Expert: Libby Bonner - 8/25/2008

Question
QUESTION: My dad is 58 years old. We believe he has been bipolar since his college days. He has never acknowledged his illness. He was diagnosed as bipolar about 10 years ago following the end of his 3rd marriage. My uncle (who is a MD) forced him to check himself into a hospital. He was diagnosed and put on lithium and responded very well. About 3 months later, my dad began telling us that my uncle had been in cahoots with his 3rd ex-wife, etc. etc. and that he had his doctor friends misdiagnose him on purpose to help her in the divorce. He stopped taking his meds and has not spoken with my uncle since.

I have two sisters. We have always known something wasn't quite right with dad but have loved him anyway. However, we feel that we MUST do something now because he seems to be spiralling out of control. His 5th marriage is about to come to an end. He was also recently detained at a local high school baseball game because he was exposing himself. Apparently his pants were ripped open at the crotch - he managed to avoid being arrested by insisting he was unaware of the rip (no explanation for why he wasn't wearing underwear). My current stepmom has also evidently discovered that he has been soliciting sex meetings from men online. He has also maxed out his credit cards gambling online.

My sisters and I are all in our twenties and we feel like we must at least try to have our dad seek help. We are wanting to all 3 approach him together and strongly encourage to check himself into a psych treatment center for evaluation. Cost is not an issue for us, in fact, my current step mom is well off and has advised us that she would gladly pay for his treatment if he agrees. My dad has completely turned against her and blames all his current problems on her so she can't really join us, but she supports us 100%.

My dad acts very normal towards my sisters and I most of the time and we have never let on to him that we suspect anything is wrong. He usually has wild explanations about the reasons for his divorces, lost jobs, financial problems, etc. and we usually just go along. Our mom was my dad's 1st wife and they divorced when we were very young so we didn't have that much exposure to my dad.

Do you have any advice on how best to approach my father to have him seek help? I have read Amador's "I am not sick I don't need help" book and one on "Surviving Manic Depression" so I know a little bit, but I was wondering if you had any practical advice from your experience? I worry that we may push him over the edge by confronting him. Despite his illness he has always loved us children very much. I could go on loving him despite his "weirdness" but I worry he is going to end up getting himself in real trouble.

Thanks for any suggestions you can provide. We are thinking about all going to see him this weekend and just telling him that we need to have a talk. We are then going to tell him we are all very concerned about his mental health and we hope he will listen to our opinions and respect them enough to at least get it checked out.


ANSWER: Your mother did a good job of raising loving children and I wish your plan had any chance at all of success.  It does not.

You are contemplating "an intervention," and these can sometimes be successful w/ drinking or other problems.  but consider the likelihood of success of an intervention if you tried it while the person was totally drunk.   

Your plan involves confronting someone who is terribly, totally sick and who has been sick and untreated for years and years - the lack of treatment compounds the bad effects of simply having been so ill so long.  His illness affects his thinking, his judgement, his moods, his behavior - I would guess there is rarely any 'well' behavior to be seen.

It is time and energy and emotion wasted to confront an irrational person w/ rational suggestions.  It simply can't work.

You say that you "worry that we may push him over the edge by confronting him."  I think it far likelier that he would respond w/ rage and you would join your uncle in having no further contact.

And "despite his illness he has always loved us children very much. I could go on loving him despite his "weirdness" but I worry he is going to end up getting himself in real trouble."

He is indeed closer and closer to getting into real trouble, trouble that may end w/ him being injured or incarcerated....realities that love may not be able to prevent.

Your stepmother might want to consult an atty re options - but guardianships and committments are not easy to get.  Also, the uninsured cost of care in a for-profit hospital or a residential facility are truly astronomical - but you might call [or google] around to see what facilities would take him, IF you could find a means of compelling his admission.   --  And then there would be the issue of his care thereafter.  I'm not sure whether anything done now, intensively and/or for months or years, would keep him on the straight and narrow once released....again, the cumulative damage mentioned in the fourth para above.

My only new idea:  is he a veteran?  If he is, you might have better luck in the VA system or with a VA hospital than elsewhere.  The VA also does still maintain some long-term care facilities as permanent group homes for vets.  Call a VA hospital to inquire.

Pls do write again if there are questions.  These things are tragic and they are nearly always without solutions of any kind.  


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

QUESTION: Thank you for your answer. It pretty much confirmed my fears. I agree with you that our attempts are more than likely going to be futile. With that said, we still plan on talking to him because we feel like we owe it to him to at least try.

In recent months my dad's health has been failing. He had to spend a couple of weeks in the hospital due to blood clots in his lungs and legs, and he has had a terrible battle with psoriasis (I know lithium would make this even worse). It is almost too sad for me to deal with. On several occasions he has mentioned to me that he feels like his "mind isn't right" or that his "brain doesn't work like it used to." Also at Easter my dad's family was discussing an inlaw's family situation involving a relative they thought may be paranoid schizophrenic. My dad interjected himself into the conversation and began going off about how that family needed to get the person help and it was horrible for the family to continue to enable her behavior in order to avoid conflict. It was very strange. I don't know if he is crying out for help or what.

Unfortunately my dad isn't a veteran, but thank you for that suggestion.

If we are deadset on talking to my dad about our concerns, do you have any advice as to what may be the best way to handle this? (I know this may be a bit like asking for advice on the best way to build a sandcastle to withstand the tide)

The approaches we are considering are as follows:

(1) Ultimatum approach - we tell him we are concerned, give him the reasons why including bringing up past incidents, etc., tell him we have found some psychiatrists or treatment centers we want him to go to, and tell him if he doesn't, we can no longer be a part of his life because we can't bear to watch him slowly deteriorate. I am not a fan of this approach, but my older sister is. For one, I don't think I could follow through with never seeing him again. Secondly, as you said, it is going to be impossible to "win" a rational argument with him, and I don't think he will be able to appreciate consequences.

(2) Here's what’s wrong approach - we go to him armed with all the info on manic depression/bipolar and with all the evidence that we have that he is suffering from bipolar. We confront him with it so he can not make excuses or justify his behavior.  I don't think this will work at all, again as you said, it is no use trying to be rational with an irrational person.

(3) We are worried approach - with this approach, we just tell him we are there because we are worried about him, we tell him that we want to discuss our concerns with him and that we don't want to argue about whether they are valid, instead we just want to put them on the table and we hope he can respect our concerns. Tell him we may be wrong, but it would mean alot to us if he would at least have an evaluation and then suggest that he check himself in some places. With this approach we wouldn't even mention bipolar, etc., Instead we would just couch our concerns as being about his “mental health.” This is my favored approach, but my older sister believes that showing weakness will bolster his opinion that nothing is wrong with him.

(4) What’s wrong approach - we just tell him that we are there because we can tell something is going on with him but we are not sure what and try to talk to him until he admits that something is not right and decides on his own that he needs help. Unfortunately none of us are trained psychiatrists so I don't think this will work at all.

(5) We love you approach - just tell him that we are concerned about his mental health, but we aren't there to force him into anything. We just want him to know that we love him and will support him no matter what. Tell him despite how much we love him, we feel his condition is preventing us from having the kind of relationship with him we would like, but if he is happy with the way the relationship is, we can leave it alone. Leave it up to him to ask us for help.

Anyway, those are cliff notes of the some of the approaches we are considering. We haven’t fully thought this out just yet.

Also, not sure it is relevant but we are from Texas (close to Houston) and the place we have found that we would like him to check himself into is http://www.intracare.org/. Again, I know the chances of this actually happening are very remote.

My dad is a loving and caring person. Despite his illness he has always loved his children. He is also very kind hearted and great with pets and small children - basically anyone that doesn't have any expectations out of him and anyone that will love him unconditionally.  My dad is also extremely intelligent - I would even argue almost brilliant (as I understand many people are that are afflicted with this disorder). He has given me some of the best advice I have ever received and I really can't stand the thought of not having him in my life. A part of me thinks everything will be okay because he is my dad and he will respect our opinions, but a part of me knows that his sickness may not allow this to happen.

Sorry for writing so long, I know you must have many questions to answers, and I'm sure there are some people that you can help a great deal more than you can help us due to our almost unwinable situation, but as you might imagine, I am incredibly troubled by all of this and it really really helps me to feel like someone who understands is listening. My thoughts are all jumbled and I'm sure it if very difficult for you to read and answer. I will not write back after this message in order to allow you to help others. But thank you so much for your time and input, you can not imagine how much it means.


ANSWER: 8/19 Matt!  I wrote about your response to my first answer before reading this email, full of more info and ideas.  A couple have a samll chance, maybe.

I will answer ASAP - am just letting you know that I have received and read this.

"ASAP" is today or tomorrow......
***************************************************
8/20
M: In recent months my dad's health has been failing. He had to spend a couple of weeks in the hospital due to blood clots in his lungs and legs, It is almost too sad for me to deal with.

LB: Diagnosis is what - some sort of phlebitis, or --? Can you - has someone - talked w/ the doc about that episode and about his prognosis.  This might preclude a focus, now, on mental health:  this could be his more serious immediate critical problem.  And its outcome could change your focus....

M: On several occasions he has mentioned to me that he feels like his "mind isn't right" or that his "brain doesn't work like it used to."

LB: If you make any physical/mental intervention, "mind, etc" is probably in your earliest paragraphs......question him gently about this: in what ways is it not right; what changed from the way it used to work; does he think anything could modify these problems.

And you might time your intervention  - but I know maybe getting all of you together is not easy? - to a time when he seems ruminative, pretty with it, and maybe best able to think, about these or any other things.

M: Also at Easter my dad's family was discussing an inlaw's family situation involving a relative they thought may be paranoid schizophrenic. My dad interjected himself into the conversation and began going off about how that family needed to get the person help...  

LB:So dad's family still includes him in their gatherings; should they be doing the intervention w/ you ??

M: ....I don't know if he is crying out for help or what.  

LB - he was maybe rational enough, at that time, on that subject, to offer an opinion.....  I dunno though, re 'cry.'.

The approaches...

(1) Ultimatum approach - we tell him we are concerned, give him the reasons why including bringing up past incidents, etc., tell him we have found some psychiatrists or treatment centers we want him to go to, and tell him if he doesn't, we can no longer be a part of his life because we can't bear to watch him slowly deteriorate. I am not a fan of this approach, but my older sister is. For one, I don't think I could follow through with never seeing him again.

LB:  I don't think you could, either.  And remember the danger that HE might not want to see any of you ever again....though your latest info suggests that you kids and he are solid, despite all.  

Also - it may be that you and other sibs have different personal needs and tolerances, and will have to take separate approaches at some point.

(2) Here's what’s wrong approach - we go to him armed with all the info on manic depression/bipolar and with all the evidence that we have that he is suffering from bipolar. We confront him with it so he can not make excuses or justify his behavior.

LB:  #2 is a True Loser.

(3) We are worried approach - with this approach, we just tell him we are there because we are worried about him, we tell him that we want to discuss our concerns with him and that we don't want to argue about whether they are valid, instead we just want to put them on the table and we hope he can respect our concerns. Tell him we may be wrong, but it would mean alot to us if he would at least have an evaluation and then suggest that he check himself in some places. With this approach we wouldn't even mention bipolar, etc., Instead we would just couch our concerns as being about his “mental health.” This is my favored approach, but my older sister believes that showing weakness will bolster his opinion that nothing is wrong with him.

LB:  [Satisfy sister by omitting "we may be wrong.']  Lap back, above, to "mind isn't right" and meld that w/ #3.  Use the word "love" maybe more often than "concern/ed."  I do LOVE "evaluation," since this would BE the first thing done, probably some paper and pencil tests, some scans, whatever, in a mental hospital.  Is there a way to lie/cheat/steal [he is v intelligent, though] to suggest you want a better understanding of his physical health, want optimum care w/ it??

Could you set up something beforehand, w/ anyone anywhere, such that he would, in fact, get a complete medical work-up AND, by arrangement, some mental testing?????  [FYI - every non-emergency work-up that the Mayo Clinic, in Rochester MN, does, includes a battery of psychological testing.]   Depending on his insurance, maybe you could get him admitted to a 'regular' hospital.....    [Though his physical diagnosis/treatment/prognosis may be so clear as to not have grounds for admission.  Hmmm - he probably should be on blood thinners, btw: is he?  But I am not a doc.]

(4) What’s wrong approach - we just tell him that we are there because we can tell something is going on with him but we are not sure what and try to talk to him until he admits that something is not right and decides on his own that he needs help. Unfortunately none of us are trained psychiatrists so I don't think this will work at all.

LB:  Again, meld it in w/ "mind not right."  And - we can tell "something isn't right"  OR "something seems to be bothering you"?   Hmmm -not liking this much.  BUT - don't worry about not being docs.....he probably won't offer ideas that common sense and your own concerns can't deal with.

(5) We love you approach - just tell him that we are concerned about his mental health, but we aren't there to force him into anything. We just want him to know that we love him and will support him no matter what. Tell him despite how much we love him, we feel his condition is preventing us from having the kind of relationship with him we would like, but if he is happy with the way the relationship is, we can leave it alone.

LB:  We are concerned about your HEALTH, leave out mental, leave out not going to force - defenses go up right there.  AND - is it true, for each of you, that his condition is preventing, etc.?  Don't know; just asking.  You, at least, love him unconditionally now.  You wish he weren't imperilling/imperiling himself, but YOU will love him regardless......   So this is really a non-confrontation that only semi-states the status quo, no?

M: Also, not sure it is relevant but we are from Texas (close to Houston) and the place we have found that we would like him to check himself into is http://www.intracare.org/.

LB: Talk w/ the hospital, if you have not, about this resistant patient, and about how how how.  E.g., IF he gets into a hosp for health reasons again, can there be some pre-arrangement for him to be seen in the med hosp by one of their staff???  Other ploys???

M: My dad is a loving and caring person.  ...I really can't stand the thought of not having him in my life.

LB:  NAMI.  Start at once.  They will help you bear the unbearable.  And/or - any GOOD counselor/therapist for yourself, soon, for 2 or 3 visits.  Or Google "grief," since you are grieving now.  There could be something appropriate in the metro area.   

NAMI will come to mean more to you than you can imagine.  Your terrible burdens will be lightened....   You will be in a place where EVERYONE in the room understands every word you say and all that you are feeling....   Look for an affiliate with a super family support group.

Do write again, if you wish:  if things change, good news, bad news, whatever.  Take care of yourself, for yourself.

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

QUESTION: Libby:

You won't believe this but we talked to dad this weekend and it actually went pretty well.

The 3 of us sat down with him and told him that for some time we had been very concerned about him. We kind of went over how we loved him more than anything and we would always loved him no matter what, but we didn't think he was the person he could be and that he needed to get back to being that person. We told him that we thought that we would like to all go see a psychiatrist together so we could talk about our concerns with each other.

My dad was very rational and completely understanding yesterday. He didn't come out and admit he has a problem.  He said that although he is perfectly okay other than just being tired and exhausted from his physical problems, that he would do anything we children wanted him to do. He told us we were the most important thing in his life and if we thought therapy would help us and him, he would be glad to do it.

Additionally, my dad agreed to allow me to look over all of his finances and even take control of his accounts if I thought it was necessary.

We brought up some of the things we were concerned about (gambling online, excessive purchasing) and of course he rationalized the behavior, so we just told him there were other concerns but we thought it best if we saved them for therapy, knowing we weren't going to "cure" him ourselves.

We know we still have a lot of work to do, but I think we are at a place now that we can talk openly about our concerns. I think it will be good to have a professional involved in the process as well. We plan on first each going indvidiually to talk about our concerns and then having dad go. Then maybe all do some group counseling (meaning kids and dad), with dad contiuning to do individual sessions.

Although I don't have any hopes that he will be magically cured, I think the counseling will do wonders for us being able to cope with his condition, and maybe dad will respond well to the treatment.

The one downer is we are pretty sure our step-mom is planning on asking our dad to leave the house tomorrow morning. We are worried that such a drastic change will offset our plans, but unfortunately in situations like this, people don't always have the same goals.

We also told our dad about our concern regarding his wife and he has responded that he is committed to sticking to our "plan" no matter what happens between he and his wife.

Anyway, I really wanted to tell you how much I appreciated your guidance. Without it, I don't think we would have had to confidence to go through with it.

Answer
In a hurry, but congratulations.

Thought he was OUT of house.  Stepmom still willing to pay for treatment?

You MUST have a professional involved.  Contact that psych hospital whose site you sent me, to get name.  Let the person, whomever, guide you about going singly in advance of dad, or the order/how this should happen.  Do not pick a name from the phone book.

Maybe get a durable power of atty, you, for your dad.

Do not get him involved w/ any health provider w/o having him sign a Release of Information, naming you and/or your sibs as the recipients of that info.  Each and every provider, in case his cooperation ceases.

Pls do get his the names of his physical disorders, and procede therefrom.

Again, congratulations.  You had many good plans before I arrived on the scene.   I rather suspect, as well, that your dad, as you mention, is pretty tired right now AND it may even be, as repeated anecdotal evidence shows, that some/many mental illnesses sort of mellow out at later ages....you may have inadvertantly chosen a very good time.

Maybe still find an atty via NAMI.org or NAMI-TX - s/he could draw up that durable power and be on deck as needed.