Dealing with the Bipolar Rage of a Loved One

I spent most of today composing this post in my head, then mentally erasing it as I decided that I would not post something so personal. I finally decided that if I am going to be completely honest about how bipolar disorder (and S's other disability) affects me, I have to post the hard times as well as the easy or clinical.

S deals with Type I Rapid-Cycling Bipolar Disorder. This means that, unmedicated, his moods shift rapidly from manic to depressed and back multiple times through out a day.

My stepdaughter also suffers with bipolar disorder. We are unsure of the severity of her condition, because she refuses to work with any psychiatrist or psychologist. She was diagnosed when she was placed in therapy through a court order.

One of the most disturbing parts of unmedicated bipolar disorder is the uncontrolled rage. It is for bipolar individuals to become enraged over the most seemingly insignificant things. When they are in a rage, they cannot control their actions. S and others whom I have talked to say that they feel sort of "outside" themselves. They know their actions are wrong and harmful, but they cannot stop until the rage is over.

My stepdaughter, who is 22 weeks pregnant, had one of these rages last night. She threw herself on her stomach on the floor ("exactly like a four year old," she says), punched her boyfriend repeatedly, completely destroyed her phone (arguably her most prized possession) and threatened her boyfriend with a knife. I have been through many of her rages, some of them targeted at me, it is quite frightening.

However, that is not the most disconcerting part of the episodes. What is truly unnerving is the way she can flip from complete rage to laughing and joking like nothing ever happened in the blink of an eye. This switch is why she is never admitted to a psychiatric hospital, no matter how hard we try.

By the time her grandmother got to her last night, the rage was over. My stepdaughter downplayed the entire episode, even though my mother-in-law heard most of it on the phone. She did agree to seek psychiatric help, so we drove her to the hospital, which is an hour away. (In our area all hospitals are at least an hour away.) By the time we made it to the hospital, her story had changed to "she had fallen, and needed the baby to be checked out." We confronted her, and she admitted to the real story, but did not see the need for an inpatient stay.

Because she was so calm and under control, the mental health worker did not see a need to admit her either. She denied any intention of harming anyone and there were no accessible medical records supporting her bipolar disorder. I do understand how he came to his decision.

Unfortunately, a normal person's moods and feelings do not switch that fast. Even though I understand what happened intellectually, emotionally I am still mad as hell and scared for her boyfriend, her unborn child and her.

The rages are increasing in severity, which is also a sign that her bipolar disorder is increasing in severity. I fear what she will do.

I have known one bipolar individual who had a standoff with the police, complete with guns. I know S has done some incredibly stupid things in a fit of rage. Both S and I have gotten hurt trying to subdue our daughter during one of her rages. She has destroyed property, broken down doors and kicked her four year old brother.

Right now, the only thing S and I can do is to refuse to allow her into our home and around our younger children.

This is one of the hardest decisions we have ever made.

It is hard to tell one of your children that she can no longer have contact with you. I truly hope you never have to experience this. But, we have to protect our own sanity, and we have the safety and innocence of our younger children to think about. In this instance we truly have to sacrifice one to save many. Knowing this does not keep me from crying for and worrying about her and her unborn child.

Please understand, before you judge me, this is not a unique instance. This has been going on for the five years that I have been in her life and even longer. Her mother,father and brother have been dealing with this all of her life. At some point, you have to say "STOP!" She is 18 years old, living on her own and responsible for her own life. Everyone needs a break from it. And, if she is not going to get help, she must deal with the consequences on her own. We cannot force her to do anything. Nor, can we stop this. We must now think of our other children and ourselves.

Tolerance, Dependence, and Addiction

Tolerance is a patient's need for an increasing quantity of medication in order to achieve the same effectiveness.

Physical dependence, by contrast, is a known effect of certain types of medication and is characterized by symptoms of withdrawal that differ among medicines...Medically speaking, physical dependence is not considered to be either postive or negative.

Addiction..is primary, chronic disease influenced by psychosocial and environmental facters.  It is also strongly genetic.  Addicts are not made from people who do not have the appropriate genetic makeup.  Exposure to pain medications..does not create addicts.  Psuedoaddiction is a syndrome in whcih patients who desperately seek relief from undertreated pain mimic the behavior of those seeking drugs for different reasons, and this merely clouds the picture.  People in genuine chronic pain suffer the more because these distinctions are not generally understood. 

Arthur Rosenfeld: The Truth About Chronic Pain

After reading the first part of Rosenfeld's book, I realized that S's struggles to get proper pain medication are not unique.  What is unique is the fact that he has bipolar disorder.  Bipolar individuals often self medicate with alcohol, narcotics and other illegal drugs.  They are much more susceptible to addiction in the true sense of the word. S was automatically classed with the drug addicts and drug seekers before he even explained what hurt.

After his second surgery, S wanted to get off the narcotics all together.  He was sick of the constipation, the fight with his doctor to get the proper dosages, and, above all, he was sick of being seen as a drug addict.  He was still in excruciating pain, but he was so humiliated by how he was treated that he felt the pain was better than fighting for proper pain management.  His psychiatrist actually asked him "Are you out looking for street drugs, yet?" When S responded with an emphatic "NO!" His doctor came back with "You will be."

His primary care physician told him flat out that he would no longer prescribe any pain medication and to either admit himself into a rehab program or experience withdrawal and all the wonderful things that come with it alone.
The neurosurgeon--who started him on the medications in the first place and later put him back on them--referred him to a pain management clinic.

The doctor at the pain management clinic told him that because of his bipolar disorder and the extent of the surgeries, S could not take the normal route of steroids and nerve oblation. The only option open to him was narcotics, but they could not prescribe narcotics because he was bipolar. "Go back to your family physician."

He tried to withdrawal at home. It was horrible. I had just had a baby less than a month before. We had been warned that because of the high dosage of medications he had been taking, he could end up with seizures and possibly die.  I just couldn't deal with that and a newborn, so he admitted himself into a rehab eight hours away from where we lived. It was the only one with an open bed.

He was not addicted to the medication. He was dependent on it. Just like I am dependent on my medication. If I am not properly stepped down from my medication, I go through severe withdrawal symptoms--dizziness, disorientation and possible suicidal thoughts. My doctor will step me down when it is time. The difference between me and S? My medication is a non-tricyclic antidepressant and his are narcotics.

The ironic part of this story? Within a month of returning from the rehab program, it was discovered that the second fusion had failed which explained the horrible pain he was experiencing and the need for additional pain management. His neurosurgeon prescribed an even higher dose of pain medication than he had been taking to get him through until the third surgery could be performed.  And, to add to the fun, we were told the third surgery was only to ensure that his spine was properly supported. The chances of actual pain relief were slim to none. We were looking at starting the medication game all over again.

About Us

Photo by Michael Dorausch

Three years ago, my fiance, S, started a long journey to repair a herniated disc that included two posterior lumbar and one anterior lumbar fusions.  Due to his inability to grow bone, the posterior fusions never "took".  The anterior fusion was simply to stabilize his spine.  The area where the disc used to be is now completely encased in a titanium cage.  The titanium cage does not move like the rest of the spine, which puts pressure on the discs above the fusion.  The failed fusions, combined with the pressure on the adjacent discs have left him in constant pain, unable to stay in one position for any length of time and on heavy narcotics.  He will never get better without a miracle, he will probably get worse, and he's 40 years old.

In addition to his back problems, S also has rapid cycling bipolar disorder.  We have spent the last five years finding and tweaking the medicine that works for him.  Unfortunately, his bipolar medication causes his body to absorb the narcotics at a much higher rate than most other people.  And, the narcotics affect the way his body handles the bipolar medication.  He walks a very fine line, medication wise.

As anyone who lives with and loves a person with a disability knows, his health problems do not only affect him.  It affects the whole family.  As his partner (for lack of a better term), I have become an "expert" in S.  Ask me anything about his medications, how they interact, what happens when he misses a dose, his pain levels, his moods, etc., I can give you the answer.  I am his advocate, his cheerleader, his chauffeur (he doesn't drive), his nurse, his whipping bag, his spouse.   The order of these roles changes on a daily basis.  I am the person who tells the doctor how it really is, because S is so sick of talking about it and just wants it to go away.  I pick up the pieces of our life that he can no longer do along with the chores I already did.  And, I try to smile while doing it.  I am 37 years old.

I am starting this blog to help other people in my situation.  There is all kinds of information out there for caregivers for the terminally ill or older individuals.  What about those of us with small children and a life ahead of us?  How do we deal with the fact that our plans for the future are drastically changed?  How do we deal with the fact that we will be living with this for the next 40 years?  Where do we fit in? My hope is that I can be a help to other people in my situation and that they can help me.

Welcome.