What to Do if Someone with Bipolar Refuses Treatment

Dear Marie & Carolyn, I am so saddened to read of your heartache as I have walked in your shoes, I became involved with a BP we were childhood sweethearts & back then it was known as manic depression but to myself at 16 I had forgotten about the diagnosis & just thought he was crazy, I endured emotional & physical abuse daily when one night in fear of my life I sat with my 3year old in a shopping centre on a Thursday night till the shops closed plotting an escape I then ambled on home with my sleeping child in my arms on along walk home to arrive to home that looked like it had been burgled not a thing was left in a draw or cupboard as he had turned the house inside out & yes I coped a beating but this time I had a plan. The following morning I brought a newspaper & bordered the train for work & burying my face in the paper hoping nobody could see my battered face I searched for share accommodation in an area I knew that had a furnished room & when I got off that train my life had started anew & now I am married to the most beautiful man. Now my son has BP has never been diagnosed & with each year that goes by he becomes more of a stranger to me, my son is now 33years old & looking back over the years he was 18 when I began to notice the depression which before then was more of a personality trait to me & the anxiety,paranoia soon followed by delusional thoughts, he lives the life of a hermit it saddens me greatly I cant talk to him about it as it's like talking to his father & yes I am scared of him & now I have a 13year old Grandson whom I Have watched over from the time he was a toddler it was very evident he too has BP & while this one stands out to all who come in contact with him that something is very wrong he has been to psychiatrists & councillors but nobody can put a label too it. Anyway I just wanted you to know that they cant help themselves if they choose not too but you can I did it with a small child & you can do it too. Best wishes to you both.

Marie King, It would be great to be in touch with you. I have endured the same type of abuse for over 25 years. I didn't know what Bipolar was until 10 years after. I just thought the behavior was crazy. I feel trapped and still have a 16 year old at home.If you see this, Lets connect somehow.

When you've made attempt after attempt to encourage someone to get help to no avail, and the situation becomes emotionally abusive or financially devastating or physically abusive, it is time to protect yourself and your children and leave.
Is that heartbreaking? It was for me. But, three years later my children are still recovering with on-going therapy from the emotional abuse they experienced - it's a good thing I took action.
If you don't take care of yourself, you can't help others to the extent you are hoping to. I wish for each of you courage and a support network to help you make a healthy choice for yourself.

I am always surprised when people say that mania "feels good" as one of commenter suggested. Hypomania may feel good, but true mania is often accompanied by uncontrollable racing thoughts, agitation, delusions, paranoia, and hostility. It doesn't feel good to lose your job, ruin relationships, spend your entire savings, engage in uncharacteristic sexual behavior, get arrested, or to end up in restraints. I think people often confuse hypomania and mania. You can live with hypomania, but severe mania can damage everything.

My husband of 20 years was diagnosed with bipolar disorder back in the late 90's. He took his medication for two weeks and then decided to stop taking it. He has done this before. He also had ADHD and never sees anything through on any treatment. He also has serious rage issues and was once in anger management but when it was recommended that he continue, he refused. As a result of this I have had to endure 20 years of extreme mental, verbal, and emotional abuse, and at times physical abuse as well. His behavior toward me is deplorable and he also has had serious anger issues at work. He does not manage money well at all. Lost his job of 21 years because of his inability to filter what comes out of his mouth at work or in public. He has been asked to leave many stores in the past because of his outrageous anger towards others in the store. I have endured 20 years of this abuse and he always blames me for his bad behavior and his rage. As a result I have been in a constant state of severe stress that has resulted in serious heath issues brought on by the stress. He is 53 and I am a 64 year old disabled/retired teacher. Am I supposed to endure another 20 years of his abuse and bad behavior? I have been nothing but supportive of him through all of this, but the fact that he not only refuses to recognize that he was indeed diagnosed with bi polar but that he has also been putting me through hell every single day. He has been out of work for two years having jumped from job to job and losing each new job after only a couple of months. I have gone above and beyond being supportive, but I fear that if I do not get this man out of my life that I will go to my grave sooner than I have to due to the stress. At what point does the person with bi polar be held accountable for their actions? Why should I continue to suffer the abuse I endure? By staying married to him, I feel that in some ways I am enabling him to continue with his horrible behavior towards me. I would like to see the issue of abuse at the hands of someone with bi polar addressed. I am not saying that all people with bi polar abuse their spouses, but it certainly is an issue with many. No one should have to put up with the kind of abuse that I have suffered. There are no excuses for that kind of behavior.

my family is going thru situation of BP -my son
He currently is facing charges due to a situation when
he was in a manic state.
He is an adult. Does anyone know anything about
Conservatorship??? or the Tarasoff Law?/My son is not capable of making decisions to help him know. He refuses to take
medication or even confront, or be labeled as BP.
His physch eval shows the findings of mental illess
and refuses to release this report, which if the
Judge receive/reads it will lessen his charges.
Main concern is for him to get the treatment he needs
He says his God doesn't allow him to take medicine.
I said God can work thru doctors and medicine.
I cannot make reason or connect to him
Any suggestions?

My heart goes out to everyone dealing with a mentally ill person when the mentally ill person refuses treatment and medication it makes it even tougher for everyone involved.
I know someone who has dealt with a mentally ill person with bipolar and other personality disorders for over ten years they deny their illness and cleaver enough to manipulate people, family, officials, Judges and professionals into believing they don't have any mental illness and these officials refuse to look at any medical records that clearly prove the person has mental illness personality disorders uncontrollable anger, violent behavior and suicidal tendencies since childhood.
The last ten years this mentally ill person has constantly abused terrorized damaged and threatened to kill her children grandchildren and her. The grandchildren are very young children.
This person's mental illness, abuse violence and threats to kill them is constantly ignored and when she reports it she is attacked slandered called a liar and crazy even though the medical records prove she is telling the truth the person is mentally ill and has a long history of uncontrollable anger issues violent behavior and suicidal tendencies and has even been hospitalized for his mental illness but every piece of evidence about their mental illness, abuse and violence is covered up.
It is hard to get help when officials ignore all the documentation by hospital staff, therapists and professionals who know the person's history and mental condition and has written testified or documented the person is mentally ill, their condition is incurable they are a danger to self and to others and poses a threat for future dangerousness and even with medication and treatment their prognoses is poor.
It has to be traumatizing and severely damaging for these children to be forced to live in this kind of fear or made to live with a mentally ill person who has abused them, abused their mother, siblings and others right in front of them and hearing this person say they are going to kill them their mother, sibling, grandmother and other family members constantly.
It has to be unbearable and heartbreaking to report the abuse violence and threats trying to protect the children involved and be constantly attacked by officials and be denied contact with the children they are trying to protect because the Court refuses to look at any of the evidence about the mentally ill person but calls them a liar and crazy and hands the helpless child over to the mentally ill violent person who is abusing and threatening to kill the child and his family.
It is unbelievable they will ignore the mentally ill person being violent in the courtroom and the Judge having them arrested handcuffed and removed because of their violent out of control behavior but puts a child in that kind of danger the child doesn't have a deputy available to handcuff the mentally ill person when they are hurting them.
It is frustrating to have all that medical documentation proving the person is mentally ill but you're called a liar and crazy when you report the person is mentally ill abusive and violent and they need help before they seriously hurt or kill one of them and you are ignored and left to deal with the violence without any protection.
It's tragic when officials refuse to view any videos taken year after year showing the child screaming begging not to go with the mentally ill person telling you they are hitting and hurting them and officials ignoring or refusing to view all the pictures taken showing the multiple bruises on the child, or seeing another child constantly being traumatized when the ill person constantly threatens to kill that child, his mother and grandmother in front of both of these children but every time you report all the violence and even after submitted to a polygraph to prove your truthfulness you are still called a liar and crazy.
It has to be pure anguish to be denied contact with the child your trying to protect because the court gave the child to the mentally ill person because you wouldn't stop reporting the abuse violence and threats.
It is wrong when the mentally ill person goes out and hires a therapist who had never even met you or your family members but wrote a report to the Court saying you shouldn't have contact with the child and the Court doesn't allow you to argue against that report but denies you contact with the child anyway without a trial and the case is continued and that therapist is still allowed to be involved.
It is wrong for the therapist to fail to tell the Judge about the child telling her the mentally ill person is hitting them and screams not to go with them, the incident was reported to the Social Services and they contacted the therapist because a therapist is a mandated reporter she was supposed to report it but didn't instead she destroyed the video she had taken of that session when the child said it mostly to protect herself but also to keep protecting the mentally ill person because he is paying her.
I can't even imagine what the child is going through being with this mentally ill person who is abusing him and constantly threatens to kill his mother, sibling, grandmother and other family members he loves right in front of him it also has to be traumatic for this child to be ripped from the family he loves and wants to be with and who has tried to protect him from all this abuse and violence and even it has to be traumatizing terrifying for this child to be denied contact with the family he loves was raised with until the mentally ill person manipulate some officials to lie and manipulate the Judges into giving the mental ill person custody and denying them contact.
If the Judges would've viewed the evidence instead of taking the word of lawyers this situation wouldn't have turned out this tragic and these children wouldn't have been permanently damage and one seriously injured and maybe the mentally ill person could have gotten the help they needed. The mentally ill person is a victim to.
They can't help being mentally ill it is an illness they have no control over their thinking it isn't rational they behavior is unstable and unpredictable but mentally ill people are clever they know how to act the victim in their mind they don't think they did anything wrong it is always someone else's fault not theirs and they don't believe they are mentally ill the doctors are wrong and when they are violent someone caused them to be it wasn't their fault in their mind.
Mentally ill people don't want to be mentally ill some don't want help don't want treatment and don't want to take medication and they don't want to believe they are mentally ill.
When a person is mentally ill and are violent even if the Court can't legally order them to receive treatment they still should protect the people the mentally ill person is abusing hurting and threatening.
Not all mentally ill persons are abusive and violent but when they are the Court ignoring the mental illness abuse violence and threats won't make it stop and ignoring it can lead to permanent damage, serious injury or deadly consequences for the victims forced to deal with the mentally ill person without any kind of protection.
Senator Deeds found out just how deadly the situation turn when a mentally ill person doesn't receive treatment.
When you can't get help or protection from CPS, police, or the court officials who can you turn to? When you have written asking for help from government officials Senators, Governor, President Obama local news stations and to talk show hosts who had stories about domestic violence child abuse and Courts ignoring it and giving children to the abusers but you get few responses that only commend you for fighting to protect the children but tell you they can't do anything to help you and tell you to keep going through the Courts, when the Court is the problem ignoring the mental illness abuse and violence and forcing you to hand a terrified child over to the mentally ill person the children say is hurting them.
When a child is seriously injured after you reported the abuse to the Court they ignored the prior abuse and injuries to the child and forced you to send the child back to their abuser again and the child is seriously injured but you can't hold these officials liable of accountable for the damages to the child they put the child is danger but they have immunity is that fair?
Don't let all these officials pat themselves on the back claiming they are doing something about domestic violence and child abuse when we have over five million children being abused and thousands dying every year in the United States and they say they can't do anything when a person writes to them asking for help because children they love are being hurt and damaged and the Courts are ignoring it.
If it were their child grandchild or a child they loved they would know who to turn to and they would get the case investigated to protect the child they love.
When a child is being hurt everyone should care. Laws need to be changed. Officials need to be held accountable when they ignore mental illness, child abuse, domestic violence and put a helpless child in that kind of dangerous situation. They wouldn't visit or live with a person who was abusing them and threatening to kill them, their mother,sibling grandmother and other family members why would they make a child?
One person can't force a change but if every honest american citizen stood together there would be changes. Our system isn't broken like I hear people says. It would work just as it was designed to but we have so many dishonest and corrupt people working in the system and until honest citizens are willing to speak out and stand together to have the bad officials removed the system will continue to fail our children.

I feel I can greatly relate to everyone's experiences here with relatives/loved ones with extreme bipolar disorder. However, I feel that the situation I find myself in with relation to my brother in law is quite unique, and I feel that I have nowhere to turn to.
My brother in law to say the least has had a very harsh upbringing to my recent knowledge. He has been diagnosed with bipolar disorder and quite possibly schitzophrenia. He is 30 years old and for the past 8 years has been wondering across many Latin American countries as a hippie/homeless person with a lot of substance abuse.
I recently became married to his sister who is from Colombia. We got married and live in Chicago Illinois, and are new parents within a year timeframe. This has been challenging by itself, and he has been used to his siblings and mother to always get him out of trouble financially or legally wherever he finds himself.
Upon hearing that we got married and moved to Chicago, he took it upon himself to come to the US by illegally crossing the Arizona border and nearly dying in the desert before being picked up with the dillusion of having to rescue his sister.
My wife and I had no idea that he had decided to do this, and were able to take him in on a pending immigration case. Since then our lives have been turned upside down with his episodes. I currently am the only working spouse to maintain 3 of us and has been difficult enough. My wife does not work, does not know English, and is a first timer to the US.
The difficulties with his condition has included everything: Insulting my wife, not cleaning up after himself, becoming violent, depressive, not wanting to work, substance abuse, constantly asking for money, excessive smoker, and even attempted murder within my own home.
We had him hospitalized, and was told that he had to be on medication for life. Well, he took the medication for 2 months time only to abandon the treatment and continue with his Hippie lifestyle. My Wife continues to defend him and I feel I can't do anything.
I feel caught in the middle, because despite my wife not wanting to tolerate his behavior she continues to defend him because he's her brother. The frustration leads to threats of divorce if I don't continue to tolerate because he's "sick" but the fact is he does not want help, and refuses to get treatment. Fact is that this ongoing trauma is holding us hostage and not being able to progress as a family. I really don't know what to do here. Really really difficult, and creates a huge distraction even when I'm at work. We are already trying to recover from many extreme changes personally as a couple since we got married. My wife: New country, no English, just married, first time mother, post part depression, first ever winter and the harshest we have ever had, neglect from my side of family to accept her, and on top of that her brother lands on our lap.
sort of desperate here.

Hello Ashley and I'm so sorry to hear you are going through what I want to thank you for sharing. I question the symptoms your mother is having as well as you do. Innoway they don't sound like bipolar but in fact schizophrenia. She would need to have that diagnosed I know how hard this is for you and the family to go through and see this happening to her while she seems to spiral out of control. This not only affects hard but you and the rest of the family as well. My son was diagnosed with bipolar disorder a few years ago and was on medication it was very effective for him but he decided to wean himself off about a year ago. He has been having the cyclic behaviors and is now in a manic stage. What is happening is the more he cycles the worse the episodes are getting. Right now he is going through a manic episode which is the longest and the worst I have seen since he stopped taking his medication. His actions are becoming more distractive his driving is becoming erratic and his actions are becoming erratic as well . He is usually very close to me to my family but over the past 48 hours he is distancing himself and basically telling us especially me, his mother, to back off leave him alone and let him live his own life. I know the difficulty of this because if we actually back off we don't know what's in store for them. They are not only spiraling out of control themselves but bringing us with them. All I could say is to try to speak to someone and maybe have an intervention with her but I would get a counselor to attend as well someone who could mediate the meeting. Good luck to you and I pray that everything works out you will find some peace.

Hi, thank you for this post but unfortunately it has not helped. I am a 21 year old with a three year old son and a supportive husband. I have a mother that is diagnosed with bipolar mania disorder. But I have reasons to question that diagnosis because I feel that she is schizophrenic. She has no motivation to do anything. She sits around all day and does not take care of herself in a hygienic way and she does not eat properly because she says she is fasting for God for prosperity. Keep in mind that she has been fasting for 2+ years. She will sometimes break her fast and becomes very distraught and start screaming and cussing God and the devil. She talks to herself like she is talking to God and the devil and then replies to herself as if she is someone else. She will not do ANYTHING because God tells her not to. She will not clean herself regularly and has been wearing the same set of clothes for months. I believe that she does this because she has no energy to do anything for herself unless her family talks her into it. She was receiving SSI and I was her payee and I had to take on the burden of taking care of all her finances. I also had to deal with her getting angry and thinking that the bank was stealing her money when in reality she was spending it and forgetting about it. I used to get so stressed because I felt like I was spending all my time in taking care of her and me and my husband would fight because I had no time to take care of me and my family. I don't know what to do because she absolutely will not take her medication or go to her counseling sessions. She says God doesn't want her to and he has delivered her from her medication. You said that the main reason they don't take their medication is because of fear but I don't think that is her case. I have talked to her about taking her medication but then she gets mad and gets in a fight with God and the devil again. She has been admitted twice to a mental hospital and just recently our family has ran out of options in trying to help her. So we went to the courthouse and tried to get her admitted to a hospital again but the authorities took her to the hospital here in town and she knew how to pass the mental evaluation and she did and they discharged her. It's like she knows how to turn off her condition to make it look like there is nothing wrong with her. She was living with my grandma in an apartment and my grandma was living off of housing. They found out my mom was living with my grandma and cancelled my grandmas housing so now they are living with my uncle which is my moms brother. There have been several incidences where the cops have been called on her for her screaming and violence. She has been aggressive with her own family and also towards neighbors. So because of that the cops have been called on her. She has also been aggressive towards me before. I had to call the cops for her to leave my house because she was trying to be physically violent. My uncle can't handle the way she acts and this causes them to fight so it is not healthy for her to live there and I have no room at my house and I cannot have her around my kid especially when she does not take her medication. I am stuck at a crossroads with her and I don't know what to do anymore! I love her and want her back to her normal self but how can I help someone that doesn't want it? We were helping her look for a house for a while but her expectations in a house were so unrealistic that even the realtors could not help her. For a while she said that God was going to give her a mansion so she did not have to spend her money on a house. And by the way, I am no longer her payee for SSI because she got an inheritance from her father because he passed away. She was going to spend some of that money on a house but her out there delusions have gotten in the way of that. She also tells us she has an aneurism and we have had her checked out and the doctors said she does not have one. We have looked for houses but none of them were fit for her because she was expecting to have a super nice 4-5 bedroom house for only $80,000. That is unrealistic. She does not qualify for a home loan so she would have to pay it all off up front. When it comes down to paying it she tells me that she doesn't have to pay it all at once because that is not how buying a house works. I have explained to her time and time again that in order to only make payments towards the house is through a loan or contract and she does not qualify for either one. She does not want to help herself because God said for her not to take her medications and without them she is having angry outbursts almost on a daily basis. When we try to get her admitted she passes the mental evaluation because she knows how to answer the questions just right so she doesn't seem like there is something wrong with her. And when she goes into the hospitals for her mental health she gets out in no time because she plays it off like there is nothing going on with her. I don't know what to do! This is one bad situation with her and I have completely ran out of options. I am the only one that can take care of her and make sure her finances are taken care of but it is too much for me. And I feel like there is nothing more for me to do for her but I can't stand to see her suffer the way she is. I need help and guidance and resources. I feel like she needs a caregiver but its too much for me to handle. Please help me or if you can guide me in the right direction in how I can help her or who I can contact to get her the help she needs I would much appreciate it! Thank you so much for taking the time to read this. Please help me! I am desperate!
Sincerely,
Ashley

When I was a little kid, around 8 or 9. I was diagnosed Bipolar. I was put on meds and everything, but I stopped taking them when I was around 11 when I realized they where deadening my personality. I was no longer energetic and happy, and was always apathetic and tired. If that was my REAL personality, it disgusts me. So I stopped taking my medication. I've been fine not getting treatment for close to a decade now, I can socialize and function and while my manic episodes makes people think I'm a little eccentric and my depressive ones make people shy to be around me, I have a huge circle of friends and an active sex life. To all my fellow Bipolar sufferers, the only help you need is self discipline, practice meditation, take up hobbies to occupy your mania, and read and listen to music or other stimuli when you're depressive. There's no need for pills!

This condition requires a higher power of intervention. So, I have noticed that when my wife does pray for about 30mins or so that it helps her to get through the day. One day at a time. She is bipolar and it does feel like I live with two polar bears that are going to eat me at any time. God help us! I do love her and that is the only thing that keeps us together. Amen!

I understand the concept expressed in this blog but it sacrifices the complete perspective. In the example of a spouse accusing a partner and the constant blame it must be mentioned that this is abuse. It is not ok and if a person communicates this it must be responded to. The major challenge with bipolar is that they can not communicate in a rational way. If a bipolar person were thinking rationally they would not refuse treatment. The fear of doctors is a common one. It is rational thought that gets us to get treatment. Would a bipolar person refuse treatment for a broken limb or cardiac emergency? It is the same mechanism. The mental health industry is the only one that waits for a problem to present acute symptoms that often are a result of a loss of quality of life. A sane and rational conversation may not be possible. I would argue that a life partner is not a caregiver. The difference is an order of magnitude. I honestly feel that those with bipolar have it hard enough. The same probing questions that keeps a bipolar from getting treatment are exponentially more difficult coming from a loved one. Medication alone is useless. Anti depressants with mood stabalyzers are not effective together as much as they are alone. Medication can also stop being effective as soon as 8 weeks and they may take months to be helpful again. Treatment should be the entire spectrum. Start with therapy. Ask about support groups and if your loved one wont go for them they will go for you. They need proof. Not words and at the end of the day we must all work harder to remove the stigma and we need the medical community to work much harder to restore trust. These fear excuses can be resolved by everyone. A diagnosis of bipolar is hard enough and they should not be forced to face the stigmas and terrible medical treatment when they are not responsible and frankly they have enough work to do. I am disabled and I find more and more that I am my own advocate and I have to educate people on basic respect in that I am different, not less than. I imagine people who are bipolar feel the same. Treatment is everything and anything can be treatment. It is important for a loved one to maintain positive health just as it is important for a bipolar person to keep trying. Just my opinion. I've been married to a rapid cycling bipolar woman for 6 years. She can be difficult but of anyone else she knows I just want to have an ordinary life and I do not want to be some inspiration story, neither does she. I just know I would never stop trying to get my wife help. Whatever it took. I won't wait for an emergency crisis to get her help. I won't quit no matter what.

Hi Susan,
I don't believe there is any evidence to suggest that a person can go from bipolar to schizophrenia due to a prolonged manic episode. Like, what will happen (in my non-medical opinion, I am not a doctor) is that he will cycle down on his own as bipolar disorder is a cyclical illness. However, when I say cycle down, that will likely be into a depression. If that happens, he may more readily accept medical intervention.
- Natasha

My son is bipolar and is now in jail for his actions being off the medicine. I am visiting him in jail and see that he is still manic. The court system is a long process and I have to be patient. My question is if he never gets treatment again and remains in this state can he become schizophrenic or worse and have to be institutionalizaed? I worry that he may never accept the medicine again.

Kathryn,
Couples therapy with someone who knows and understands bipolar disorder (likely a psychologist is often the best bet here, but it doesn't have to be).
If you can't get him to go, at least go for yourself--for your own sanity. You'll at least have a sounding board, but more importantly you'll be able to gain some perspective and skill as to how you can handle those difficult situations that are so hurtful.
Good luck!

I'm married 2 1/2 years now to a bipolar. It's so hard to keep it together. He's refusing to take his meds. He took them for a month and stopped. I can't talk to him about anything. He spends money like it grows on trees. He accuses me of things I haven't done; and gets out of control with accusing. I sometimes think of leaving, but feel I need to be here for him. That as well as I love him. We have good days and bad. The bad is always my fault for some reason. I just don't know what to do. Eggshells is an understatement.

@Maria Gostrey
Thank you Maria for your post. I agree with everything you write and feel the same.

yes I have leared
do not take end up In the mental hospital so now I take my meds and go to counseling and stay halfway sane I think bean in the hosp for not taking meds or the meds stop working right about 7 or 8 times after awhile you lose track .

Thank you Natasha for your Blogs on Bipolar disorder.I am a Bipolar,inspite of my best effort i could not tolerate quitipine so i gave up at my own.

Twenty years ago I went into a severe depression and saw a social worker/counselor who suggested I see a psychiatrist, I was 35, and flat out refused.The idea that I needed a psychiatrist was frightening, even though I knew that feeling and acting like a yo-yo since my teens was not normal. My son's friend's mother was on lithium and the side effects scared the daylights out of me. So for years my family endured Dr.Jekyll and and Mrs.Hyde. I went into another severe depression, the meds didn't, and a nurse practioner suggested I see a psychiatrist. This time I listened, and the Pdoc prescribed Lamictal,Abilify,and Seroquel.I often lament all the years lost to bipolar and the denial that anything was wrong. I believe that the biggest step is to accept that something is amiss and seek help.

Thank you, MIPO. I read about LEAP a couple of years ago, when I first broached the topic of his behavioral health history and my request that he resume treatment, or at least seek a consultation (after our first year together). That met with anger and vehement denial that there had ever been an underlying MI and the problem was actually mine. While I never accepted this , I decided to take the slow approach, believing that if I could at least listen and empathize, perhaps we could develop a partnership and some tactics for dealing with episodes of compulsive shopping, self-medicating, breakdowns at social events, etc. This was the approach I took for the next two years. It's not working, and I believe this is because we cannot move forward with the LEAP approach if we don't agree that there is an underlying MI. I have always said that whether to seek treatment and what sort is entirely his decision, but that I can no longer be complicit in his total denial that there is an underlying MI. Problems that arise from his MI are always attributed to external circumstances or are dismissed as "everyone does this/feels this way". I have come to the conclusion that unless he can acknowledge that there is some sort of behavioral health issue in play, there is really no possibility of a healthy role for me in his life, because the role he wants me to play is as someone who will support his belief that he is just fine. That, to me, seems actually more harmful than healthy.

I've heard it said that mania feels good. So why get treated? Likewise, it feels real. It feels like you really are master of the universe, versus someone unable to recognize you are ill. So my guess is people with mania don't want to get treated, cuz they don't want to lose the high and because they don't believe the high is an illness.
Depressive stage is more traditional reasons to refuse treatment. Belief you'll get over it on own; too depressed to get treatment; don't want a life on meds; and the reasons you mentioned.
The best advice I've heard is Xavier Amadors' "Listen, Empathize, Agree, and partner.

Thank you for your beautiful blog. I just discovered it and the timing of this post is, for me, uncanny. I am an old friend and 3-year partner of a man who has been diagnosed at least three times with BP and he has been hospitalized three times over the past few decades. I entered into a relationship with him fully aware of his medical history and also aware of the fact that he had stopped taking medication a few years earlier and was instead deeply involved with meditation. What I did not entirely understand was that he believes that his diagnoses were incorrect and there is no behavior health problem at all. The proof for him is that he has not had a psychotic episode since stopping medication and has not required hospitalization. I am not a psychologist, but I can see plainly that his behaviors and habits of thinking are sometimes, well, “crazy,” as you say. My own course of therapy led me to confront my denial about his illness: I wanted to believe that he is well even as it’s plain to me that a behavioral health issue is involved. I decided that I cannot live in denial. I explained to my partner that I love him as he is, I fell in love with him knowing of his history, I accept him as he is (unable to work, but usually occupied in a healthy way), and I am not asking that he seek treatment—that is totally up to him; I did, however, insist that we give the elephant in the room a name. This conversation went surprisingly well, and while he wouldn’t accept BP, he did allow that there might be a behavioral health issue. This, for me, was an unexpected and amazing step forward. What followed were, for me, the best few weeks of our relationship. It felt like we finally had some genuine trust. Now, about a month later, he says he was just playing along with me to make me happy, that there’s nothing wrong with him, and the problem arises from my need to “create crises” to feel better about myself and “control everything” and that I am abusive and incapable of genuine intimacy and that this is just more evidence that I do not love him. (Not surprisingly, I was observing the little cues that indicate he’s headed for a not-so-healthy phase in the days leading up to this reversal.) So if there’s a question in all of this it’s this: how can a partner be supportive and accepting in a situation of total denial? I have drawn a line and made clear that I will not remain in the relationship if it’s based on denying the fact of his mental illness, and the breakup seems to be happening, though he has gone away for a few days to rest before figuring out where he’ll go.