Q:  When is Behavior Excusable as Bipolar Related?

How do I respond to friends/people who are "uneducated" about bipolar disorder, when they say "well he's choosing to do the things he does, and you're using manic depression as an excuse for him, all he has to do is make different choices"(while in a manic phase--i.e. go with the wrong kids, stay out all night, not go to school, etc., etc.)

How do I intelligently defend the illness he has without making "excuses" for him?



Dear Jean -- 
Ah, tricky but very important question.  It goes to the heart of our concept of free will, doesn't it?  And our society is not ready to fully grant that people with bipolar disorder really do completely lose control of their behavior at times.  And I'm not sure we want society to start thinking that way, either: they might respond by getting more controlling, no? 

So, one thing I figure is pretty solid: a person with bipolar disorder can be held responsible for taking all routine steps to avoid a recurrence of mania.  Make sure to get enough sleep; make sure to have therapeutic levels of mood stabilizers with track records of preventing mania; have an emergency plan for family/significant others to catch early signs and symptoms and get the psychiatrist/NP alerted and some actions taken; perhaps even, for people with really severe and especially really destructive manic episodes, have an "advance directive" document okaying hospitalization and treatment with medications even though at that point he might be refusing these. 

You could ask for a clear statement from him and/or his psychiatrist/NP about what are manic symptoms for him.  If they are not present when he's skipping school, that's not "excusable" by "bipolar disorder".  If they are present and he's not taking active steps to get his manic symptoms treated, that's not excusable either: time then for some resetting of boundaries/expectations.  Hope that helps. 

Dr. Phelps

Published April, 2001