Nadia asks: Do the same rules apply to people with dual diagnosis? What if my loved one is diagnosed with bipolar with psychotic features? He is currently at the hospital. I still see him as healthy and whole inside, but he’s very unstable now.
Nadia, thank you so much for your question. I know for sure that you’re not the only one wondering about this issue.
I love that you’re saying, “I still see him as healthy and whole inside.” I hope that you’ll hold on to that because he is. That’s who he really is deep down, but there are extenuating circumstances currently holding him back from presenting as his best self. When people have mental health conditions, the brain is acting in ways chemically that aren’t conducive to recovery. There are medications that need to be used for the brain to be able to get what it needs. And I see mental health in exactly the same way as physical health. Having Crohn’s disease for many years, there are things that I need to do to take care of myself. And there are things that somebody with bipolar or any mental health condition needs to do to take care of themselves. If the person who’s addicted in your life isn’t willing to take those medications, it’s hard for them sometimes because they don’t always feel good inside. They may not like taking the medication, but they need it.
If they’re not willing to do what’s important for them, then you’re probably going to have to set some boundaries around that, such as: “We love you so much, and we really want you to be part of the family. We are not able to continue with the mood swings that happen with your bipolar disorder. We understand that you have an illness, and we understand that you need medication. If you’re not willing to take care of yourself and do what you need to do, then we might not be able to have a lot to do with you. We’re hoping that you’ll follow medical advice so that we can have you in our lives because we love you.”
That would be a message that I would give somebody with a dual diagnosis. It’s real. There can be a lot of dysfunction going on in the brain. When somebody is using or drinking and putting other toxic chemicals into their brains, it can be particularly hard to make a full assessment about what’s really going on for them with dual diagnosis. It’s difficult to know where one stops and the other one starts.
In order to truly assess somebody, they need to be clean and sober for a little while and, unfortunately, that doesn’t always work out well. But if they’ve been assessed as bipolar, schizophrenia, or a similar diagnosis and they’re not willing to take the medications they need, nothing much is going to change with them. They’re going to keep having their problematic symptoms, and if you keep having a lot of contact with them, you’ll be dealing with those issues. Until you set some boundaries, they will expect you to deal with that. This is what makes dual diagnosis such a difficult thing. There are people who specialize in dual diagnosis (which can also be known as “co-morbidity”), and I would suggest that you reach out to somebody who knows that so that they can give you the best advice.
All my best,
Candace
