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Summary
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An adult child describes a father’s sudden impulsive behavior, estrangement, and refusal of treatment after years of managed depression. The family wants to support their mother and understand whether reconnection is possible.
The response explains that manic-like changes need a psychiatric assessment, while noting that several possible causes cannot be distinguished from the letter alone.
It suggests maintaining loving contact when possible, sharing relevant history if emergency care occurs, and exploring family or individual therapy to cope with the situation and consider ways to encourage treatment.
Question
Reader · Identity withheldI’m a 30-year-old with two older siblings. We were raised in a loving home by parents who were deeply devoted to each other and to us. Though we’ve since moved to different parts of the country, we've remained close with our parents, who were set to celebrate their 40th wedding anniversary this year.
\nOur father has lived with clinical depression for most of his life, but with medication and occasional adjustments, he managed it well and, for the most part, led a happy, stable life. That changed last spring when he began exhibiting manic behavior, as she had during past episodes, our mother gently encouraged him to get a medication check. This time instead of seeing his doctor he refused treatment entirely. He abruptly moved out, began living in a building with no roof and started seeing other women. All of these actions are completely out of character for him.
\nDespite our mother's continued efforts to get him into therapy, he refused, blaming her for all of his unhappiness. He claimed he had been miserable for 40 years, which simply isn’t true. His entire personality seemed to shift overnight. He cut off contact with all of us (his children) after we each expressed concern. He now surrounds himself with new people who seem unaware or unconcerned about his mental state, and he labels anyone from his past life who challenges him as \"toxic.\"
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He’s become disturbingly narcissistic, saying things like “I want to feel the highs” and telling anyone who will listen how euphoric he feels. He has stopped taking his medication altogether. He filed for divorce, is aggressively pursuing our mother’s assets, and is unwilling to listen to reason. He has even sent cruel, accusatory letters about our mother, not just to us, but to distant relatives, accusing her of ruining his life. These claims are patently false and deeply distressing.
\nWe’re incredibly worried. This goes far beyond a mid-life crisis or a difficult divorce. Everyone who knows him agrees this is a severe mental health crisis. He’s acting erratically, irrationally, and in ways completely inconsistent with the kind, laid-back man we’ve known for decades. It’s as if our father has vanished and been replaced by someone we don’t recognize who wants nothing to do with us.
\nWe’re heartbroken and overwhelmed. Right now, we’re focused on supporting our mother, who has been blindsided by all of this. But looking ahead, we’re unsure how or even if it will be possible to reconnect with our father. Is there anything we can do? Is there a way to reach someone in this kind of mental state that could lead to a positive outcome? We feel powerless and hurt and are desperately hoping for guidance.
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Answer
Mark Vigil Dombeck, Ph.D.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.
\nAs 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.
\nHowever 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”.
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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.
\nIf 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.
\nThe 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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