denialSomeone you love is no longer the same. They may be moody, angry at times, irrational, paranoid or they may act in ways that are harmful to themselves or to you.

Trying to help loved ones deal with this situation is one of the most perplexing and difficult things that I do as a professional.

The boyfriend of a young woman who recently flew off to Latin America to study the violin, abandoning a promising job, and having an affair with an older man in the process, comes in trying to figure out how to respond to her adamant denial that she has any psychiatric problems.

The wife of a middle-aged man who has become convinced that he alone has the knowledge to save the world and now, instead of spending time at work or with his family, hands out leaflets in downtown San Francisco reluctantly decides that she has to divorce her husband who refuses to accept treatment.

These are just some of the poignant stories that I have heard over the last few months.

Writer Julie Fast wrote an article on this topic for BP Hope in 2011 which is one of the most commonly read and commented upon articles on that website.

She had some points to consider:

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…

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… It will be up to you to decide the consequences if your expectations aren’t met.

Understand the challenges… 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…. 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. 

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.

I think her point about timing is an important one, as is the embedded idea that, in most situations, dealing with denial is something that is likely to take weeks or even months and having realistic expectations (and also taking care of yourself in the process) is an important part of achieving success. Too many people alternate between a sense of urgency about getting the problem taken care of and interspersed periods of not talking about it at all. Find your moment to talk about it but also don’t pretend that the problem doesn’t exist even when it might not be timely to bring it up.

It is helpful to conceptualize the process of dealing with denial as one that involves a marathon rather than a sprint.

The idea of setting expectations touches upon another important point. For most people what they most care about is people’s behavior. This is something that is objective and less likely to be a topic of disagreement than the more abstract notion of “being bipolar.” Focus on the behavior is often helpful and more realistic than focusing on “insight” about what is going on. To put it in a different way, it’s okay if the person takes medication or agrees to see a mental health professional just “to please you.” That is often the first step.

Dr. Xavier Amador is another writer who has written books on the subject (I Am Not Sick I Don’t Need Help) that I often recommend to loved ones as a starting point.

For More Information

Julie Fast’s article

Xavier Amador’s website

The Problem of Denial: How to Help Loved Ones with Substance Use and Other Destructive Habits

Denial: I’m not Bipolar, Doctor