Expert: Libby Bonner - 6/7/2009

Question
My son is now 26, he was diagnosed with bi polar years ago, he thinks it's not true as he says they diagnose everyone with it,so he is not on medications. He drinks way too much and every few months he goes out of control,like blacks out and destroys cars, property,houses,scares his girlfriends(he never hurts them)then hates his life,wants to kill himself,then passes out and wakes up remorseful,hating himself,but won't accept that he nedds help, or that alcohol is poison to him(he's already on blood thinners as his drinking caused him arythmia and he almost died) he won't let us help,plus he's 1500 miles away now,what can we do,should we do?? desperate mom

Answer
These are terrible situations when the person at least is in literal reach of his family.  Once 1500 miles intervenes, the situation pretty much defies solution by family.

I wonder what sort of help of yours he has refused.

I'm also interested in his spectacular pattern of behavior.  It is very common for bipolars to "self-medicate" w/ alc or drugs in order not to feel so bad, but I wonder if in this case we aren't seeing alcoholism as the primary disorder.

There are a couple keys to whether you can help at all.  One is whether he has signed Release of Information forms for his major docs naming you or your husband as the person/s then given permission to actually talk to anyone treating him. [Need to be re-signed each calendar year.]  Without that, you have no access to the docs themselves, but only what he tells you about his appts, which is likely to be at least somewhat different from what was actually said -- not lies, just faulty recall, or didn't think it was important, etc.

I do wonder, re his arryhthmia, whether he adheres to his blood thinner treatment and gets his pro-times checked as orderd.  He does or doesn't yet have a pacemaker?  It occurs to me that a non-psychiatric person, like a cardiologist or general surgeon, would not present the same enormous unbreachable privacy as p-med docs do?  Wonder if they would open up to you....though I'm not sure where that gets you. You do seem to have pretty good facts on this, so maybe good contacts have been established w/ those docs already w/o benefit of signed Releases.

The other thing I would check would be treatmentadvocacycenter.org for a discussion of "involuntary outpatient treatment," and a summary of the status of IOT in each state.  However, were the laws where he is ideal for your purposes, someone has to bring this case to the local court's attention.    And now we are in an area of committals, guardianships,about which I wish I knew more.  -- This book does cover it, though its recommended methodolgy might not be its main use to you, though it could provide a better notion of where he is coming from.  Its use to you may be in laying out ways that the legal system can be brought to bear on this.  Author is Amador.  Title is I am not sick, I don't need help.  Buy it, but ONLY the later edition...maybe 2005, or so.

Amador again, though.....might help you open this dialog w/ him:  "what do you want from your life and what would you do to attain it?"  Amador uses a case like this to get someone into treatment, his reasoning being "forget illness, forget arguing endlessly Yes/No relative to is there illness present, and let the patient open up to you:  'what to you want??' "

Ultimately, you are going to need an atty where you are and one where he is....

Meanwhile, get involved w/ a NAMI affiliate near you, hopefully one that has regular meetings but also a support group for families.  You can locate any affiliate and any state NAMI office via nami.org.  Perhaps you will find it helpful to contact the state NAMI office where he is; they might now of laws peculiar to that state that would help; they might know attys.  NAMI's biggest help to you will be your contacts locally w/ others  in difficult situations, and ways that some have solved them.  It feels good to be at NAMI meetings, because people there understand your story, and you can tell your story w/o mincing words.  IF [your]understanding of his behavior is an issue -  remember, he is irrational - pls consider taking NAMI's free 12-week class Family to Family, taught by trained family members. You will learn a lot that will be very freeing, as well as perhaps finding one or more special couples for extra support.

Do remember in all your contacts w/ him that he is ill. Don't waste your time w/ persuasive argment; he is irrational and that sort of approach just wears everyone out.

Don't bother to reply unless you wish, but he and the criminal justice folks have never crossed paths??  He would seem to be liable for a great deal of "destruction" leading to criminal or civial suits, not all of which he surely has won?  But of coure warning him of that likelihood, if it has yet to occur, will just be so much more wasted breath.

I wish you luck.