Expert: Jennifer - 7/13/2008

Question
Hi Jennifer - thanks for helping here.  I have a 43-year-old younger brother who inherited our mother's catalogue of bipolar symptoms and behavior.  He has been cycling into mania with 6-month duration, cycles of about 2 years, since 1990, and his family (another brother, both parents) and friends have never been able to do anything for him.  I live in California and the rest of the family is in Canada, so I'm able to do less than them... but they've never been able to do anything at all, medically or legally.  He's very bright and has talked himself out of commitment after a few hours, 3 times -- as our mother did repeatedly (once even having our father examined after he brought her in).  Each time he "cycles up," Phil does the same things with alarming monotony:  a) angers and threatens family, friends and co-workers and gets fired or quits his job; b) drinks more and gets in fights; c) travels compulsively; d) spends all his savings; e) LOSES everything he has - cars, passports, wallets, laptops -- leaves cars in parking lots running at the airport, flies to Bangkok, etc.  

Of course the other maddening corollary is that he absolutely denies there's anything wrong with him.  He's been jailed (and beaten up in jail) for his behavior several times, he's in his 3rd bankruptcy; his 3rd or 4th long-term relationship was just ruined.  

The family's got debts from bailing him out, fixing his smashed stuff, wiring him money to fly home from Korea/Havana/Beijing (which he loses or spends on booze).  

My big question:  is there ANY HELP for family members in situations like this?  Phil's depressions and slow re-buildings are heartbreaking - he's normally a sincere, sympathetic, whimsical, smart, quiet guy.  But as soon as he starts to "cycle up" he stops his meds, quits his support group and starts to travel.  I email him copies of his old letters bemoaning what he did to himself in 1992, 1996, 2002, 2002, 2006... and he dismisses it all.  Of course he does; he feels like Superman.

Does this sound all too familiar?  Is there anything that families can do?  Phil's relations with our (in-between) brother are wrecked from the last time he had Phil commited for examination and Phil talked himself out in 30 minutes and cops showed up at the other brother's house to arrest him for harrassment.  There's little I can do in Los Angeles unless he turns up here... and when he has done so, there's still nothing I can do, except lock him out (he steals stuff and sells it, rationalizing all the "good things" he's done for people in the past, which makes them "owe him.").  I've just spent 3 hours searching the internet for some sort of advice.  The help groups are all for self-sufferers, the tabs are mostly for pharma companies - seroquel, abilify, depakote.  I've never encountered this problem in Newsweek's MY TURN pages or in Time or really anywhere.  

ANother heartbreaking component for me was that when our mom began to flip out - for the first time, in her 40s - I was just at the age when I could - and did - leave home - but Phil was left with this madwoman, at 16.  He feared all his life that this would hit him too... and now that it has, in the grip of it, he looks on it as an absolute blessing.  

So:  how common is this problem?  Never mind Canadians, what do Americans do?  How obstreperous does a manic have to be before he can be put into the legal system, when the legal system exists to protect others, and not to protect him from himself?

And are there any other resources available on the web for this problem?  Thanks.   ANdrew

Answer
Unfortunately, there are limited options available to families like yours who are dealing with similar situations.

  Legally, if someone in your family is willing to volunteer for the 'job', you can submit a petition to the court to appoint a conservator.  This requires extensive documentation of why the family believes that this is needed, documentation of who spent what and when, letters from doctors regarding his mental state and their assessment of his ability to care for himself, and letters from family and friends describing their relevant experiences.  However, this is primarily for financial purposes, and I don't know exactly how much of a benefit it would be.  
  Because of the general attitude that unless an individual presents a threat to the safety of others, in which case they would already be in court to face charges for some crime, the court is often hesitant to give the approval for someone to be committed against their will.  This issue is extremely touchy, and all cases dealing with it must follow a very strict procedure from start to finish.  Even then, if the person who is possibly being committed manages to present themselves as competent individuals, the attempt to have them hospitalized and all the work that went into the process will be for nothing.
  If he cannot see what he is doing to his family, it may be time to simply cut him off financially and stop bailing him out of his mini-disasters.  While it may seem harsh, it could be just the thing that pulls him into a moment of clarity in which he is able to see the things that he must start to do and continue doing if he wants to be part of his family and find his friends again.  

There may be some information to look over at the national institute of mental health website (www.nimh.gov) and additional links that you may find useful.  Let me know if I can help you with anything further.