Bipolar Crisis: Damage to the Wallet and the Soul

The world became a slightly different place in 1958, when American Express began issuing the first plastic “charge” or credit card. Shortly thereafter, as credit cards allowing for the balance due to be paid over a period of time came into use, the American concept of debt began to change. Now, consumers charge in the area of 1.8 trillion dollars annually; a staggering figure to most of society.

While financial difficulties are a concern for the mentally ill during most of their adult lives; in the form of attempting to pay for treatment and medications, inability to maintain employment or a stable income, behavior patterns that are altered during periods of acute illness can be as individually staggering as the previously stated communal annual credit card debt.

In the midst of attempting to recover, from a psychiatric standpoint, from an acute episode of depression with psychotic features in association with a chronic diagnosis of Bipolar disorder, many individuals may find themselves struggling with the financial impact that their  illness places on theirfamily. Not only are they unable to earn their usual salaries, not only are they burdened with extensive hospital co-pay bills and expenses related to treatment such as psychotherapy and perhaps even ECT (electro-convulsive therapy) and their portion of the cost of their medications, which can run into hundreds of dollars per month at even the most inexpensive pharmacy, but the bills associated with their illness-related behavior start rolling in.

Often during periods of acute depression, acute mania, dissociative disorder or even anxiety and panic, the individual suffering participates in spending sprees. From book and movie clubs, to clothing, to jewelry and cruises, it is not uncommon for a mentally ill individual to spend money they do not have, in an attempt to feel better, more in control, or even in a state of unawareness of what they are doing.

Some may be lucky enough to have a spouse or other family members who are supportive and understanding, ready to help correct the damage. Other issues of dangerous behavior during these acute episodes may include excessive use of alcohol or illegal substances, promiscuous behavior, and other acts which the person, when mentally stable, would never consider doing.

The correct usage of a combination of antipsychotic medications, mood stabilizers and antidepressants, while costly, can help to reduce the frequency of future occurrences of acute crisis. Not eliminate the risk of, but decrease it at least. While that is reassuring, the fact that the potential exists is still alarming, and one potential  reasonable solution might be a prepaid credit card that the person diagnosed with bipolar disorder, depression, or any other mental illness, could have access to, without the ability to exceed the limits of their  ability to pay.

Some of my peers might suggest that this is infantilizing or demeaning to the mentally ill, treating them like a child who can’t manage his or her allowance, but the fact is that it allows freedom and dignity, without the risk of incurring considerable debt during a period of decompensation.

Most credit card companies offer such pre-paid general use cards, with the value placed on them determined by the consumer. This way, when the individual is not psychotic, and is in full control of both their emotions and their spending, they areable to participate actively in the decision making process. In other words, the next time, if there is a next time,they will only be able to spend a certain amount of money- and won’t be crying and ashamed in front of a stack of bills. Their illness can continue to impact on their  life, but they don’t have to allow it to completely destroy the quality of their lives.