Self-diagnosed bipolar

December 4, 2006 7:03 PM

My kid brother thinks he's bipolar

He basically self diagnosed himself via WebMD, but we have a serious genetic history of it (grandfather, an uncle or two, a first cousin) so I guess I tend to believe him. He doesn't want to go to a psychiatrist and be on what he descibes as zombie drugs. He says he is not suicidal.
What is the best thing I can say to make him feel better about the whole situation?
Is there anything he should read? Memoir or otherwise that would be helpful? All I could think of was Jane Pauley's book, which I ca'nt imagine a 25 year old boy would identify with all that much.
He also believes that he is drinking too much to cope with it. We also have a history of addiction in our family (Alcohol and drug) which I am sure is to cope with the bipolar. He thinks he could stop, but he had a blackout the other night after saying some things he regretted. He says he can't remember what those things were but they cost him a relationship and I think that is what prompted him to call me, his older sister.
I love him more than anything on this earth and I want more than anything to be helpful. Help me do that! He really does NOT want to see someone. I realize that is the first step, but please shoot me additional ideas failing that one. I can't make him go.

posted by chickaboo to health & fitness (32 comments total)

Most drugs for treatment of bipolar disorder are not "zombie drugs". That was pretty much the case about 20 years ago, but these days there are many alternatives, some of which are ups instead of downs.

The best thing for him to do is to start seeing a therapist. This is not the kind of condition that can be dealt with by "the power of positive thinking" or by reading motivational books.
posted by Steven C. Den Beste at 7:08 PM on December 4, 2006

He also believes that he is drinking too much to cope with it.

We also have a history of addiction in our family

If he's aware and admits to both these things, there are better ways to treat bipolar now than "zombie drugs," and certainly much better things than alcohol with blackouts.

He really should see a psychiatrist--I don't think he wants to have a depressive episode, or a manic one (while manics often say they miss the high of mania, it can get them into a ton of legal, financial, and social trouble).
posted by gramcracker at 7:14 PM on December 4, 2006

He does not have to take medication. He's an adult and unless he's ruled incompetent to make his own decisions by a court, he's free to choose his own course of treatment. If he keeps up with the drinking then he will eventually face that hearing, or another similar hearing for assault or drunk driving or public intoxication.

If he really is bipolar the only way to be diagnossed is by a professional. Regardless of the diagnosis your brother has a problem and needs professional help. If you ltruly love him more than anything you will help him get that help. If you do not you will watch him spiral ever downward. If you cannot convince him to seek help on his own start preparing yourself for the long hard road ahead.

Start keeping a journal. Document every late night phone call, every time that he has a fit of anger or depression, every time he lies or gets belligerent. You will need this down the road for the intervention.

I don't mean to sound harsh, but this is the reality of the situation you and your loved ones are facing. Drinking until you black out to block out what's going on inside, that is suicidal.
posted by Pollomacho at 7:16 PM on December 4, 2006

Kay Redfield Jamison's memoir An Unquiet Mind gives great insight to bipolar disorder, and Jamison addresses the question of whether to take meds in her book. (She stopped mood stabilizers after a few years, I believe.)
posted by brina at 7:32 PM on December 4, 2006 [1 favorite has favorites]

The thing about medication is (I believe) for it to be the best it can be is to be active in finding what works. This involves a lot of pain and suffering in the start, going on and going off medications, but if he can find the right combination then they certainly can be very beneficial with minimal zombification. It's hard, and a lot of people quit before finding what works for them.

There are other ways to deal with it, but there is nothing that will make him un-sick, it's all about controlling the symptoms, not curing them.

But, whatever else, medication or not, he needs to treat the substance abuse, that will lead to heartache and suffering, and if he is bipolar it'll just make things that much worse
posted by edgeways at 7:57 PM on December 4, 2006

He needs to see a professional. It may very well be that he's right, but having a trained psychiatrist confirm the diagnosis will help in a lot of ways. They can offer support, treatment options, and so on.

Best of luck.
posted by chrisamiller at 8:05 PM on December 4, 2006

Do you have any (male?) friends or family members who are being successfully treated for bipolar disorder? Maybe you could suggest, "I know so-and-so who's got the same problem... I'll put him in touch with you." Maybe your arranging contact from someone who can relate to him will help him sort out what steps he can take to live in a more healthy way. Email would be ideal for that 'cause it's non-threatening. That's something I've always thought would be really helpful for a couple of situations I've been through in my life. (Even maybe linking him to some good bipolar blogs or online communities?)

I know from experience that it's incredibly delicate to deal with a treatment-resistant bipolar individual. Being perceived as pushing just a little too hard can cause a hugely out-of-proportion resistance and refusal. But remember that he's just cluing in to this aspect of his life, so with the right kind of resources and encouragement he may open up to treatment down the road. All you can really do is learn about the illness, provide the best resources you can find, and make sure he knows you're there for him.

Good luck.
posted by loiseau at 8:18 PM on December 4, 2006

I'm bipolar-my drugs make me feel NORMAL, not zombielike.

One thing he needs to know, is that untreated this illness gets worse-and gets harder to treat the longer it goes untreated.

Email's in my profile if he-or you-wants to yack.
posted by konolia at 8:42 PM on December 4, 2006

I would go with the diagnosis that you can actually make: incipient (at the very least) alcoholism.

Having blackouts is not a normal part of life -- it is indicative of a serious disease in progress. He may or may not be bipolar, but he is certainly using the family history of it as a story for why he's drinking too much.

Start with the basics: ask him to drink no alcohol for two weeks, as a favor to his dear old sis who is terribly worried about his blackout. Just to put her fear of alcoholism to rest, mind you.

If, and only if, he manages that to your satisfaction should you start focusing on the bipolar aspect of things. Until then I would start reading up on alcoholism and families, and see about getting him into some treatment before he does himself (or someone else) some irreversible damage.
posted by tkolar at 10:17 PM on December 4, 2006

Jebus, can people here answer the actual questions?

Things to say?
- plenty of people have bipolar
- plenty of functional, nay, successful people have it (your chances of making *who's who* apparently go up 100-fold)
- it can be treated with medication that doesn't turn you into a zombie
- depression can be fatal, as can mania, although mania is more likely just to lose you all your friends & possessions

Things to read?

strangely, there isn't really a whole lot of useful lay literature. that i've noticed. An Unquiet Mind by Kay Redfield Jamison is OK as a memoir. I also once saw an OK-looking day-to-day "survival guide" - hopefully somebody will know the one i am talking about...? full of mood checklists & so on, for self-management.

Finally, not answering the question: self-diagnosis is a bit of a crock of shit. plenty of people who just have normal ups & downs call themselves bipolar, whereas real bipolar is not just about having varying moods. there is no way in the world that mania corresponds with a normal person just feeling happy or creative or full of beans.
posted by UbuRoivas at 10:29 PM on December 4, 2006

I'm bipolar. Although I haven't received my degree, I've helped out a few of my friends in urgent situations and there hasn't been any instance of a psychiatrist disagreeing with my advice. I also follow the current literature obsessively (not to toot my own horn, just an attempt to give the OP a clear picture of how qualified I might be).

If he sees a doctor, it is very important to see a doctor who specializes in mood disorders, preferably at an outpatient facility associated with a medical school or major hospital. Besides being up to date on contemporary treatment (therapy/medication) they are also likely to have better intuition about the patient's mental health.

I'm told often that I have a strong intuition about these sorts of things. If you wish to privately get in touch, email me at [my username]@gmail.com. I'd be more than happy to help. I wish your brother well.
posted by Frankieist at 11:23 PM on December 4, 2006

Maybe Ubu is thinking of the Bipolar Disorder Survival Guide by David J Miklowitz. You might want to pick it up. You and your brother might read it to see whether it confirms his self-diagnosis, and meanwhile it makes a pretty persuasive case for taking meds and going to therapy.

Because if your brother has bipolar, he has to take meds and go to therapy. (About meds, recently.) He doesn't get to just tell you that he thinks he has a serious, possibly fatal disease, but is not going to treat it or even find out for sure if he has it.

You: Hello?
Your brother: Hey sis. I've done some reading, and I am pretty sure I have a brain tumor.
You: What?
Your brother: It all fits -- this, this, this, that.
You: Oh my god. Well, what does the doctor say?
Your brother: I don't want to go to the doctor. They just make you bald. And anyway, I know about it now, so I can just handle it myself with positive thinking.
You: !?

You've got to call him on this. Surely he wasn't just trying to scare you. The fact is, he doesn't know (a) what is wrong with him or (b) what the doctors can and cannot do about it, at this point. He should know that (c) he is in charge, now and forever, unless he is suicidal or homicidal -- he decides whether to take the doctors' advice at every point, and he is always free to try something else or find another doctor if he isn't feeling better. What in hell is there to lose by going down there and finding out what the doctors have to say?

If you think your brother would benefit from having a fellow bipolar on his ass -- please feel free to email me.
posted by Methylviolet at 12:07 AM on December 5, 2006

I can't make him go.

Sure you can. Of course you can't literally force him, besides, that would likely backfire, but you can insist, find a way to make it easier for him to get past this resistance.

Why doesn't he want to go, really? He's afraid of what? He's got something in principle against the whole profession?

Because he needs to know that, no matter what his general objections are, it will all depend on the person - there can be bad therapists, mediocre ones, and good ones, or even good ones with whom he won't get along, but once he has someone good he clicks with, he'll regret not having started earlier. And if he's not happy with the first try, he can look for someone else. And if at any time he feels uneasy, he should voice his doubts to the therapist himself, to you, etc..

He has to stick with it for a while to make it work, and be willing to try different meds and discuss them with the therapist until they find the best ones for him, but it's not prison, he can change his mind later, he has nothing to lose, he won't be giving up any freedom.

He will be using the services of a professional just like someone who has a broken computer goes to an IT technician. Ok not "just like", but you get the point - he needs to start seeing it in terms of having the freedom and power to choose a service that will be useful to him. He's the one with the power over his own life, not the therapist. The therapist is just a means to an end. (Using therapist as a general term - he needs to see a psychiatrist for the meds, but he would also benefit from talk therapy. Depends.)

You could look up the information yourself, or better, if possible, get personal recommendations for therapists in your area, then go yourself first, talk to them, explain the situation and get an idea of how suitable for your brother they are. Then, talk to him and encourage him to just go have a chat himself, again by stressing his freedom and the need to approach this on a trial basis, even while you recommend he does make a honest effort. It won't be too much effort for you and it stands a good chance of working.

Failing that, you need to scare the shit out of him, blackmail him, or tie him to the car seat and drive him there (no, I'm kidding, but just the idea that you will need to be much more annoying) but first try the easy soft no-commitment approach. Best of luck!
posted by pleeker at 1:31 AM on December 5, 2006

(or, even, what Methylviolet also said)
posted by pleeker at 1:35 AM on December 5, 2006

Just as a source of ideas, Stephen Fry (also bipolar) did a recent two-part documentary on the condition for the BBC. He talks to a lot of people about how they've managed. It's quite personal - he's looking into whether he should take medication - but you get a good range of perspectives. Must be online somewhere...
posted by crocomancer at 3:27 AM on December 5, 2006

Yeah, not Zombie drugs but they can be miracle drugs. My father has been on some of these drugs.

He said he felt normal, then he started feeling a bit different.

He later realised the weirdness was because the black clouds of doom weren't descending on him nightly like they had, and he realised that hey, most people don't ever feel that!
posted by tomble at 3:54 AM on December 5, 2006

I like Kay Jamison's books, including Touched By Fire, which is about the history of BPD and artistic expression.

You should tell your brother that he should get diagnosed and evaluated by a professional. He may well find that he isn't diagnosed as bipolar, although it's a popular diagnosis right now, so he may well be. Even if he doesn't choose medication for treatment right now, he may feel differently in the future, and it can't hurt to start a treatment relationship with someone.

My google searches have come up empty, but in the past 18 months or so there was a study published indicating that psychotherapy focussed on a schedule and a regular, normalized life, was quite useful in preventing big mood swings in people with BPD who were not taking meds. I'll keep looking for the reference.

Essentially, I'd point out to your brother that not wanting to take medications is not the same as not wanting treatment (he does want treatment, or he wouldn't be drinking so much), so he should explore treatment up to the point of taking meds.

Alternatively, your brother is simply using this familial disease a cover and justification for his incipient alcoholism, in which case you should call him on it.
posted by OmieWise at 6:21 AM on December 5, 2006

Thank you so much for all the insightful advice.

I tried reassuring him that millions and millions of people have it but he's apparently already looked that up and concluded that there are 6 million, divided by the 280 million or whatever the US population us = 1 out of 50. he wasn't reassured although that seems like a lot of people.

I know he needs to go see someone... I will try to find someone in his area though we live on opposite sides of the country.

He's going out of the country on business for 2 weeks but then I will see him for the holidays.

If you're bipolar, how do you cope with anger etc. Do the meds do it or do you learn to do it on your own?

I might send him a few of your email addresses just to see if he decides to reach out -- hopefully it will work. Thanks for sounding so positive about the options here. I feel better, if he doesn't.
Thanks
posted by chickaboo at 6:25 AM on December 5, 2006

If he really is bipolar the only way to be diagnossed is by a professional.

whether or not someone "really" is bipolar is a judgment call. A professional may have better judgment, having seen many different cases, but at the end of the day, it is still a person's opinion about the mood tendencies of another individual. There is no concrete / hard fact / blood test type of diagnosis.

medication's a weird thing to deal with, and it often takes a lot of different attempts to find something that actually feels like it works. If a med feels zombifying, you can just stop taking it, though. So it's something to try. If he doesn't feel like his moods are having that negative an effect on his life at this stage, he can try other approaches, though. Talk therapy is useful for some people; keeping a diary is sometimes helpful; stable relationships can make a big difference... a lot of people in my family have been through bad periods mood-wise in their lives, but almost none of us are currently on mood stabilizers (though, again, many of us have been at one time or another). There are a lot of grey areas, and ultimately it is one's choice how to proceed.

Is he happy with his life? If not, then he should implement changes. What changes are possible? which ones seem most likely to have positive effects? Make a list, consider the costs and benefits, and make decisions. reassess on a regular basis. if you can find a good therapist who can work with you on the project, all the better (esp if they can provide prescriptions if nec...)
posted by mdn at 6:27 AM on December 5, 2006

real bipolar is not just about having varying moods. there is no way in the world that mania corresponds with a normal person just feeling happy or creative or full of beans.

Well, now, that depends on what kind you have. I have bipolar type two, in which my (hypo)mania basically is just like a "normal" person full of beans, only with a bit less judgment. Not all of us have wild manias. Besides, it's usually the depression side that will kill you.

Chickaboo, the meds did help me with anger somewhat but I had to learn how to handle it myself as well. The key is to not let the emotion "trip the switch" -in other words, calm down before you really get revved up. You do hit a "point of no return" where it is extremely difficult to calm down. It literally takes me hours to recover from getting angry so it is very important for me to recognise the signs and adjust my attitude before things escalate to that point. But, yes, meds do help.
posted by konolia at 6:40 AM on December 5, 2006

Your brother sounds to me like a reasonably intelligent and insightful person, this is a good start. To encourage him to get the professional help you think he needs (and he probabaly knows he needs also) perhaps some medical literature which explains the physiological causes of mental illness to help him understand that it is just as valid a disease process as any other and the medications that he may be prescribed are for the purposes of treating the physiological imbalances just as a person is prescribed medication to relieve high blood pressure or insulin to treat diabetes.

Then there is the alternate tack of putting in more simple context.

If you're having car trouble you see a mechanic
If you're having legal trouble you see a lawyer
If you're having financial trouble you see an accountant
If you're having psychological trouble you see a psychiatrist

If something is not functioning the way it should be you take it to an expert who can help you repair it.

You may also wish to discuss the consequences for him if he becomes out of control and requires a mental health detention, and the resulting lack of power he will have in that situation.

At the moment he still has the power to make a decision to seek treatment and make decisions about his care and he may wish to embark along that course of action before that crisis point is reached and that power is taken from him.

Support, reassurance and gentle guidance is the best you can offer until he decides to seek help for himself, or a crisis event occurs and the control is taken from him.
posted by mule at 6:49 AM on December 5, 2006

If you're having car trouble you see a mechanic
If you're having legal trouble you see a lawyer
If you're having financial trouble you see an accountant
If you're having psychological trouble you see a psychiatrist

cars, laws, and money are things set up by human beings. The psyche is of another order altogether.

I'm not saying experts can't help. But it's not that simple.
posted by mdn at 7:36 AM on December 5, 2006

As far as anger, mood swings, blah blah blah...
Self-link blog entry. My hyperbole at the time is kind of embarassing now -- and no, I didn't end up needing to stab anyone in the eye -- but I think it illustrates the bipolar-on-meds experience. On the one hand, you are still yourself, you have feelings, you get happy or sad or angry, but on the other hand, your feelings don't blot out the sun. You can go about your business, while having feelings.

For myself, I feel exactly the same, just maybe less so. I think exactly the same, too, without diminution, and that had been something I was worried about. I had always thought smart is all I got and was reluctant to imperil that, my one thing, as long as I could possibly kid myself that it would pass, or I'm-not-mentally-ill-just-a-whiner, or whatever. Maybe that is your brother's "zombification" concern. Well, at least in my house, crazy doesn't mean wrong or stupid.

Me: ...Maternal wisdom blah blah blah...
Teenage children of Methylviolet (who sometimes forget themselves): Are you crazy!?
Me: Yes -- ?
TCoM: Well you are also wrong.
Me: Well you're on drugs! AND wrong!
TCoM and/or Me: All I wanted was a Pepsi, etc...
posted by Methylviolet at 8:34 AM on December 5, 2006

You might want to suggest to him that he avoid putting a label on anything right now. I would encourage him to start by looking at behaviors he exhibits that affect his life in negative ways, and then go about examining how to change that. In other words, instead of trying to deal with a big diagnosis, try to start by dealing with discrete parts.

It sounds like he wants to deal with his drinking, and if he's upset about the relationship that he just lost then he probably needs to deal with the feelings from that incident.

I think you need to respect his wishes not to be forced to see a therapist. (I know that will be an unpopular opinion, but if he refuses to go then I don't see what good he would get out of it, even if you could drag him.)

Let him know how much you love him, and that you're there to support him, and to help him however you can.
posted by KAS at 1:37 PM on December 5, 2006

If you're bipolar, how do you cope with anger etc. Do the meds do it or do you learn to do it on your own?

um, what anger? and what etc? in a hypo/manic state, one might become frustrated with friends & relatives trying to stop one from carrying out whimsical projects (like, say, wanting to buy a couple of concert grand pianos, one for each hand, because you've suddenly decided you'd like to teach yourself to play), and this frustration might manifest itself as anger or chronic impatience, but if the meds prevent the mania then this situation doesn't arise. i don't think there's much room for anger in a depressive state - there's just not enough energy to spend on such an emotion.

and yes, that Miklowitz book was the one I was thinking of. thank you, Methylviolet.
posted by UbuRoivas at 1:56 PM on December 5, 2006

UbuRoivas, you must not have ever heard of dysphoric mania or dysphoric hypomania. What this is is an irritable (hypo)mania which can be described as severe PMS on steroids. It's hell. I'd almost rather be depressed. I used to get 8 on a scale of one-to-ten angry just because I had to wait in line for the fax machine...if my husband was chewing loudly I wanted to beat his face in.

Of course I didn't act on any of that, but don't ask me about the post office story...
posted by konolia at 2:12 PM on December 5, 2006

I have the Stephen Fry documentary...
If you like I could burn it to disc and mail it to you...

I have some personal experience with bipolar and found the documentary amazingly insightful...

just let me know...
posted by MonkNoiz at 2:17 PM on December 5, 2006

konolia: well, the question was asked as "how do *you* deal with...", but I probably should be more careful in not seeming to speak for all flavours of bipolar giftedness. That dysphoria sounds like shite, BTW. Is that the antonym of euphoria?
posted by UbuRoivas at 3:10 PM on December 5, 2006

UbuRoivas, be glad you've never experienced dysphoria. For once, I agree with konolia. Chickaboo, do your best to get your brother to see a crazy doctor.
posted by oats at 9:03 PM on December 5, 2006

by the way... i'm very in favor of the idea of a doctor in cases like this...
posted by MonkNoiz at 1:32 AM on December 6, 2006

Hmm - he is definitely sounding like what konolia describes.

I had another long chat with him last night. He seems willing to read both of the books you guys recommended so I plan to send them.
I think his main objection to talking to someone is the embarassment he feels about this but he has said if I stop pushing him he might come around to being willing to do so.


One concern he has is whether he can remain on ADD medication and also take mood stabilizers. Another is the cost of copays etc on all of this but he knows that the problem is getting worse not better.

At the moment he's not willing to reach out to anyone by email but thank you for the offer. I'll keep working on him.
posted by chickaboo at 9:45 AM on December 6, 2006

Tell him a lot of bipolar people also have ADD. I suppose it depends on what he is taking for it but I was on Strattera for awhile while on my other meds. (Mine was because the drug supposedly helps with depression for bipolars. I later found Lamictal for the bp and don't have to take anything else.)

When he does go see a shrink make sure to get one that is really good with meds along with being one that treats a lot of bipolars. Also have him check out the crazymeds site (don't have a link but you should be able to google easily) as it is some of the best info one can find on psych meds in general.) He may also want to find some bipolar forums online-most folks are really helpful and even if all he wants to do is lurk he may find it useful.
posted by konolia at 10:30 AM on December 6, 2006