Friend in crisis – need advice
May 30, 2016 3:30 PM   Subscribe

My friend A. has bipolar which is usually very well controlled. The last few months to a year, however, she has come off her medication, and things have gone from bad to worse. Now she is in full-on crisis and keeps harming herself and others on a daily basis (so far mostly socially and emotionally). More specifics plus my question inside.

I am not sure when A. has stopped taking her medication, but I think it was early last summer. Her behavior changed pretty dramatically, particularly since November last year. Three weeks ago, after tensions increased for a few months, there was a huge blow-up at work. Her boss wanted to fire her. A. managed to take paid leave instead and went to see a doctor to get back on her meds. I thought this would be the end of it. Instead, it seems to have escalated matters even more. She is doing the most unimaginable things - unimaginable and utterly destructive in general, but also completely out of character for her.

People who have known her for longer say she has never before been quite like this during previous crises – she is MORE promiscuous, MORE angry and aggressive, more wired and calling every single person in her address book at all hours of the night with outlandish requests.

Compared to previous crises, this time round she also has far less support: her dad died, her mother is over 80 and in very poor health, her boyfriend sounds incredibly fed up and on the verge of a breakdown himself. She has, in the past, burned many bridges, so has relatively few close friends. She is on very shaky ground at work. They have wanted to get rid of her for years, but haven’t so far, mostly, I assume, for fear of a lawsuit and because she is in an underpaid, low-stakes job.

Today, she + boyfriend + her mum went to a new doctor. She is scheduled for an injection tomorrow morning, but nothing was said about a hospital stay. Her boyfriend is desperate, A.’s mum is kind of reeling, while A. is actually playing little children’s games with them. Her mum can barely move, her boyfriend has a condition which also makes him really slow, yet whilst I was talking to them, A. started running around to play tag with them, whilst shrieking with laughter like a joyful 5-year-old playing tag. It was surreal.

The boyfriend is worried that she won’t go tomorrow, or that she would do something after the first dose of meds. I’m worried that she will take off one night and we’ll find her in a ditch somewhere. I can't emphasize how unlike herself she is and how much shit she has done in a few weeks. So I decided to tell her that I no longer want to talk to her or see her unless she takes her medication/ has herself admitted into hospital, whatever it takes to get help for herself.

My question: does this sound like a good plan? The aim is to possibly contribute to her … taking her meds/ going to hospital/ doing whatever it takes to get well. She knows me as someone who is pretty easy-going, so if I draw a line it might wake her up enough for her to be serious about her recovery. On the other hand, maybe saying nothing and remaining somewhat available without being judgmental would be of more help? If you have been through such a situation yourself, I would be grateful for any other advice.
posted by miorita to Health & Fitness (11 answers total) 1 user marked this as a favorite
If you need to set that boundary for yourself - because A's actions are harming you in some way, or it is too stressful for you to be a part of all this drama, or for any other reason - then you 100% should do so. You have every right to do whatever you need to take care of yourself. But if your primary motivation is the hope that doing so will somehow cause your friend to have a realization and 'get serious' then, no, I wouldn't. I doubt it will have the result you're looking for.

You cannot reason with someone in the midst of a serious bipolar crisis. The "well, Person X is generally pretty chill and on my side so if they say Y it's probably true even if I can't see it" circuit is, in my experience and from what I've heard from others, simply not functional in major crisis mode. You may trigger more terrible behavior, or you may simply mark yourself in your friend's mind as An Enemy, and not someone to be trusted, so later she may not come to you for help when she is ready for it. (Please note that if those things do happen, they are not your fault, or your friend's, they're the illness' fault.)

I would suggest instead supporting and pushing for whatever positive changes you can. Hopefully your friend will go to the hospital tomorrow, and handle her new meds well. You can support that by doing stuff like offering rides to doctors appointments if needed, asking how things are going and truly listening and offering support or sympathy as appropriate, suggesting if your friend wants to go off meds again that she stay on them at least until her next doctor appointment, supporting any other healthy changes they may be able to make (a regular sleep schedule, cutting back on drinking or drugs, avoiding situations that tend to flip them into mania or depression, etc.) Being available and supportive without judgment can be slow and painful but from my own experience, I think it's more likely to get your friend back to a good place.

I'm sorry you're going through this. It's so painful. You may want to look into support groups in your area for you and/or for your friend's boyfriend (DBSA is a good starting point), and/or finding out whether there's a crisis intervention hotline in your area. If so, I suggest carrying the number with you, and maybe going ahead and giving them a call now to ask about what sorts of local resources might be available, for your friend or her boyfriend or for you.

(Caveat: This all comes from the partner of a person with bipolar, who has been through a few crises with him. I'd like to ask for his take on your question but he's not available just now - I'll hopefully be able to come back with some feedback from him later.)
posted by Stacey at 3:48 PM on May 30, 2016 [5 favorites]

She is seriously mentally ill. Her behavior may look like some kind of self-indulgence, but it's not. She is not in control of it. Her judgment is gone. You are not going to induce some kind of epiphany by cutting her off.

However. You are not required to martyr yourself to her illness, either. If you honestly can't bear to be around her when she's not getting treatment, you are allowed to set boundaries or even cut her off completely. This is not shameful. Just don't tell yourself you're doing it for her. You're allowed to do it for you.
posted by praemunire at 3:51 PM on May 30, 2016 [5 favorites]

For the next 12 hours, I would focus on putting the weight of your friendship behind getting her to the appointment. Assuming that she is not refusing to go to the appointment, focus on how worried you have been and how glad you are that she is taking care of yourself. Ask if there is anything you can do to help her get to the appointment. In the morning, call again. If you think it would help, offer to go with the family.
posted by metahawk at 3:51 PM on May 30, 2016 [2 favorites]

Oh, hell. That's a terrible situation. I'm so sorry for everyone. She's not reasonable at the moment and not looking after herself or anyone else. She has family. You are not her mental health professional. You don't have to give her an ultimatum to coerce her in to treatment. Nor should you. Just say, "I love you very much and will always be your friend, but I cannot be around you when you behave this way." That's protecting yourself and not blackmailing your friend. If she deteriorates further it's not your fault and someone may then be able to mandate treatment. But that's nothing to do with you. Maintaining your boundaries is best for you and for her. And emotional blackmail isn't how boundaries are respected. Be available once she's well, be forgiving and loving. But if you're not next of kin, don't be drawn in. You're a dear friend to want to help so much. But that's not great for anyone.
posted by taff at 3:55 PM on May 30, 2016 [3 favorites]

Sounds like you are in the UK? You might want to familiarize yourself with local laws about involuntary hospitalization. That's a plan of last resort, but it can be a useful tool for getting someone self-destruction into a safe environment where they can re-stabilize.
posted by the_blizz at 4:00 PM on May 30, 2016

Quickie update: My partner says basically what I said above but also suggested that maybe you can pair the appointment with some positive reinforcement - e.g., can you offer to go with them, and then take them to a restaurant they like or a movie or something? Assuming it's an outpatient visit.
posted by Stacey at 4:16 PM on May 30, 2016

I agree with everything said above, especially Stacey's point that drawing a hard line or issuing an ultimatum may actually result in the opposite of what you are hoping to achieve. When discussing mental illness & mania, it is hard to speak in generalities, but it is not unusual for a person who makes a demand or seems disapproving to suddenly be seen as wrong at best and an enemy at worst by the manic person. You are better off being supportive and encouraging things that will help her without telling her she is wrong or expressing judgment. It's a really fine line to walk. Your friend is in there, but right now she is being held hostage by the chemicals in her brain. It is difficult to predict how she will respond and her responses may make no sense to you. Thankfully, it sounds like she is being somewhat cooperative, so I would validate that behavior as much as possible. I don't know if this injection will be enough to get her on track, but here's hoping.

I'm sure you know this, but if she has expressed that she might cause harm to herself or others, she can be involuntarily detained. IANAD, IANAL, and I am not familiar with the UK system at all, but that link provides some helpful information about what that involves in the UK. It's worth a read by you and her boyfriend.

Lastly, you are doing the best you can and trying to be a good friend. Listen to her, encourage her to make healthy choices, and, again, if she expresses an intent to harm herself or others, please tell someone. As long as you have the wherewithal to do that, those are the most helpful things you can do right now. If you need to step away at some point, that's okay, too. With proper treatment, you can and hopefully will get your friend back. When she stabilizes, having a support system and friends will be essential to her continued health. Most likely, she will be remorseful, mortified, and overwhelmed by what it will take to rebuild. She will be lucky to have someone like you in her corner. Best of luck to everyone involved. It is a terrible situation and I feel for you all.
posted by katemcd at 4:19 PM on May 30, 2016 [2 favorites]

Thank you very much for your answers so far, and thank you Stacey for talking to your partner.

Thanks to you, I decided I won't go the tough love route if it isn't helpful, will just try to gently lead her to meds / hospital etc. or just be available.

the_blizz: unfortunately not in the UK, alas. Eastern Europe.

If I may just tag on a couple more questions:

1. The only person who can mandate a hospital stay is her mum (no other next of kin other than a sister abroad), but my feeling is that she is not quite grasping how serious her daughter's situation is. She is also very frail (had a colostomy a couple of years back) and is only just on speaking terms with the boyfriend. Would it be worth while talking to her?

2. A.'s boyfriend has wanted to break up with her for over a year now (mostly due to the pressure - this is A.'s 5th or 6th crisis since they are together) and is verging on a breakdown himself. He himself has a serious condition and sort of shitty circumstances. He is a German citizen who has lived in Eastern Europe for almost 20 years. Resources where we are are virtually non-existent. Do you have any recommendations for German-language and/ or English-language international resources for him? I feel if he also cracks the shit will really hit the fan.

Thanks so much again.
posted by miorita at 4:38 PM on May 30, 2016

Hi, miorita. For what it's worth:

1. It would be worth making sure her mother does understand the severity of her behavior. It might be worth talking with A's boyfriend first to see if he has tried already or what he has passed along, so that you can be sure you're providing useful information and backing up whatever his mom already knows. (Also, I imagine you've already looked at this pretty carefully, but if not, you might want to be really sure that's how the law works - I definitely have no idea about European law, but it seems like there ought to be some other option for involuntary hospitalization? Can you just...not, ever, have someone evaluated for hospitalization if they don't have a next of kin to do it? I do not recommend the involuntary route except as a very desperate last resort, but it would be worth making very sure you know what the law is in case you all find yourselves in that last resort.)

2. If her boyfriend can find a local support group that's probably best, but as an interim measure he may want to look at I haven't looked at the website resources in years so I don't know what all is there, but the email list can be a lifeline. To be perfectly clear, it can also be really depressing - it tends to be a space where people go when they desperately need support or venting, so it can paint kind of a bleak picture of life with a partner with bipolar, since people rarely turn up just to say "Hey, things are going really well and I'm having a nice day." But it can be a good way to feel less alone and/or get some advice from people who've been in his shoes or still are.
posted by Stacey at 4:51 PM on May 30, 2016

Courts mandate treatment from doctor recommendations. Not family. That's a potential abuse of liberty and rights. It's very serious. Boyfriend can ring the gp or get her to an emergency department. But citizens never have the authority to mandate treatment of adults. They can give permission if they are next of kin and know the wishes in critical situations. But this is not that kind of situation. Mum has no authority. But she could tell a family doctor or local police or community mental health worker that she was worried or frightened.
posted by taff at 10:26 PM on May 30, 2016

It sounds like your friend may be in full blown mania, which is scary, dangerous and not your friend's fault. Her best bet for stabilization is immediate hospitalization. Will send you some links when I'm at a computer. You are a good friend, best of luck!
posted by Bella Donna at 9:19 AM on May 31, 2016

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