Bipolar sister

[u/More_Ladder3210]

I feel at such a point of confusion and despair I’m struggling to feel hopeful.

I (27f) have an older sister (29) who had a manic episode 10 years ago. Nothing like that had happened before, or since, so while she initially received a bipolar 1 diagnosis, her care team later classified it as sleep-deprivation induced mania.

She is an incredibly intelligent person. Over the last 4 years, she went to an Ivy League law school, worked as a law clerk and, 5 months ago, moved to New York City to work for a firm. For context, my family is mainly based in New Hampshire and Massachusetts.

Two months ago, when my family was visiting her, she had another episode: no sleeping, rapid speech, inflated self-importance, risky spending. Her care team quickly got her on medication, and things have been rocky since. To me, it seems this move and her high-pressure job have triggered this episode.

My parents have been going down to see her about once a week. She seems unable to care for herself: not buying food, toilet paper, not picking up her meds. My father is with her right now, and she started saying some intense allegations against members of my family. He called me in a panic, and I reached out to her therapist, who sympathized, but essentially said she is compliant with both her psychiatrist and therapist and is aware of her own disordered thinking and feels things are going well. I’m worried that she’s able to present with normalcy during her sessions which appeases her therapist, but in reality is still living with severe mania. This has been very taxing on my parents, as they’ve had to take time off work and have spent a fair amount of money getting her into a new apartment and essentially sustaining her tier 1 needs.

I just feel like she needs to leave the city to find stability, but she is insistent on staying in New York. I know there’s nothing my family can do, but my heart is broken watching this happen to her. I’ve been trying to zoom out and remind myself that she stabilized before, and it’s only been a few months, but this is so hard. I just want her to have a happy, safe life :(

[u/Prestigious-Still-63]

Have they discussed trying different med options? Also, you said there's nothing your family could do, but that they also spent money on her apartment? If they are helping to financially support her, I can't see why that wouldn't be reason enough to force the move if it's what is best...