Expert: Jennifer - 6/9/2008

Question
QUESTION: The love of my life, who I met Dec 2006, has been diagnosed bipolar disorder for most of his life. His mom says the problem started when he was 18 years old.  Currently, he is 49 yrs old, and refuses to take his medications , refuses to acknowledge that he has a problem.  In the last six, months of his not taking medications he he getting worst.  I do not know much about the bipolar disorder, but what i have read is exactly  what he and i are going through.  I try and try to get him to take meds , so days he is okay and then the next day he is very different.   I need help.  How can i get him to take medications?  How can I show him that I care enough not to leave him,all alone throughout his mood changes and other problems caused  by the bipolar.  He refuses to listen to me, he tells me that I have the problems not him.  However, recently he did go to the doctor and therapist to get a refill of medications.  However, he still won't take these meds.  I tell the doctors that will not take the med, they said its up to him.  Help me, please.

ANSWER: I am so sorry for taking so long to answer you!  My motherboard had to be replaced for the second time, thank goodness it's still covered by the extended warranty.  

When you say that his behavior has been getting progressively worse over the last six months, in what ways do you mean?  If he has seemed like he's getting more forgetful, or withdrawn/depressed -- my answer would be different in the event that what you mean by "getting worse", he's increasingly hostile, threatening, and/or violent.  Regardless, his doctors are right; it's like the old saying "you can lead a horse to water but you can't make him drink"; the only person who can make him take his medications is him.  Has he given any particular reason for why he doesn't want to take his medications?  The fact that he has gone to the doctor to get a refill of his prescriptions seems to indicate that he knows he needs to take them to control the symptoms of his condition, which you should consider as a sign of hope that he can/will get to a place where he consistently takes his meds in the future.  One thing that I would recommend for you is to learn all that you can about bipolar disorder.  If he were diabetic, I'm certain that you would want to find out as much as possible regarding diabetes -- both conditions are (more or less) lifelong, and require the patient and anyone that is close to them to be involved in the treatment to varying extents.

Hopefully you will be able to clarify a little more on the areas I mentioned above, so I can give you a more in depth answer on how you might be able to encourage him towards his meds.

---------- FOLLOW-UP ----------

QUESTION: Thanks for answering my question.  I feel that you know exactly what I am going through.  Yes, I want to help him, just like if he had diabetes however, if very hard to if his refuses to accept my help. Yes, going to the doctor, I thought the same, that he knows that something is wrong and needs meds.  However, when I say that his is getting worse, its many things:  his searches though my stuff, says he is looking for what I took from him?  He forgets where he put a book, a lighter, and forgets that he told me something.  I have noticed that he repeats some words over  and over the same phasse when he talks, because he says that I do not understand so he has to repeat for me.  He says that I have the problem, that i treat him different, I explain that by his yelling, and cursing at me,that i don't know what to expect from him that day therefore yes, I have to treat him  different to try to stop him from yelling. He was before always cleaning the house, but now he throws trash throughtout the house on floor and anywhere.  His appetite is  low, he leaves cereal from brkft to eat later on.  he saves food to eat later.  There are so much difference in him that I can not list all.   He yells about the simplest things, for example where did I put his radio,where did I put his lighter he curse and tells me that I am an idiot, stupid and do not know shit.  But then he finds where he put these items, and then smiles at me saying that he is sorry, then kisses to make up.  He does not seem depressed, yes he will say that his life is hopeless, and that we need to get to a place where when jesus returns that we will be there to be chosen to go heaven with god. He says that he is very christain now, and threatens marriage or not relationship, no sex, no touching, etc.Last month, he sent a  $628 donation to a radio prophet, that he whole SSI check.  Recently, he has been spending money like crazy, buying the smallest thing that cost the highest price, and the just going to any store to spend money on whatever. He spent $300 in two days.     He is not violent, not hostile but he can be threatening my his words, and then he will slam doors, curse out loud suddenly and I go running the find out what is wrong.   I need to learn more about the bipolar disorder, I worry about him daily. Our relationship is not the same since, he refuses to take the meds, he says that the med make him feel worst, confused and a too strong. I have explained that we we tell the doctor and give different meds , the doctor thinks that the current meds are doing good.

Answer
Many times, regardless of whether it's because the person does not know they have bipolar or are aware but choosing to go untreated, the longer that the condition is allowed to remain unchecked the overall result can be significant due to the degenerative nature of this condition for people who have a.) a history of brief periods where medication compliance occurred with long time spans in between; b.) incorrect diagnosis leading to ineffective or non-existent treatments for bipolar disorder; or c.)individuals who have received a diagnosis of bipolar disorder but refused any & all treatment for their condition.  Memory loss, greater mood instability, increased financial sexual, or other risky behaviors; inappropriate responses to situations & those around them, greater risk of suicide, increased potential for violence -- are only part of what can result when an individual with bipolar is unmedicated.  
  If he is yelling at you, calling you names, and putting you down, whether he later decides he wants to kiss and make up or not, he's being abusive towards you.  You shouldn't have to be walking on eggshells & trying to find any way you can to avoid him yelling at you.  It's obvious that he's at a point where things are out of control, he's struggling to find excuses for why he isn't taking meds, and he's damaging his relationship with you by behaving like he is.  I'd suggest to him that the two of you look for a doctor who specializes in treating bipolar disorder, have him write a list of all the meds he's ever taken and what side effects were problematic enough to make him decide to stop taking them, and a specialist will be able to work with him on treatment options from there.  If he doesn't want to do any of that, your best bet (as hard as it would be) is to move on, because you can't make him take meds, but you shouldn't let his poor choices and harmful behavior take over your whole life either.  Sometimes, it takes someone who really loves them to take a stand or walking away, before a serious commitment to getting treatment and sticking to it can happen.  Relationships require both people to work together and fully do their part to the best of their ability -- part of that for bipolars is making sure that they are managing their symptoms as much as possible - nothing can stop an episode from ever occurring, and there's no cure.  I personally feel that by doing that, it's not because I'm trying to make myself easier to deal with for other people, rather, it's because of what it makes possible for me.

I hope that you are able to work things out, whether it means sticking it out or moving on, it's important to do what is best for you both in the long run.  Good luck, and if you have any other questions, I'll be here. =)