Bipolar family member draining everyone's health

July 9, 2012 7:00 AM

My sister (in her 20's) has recently been diagnosed as bipolar, after many manic episodes that have previously been attributed to depression. Right now she is staying with our parents and driving them crazy - every time I talk to my mom on the phone she is either close to tears or past that line. I have no idea how to help, maybe you do?

This is such a mess, I don't really know where to start... I guess first and foremost I'd like to know what resources are available to help families deal with an individual like this. I'm just going to describe what I can of the situation:

My parents are in the middle of bankruptcy, so money is ridiculously tight. (I live away from them with my husband, and we're both searching for jobs while going through our remaining savings. I wish I could help more financially.)

When things were a little better, my sister had a lot of her tuition at a UC school - as well as two years of rent, basically - paid by our parents. And she's become used to things like that. But because of her episodes and inability to maintain a decent living environment, she was kicked out of both places. Everything was neglected. Everything. She had a long-term relationship that ended due to her lying about various inappropriate contacts. She's had a lot of weird and scary sexual experiences that she had to be bailed out of, and it's just too much for everyone at this point. She can't seem to control her desires or actions. She's prescribed medication, but my parents don't know if she's actually taking it and can't watch her constantly. She throws fits about them not giving her enough money, about not being allowed to be an adult, etc. Ever since she moved back into the house, she hasn't lifted a finger to help out. I can see that this is taking an incredible toll, day in and day out. The fits, the rudeness, the entitlement, it's nonstop. She's also been hospitalized several times now because of her self-harm, and after a while that behavior always shows up again.

She was seeing a therapist for several years, but that stopped after it was evident the therapist was wasting everyone's time. Her current psychiatrist is decent. But at this point my parents feel extremely alone and helpless. We all have become so angry at her complete disregard for anyone's physical or mental health, that honestly I just want her to move out somewhere and drop all contact. I know she has a condition that influences her actions, but there have been dreadful, sleepless months due to her behavior. Something needs to happen.

Just a few minutes ago I learned about NAMI... Do I just call a local center and explain the situation? What could I expect..? Could anyone with experience share a few more details about it?

I just know my sister is going to put someone in the hospital (again!) if we don't get her under control. Considering how everyone is struggling, and she hasn't finished school or ever held down a job, the situation just seems impossible to get out of. How do you get someone like this to be independent with such limited resources?

Thanks AskMe.

posted by anonymous to health & fitness (14 answers total)

You have my sympathy. Dealing with someone who is sick in this way is not easy, and it can be very hard to have to be the adult in the room all the time. I don't know anything about NAMI, but if you're in California, as your question seems to indicate, you should check out the California Dept. of Mental Health. Be prepared for rejection from various goverment programs, though. A few months ago I was dealing with a very sick friend and I kept trying to get her help, and kept getting blown off because she was not "in a crisis," meaning she wasn't an imminent danger to herself or others at the time.


How do you get someone like this to be independent with such limited resources?

Have your parents talk to her doctor about disability. This may be the best option for her if she is unable to work.
posted by dortmunder at 7:33 AM on July 9, 2012 [2 favorites]

I am so sorry your family is going through this.

Just a few minutes ago I learned about NAMI.

You can call the national number and they can walk you through connecting to your local resources. Both you and particularly your mom will benefit from the support and experiences of other families in the same boat. NAMI may also be able to help your family access social services. Take whatever you can get.

How do you get someone like this to be independent with such limited resources?

SSI is generally the answer to this question if she has not paid into Social Security and does not qualify for SSDI. You need to be forewarned that this process can take absolute ages, is difficult and cumbersome, and she will be rejected the first time she applies. At that point you get a SSDI lawyer for your appeal. (They work on contingency.)
posted by DarlingBri at 7:38 AM on July 9, 2012 [1 favorite]

There is a wealth of support material at bpdcentral.com. I realize that bipolar disorder is not the same as borderline personality disorder, but many of the coping techniques for outsiders are the same.
posted by ubiquity at 7:41 AM on July 9, 2012

I am so sorry your family is going through this. Your sister sounds like one of my family members. Very much so.

The sad, hard, impossibly cruel thing about mental health problems is how people choose them. Yes, it's a sickness, absolutely, but some people just choose to be sick. In a weird way they feel safe being sick. It's what they know.

This is why people in recovery from addiction talk about hitting bottom: the ones who recover are the ones who have found something that they would rather have than the addiction which has taken everything else away. Sometimes a person with a mental health problem would rather lose everything than lose their sickness. And this is impossibly, awfully hard for the people who want to stand by and support and help a person who has a sickness like this.

Your sister has to want to be better before anything. If she is not working with a good therapist and a psychiatrist, if she is not taking her medication, if she is acting out, she may not really want to be better. She may want to be sick. And, if she does, then the horribly cruel thing is that, for the most part, helping her out is the same thing as enabling her.

It's really, really hard for a parent to cut off a child who isn't going to be able to take care of themselves. Your parents may not be there yet. They may never get there. Maybe your sister will stop wanting to be sick before your parents get there. But your parents are making choices, too, to give her food and a place to stay, and not to keep her accountable on taking her meds or working with her therapist. And sometimes it's just hard, really hard; sometimes there are no good options other than to be kind to others and take care of yourself how best you can.

On the latter point: you might have some resentment or anger at your sister. You might be sick of your parents' every conversation being about her and how they are stressed out by her and what her problems are. You might feel like she has taken them away from you, like you don't have the parents you should have because she's using them up. Those are all perfectly normal things to feel and you are not a bad person for feeling them, or even for expressing them appropriately. You don't have to be perfect either.
posted by gauche at 7:46 AM on July 9, 2012 [16 favorites]

My mom is bipolar, so I know hard this is. One thing to think about-- your sister may be eligible for social security disability (ssi). That's only about $600 a month, but it's something. It will open other doors of financial help too medicaid (very important because her meds will be expensive), section 8 housing. Also, she and your parents are probably eligible for food stamps and that at least will keep them fed.

Honestly, we don't have the greatest resources for the mentally ill in this country. But occasionally you will find a social worker who's good and who can help. The psychiatrist can probably put you in touch with a social worker. Also, my mom had a visiting psychiatric nurse for a while. He checked in on her to make sure she was taking her meds and gave her someone to talk to. It's expensive, but a lot cheaper than hospitalization.

You and your parents might seek out support groups for families of the mentally ill. The thing about bipolar is that it causes you to alienate everyone around you and then you are alone, which makes your depression and mania worse. It's a horrible spiraling down that can end in homelessness or suicide. But the good news is doesn't have to be that way. With the right meds and assistance your sister can live independently and successfully.

You might read the book the memory palace. It was comforting to me to see that someone else had been through what I'd been through.
posted by bananafish at 7:59 AM on July 9, 2012

Anyone who advises having your sister "committed" or goes on about the mentally ill being "the problem" of the medical establishment in this country doesn't know what they're talking about and shouldn't be listened to. They're uninformed and wrong, and likely getting all of their information from movies, novels and television. The system doesn't work like that and the babblings of those who preach otherwise should be ignored.

NAMI should be your first stop, yes. It is good that you found them and a local chapter should be able to help you suss out available resources. Yes, call the California Department of Mental Health. Yes, begin the process of applying for disability, but prepare yourself for the inevitable judgmental, nay-saying, dismissive bureaucracy to misunderstand mental illness completely and behave as if because your sister is not flinging her own excrement in a basement somewhere that she is perfectly capable of holding down a regular job. DarlingBri is spot-on in saying that a good lawyer will likely become essential through that process. But also prepare yourself to be on the lookout for the occasional doctor, nurse, case worker, or administrative person who genuinely seems to care about people with mental illness, who takes a genuine interest in your family, and who has genuine empathy for what all of you have gone through and will go through. Those people exist and cultivating relationships with them will be key to helping your family and your sister get the medical treatment she needs.

Familiarize yourself with the work of Kay Redfield Jamison, PhD. She's a clinical psychologist who has bipolar disorder and who's written extensively on the subject. "Touched with Fire" and "An Unquiet Mind" are both excellent books which may help your family begin to understand your sister's illness. Also check out that entire site, bphope.com. Doing so may help you to fully realize that lots of people have bipolar disorder, lots of families cope with it, and many of those families have limited resources. You're not alone and, thankfully, you do live in a state which has a greater pool of resources available to people living with bpd and their families.

Lastly, your anger at your sister is your issue. Yes, she's a pain in the ass. Yes, you've likely gotten the short end of the stick as far as the allotment of love, time, attention and mental energy in your family goes. I can relate to that. But your anger is your problem; you should have your own therapist to talk to about all of that. The fact is, your sister is sick. Sick people don't think like healthy people. Sick people live in hell most of the time, regardless of whether or not someone else pays their rent. You have every right to be angry, hurt and scared. But you also have to realize that directing your anger at your sister exacerbates the problem for everyone. This does not mean she is not ultimately responsible for taking care of herself; if she can be stabilized through proper medication, therapy and monitoring by a maintenance team, it's possible she can ultimately provide for her basic needs, which she absolutely should. If she is capable of doing so. That "if" remains to be determined.

Good luck to you and your family. Bipolar is a hard disease to treat. There are options out there for you, your family and your sister. Remain calm, focus on solutions rather than on blame, and take care of yourself in the process.
posted by TryTheTilapia at 8:14 AM on July 9, 2012 [15 favorites]

I just wanted to reassure you that in this overwhelming situation it is okay to take a little break from contact with your parents and sister. It is an act of self-preservation to allow you to centre yourself, focus on the positive things in your life and then be able to contact them feeling calmer and with resources to help. I know money is tight but look into resources for yourself, yoga classes, meditation, therapy, books from the library, anything that wil help you during this long-lasting crisis.
posted by saucysault at 8:52 AM on July 9, 2012 [1 favorite]

No specific recommendations, but you might find Stephen Fry: The Secret Life of the Manic Depressive (pt 2) beneficial. It's an exploration of his own bipolar diagnosis (and how it re re-contextualized so much of his life up til then) as well as interviews with other bipolar sufferers, researchers in the field, and families w/ bipolar members.

Best of luck.
posted by Pirate-Bartender-Zombie-Monkey at 8:57 AM on July 9, 2012 [1 favorite]

Some great advice in this thread and some not so great. I've got bipolar, so I can shed a bit of light on some of what's been said here.

"The sad, hard, impossibly cruel thing about mental health problems is how people choose them. Yes, it's a sickness, absolutely, but some people just choose to be sick. In a weird way they feel safe being sick. It's what they know."

No. Sorry. Bipolar disorder is a physical illness with psychological implications for which there are a few mostly shitty and poorly understood treatments. I started a new medication a few years ago that was miraculous, but it only stabilized my mood for a couple of years. I did not want to go back to never leaving my house and crying over Geico commercials because it fucking sucks. Even when giving my best effort--exercising, going to school, sleeping normal hours, taking all my medication--my symptoms returned.

"Maybe your sister will stop wanting to be sick before your parents get there."

If I had cancer, no one would accuse me of wanting to be sick. I could go through treatment and still suffer and/or die. Mental illness is exactly the same, particularly extremely serious illnesses like bipolar and schizophrenia, which are on the same spectrum. When I do things like stop taking my medication, it's not because I want to be an asshole. It's because I'm fucked up, and I need a keeper.

The key with bipolar is to separate the keeper from the family because family is too emotionally overwrought and undertrained to deal with this. Your sister may be eligible for disability or other social services as others in this thread have recommended. Someone who isn't you or your parents needs to be responsible for helping her make and meet her goals. But the truth is that even with the best treatments and a perfect record of taking medication, relapses can and do happen.

For the record, my brother barely speaks to me because of my illness and he's made it clear to my parents that after they're gone I'm on my own. I don't blame him. He's chosen to keep himself healthy by remaining separate. That's his prerogative.
posted by xyzzy at 9:14 AM on July 9, 2012 [24 favorites]

There's no easy answer here. But getting your sister independent should be everyone's goal.

I agree that SSI is one step that your sister needs to take ASAP. Get the application going.

Another step is for your parents to sit down with your sister and lay down hard and firm rules.

1. Sister must get and keep a job.

2. Sister must do specific chores around the house.

3. Sister is no longer a child and therefore does not get money from Mom and Dad.

4. Sister must continue to see therapist and must take meds, in front of Mom or Dad, as prescribed.

Failure to comply means that sister has chosen to fend for herself. Just because she's bi-polar does not mean that she's exempt from having to pull her own weight. I agree, it's probably better if she could stay with your parents, but people's ability to deal with this is limited and ultimately the sick person must choose to take care of herself.

My cousin was bi-polar and his father had a ton of resources, he paid rent in an apartment, bought a car, bought groceries. My cousin would sell the car, invite neer-do-wells into the apartment and everyone would eat the food and do drugs until the next infusion of cash. This did not end well.

You all need to get into a support group, so that you can give the appropriate support, without putting the whole family into a bad situation.

Your sister has to want to work with her doctors and therapists to be as mentally healthy as she can be. She may need a kick in the ass to come to this realization.
posted by Ruthless Bunny at 9:14 AM on July 9, 2012

Sometimes folks who suffer from serious psychiatric conditions are just ... unable to hold down a job, pay rent, finish school, pursue a career, have a healthy romantic relationship, et cetera. There's a judgment that comes with this inability, because with anyone who is not sick you'd say, "Get a job!" or "Move out of your parents' house!" or "Stop putting yourself in dangerous situations!"

But when someone is very seriously ill, you can't just tell them to get a job. You can't cut them loose and hope they find a reservoir of strength once they're on their own.

It's very hard not to be judgmental. Because all of the problems you listed above are the sorts of things you'd judge a "normal" person for having.

The thing is, I would bet a thousand bucks your sister feels enormous guilt for all of her perceived failings. Adults want independence. We want careers and marriages and maybe children. We want our own homes and our own money. We all, even and especially the mentally ill, want to be self-reliant.

I suffer from chronic mental illness, and so do many of my friends. I have one friend in a very similar situation to your sister's -- the worst part of it is that my friend is ridiculously brilliant, and before she became ill she saw herself with a superstar future. She should have it, too, but she has a hard time staying on her meds and keeping herself from going on spending sprees and -- this is one of the terrible tricks of bipolar disorder -- in her worst depressions she craves mania, because when she was manic she could at least get shit done.

So the first thing to remember is that your sister is sick, legitimately sick, and that her symptoms are not an upset stomach or a terrible headache but instead an inability to establish or maintain self-sufficiency. And really, when it's a triumph to even get out of bed or take a shower, self-sufficiency is kind of a far ways off.

It's good you got in touch with NAMI. Once you and maybe your parents attend a support group, you'll hear other stories that are very, very similar to your own. That helps.

Therapy is also a great idea. The toll of having a mentally ill loved one is incredibly emotionally sapping. You deserve to have your own help dealing with this, particularly with the anger and resentment that you're feeling.

As for your sister, if you can help her find a new psychologist, that would be great. She should be under the care of both a psychiatrist AND a psychologist, if at all possible. You could also look into a DBT group where she could learn some coping skills so that when she feels like self-harming or going off medications or buying all the things, she has a toolbox of other options.

If SSI, Medicare, and Medicaid are options, you should look into them. You can probably hire a social worker by posting on a message board at the local social work grad school. This person would be able to help your sister with her applications. The best part of SSI is that your sister will receive a small check every month, and that money will be ALL HERS. So even with your parents going through bankruptcy, your sister will still have a tiny amount of mad money she can spend on movies and music and clothes and lattes. It's really important to have a bit of spending money.

Your parents obviously can't watch everything your sister does. But when a person suffers from bipolar disorder, it's super-important to take prescribed meds. Sometimes the medications have nasty side effects (ravenous hunger, numbness), and so bipolar patients often stop taking them. This is one of those situations where I'd say your parents should set a rule. "Breakfast is at eight, and that is when medications will be dispensed, and Sister must take those meds in front of parents." Seriously, it sounds like the kind of thing you'd do with a kid who's four, but it's not uncommon for folks to monitor meds for a bipolar family member.

But no, contrary to what gauche says, you don't get to cut your sister loose. She would still be sick, and no amount of bootstrap-pulling can change that. Unless you think it's okay for your sister to be sick AND homeless, you can't just toss her to the wolves.

Bipolar disorder can be every bit as crippling as a terminal illness. Try to remember that. Try to remember that her bad behaviors are symptoms of the underlying disorder, and not ways in which she is immature, selfish, or lazy.

As for independence for your sister, you may have to shine it on for a little while. She might not be able to achieve independence right now. But with the help of a social worker, she might find it within reach at some point down the road.

Best of luck to you and your family.
posted by brina at 9:23 AM on July 9, 2012 [8 favorites]

But no, contrary to what gauche says, you don't get to cut your sister loose. She would still be sick, and no amount of bootstrap-pulling can change that. Unless you think it's okay for your sister to be sick AND homeless, you can't just toss her to the wolves.

I realise this is a difference of philosophy but the reality is that any one person, or group of people in the case of family/friends has only so much resources. There literally is only a finite amount of money, time and emotional resilience to share. It would be entirely possible for the OP's family to give ALL their resources to the sister and then have everyone sick and homeless. It is the responsiblity of each individual to provide as much as the resources they need, sharing or borrowing when necessary but trying to ultimately come out even.

Shaming the OP does not help them with a long term problem, it is entirely appropriate for them to put their own oxygen mask on first.
posted by saucysault at 10:11 AM on July 9, 2012 [8 favorites]

It would be good if your parents could see a therapist once or twice. Living with a mentally ill person can be extremely hard. When I was deeply depressed, my husband wanted to be kind, helpful, and supportive. But he didn't feel right about just going on about his own life, protecting himself emotionally, taking care of his personal need for relief and escape. Family members do need to get clear on what things are NOT their responsibility, and also on the fact that some efforts to "help" will take a lot out of them and not really be what the mentally-ill person actually needs.
posted by wryly at 10:16 AM on July 9, 2012

I agree with almost everything that brina has to say, with the exception of it not being okay to cut your sister loose. Being responsible for a mentally ill adult who refuses to participate in his or her own care is totally exhausting and there may come a point where your parents will no longer be physically and/or mentally capable of it.

I think that the most important thing your parents could be doing for her right now is physically handing her the medication and watching as she takes it, every single time. Getting her stabilized is essential before you can even think of anything like independent living. And not to be the voice of doom (just the tired voice of experience), but she may never be able to live totally independently.
posted by crankylex at 10:31 AM on July 9, 2012 [3 favorites]