Practical Advice for the Bi-Polar Care-Giver

I’ve been to a number of events put on by social services to help families coping with the mental illness of a loved one or at least a family member. Social workers at community groups will give you generic advice, but it’s of no practical use for someone who has been run ragged by a bi-polar person for decades. For example, they’ll tell you to reduce stress and other paint-by-numbers advice, but nothing concrete.

I have distilled my experiences into the following. Keep in mind, I’m in my 40s, am unmarried with no children and am dealing with parent diagnosed with bi-polar disorder a long time ago and has been in treatment for it since; geriatric issues are slowly beginning to appear. Your own experiences and mileage will vary.

Image of man-made drain in a natural lake

Your soul in 20 years

Basically, you’re fucked

Why are you fucked? Because you’re the only one left. Your relations and your bi-polar person’s friends have figured out that life is too short to endure the agony of close contact with the person in question. You know what, maybe you can take some of their advice. The agony will end when your bi-polar parent slips into permanent senility or is in the sweet embrace of a casket. Until then, you’ll be dealing with an uncooperative paleologic tangle of need who will create an endless string of manufactured emergencies about random subjects between temper tantrums and periods of operatic self-pitying.

You don’t need to be in daily contact. If the person is capable of bathing, you’re fucked but not completely. To quote the great Admiral Nelson, ‘Desperate affairs require desperate measures.’ Don’t worry about what other people think as they are not the ones with their arses on the line.

What you need to do, is reduce the amount that your are fucked. Essentially, damage control. You are fucked in two ways: damage to yourself and damage the mentally ill person will to do him or herself. This essay covers some of each.

1. Control contact

Assuming the mentally ill person can manage bathing and other sundries, there is no reason to have daily contact. Print that and stick it on the kitchen door. You are in no obligation to be in contact with this person every day.

  • Reduce the amount of telephone contact
    If the person is a phone-a-holic, find out which mobile phone service will allow you to block calls that way you are in control of when you communicate and how often. I required this step myself and I should have done it years ago. My parent would fill my voicemail by lunchtime and if I deleted the messages she’d only leave more. Finally I arranged to have her inbound calls blocked but I needed to switch phone companies to do it. (I’ll return to this topic later.)
  • Reduce the amount of direct contact
    Contact shouldn’t be free therapy sessions. Instead, make your visits task oriented events such as the weekly shopping. Or have groceries delivered and have the task oriented visit tackle something else. This way, when the task is done, you and the mentally ill relation can part company and it’s been productive. This also prevents the ‘you don’t do anything for me’ complaint because that is specifically why you are there.

2. Ring fence the amount of financial damage the mentally ill relation can do to him or herself.

Contact the bank and have a reduced credit card limit on the person’s card to ensure that she or he cannot do much damage to the family finances. After all, unless you are buying a car or renovating a house, how much credit do you really need at a moment’s notice? Get the bank manager to sell the mentally person on a bank mandate. This will ensure you have administrative access to the person’s finances to a) monitor for irregularities and b) ensure bills get paid. I am suggesting that you get a bank mandate first because it’s an easier sell than a general mandate in case of incapacity. As you are no doubt aware, bipolar people have moments of incapacity and general times when they’re on the ball. The general mandate in case of incapacity is really the nuclear option and should only be employed in extreme old age. You should probably get one but it’s a separate step and it’s a big one; wait a few years.

Use your meeting with the bank manager to ensure any concerns about a cash grab by relations are discussed. There is usually one in the family tree. The bank should have some pamphlets about financial abuse of elders handy.

In my case, I’m dealing with a geriatric bipolar person and the bank was more than happy to have me take over for her. She was using the bank as her place to socialize. If your bi-polar relation monologues as much as mine, the bank staff will be overjoyed to help you and even arrange for a marching band to celebrate the event.

Obviously, set up automated payments for bills. If you’re not good with this sort of thing, the bank will help you with this happily.

3. Documentation

What ever bi-polar parent’s medical condition (i.e. any comorbidities), get the doctor to document all diagnoses on what ever certificates and forms they think best. Being able to wave a piece of paper under sundry noses can be very useful for obtaining various services from the various levels of government in your area. There are all sorts of classifications for medical conditions, and your bi-polar relation doubtless is on one or more of them.

Documentation is key. You never know what programs will be announced or  — in these days of austerity — cut. Having your mentally ill parent classified, named, stamped and certified on this or that form ahead of time may can be a good idea. As program spending is reduced, being the first one in line with a piece of paper documenting your bi-polar relation’s acuity may prove vital.

4. Ignore what social workers say and watch what they do, which will be nothing. 

Social workers are wonderfully adept at holding your hand and cooing sympathetically while doing nothing. If you’re a social worker and reading this, I don’t mean to sound unsympathetic, as I’m aware you’re dealing with finite budgets, but I don’t care about you, I care about the bi-polar caregiver who’s having murder dreams.

I’ll return to this theme in a later post, but if you want to get anywhere with a social worker, the best way is to never speak with them. If you speak to a social worker,on behalf of your bi-polar parent it’s game over however, assuming it’s not too late because some sort of process has begun, here’s what you may wish to do.

If you’re on a phone call with a social worker, and you get the feeling you’re being told that you’re getting nothing, stiffen your spine and actually ask direct questions to obtain unambiguous yes or no replies. Police are skilled into getting people to incriminate themselves by asking questions that result in practical confessions; similarly, social workers are very well practiced in saying ‘Tough luck, you’re on your own’ when making it sound like they’re doing you a favour and getting you to thank them for it. Ask questions like:

  • ‘I’m sorry, I don’t understand: can you tell me in 12 words or fewer the purpose of this call?’
  • ‘So, you’re telling me that you have a geriatric bipolar person who has mobility issues, and has had falls and you are choosing to risk incurring greater expense to the system, rather than provide a walker? Do I have that right? Can you give this to me in writing, please?’
  • ‘You’re suggesting I quit my job and go on social assistance to become a full time unpaid geriatric psychiatric nurse and abandon my children. Okay, please explain why I would do that?’
  • ‘We’ve established that this is a geriatric patient with diagnosis of bi-polar disorder, kidney failure and an undiagnosed palsy and I live an hour away. Your suggestion for her getting to medical appointments is that I take off five days of work per month forever. In practical terms, you’re asking for me to get fired, is this correct?’

Once you’ve shone a light on what they’ve said — that you’re being hung out to dry — ask them specifically what you can do to get on the other side of the decision line. I know I’m knocking the valuable and important work that social workers probably do, and I promise to make up for it in another post but my practical advice is to never assume that social workers will help you and certainly not immediately or with speed. (UPDATE – – Topic revisited in a follow-up post.)

As a side effect, sometimes due to a medical event, a hospital will call and say to pick this person up but stay with her the next 24/48/72 hours. When will they call? Friday afternoon. I’ll probably return to this subject in a later post but the ‘no’ word can work wonders here too. Remember, they’re past masters at getting you to agree to this sort of thing. (UPDATE – – Topic revisited in a follow-up post.)

5. Get the person into a supervised environment.

Should family members live together? Maybe, but don’t be guilt-tripped into it. Your life isn’t a Norman Rockwell painting so don’t pretend it is for the benefit of others. And certainly since you probably the last one left to deal with your bi-polar relation, it’s suspicious how few of your relatives seem to be jumping at the chance, eh?

Okay, now people have different levels of income and I cannot know what your financial situation is, dear reader, but there has to be some sort of environment where the bi-polar person can live, or live near. The reason is the worst thing that can happen is medication compliance issues. Getting the person into a location where meds are supervised is key. The latent assumption here is that your parent’s spouse is now deceased and that you’re the only one left talking to your bi-polar, geriatric parent.

Your own life matters and as I told a social worker: ‘If she moved in with me I’d move out.’ Like it or not, your long term goal: to get this person into a good environment with people her own age, and programs, and busses and social activities. If you don’t have the financial wherewithal to make it happen immediately, make this your long term goal; it may take a while to get onto enough waiting lists to get this to happen which is why documentation is so vital.

  • Use the ‘No’ word when people insist the bi-polar person be moved in with you. If they think it’s such a hot idea, they can go first.
  • Do not worry about what other people think.

6. Doughnuts and stamps

Seriously, bring sticky buns every once in a while — every three months for a senior’s home for example — in order to grease the wheels. Doubtless your bi-polar parent has been driving the staff  and management crazy. You’d be surprized how much a thing like this counts. They have hard jobs, showing sympathy and appreciation counts.

Once you convert a ‘tough luck, let us know how it works out’ to a ‘O, we did find some money under the seat cushions for that program,’ mail a thank you card to whoever got your mom or dad into that program. Seriously, no one does that any more. You’d be surprised how well that goes over. Moreover, call just to say ‘hi’ and two weeks after they’ve told you to fuck off. You never know what might get shaken loose the next time you call.

7. Never accept blackmail

People are generally reasonable but the universe looks very different to a mentally ill person. Basically, the world seems to operate on supernatural forces with no rules. So, the few things over which the bi-polar person have control, they tend to use like a stick. My mother refused for years to do a will as it was a club with which she could beat me. Finally, one night she rung me to say that she needed a soft drink and I should drive across town in rush hour because ‘I’m going to do my will soon.’

I replied: ‘Let me get this straight: you’re blackmailing me over club soda’ hung up, and didn’t return the next three dozen phone calls.

If you give in to black mail, the person won’t respect you. In my case, the mentally ill person was using the power of denial — a long time favourite tactic — to control. Any time she had a decision to make, she use that power to fuck things up for others ‘just because’. Well, don’t accept it. Call the bluff and hang up.

Your self-respect and sanity is not worth it. 

Pro tip: Blackmail regarding the mentally ill may not come directly from the person in question. Other relations may use it because they don’t want the, um, pleasure of the mentally ill person’s company.

8. Become a yes man

Agree with everything the bi-polar person says and then go ahead with what you were planning anyway. This was suggested by a friend who is a parent and, while it can be disrespectful and autonomy reducing, I guess it’s what dads and moms do sometimes. Not being a parent myself, I assume everyone with whom I am dealing is a rational agent. Wading through the sudden shifts in contradictory demands, I assume there’s a logical thread and what’s frustrating is that there is none. Of course, it’s maddening to me that there is none, and after several decades of this, you’d think I’d eventually learn but in my defence, I guess my instincts for logic are overly muscular.

Say yes, and move on and hope the bi-polar person moves on. Key to doing this, however, is to reduce the amount of contact so you don’t have to wade through a firehose spray of demands and end-of-the-world needs.

Say yes and move on. If asked why, say ‘soon’ or throw out an obfuscating delay like the pressures of work or your car sprained its differential or that your computer needs a new oscillation over thruster.

Summary

You actually have cards to play.

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One thought on “Practical Advice for the Bi-Polar Care-Giver

  1. CAROL HILL says:

    WOW THATS ALL I CAN SAY 🙂

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