When My Crazy Father Actually Lost His Mind

You expect a schizophrenic man to argue to the judge that he shouldn't be committed because when he said he was going to shoot his kids with a shotgun, he didn't really mean it; you might not expect his perfectly sane court-appointed lawyer to pick through every detail of your records looking for a reason to let him out.

My mother called me last week upset nearly to tears by a phone call she'd had from a "doctor" employed by an insurance company, who was trying to argue that her patient's mania (which he knew nothing about) wasn't a serious enough medical problem for them to pay for treatment.

At this point she's planning to get out of clinical work; she wants to help people, but she feels like the system just isn't set up to let her make a difference.

We need to fix this a decade ago.

But in 2011, when she had another bout, the hospitals refused to hold her for more than a week, and she was returned home only to be a nuisance to her landlord and a weirdo on the street. The social worker said to ask the police to take her to CPMC or St Francis (private hospitals) who will be more likely to hold her for long enough to recover instead of SF General, but since then she hasn’t been an imminent threat; merely a loud, paranoid insomniac who can’t get anything done.

It’s very difficult to reason with her regarding her illness, which she denies when she’s manic. I don’t know first-hand the facts of her police mistreatment or landlord interactions or whatever she happens to be angry about, so I can’t convince her that she’s wrong. Oh, and she refuses to take her medication because she’s convinced that they will ruin her liver. I sometimes wonder whether a smarter, more introspective manic person would be able to deduce logically that their paranoias are irrational and rein themselves in. But alas, her poor concentration and temper hare never allowed her this power.

"21% of patients with bipolar disorder and a diagnosis of severe substance abuse (alcohol or illegal drugs) were convicted of violent crimes, compared to 5% of those with bipolar disorder but without substance abuse, 5% among the unaffected siblings of bipolar patients, and 3% among general public control individuals."

Source: http://www.ncbi.nlm.nih.gov/pubmed/20819987

I haven't actually read the study much less the rest of the research on this, but the actual statistics on this (whatever they are) seemed conspicuously absent from this article. In fact there really really no statistics whatsoever. It's a heart wrenching story, but there are good reasons why it's generally not a bad idea to create public policy based solely on individual cases.

Granted there isn't nearly as much research as there should be, and at some level you eventually do have to go with your get because of that, but at the same time there is a hell of a lot more evidence than was presented.

But since we are in the USA, this will take decades to happen, if ever. The only hope is a massively profitable, universal drug is invented, then pharmaceutical companies will fall all over themselves spending a fortune to market it like viagra and make it "hip".

Until fairly recently doctors had no idea how to measure minimum effective doses of lithium, so many older people with bipolar disorder are suffering damage to their liver, kidneys, and thyroid. Mental health practitioners also used haldol and thorazine with a pretty loose hand - without worrying about side effects or toxicity.

So realize that she has a reason to believe that her meds are bad for her - because they are, they are just better for her than going un-medicated. Her doctor or social worker should probably be the one to explain to her the kind of testing and monitoring they do to make sure that they do as little damage as possible.