Carrie there are several things I'm very surprised at in your post, so I'll list them with my thoughts:
[2) In Ottawa my sister was in a group for people suffering depression/anxiety etc. It was some kind of life skills program to help them get a job/on with life etc. The psychiatrist in question treated her like 'teacher's pet' and with her hypomanic charm and wiles had him wrapped around her little finger. Meanwhile another girl in the group was so depressed by his criticism of her in ''class'' that she felt a desire to kill herself over a weekend. When told this in group the following session.. he laughed at her and said "over me???" My sister and this other girl in the class later told me alot of inappropriate stories about this guy. He frankly shouldn't have a license to practice but par for the course I've found over the years. Unfortunately more are incompetent than are competent.
This sounds like day hospital which is generally run by psychiatric nurses under the supervision of Doctors. At no point should these classes provide for an unsafe environment. If someone presents the claim of directly harming themselves they are immediately pulled out of such classes.
Judging by your sister's propensity to lie, as evidence about the "eviction", which is not unusual for bipolar subjects, I have to wonder how true this is. I know you believe it because of the verification but believe me it is not hard to convince someone who is this ill that something happened that in fact didn't. It should have been reported because if a pattern emerges of such complaints it is the only way a Hospital can decide that something may in fact be wrong.
I think you are reading far too much into this Dr. blaming you for her behavior. I think he was just trying to find the stress that sent her into the manic phase. Certainly the belief, real or imagined, can cause enough stress to trigger an episode. Most likely the DR was testing to see if in fact it was real or imagined. From your testimony I'm sure the eviction was imagined - this is very important information for treatment purposes.
3) on another occasion after a verbal assault to someone in the place she was living she was admitted to the hospital. Being beligerant as manic individuals are apt to do.. she was given the ultimatum to 'behave' or go to jail.. of course part of the disorder makes them insolent soooo .. she mouthed back and said "jail" AND they sent her there!!!! This is akin to threatening a child in the back seat of a car with stopping and leaving them at the side of the road and then following through with it!
When she left jail after 3 days she was ordered to get out of town (with no financial assistance) get a psychiatrist (which by the way they did not provide for her), see a probation officer (which of course they did provide), stay away from the former roomate but not get her another place to live. She's on disability but had lost all her id in the meantime. At this point in time in her life I had stopped stepping in to take care of everything... long journey but one I had to take to keep sane myself.
Unfortunately this happens way too often. In this Country you can't make a person seek treatment unless of course it is an extreme case and that's very hard to determine and involves the courts. A Police Officer can invoke the 72 hour observation but rarely do. LEOs are getting better educated but have a ways to go.
In addition you did the right thing not to step in. Your sister clearly sounds like she is refusing treatment. While that is her right, provided that she is no immediate threat to herself or the public, you have the right to get on with your life. This illness can be very hard on family members especially if the patient refuses treatment.
How? 30 years ago when my sister started smoking pot.. she exhibited the exact same behavior. Until recently I thought she got manic from several different ways.. but now I realize probably 90% if not 100% of the time pot was the initiating factor. Of course she was very very secretive about it and the manic high she gets is like a crack addiction.
Here's my thoughts on the matter in the last few years. Had my sister never smoked up in high school would she even have experienced hypomania and eventually mania? Brittany - a very public example of this (and by the way not diagnosed for several months when this whole thing started) may not have either had she not started smoking pot. Now of course I have no proof to back this up..
The answer to this is that your sister would have experienced mania, with or without pot and most likely was at the beginning stages of mania when she took up smoking pot. Pot, crack, alcohol, gambling, sexual behavior are all things that Bipolar people use to excess to self medicate. Once properly medicated they generally stop. You may have associated this behavior of hers, smoking pot, as the trigger but it is likely that this is the first you noticed the symptoms. Your sister most likely was well on her way in an episode before she started to self medicate. You have to remember at the beginning stages most people with Bipolar who start to slip into mania actually enjoy that stage and appear happy and very functional. As mania advances then the hell begins as does the destructive phase. You are most likely observing the middle or end stages when she smokes. The smoking only seems to enhance the mania but really all the smoking is doing is further impairing her judgment beyond what the mania has already done.
Bipolar is thought to be a genetic problem since it is evidenced that it flows through the family tree. However you can have identical twins, one who has Bipolar and one who is not, so it is thought that in combination with the genetic error - that a stressful event occurred to trigger the illness. Stress is generally at the root of an event.
I would like to add that I once read a paper that a Toronto Psychiatrist wrote suggesting that the genetic defect that cause bipolar disorder is a evolutionary change in humans not complete. The point was that most Bipolar patients have higher IQs, are more creative and generally faster thinkers then general public. I found that kind of interesting when you consider that both Issac Newton and Winston Churchill were thought to be Bipolar. If the violent mood swings and psychosis could be eliminated without slowing the brain down think of the advantages a Bipolar person would have in an ever increasing stimulating world.
