A manic crisis can frighten the wits out of anyone, especially if the onlooker is a close friend or relative. As we watch our friend rave, frenziedly try to achieve many ‘important’ tasks and abuse us, all the while drinking voraciously, most people’s usual reaction is fear. From that fear we are urgently compelled to do something to ‘fix’ the situation and resolve our fear by attempting to persuade our friend to see sense and go to the hospital.
Alternatively, especially if there are children in the house, we might attempt to flee, removing ourselves from the source of fear and riding on our responsibility for the children. But there is a dilemma: who has the primary call on our responsibility: the children or the person who is seriously ill? It’s tempting to give up thinking about it at that point, and just do what we can.
The difficulty in persuading people to go to hospital, or let us use the phone to arrange it, arises not because they are too busy. And it’s not because they have a superior ability to argue. So why won’t they budge? If they have been to hospital before they know it can be a very humiliating experience because of staff attitudes. Another element is that you have suddenly become very bossy, not like the friend or partner you usually are. They resist because they feel you are not treating them with the respect they deserve.
So how can we proceed? Those of you who have been around psychiatric hospitals may have seen expert psychiatric nurses plying their trade. Look closely and you will see that they collect themselves, takea deep breath. They blinker their vision so they are not distracted by the symptomatic behaviour, and can connect with the person’s healthy spirit. They ask where the person is at: “What’s happening, Jo?” They listen very carefully, finding something that is bothering the person.
Here is the crux: a person with a mental illness is temporarily not thinking well. Logic falls away. This creates a vulnerability in them that you can exploit for their benefit. Having heard what is bothering the person, you can offer a solution, as long as it involves a choice for them. For example ‘I think the people at the hospital can help you with that. I can take you to the hospital now in the car or I’ll call the ambulance (or police, CAT team etc) to take you there. How would you like to go there?’ Then there is no opportunity for a row. If the response is ”I’m not going to the hospital at all’ you have the mandate to ring the ambulance.
If you try that, and but then can’t arrange hospital or other avenue because, the person is violent or armed, can you walk away? Can you leave the person in this circumstance? In my view, as both a sufferer and a partner of one, you certainly can and should walk away for your physical and psychological safety and that of your children, if any.
Life is a long story, usually even with bipolar disorder. Sure there is a risk of suicide, but the farmers of Australia have a suicide risk not far behind people with bipolar. You cannot, simply by hanging around all the time, keep your friend alive. Episodes come and go, life goes on. Bipolar is a cross to carry, just like any other.
Let the person with bipolar be a person with bipolar. They are learning, however slowly, how to live and cope with it, manage it. There are a lot of guilt-ridden stumbling blocks in the ethics of this. No one wants to have to answer to prejudiced accusations of ‘abandoning’ someone who then suicides. But your right to wellness is equal to your friend’s. Your power, as an untrained ‘volunteer psychiatric nurse’ is limited. Be realistic about that. Let your friend make decisions and learn. Believe it or not, people can make decisions in the midst of bipolar crises.
Of course the downside of running before the pseudo-guilt of ignorant and unfair accusations is the nasty consequence called co-dependency. That means you have kow-towed to what you think people will say and then find you need your relationship with your friend to establish and define your new identity: professional caregiver with a ‘victim outlook’ who has no life apart from the person with bipolar. You may comfort yourself with the thought that other people will think you are heroic and a martyr, but the only thing being martyred is you. Because you need your friend to ‘have bipolar’, they will stay sick.
If you know how to pray, I encourage you to do so. Not just for the health of your friend, but also to listen for guidance on how you should respond. Mental illness is difficult for the sufferer, and it’s difficult for friends and partners. Most people think the difficulty for friends and partners is in coping with the behaviour of their ill friend. A much more serious danger lies in the response you make to the illness.