Expert: Ivan Goldberg, M.D. - 5/26/2010

Question
QUESTION: Our daughter (31 years old)and was found to be bi-polar over a year ago and  now takes 23 different pills, plus lots of nerve pills and pain pills when she can talk various ERs into giving them to her. She has no up side/ no down side just cussing mad at the world all the time. She smokes 2-3 packs of cigs a day(her counselor said we are to continue to support her and not to ask her to stop smoking. She smokes in bed and falls asleep and countless times I have gone down stairs and found her couch, blankets smolder. I told her counselor the idea of being burned a live in a house fire scares me and he said well don't worry you're still here aren't you?. Being around cig smoke gives me dreadful migraines and thus the no smoke in the house rule/PLUS THE SAFETY ISSUSE- and to make matters  worse her counselor says unable to work her  AND I need to support her and buy her cigs. (and just take an aspirin for the headache)Some how this is too insane...
also she drinks 24 or more cokes a day and in all of this if I don't pay to get her nails and hair done, buy the current new make-up,etc I am not showing I want her to get well. Her counselor and she said I caused her to be bi-polar because I made her graduate from high school and won't buy her a car of her own. She has totaled three of my cars while drink drunk and NO I will not let her touch my current car. Not matter what her counselor says-maybe he SHOULD buy her a car?)
I am still paying high insurance rates from these 'little mishaps' and he calls them)
She is on probation( IN TWO DIFFERENT STATES) which her counselor says I must pay for) AND IN ALL OF THIS she can't be held accountable since she is bi-polar. What do I do?

ANSWER: Hi, Mamaie . . .

It sounds as if your daughter needs a reevaluation and probably a new therapist. It is impossible to successfully treat someone properly diagnosed with bipolar disorder if they abuse caffeine. For a therapist to blame the parents for their child's bipolar disorder is not a professional thing for a therapist to do. Bipolar disorder is the result of both biological and psycho-social factors . . . blaming you ignores the biological factors that were at work in causing your daughter's illness.

Being mad all th time is typical of some people with bipolar disorder. It is actually called dysphoric mania and is often seen in people who are out of control with regard to their drinking, drugging, driving, and spending.

If I had a patient who behaved as you describe your daughter, I would refuse to treat such a patient outside of a hospital, as only in a controlled environment can such a patient's behavior be controlled.

I think it would be wise to have her reevaluated by one of the physicians listed at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Things are getting worse and her pshcharist is now giving her rx for sleeping pills(she says 'her shrink' has said whatever she  says or does when taking these pills she can not be held accountable for) and xanaxs among the other drugs from the zillion other doctors she can con out of pain meds- her verbal abuse has become DREADFUL-she is mean, hateful and  becoming very cruel-she said if I loved her I would kill myself to get out of her way since I am the one who made her bi-polar because I made her graduate from high school and wouldn't allow illegal drugs in my home(same old blame for the last 12 years). I fear one day this family will make the news- after she has killed us -we sleep with the bedroom door locked-but that offers little protection. where do turn?
I have left several DETAILED/FRANTIC messages for her phscharist-who has refused to talk with me since our daughter has said she will  not allow  us to do so- and then he in turn has shared the nature of my confidental messages with her which only fuels her hatred-  If I had the money I would more than gladly get her her own place-but I can not offord this. I fear we are doomed.

Answer
Hi Mamaie . . .

it sounds as it the situation not has legal as well as medical aspects to it. I think you should send a certified letter...return receipt requested to you daughter's psychiatrist informing him of what is going on.

I also think you have to talk to a lawyer about what mechanism there maybe in your state to force someone into treatment./

Unfortunately I can think of nothing else to suggest.

Best regards . . .

Ivan
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