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My Son's Bi-Polar


rs422a

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Greetings:

Well where to begin. My 24 year old son was hospitalized in February this year from overdose of Lortab after break-up with a girl. He was referred to a treatment hospital near where we live (United States) where he spent a week in detox for addiction to pain pills. He was diagnosed with BP. When he got out we tried to be very understanding , caring, and loving. But he refused to do what he was supposed to do like group therapy. We did make sure he took his meds. He was up and down all year but holding. Then last Monday after a stressful family get-together, he became very paranoid and started making statements about killing people, including -sad to say- his own family. I took him to a psychiatrist (not his regular one) and she suggested hospitalization again. He has been in since Tuesday. His case worker called yesterday and said they had changed his meds to Depakote with Klonipin and Serquel (sorry about spellings if wrong) and says he might can come home Monday.

There is much more background but too much for here. My main question is this: How do we continue to deal with this? One, he has no mental health insurance so I have to burden the cost 3000-6000 dollars a week. Two, there is no guidance for us parents and siblings and we don't know if we are doing right or wrong. I know this a lifetime problem (I don't think he believes it is), and we will do whatever we can do for him.

Please I'd love to hear some of your thoughts. Especially from those with BP.

Thank you

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Hi rs.

welcome to the forum, I hope that you can find some support here.

I have bipolor type 2 and PTSD. I was diagnosed in 2003, of course I had symptoms long before that. I have rapid cycles, so therepists and docs would miss it and treat me for depression. It took a long time to figure out what meds worked best for me, everyone is different. for me its Lamictal, lithium and currently on zyprexa, don't know yet if pdoc is going to put me back on seroquel or not or keep me on litium, so you see even now my meds or being "tweeked" a bit.

As for how to deal with him, I don't have a very good answer other than trying to be patient and make sure he is safe and that your family is too. As for the cost for meds, have you talked to pdoc or someone to see if he is eligible SSDI and or check with NAMI to see if they can help with gettin medications for him.

I don't know if this is of any support to you or not. You need to take care of yourself as well, you could look and see if there is some sort of support group you can go to. Its important to have support.

take care, I wish the best for you.

Shannon

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Thanks Shannon. Yes his meds have been tweeked several times since Feb. At one point in August his doc suggested he may respond to ADD meds for focus and attention. This was a severe mistake. He couldn't handle the speed at all. Shaking all the time, trouble eating, starting drinking beer to come down off it. The doc pulled the dosage back to lowest but my son couldn't pull out of the spiral it had set up. Don't know why the doc didn't just take him off it completely. I am his Dad and he seems to really only trust me. He loves his Mom but will not discuss things openly with her. Don't know why really as I was hardest on him growing up. My son is unable to work right now and we will take care of him. I can't wait for him to come home so he can be with us again.

Mental health care in the states is horrible. The only alternative is indigent care and those places (here in the states) are pretty bad. Thanks for sharing with me.

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oh and we are going to see if he can go on SSDI. Not familiar with NAMI. But I'm going to have to get help from somewhere financially after this. I've probably spent over 12 grand on him this year. I'm out of money. Not that money matters but you know what I mean.

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Hello rs,

It's tough. I have a child who went through some difficult times as well -- they were later diagnosed with bipolar/schizoaffective. Their initial experience was fueled by a combination of stressors: the breakdown of a significant (romantic) relationship, some emotional trauma, sleep deprivation, lots of marijuana to wash it all down.

We did about two years of mania, some psychosis, a few suicide attempts, an arrest, some severe depression, four hospitals and probably somewhere in the range of $25,000 in associated costs. It's not easy but it's now a few years later and my child is now doing quite well -- well enough that their psychiatrist is no longer certain their diagnosis was appropriate. They are working (part-time) with plans to return to secondary forms of education that were disrupted when all this began. They have partnered with someone who is very good for them, have moved out, and are engaged to be married.

In terms of your own situation is sounds as if this is a very pressing need that must be relieved: he has no mental health insurance so I have to burden the cost 3000-6000 dollars a week.

Some possibilities for you to consider...

- This link may be helpful: Free or low-cost medications provided by pharmaceutical companies

- If you have medical insurance through your workplace it's possible you can have your son added as a dependant.

- It's possible you may be eligible for some form of re-imbursement from a government agency or tax credit.

- There may be other programs available that will cover the cost of your son's medications. I would urge you to follow up on this as soon as you can as I wouldn't expect there would be any retroactive assistance offered. I know if we were having to put out that kind of money on a weekly basis our entire family would soon be homeless.

- You could explore generic brands of medications.

- You could explore non-pharmaceutical methods of treatment. These are seldom free either but they may be less expensive. I have heard of some people having enormous success with various vitamin therapies in conjunction with other therapies such as psychological counselling, mindfulness meditation, etc.

I see that as being very critical since the financial burden of the situation is likely adding mountains of stress to everyone's plate.

There, that's one post. More coming up.

~ Namaste

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This is some "standard" advice I tend to share with people who are in recovery or caring for people who are. Please excuse the "packageness" of it.

Support Teams are comprised of people you find helpful and should include: Professionals; Family and Friends; Peers, and; Mentors. Each member of your team can address unique needs.

  • Professionals provide medical and psychotherapeutic care and may include psychiatrists, psychologists, counselors, social workers, therapists, general practioners, nurses, nutritionists, massage therapists, etc.

  • Family and Friends provide connection, meaning, purpose and are often in a unique position to provide vital feedback. For example, if you are taking a new medication your family will be very much aware if it is working for you. Or if you are beginning to slip into a depressive, manic or psychotic episode, they may well become aware of it before you do.

  • Peers are especially important because, in my experience, they can often provide the best forms of emotional support and understanding -- they have been there; they have walked in your shoes; they know what it's like. Many people look to their family and friends to offer peer support but these people may lack the insight that shared experience can offer. They can also be so intimately involved and deeply impacted by your experience that they lack the ability to provide impartial support and may, in fact, require their own support team. The latter will be especially true for those who are in a position of primary caretaker.

  • Mentors serve in a unique capacity because these are the people who inspire you to reach for your best. Mentors can be drawn from any other area of your support team (i.e. a family member can be a mentor) but more likely, they will be drawn from the larger world around you. It's not necessary that any chosen mentors also carry a diagnosis of any kind of mental illness; rather, they simply need to have been another human being who faced some enormous challenges and either overcame them or turned them to his/her advantage. If your support team does not have at least a few mentors on it, your team is lacking. One point worth emphasizing is that Mentors must be self-chosen. It's also worth noting that they needn't be alive; some of my mentors have included Helen Keller, Viktor Frankl and my own mother -- all of whom are dead.

Support Toolboxes are made up of things you (and members of your Support Team) recognize as beneficial and helpful. Support toolboxes can be quite unique because what we find helpful on an individual basis may vary considerably. They may include things such as education, exercise, medication, meditation, music, nutritional therapies, spiritual practices, personal journaling, etc.

A strong Support Team and a well-equipped Support Toolbox greatly increases the odds that if you're floundering in any capacity, you'll be able to find the person or thing that is most going to help take you forward. So, choose your team wisely and outfit your toolbox with care.

The following are also some helpful links for understanding medications you or your loved one may be making use of. I often recommend that people make use of both medically oriented sites and consumer oriented sites. One will give you the professional spiel, the other will provide valuable insights from other individuals who actually have personal experience with that particular medication.

Resources for researching the drugs your loved one has been prescribed. All of the links below are free and should not be construed as medical advice. Research is a starting point only. If you are concerned about a medication, research it, highlight your concerns and bring them to the attention of your medical provider.

- rxlist.com: This site is medically oriented with detailed reports.

- drugs.com: Medically oriented site. Reports are not as detailed as rxlist.

- askapatient.com: Consumer-oriented site with consumer ratings and comments.

- Drug Interaction Checker: Allows you to search for drug interactions you should be aware of.

- Reclaiming Your Power During Medication Visits with your Psychiatrist: A handout prepared by diagnosed schizophrenic and clinical psychologist, Patricia Deegan.

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I do know what you mean about the money, I take care of my mother who has progressive MS and she is spending so much of her retirement for medical supplies, transportation and in homecare, because she has an income much of her needs she pays out of pocket, but she is home where she is happy

Some meds you can just stop cold turkey, they have to ease off gradually. And yes, Mental Health care isn't the best. But there are very good therepists, counselors, and support groups it just takes some shopping to find the right one.

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The following is also a cut and paste from elsewhere. I share it because it can be useful to understand that diagnoses are based upon symptoms. If or as symptoms change, so too does the diagnosis. Don't be surprised if your son's "label" does the slippery-slidey thing -- it's common. I mention as much because it wouldn't surprise me if your son's doctors came back with a label of schizoaffective at this point. What may be more helpful to focus on is symptoms. When it comes to "severe" forms of mental illness, we're usually only talking about three or four symptoms. I define them thusly...

Depression = A deflated ego state

Mania = An inflated ego state

Psychosis = A fragmented or collapsed ego state

People who experience bipolar may shift back and forth between a deflated (depressed) ego state and an inflated (manic) ego state. Some people are naturally inclined to spend more time on the manic side of the equation and others, on the depressed side. It's very difficult for them to find equilibrium between these two states, rather, they are pulled back and forth from one extreme to the other. These shifts can occur rapidly or they can occur very slowly. Psychosis can occur at the far ends of either state.

The hallmark characteristic of mania is greatness. If delusional thinking is present it will be related to how much everyone else loves them, how clever, talented, beautiful, worthy and fantastic they are -- this is what makes them superior to everyone else.

The hallmark characteristic of depression on the other hand, is unworthiness; they are not great, they are small, insignificant, worthless, ugly, forlorn, it's all their fault. This can also be a form of delusional thinking but it runs to the other side of grandiosity. Notice however how in both states, the sense of self is still present and very much preoccupied with one's own deflated or inflated value and self-worth.

In psychosis however, the boundaries break down between self and other; people cannot tell where they end and the other begins; they can no longer differentiate between the internal world and the external world. We may still see deflation and inflation but it will be shattered into pieces and muddied into a bewildering mix.

In their communications with others, people who are manic can be incredibly lucid. It may be very difficult for anyone who doesn't know them well to recognize that they are not "themselves". Because it's such an energetic state, they may be admired for their zanyness, zest, or lack of inhibition. People who are depressed however have energy levels that are very low. They are tearful, apologetic, lacklustre. Others may interpret their actions as signs of neediness, lazyness or lack of self-will. They may be described as 'draining'. People who are psychotic are clearly in a different state. They may express themselves metaphorically and be preoccupied with symbols, myth, religious figures, aliens, etc.

When people are in a psychotic or depressed state they often become quiet and withdrawn. Depression and psychosis take a person inward; mania takes a person outward. When people are in a manic state, that seems to come with a strong need and desire to interact and engage with the larger world. Overt sexuality can also be part of manic states. It's been my experience that people who are experiencing mania are most inclined to stop taking medication because they feel good. In fact, they feel FANTASTIC and if not fantastic, angry and superior. They are not open to other people suggesting they may need help or may benefit from reining themselves in.

People in manic states may benefit from some form of -- ideally, non-invasive -- containment whereas people in psychotic states are often so frightened and confused, they won't go anywhere, do anything, or interact with others. Psychosis and depression can be very damaging to the individual's sense of self but they have their own containment properties as an inherent structure of that particular ego state. Mania on the other hand can be very damaging to the individual's social identity and relationships with others including family, spouses, friends, employers, etc. as a result of the lack of containment.

Mania and psychosis also produce different reactions in the people who are on the outside, looking in. With mania, what you may see is anger, betrayal, hurt (for themselves), confusion and a stronger desire to move away from the individual in crisis as a means of protecting themselves. With psychosis, you see a different kind of confusion, more concern for the individual in crisis, a stronger desire to help in some manner, to get closer.

With psychosis, social connections are often cut or minimized by the individual in crisis; with mania, those same connections are cut by the people in their wider social circle, not the individual in crisis. However, the person who is manic may cut social connections with people they feel are judgemental or controlling -- quite often, this includes family members.

Manic states can go on for several weeks, even months. Mania can be triggered by pharmaceutical drug use (anti-depressants are known to trigger manic episodes), recreational drug use (i.e., cannabis, ecstacy) and one's own innate response to life's challenges, thrills and stressors.

Manic episodes are often followed by depressive episodes. During this phase, the person draws that energy back inward and becomes tearful, despondent, despairing and highly self-critical. This is the phase in the cycle where they may be most open to seeking professional care because they feel so awful. What they'll lack is the energy or will to actually get themselves from the couch to the doctor's. However, if you'll make the appointment, come over early, cajole them to get dressed and brush their hair, and then, actually take them to the doctor's office -- they might go.

Being able to differentiate between the different states can be helpful because it gives us some insight into what is happening for that particular individual.

-- spiritual emergency

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Hi welcome to the forum...

I have bipolar and PTSD. I was diagnosed almost 5 yrs ago when I crashed into major depression after a very successful and happy life. I see the burden it puts on the family especially my husband and kids.

After finally accepting the diagnosis, and that is the first step to wellness, I finally began to help myself. The struggle of frustration of it and what it is doing to my family is very conflicting. So just that he haves you is wonderful and there are 2 paths to take. Helping him and letting him go. That will depend on how he feels. You will not help him if he doesnt want help but helping him find that place is also support.

I would try and have a family meeting with the social worker before he leaves the hospital. lay the cards out and see how he deals with his new responsiblities and expectations. At least it is done in a place where he is safe and has support. Do you have a follow up psychiatrist and therapist as outpatient? Also there is IOP(intensive outpatient) and PHP(partial hospital program) for when he leaves the hospital. This will give him some supportive follow through when he is out of the hospital.

Yes support groups like NAMI(national assoc mental illness) and DBSA(depression bipolar support alliance) are very resourceful especially for services and help in your local area, you can google them with your town and see what meetings are near you. They will be very supportive for you and him. I believe Nami has a family support group as well so family members can go for a support group as well.

I also have an autistic 14 yr old son, so I understand the parent child relationship of a child having a mental illness. And it's not easy no matter what.

I hope this helps and keep us posted :)

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shanrucus: Some meds you can just stop cold turkey, they have to ease off gradually.

Yes. It's my understanding that psychiatric drugs should never be stopped abruptly except in life-threatening situations such as neuroleptic malignant syndrome. Reduction or withdrawal should ideally be supervised by a medical caregiver over a sustained period of time. With each reduction, time should be allowed to adjust to the lower dose. If the individual is able to stabilize, another small reduction can be attempted after a period of time. If they do not function well at the lower dose they can return to the last dose they were at that assisted daily function.

In case you weren't aware of it, rs, the medications your child is taking are categorized as:

Seroquel: Anti-psychotic

Depakote: Anti-convulsant used off-label as a mood stabilizer

Clonidine: Like Depakote, this blood pressure medication is also used, off-label, as a form of mood-stabilizer.

You should be aware that all of these drugs come with significant risks. I would strongly encourage you to educate yourself on what they are so you can be alert to indications that your child should not be making use of them. I know that's often distressing news to caregivers. We would prefer that there are easy, risk-free answers. It doesn't seem to work that way.

My child is currently making use of Depakote and Seroquel. I would prefer that they not be on any medications at all but they identify them as helpful to them and for that reason, they make use of them. I also recognize that they are finding some benefit in these medications although they did also gain more than 50 pounds which puts them at risk for diabetes.

They do know they have our support if they wish to withdraw. For now, they are on the lowest dose possible to maintain stability. What this dose is will depend on the individual, their environment and their ability to cope with the mundane stress and challenges of life. We hope that they can withdraw from the Seroquel at minimum at some point in the future. Given that they have experienced seizures in the past, the Depakote may be necessary over the longer term.

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Linda: After finally accepting the diagnosis, and that is the first step to wellness, I finally began to help myself.

People have different responses to the diagnostic label. My own child was quite relieved to be told they had "bipolar disorder" as it helped provide a framework that explained their sometimes erratic behavior to them. I, on the other hand, have not cared much for labels and am well aware that they can do that slippery thing anyway.

Nonetheless, I do agree that no one begins to recover until they make the decision to do so. I don't think it's necessary that they accept anyone else's label but it does seem to be necessary that they accept that their life is not going the way they had envisioned and want it to go -- they do need to accept that they need help.

I also firmly believe that one of the most essential starting points is hope. This is why I am so opposed to people being told they cannot recover and this is also why I identify Mentors as such an essential component of an individual's support team.

A second component that is so very vital is knowing that there are always other options. If you get a crappy psychiatrist the first time out, there are always other psychiatrists. If the form of treatment you are using doesn't seem to be helping, there are always other forms of treatment. If something's not helping, try something else. Beneficial treatment always produces beneficial results.

Admittedly, I know of few people who have had success the first time out. By the time people have been at it for a few years however they often have a far greater understanding of themselves and what is truly beneficial for them. The difficult part is figuring out who belongs on your support team and what belongs in your support toolbox.

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Yes SE I agree that finding the right help is essential. I left my therapsit whom I have seen for almost 2 yrs and after feeling stuck and frustrated because I needed "more", more push and more information from her, so I decided to find a "trauma specialist". The whole idea was scary and since it is uncharted waters it can be very stressful. But I was in the right frame of mind to finally pursue exactly what was a trauma specialist and what exactly qualifies them as such.

So after much research I found someone and the switch is a little hard but I am doing it and I can see already in only a month or so how much of a difference she has made with me and how her expertise in the field is so different then a "therapist"

So yes we all need to keep moving sometimes it feels 1 step forward 2 steps back but it is what it is... :)

And as in other posts, I also believe that when we can and are able to, we need to find the right people to be in our support group. Sometimes it is hard because it may not always be the people we want it to be and sometimes support and understanding come from the least expected places...

Also rs422a, have you tried maybe a pastor or someone in the church to help. Sometimes the support is not necessarily with someone who is educated in the mental health field, it can be someone who is willing to understand.

I'm not sure exactly where you live but I know for me here in NJ, I travel almost an hour for my psychiatrist and it is well worth it for me. And as long as I am willing, so is my family willing to drive and deal with my pdoc appt and therapy 3 times a week. So sacrifices are new and the routine will change but finding that good basic foundation of help is essential for the wellness of everyone... Good Luck :)

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Some more information for you rs -- take it or leave it as you see fit.

rs: My 24 year old son was hospitalized in February this year from overdose of Lortab...

Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates—codeine and thebaine. Hydrocodone is an orally active narcotic analgesic (pain reliever) and antitussive (cough suppressant). It is commonly available in tablet, capsule, and syrup form, and is often compounded with other, generally less effective non-opioid compounds such as paracetamol (also known as acetaminophen) or ibuprofen, often added to both discourage recreational use (as paracetamol can cause potentially fatal liver toxicity at high doses), and to provide a possible synergy of analgesic effects between hydrocodone and the non-opioid compounds present. However, the effectiveness and safety of hydrocodone compound products versus hydrocodone-only products remains a highly debated issue. ...

... Hydrocodone and compounds containing it are marketed, in varying forms, under a number of trademarks, including Vicodin, Hydrococet, Symtan, Anexsia, Damason-P, Dicodid, Hycodan (or generically Hydromet), Hycomine, Hycet, Lorcet, Lortab, Norco, Novahistex, Hydrovo, Duodin, Kolikodol, Orthoxycol, Panacet, Zydone, Mercodinone, Synkonin, Norgan, Xodol and Hydrokon.

Recreational use and dependency

Due to its opiate-related side effects such as euphoria, sedation and somnolence, hydrocodone is now one of the most common recreational prescription drugs in America, along with oxycodone. Recreational hydrocodone use is particularly prevalent among teenagers and young adults because of the drug's widespread availability.

Source: Wikipedia - Hydrocone

What caught my eye about that was the reference to a cough syrup and recreational drug use. There are some young people who do use cough syrup for recreational reasons, particularly those with DMT (dextromethorphan). In some individuals, this can trigger a drug-induced psychotic episode.

I'm not suggesting your son was making use of Lortab recreationally. Rather, I merely wanted to point out that if, in his initial hospitalization, he appeared to be experiencing psychotic or manic states, it may have been drug-induced and not a naturally occurring state at all.

If that was the case then it might be more reasonable to conclude that your son was distressed by his breakup with the girl and made a suicide attempt. That's a different sort of situation than bipolar disorder and one that might require a different approach in terms of treatment.

One of the difficulties we faced with our own child was they continued to use cannabis after it was established it was triggering manic episodes in them. They began to experiment with it when they went away to university and soon discovered they could get their hands on some, typically within 15 minutes of a well-placed phone call. We did attempt to educate their circle of friends and cautioned them that they shouldn't provide any to them but this went over about as well as a lecture on Sex, Drugs and Rock n' Roll in the late 60's.

In the end, our child discovered the hard way that in spite of what it did for their friends, it was not producing any benefit in their life. Their fiancee was also very explicit in that regard -- they told them they absolutely will not stay with them if they use drugs. This had far more impact on them than anything we had said to date.

See also: Dextromethorphan-Induced Psychosis

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I read all the posts last night and I thank you all. I have a few questions. My son may be released tomorrow from the hospital. However, my wife and I feel that we need to set some boundaries with my son. Until we see some sort of improvement we are hesitant to allow use of his car. We are concerned that a few of his "friends" are involved in drug use, and we can't go back to that again. My son does not have a job at present so we have to basically pay his bills for him. Which includes car payment and insurance.

So, shouldn't we be able to set some rules and allow him to earn back his privileges in exchange for doing what the doctor and his therapist says? How do you go about telling him in a way he understands is not confrontational? I have these questions because I don't know how he will be when we pick him up. So I feel I need to be prepared.

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Hi Rs422

well I can relate to that because at 49, I am carless. Not for drug use but for my safety with dissociative episodes including cycling into depression with suicide ideations. I am so obsessed sometimes with just not having the car that I actually have made copies of keys, found the hidden keys,hot wired it, called tripple and attempted to rent a car.

So my therapsit was just talking about that with me on how something will be set up for checks and balances and earning the privelage so I dont make my family even more afraid and that I am safe.

It was hard at first, I saw it as control from my husband which literally sends me into crazy land in of itself, but then I realized it was for my protection after the last place I went while driving I must have cycled down, found a real hidden place to park and contemplate whatever and then my car wouldnt start. So it involved everyone in "rescuing" me... Not good....

But I have 2 kids in their 20's and I can see the dilemma of the house rules and boundaries. Thats why I said you really need to discuss this at the hospital BEFORE he gets released. He just might prove with his reaction, he is not ready to face the real world rules that you will be enforcing and prove that he needs to stay a little longer rather then have him come home back to life that will only make his hospital stay seem useless...

But, if he understands and is willing to accept soem rules especially since he lives with you and he realizes that you are trying to help not hinder his social life then yes I would definately try to set some good boundaries that he must adhere to.

I hope my situation can at least shed a little light on your situation... good luck and let us know how you make out :)

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Hello rs,

Yes, I do think it's reasonable to set boundaries and make rules. We did, at one point in time, pull driving privileges away from our own child. This wasn't a punitive action -- they kept having accidents and it wasn't their vehicle. We didn't want them to get hurt, we didn't want anyone else to get hurt and we didn't want us to get hurt either.

Until we see some sort of improvement we are hesitant to allow use of his car.

I think this is where you have to be careful -- in the expectation that is linked to the action. As Linda notes, there is likely to be some sensitivity on your son's part and no matter how you present it, he may resist and resent your control. If we're being honest, we have to admit that we are attempting to impose control, even if we're doing it for "good reasons".

I would suggest that you check your intents and motivations so you can be certain of them. Try to be aware of any places where there is resentment, anger or the desire for punitive action within yourself because this can distort our intent and we can't afford to have our relationships with our children undergoing any more stress than is necessary.

We are concerned that a few of his "friends" are involved in drug use, and we can't go back to that again.

Is this what motivates you to take the car away? Are you hoping to limit your son's social interactions with his friends as a means of cutting off or reducing his access to recreational drugs? If this is the motive, ask yourself if taking the car away will truly accomplish your aims. If you live out in the country somewhere, miles from civilization, it might. If you're in the city... there's probably several other transportation modes he can make use of so your action may be pointless and only lead to a confrontation that doesn't really gain you any ground.

My essential point is, choose your battles wisely and do so while being alert to where their "emotional space" might be.

- If they are in a depressive stage, they will be more likely to accept your rule but feel hurt by it -- they don't have the energy to argue but they may feel the pain of not being trusted, of feeling they are a burden to their family, of feeling that the people they most need to love them are instead, angry and disappointed in them. They're going to internalize. When you pass the rule, try to give them a hug and reassure them that you love them.

If they are in a manic phase it may not be enough to say, "You can't drive the car anymore." You will need to take the keys and put them in a place where he can't access them. You may need to do that with all the keys because you and your wife will need to sleep sometime whereas he won't have that same need. What's more, he may be given to impulsiveness -- taking the car while you're sleeping might not only seem like a reasonable idea, it might seem like a fantastic idea! I took to sleeping in only small spurts during these phases and whenever possible, my husband and I would sleep in separate shifts.

Because our own child was naturally given to spend more time on the manic side of the equation we also, at a certain point, invested in a solid lock for our closet door. Car keys, alcohol, medications, credit cards, cash... these went behind the locked door. It set a boundary, not an impenetrable one but one they painfully or reluctantly respected.

During this period in our child's life, I also stopped working. We did so because initially, we thought we were dealing with a short term crisis. As it went on, we continued to do so because they needed someone to be with them -- whether it was to encourage them when they were depressed, accompany them through psychosis, or run madly after them when they were manic. They needed us. If that is not an option you can do, try to find other means of putting a care team together to cover off the periods when you or your wife are not available.

A few other ideas that may prove helpful:

- DO, as much as possible, remain on good terms with everyone in their social circle. You want to keep the lines of communication open. Be honest, be respectful.

- DO ensure they have a cell phone. This can be especially helpful during manic stages. At one point, our own child headed into the mountains wearing nothing more than light clothing. A cell phone effectively works as a GPS tracking device that the police can access.

- DON'T treat this as if it is a forever kind of thing. It may not be and your son may need to hear that. My own area of knowledge in this regard is related to schizophrenia/psychosis and recovery. I am aware of many people who have made full recoveries from schizophrenia; I know a few folks with bipolar who have done the same. Your son needs to have hope that this is not the end of the world, he can still have a good, productive and fulfilling life and he may not have to take medications forever. The phase of producing stability is a challenging one but for most people, it is only a phase -- it will pass. You and your wife need to remind yourself of the same.

- DO take time to love each other. Enjoy the moments when the times are good. Laugh as you can. Cry as you need to. Try to channel anger effectively. Forgive yourself if you screw up once in a while and blow a gasket.

- DO find people you can talk to. An online forum can be good because we don't know you, we don't know your wife, we don't know your son. You may be able to talk more freely to strangers about your own needs and feelings than you can with friends or family members who have a relationship with your family. This can help to reduce some of those blown gasket moments.

- DO keep in mind that good things can come from enormously challenging times. The marriage my husband and I have now is better than the one we had before this happened with our child; the relationship I have with my child is stronger, cemented -- we have been through hell and back, together. We are better people for it.

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Thanks very much. Yeah the car thing bothers me. I'm not trying to punish him per se' but with him excess freedom means trouble. Sometimes he doesn't come home until 2 AM, then goes about making food in the kitchen and waking us up. I've mentioned this to him but he doesn't seem to care. I know that some of the things he does makes you think he doesn't care when he doesn't mean to - if that makes sense. He has very few friends that he hangs out with and most of them do some sort of drug. Again, I'm afraid he will eventually succumb to the temptation. We live on a farm so we do have guns. Since he made threats Monday indicating his desire to "shoot people" (which is why he is in the hospital) I am putting all weapons in the gun safe and installing extra locks today. In the past he has respected firearms but now...not so sure. So no guns period.

The cell phone. Well last weekend while he was manic he lost his second 400 dollar iPhone. The first went missing last year before his overdose. Of course, he is almost OCD when it comes to texting. he stays on it continuously. So when I spoke with him last night the first thing he says is how he wants a new phone. He can't afford another iPhone and neither can I because God only knows what the bill will be at the hospital. So I guess we will have to work that out. But I know he is lost without it.

My wife does not work, and I work from home based business, so there will always be someone here to watch him and to talk. But to be quite honest, I really don't trust him right now. I spoke with him last night and don't sense a big change at least over the phone. Still feel he is in a manic stage. We haven't been able to time his rhythm on his stages because they are so erratic. My wife's niece is BP and her phases come and go every 5 months. But she is 34 and learning to cope. My son though is all over the place. Who knows? Tonight he may crash and be docile as a lamb.

Thanks for being here for us. I am showing my wife the posts and she is reading along too. I appreciate it.

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Hi Rs, yes I understand the coming and going and when they are that age, they really should have a place of their own. My 20 yr old works different hours of night and day and although my house is large and he is on the other side, he doesnt wake us up but we know he is up way too late. So I am dealing with those growing pains of rules and boundaries with him.

I also think something is going on with my son as well, he details his car at all hours of the night so I see the OCD stuff too. And hey they are adults but they need to be responsible enough to either appreciate the gift of living at home or they need to move out. Simple, he threatens sometimes when he is frustrated by saying he will join the military and you know, that might be a good life learned lesson of growing up... :)

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rs: Thanks very much. Yeah the car thing bothers me. I'm not trying to punish him per se' but with him excess freedom means trouble. Sometimes he doesn't come home until 2 AM, then goes about making food in the kitchen and waking us up.

I suppose you will have to determine for yourself if these are inconveniences you can tolerate or if they are situations that must be addressed. Maybe you could come to an agreement that he has to be home by 11:00. Maybe his mom can make him a sandwich and put it in the fridge on the nights he goes out. Those are just suggestions of course but it does go back to that point about choosing our battles.

He has very few friends that he hangs out with and most of them do some sort of drug. Again, I'm afraid he will eventually succumb to the temptation.

It's very common in that age group and it's difficult to try and address. Our own approach has been that whether it's pharamaceutical or recreational, it's a drug. Some drugs help, some drugs harm and the only way to know the difference is to observe carefully. Once it was established that cannabis played a significant role in their manic episodes we set a rule: No marijuana. What we didn't say however was, "If you smoke again, you're out!" We knew that kids who end up on the streets are at a significant disadvantage for risk and recovery. So, the consequences did not entail losing their family or their home. They did involve some anguished moments, a sense of betrayal, anger, some blown gaskets, a drug counselor. We did the things we had to do but what we couldn't do was make them change. They had to make that choice for themselves and it took tripping up several times before they did, along with the risk that they might lose their chosen partner.

We live on a farm so we do have guns. Since he made threats Monday indicating his desire to "shoot people" (which is why he is in the hospital) I am putting all weapons in the gun safe and installing extra locks today. In the past he has respected firearms but now...not so sure. So no guns period.

I have a friend -- a writer -- who once said to me, "If you introduce a gun in Act I, you have to use it by Act III." I would suggest that you take your gun safe to a trusted friend's home. A lock is only a barrier, not a guarantee. Meantime, when people are distressed they may say things they don't really mean and this can include statements such as I hate you, I wish you were dead, I wish I were dead. Most of the time these are nothing more than expressions of emotional turmoil but for now, it may be better to remove all risk. You know your son is not stable right now. If anything were to happen you'd never be able to forgive yourself.

He can't afford another iPhone and neither can I because God only knows what the bill will be at the hospital. So I guess we will have to work that out. But I know he is lost without it.

I sympathize. Most of the young people these days are attached to those things at the hip. I like the old dial-up myself but I certainly appreciated that my child had that cell phone with them when they went wandering. I've since been told that someone is making watches with GPS devices in them. I can see where they could be life-saving devices in some situations such as a parent with Alzheimer's but I can also see where they could be used in an unhealthy manner too. I didn't go so far as to purchase a watch but I thought about it.

But to be quite honest, I really don't trust him right now.

That's understandable. Trust is something that can be earned back and it is appropriate to withdraw it when it's been damaged. Our child broke our trust too. We let them know we were hurt by that but we also gave them opportunities to earn it back. They have come an incredibly long way in that regard.

I spoke with him last night and don't sense a big change at least over the phone. Still feel he is in a manic stage. We haven't been able to time his rhythm on his stages because they are so erratic.

Keep watching and be alert to what is happening in his environment as well as any substances he is ingesting, including prescribed pharmaceuticals. Our own child's manic episodes may have been worsened by treatment with an anti-depressant in the early stages of their treatment.

My wife's niece is BP and her phases come and go every 5 months. But she is 34 and learning to cope. My son though is all over the place.

Does your son have any sort of relationship with his cousin? It's possible she could serve as a peer to him. Peers are very important to have on your support team for many reasons but it's best if they're healthy peers. If your son does not have peers the online environment can sometimes be a good place to find them. I could make some recommendations in that regard but it might be helpful to hear from you what your son's take is on all this first.

Who knows? Tonight he may crash and be docile as a lamb.

It's easy to remember why we love them so when they do.

I'm glad to know you and your wife are finding some helpful words here, rs. I don't have bipolar myself so there are aspects I can't personally address in that regard -- other people can lend their voices though to help give you those insights. I can however, speak as a parent and as someone who has undergone some extreme states of my own.

~ Namaste

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Son has been home from hospital 2.5 days. When he came home we talked for about 3 hours. He talked - I listened. Basically it was a laundry list of things he considers to be possible triggers for his manic stage. I made notes and was hesitant to fall into "bipolar conversation" so I suggested some things and others I asked him if I could think about until the next day. But around 3 the next day he wanted to go to a friend's to visit and then see a movie. Said he be home early. At 10 he called to say he was just getting to the movie and would be home at 12:30. I don't know what time he got home because I went to bed as I was exhausted. Yesterday he milled around until 3 and left again to see the same friend and came in last night at 10. Now I'm pretty sure he had been drinking beer both nights and not eating. So I sort of lost it with him last night. I said things maybe he didn't understand like "You have to make the choice to get on top of this thing and we will be there for you". But I probably did lay a bit of a guilt trip on him too by telling him "I can't be worried all the time about you, and there are other people in the house to think about." I didn't specifically bring up money to him, but the past week has cost my wife and I over 7 thousand dollars in his care alone.

My general impression is that he is not accepting his illness. I'm not sure he wants the help we are offering. I can't seem to get a handle on what he is thinking because he hasn't been around enough for us to talk. I am having a difficult time trusting him. He is supposed to start a new job on Monday and I think its too early. He has not seen his therapist yet and his first psychiatric appointment is Dec. 9 . I asked him to wait but he seems overly obsessed with money (so he can get even more tattoos.) I know he is clean as far as drugs because he had to take a drug test today and it was clean. But as I said, I'm almost positive he's been drinking with his buddy.

So, any thoughts on how we should approach him? I know he got mad at me last night and I have no idea what he'll be like today.

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rs: When he came home we talked for about 3 hours. He talked - I listened. Basically it was a laundry list of things he considers to be possible triggers for his manic stage. I made notes and was hesitant to fall into "bipolar conversation" so I suggested some things and others I asked him if I could think about until the next day.

What did he come up with rs? I ask because this could be a possible bridge to reaching him. It also demonstrates that he is thinking about all this. Digestion and acceptance does take time and it's very difficult to not want to rush it.

...the past week has cost my wife and I over 7 thousand dollars in his care alone.

I find this to be absolutely maddening. What are people supposed to do when the treatment you are told you must have is so prohibitively expensive? It places families in a very difficult place and it increases their tension and potential frustration/exasperation with their loved one, which in turn, seldom helps them! It's a horrible catch-22. Were you able to investigate any options that might help you with the financial burden?

He is supposed to start a new job on Monday and I think its too early. He has not seen his therapist yet and his first psychiatric appointment is Dec. 9 . I asked him to wait but he seems overly obsessed with money (so he can get even more tattoos.)

Our child went through a number of jobs too. For them, one of the things they struggled with was their current unwanted state of dependancy upon their parents and their desire to be an independant adult. In their case, they did attempt to return to work too early. They ended up with a string of failures as opposed to being able to create success that would enhance confidence.

On the positive side, a job may be able to add some structure to his life (often very important for an individual learning to cope with those wild swings) if he is able to cope with the demands of working.

I have no idea what he'll be like today.

You probably don't know what you'll be like today either. :) You take it as it comes, responding to each moment as you do.

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"What did he come up with rs? I ask because this could be a possible bridge to reaching him."

First and foremost is his wish to make as much money as he can as fast as he can. I think it may be partially to try and prove he can be independent of our help financially as we have borne the brunt of his bills for the past 3 months. However, he seems to be obsessing on this pretty hard.

He is very frustrated that a couple of people who he thought were his "friends" have apparently abandoned him. One girl is doing drugs and hanging around his old girlfriend. And one guy has a new girlfriend with whom he spends all his time. He has always had people around him even since he was a teenager and now he sees his circle of friends dwindling away.

He's been working on restoring an old pickup truck the past few months but because of the weather and now my finances, we are at a holding point and he cannot deal with the boredom. If he isn't moving at full speed during his waking hours, he gets very frustrated.

He is concerned about what to do the rest of his life. Talks about starting a business yet has no money and again gets in that "circle" in his head.

These are the major points.

I am concerned about what to say to him and how to say it. I don't want to discourage him or overly encourage him either. I know I've been harping to him on wanting to get better and that he must accept his illness before he can do so. I know it takes time for them to realize this, but I get "angry" with him because he doesn't really seem to want to be better. At least he hasn't "said" he wants to get better.

Maybe this job will be good for him. I just hope he can do it. He is having a hard time on these news meds. He seems to be "out of it" allot. Has difficult time getting up in the mornings. He has worked at this place before and knows people there, so I am hoping this will lift his spirits some. Just worried it is too soon. But we'll see.

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I had asked: What did he come up with rs? I ask because this could be a possible bridge to reaching him.

I had been curious to know if he was able to identify some of the symptoms/behaviors that indicated he was entering a manic phase. Some of the symptoms we (myself, my husband, and our child) were able to identify that mania was just around the corner were:

- They would begin to sleep less and eat more. In depression, the reverse was true -- they would eat less and sleep more.

- There was a strong need to interact socially with others as opposed to a desire to withdraw into themselves.

- Their intentions would run in several different directions, i.e. they would speak of plans to follow up on not just "a" career, but seven different careers, all at the same time.

- Their behavior would become much more animated. They would have more energy but that energy would be scattered with little focus.

- They would speak rapidly and when conversing with them, there wasn't that usual interchange of taking turns. More likely, they would talk right over you and switch streams in the conversation, going rapidly from one subject to another.

- Their mood would be "up".

- A lack of inhibition or respect for "social mores".

It was our hopes that by recognizing the symptoms early we could take action then to prevent a full blown episode from occurring or at least, be on alert that one was coming. On some occasions, our child did seem to be capable of channeling that energy in a productive and harmless manner; in other cases, full blown mania would take hold and with it, impulsive actions that were often harmful or dangerous. It was at those times they were also most likely to use cannabis in spite of whatever they had said about not using before. In turn, this would enhance the mania.

I am concerned about what to say to him and how to say it. I don't want to discourage him or overly encourage him either. I know I've been harping to him on wanting to get better and that he must accept his illness before he can do so. I know it takes time for them to realize this, but I get "angry" with him because he doesn't really seem to want to be better. At least he hasn't "said" he wants to get better.

My own experience has been that most people want to get better but there may be some discrepancy between you and them in terms of what "better" looks like and the best means of getting there. It's also been my experience that much as we may want wellness for the other, we cannot impose a schedule upon the recovery process. There are, however, things we can do that will enhance it and things that will impede it.

For ourselves, what we most want is for everything that has happened to have not happened. We want things to go back to the way they were before and this impossible desire of our own will often creep into our speech and expectations. To some degree, some of our anger is blame -- we blame them because we can't yet accept what has happened.

One of the major challenges with mental illness is there is no blood. If we or our loved one had been hit by a car, if we could see the broken bones, the casts, the crutches, the bandages, we wouldn't impose the same sort of expectations upon the situation and we wouldn't hold our loved ones (or ourselves) to the same timeline when it comes to "getting better".

With "mental illness" so much of what occurs does so behind the scenes where we can't see it. This has a profound impact upon our own expectations including where and how we will judge and blame if our expectations aren't met. In turn, this can impede recovery and eat away at the relationship that is in place. It's a terribly fine line for caregivers to try and walk. Nonetheless, it may be helpful to hold that image in mind and try to remember that our loved one has been through the equivalent of a car wreck. Will they ever be able to walk again? Chances are good that yes, they will and there is plenty of room for optimism. But it takes time and no one can reliably predict just how much time it will take -- it's not going to be next week though.

Something I neglected to comment on yesterday.

rs: I know he is clean as far as drugs because he had to take a drug test today and it was clean.

Don't forget to celebrate your successes. It's very encouraging to hear that your son is not making use of recreational drugs. They are, much to the chagrin of many, creating forms of havoc in the biochemistry of numerous people. Should you or your wife be interested in learning more, there's a collection of some studies here: Polypharmacy/Bipolar illness.

First and foremost is his wish to make as much money as he can as fast as he can. I think it may be partially to try and prove he can be independent of our help financially as we have borne the brunt of his bills for the past 3 months. However, he seems to be obsessing on this pretty hard.

My guess would be it's strongly linked to his sense of self-identity which would have been bruised, at minimum, by the "illness/experience" and the recent hospitalization. Regaining his earning ability is a means of shoring up that flagging self-esteem.

He is very frustrated that a couple of people who he thought were his "friends" have apparently abandoned him. One girl is doing drugs and hanging around his old girlfriend. And one guy has a new girlfriend with whom he spends all his time. He has always had people around him even since he was a teenager and now he sees his circle of friends dwindling away.

Our child went through the same. Some of it would have happened anyway as they transitioned from high school/post secondary education but a large degree of it was hastened by their ongoing bouts of mania. This was painful to them at the time for it struck chords of abandonment as coupled with guilt and self-doubt. Over the long term, it's been beneficial as their former social circle did have a tendency to make use of cannabis on a regular basis. The new friends they are making for themselves do not. This latter transition has taken place over the course of the past year.

More thoughts later, rs. Daily duties call.

~ Namaste

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