Parental Dilemmas in Relation to Bipolar Adult Children

Trying to help an adult child with bipolarity who doesn’t want help, denies the presence of the illness, isn't treatment compliant or whose lifestyle contributes to their instability is a painful dilemma for parents!

In July 2016, I wrote a post titled Tough Choices for Parents of Adults with Bipolar Disorder. The post addressed the difficult choices faced by parents of adult children struggling with bipolar disorder. I've frankly been surprised to find that among my different blog posts, it generates some of the highest numbers of inquiries and comments from parents facing these kinds of situations.

While the details of each family’s dilemma require situationally-specific approaches, I do want to offer some additional perspective for parents struggling with their own helplessness in relation to an adult child’s maladaptive behaviors.

1. Parents and adult children with bipolar disorder need to be able to have constructive communication about the dilemmas they’re faced with.

Often, I hear that communication has broken down. The family isn’t openly communicating about difficult issues, or worse, communication has broken down and been replaced with open conflict or a severed connection. Essentially people are not feeling heard or understood and there’s a lot of consequent anger and hurt.

I strongly recommend that parents and their adult children become involved in family therapy. This need not occur with someone who also specializes in treating bipolar disorder, though I do think it's helpful for the therapist to have some familiarity with the bipolar issues. Mostly, parents and their adult children with bipolar disorder need to have a safe place where constructive communication can occur on an ongoing basis.

Sometimes the adult child may be living in a different geographic area from the parents. In these instances, it can still make sense to have a therapist in one of the two locations (parent or child’s home town) where the parents and child meet can meet to discuss the issues they identify as being problematic. Even if the therapy occurs only a few times a year, the outcome may be preferable to ongoing communication problems without help.

Not too long ago I was meeting with a woman whose daughter lived on the other side of the U.S. from her. The mother traveled to the daughter's home city, spent a week there, and had three therapy sessions with the daughter over the course of the week. The experience was beneficial to both.

Additionally, online counseling and psychotherapy services are beginning to be more available. Some of these services may be able to work with families remotely without individuals having to travel in order to be at the same location as the therapist. That said, my own bias is that face-to-face work, particularly with the family issues, is usually more effective.

2. Recognize that your child is an adult and your ability to help them is limited.

I see this as being one of the hardest issues for parents to come to terms with. We don't often experience deeper commitments towards helping and protecting than we do in relation to our children. After at least two decades of active parenting, the parental role is deeply hardwired. Just because the child has progressed beyond the years of legal dependency, it doesn't mean that parents experience any lessened need to help.

When the child was 12, parents had far more influence. There typically wasn't much that interfered with parents’ ability to take the child to a physician in order to receive appropriate care. But that capacity is gone once the child is of legal age. Parental influence also gradually diminishes as the child progresses beyond the adolescent years.

When the adult child is struggling, parents typically want to do all they can to assist and potentially prevent further decline. But there’s no guarantee that a corresponding desire for help from parents will be experienced by the child. In fact, the child may push back against help partly through an intense need to hold on to adult autonomy. Accepting parental help may actually be experienced as regressive—taking the child backward to an earlier stage of development.

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In addition to issues of autonomy, the adult child may be in denial about his or her bipolarity, or worse, may not have the capacity to recognize the illness due to impairment of insight and self-observation. In these instances, parents will likely experience even stronger helplessness as they may find that their concerns and desires to help are fully rejected by the child.

These realities are not easily changeable. It doesn't mean that all efforts shouldn't be made towards helping the adult child. But sometimes parents have no other choice than accepting the reality that their efforts to help are rejected by their child.

3. Recognize that bipolar disorder spans a broad spectrum of acuity and those with more severe illness are not easily helped.

On the lower end of the bipolar severity continuum (milder acuity), we see individuals who are capable of managing their illness and functioning effectively. However, as we move upwards on the severity continuum the illness presents with stronger mood intensity symptoms, higher frequency mood cycling, and decreasing insight and self-observing capacities. We also see that with more severe symptoms the adult child is increasingly less responsive to many of the psychiatric medications currently used to treat bipolar illness. Thus, even when excellent helping resources are brought to bear upon the illness, we can’t assume that the outcome will always be good. Some individuals who live with more severe bipolarity do indeed live with a lot of dysfunction.

For parents who want to lessen their children’s suffering, accepting the limits of what is achievable is a difficult and emotionally painful process. In fact, it may feel like it's an unacceptable reality. I want to be very clear: I'm not intending to be fatalistic or to suggest that parents simply throw in the towel. No; as parents we continue to try because we want the best lives possible for our children. What I am saying is that it’s important for parents to be realistic about what is achievable, while also continuing to do their best to assist their adult children with bipolar disorder.

The National Alliance for the Mentally ill (NAMI) can be a very helpful resource for parents and families. If you can find a chapter close to your geographic region, most will offer ongoing support groups for parents and families of individuals living with mental illness. I strongly recommend that parents try attending a support group, as it can be enormously helpful to receive support from others who are struggling with similar dilemmas. And if a group setting isn’t your thing, then at least seek the help and support of an individual therapist who is familiar with the realities of bipolarity.

To find a therapist, please visit the Psychology Today Therapy Directory.