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Q:  I have been in and out of a relationship for one year with a young man (22) who suffers from bipolar disorder. He off and on uses cocaine and drinks at least 3 nights a week. He is a fabulous and fun person normally, but one side is very cold and selfish. He refuses to take medication, his reasoning either being "I don't know why I can't take it, but I can't," or that he wants to be strong enough to "fix it" himself.

I love him more than anything, but every 2-3 months we either quickly break up, he does something incredibly inconsiderate, or he just disappears for a week. My question is when I should give up- do these type of people usually hit a point in their life where they all of the sudden realize that they need to be properly medicated? And can I really help him reach that point, or must it be achieved completely on his own?

Thank you for any help/advice you can give me.

Dear D,

     There are many things about bipolar disorder that you may not like but the more accepting you are of the realities of this illness and how they may affect your relationship in the future, the easier it will be to either help your partner find stability or make the decision that you no longer want to stay in the relationship.  Your partner seems to be cycling through extreme changes in mood during these 2-3 month periods which you describe.  This is very likely a part of his unmedicated bipolar illness.

     Your partner may in fact be attempting to medicate himself with his use of cocaine and alcohol; however, alcohol and drug abuse tend to reek havoc in an individual whose neurochemical system is already unstable.  Bipolar disorder is a chronic illness like diabetes and requires constant treatment and re-evaluation.  Unmedicated bipolar disorder always causes problems.  Your partner must stay on his treatment.  It requires patience and persistence to get the correct medications and dosages and once improvement is noticed, he must continue taking his medication for the rest of his life.  Stopping medication "just because you feel better", can throw him into a relapse, which can adversely impact his ability to return to his earlier level of functioning.

     People with bipolar disorder frequently learn over time that they need to be properly medicated when they view the benefits as outweighing the disadvantages.  You need to try to sit down with your partner (and his psychiatrist) and create a plan that keeps him on his medications and away from drugs/alcohol.  This can include writing down the thoughts and feelings your partner first has when they start to feel they're well enough to stop the medications.  It also means having for example a doctor's number written on this list to call if you feel your partner is getting sick because they stopped their medications.  If you've created a plan and your partner won't use it, you may have to make decisions about your own life.  Do you stay or do you go?

     You need to get clear and set strict boundaries about what you will and will not tolerate regarding his untreated bipolar disorder and then stick to what you say.  It may be that you will have to tell your partner that you can be with them only if they continue to take the medications that prevent them from becoming sick.  Only you can decide how long you should stay in a relationship that isn't working.  What if no matter what you say or do, your partner simply refuses to make any changes?  You really can't change someone, but you can make it clear what you need in the relationship.  You can't force your partner to do anything.  At times, you can only take care of yourself.

David Schafer, M.Ed.
Staff Psychologist

Published April, 2006

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