Fast Talk: Dealing With DenialEventually, we need to face the facts about our reality and diagnoses
By Julie A. Fast
It can be upsetting, stressful, and downright incomprehensible when someone with a diagnosis of bipolar disorder denies the illness and refuses treatment. You may find yourself watching helplessly as behaviors tied to untreated bipolar lead to family distress, broken relationships, problems at school and work, money woes, and alcohol and drug abuse.
If you try to help someone in denial, you will probably be accused of interfering if you even mention the word bipolar. This is confusing because it’s very easy for you to see what’s wrong, and naturally you want to point out the problem in hopes that the person will then get help. Often, however, your attempt just makes things worse.
It hurts when a person in denial shuts you out, but it’s common.
What’s even more confusing is that you can have an honest conversation about bipolar when your loved one is stable, reviving your hopes that the person will enter or stick with treatment. Then boom! Here comes the denial again.
It may be cold comfort to learn that it is very typical behavior for people with bipolar disorder to deny they are sick and avoid treatment, even if they have been in the hospital or taken medications for the illness in the past.
It’s important to remember that people in denial are usually miserable, in a great deal of internal pain, and can’t see a way out. It’s easy to believe they really can’t see what’s going on, but unless denial is a result of a mood swing such as strong maniaor paranoia, the affected individuals usually know what is happening. They respond to your concern with aggression because they are trying to protect their decision to deny the illness.
It hurts when a person in denial shuts you out, but it’s common. The person prefers to be around others who don’t mention the illness, and will paint you as the bad guy because you are the one who is stating the truth.
There is good news, however. I’ve talked with hundreds of people who moved through denial to eventually admit that bipolar is at the root of their problems and they needed help. Over and over I’ve been told how despite their relentless inner pain and confusion, they refused help and pushed away the people who cared about them.
It’s when someone realizes that they no longer want a life controlled by bipolar disorder that they begin to listen to loving advice instead of fighting back.
Steps toward change
Find the sweet spot. Are there periods when your loved one is more open to discussion? Often people are more receptive during a mild depression. Once you see a pattern in your loved one’s moods, you’ll have a better sense of when to gently start a conversation.
Set expectations. If a loved one with bipolar is living with you, you have the right to set expectations for behaviors such as drug use, drinking, yelling, staying in bed all day, staying out all hours and, yes, refusing treatment. You are always in control of what works best for you. It’s not always about the person with the illness. It will be up to you to decide the consequences if your expectations aren’t met.
Understand the challenges. Always remember that bipolar is an illness. No one chooses to have bipolar disorder. People in denial can be very unpleasant and it’s easy to walk away from them, but don’t forget they are suffering. It’s OK to address this directly. Go ahead and say you understand that it must be hard to have someone tell you what to do. Say that you can tell the person feels misunderstood. People in denial may get angry or refuse to reply, but they have heard you. Many times, when they get better, they will tell you they heard you.
Hold on to hope. I’ve known many people who accepted treatment after years of denial, often when loved ones learn simple strategies and get them help at the right time. It isn’t easy to hang on until then. Nothing with bipolar disorder is easy! But bipolar is treatable, even for those who currently refuse to admit they are ill.
Printed as “Fast Talk: The Denial Factor”, Summer 2011