Hanging on by a thread....
My daughter who is 13 now, was diagnosed at age 7 with bp. Parenting her has been hard but i've always been able to get through the rough times. Lately i've really been having a difficult time dealing with all of it. I've been watching her slowly turn into a completely different girl. Last week she told me that she believes she is manipulating and controlling me, her psychologist, and all of the support staff at her school to reach her objective. Her latest one being, she wants to go back into the inpatient hospital. She has come to think of that place as her getaway when she wants a break. I get where that feeling would come from, but i've tried to get her to understand that the illness is there regardless of her location. What is really bothering me is how she is using threats of self harm to get admitted. As her psychologist puts it "she knows how to work the system." Just to clarify I always take any threat she makes seriously and have her assessed. But this time her entire support system knows what she is after, she has told almost everyone that she just wants to go and why. This afternoon when I was trying to talk to her about some new coping skills and trying to work through down times, she said "i'm going to the hospital. You already know what's going to happen tommorrow. I'm going to go to the guidance office, tell them I want to kill myself and you'll pick me up and take me there." After that I honestly didn't want to be in the same room with her but felt I needed to watch her just in case. She was inpatient 5 different times this year and I've been told by doctors there that she may need long term hospitalization because of her pattern of frequent stays. They explained to her that for someone to lead a productful life they need to be able to be present in daily life for the majority of the time(school, job as an adult, ect). I do everything in my power to try to put myself in her shoes because I know it has to be so hard being on the inside of bp, but it's starting to feel like it'll never be enough for her. She is constantly complaining about everything and everyone in her life, always has some kind of imaginary aillment, treats her siblings horribly, not to mention the hurtful things she says to me and has now started breaking things and punching walls when she's angry. And it seems to be all of the time now. My 4yr old daughter is starting to pick up some of her choice words and has seen the severe behavior a few times (I try my best to get them somewhere else when she is acting out) and I could tell she became worried and confused. My 9yr old son knows that she has anger issues and has developed his own ways of dealing with her. I worry about them just as much as her because I know that they are losing out on attention that they deserve from their mother when i'm devoting so much time and energy on her. All of this is so hard on our family and i'm starting to feel like it's only going to get worse.
I am going to repeat a refrain that was told to me by our pdoc and one that you probably are not going to like. It is going to get worse. Why? Because your daughter is in the middle of puberty and adolescence and that period is difficult even for normal teens and about 100 times harder for bipolar teens. BUT, and this is important, if you can get through this period it will (and does as I can testify) get much better. I know it is hard. It sounds like you have a good support team of doctors and therapists behind you. Your concern for your younger children is valid and I too had to deal with that. I found myself depending on friends to help me out and my youngest son grew up having more playdates than most of his friends. On the plus side he is a very friendly and sociable kid who other kids like a lot, so he did get something out of that experience.
As for the behavior at the moment. Why does she want to go back in-patient? What is it about being in-patient that made her feel safe and good. Most kids do not like being in the hospital. Is it the routine and structure? Is it being with other peers? Are there clinicians there that she felt attached to? Is it because she does not have to go to school? Is it due to anxiety? If you can figure out what her motivation is then maybe you and your treatment team can start to address it. You can make home feel more "hospital" like by removing distractions and making things more structured. You can address anxiety with medication and therapy. You can address school problems through the IEP process.
Would your daughter maybe do better in a Residential Treatment Center (RTC)? Children who attend RTC's get therapy and support along with schooling while living in dorm like settings. There are many parents on these boards whose children have attended RTCs and they can talk to you about the pros and cons of them and which ones might be suitable for your daughter.
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Jistac
Mother of 3 (21, 19, 16) with a variety of mental health issues. Been involved with using Empower as a treatment since 2003
My dd is in the hospital right now, the 3rd time this year, 2nd time since August. She is also 13. I too think that she really likes it there. She never asks to come home and acts like its summer camp. I think she thrives in the routine and structure but on top of that she bellieves that the doctors are really helping her. And frankly they are. Every time she is released she is better able to talk about what is going on with her moods and thoughts. They haven't found the right combination of meds yet so when she is out, she is very unstable. I think she doesn't like that at all even though she carries on (loudly) about how there is nothing wrong with her. I don't want to keep admitting her, but at the same time, she is so erratic when she is unstable that I cannot keep her safe. I am starting to think RTC might really be what she needs but I'm not ready to go there yet. And she will fight it. *sigh*
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Karenj
Self: as sane as I can be everyday
A - DD (17yo) well adjusted, high functioning, motivated, successful, waiting patiently to go away to college
M - DD (13yo) Mood Disorder NOS (dx 4/2011) ADHD (dx 2nd grade), dumb high IQ, mainstream education with IEP/BIP, Seroquel 100mg twice daily - morning and bed time
BF - Live in boyfriend of 5 years, supportive and learning more every day
EX - Ex-husband, divorced since 2002, family history of bipolar, unpredictable and sometimes explosive
Karen,
You don't feel like ready to put your daughter in RTC. But if your daughter were suffering from a coronary disease, that she would need to stay one year in a center to reeducate her at effort because neither you, nor the hospital could do it, would you give up your daughter ?
No, you wouldn't give her up because you send her to a center for reeducating her at effort, you would do it without thinking twice because you can't provide her this reeducation and watching her around the clock.
Same for her bipolar.
You don't give her up. You put her in RTC to make her feel better, and it's the best gift you can make her : to hear that she needs a help you can't provide her. And it's normal you can't always provide her help, because you are not Wonderwoman, you are "only" (but it's already a lot) her mother. You do your best ok, but you can't always manage and that's okay, nothing to feel guilty about.
And let me tell you that it's very positive, as for you, as for your daughter, that your dd asks you to go to RTC. She understands that she needs a help you can't, and that she can't receive as outpatient.
She feels unstable and seeks help because she understands that her bipolar is getting worse.
And you know what ? You can be proud to have a daughter who asks help because she understands that her bipolar gets worse, and that it won't fix it by itself. You can be proud of all what you did and do for her.
Now, she asks you a help you can't give her, and it means also that she is very confident with you. She doesn't give you up, she doesn't leave any kind of confident she has with you : she just needs a help that her family can't give her. And I will repeat it tiredlessly if I need to do so, but it's ok to tell that she needs more help.
You have no reason to feel guilty about sending her to RTC. Instead, you can only be happy that your daughter is willing to seek the help she needs and deserves, because she realizes that she doesn't get as outpatient and at home.
And realize that not many teenagers are like your daughter, especially at 13yo : at 13yo, you want to be invincible, you want to be anything but sick, let think about being cared in psychiatry !!!!!
So really, be proud of your daughter and of yourself : if your daughter has reached a point to tell you : "Mom, I love you, but I need a greater help than home can give me", it's because of all you did for her, to support and advocate for her to receive the help she needs.
RTC doesn't mean that you get no contacts with her. You don't terminate your parental rights to send your daughter in RTC. Your daughter is still emotionally and legally your daughter. And she will still love you, even if she doesn't live with you.
And RTC has the aim to make your daughter able to live back in the community because she has the needed skills to do so. RTC is not a life sentence, it's a moment she goes there because she needs at a particular moment a help she needs so. After, a lighter help will be sufficient.
And just wonder yourself if it's better to send her in RTC against her will, while everything is on eggshells or if it's better that your daughter realizes that she needs to go, and asks you proactively to go because she feels that she needs a help she is not able to receive in the community.
You will certainely realize that it's not a bleak future : instead, the fture is much more promising than you believe right now.
And feel safe for your daughter : she is able to make the right decisions, even at 13.
How many teenagers prefers taking drugs or alcohol with their meds instead of telling their parents that they need to go to hospital or RTC ? It sounds like your daughter prefers receiving therapy instead of self medicating for her bipolar. I will repeat it tiredlessly to give you nausea *sight*, but you don't need to have the slightest culprit : be proud of her, and be proud of you for this request of help. Because if she arrived to this point at 13, it's because everything you did and still do for her.
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25 yo, ADHD, sensory issues, Maths LD and prelingual Single Sided Deafness.
Preparing myself to go back to university to study Law (hope to become a lawyer).
Interests : languages (I speak French as mother tongue, Italian, English and Modern Greek), medicine, law, computer.
Thank you for the support. I think mostly that I feel that all of this has unraveled so quickly (only this year) but it is going so fast. I realize RTC is a good thing if it is the right thing for her. But at the same time she is still enrolled in general ed but with an IEP so I fell like it is a big leap from one to the next. You are right though, she does realize she is not well and that is an amazingly hopeful sign. She is as frustrated as I am that the process of finding the right treatment is so slow. And I do use the 'other health problem' comparison often as I make decisions about what to do next. At this point I'm waiting to see what the hospital says about releasing her and sending her back to school. I think she needs an interim placement before she goes back to the 'real' world.
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Karenj
Self: as sane as I can be everyday
A - DD (17yo) well adjusted, high functioning, motivated, successful, waiting patiently to go away to college
M - DD (13yo) Mood Disorder NOS (dx 4/2011) ADHD (dx 2nd grade), dumb high IQ, mainstream education with IEP/BIP, Seroquel 100mg twice daily - morning and bed time
BF - Live in boyfriend of 5 years, supportive and learning more every day
EX - Ex-husband, divorced since 2002, family history of bipolar, unpredictable and sometimes explosive
Leap from one to the next ? But after RTC, she may be able to go to school with IEP !
RTC is something provisory, it's not somewhere she will stay all her life. Her life is in the community.
But to be able to live in the community, she needs at a moment to live in a place where she gets more help, and for longer than during short hospital stays.
So what ? Life is not a race where children have to go faster than their peers to be great people !
At a moment, she needs to go to RTC. It's by no way a sentence of failure : asking help and admitting you can't help doesn't absolutely mean that you are a failure.
Her sister doesn't need to go to RTC, but her sister doesn't have bipolar, neither ADHD. But her sister will live her own struggle, and even her healthy sister will probably face moments where you can't help. It's only the human condition.
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25 yo, ADHD, sensory issues, Maths LD and prelingual Single Sided Deafness.
Preparing myself to go back to university to study Law (hope to become a lawyer).
Interests : languages (I speak French as mother tongue, Italian, English and Modern Greek), medicine, law, computer.
Karen,
Sometimes a "big leap" is what a child needs to get him or her healthy. My son was in an alternative public high school with a 504 plan when he made his first sucide attempt. After his first psychiatric hospitalization of 5 days we tried going directly back to school with weekly therapy. Within 5 days he was back in the psychiatic hospital. After 12 days he was discharged and we tried a partial hospitalization program. He was in the PHP for 7 days when they recommended that he go to an RTC. He was in the RTC for 67 days and then returned to the PHP for 6 days. He is now back in the alternative public high school with an IEP and sees a therapist twice a week.
My son believes that the time in the RTC saved his life. My husband and I completely agree with him. He still has a long way to go, but RTC got him to the point that he is once again able to function in the community.
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Beth
DH - Husband & Father
DS 16.2 - Cyclothymic Disorder or BP II (psychiatrist is still considering which one is the correct diagnosis), NVLD, GAD, Transgender (female to male) and gifted
Geodon 40mg AM/PM, Prozac 20mg PM (tapering off) and Buspar 15mg AM/PM
In 11th grade at a small alternative hybrid competency based public high school in Northern California, with IEP for ED & SLD
You are right, I hadn't thought of it as a temporary placement before. I had instead been thinking of it as a 4 year boarding school with therapy. I will look up my options and see what I can find.
Thanks.
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Karenj
Self: as sane as I can be everyday
A - DD (17yo) well adjusted, high functioning, motivated, successful, waiting patiently to go away to college
M - DD (13yo) Mood Disorder NOS (dx 4/2011) ADHD (dx 2nd grade), dumb high IQ, mainstream education with IEP/BIP, Seroquel 100mg twice daily - morning and bed time
BF - Live in boyfriend of 5 years, supportive and learning more every day
EX - Ex-husband, divorced since 2002, family history of bipolar, unpredictable and sometimes explosive
And whether it lasts 4 years or 1 year, where is the issue ? As I repeat it, your daughter needs the time she needs. If she can go back to school with IEP, great, but otherwise, it's ok, it's not the end of the world.
The important is : your daughter's health and sanity. If she can go to school whereas she is cared for her bipolar, if she is happy, if she can make plans to live her life to its fullest while being healthy, you and your daughter have won everything.
The rest has really no importance at all, not even what the neighbors may gossip.
The number one priority is your daughter's health and sanity. Otherwise, even with the best diploma and the highest grades, she won't do nothing.
The rest is what it is : if you have it, great, otherwise it's not such a deal.
I know that it's very difficult to reach it, but it's fondamental to be happy in life :D
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25 yo, ADHD, sensory issues, Maths LD and prelingual Single Sided Deafness.
Preparing myself to go back to university to study Law (hope to become a lawyer).
Interests : languages (I speak French as mother tongue, Italian, English and Modern Greek), medicine, law, computer.
Thanks everyone. After meeting with the hospitals and talking dd's best ally her school (who is also the Dean and has amazing insight into both mental illness generally and my dd in particular) I think I will be placing her in day treatment withing the hospital until I can work through the department of education to get her iep changed to a theraputic day school. She is going to flip out. And refuse to go. Which will indicate that the placement is not right and will open the door to RTC. I can always hope that she stabelizes in the meantime and he can go back to gen ed with and IEP. But what she needs now is to be safe and healthy and the current arrangement accomplishes neither of those things.
Again thanks for all of the support and the occasional hard truths. I fell like I know them in my heart but sometimes I am too scared or too tired to say them out loud.
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Karenj
Self: as sane as I can be everyday
A - DD (17yo) well adjusted, high functioning, motivated, successful, waiting patiently to go away to college
M - DD (13yo) Mood Disorder NOS (dx 4/2011) ADHD (dx 2nd grade), dumb high IQ, mainstream education with IEP/BIP, Seroquel 100mg twice daily - morning and bed time
BF - Live in boyfriend of 5 years, supportive and learning more every day
EX - Ex-husband, divorced since 2002, family history of bipolar, unpredictable and sometimes explosive
Karen - I forget where in NY you are, but I was reading about places in Rockland Co. today (an outside possibility of moving there some time in the future/long-distance thing I've had going since the late 90s which I've put off due to having an established IEP in CA). I read about a place in Nyack called Summit School which looks very promising ... in case you reach that point. :)
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Shelle, 49 in So Cal - Celexa 20mg, Xanax 0.5mg rarely as needed
Family Response Team Volunteer, Child & Adolescent Bipolar Foundation
rmadmom@hotmail.com
Single Working Mom to Rachel, 12 - BP w/anxiety - Lamictal 200mg am+Seroquel 50mg am/200mg early pm, Therapeutic School/7th Grade
We also have Birdie, the love bird - she bites; and Scarlett, the kitten - she does too
FROM CABF: Do not start, stop, or change medication or other treatment for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.
Karen, I have 2 daughters with bi polar and a whole list of other things. RTC for my oldest was great for her. She did not want to go but she went. Her dad just told her there is no other answer. She was 13 at the time. She was there for 3 months. She is now a produtive person. Gradutated high school on time with just an IEP. She is now going to Beauty School finishing up in July. We are very proud of her. See there is a rainbow. I am having the same issues as you with my 15 yr old daughter. Hang in there and use your mommy gut and do what you know is right for your daughter.
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Shelle