The Effects of
Manic-Depressive Illness

Emotional Effects

If symptoms are related to an individual's aggression or inability to fulfill responsibilities, family members may well become angry with the individual. They may experience anger if they see the individual as malingering or manipulative. Anger can also be directed at the "helping" professionals who are unsuccessful in curing the illness "once and for all" Anger may be directed at other family members, friends or God.

Typically these same family members experience feelings of extreme guilt after the individual has been diagnosed with a mental illness. They are concerned about having had angry or hateful thoughts and may wonder whether they somehow caused the illness by being unsupportive or short-tempered. Moreover, much literature and other media of the past few decades have largely supported (erroneously) a common notion that parents are somehow always responsible for producing mental illness in children. And so, parents and to a lesser degree, other family members may find that feelings of guilt and the wish to compensate for any wrongdoings prevent them from effectively setting limits and developing realistic expectations.

If the individual's illness creates an ongoing burden for the family because of such things as decreased income or continual disruptions in family routines, it is not uncommon for family members to find themselves in a cyclic pattern of alternating feelings of anger and guilt.

Equally painful is the sense of loss that is associated with the growing awareness that, in severe cases of recurrent manic-depressive illness, an individual may never be quite the same person the family knew before the illness. There is grieving over lost hopes and dreams. The mourning process is usually marked with periods of resignation and acceptance and intermittent periods of renewed grief stimulated perhaps, by the accomplishment of a peer, a family celebration or some other seemingly minor event. Eventually, as with any other loss, whether the end of a marriage, the death of a loved one, or the loss of ability through illness or accident, what is needed is a careful re-evaluation of goals and an adjustment of expectations.

Related here, may be some feelings of shame associated with unfulfilled expectations and with the stigma of mental illness. It may be interesting for family members to realize that one of the reasons that mental illness carries with it such a stigma (less so nowadays), is that mental illness is often associated with decreased productivity. The value of productivity and the notion of "the bigger the better', have long formed a mainstay of North American culture. The family may have to grapple with whether they want to place such emphasis on these values. Shifting emphasis on to values related to family, spirituality or other focus may help to diminish any unnecessary suffering due to feelings of shame.

Finally, anxiety may be ever present as family members grow to continually anticipate a change of mood, a return of symptoms. Families may find planning events fraught with worries of whether the ill relative will present any problems at the event. There may be fear that unprovoked conflicts will arise at any time, that other family members may suffer. Children may fear that they will inherit the illness, they fear that they may have to manage the care of their ill relative as well as manage their own lives when the primary caretakers can no longer do the job. To cope with such consuming anxiety, some family members learn to distance themselves (both physically and emotionally) from the family while others may put their personal goals on hold in anticipation of the next crisis. In any event, families need support to learn to manage anxiety and to lead as fulfilling lives as possible. Attending manic-depressive support groups can help to relieve the pressures experienced by families caught in their stressful situations.

The Social Effects

In severe cases of manic-depressive illness, families typically find that their social network starts shrinking in size for several reasons. The family is often embarrassed by the varied symptoms of an ill relative whether these symptoms have to do with poor self-care skills or belligerent behaviour. Visitors may feel awkward about what to say or how to help the family. Usually they say nothing at all and soon both family and friends find themselves participating in a conspiracy of silence. Eventually, it becomes easier to avoid each other.

Going to a manic-depressive support group is one way to help reduce the sense of isolation a family often faces. Through the practice of self-disclosure and the development of a vocabulary to use and the self-confidence to use it, a family can gradually learn how to communicate with extended family members and friends.

The Changes Within Family Members

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Family members often feel exhausted because of the time and energy spent on issues related to the illness. There is little energy left to invest in other potentially satisfying relationships or rewarding activities. Increased tension leads to risk of marital dissolution and stress-related physical symptoms. It is not uncommon to hear worn-out spouses desperately stating, half jokingly, half seriously, "I'm the one who will be in hospital next"

Siblings may experience jealously if too much attention is devoted to the ill member and not enough to themselves. To deal with feelings of resentment and guilt, siblings spend more time away from the family. When the ill member is a parent who cannot meet the emotional needs of his or her spouse, a child may assume the role of confidante with the well parent and may sacrifice some of his or her own personal development as an independent individual.

In general, the emotional welfare of all family members is at risk because of the ongoing stress. It is important for the family to be aware of these risks and to take appropriate measures (for instance, getting support from outside sources) in order to minimize the risks.

Changes Within Family Structure

Regardless of which family member is ill, role relationships often shift in response to the illness. If, for instance, a father is unable to provide financial and emotional support, the mother may have to take on additional responsibilities in both spheres in order to compensate. She may find herself in the position of a single parent but without the freedom of decision-making afforded by single parenting. Added to this, the wife may find herself parenting her ill husband as she monitors his symptoms, his medications and deals with his hospitalizations. As the husband's capacity for work and family participation fluctuates, the wife is at risk for ongoing confusion and resentment. Children may take on caretaking responsibilities when mother is absent and as mentioned previously, may even become the sole source of emotional support for mother when she is present. If a sibling is ill, other siblings may have to take on the role of caretaker when parents are away. All members are subjected to demands far greater than would be normally expected.

Expectations

A major challenge facing families of manic-depressive patients is the formation of realistic expectations both of the mental health system and of the ill member.

a) Mental Health System

When families bring their ill member for medical help they often expect a firm diagnosis and a clearcut treatment regimen which will quickly and permanently cure the illness. They then expect the relative to resume a normal life immediately following treatment.

It is usually only after several experiences of trial medications, many disappointments at hospital and at home over unfulfilled expectations that the family starts to appreciate the somewhat nebulous nature of manic-depressive illness. The illness has no clearcut beginning or end. There are often residual impairments and ongoing vulnerabilities (weaknesses) after acute treatment. The family must start taking into account the limitations of the mental health system both in terms of knowledge base and resources.

b) The Ill Individual

Some of the residual symptoms an ill relative can experience after acute treatment include social withdrawal, poor grooming, aggression and lack of motivation. A family must try to sort out what a relative is and is not capable of doing. Unrealistically high expectations may lead to frustration and tension and finally, relapse while too low expectations may lead to prolonged symptoms and increased depression in the relative and a sense of helplessness in the family. It may be necessary to give a helping hand or at times, to completely take over the regular duties of an ill member. As he or she recovers, the responsibilities should be returned at a comfortable pace.

Related Information:

• Families of the Mentally Ill: How Mental Illness Impacts Family Members
• Best Things to Say to Someone Who Is Depressed

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