I have written before that you can sort of, a little bit, manage bipolar disorder without medication. There are a few proven treatment strategies that do work to manage bipolar disorder and keep you out of the prescription line at the pharmacy.
Nevertheless, I’m still a big believer in medication. I believe that if your life is out-of-control because of bipolar disorder, then medication is probably the best thing for you. I believe that if you’re in pain because of bipolar disorder, then you should be seeing a psychiatrist. I believe that if your functionality is compromised by a disordered brain, then you should be looking at a medical solution.
But does this mean that people with uncontrolled bipolar disorder should be forced to take medication?
People with Bipolar Disorder Are Different
Bipolar disorder is not one thing – bipolar disorder is a whole lot of things all clumped together. You only need to have a percentage of the known symptoms in order to qualify for the diagnosis of bipolar disorder and people experience different symptom sets. Some people get manic, others get hypomanic. Some people get psychotic, some people don’t. Some people attempt suicide, some people become catatonic. And so on. Everyone is different.
Severity of Bipolar Differs
And so are severities. Bipolar doesn’t come in one severity level. The symptom impact has to reach a certain level for diagnosis (it must significantly impact functioning or quality of life) but not all bipolars are created equal. Some people with bipolar have to go on supplemental security income assistance – they cannot work – while others maintain employment. Some can’t manage themselves well enough to stay off the streets and others maintain a mortgage and car payments just fine. Bipolar severity varies dramatically.
Medication Choices in Bipolar Disorder
And so, depending on your specific symptoms and their impact on your life, your choices around treatment are going to differ. I would say that if you’re experiencing psychosis (the presence of delusions and hallucinations), you should be on medication, period. I would say that if you’re too depressed to bathe or leave the house, you should be on medication. I would say that if you’re in financial and personal ruin due to uncontrolled manic episodes, you should be on medication. And I would say that there are a lot of other clear cut examples of people who absolutely need to be on medication.
But should anyone force the issue?
I’m afraid not.
Bipolar Medication Is a Personal Choice
See, while I’m very experienced with bipolar disorder and I think I know what’s best in many cases, these cases are not my life and I can’t dictate what people must do. I can dictate what I must do, and that is all. I don’t have the right to tell others what is best for them. I can have an opinion, but ultimately, the choice must be theirs. Except in cases where the person is a danger to themselves or others (or they’re underage), it must clearly be their choice.
And there are two reasons for this. One is simple freedom. We live in a free country (many people do) and no one can dictate to us what we must ingest. No one can tell us what to do and if we want to lie around in our own illness demonstrating crazy at every turn, then that is our right. If we want to be floridly psychotic and live on the street, then that is our right. If we want to be so depressed that we do nothing but stare at the wall all day, then that is our right.
I would say these are poor decisions, but we have the right to make them. Just because we have a mental illness that doesn’t take away our right to make bad decisions. People without a mental illness make them all the time.
And secondly, medication should, whenever possible, be a choice because it just plain works better that way. When a patient feels like he is in control of his treatment, the outcome is better. Studies show this. When you force medication down someone’s throat it just makes sense that the outcome would be worse.
Can You Manage Bipolar without Medication?
And yes, I think a very small, minority of people can manage their bipolar disorder without using medication. I think it is possible. These are non-severe cases that respond well to non-pharmacological methods of management. These people will still have to do something to manage their illness, but a very tiny number might get away with minimal or even no medication.
And even if life not on medication isn’t perfect, it’s their choice to live that way. Maybe we think that there is room for improvement and that meds could be that improvement. That might be so, but all our lives have room for improvement and it’s always our choice as to how to go about getting that improvement. And our pressuring someone to take meds really isn’t going to help the situation.
I learned a very long time ago that no one can take responsibility for a person’s mental health except himself and I also learned that we need to respect that if there is to be any peace. We can disagree, we can even think we know better, but until you’re in that person’s brain, in the very soul of their being, you can’t know what really is best for him. So take a step back and consider how you would feel if someone tried to thrust consciousness-altering substances on your life and respect that is just not what everyone wants.
I disagree. There is a not often talked about symptom called anosognosia. Its different from actual denial, its actually a brain deficit. It’s seen in patients with brain damage,patients with stroke patients… they may be paralyzed and completely unaware that they are, even when shown the evidence. It’s also seen in schizophrenia, and in bipolar. I think if a person has anosognosia, they should be forced to take medication, for sure. But only in that case.
These are the people who end up on the street because they think they are not sick. If a person with dementia thinks they shouldn’t take medication or get care, its recognized that they aren’t with it. Why can’t we do the same for those with bipolar who have a cognitive brain deficit that makes them incapable of recognizing that they have bipolar, despite often being homeless, suicidal, hallucinating, etc?
If a person has bipolar and they truly recognize that they have it- then they do and decide to not take the medications thats one thing. But, if they are seriously lacking insight due to brain damage that comes with bipolar, its not fair to them to let their illness dictate whether or not they get care.
I think maybe, the rules for who should and should not be forced to take medication should be really strict though. For example, maybe more than one doctor has to diagnosis anosognosia. Then maybe they have to be completely nonfunctional- ie living on the street (or would be without family) or if living with family, the family is constantly afraid of being hurt (That last one is probably more common in schizophrenia). And then, the TYPE of medication and the doctor who prescribes it should be left up to the patient. (If they have totally lost touch with reality they may not be able to choose, but once they are stable on a medication, they should be allowed to change medications or doctors if they choose. And if they are with it enough when not stable they should be allowed to choose as well). But I think for people with anosognosia, its not fair to let their illness decide that they won’t take it, which condemns them to a life of homelessness, and basically, a ruined life.
Medication is the mental arena. Once your fitted with right gear, its up to you to slug it out.
Train well, there are fights that are fixed, and the odds are sometimes against you. In the long run you want to be standing when the bell rings – and it rings everyday.
I have tried many pills over the years,, And now i dont have a choice i can no longer take any pill, as my immune system says nope, so now i am left with dealing with Bi polar 1 , without anything, I have tryed taking my own life , more than a few times, to the shock and horror of others,. My bi polar 1 is dangerous to me, and i know that, i know when to take a pain tablet so it knocks me out, i know my cycles better than anyone … I wold love nothing more than to take pills and move forward with my life, tho at this point i think i am moving forward with out taking the pills, . For me learning the moods and cycling was most important, keeping your self busy was one thing that i have had to do when the cycling got to the point of self harm, i had to remove that thought, and that isnt easy when there are no meds in place,..PPl might think that i should try everything that there is out there in the med world, but the fact is, if i try anything and i react i am dead, so i would rather not take meds and try and deal with the cycling and really bad moods of death and self harm, because as bad as it gets, i have to keep breathing for my kids, family and most important thing ME… I have control over it, tho at times, it can get out of my control and than the fight is on, for who ever wins, its a battle, and it takes days to win, and i am so over it , by the time its done, but it will always come back, sometimes i even look forward to it making its way into my head, because when i am not taking the meds that make you so you cant feel a bloody thing, i want to be able to feel it all…….. i have no other choice, but if i did have another choice, i would never take the pills , i would rather feel it all, and for me and others, that is how it has to be…..
I can’t even get my head around all the various medications/cocktails and then when the dosages and types are changes it does my head-in even more so. My husband has always been the one monitoring my meds and keeping up with what’s what and when and if at all and need to take certain meds.
I initially sort out treatment when I decided I couldn’t cope with whatever was going on with my brain and was diagnosed with bipolar which took a while to arrive to. I did it not for me but for my husband and kids. But when it turned me into a zombie and brought on other medical organ issues due to various meds therefore having to take additional meds to treat these side effects, I chucked it all in after many years of trying to do the whole meds psychiatrist psychologist specialist etc. I’m now on just one med so I can get a bit of sleep from the ultradian cycling and relief from physical pain. Even though it’s turns me into an addict for the one drug it’s still my choice to take a milder sedative from my GP then what my psychiatrist originally perscribed. I have a family and I want to be aware as much as possible of their existence even if I don’t want to exist myself. Ultimately I do not believe for me personally that it should be forced upon me unless I was a danger to myself and I would trust my husband of 20+ years to make that decision for me. I’m fortunate I have him as my support as my extended family have been an absolute ignorant bunch and refuse to believe that I even have a MI because I have managed to still live a succefull live and have achieved a lot having taken advantage of time when in remission or full blown Mania. I still tell people openly that I’m bipolar and even after years of knowing me they are shocked. But how well do people really know us like our support partners do. They don’t see what happens behind closed doors so they don’t know me at all!
I hate bipolar!!!
No!!! We should not have to be forced to take meds or get booted off of ssi.! Which is the current rule in Texas!!! Why? because these meds do not work or agree with every one. I have severe side effects from several of the med prescribed. Now I battle heart arrhythmia and I’m positive it was brought on from the side effects of said meds because that is what these types of meds do to me. My now heart doctor has told me they shouldn’t do that and if medications do that to you don’t take them…so now I’m terrified of being booted off of ssi because the meds do not work for me. As a matter of fact a lot of people are not helped by them however, they are now so used to them (habit forming) and so now they have to have them…and that is whole other can of worms about being forced to take them!!!!!
I hate having bipolar disorder I am judged by everybody my doctor made me very sick on Lamictal now I refuse all drugs cuz I had it what psychiatrist in their game I have drug induced lupus because of drug lamictal . I had a part time job and on Social Security I lost my job and I’m lucky I’m not dead because of it then no one wanted to meet there was a problem the idiot still wanted me to take the drug it’s horrible give a drug the not to omit you’re the person giving it to me and you’re making me sick if you say to a psychiatrist you believe in God they think you’re a psycho they hate that people have for the mental ill around them isn’t fair not all mental health patients are crazy
Bipolar disorder has a huge sliding scale and different people have the disorder differently. Should all moderate to severe cases take meds? ABSOLUTELY. All bad cases Ive come across in my lifetime caused horrible strife to others. One I know is so bad, she is 100% disabled and stays home. She lives her life on the internet ruining the lives of anyone and everyone who dares to cross her.
A man I met several years ago would fly all over the place during his manic episodes and be the life of the party.
When the depression hit, he’d sit off in a corner by himself barely speaking to anyone for several days. He did not take any medication. It ruined his marriage and he could not form any close relationships.
Another gal I used to work with was diagnosed in the moderate zone. While a normal person could be a manipulative witch, she lived her life screwing with others and she once told me she knew it was because she was ill. I could tell she wasnt using her illness as an excuse to act out either. She was dead serious.
YES ITS WRONG IF SHE HAS ALL THAT MEDICINE AND NOT TAKING IT BUT STORING IT AND ONLY DOING THIS TO RECIEVE MONEY WHILE PEOPLE LIKE ME ARE SUFFERING!!!!!!!!! Im suffering right now from this with no medication because I.CANT AFFORD $ 500 perscription people like this discust me
I’m staying with a organic bi polar woman. She receives disability. She goes to see her psychiatrist each month in order to continue to receive her benefits. They prescribe her meds yet they tell her each time that since they are so expensive that they will give her samples. She has yet to take any of the meds and has them stored away. She freely admits to me, manic or not, that she only goes to her appts in order to continue receiving her money. She also has 100% medical coverage.
Is this wrong? Is this against the law?
She is out of control, manipulating, lying, etc. , spending money, treats her loved ones and me rudely but acts like she does us favors.
If you are on SSI you are forced to take medications or get booted off ssi. I am one of the ones who has an awful time with medications. I don’t take them bc they make me worse. But the stupid assistant I HAVE TO SEE every month doesn’t seem to get that this is not a medication fits all illness! They make you take a urine test to make sure you take your medication. We are treated like animals going to slaughter . No one cares. They want any reason they can find to boot you . They don’t care about helping you to get well! Its a nightmare!
>>just me,are you currently in a hospital? i’ve never been urine tested for medication and i was diagnosed in 1980..I can understand it if you’re in a hospital cause as a patient as you’d have no choice to but to give urine samples if they demand it..
I know this is an older post but had to respond to “Steve” from Sept 23,2013. Bipolar is a brain disorder whether you like it or not. Our brains don’t work the same way as other peoples. We don’t have diet induced behavior problems, ( or whatever the latest attempt to degrade us for being ill is ) we have insufficient brain chemical or over abundant brain chemical issues which cause us to be unable to regulate our mood states.There is evidence that some of us experience a form of seizure which is as serious for us as it is to someone with epilepsy. It sucks. Opinions like yours do not help, they only foster a dangerous mentality that we can stop taking something that many of us admit may be the only reason we are still alive. The side effects can be brutal, we aren’t doing this for fun, we’re doing this for survival. You made the comment that “you never get better”, about which you are correct. We never will get “better” but our symptoms can. Virtual all of us have quit our meds at one time or another only to have our lives come unraveled. I’m truly sorry about your personal bad experience, I think maybe you were misdiagnosed. I have always maintained that anyone who has “cured” their bipolar was never bipolar to begin with. The tone of your post and hostility towards those of us who suffer leads me to believe that you do have some issue and I encourage you to seek help. Believing you could have ” helped” mentally ill mass shooters with an undisclosed miracle answer as 100% fact is a delusion of grandeur. It is a very dangerous way to view life. Sometimes you get a shitty psych professional but there are many excellent people out there who can properly diagnose you and give you the proper treatment you seem to be crying out for. Choosing not to is your right but please don’t hack away at the progress being made to help us. Bipolar is a difficult and insidious illness and the psychiatric world is dong their best to help us find peace. Just my opinion.
I realize these are all older posts ,but i come across posts that i left several years ago all the time..kind of freaky really when i come across them ,but none the less,are interesting when replied to.. To IvanP>> I’m bipolar butI stopped taking anti depressants because the facts are that they can easily and usually do cut down on one’s lifespan (longevity) by as much as 9 years or more..While they stabilize one’s bipolar they also do things like slow down heart rate and a number of other things which in the long run constitute and earlier than normal death..I found there are natural supplements that help my bipolar nd they’re not expensive..I’m not saying that all bipolars should give up anti-depressants ‘now would i ever encourage it..Bipolars please do not stop taking your medication if it’s keeping you stable!! I’m just saying i did and it all worked out..Natural Supplements in place of pharmaceuticals is not the perfect situation for all bipolars.. They are for me however.. T o those bipolars that have not locked on to the perfect working ant-depressant or bipolar meds ,try natural supplements.I take Cholrella,a vitamin b12 supplement , ashwagahdha and Nutritional yeast flakes…again these might not work for everyone or even most,bu they work for me..But just as with any medications,you have to take them regularly!!
I’m reading up on bi-polar disorder a lot lately–my friend is in the midst of his latest (9th? 10th? I’ve lost count) manic episode. He doesn’t want to take meds, he continually goes off them, loses a job, hits a bottom, gets back on meds because relatives (parents usually) make him — then he repeats the whole process. He’s a very intelligent person, and very crafty. He has become very used to running from his problems and lying like crazy about everything.
I’m one of the people he is trying to get money from presently. That makes me sort of hopeful because I’m not rich and him asking me means he’s run out of “rich people” who in the past have enabled him more. I’m thinking of asking him why he doesn’t want to take meds, and the reason is because I’m not sure *anyone* has ever actually asked him that. I read your article about why people go off meds and the reasons are so varied I think it could be a number of them, combinations maybe. I don’t know if he’ll want to talk about it with me or even answer me truthfully.
Another thing that I’ve been considering is actually giving him $500. This is because I feel like I can keep in touch with him if he thinks I’m being his friend and not preaching to him, etc. Some people are saying NO, DON’T DO THIS! and I can understand why. It would be purely a strategic move; he really needs treatment.
I agree with you that people like him (he is nonviolent–for the most part) shouldn’t be forced to take meds and that only extreme, criminal cases warrant that. Thanks for your valuable insights. Feel free to respond.
Hi Natasha. This subject is one that is close to my heart because I have bipolar II and will not take antipsychotics or Depakote. I manage with Lamictal and Effexor (which I want to get off because it keeps triggering me). I have been traumatized multiple times by the medical system and my legs shake so much every time I’m in a hospital that I can barely stand up or walk. It’s one long panic attack until I leave.
Attitudes like those of J. Kimber Rotchford and Cathryne below are why I will never, ever call a mental health hotline, no matter how severe the crisis. I will never call 9-1-1, even with the chair and the rope in hand, even if the alternative was homelessness or prison.
At this point, breezy comments like “get help” just seem like a sick, cruel joke. Here’s the truth: there is no help.
If you are still feeling unstable on what you are taking, then you are taking medication that doesn’t work. There is also one other possibility: undiagnosed mental illnesses that trigger your bipolar. Or a misdiagnosis completely. (You obviously have something, but what you have, the doctors might have gotten that wrong).
You obviously have at least some anxiety issues if you are getting panic attacks in the hospital. If you were raped or beaten in a hospital setting, maybe its PTSD, I don’t know. Or maybe its nothing as bad as that and you interpreted everything really badly because you were in a bad mental place.
I’ve been in inpatient hospital twice, in two different states, and various trips to ER. I never had a bad experience with the hospital staff themselves, but then again I don’t get manic. A friend of mine got manic in the hospital, and he said he had a horrible experience staying in the hospital. But when he told me what happened, it was obvious to me that his bad experience was the reaction to the staff, and the staff were reacting to his mania. When I stayed in the hospital, there were a couple people who were very violent or dangerous and security got called on them constantly. I think if thats why you are panicking about being in the hospital (like my friend) then its a little unfair to blame the hospital staff for just reacting to what you are doing. However, at the same time, that isn’t to minimize your experience. If you are having panic attacks in the hospital that is very real, and not something to gloss over. If it is PTSD, then it might be very difficult to deal with, but you need to tell someone that you are having panic attacks so that they can help you.
In my case, I’ve been having problems with my life, trouble with holding a job, getting really depressed at my failures, etc. Despite being treated successfully for bipolar 2. I thought I had just bipolar for years, but just learned I also have ADHD, as well as a bit of anxiety related to problems my ADHD has caused. I am getting treatment now for it, and things are going a LOT better. It turns out, problems with my ADHD as well as anxiety were triggering my depression. Ironically, I was diagnosed with ADHD as a kid (I thought I outgrew it as an adult) and they missed my bipolar when I was a kid, so the ADHD medications didn’t work back then. Basically, if only ONE of my illnesses got treated, I was a basket case- depressed, moody, anxious. Either my ADHD was causing failure in my life that made me depressed or anxious, or my bipolar was causing me problems when my ADHD was treated. The result, essentially, is that it SEEMED like nothing was working. But in truth, I had more than bipolar and the ADHD and anxiety was triggering bipolar episodes.
If you have another mental illness that you aren’t aware of, very likely that is happening to you too. I suspect anxiety is one possible thing, though there could be others, could be even more than one additional mental illness. When I was int he hospital I met a woman who got there because she was an alcoholic. While she was there, she learned that she had had severe anxiety for years and never knew it. And she tried to cope by drinking. But she finally figured out that she had anxiety, so she was on her way to getting better.
There is also one other possibility- that you don’t have bipolar at all, but that you have borderline personality disorder. Borderline and bipolar 2 are frequently confused with each other so its not unusual. Also, doctors may know you have borderline but for insurance purpose, put down bipolar. (insurance companies don’t like to cover borderline patients.) Its not a bad thing if you do have borderline, despite the scary sounding name. I had a therapist tell me once, it would be better if I had that than bipolar because after ten years of DBT therapy with a good therapist who treats borderline patients, you can essentially get rid of the borderline symptoms. But borderline personality disorder does NOT respond well to medication. Anxiety is also common with people who have borderline. ALSO, if you have borderline instead of, or in addition to, bipolar, then this could also explain why the medical staff at hospitals didn’t treat you so well. Borderline, in general, tends to make people react badly to the person with it, especially people that go beyond acquaintances or see someone beyond work. Also, for those who don’t specialize in borderline patients, there is some stigma among mental health professionals. They were once thought of as untreatable, but now they aren’t, there is DBT and after years of DBT people can get better, practically cured. (DBT was actually invented by a psychologist with borderline). The two people I remember having the worst time of it when I was first hospitalized, one had borderline and the other schizoaffective disorder. So that could also be the reason.
So there is hope, for sure. But the biggest problem the field of psychology has is that they aren’t very good at diagnosing people. There are no blood tests or genetic tests, at least not now. Most of the time, in my experience and from people I know, the REASON things aren’t working is because they are either misdiagnosed, or are missing a diagnosis. I think my dad was such a person, though he died a long time ago. He was diagnosed with only depression, and not a single medication worked for him. I think he had bipolar, I also know he had a prescription drug addiction.
So this is true for anyone reading this- if it seems no matter what you try you aren’t getting better…look into whether or not you have maybe another missed diagnosis, or whether or not you are misdiagnosed. Talk to your doctor, and say “I am wondering if things aren’t working because maybe we have the diagnosis wrong or are missing a diagnosis.” If the doctor is rigid and won’t consider this, move on to a new one. The beauty of changing doctors is that, you can start a fresh. You can go to a new doctor… and not tell them about your previous diagnosis and see if they can come to their own conclusions. They might get it more right than the last doctor.
And say you think you might have borderline not bipolar. (if you try this route and you think you have bordelrine, make sure you see a doctor that lists borderline patients as a specilty, and especially a therapist that lists borderline as a specialty). Again, for borderline, your main treatment will be from your therapist not doctor.
But anyway, you can go to a new doctor, and say “I have these symptoms: etc etc. and I wonder if I have borderline” or something like that. Or you could say, “I was diagnosed with bipolar, but I think I have another mental illness too… because nothing I tried worked” its kind of hard, sometimes, to really separate out whats what. I think anxiety in particular, can be hard to spot, even though it would seem that it wouldn’t be. Hell you could even have aspergers on top of bipolar, it could be anything, but mental illnesses tend to make each other worse when they aren’t treated properly.
So instead of saying “there is no hope” (which is probably depression talking anyway) try to see if you can figure out whether or not you have been misdiagnosed or if a mental illness has been missed. good luck.
great article. i’ve read that bipolar is the one mental illness that has to be treated medically. not necessarily true. but how many people try no meds and at some point wished they had. i could care less what people do with their treatment but if they are obviously out of control i suggest that maybe they should think about meds.
they don’t.
i was misdiagnosed for twenty years and stopped meds a few times when i was young. So i start jogging and everyday my symptoms got worse. my anxiety before meds was so bad that i had rings of perspiration and had huge circles under my arms that showed through a sport coat. that increased my anxiety in itself.
my stomach was so noisy that i freaked people out. no way to talk to someone in an office.
when i started meds they both went away within 48 hours. do i want to try that again? no, because i know that if i do i will fall to the center of the earth in a few weeks. but still, i’m on disability and i know that’s where i belong. Maybe for now or forever. I worked for 45 years but reached a point where i could not imagine doing a resume. Who knows? I try telling friends what’s up. if they don’t buy it, it’s not my problem. I’m 61 years old and battle fatigued and I just can’t keep pushing myself. if someone isn’t bipolar I they think i can do better. if i could do better i would be doing it. i always busted my ass to do a great job. I’ve never been told that i’m lazy.
Sorry but it is my body, the one and only thing on earth I truly own. Anyone who forces anything inside my body against my wishes is a rapist . That’s what I told them when drinking too much landed me in the hospital and threats to coerce medication came my way.
No. We have enough laws already. Some people are court-ordered and others are under conservatorship. They are going to implement Laura’s law (assisted outpatient treatment) in my county. I need my medication, but I don’t think anyone should be forced. But, I also think they should be given the opportunity for treatment. It is hard to qualify for low cost care here.
Choice and Freedom often come up in these discussions. Is someone who is color blind free to see a red light? Do they have a choice to see a red light? When there is objective evidence that a disability is not a matter of choice, and that disability can and objectively involves a lack of insight, we as a society have historically tended to error on the side of assuming people have a choice. I would argue that if someone is on disability, having legal problems, or provides objective evidence for brain dysfunction including a diagnosis of Bipolar disorder by a competent clinician let them “prove” they are capable of insight and making a decision/choice when it comes to refusing a medication. Who wouldn’t choose not to take a medicine if they felt nothing was wrong with them! Who would take a medicine if they held a belief/delusion that drug companies and doctors were all evil and part of a conspiracy to destroy our environment.?
Another possible grounds for refusal would be no objective marker for less disability or disruptive behavior.
Serious immediate harm to themselves or others is no longer, in my opinion, a compassionate or respectful option based on what we know about “choice” and “freedom” when it comes to brains not working right. We recognize that children have limited ability to make informed choices because of limited brain function/development. Why must it be so different because of some arbitrary age such as 18 particularly when evidence supports significant brain dysfunction precluding proper choices and freedom?
Of course someone motivated and who has bought into medications has a better prognosis. Why is that? Could it be because their brains are working better as evidenced by proper insight and choices directed at maximizing function and quality relationships. Good therapeutic relationships, diet, exercise, etc. help heal brains. Medications are not the only way but I would say that patients who have bought in to the value of taking medicines either “have hit bottom” which is a good indicator for a possible change for the better, or based on relationships or a reprieve in the cyclic nature of most mental illnesses, their brains are functioning better, and consequently are more likely to continue to take medications.
If patients are not getting better even though they are taking medications I would argue they are not taking the right medication or there are other non “biological” contributors to poor function, including cultural and intrinsic “belief” systems. In most cases I would assume it is a combination of the two or three….but why not force someone to try a medication? Do the benefits outweigh the risks? I think so if done with respect and compassion.
Forced meds? Before I was officially diagnosed with BPD, I exercised heavily and religiously, took lots of vitamins and ate a healthy diet. It was under control for the most part, but of course there were breakthroughs that I didn’t understand. I did this for 15 years.
After the birth of my third child, none of that worked any longer. In my third trimester I could tell something had changed. I wasn’t happy, I wasn’t sad I was nothing. No emotions. Then came the psychotic features. Rough is not the word for it. No amount of vitamins, exercise or food could right that problem.
I always feel so badly when I read that a mother has killed her children because they thought they would be better off dead than to live in a world that is so tainted. I completely understand where they are coming from. Thankfully that didn’t happen to us, but I was so distraught with grief and confusion.
I would have gladly taken medication for this, but as I said I was confused. I need someone to take care of me, but that didn’t happen. I feel that being forced to take medicine would be relevant in this situation. Even if a person doesn’t think that they are being irrational, it should be done without question.
I am not kidding when I state that if you are severly disabled by your mental illness you need to be put on a med regiem and be subject to Laura’s Law, especially if you are in my particular space with it. I have a pretty high tollerance for peoples “in your facedness” If I notice your are way off center with your mental illness so does the next person, and the next person. You are not only a danger to me, you are a danger to yourself. Someone is going to take you up on your verbal threats and possibly hurt you.
That being said, here where I happen to live there is no in-patient mental health. Wer’e too cool for that. Actually, as a county, we’re too broke for that. If you are truly chronically mentally ill we will place you in a facility in mid -state. 400 miles away. That is the only place we as a county have an agreement with. You may think that one county over might accept patients from this county. But we do not have an agreement with their countuy facility. to transfer. So Laura’s law, while perfectly sound, doesn’t apply well here. We will send you not to mid-state first, but to the county hospital, or to jail. Jail for bi-polar affected, floridly symtomatic people is a horrible place.
Here, the police have only had negative relations with the mentally ill homeless and have killed in the line of duty several of them. I am in the Cop Watch program here for this very reason. They have had multiple training session with how to work the the mentally ill with varied success. Most police here absolutely cannot stand the mentally ill. I have a friend who’s a police officer and though not completly unarmed intellectually, is a bit of a dope on this subject. So I say, if you know a floridly symtomatic person, get that person on some kind of med. Now. Because the police in our area are just like the police in your area
If you are a fairly average bi-polar affected individual. Make your own decisions, but be aware that your decision is also influeced by your bi-polar mind. Mine are, certainly, and on a daily or semi-daily basis. And so will the decision to treat or not treat with medication. I am at the low end of the bi-polar sprectrum. Not all that affected. But still often affected to some degree. Just went through a year long mixed episode but went to work every single day. Even went to Asia on assignment.
But, yes I am influenced by big pharma. My father worked as a chemical engineer for Pfizer. So yes you have to consider that when reading this.
I know medication has saved me from severe hard drug use in order to manage symptoms.
Also keeps me without a police record for possible assault from my super violent rages during mania.
Helps me focus,slow my brain down,aid with sleep.
However,being a rapid cycler I’m very time sensitive to my meds.
I’m a little odd,don’t like taking pills in a public place…???
Anyway there are side effects that I don’t like,but it’s a trade off,basically.
I truly feel you know yourself best,so..i think it’s an individual choice…but one should talk to someone regarding the pros and cons,like any kind of illness.
That’s me. Cheers from Canada! Sadie ( Sandra)
I spent nearly 50 years doing everything I could to fix myself, in fact I believe I qualify for a PhD in Getting Better. I would like to urge people who are told they need evaluation and possibly meds to give therapy & meds a try. I wish I could have found this level of recovery that I always wanted earlier in life. I’m 68 and was diagnosed and given mood and depression meds at age 64. It’s never too late or too early to do what you can & avail yourself of the outside help you deserve.
It would be easier to make the argument for forced medication if the meds worked better and didn’t cause such horrible side effects. They really don’t work very well, and you have to try a lot to find what works- something that is hard to do with someone who is not voluntarily taking meds. And then what happens if you get tardive dyskinesia- can you sue the state?
Hi all,
People seem to think this is a change in view – it isn’t. I’ve always been against forced medication except in extreme circumstances, as noted. Those circumstances are, when you’re a danger to yourself or others, when you’re found non compos mentis by a court or when you’re a minor. Those are times when medication without consent is warranted.
And this doesn’t mean I’ve changed my mind on Laura’s Law either. I still believe that a very tiny percentage of people who have broken laws or have been repeatedly committed and have been shown to be a danger should be in enforced treatment. This doesn’t mean medication, per se, but it sure the heck means that those people need more help than they’re getting.
This post is about your average mentally ill person. One who can make decisions and just chooses not to take medication.
– Natasha Tracy
I am pleasantly suprised by this article. I wonder what caused the change of stance? I remember few articles proposing how forcing treatment on person is “freedom to get better” and yadda yadda. This is a pleasant change in tone.
But yeah… it should be a choice. If meds don’ť work for somebody, forcing them on the person will not make them work. And will cause unnecesary trauma.
And for some it’s choice between suck and medicated suck. So some chose suck without side effects and should be respected for it.
This seems to be an extension of a previous blog post that you noted, not too long ago.
I have Bipolar I or Bipolar 2, depending on which psychiatrist I see and when (diagnosed with BP I again, in July 2013). I am also “high functional”, which means I work FT outside the home, I pay my bills relatively well, I raise my teenager on my own relatively well.. all considering my mind war/battle.
I have periods of decompensation… really bad periods of decompensation.
I’ve had 5 psych hospitalizations in my lifetime, the last in 2006. Each trip, in which I was actually admitted (cause I’ve had 2 trips for which they DID not admit me) – I SIGNED MYSELF in voluntarily and willingly. I knew I was in deep deep crisis.
I’ve never had meds forced upon or within me, nor any other form of treatment. I, on occasion, am hallucinatory and paranoid and at times – delusional… and yet, strangely, there is still that small minut’ reasoning and awareness involved.
My stance is this: person is extremely dangerous to themselves and/or others – force the meds BUT not long term and not a moderate-severe length of hospitalization.
Meds are NOT for all with Bipolar and not all meds work on all with Bipolar.
Many of the psych meds, on the whole, can cause psychosis, aggressiveness, suicidal depression, major anxiety and other psych symptoms all on their own OR worsen what may already be there…
I liked you better before you became politically correct. (grin). You admit medication over objection should be allowed ” where the person is a danger to themselves or others (or they’re underage)”. Is the person dangerous when they start deterioriating, start to contemplate suicide, buy a gun, or do they have to fire the bullet first? I am also glad to see you make an exception for the underage, but what about those currently psychotic? It seems to me that someone currently psychotic, hallucinating, delusional should have someone else make decisions for them. That decision may be to treat or not, but someone should be helping. As for civil liberties, i don’t think being delusional is an exercise of free will, it is having your brain stolen so you can’t exercise free will. You’re one of my fav writers, but this wasn’t your best piece. Still, I wish I wrote as many good pieces as you. DJ Jaffe http://mentalillnesspolicy.org
Well written, DJ. I agree that a person who is floridly psychotic is incapable of making sound decisions and needs assistance even if not in immediate danger. I think it’s just the right thing to do, just as I think assisting somebody in the midst of any other medical emergency is deserving of help even if they cannot communicate. Natasha Tracy writes beautifully and her blogs are worth a read just to appreciate the lovely prose. Of course it’s a huge bonus that I think she’s right on target a vast majority of the time. DJ and Natasha, thanks to both of you.
I am not only Bipolar & properly medicated (yay!), but I am also an RN on acute inpatient Behavioral Health units at two hospitals. I am a strong advocate of the commitment to a combination of therapy & lifelong medication for those with Bipolar Disorder. I have lived through too much & seen so much more to ever be convinced otherwise. The vast majority of these patients who are not med compliant, suffer tremendously, as do their families–if they can bear to stick around to watch the nearly inevitable eventual downward spiral into dispair. Of this patient sub-population, many self medicate with etoh, illegal drugs, or prescription meds begged, borrowed, or stolen from others. I am not judging…I can clearly imagine many situations & have listened through countless heartbreaking hours reliving long buried memories of dark, hopeless, lonely nights when these tortured souls finally reached that point where the desire to numb the pain trumps typical societal mores & sometimes the will to carry on. Yet, I find myself firmly on one side of the line. I am strongly opposed to forced medication. The only exception to my personal rule is a two doc order to force IM (only legal in PA if the patient is on a 302 commitment & deemed mentally incompetent) meds if PO meds are refused, ONLY during a crisis situation in an inpatient psychiatric facility, ONLY when the patient is an immediate, imminent threat to themselves or others & all other less invasive / restrictive measures have been exhausted. If ALL of these criteria are met, then I believe the forced meds are appropriate & in the patient’s best interest. For all of these conditions to coexist, it will be very short term. If your question was regarding an open-ended time frame, then NO!!! Despite some very primal, extinctual (temporary) behavior, i.e. biting, spitting, “playing” in their own feces, anything…these people are just as human as you & me & should be treated with the same empathy, concern, compassion as the Oncology & Hospice patients on the next floor. All three have serious, life-threatening diseases. Today, we are the outsiders, trying to comprehend. Tomorrow, we could be them, still trying to comprehend. We know not what tomorrow brings.
Yes, I think they should be experimented with to see what is effective and what is not. Some can’t be fixed no matter what you do or what you try. Others, however, respond well to treatment. In my case, the person is not aware of their illness. I would welcome when the time comes to try medicine for my loved one. Her illness could be managed successfully. Yes, I do.
I dont think anyone can force anyone to do anything but I am thankful that my CPN and shrink gently remind me of the reasons of why I do take it. I am known to stop taking it when I feel well and this results in as you can imagine another knock for me as then I am back to square one.
While medication works for some others don’t need it, we are all different just as is bipolar. There is no tick box that we all tick.
I function better on medication, but I know friends manage well without it.
We know ourselves what works and our opinions and thoughts should always be taken into consideration.
This is definitely a controversial issue, and unfortunately there isn’t a really clear answer for it. While I agree to extent with you when you said that you should be the one to dictate your own life and make your own decisions, I also agree with the commenter above me who said that it’s a different scenario when people can’t recognize their own illness, and they could potentially live a higher quality life if they could.
But what about those unable to recognize their illness, because of the illness itself (anosognosia)? This is typical with many diagnoses. Of course someone who truly believes they aren’t mentally ill isn’t going to agree to treatment. But when bipolar or other mental illness is clearly demonstrated and documented, regardless of whether the person believes it, shouldn’t a doctor or loved one have the right to insist on treatment to try and achieve some level of stability? If this had been available for the people who committed the Navy Yard, Sandy Hook, and other mass shootings, these tragedies might have been prevented. I completely agree that someone whose illness is stabilized has every right to determine their treatment (or lack thereof), but what about those who don’t even know they’re ill? An Alzheimers patient doesn’t make treatment decisions on their own, because they simply can’t. The same applies to many who are mentally ill.
I’m sorry but I had to comment on the Mass shootings.t! Most of these horrific crimes are caused by individuals who were on or coming off Drugs.
Sorry to say they were the Victims!
Fact! Doctors destroyed their lives and they do it every day and get away with it. They should be accountable for their actions putting them toxic poisons Drugs when they should have been taught what to eat and to avoid as well as taught nutrition. The truth is out there and it does work!! I know I have been there. This is not a brain Disease!
Drugs, you will pay the price down the road. Drugs offer no nutrition just plain poison which you cannot live on. Eventually something has to give!
It has been 5 years for me and I am still learning something new every day.
I have been through a lot. Thankfully l I found truth and am now drug free but a lot of permanent Damage is done and family destroyed as lots of time and money just getting the run around. Trust me you never get better just sicker. All because I put my faith in drug Doctors! I was also a Victim just like the victims of the mass shootings. I know for a Fact I could have helped them where Doctors couldn’t. That is also a 100% fact! You can’t imagine how good it feels to be alive not in a drug induced coma waiting to Die.
If we were treated properly and told what caused there symptoms we all could of lived a decent life
And never made into some crazy person as Doctors, Drugs and there lies do.
I know I have been through the mill and back and I have the proof!!
Steve
The difference between Sandy Hook and the Navy Yard, as I understand via the news media…. the Navy Yard shooter was aware something was off, he tried on many occasions to receive psychiatric help and assistance, he even – as I understand it – went to a hospital a time or two, for help.
A person to receive treatment and achieve some level of stability – be aware, the stability IS NOT always stable.
Anything can throw off stability at any point in time, even some of the meds themselves via their adverse reactions and effects.
Not all who are diagnosed with a mental illness require meds for long periods of time or even a lifetime. Most do, but not all. There are even a few with Bipolar who have never seen the inside of a mental hospital, because they’ve not needed one.
Also, if I am correct (which I may not be)… a person with Alzheimers – unless they have already prepared a legal process in which another is assigned to act as and in authority of when they were “in their right mind and in charge of their own affairs/faculties”… someone has to go to court or file a legal proceeding to receive said assignment of authority
Dear Natasha..read with much interest your SHOULD BIPOLAR PEOPLE BE MEDICALLY TREATED..EVRYONES PERSONAL CHOICE..i do believe that there are scads of foolk out there and everywhere tghat need the medication..i have been on meds since mar 2001 and it stinks….why? because of what the meds have done to me,,i was prescribed olanzapine and that is all I need to tell you..look it up in the computer..as a matter of fact look them all up and see what damage they do to the body..a…ns eventually he damage gets transferred to the mind..the brain…I would like to see as an experiment just 1 or 2 months of not taking my meds what will happen but I am sure that this will neverr happen ..Natasha..still trying to get the va to confess that diabetes is not a justifiable side effect of zyprexa..olanzapine..yes..you read it right..they claim it is justifiable..i wonder how many people are on this med and have diabetes as cause of ingesting said med. oh well I will keep pursuing my dream of seeing the va confess to their med mal..once again Natasha..stay well..God Bless..until the next time…paul j
I choose to take medication to manage my Bipolar 1 disorder. I have been taking medication for 19 years. I am now on Social Security Disability, I but am hoping to get off one day and support myself while working at a full-time job that allows me the flexibility to do everything I must do to take care of myself, including scheduling last-minute appointments with my psychiatrist and therapist when necessary. I worked at full-time jobs for many years, but none of them offered the flexibility I needed to prevent relapse. I am working at a part-time job now, but it is hard to find a full-time job with the amount of flexibility that I need.
I believe that it is crucial for treatment decisions to be up to each patient. I think that mental illness is just like any physical illness, and that all patients have a right to refuse treatment if that is what they choose to do.