Q. My husband showed signs of BP for many years. We said he was either extremely happy or angry. We wanted him to seek help for this and he wouldn't. He has two sisters with clinical depression and a mother who has BP. He had a true manic break two years ago and for safety reasons he had to leave the home. He did go to the doctor and counselor and received a diagnosis. He would not accept it and he is in total denial of his disease. He medicated for awhile but said he didn't 'feel' any different although we saw a huge improvement. He also denies his actions from spending loads of money, to having affairs, to dropping our children off in a metropolitan area when he became angry at them. He blames all of his problems on his children and on me. He has isolated himself from his children, his friends, and anything that can cause him stress. He wants no responsibility. We have tried intervention, to no avail. I have had to protect myself financially. Can you tell me 1. how does a person help someone break through their denial? 2. how long can this episode last? 3. what is it about the disease that creates such denial in a person?

  A. Good questions, and no easy answers for any of them. You may wish to talk to your husband's doctors and therapists if he will allow it. They may have better insight into how he thinks than I can give you in the thumbnail sketch you provided.

1. People experience reality based on how they see the world. If your brain chemistry is off, you see it different from other folks. Unfortunately, you cannot change chemistry enough--break the denial-- by talking to it. It is all chemistry. On top of this, if there is not any insight by the afflicted individual into the wrongfulness of their actions, there is little change that will occur. You really cannot do much other than to hold your ground.

2. This question is really better phrased, " How long until they get insight?" Answer is it depends. It can be anywhere from soon to never. Again, if the behaviors are not perceived of as being wrong, they will not change.

3. This revolves around the same answer as in 1. It is a lot like democrats versus republicans. They both really believe their way of helping the country is the right one, and cannot understand why the "other side" doesn't get it. Your husband is like that. He has a view of the world, and cannot understand how you see it different.