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?