Feedback Friday: What Every Loved One Needs to Know About Meds Noncompliance

John McManamy Health Guide
  • To readers: After a brief sabbatical from my shareposts here, we have retooled my shareposts to respond to issues that YOU raise here at BipolarConnect. Every Friday, I will respond to topics you have initiated over the course of the week, on features throughout the site, such as the popular Ask feature.

    For lack of a better term, let's call this series of shareposts "Feedback Friday."

    Those who wish to follow my own daily musings on mental health are encouraged to check out my blog, Knowledge is Necessity, which has been going for two months.

    But please come back here. The way I look at it: You own BipolarConnect. What you say informs my thinking, kicks my brain into gear. Take my word for it, you have lifted my game considerably. And I welcome the opportunity for an even deeper involvement.

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    Let's get started ... 

    In the Ask feature here at BipolarConnect, Lindsey writes:

    "My husband went off his meds about 6 weeks ago and is definitely in a manic state ... "


    First, let me say to all loved ones, I'm in your corner completely. A person who really opened up my eyes is Judy Eron, author of "What Goes Up: Surviving the Manic Episode of a Loved One."

    I've met Judy several times, plus we regularly exchange emails.

    In the book, Judy describes how her husband and soulmate Jim went off his lithium. No sooner had the drug washed out of his system than his behavior became bizarre and abusive. Judy was caught in the classic innocent bystander situation, forced to deal with this alien impostor who had replaced her husband. As the marriage disintegrated, she had no choice but to find refuge in her friends and family.

    Unfortunately, Jim never came to his senses. One day, Judy received a phone call. As I describe it on my website:

    "It was the Jewish Day of Atonement. At-one-ment. Jim had completed his tortured path to spiritual wholeness. For the woman he left behind, putting back the shattered pieces of her life was only just beginning."

    Hopefully, if you're a loved one in this situation, events will resolve on a much happier note, which brings us back to Lindsey. Part of her question goes:

    "I'm tempted to say unless you come home and take your meds you can not come near the house but i am scared of pushing him away ... "

    Lindsey (and other loved ones) really got me thinking. Sooner or later - generally after the short-term crisis has been resolved - you are going to need to confront your non-medicated partner. Do you read him (lately it's been males) the Riot Act? Or do you try diplomacy?

    The two of you are seated at the table. Your loved one makes eye contact. He is waiting for you. It is time ...

    Here is where it gets difficult. You probably want to remind him that going off meds is stupid and destructive, but that's your logic at work, not his.

    So, first step, unwrap your fingers from the handle of that skillet, take a deep breath, and validate - yes, validate - where he is coming from.

    Something like this would be a good opener:

    "I don't blame you for wanting to flush your meds down the toilet at times. I can see that having to take them really bothers you. Do you want to talk about it with me?"

  • Keep in mind, noncompliance rates are very high for bipolars, and it's not necessarily because we are addicted to our hypomanias. For one, the meds are often problematic and tend to come fully-loaded with onerous side effects. Often, they affect our ability to think clearly. Now you may take your brain for granted, but we don't.

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    Typically, a bipolar will initially feel better when he goes off his meds. There is a grace period where clarity of thought returns and one's mood has not spun out of control. In short, for one brief shining moment, your loved one is feeling like you.

    Also, you need to be mindful of the fact that while our meds tend to make us feel better, they do not necessarily make us feel well. Is this it? we often wonder. Is this the best it gets? Is this what it's going to be like for the rest of our lives?

    A good psychiatrist, together with other clinicians, can work with your loved one in getting him to well. Into having a brain that thinks clearly, without losing control. But too often, psychiatrists abdicate responsibility. They are content with stable, not well. They don't listen to your loved one.

    "Stay on your meds," the psychiatrist says. "You know what happens when you go off."

    No doubt, this is exactly what you want to tell your loved one. One word:


    This is a sure conversation-stopper. What you are saying, in effect, is all that meds are good for is keeping people out of crisis. Your loved one is looking to win back his life, not hover in the same holding pattern over the same bleak vortex the rest of his life.

    You're the one who knows your loved one best. If you serve up the proper cues and assure him that he can speak his mind without fear of disapproval, you are likely to hear things you never even suspected were on his mind. His hopes. His fears. His frustrations.

    Finally! he may be thinking! Someone is listening.

    This is your cue to say you are here to help. That you will work with him in getting him to well, not better. That you will be his ally in his efforts to find the right meds and the right treatment team. Whatever it takes.

    Ah, meds. By this point in the conversation, the two of you may be on the same page.

    There are many more facets to this, but for right now, the two of you are off to a good start. More later ...

Published On: February 27, 2009