Need help dealing with a bipolar sibling

My brother was diagnosed with bipolar a few years ago after coming out of a year-long depression that he fell into after having to get open-heart surgery (at age 28) to correct a previously undiagnosed congenital heart defect. Prior to the surgery, he held an office job in the tech industry, saved money, and tended to be a sweet, well-tempered person. He did experience periods of depression but seemed to cope with it. His first manic episode involved delusions of grandiosity (e.g., trying to convince a former colleague to become a founding C-level officer at a startup idea he was working on with no business plan, hiring strangers to be his bodyguard, personal driver, and secretary), risk-seeking behavior (e.g., smoking marijuana with a vaporizer in an airplane restroom), reckless spending of his savings, alienating friends and family in favor of strangers whom he felt better understood him and didn’t judge him for behaving differently from how he had before, and not believing there was anything wrong with himself. Only after he’d hit bottom (financially and romantically) and swung back into a severe depression was he willing to see a psychiatrist and take lithium.

Even though he didn’t regularly see a psychiatrist since he doesn’t have health insurance, he continued taking lithium and seemed to be on the road to recovery and even started working part-time at the front desk of a friend’s small business. But one day a childhood classmate walked in and recognized him and asked him what he was doing there and not at [well-known tech company that shall remain unnamed], which likely shattered any sense of self-worth he had. Also, one of his friends (not a medical professional) told him that lithium isn’t good for the heart. And he found and had some magic brownies at another friend’s place. He quit taking lithium, is now back in a manic phase, claims that he’s in control, and wants to find his own way to manage it, not through conventional means. He saw an acupuncturist, and after two sessions, he claims that any pain he had is gone. When my parents asked if he wanted to see his psychiatrist and take prescribed medication, he refused. So they went to see his psychiatrist and asked what they should do, to which the doctor recommended sending my brother to an emergency psychiatric hospital to get a shot of anti-psychotic medication. But he had to be drugged and tricked into going since he would have none of that if he were sober. The hospital didn’t end up giving them a shot anyway because the doctor on duty claimed that he had been given too much anti-psychotic medication, and he refused to sign the paperwork to commit himself to the hospital for 2-4 weeks.

The only good thing that has come out of that nightmarish situation is he’s now willing to see his psychiatrist and take prescriptions, which he has been doing for the past few days. However, he is still very short-tempered and self-centered. My dad confiscated his wallet, so he doesn’t have access to his debit or credit cards, which he’s really ...... about and keeps trying to figure out ways to get it back or weaseling around it. He is unreceptive to anyone’s requests to calm down whenever he’s yelling, and he believes he is the ultimate expert of his own health and doesn’t feel like taking any sleep medication or get 7-9 hours of sleep a night. (He thinks that amount is what “normal people” need but not him.) In general, he doesn’t trust doctors who lack good communication skills. He is restless and doesn’t want to stay home, and although we tried accompanying him everywhere, we have been dragged into fatigue and can’t keep up. Interacting with him is exhausting since we never know what is going to set him off.

I don’t know if anyone has any advice to offer on how we can best help him. Should he get his wallet back now? Should he be free to roam the streets in the middle of the night? What else can we say or do? He is eager to move back out, do his own thing, and seek out (unproven) alternatives to bipolar medication. Are we just supposed to let him go and fall into another self-dug grave that we’ll end up having to claw him out of after he swings back into a depression?

[Stilltrying_]

It sounds like at least he is being compliant with medication right now. I guess it is questionable whether he is sectionable right now? It sounds like that could be the best thing as he is clearly delusional but if he isn't sectionable then there isn't much else you can do apart from my suggestion below . I'm not sure about giving his wallet back. Can he really be trusted with making any rational decisions at the moment? He is clearly unwell, though I'm not an expert on what's sectionable and what isn't but if he was then that would be easier on you as they can enforce treatment which will stabilise him. It obviously wouldn't be a good idea for him to neglect his medication which is why if this was to happen then maybe it would need to be enforced. Personally I would work as closely as possible with the people who are treating him and mention all of your concerns and all of the behaviour to them. Anyone else got any advice? X

[Hidden in reply to Stilltrying_]

Thanks, Stilltrying_! My family recently moved outside of the US, so I’m unfamiliar with the laws here. But I will talk to a local psychiatrist on Monday to see if there is an equivalent to the Mental Health Act. My brother came to visit us from the US without expecting any of the recent events to happen, but since my parents took away his passport, he is at least unable to easily flee the country. We hope he continues to be willing to see his psychiatrist and take medication. But he does seem to only be doing it to humor us.

[MAS_Nurse]

Hi Spiffytiffy and welcome to this caring forum. This must be a very difficult situation for you and your family. Your brother is now willing to see his psychiatrist and take prescribed medication. and this is a very encouraging step forward. Regarding the wallet, as Stilltrying has said, can he be trusted with making any rational decisions at this time? It would be a good idea to keep in close contact with the health professionals who are treating him. It does not sound as if he would be safe to go out alone. Again, discuss your concerns with his mental health team. I hope that things improve for you all. He should be more stable when his medication begins to take effect. You may find the pinned posts on the screen helpful and please stay on the forum to receive support from other members. Are any other forum members able to help Spiffyliffy, please?

[Hidden in reply to MAS_Nurse]

Thank you, MAS_Nurse! We are letting my brother believe he’s on some kind of police watchlist having had to call them to get him to walk into the emergency psychiatric hospital. I think that’s the only way I’ve been able to get him to agree not to go to a 24-hour poolhall that he was frequenting prior to hospitalization. I’ve scheduled an appointment for me to meet with his psychiatrist on Monday and hope he can offer more insight and guidance on how to handle my brother in his manic state. Currently, I don’t believe he can be trusted with access to money or have his own set of keys to our apartment.

[lin62-65ze]

Goodness me I really simpathise with you. Bi polar is difficult to handle and I personally have been on Lithium for over 20 years, I fully understand everything your brother has experienced, mine started with a manic episode, I was spending money, not sleeping fantasising etc. I ended up over 6 weeks in mental hospital, I was 35 years old with 3 children and husband. Since taking Lithium I have been fine. Coming back to the issues with your brother, I feel very concerned he is not seeing a Psychriastrist as they are professionals and can help him. However that said my 39 year old son is also bi polar, he was prescribed Depakote which has not suited him and made him almost suicidal. Bi polar can make the sufferer lie, pretend to others they are fine, delude themselves they do not need help etc. From what I have read he is very lucky to have you and parents who care. He really needs to take his Lithium regularly and see professionals, I appreciate that it is hard when you cannot force someone to do this as he himself cannot see what chaos he is causing. There are many young people in show business who are sufferers, they have also caused mayhem in their lives, I wonder if this could be pointed out to him, Stephen Fry has bi polar, Lily Allen, there is one who is in a group he is young and married, cannot think of his name. Please try to make sure he takes his medication, I do hope I have been of some help, most importantly DONT GIVE UP he will not be like this forever, love Helen xxx

[Stilltrying_]

This is very interesting about the Depakote Helen. I have a friend who is supposedly bi-polar. I say "supposedly" because I have not seen her in anything like a manic state but she is constantly extremely depressed, stressed and suicidal. We tend to think that the psychiatrists know what they are doing with meds but you are making me wonder whether or not changing her meds could help her. She isn't very assertive so would probably never question what she is given. I know she is on an injection but I don't know what; though I have also met another person who says she is on Depakote and also feels suicidal much of the time and has made suicide attempts. I have found myself feeling very close to this first lady I mentioned and it broke my heart when she recently attempted suicide. Thank God (for me) that she survived. ( she herself is unclear whether that is a good thing or not for her, having told me that she wished it had succeeded, which again virtually breaks me but at the same time I don't want her to lie).

I am going to (gently) try and find out what injection and what meds she is on and maybe offer to go along with her to the psychiatrist. She is married though and has children so really I have to be careful I am not getting too emotionally involved in a situation which is unsolvable. (She's constantly telling me that her husband is triggering her despair by various things he does or doesn't do). I've had to come to the conclusion that there are two sides to every story and that getting involved in marital disputes is probably not a good idea. I've tried talking to both sides but eventually they go back to their longterm patterns with each other which seem in some ways to create distance and negative emotions on both sides.

Anyway enough of my ramble. I am still really suffering the effects that her suicide attempt had on me ( I was ok at first, very strong, but just lately feel devastated and desperately worried she will try again and that I won't have a friend anymore; it happened about three weeks ago ). I have told her this and infact broke down the other day as I couldn't hold it together. I am taking time out and distracting myself which I think is the best thing to do for both of us whilst also having arranged to see her in a few days so she doesn't think I have deserted her which I wouldn't do.

When I feel stronger though I may ask her about her meds. She's been ill for a long time and doesn't seem to have been offered any sort of counselling or anything else after this attempt except for the crisis team visiting her. I guess that over the years many things may have been tried which I am not privvy to having only just met her in that last few months (she's been ill for at least 30 years).

Thanks anyway Helen for your input. Gemma XXXX