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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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My29-yr old brother was diagnosed with bipolar depression

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My29-yr old brother was diagnosed with bipolar depression several years ago. It seems to be that yearly, he suffers from a deep depression resulting from quitting medication. He feels he needs to defy the system, despises his condition and can't understand why he can't be "normal". He is currently in this state and I fear he may be suicidal. He is giving away his belongings, extremely negative and sleeps for days at a time. When I plead for him to get psychiatric help he snaps and refuses to pay (he has no health insurance) for a visit. I've offered to pay, he still refuses. He feels as though there is nothing that can help him. I am deeply concerned and need advice. I want to help him. How do I go by doing this? I'm usually the person he trusts most and confides in, but I feel as though I can not get through this time. PLEASE HELP
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 6 years ago.

Hi. I believe I can be of help with this issue.

First, let me say I can imagine how frustrating and worrisome this situation must be for you. You are clearly a loving and caring sister and he's very fortunate to have you. My answer is going to focus at first on you, though, instead of him. Why?

Because I'm concerned about you getting used up emotionally over this. Your brother is going through something very difficult and it could indeed have tragic consequences. And if he does commit suicide you will be heartbroken. Yes, depression is a very selfish disorder. The sufferer is totally self-focused and not considering what his actions will do to loved ones. But that you will be grief stricken if the unlikely unthinkable does happen is NOT a reason for you to let this dominate your actions. You need to make the good efforts you are making. But if he does not choose to respond, then you've done what you can and you need to continue with making your own life. Okay?

This is very important. You may indeed already know this, but I wanted to make sure that you have my support in this: you can't own his recovery. He has to find his way to his health. In the same way, you can't own his disease. It's his. You need to lead a healthy life.

And so my first recommendation is also going to be a bit in terms of your needs as well as his, though mostly how to help him. Because Bipolar Disorder (BD) is a very tenacious disorder. and I want to to borrow a tool and technique from the world of schizophrenia to guide here in this situation that BD has him in.

BD and Schizophrenia share one thing that is important in our discussion: treatment resistance. With BD, the people I've worked with find that they are so used to their extremes that they imagine it to be normal. Being depressed is normal and the meds take the only relief they know from it: the manic or hypomanic phase. And part of the disorder is often resistance to living that "shallow" and "flat" life of the meds.

So he is being held hostage here by his disorder. I would like to recommend to you the work of Dr. Xavier Amador. I think that in this area of treatment resistance he has been invaluable to all of us working with schizophrenia and treatment resistant BD. Now a caveat: he works with schizophrenia and I'm adapting it here for BD. Okay? I believe the dynamics are exactly the same, so keep in mind, when you get his books from the library or store, he'll be talking about schizophrenia.

I know some people don't go for his style, but I have found it very valuable and I think you will see its value as well. His whole approach is to find the way to make treatment a win-win situation. Because for your brother, treatment is always going to be only for others' sakes: family, doctors, etc. Not for himself. The meds probably cause whole sorts of side effects he doesn't like.

So this approach can help you very much. Here are his two most known books:

I am Not Sick, I Don't Need Help. This is the book that made Dr. Amador famous. It details a bit the story of his brother, who will remind of you of your brother probably in some aspects even though he has BD.

The other book is I'm Right You're Wrong, Now what? Break the Impasse and Get What You Need.

So, read it and digest the idea and then see if you can use the approach to help your brother.

I want to strongly recommend you find a psychologist or psychotherapist who works with BD and is experienced with the concept of MANAGEMENT of the moods and the swings. And someone who can counsel you on how to deal with your brother. So it needs to be someone that YOU relate to and feel confidence with; someone smart.

In my practice, I use the resources with people with BD from Mary Ellen Copeland. I have found her work easy for people to use and easy to keep with him . The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). First let me cite one of her books for you.

The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon:

Now here's a YouTube search I've put together on the WRAP program. I want you to look at the videos and see what you think. I'm hoping he'll be willing to look at them and it may spur him to take some action:

The video with Mary Ellen is a bit strong but worthwhile. Okay, so you see I hope my point here for him: if you can get him to agree as a rule of life to go at least once a week to the psychologist and the psychologist can slowly sell him on a management plan like WRAP, you have a chance of getting him to stabilization. This is not asking him to take meds yet. So he might be willing. You will need to have at least one session with this person and assess both their smarts, sensitivity, and competency. You are clearly a very intelligent person. Make sure it's someone you think can be your partner in helping him.

If he doesn't have income, he should qualify for Medicaid in your state. You can then look for psychologists accepting Medicaid. Problem: Medicaid doesn't pay that much so finding someone who fits the bill may be tough. Here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful look at the listing and see if they list BD or mood disorders as something they work with and perhaps if they accept a sliding fee.

Good Therapy is a non profit directory. Same idea as the one above:

I wish you the very best!

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