The financial impact of elevated phases in bipolar disorder: purchases, rash decisions, money that disappears. A piece for the family.
The statement arrives on an ordinary Thursday.
The total does not make sense. It is not a small discrepancy, the kind you explain away with a forgotten dinner out. It is a number that does not belong to that house. And underneath it, the list: a plane ticket to somewhere nobody had any plans to go, three purchases from the same shop on consecutive days, an expensive piece of equipment nobody can find, an annual subscription to something, a large round sum transferred to a name nobody recognizes.
The first reaction is not anger. It is confusion. You stand there staring at the list, trying to find an explanation that still fits inside the normal world — a bank error, a cloned card, a misunderstanding.
Then comes the memory of those three weeks. He was so well. He was even a bit too cheerful, and someone at home did say so, but it felt mean-spirited to complain about a man who had finally started laughing again. He talked about a new venture with a conviction that was hard to argue with. He had an answer ready for every objection. He seemed to see further than everyone else.
And now he is in the bedroom with the curtains shut, unable to get up — and the statement is on the kitchen table.
When this story reaches the consulting room, it almost never arrives first. It arrives later, at the second or third appointment, in a lowered voice, with an unspoken request not to be judged. Sometimes the sum is a car. Sometimes it is a house. Sometimes it is a business the family spent twenty years building.
Perhaps you recognized your own kitchen in that description. Or perhaps you thought of another family — someone who dropped out of view after a strange period, a relative who is spoken about only in passing, as having “got himself into a mess”. Either way, it is worth saying: there would be no shame in it. This is one of the most silenced subjects there is in these families, and the silence is exactly what costs the most.
It is not irresponsibility of character
This is the most important point in the whole text, and the hardest one to accept while you are holding the statement.
The spending that happens during an accelerated phase is not the spending of a spendthrift. It has a structure of its own, and that structure is recognizable.
First, the judgment of risk changes. It is not that the person decides to take a bigger risk — it is that the risk simply does not appear in the sum. The probability of it going wrong, which anybody would calculate automatically, stops being calculated. What is visible is only the good side of the deal, with a sharpness that convinces.
Second, the urgency is real. It is not impulse in the sense of a whim. It is the genuine sense that this has to be done now, today, before the opportunity passes. Waiting until Monday feels like an irrational waste of time.
Third, the ability to argue increases, and that is what fools the whole family. A person in that phase tends to be persuasive. There is energy, there is apparent clarity, there is an answer for everything. Business partners invest. Banks approve. Relatives lend. Nobody around him is being naive — it is that the state, seen from the outside, looks a great deal like confidence and vision.
And there is a detail that almost never gets told: sometimes the decision was not even a bad one in itself. It was not delusional, it was not absurd. What went wrong was the scale, the speed, and the total absence of any margin for error. That makes everything more confusing afterwards, because you cannot simply say it was madness.
When the phase passes, the family is not the only one left with the bill. So is the person himself, who has to look at decisions he recognizes as his own — because he was the one who signed — and at the same time does not recognize as his own, because he cannot remember ever thinking that way. That experience is devastating, and it usually comes with a shame that lasts years.
What money carries besides money
The financial damage rarely stays merely financial.
It becomes the subject that cannot be touched. It becomes the reason the family stopped going to certain birthdays. It becomes the remainder of a debt to a brother who lent the money and never chased it, but was never quite the same afterwards. It becomes the course the son did not take. It becomes the move to a smaller house that nobody wanted to make.
And it becomes, above all, a quiet reorganisation of power inside the marriage or the family. Someone takes over the accounts. Someone becomes the one who is controlled. That shifts everybody’s position in a way that does not undo itself, even after things settle — and both people usually suffer under that arrangement, including the one who ended up in charge.
What I tend to see is that these families improvise solutions over the years, each in their own way, without anyone ever having talked to them about it. They put arrangements together, hide cards, invent informal rules. They do it on improvisation and guilt, because there is no manual and because the subject never makes it into the appointment.
I am not going to say here which arrangement is the right one. There is no single one, and it is not decided in writing — it depends on the picture, on the history, on the people involved and on the moment. What can be said is that this subject is legitimate, it is clinical, and it deserves room in an assessment. It is not a matter for the bank. It is part of the picture.
Why it is usually money that finally makes a family seek help
This is worth saying without dressing it up, because it is what happens in practice.
Many families go through years of suffering without ever seeking an assessment. They go through arguments, isolation, months spent in bed, marriages coming apart. Each of those things hurts, but none of them produces a document.
Debt does. It arrives with a date, an amount and a name on it. It is irrefutable in a way that suffering is not. And that is precisely why, very often, it is debt that finally pushes somebody to book an appointment.
If that is how it went in your house, there is nothing shameful about it. It does not mean the family cares more about money than about the person. It means the financial damage was the first sign that could not be explained away, negotiated or postponed. It broke an agreement of silence that had already been running for years.
What I tend to see, in fact, is that when this subject is finally said out loud in a consultation, the relief is enormous — on both sides. Because until then each of them was carrying it alone, convinced they were the only case in the world.
What it says about the illness
There is something practical here, and it matters.
Repeated financial damage is not a biographical detail. It is a marker of severity and of insufficient control. When a family describes more than one episode with serious material damage, that usually indicates the reading of the case needs to be revised — not continued.
And there is an additional detail that goes unnoticed: accelerated phases are, almost always, the part of the picture that appears least in consultations. The person does not seek help during them, does not remember them well afterwards, and does not report them as symptoms. So the financial history the family keeps — the dates, the amounts, what happened in each period — tends to be the most reliable record in existence of that whole history.
That information is worth a great deal. It is often what makes it possible to rebuild a timeline that was never assembled in ten or fifteen years of treatment.
If the statement is on the table in front of you
You do not have to sort this out today. You do not have to decide who is right, or settle the accounts, or work out where every amount went.
Perhaps just hold on to two things. The first: what happened has a clinical explanation, and that explanation is neither an excuse nor an absolution — it is information about what needs looking after. The second: yours is not the only family this has happened to, even though almost nobody talks about it out loud.
And if what came to mind while you were reading was somebody else’s story rather than your own, that counts too. Sometimes telling a person that it was not a failure of character is what allows the conversation to finally happen.
You do not have to conclude anything today.
Related reading
- He stopped taking it because he was finally well
- How long does lithium take to work
- It is not just the way he is
Are the elevated phases causing financial harm to the family?
Book your appointment here
In-person appointments in Brasília (Asa Sul) or by teleconsultation anywhere in Brazil.
Dr. Leonardo Sodré is a psychiatrist and psychotherapist in Brasília, Brazil (CRM-DF 14.206 · RQE 14.761). He holds a PhD in Psychiatry from UFRGS and teaches at the University of Brasília School of Medicine. This content is informative and educational and does not replace individual assessment, diagnosis or treatment.