Shirah Vollmer MD

The Musings of Dr. Vollmer

Whose Mania Is It?

Posted by Dr. Vollmer on January 10, 2011

   Barry, sixty-one, divorced three times, has one eighteen year old son, Casey, now living with his girlfriend, Jennifer,  of two years has escalated into mania. He sleeps four hours a day. He has lost twenty pounds in two weeks. He bought a brand new motorcycle, draining his bank account. Barry has a positive family history for bipolar disorder and he has had five prior manic episodes since the age of seventeen. Barry does not want medical attention, “everyone else is the problem” he says. This is Jennifer’s first experience of mania; she knew Barry had a history, but she did not  know what that meant. Now she knows, and she is frightened and paralyzed. Casey is scared too. Barry is still friendly with his first ex-wife Michelle, not Casey’s mother. Michelle lived through three or four manic episodes with Barry; she is also scared, but not paralyzed. She wants to help him, but she has no legal rights as they are no longer related. Barry is a gentle soul, but when he is manic, he is scary and potentially dangerous. “It is time for the police,” I say to Michelle, with a heavy heart. “He needs to be hospitalized and contained so he can de-escalate,” I say, knowing that every option seems so unsettling. Most of the time Barry is competent to make decisions about his medical care, except not when he is manic. The laws in our country make it difficult to assume responsibility for an adult’s care in the absence of a life-threatening emergency and without a conservatorship. Hence the intervention, when it comes to psychiatric illness, often involves law enforcement. Barry needs to be protected from harm, both self-harm and harming others. He needs a locked unit. Most of the Barry’s in the world end up in the criminal justice system, not the mental health system. Without an advocate, Barry ‘s behavior would be misunderstood as criminal, rather than symptoms of a  psychiatric illness. I do not have answers or ideas about how to change things, only sorrow for the individuals and the families that live anxiously awaiting some relief.

2 Responses to “Whose Mania Is It?”

  1. Shelly said

    Do you have a role in this family tragedy? Can you help get him the medical help he needs? Other than a moral obligation, does Michelle have to get involved since she has divorced Barry? Can you simply call the police, explain the situation and let them handle the rest?

    • Good question. As a professional, outside of the family, I can offer some perspective. For him to get medical help he either needs to consent to treatment or be held involuntarily. Sometimes things have to get worse before they get better. Michelle does not have to get involved, but she is concerned so she wants to help. In order to call the police, I have to know where he is, and that is not clear. Plus, he could get his thoughts organized temporarily, in which case the police cannot do anything.

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