Mental Health Blogs

What to Do if Someone with Bipolar Refuses Treatment

Bipolar disorder is a scary illness, but sometimes even scarier is the idea of treatment. Logically, going to the doctor, getting a diagnosis and getting help doesn’t sound scary, but if you’re the one faced with psychiatrists, personal, probing questions, destroying what you know and treatments that might make you feel worse before you feel better, you might find the concept daunting.

But what do you do if you’re a loved one of a person with bipolar (or another mental illness) who is refusing treatment?

Why Do People Refuse Treatment?

People refuse treatment for many reasons. As I mentioned, one of them is fear of treatment and fear of the unknown but there are other reasons too, such as:

  • Fear of doctors
  • Lack of trust or belief in medical treatment
  • Fear of side effects
  • No wanting to lose the mania of bipolar disorder
  • Fear of labeling and stigma

What’s a Loved One to Do?

And sometimes, when faced with this wall of reasons not to get treatment, it can seem absolutely hopeless to get the person to see reason. But here’s the thing, this wall of reasons basically comes down to only one thing: fear. And bipolar education creates knowledge and that knowledge dispels fear.

Knowledge of Bipolar Treatment Makes Things Less Scary

So my best advice is to take a very logical approach with a loved one and deal with each fear one at a time. Sit down and ask the person why they are refusing treatment. Only he or she knows for sure, so make sure you at least understand his perspective as it’s absolutely real and valid.

And then start dealing with the fear. If the person is afraid of doctors, this is perfectly reasonable. You can help by researching what will happen in the appointment ahead of time. You can help by researching doctors in the area and finding the best one. You can help by facilitating and going to the appointment. You can help by supporting the patient’s wishes during the appointment. Doctors absolutely can be scary but what a patient really needs is someone on his side so that he doesn’t feel “out-gunned” by someone in a position of authority.

If the fear is lack of trust or faith in medical treatment, this is understandable too. Then it’s time to do research on treatments and find success stories for the person to read.

In short, calm, rational conversation can often pinpoint exactly why a person is refusing help and doing some research on your part can help assuage whatever fear the patient may have.

But What if They Still Refuse Treatment?

Okay, but what if you’ve done all that and the person still refuses treatment?

Well then you might want to remind them of what the problems are and what treatment can do. People only need help for a mental illness once the mental illness becomes a problem in their lives like when a person loses a job, or does poorly in school, or destroys relationships and so on. It’s then that help is needed and so it’s entirely appropriate to remind the person of these problems and talk about how something needs to be done to address them. And if not treatment, then what? Does the person want to live without being able to work? Does he not want personal relationships? Does he want to flunk out of school? Probably not. And treatment is the way to address all these issues.

And if you do all that and you’re supportive and your try your best and the person still refuses to budge, then you need to respect his opinion. I know it’s hard to hear when you love someone, but unless the person is a minor or unless he’s a danger to himself or others, the person absolutely has the right to refuse treatment. We’re adults. We get to make choices and then live with the ramifications thereof, even if our loved ones disagree.

(And once that choice is made, you, as a loved one, have your own choices to make, many of which can be very hard, but that will have to wait for another article.)

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

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16 Responses to What to Do if Someone with Bipolar Refuses Treatment

  1. Maria Gostrey says:

    Thank you for your beautiful blog. I just discovered it and the timing of this post is, for me, uncanny. I am an old friend and 3-year partner of a man who has been diagnosed at least three times with BP and he has been hospitalized three times over the past few decades. I entered into a relationship with him fully aware of his medical history and also aware of the fact that he had stopped taking medication a few years earlier and was instead deeply involved with meditation. What I did not entirely understand was that he believes that his diagnoses were incorrect and there is no behavior health problem at all. The proof for him is that he has not had a psychotic episode since stopping medication and has not required hospitalization. I am not a psychologist, but I can see plainly that his behaviors and habits of thinking are sometimes, well, “crazy,” as you say. My own course of therapy led me to confront my denial about his illness: I wanted to believe that he is well even as it’s plain to me that a behavioral health issue is involved. I decided that I cannot live in denial. I explained to my partner that I love him as he is, I fell in love with him knowing of his history, I accept him as he is (unable to work, but usually occupied in a healthy way), and I am not asking that he seek treatment—that is totally up to him; I did, however, insist that we give the elephant in the room a name. This conversation went surprisingly well, and while he wouldn’t accept BP, he did allow that there might be a behavioral health issue. This, for me, was an unexpected and amazing step forward. What followed were, for me, the best few weeks of our relationship. It felt like we finally had some genuine trust. Now, about a month later, he says he was just playing along with me to make me happy, that there’s nothing wrong with him, and the problem arises from my need to “create crises” to feel better about myself and “control everything” and that I am abusive and incapable of genuine intimacy and that this is just more evidence that I do not love him. (Not surprisingly, I was observing the little cues that indicate he’s headed for a not-so-healthy phase in the days leading up to this reversal.) So if there’s a question in all of this it’s this: how can a partner be supportive and accepting in a situation of total denial? I have drawn a line and made clear that I will not remain in the relationship if it’s based on denying the fact of his mental illness, and the breakup seems to be happening, though he has gone away for a few days to rest before figuring out where he’ll go.

  2. I’ve heard it said that mania feels good. So why get treated? Likewise, it feels real. It feels like you really are master of the universe, versus someone unable to recognize you are ill. So my guess is people with mania don’t want to get treated, cuz they don’t want to lose the high and because they don’t believe the high is an illness.

    Depressive stage is more traditional reasons to refuse treatment. Belief you’ll get over it on own; too depressed to get treatment; don’t want a life on meds; and the reasons you mentioned.

    The best advice I’ve heard is Xavier Amadors’ “Listen, Empathize, Agree, and partner.

  3. Maria Gostrey says:

    Thank you, MIPO. I read about LEAP a couple of years ago, when I first broached the topic of his behavioral health history and my request that he resume treatment, or at least seek a consultation (after our first year together). That met with anger and vehement denial that there had ever been an underlying MI and the problem was actually mine. While I never accepted this , I decided to take the slow approach, believing that if I could at least listen and empathize, perhaps we could develop a partnership and some tactics for dealing with episodes of compulsive shopping, self-medicating, breakdowns at social events, etc. This was the approach I took for the next two years. It’s not working, and I believe this is because we cannot move forward with the LEAP approach if we don’t agree that there is an underlying MI. I have always said that whether to seek treatment and what sort is entirely his decision, but that I can no longer be complicit in his total denial that there is an underlying MI. Problems that arise from his MI are always attributed to external circumstances or are dismissed as “everyone does this/feels this way”. I have come to the conclusion that unless he can acknowledge that there is some sort of behavioral health issue in play, there is really no possibility of a healthy role for me in his life, because the role he wants me to play is as someone who will support his belief that he is just fine. That, to me, seems actually more harmful than healthy.

  4. cindyaka says:

    Twenty years ago I went into a severe depression and saw a social worker/counselor who suggested I see a psychiatrist, I was 35, and flat out refused.The idea that I needed a psychiatrist was frightening, even though I knew that feeling and acting like a yo-yo since my teens was not normal. My son’s friend’s mother was on lithium and the side effects scared the daylights out of me. So for years my family endured Dr.Jekyll and and Mrs.Hyde. I went into another severe depression, the meds didn’t, and a nurse practioner suggested I see a psychiatrist. This time I listened, and the Pdoc prescribed Lamictal,Abilify,and Seroquel.I often lament all the years lost to bipolar and the denial that anything was wrong. I believe that the biggest step is to accept that something is amiss and seek help.

  5. ASHOK KUMAR CHOUDHARY says:

    Thank you Natasha for your Blogs on Bipolar disorder.I am a Bipolar,inspite of my best effort i could not tolerate quitipine so i gave up at my own.

  6. Randall says:

    yes I have leared
    do not take end up In the mental hospital so now I take my meds and go to counseling and stay halfway sane I think bean in the hosp for not taking meds or the meds stop working right about 7 or 8 times after awhile you lose track .

  7. Jane Haldane says:

    @Maria Gostrey
    Thank you Maria for your post. I agree with everything you write and feel the same.

  8. I’m married 2 1/2 years now to a bipolar. It’s so hard to keep it together. He’s refusing to take his meds. He took them for a month and stopped. I can’t talk to him about anything. He spends money like it grows on trees. He accuses me of things I haven’t done; and gets out of control with accusing. I sometimes think of leaving, but feel I need to be here for him. That as well as I love him. We have good days and bad. The bad is always my fault for some reason. I just don’t know what to do. Eggshells is an understatement.

  9. Julia says:

    Kathryn,
    Couples therapy with someone who knows and understands bipolar disorder (likely a psychologist is often the best bet here, but it doesn’t have to be).

    If you can’t get him to go, at least go for yourself–for your own sanity. You’ll at least have a sounding board, but more importantly you’ll be able to gain some perspective and skill as to how you can handle those difficult situations that are so hurtful.

    Good luck!

  10. Susan says:

    My son is bipolar and is now in jail for his actions being off the medicine. I am visiting him in jail and see that he is still manic. The court system is a long process and I have to be patient. My question is if he never gets treatment again and remains in this state can he become schizophrenic or worse and have to be institutionalizaed? I worry that he may never accept the medicine again.

  11. Natasha Tracy says:

    Hi Susan,

    I don’t believe there is any evidence to suggest that a person can go from bipolar to schizophrenia due to a prolonged manic episode. Like, what will happen (in my non-medical opinion, I am not a doctor) is that he will cycle down on his own as bipolar disorder is a cyclical illness. However, when I say cycle down, that will likely be into a depression. If that happens, he may more readily accept medical intervention.

    - Natasha

  12. Paul says:

    I understand the concept expressed in this blog but it sacrifices the complete perspective. In the example of a spouse accusing a partner and the constant blame it must be mentioned that this is abuse. It is not ok and if a person communicates this it must be responded to. The major challenge with bipolar is that they can not communicate in a rational way. If a bipolar person were thinking rationally they would not refuse treatment. The fear of doctors is a common one. It is rational thought that gets us to get treatment. Would a bipolar person refuse treatment for a broken limb or cardiac emergency? It is the same mechanism. The mental health industry is the only one that waits for a problem to present acute symptoms that often are a result of a loss of quality of life. A sane and rational conversation may not be possible. I would argue that a life partner is not a caregiver. The difference is an order of magnitude. I honestly feel that those with bipolar have it hard enough. The same probing questions that keeps a bipolar from getting treatment are exponentially more difficult coming from a loved one. Medication alone is useless. Anti depressants with mood stabalyzers are not effective together as much as they are alone. Medication can also stop being effective as soon as 8 weeks and they may take months to be helpful again. Treatment should be the entire spectrum. Start with therapy. Ask about support groups and if your loved one wont go for them they will go for you. They need proof. Not words and at the end of the day we must all work harder to remove the stigma and we need the medical community to work much harder to restore trust. These fear excuses can be resolved by everyone. A diagnosis of bipolar is hard enough and they should not be forced to face the stigmas and terrible medical treatment when they are not responsible and frankly they have enough work to do. I am disabled and I find more and more that I am my own advocate and I have to educate people on basic respect in that I am different, not less than. I imagine people who are bipolar feel the same. Treatment is everything and anything can be treatment. It is important for a loved one to maintain positive health just as it is important for a bipolar person to keep trying. Just my opinion. I’ve been married to a rapid cycling bipolar woman for 6 years. She can be difficult but of anyone else she knows I just want to have an ordinary life and I do not want to be some inspiration story, neither does she. I just know I would never stop trying to get my wife help. Whatever it took. I won’t wait for an emergency crisis to get her help. I won’t quit no matter what.

  13. mark says:

    This condition requires a higher power of intervention. So, I have noticed that when my wife does pray for about 30mins or so that it helps her to get through the day. One day at a time. She is bipolar and it does feel like I live with two polar bears that are going to eat me at any time. God help us! I do love her and that is the only thing that keeps us together. Amen!

  14. Chris says:

    When I was a little kid, around 8 or 9. I was diagnosed Bipolar. I was put on meds and everything, but I stopped taking them when I was around 11 when I realized they where deadening my personality. I was no longer energetic and happy, and was always apathetic and tired. If that was my REAL personality, it disgusts me. So I stopped taking my medication. I’ve been fine not getting treatment for close to a decade now, I can socialize and function and while my manic episodes makes people think I’m a little eccentric and my depressive ones make people shy to be around me, I have a huge circle of friends and an active sex life. To all my fellow Bipolar sufferers, the only help you need is self discipline, practice meditation, take up hobbies to occupy your mania, and read and listen to music or other stimuli when you’re depressive. There’s no need for pills!

  15. Ashley says:

    Hi, thank you for this post but unfortunately it has not helped. I am a 21 year old with a three year old son and a supportive husband. I have a mother that is diagnosed with bipolar mania disorder. But I have reasons to question that diagnosis because I feel that she is schizophrenic. She has no motivation to do anything. She sits around all day and does not take care of herself in a hygienic way and she does not eat properly because she says she is fasting for God for prosperity. Keep in mind that she has been fasting for 2+ years. She will sometimes break her fast and becomes very distraught and start screaming and cussing God and the devil. She talks to herself like she is talking to God and the devil and then replies to herself as if she is someone else. She will not do ANYTHING because God tells her not to. She will not clean herself regularly and has been wearing the same set of clothes for months. I believe that she does this because she has no energy to do anything for herself unless her family talks her into it. She was receiving SSI and I was her payee and I had to take on the burden of taking care of all her finances. I also had to deal with her getting angry and thinking that the bank was stealing her money when in reality she was spending it and forgetting about it. I used to get so stressed because I felt like I was spending all my time in taking care of her and me and my husband would fight because I had no time to take care of me and my family. I don’t know what to do because she absolutely will not take her medication or go to her counseling sessions. She says God doesn’t want her to and he has delivered her from her medication. You said that the main reason they don’t take their medication is because of fear but I don’t think that is her case. I have talked to her about taking her medication but then she gets mad and gets in a fight with God and the devil again. She has been admitted twice to a mental hospital and just recently our family has ran out of options in trying to help her. So we went to the courthouse and tried to get her admitted to a hospital again but the authorities took her to the hospital here in town and she knew how to pass the mental evaluation and she did and they discharged her. It’s like she knows how to turn off her condition to make it look like there is nothing wrong with her. She was living with my grandma in an apartment and my grandma was living off of housing. They found out my mom was living with my grandma and cancelled my grandmas housing so now they are living with my uncle which is my moms brother. There have been several incidences where the cops have been called on her for her screaming and violence. She has been aggressive with her own family and also towards neighbors. So because of that the cops have been called on her. She has also been aggressive towards me before. I had to call the cops for her to leave my house because she was trying to be physically violent. My uncle can’t handle the way she acts and this causes them to fight so it is not healthy for her to live there and I have no room at my house and I cannot have her around my kid especially when she does not take her medication. I am stuck at a crossroads with her and I don’t know what to do anymore! I love her and want her back to her normal self but how can I help someone that doesn’t want it? We were helping her look for a house for a while but her expectations in a house were so unrealistic that even the realtors could not help her. For a while she said that God was going to give her a mansion so she did not have to spend her money on a house. And by the way, I am no longer her payee for SSI because she got an inheritance from her father because he passed away. She was going to spend some of that money on a house but her out there delusions have gotten in the way of that. She also tells us she has an aneurism and we have had her checked out and the doctors said she does not have one. We have looked for houses but none of them were fit for her because she was expecting to have a super nice 4-5 bedroom house for only $80,000. That is unrealistic. She does not qualify for a home loan so she would have to pay it all off up front. When it comes down to paying it she tells me that she doesn’t have to pay it all at once because that is not how buying a house works. I have explained to her time and time again that in order to only make payments towards the house is through a loan or contract and she does not qualify for either one. She does not want to help herself because God said for her not to take her medications and without them she is having angry outbursts almost on a daily basis. When we try to get her admitted she passes the mental evaluation because she knows how to answer the questions just right so she doesn’t seem like there is something wrong with her. And when she goes into the hospitals for her mental health she gets out in no time because she plays it off like there is nothing going on with her. I don’t know what to do! This is one bad situation with her and I have completely ran out of options. I am the only one that can take care of her and make sure her finances are taken care of but it is too much for me. And I feel like there is nothing more for me to do for her but I can’t stand to see her suffer the way she is. I need help and guidance and resources. I feel like she needs a caregiver but its too much for me to handle. Please help me or if you can guide me in the right direction in how I can help her or who I can contact to get her the help she needs I would much appreciate it! Thank you so much for taking the time to read this. Please help me! I am desperate!

    Sincerely,
    Ashley

  16. Jill says:

    Hello Ashley and I’m so sorry to hear you are going through what I want to thank you for sharing. I question the symptoms your mother is having as well as you do. Innoway they don’t sound like bipolar but in fact schizophrenia. She would need to have that diagnosed I know how hard this is for you and the family to go through and see this happening to her while she seems to spiral out of control. This not only affects hard but you and the rest of the family as well. My son was diagnosed with bipolar disorder a few years ago and was on medication it was very effective for him but he decided to wean himself off about a year ago. He has been having the cyclic behaviors and is now in a manic stage. What is happening is the more he cycles the worse the episodes are getting. Right now he is going through a manic episode which is the longest and the worst I have seen since he stopped taking his medication. His actions are becoming more distractive his driving is becoming erratic and his actions are becoming erratic as well . He is usually very close to me to my family but over the past 48 hours he is distancing himself and basically telling us especially me, his mother, to back off leave him alone and let him live his own life. I know the difficulty of this because if we actually back off we don’t know what’s in store for them. They are not only spiraling out of control themselves but bringing us with them. All I could say is to try to speak to someone and maybe have an intervention with her but I would get a counselor to attend as well someone who could mediate the meeting. Good luck to you and I pray that everything works out you will find some peace.

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