I have a good friend who has been diagnosed as “bipolar with delusions.” He is in his mid-twenties. He has always been the type that everything seems to come together for - he’s very good looking, funny, charismatic, musical, athletic, etc. He had so much promise. It is pretty heartbreaking for his family and his friends. When he is in his manic phase, his particular delusions have a religious aspect to them. For example, he will yell at his father – who loves him dearly and is a good father – saying that his father has an evil spirit or something. He has done some seriously bizarre and frightening things, such as pulling a knife on his brother on one occasion and leaving a knife on the pillow of someone else with a note saying that he could have killed the person. He stole a car recently, bought groceries and went to Starbucks, and then returned the car. The stories go on…he has been committed twice. He insists that he does not need medication and that he is simply “in the spirit” during these phases. He has seen a therapist who tries to help people who don’t want to take medications. She suggests particular vitamins and such. If he is eating right, sleeping, and taking the vitamins, he can avoid slipping into mania for quite awhile. However, it’s really no solution as his family never knows when he might become very delusional. He obviously needs medication but insists he doesn’t. Anyone have any experience with encouraging someone to take medication? I’ve tried to talk to him, explained to him how that I initially resisted antidepressants and did not believe I needed them, but now you can try to pry them from my cold dead fingers, etc; and I know others have tried to…seems hopeless.
You why he doesn’t think he needs meds, but you haven’t said anything about why he personally doesn’t want to take them.
I assume he hasn’t seen an MD or got a script for any, but it is more than possible there’ll be a drug that won’t give him whatever bad effects he’s worried about.
Have you talked to his psychiatrist about what legal options you have? In some locales, if someone shows dangerous behavior during their mental illness they can be ordered by the court to comply with treatment for a certain period of time (beyond just having them hospitalized for a period of time). Unfortunately there are many situations where a person is so mentally ill they can’t see that they need help and that is the only way to get them to comply.
Another possibility would be to ask his doctor if being on a long term injectable medication might help, if you think there is any chance that he would be more willing to do that. In some cases people are better able to comply with getting an injection of medication every few weeks rather than take a pill every day.
So, out of curiosity, what’s he like in his depressive phase? Suicidal tendencies?
A classic issue with bipolars seems to be giving up the manias. They say that they don’t feel alive if they aren’t experiencing them.
It’s difficult to convince another to give up a part of themselves like this. He may become more receptive to the idea as he gets older.
Sorry to hear of his troubles. 
You’re right, I didn’t. He does not want to take them because he does not think he needs them. And perhaps what I said below about them taking away his closeness with God - that’s a guess. He will say something like “I know that is some people, but that’s just not me. I just don’t need that.” Then he might give an example of someone in history or in the Bible that everyone did not believe in but they were right…so in other words all of us are tripping and he is the only one who really knows the truth. I am very good friends with his sister and we have discussed how that he is the WORST person to get this because long before he was diagnosed he was 1) very very stubborn and 2) when convinced that he is right (which is relatively frequently) will not listen to reason. Add to that the delusions he as as well as the natural tendency of people to resist medication for mental illness, and it is impossible to convince him. He will quote verses like this: Acts 4:19 “But Peter and John answered and said unto them, Whether it be right in the sight of God to hearken unto you more than unto God, judge ye.” If indeed God were telling him that he did not need medication, then I would say, God’s right. Unfortunately, I do not believe God is telling him that, I believe he and his disorder are telling him that. He has seen MDs and he has been medicated when committed, but other than that I don’t know if he’s ever taken any. I know he does not like the side effects (who would).
I believe his family has and I understood it was not an option last I heard, but I don’t know. Certainly seems to be a danger to others at times. I’m two states away from him currently so it’s harder for me to be as involved.
I really like this idea in the sense that if we could convince him once or twice to have the injections, maybe he would get somewhat more into his right mind as a result, and then we could talk to him about all the crazy stuff he has done and maybe he would see reason? I don’t know. I am going to ask about this.
Haha- his sister and I have laughed (so we don’t cry) that at least one bright side of his high opinion of himself is that he is not suicidal and does not seem to show any signs of same. I know things can change. I think he does a lot of nothing though – sleeps a lot – but I’m not sure. I usually get more updates when he’s manic and doing bizarre/scary things.
I have heard that about the manias. I believe it is likely that he would say that he gets very close to God and is in the spirit and so why would he take something that would take that away or something. I suppose I can google this part, but I have heard that sometimes if a person who is delusional goes unmedicated for years, at some point they cannot be helped by medication because the delusional pathways are already burned into their brain (or whatever – please translate that into something that makes sense medically). I suspect there are variables that influence this…but that would certainly be unfortunate if he came to the place where he’d be willing to and it was too late. Thanks and thanks everyone for the replies so far.
“He insists that he does not need medication and that he is simply “in the spirit” during these phases.”
This is a quote from the OP. I know **[/tesseractB] addressed this post already and said she didn’t say why he refused to take the meds, but she did in fact say why in the OP.
I have also heard this, and in my experience it has some merit. My bipolar sister went unmedicated for over 10 years, and when she did decide to start managing her illness properly, it took 5 or 6 more years for her to become stable.
BUT, she did finally do it, and now she’s had a decent job with a state agency for seven years, owns a home (with her husband) and does fairly well for herself. So, hope is not lost for your friend, IMO.
When he is taking his meds and is lucid, is he aware of what he’s like when he doesn’t take his meds? Does he understand that he becomes delusional and threatening when he’s “in the spirit” or is he denying these things occur?
If you can’t get him committed long-term, my advice would be to take this seriously and prosecute him for any crimes he commits, including things like “menacing”.
Yes, I’m sure he’s a good kid. Yes, I know that prison won’t cure him. Yes, I know this is awful for his family. But people with delusions, mania, and a conviction of their own righteousness can and have caused real harm to numerous families. Having a criminal record might give the family leverage to have him transferred to a medical institution and possibly prevent him from really hurting someone.
I have no experience with anyone with mania, but I’m curious. Does it help to speak about the mania as a high, as an internally produced drug that a person is addicted to and that needs to be blocked? Perhaps saying that, because he loves God, he interprets the high as closeness to God, when that’s not what it really is? That would deny the mania while not denying him a closeness to God.
I wouldn’t expect it to have an immediate effect, but it might begin to redefine the situation. You could talk about worrying that the mania is cutting him off from a real connection with God by substituting a more pleasing illusion. Aaaaand now I’m starting to think of phrases like - harlots wear bright colors and wear heady perfume to confound the senses. Which probably doesn’t fit the situation at all, so I’d better stop.
Is he a member of a specific church? Has anyone from the church tried to convince him?
See Marcia Angell’s two part review in the NYR of Books this summer and then tell me why you want him to take meds. Let me summarize her arguments as briefly as possible. Before that I should state that she is certainly not some new age flake; she used to be editor-in-chief of the New England Journal of Medicine.
There is no real evidence of effectiveness: Although double blind trials show a bit better outcomes over placebos, there is no significant improvement if you compare them to non-psycho-active drugs that are strong enough to have side-effects. These trials cannot be double blind if the patient can know or guess (even incorrectly) whether he is a control).
They cause possibly permanent changes in the brain and not for the better. For example the reaction to serotonin reuptake inhibitors is that the neurons simultaneously start to emit less serotonin and the synapses become less sensitive to it. It is not clear whether these changes are reversible and, in any case, recovery from the drugs would be like detoxification from narcotics.
Bottom line: most people improve with or without drugs.
I don’t understand what this section means. Anyone can guess correctly or incorrectly whether or not they are a control. Furthermore, even placebos have side effects.
(I tried Googling for the article in question but came up with too many hits, and it’s hard to navigate on the smartphone ATM.)
I’ve heard the ‘indistinguishable from placebo’ charge leveled against certain forms of unipolar depression meds, but not so much for bipolar disorder. A friend, after going on meds, stopped believing that there was a plot against her by the government, her husband, and other conspirators. Meanwhile, my unmedicated bipolar father-in-law “only” took about 25 years to stop beating his kids during his manic-aggressive phases, but has continued with the verbal attacks to this day.
I’m wagering that in the OP’s case, they’d prefer he not threaten people’s lives and shrug off any confrontation about those incidents, and that’s why they’d like him to try the meds instead. Even if family and friends are too kind-hearted to press charges, I suspect he’ll soon threaten a stranger who will be less sympathetic.
Would it be possible to unobtrusively set up video cameras (legally), record his aberrant behavior and then stage an intervention with close family members and friends he values to tell him he needs to take his meds? It might be that he only remembers the good parts of his delusions and doesn’t take heed of his dangerous behavior. Maybe seeing the troubling behaviors could shock him into compliance.
This may help. I have clients who need medication for mental stability. I work with their families to insure that they take their medication by manipulating their religious beliefs,. Usually, this works by convincing that the taking of the medicine is a special commandment to them by whatever they believe in or that the medication has been blessed for their protection against whatever their spiritual enemies are. Since my kind of spiritual advising is informal and not a regulated health care service, their clinical health care providers simply turn a blind eye because anything that gets them to take their medicine is better than them not taking their medicine.
He won’t get help until he wants to. Usually, your life has to hit bottom in some way first.
Your friend puts me in mind of a friend of mine, who finally got medicated at age 26 and is doing incredibly well now. He was extremely delusional for most of his life; it took a divorce after an 8-year-long relationship, alcoholism, dropping out of college with only a thesis left, multiple family interventions, and no job or prospects for him to admit that he needed to change his approach.
I don’t even pretend to be a doctor or wear white, but I do think you are wrong here.
I’ve known Tony for 7 years. His brain is broken. He is better when he takes his meds, but he marches to a drifferent drummer and his personal drummer has a broken drumstick and takes LSD just to wake up on the morning.
Tony keeps getting worse. The reason I was looking at this thread is to hopefully get suggestions as to how I can get him to take his meds because if things don’t change, Tony is going to climb up a clock tower.
To the OP, I have no suggestions. Mental illness sucks. My friend stops taking his meds because they make him “foggy” and distracted. Its probably the mania that other posters have mentioned.
My friend doesn’t have God, he has a government parania. Before I had to bail him out of jail the last time, he seemed to be better if he smoked pot, but now he’s sure that if he gets pulled over he will get a pee test, he’ll go back to jail for drug use. This is also a reason to not take his meds, he doesn’t want to go to jail because he forgot to carry a copy of his scripts in his wallet.
Have you tried asking a priest to ask him for you? It’s a stupid suggestion but it might work
Lots of responses and thoughts, thanks. Really busy so will just address a few things. I really like the idea of the harlots in bright colors (seriously, that is the kind of thing that might resonate with him) and the idea that his mania is an addiction, like a drug, that brings about an illusion to God that is keeping him from true closeness with God. Which I actually believe is true. It might take three years for it to sink in, but it is something to start with that might actually gain some traction in his broken brain. Whoever this New England Journal of Medicine person is, she has not met the same people I’ve met. I know, anecdotal, etc. etc.; but I don’t think it’s true at all that most people improve with or without drugs. Also, the generally-indicated or primary medication for bipolar people is not SSRIs…
He doesn’t even really have “meds.” He has only taken medications the two times he’s been committed. I think inside the hospital they are more concerned with doping people up for safety and patient management, not long-term med management or doing the hard work of determining the right cocktail (which is tricky even with an extremely compliant patient).
He does not think that what he has done is that serious, I think, or he thinks it was justified by God so it is not only not serious but the right thing to have done. Video cameras is an interesting idea. For example, that he was running down the street in his hospital gown and nothing else when he escaped from the regular hospital for the second time, and the cops had to capture him, after which he was put into the mental hospital again last time?
Finally, we have had our ministers talk to him (and help him out of situations) many times and it has not helped. So far. He respects them but believes his revelation is stronger than theirs I think.
I think the idea of hitting bottom is misunderstood. All it really means is that whatever event caused a person to turn their life around was their own personal bottom because that’s the point where they started rising back up from. For some people, it’s yelling at their spouse; for others, it’s waking up with a dead hooker - whatever makes you realize you have a problem. But people shouldn’t use the idea of “hitting bottom” as a way of not admitting they have a problem. They shouldn’t be thinking that they don’t need to stop because the worst hasn’t happened yet.