Question:
I am a 30-year-old with two older siblings; we were all raised in a loving home with our parents. We have moved to various parts of the country but have stayed close with our parents, who were due to celebrate their 40th wedding anniversary this year. My father has always had clinical depression but was on medication and, except for a few instances where his medication needed to be adjusted, he was living a happy and content life. Last spring he started acting somewhat manic and, as in the past, my mother suggested he should go in for a med check. This time, however, instead of going to his doctor he refused, moved out, and started a strange new life (living in a building with no roof, seeing other women, and other behavior that is completely out of character.) My mother tried to encourage him to go to therapy, but he refused that as well, blaming all of his problems on her. He turned against her, claiming that he has been unhappy for 40 years. That is just not true. His personality seems to have completely changed – we children each expressed concern and he has now stopped talking to all of us. He is very narcissistic and cuts anyone out of his "new life" (his term) who expresses any concern that he is not acting normally. He’s using the classic lines like "I want to feel the highs," and is telling everyone who will listen how euphoric he is. He has completely stopped taking his medication. He filed for divorce, is bitterly pursing all of my mother’s assets and will be leaving her with nothing, and will not listen to anyone who advises him to be more reasonable. He has sent us letters explaining how horrible our mother is and how she caused him to have a miserable life – this is all so patently untrue that it is very disturbing to everyone (he has even sent them, for no reason, to distant relatives!) Since he will no longer speak to his immediate family, I am really worried that the new people he has surrounded himself with will be unable to recognize the symptoms of his mental illness – or unwilling to deal with it or help him if they do see what’s wrong. I know that people often turn angry or bitter when getting divorced, but this is much more than a mid-life crisis or a decision to leave his wife. It is pretty clear to everyone who knows them that he is experiencing some type of mental problems which are causing him to act erratically, to be extremely self-centered, and to behave in ways that are completely out of character for a man who had been very good-natured and laid-back for the previous 60 years of his life. This has been very difficult for us all, obviously, because it is as if our father has been replaced by a total stranger who will not let us help him. In addition to dealing with divorce, we are trying to cope with the complete personality change that initiated the whole situation. Is there anything we can do? Is there any way to approach a person like this that can result in any kind of positive change? We all feel very helpless and hurt by the situation, and for now we are focusing on helping my mom get through it. However, in the future we will want to try again to re-establish contact with my father, and we don’t know if or how it will ever be possible. Any suggestions you can offer will be gratefully appreciated.
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Answer:
This is an agonizing situation that you and your family members are in. I wish there was a magic wand to wave and make this better, but I don’t know that there is.
As you are more than well aware, something significant has changed about your father’s situation. What has changed; whether this is something new or an exacerbation of an existing condition, we can’t know. An accurate diagnosis is necessary for a useful treatment plan to happen. You note manic style behavior such as might occur with a diagnosis of bipolar disorder. Your father’s newfound impulsiveness and self-centeredness are consistent with such a presentation (perhaps with a late-life onset if mania has not been observed before), but there are several other possibilities that would need to be ruled out before that diagnosis could be made with any precision. Clearly, a visit to the psychiatrist is in order.
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However much your father might objectively benefit from proper diagnosis and treatment, I don’t know that he can be forced to accept diagnosis and treatment. The natural desire you may have to force him into treatment (so as to recover the father you recognize) conflicts with the “pursuit of happiness” we all cherish, namely the right of adult individuals to determine their own fates so long as they don’t actually go so far as to threaten significant harm themselves or others. As an old psychiatrist mentor used to say to patients, “you have the right to die with your rights on”.
What you can do is to stay in contact with your father as best you can. If you can find a loving way to do this, you can be a positive force encouraging him to get help, and monitoring him for excesses that require emergency treatment he might not otherwise receive. You can’t hope to influence him if you aren’t in contact with him.
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If your father becomes a danger to himself or others, he could be hospitalized against his will. During such a stay, doctors would likely try to diagnose and treat his condition, whatever it might be as well as deal with management of the immediate suicidal crisis. This back door sort of hospitalization would not be an ideal circumstance by any means. No one would want to see things come to such a state, for one thing. Also, there is nothing that will make your father remain medication compliant when he leaves the hospital except his own will to do so. If such a situation were to occur, however, helping the doctors to know about past history of this manic-like behavior could be a way to make the most of the opportunity.
The other thing you can do is to recognize that this is a true family problem and not just something happening to your father. Family therapy (with your siblings and mother at least) and/or individual therapy would be a good coping resource to explore. A therapist could help you all cope a little better with what is an ongoing and agonizing situation, and also advise you on the best ways to influence your father’s condition for the better.
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