving so that maybe they could help.

She's considering some sort of intervention when she comes to town in a few weeks. Do any of you know if something like this would help? He's refused therapy recently because he says "it implies he's broken" and, like I said, he thinks everyone's against him -- I'm worried any sort of group intervention would just intesify that.

How do you convince someone that they need help? Especially when the person in question has already decided that you're the enemy? I'm really wary of further isolating him.

posted by occhiblu to human relations (29 comments total)

Does anyone have any experience convincing someone to seek help?

Yes, and it's shown me that it can't be done. Person has to be ready to seek help himself or herself.
posted by ikkyu2 at 2:15 PM on March 30, 2005

I agree with ikkyu2, he's gonna have to "hit rock bottom" before he realizes he needs help; I say this as a bipolar person myself.

Here's the deal, I hate to say this but in my experience there's not much hope for a cure. I consider myself a "functioning bipolar". I say this because I am not dead or in prison. I fuck up constantly and I just have to keep rebuilding. I lose job after job, and ruin relationship after relationship.

Doctors put me on meds but as soon as they start to work I have to switch again because I've built up a tolerance to them. Basically, the only way I survive is by allot of good luck.

He has to admit he has the problem, that's a given, but so do you. You obviously care about this person so if you want to stay with him you'll have to realize there's a part of him that's messed up and work around it (i.e. don't let him handle the money and don't let what he says hurt you). I understand if you can do it, just about everyone I care about I've scared off.

It's a hard pill to swallow but that's the way it is.

As for his mom. They don't know what causes bipolar disorder, some say genetic some say environmental but in most the cases I have seen early childhood trauma is the cause so I wouldn't doubt that she had some roll in his problem wether it be of a passive or active nature.

Good luck.
posted by Livewire Confusion at 2:25 PM on March 30, 2005

I mean can't do it
posted by Livewire Confusion at 2:27 PM on March 30, 2005

Yes, with an ex-boyfriend who got that way towards the end of our relationship. I spent way too much time trying to nudge him into counseling and being shocked at his outrageous behavior that I didn't look out for my own self-interest and wound up staying in a type of relationship with a self-centered [and, admittedly very depressed] mopey jerk, which defeated the purpose I had originally had for breaking up with him in the first place. I sympathize very much with what you are dealing with, but if he doesn't want help it will be very hard to convince him to get it and -- in my opinion based only on what you wrote -- you should think very hard about continuing involvement with someone who is treating you that poorly at least until he's ready to make the first move.
posted by jessamyn at 2:27 PM on March 30, 2005

Does anyone have any experience convincing someone to seek help?

I have experience trying. It doesn't work. They have to want help.

How do you convince someone that they need help?

It's heart breaking, but you can't make them listen to you, even if everyone that's ever cared about them agrees and backs you up. Even if you talk to them one on one, earnestly and with love in your heart. Even if you gather up their friends, family and co-workers to say "we're all worried, we love you".

when the person in question has already decided that you're the enemy?

Especially not then.

I'm really wary of further isolating him.

If you try and force the issue, and he percieves this as further evidence of you being his enemy, then he'll isolate himself from you.

From my own experience with a friend that was headed for trouble and everyone else could see it but him:

I think you have 2 choices.

1) Sit him down and say "I really worried, here's why, I think you should get help and please know I'm saying this because I love you". Know ahead of time that he won't listen, and this won't work, and he'll be angry with you and you'll probably have to put him out of your life (or he might disappear on his own). But at least you tried.

2) Keep your mouth shut to avoid burning bridges, and stay to the sidelines. Don't enable his addictive/destructive behaviours. Take him out for coffee sometimes. Keep in touch with him so that at least he has some kind of touchstone with reality - should he ever decide to pull himself up, he'll know you're there to reach out a hand. Be prepared for him possibly never taking you up on that unspoken offer.

Option 1 is disheartening. Option 2 can destroy you if you get too involved. How much rollercoaster emotional investment is he worth? You'd have to re-evaluate that as he rides this out.
posted by raedyn at 2:37 PM on March 30, 2005

I offer this advice from the vantage of some one who has over 30 years as a mental health professional of which 20 have been as the executive of two large community mental health centers. The long and short answer is the same as IKKYU2 but I would state it a little differently. If your ex boyfriend does have a serious mental illness the most you (the generic you) can do is to clearly indicate your concern in a non judgmental manner and offer to be there if he is able to ask for help(It is a bit more complicated than that but I would go on to long). I would encourage you, especially his mother to go the web site of the National Alliance of the Mentally Ill (NAMI) www.nami.org . It is the premier organization dedicated to helping the family and friends of those with mental illness. Finally, every State
has statutes that make it possible to have persons evaluated involuntarily( either through an emergency medical application or civil process) if the person is imminently dangerous to themselves or others or is unable to care for themselves by virtue of a mental illness. In all cases it does require a clear statement (affidavit) that the risk of danger is imminent and serious. I would encourage you to contact your local or State chapter of the closest NAMI for guidance and direction. Best wishes Frank
P.S. Remember, if he is mentally ill, he can only respond from his experiences and perception and those may well not be your perceptions. There is a low probability of convincing him through reason to do something. guilty and fear are not very reliable either. The best way to get compliance is by (hopefully)gentle and repeated bumps against reality. His resistance is not willful, it is just the way it is. Interventions are a bit trickier than with substance abusers--you don't do those while the person is under the influence of drugs you do them during a bout of sobriety. If your ex is mentally ill he will not experience the equivalent of "sobriety"--Interventions can be done but I would get professional help and guidance
posted by rmhsinc at 2:57 PM on March 30, 2005

What the others have said rings true with my experience. There's not much you can do unless/until he realizes for himself that he has a problem. For my friend, it took a suicide attempt.

You have my sympathies.
posted by me3dia at 3:01 PM on March 30, 2005

Count me in as another finalist in the You Can't Make Someone Get Help Till They Decide to Get Help Themselves sweepstakes.

I broke up with the guy who's the chief contender for Great Lost Love of My Life about two years ago because he would not, would not, would not under any circumstances NO!!!! seek any sort of medical or therapeutic help for his increasingly crippling depression. I could go into painful details of how I had essentially turned into his therapist/mom instead of his girlfriend, or the vast and elaborate philosophical justifications he could come up with for refusing to seek help (some of them involving, I kid you not, Dostoevsky). But all of that's beside the point, really: in the end, he wouldn't budge, and even if I had dragged him physically to a doctor or a therapist (and believe me, I considered it strongly) he would simply have clammed up and walked back out.

The pain and agony of trying to get him help when he refused made me literally sick -- I got to the point where I was actually waking up every morning and vomiting from the anxiety. I finally realized I could either save myself, or save no one.
posted by scody at 3:03 PM on March 30, 2005

In response to "livewire"--I agree with most of what he says--except and a big except--almost all researchers, scientists and psychiatrists will agree that bipolar illness is the result of the persons unique brain chemistry and not the result of parenting--Go to the NAMI site for access to good information Thanks
posted by rmhsinc at 3:09 PM on March 30, 2005

what you should keep in mind is this...

Bipolar is a disease, just like Cancer or AIDs. Is that an exaggeration? Nope. You ever watch FOX and see these people that steal tanks and jump off buildings? Well that's bipolar disorder in action. Bipolar is not a choice. Bipolar can kill. Would you be debating leaving him if he had terminal cancer? No.

Should you stay with him? Yes, but I say this for his benefit not yours. He needs your help right now more than you need peace of mind. Will you help? Probably not. Most people are selfish and dealing with bipolar is hard, really hard. I wouldn't blame you if you chickened out.

Somedays he's gonna be fine and so charismatic that you can't think of why you'd EVER want to leave him. Other days he's gonna verbally abuse you till you feel one inch tall. (I recommend you walk out at that point and come back later don't let the heat of an argument push him to act even crazier) You're going to want to express your opinion and try to convince him. Again, he is sick and you "can't talk to a psycho like a normal human being" (thanks, Poe) You just have to subjugate yourself. Why? Because you love him and love has never been easy.

As I said before I am bipolar and I live with a girl who sometimes likes to cut herself. That's life, and nobody ever gets better the best you can do is learn to live with it and take the good parts and cherish them.

...or you can walk out and move on. You won't be the last, either. I have never seen anybody who could tow the line.
posted by Livewire Confusion at 3:12 PM on March 30, 2005

I don't say this to be harsh, but you need to accept that you are not the person to help him with this right now.

I understand that you're worried about him and that he likely really does need help. The thing is, you cannot give him any help right now. You just broke up. You are, for all practical purposes, the single person in the world (with the possible exception of his mother) who will have the least chance of helping him with anything. Things are too emotionally charged between you, even if the breakup was amicable (although it doesn't sound like it), even if you are going to "stay friends," and even though you still may care about him.

You need to remove yourself from the equation -- and by that I mean his life -- for the foreseeable future. You are not going to help anything, and you very well could make things worse.

I'm sorry. I know this is really difficult.

On preview: Livewire, she's already left him. Even if she hadn't, though, I think that it's absolutely ridiculous to stay with someone because they're mentally ill. I wouldn't stay with someone because they had cancer, either. Mental illness is a terrible thing and is often misunderstood, but no one should be obligated to stick around in a failing relationship to play nursemaid. It's not fair to either party.
posted by LittleMissCranky at 3:15 PM on March 30, 2005

In response to "livewire"--I agree with most of what he says--except and a big except--almost all researchers, scientists and psychiatrists will agree that bipolar illness is the result of the persons unique brain chemistry and not the result of parenting--Go to the NAMI site for access to good information Thanks

First off, he hasn't even been diagnosed yet. Second I have huge problem with "mental health care professionals" myself, they thrive off of it. him being happy is conflict to their interests ($$$). It's their bread and butter if people got better there'd be no money in it. It's like curing acne, why would they want to do that?! rmhsinc has not even talked to your boyfriend but as a "mental health care professional" he's already agreeing with your uniformed and snap diagnosis of Bipolar Disorder. I see the dollar bills already! I have spent SO much time with "professionals" who didn't know dick and didn't question the DSM and just selective listened to me and then wrote a subscription that either made me fat or sleepy (and in one case impotent)

In all seriousness though... there is a large amount of researchers who also blame environmental conditions as a cause. Nobody knows that's truth so it could be a possibility, I know it was in my case.

He could also be suffering from more than one disorder. Here's what you need to find out... was he abused? Is there a history of substance abuse in the family? Have these outbursts happened in the past? This could help to answer the parental abuse question (if their is one).

Should he seek help? Yes if only to stop the pot from boiling over. Talking it out can help allot. Will they "cure" him? No. He's always gonna be like this. What you're looking for is mental illness management.
posted by Livewire Confusion at 3:31 PM on March 30, 2005

I'd be happy for him to talk to anyone and just get some sort of therapy, and possibly meds, no matter what his diagnose is (even if it's just "life sucks for me right now" - itis). I'm just wondering how, or if, I should somehow facilitate him getting help.
posted by occhiblu at 3:34 PM on March 30, 2005

On preview: Livewire, she's already left him. Even if she hadn't, though, I think that it's absolutely ridiculous to stay with someone because they're mentally ill. I wouldn't stay with someone because they had cancer, either. Mental illness is a terrible thing and is often misunderstood, but no one should be obligated to stick around in a failing relationship to play nursemaid. It's not fair to either party.

That's one point of view... and I somewhat agree with it. You shouldn't stay with anybody just because they have disease, but if you LOVE them that's another enchilada altogether.


but why is it more ridiculous to stay someone who is mentally ill than if they have Cancer? This is the point I am making. People think Bipolar is bad but Cancer is worse. I can say from having colon cancer (yeah, I've had a great life LOL) that bipolar is worse, it doesn't go away.

So you need to choose, yourself or him. Tough choice.
posted by Livewire Confusion at 3:37 PM on March 30, 2005

I'd be happy for him to talk to anyone and just get some sort of therapy, and possibly meds, no matter what his diagnose is (even if it's just "life sucks for me right now" - itis). I'm just wondering how, or if, I should somehow facilitate him getting help.

Again, that part he's gotta do on his own or you could always have him committed like rmhsinc is suggesting (good job Doc!).
posted by Livewire Confusion at 3:39 PM on March 30, 2005

If he won't get help, the only thing I think you could do in this situation is keep track of him. So if he does hit that bottom, and does try to do something irrational and permanent, you'll manage to stop him. As to how to do that... I don't know. Keep things as friendly as you can manage, stay in touch with him, etc.

Even when people have been diagnosed with psychiatric disorders, it can be hard to tell them that they're going off when they don't think they are. Hopefully he'll figure this out before something really big happens.

Best of luck to you both.
posted by cmyk at 3:52 PM on March 30, 2005

Second I have huge problem with "mental health care professionals" myself, they thrive off of it. him being happy is conflict to their interests ($$$).

Isn't this a little like saying you have a problem with dentists because they "thrive" on tooth decay, and declaring that its not in their best interests to encourage their patients to have healtheir teeth and gums? I've personally struggled with depression for 20+ years (and have a family history chock-full of alcoholism and presumed-but-undiagnosed bipolars) and the times my life has been at its best is when I'm on my meds and in long-term therapy. As I get better at dealing with my life, I scale back my therapy -- currently once a month. Trust me, my therapist isn't making mortgage payments in L.A. on the $75 a month she gets from me.

/derail
posted by scody at 3:53 PM on March 30, 2005

This is a tough situation, but on a brighter note, it seems you've done all the right things so far. You've ended the relationship and moved out. Good for you. Keep taking care of yourself and if he decides he does need your help you'll be better able. What little miss cranky said too.
posted by snsranch at 3:54 PM on March 30, 2005

Should you stay with him? Yes, but I say this for his benefit not yours

As someone who spent far too long remaining married to and partially helping / caring for someone who was borderline bipolar-2:

Worst. Advice. Ever.

This is a "Say your peace and depart" situation, with at most occasional reminders to him that you'll still be around (***NOT ***) when and if he wants support in his treatment. He's very likely to get worse before he gets better, and you need have no part of that.

This is not about you. Him getting sick is not your fault, even the slightest, and it is very unlikely that you will play any significant role in any recovery he might have. You're not his wife or his mother or his family, you're his ex-girlfriend, and you don't owe him any more than basic human decency (insofar as it's safe for you to offer it). Even if, maybe, spouses owe it to each other to stick around in this sort of horror, and mothers owe it to their children, you are neither and are free to divest yourself of the shreds of a relationship that could easily harm you emotionally, financially, or perhaps even physically.

By all means say your peace to him, to whatever extent you need to to satisfy yourself that you really tried to get him to get help -- do this for you, if not for the off-chance that it might help -- but then Go Away.

but why is it more ridiculous to stay someone who is mentally ill than if they have Cancer?

Because people with cancer don't, as a matter of course, lash out at their significant others verbally and sometimes physically, don't spend the family's life savings gambling or on fancy clothes, don't disappear for a few weeks to hit the Riviera, don't kill their kids in the bathroom, don't do any of the vast array of harmful things that mentally ill (and especially people with Other-Than-Depression) quite often do to themselves and those around them.
posted by ROU_Xenophobe at 4:44 PM on March 30, 2005

(***NOT*** as a girlfriend) that is. just as a person. why isn't there a preview thingy so I can catch stuff like that before I make an ass of myself again?
posted by ROU_Xenophobe at 4:45 PM on March 30, 2005

First of all, I agree with scody. Do you think that every health care professional is in it to make you sicker? Or at least keep you sick? By that logic, you should never hire a plumber if you ever want to flush your toilet again.

but why is it more ridiculous to stay someone who is mentally ill than if they have Cancer? This is the point I am making.

No one said that it was. There was no comparison of degrees of ridiculousness.

It is, however, more complicated, since cancer generally doesn't make you periodically treat your partner and other loved ones like shit. Yes, it's the disease talking. However, that doesn't really change the fact that the partner is being treated like shit. That can get to be too much for someone to bear, no matter how altruistic that person is.

So you need to choose, yourself or him. Tough choice.

That's not the choice, though. People need to be in relationships that work for them. NO ONE should be in a romantic relationship out of a sense of obligation to the other person, especially because of an illness. You can choose to be understanding of your partner's illness, which can certainly make a difference in how you react to the poor treatment. However, sometimes that's not enough to make the situation livable. It's not right to frame that in a way that makes the partner selfish for not being able to live with it.

Look, this isn't about whether someone "deserves" to get dumped because they are mentally ill. Of course they don't "deserve" it. It's about what a person can tolerate and still have a fulfilling relationship and a happy life. That's the goal, right? No one loses the right to pursue that because they enter a relationship with someone who is mentally ill.

NB: I am not saying that you, personally, treat anyone badly. I don't know you, and you may be a prince among men.
posted by LittleMissCranky at 4:49 PM on March 30, 2005

why is it more ridiculous to stay someone who is mentally ill than if they have Cancer?

Well, because someone who has cancer can still be rational.
posted by kindall at 5:05 PM on March 30, 2005

My experience in this sort of thing is somewhat more limited than those of folks posting above, but overall I'd concur with what ROU had to say.

You've tried, and now you should just move on. Maybe if his mom, or he himself, ask for your help in the future then you can do more. Right now though, you're done. Trying to do more will probably just make things worse for all of you.

IMHO, anyway.
posted by aramaic at 5:14 PM on March 30, 2005

As someone who grew up with a mother who is bipolar, I can say that you have nothing to be ashamed of if you decide to either end the relationship or stay a healthy distance apart.

It took me many years and much introspection to realize that I could not change my mom nor am I responsible for her. I'm very doubtful of an intervention scenario, if he truly is bipolar.

I agree that bipolar is a disease, but it's different from something like cancer or tuberculosis. In my case, I grew up with my mother constantly self-destructing, pushing my buttons, and basically using me and my brother as an emotional dumping ground. I love my mom, but I've learned that I must limit my relationship with her.
posted by devilshgrin at 8:22 PM on March 30, 2005

Bipolar is a disease, just like Cancer or AIDs. Is that an exaggeration? Nope.

This is an easy answer, but not really fair. The physical body is extremely complex, but the mind makes it look like a simple jigsaw puzzle in comparison. We really have no idea at this stage what's what, and to say it's a clear cut immediately recognizable disease that demands (whatever therapy) is misleading. We don't really know what causes it, or how it works, and the criteria for diagnosis are somewhat vague and subjective.

But I would agree that you are the last person to be trying to help. If he has any close friends or peers you know, you could suggest they keep a bit of an eye on him, but frankly, the idea of you & his mother emailing back and forth could easily come across like condescending "that poor, messed up boy, my goodness, what shall we do" style reactions, and if he heard about it, he'd probably only feel more alienated and angry.

The difference between the psychiatrist and the dentist is that the line between 'personality' and 'medical condition' is far, far more blurry than the line between 'healthy teeth' and 'unhealthy teeth.' Being sad is not a disease. Being excited or angry is not a disease. But, being "manic-depressive" is a disease. We have collectively decided on lists that describe whether someone is just sad or whether they're "clinically depressed" but different health care professionals use these differently, and in some places, in my experience, anyone who is ever sad can get a prescription for prozac. Dentists may disagree a little on how far along tooth decay should be before drilling & filling, but there's less room for interpretation than in mental health.
posted by mdn at 6:24 AM on March 31, 2005

I've had a similar experience to devilshgrin. Here's my perspective, if you've made it this far:

- You may get a lot of benefit from Al Anon. Granted, its focus is on alcoholism and I've never actually gone myself, but if I had known about it 15 years ago I could have saved myself a whole lot of crap. In your case, it's an organization designed to help those who are companions of someone with a crippling, destructive behavior learn the tools to help their loved ones while, first and foremost, looking after their own well being.

- Ignore all of Livewire's advice. LC, you're looking at this through the cloud of your own bad personal experience. I'm sorry you have apparently not met any of them, but there are plenty of very good therapists around. If you don't go to a psychiatrist (the ones with an MD), then medication isn't even on the table.

- You are not responsible for getting this person help.

- You are not responsible for getting this person help.

- Make boundaries not only with your ex-, but with his mother. Don't encourage situations where she calls you after he calls her, because you're physically nearby.
posted by mkultra at 8:39 AM on March 31, 2005

Everyone may consider staying on track, helping this one person, rather than debating how much money the psych industry is making. There's a huge debate there, I just don't think it's appropriate here.

I want to commend you for leaving him, for having the knowledge to know what you have to do to take care of yourself, which most people who stay with someone just b/c they're sick, do not. Don't sacrifice yourself b/c he does not have any self awareness. He has not been diagnosed and the reality is that he has no right to treat you that way, and you have every right to leave. He is responsible for his own actions, a diagnosis does not change that. That behavior is real, it is part of him. Those who can accept his behavior as part of their life, feel alright protecting themselves in their own ways, will stay around, but we all have to understand our own limits.

As for him, yea, he's going to have to realise he needs help on his own. Don't shelter him. If you and his mother have been constantly trying to help him, he'll never learn how to take care of himself. Only living his own life will show him the consequences of his possible condition, without those consequences he sees the behavior as acceptable. Make those calls that people suggested, support him, but don't sacrifice your own life.

I also v much second Al Anon, or the family of Alcoholics meetings.
posted by scazza at 10:08 AM on March 31, 2005

Ochiblu, I think it's helpful to state to the former bf that you are concerned that he may have a genuine, treatable, mental disorder, and suggest qualified help. Over time, if others also say this, it may make a difference. Or not. But I thinks it's the honest and loving response. It may help to stress that you believe he has the chance to be happier and healthier, and that's what you wish for him.

I have some experience of living with someone with bipolar disorder, and this question has really stayed in my mind.
posted by theora55 at 10:56 AM on March 31, 2005

Thank you, everybody. I actually just talked to him, and he's flying out to be with his (step) family because his grandmother just died, so at least he'll be near people who care about him for a while. I think some of my main concern is that I'm the only person really emotionally close to him in this city, so I felt a lot of responsibility because of that. It's a relief to hear he'll be able to rely on / be "tracked" by other people for a while.

If and when he returns, I will try to keep a non-interfering eye on him and see how it goes. Thank you all for your support and suggestions.
posted by occhiblu at 11:44 AM on March 31, 2005