How do I Best Respond to a Friend in a Manic Episode
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Q:  When my bipolar friend is headed for a manic episode and makes bizzare statements such as 'they implant something on my forehead' what is the most appropriate way to respond? He already takes mood altering medications.

Dear Cynthia -- 
First, the best way to set this up is to work with your friend when he's not making bizarre statements and make a plan for how he'd like to have you help him.  

For example, the agreement might be that you call his doctor and leave a voicemail saying "he's making bizarre statements again, and he has an appointment for Feb 10th (which you helped get set up) so you don't need to do anything right now, just letting you know what it looks like out here".  Or, "he's really bizarre now, worst I've seen, he needs to be seen right away but your office says your next available appointment is not until Feb 10th.  He's willing to come in to see you still, but if this gets any worse I'm not so sure about that.  Can you get him in sooner?"  Or finally "he's so bizarre I'm really afraid for him, he's talking about doing things I think might be dangerous.  Can you help get him in the hospital?  He's willing to go in.  You can reach him today at 310 000 0000 until 4 pm and after that at home at 310 111 1111"

Or the agreement might be that you would take him to an emergency room if it ever gets so bad he doesn't really know what's real anymore -- if working through the doctor or clinic is just impossible (but once you go an emergency room you're kind of at their mercy regarding when you'll get seen and what will be done -- but at least they're always there).  

You could have this agreement include several other people, perhaps including some family member of his, so you don't have to do this all on your own.  

But notice, the general idea is that he gets to set up the plan, or at least set it up with you.  Okay, but what are you supposed to do now? If you are really sure what approaches, like those described above, he'd want you to take if he was able to tell you (and maybe he's still able to tell you if you ask?), you can take them this time and work out the "next time if there is one" plan later.  

Lots of people don't know this, including some doctors, but the "release of information" thing the doctor must have to talk with you does not prevent you from talking to her via voicemail!  Then you know she knows what's up, at minimum.  You can really help her by saying that a call back is not required, this is just for her information.  Or if a call is really needed, help her establish "how fast?" and to what number, with multiple time options, and make sure it will work.  

Finally, what else to do if things are headed toward mania?  If you know what usually happens and the ways in which it's destructive for him or you or others, you can get started trying to head that off.  Even going so far as removing credit cards from his wallet, for example, would be acceptable in my view, in many cases, but you can see why getting this worked out in advance with his consent is such a big deal.  Generally, getting several other people involved to help you is a good idea, so that you can discuss with them what you're thinking might be necessary.  This way you can get some input on how far you can go trying to limit his autonomy -- consensus amongst several friends/family is much better than trying to do that on your own.  

Writing bulletin boards like those here at Bipolar World and describing in more detail the situation and your worries will also get you some help and some ideas, from people who've been through this on "both sides" of the illness.  

Dr. Phelps

Published February, 2003


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