In trying to support a person with bipolar disorder, how do you make sense of the ups, downs and sometimes downright craziness?
Bipolar in the Family: Difficult on Everyone
When one member of a family has bipolar disorder, the illness affects everyone else in the family. Family members often feel confused and alienated when a person is having an episode and is not acting like him or herself. During manic episodes or phases, family and friends may watch in disbelief as their loved one transforms into a person they do not know and cannot communicate with. During episodes of depression, everyone can become frustrated, desperately trying to cheer up the depressed person. And sometimes a person's moods are so unpredictable that family members may feel that they're stuck on a rollercoaster ride that's out of control.
It can be tough, but family members and friends need to remember that having bipolar disorder is not the fault of the afflicted person. Supporting their loved one can make all the difference - whether it means assuming extra responsibilities around the house during a depressive episode, or admitting a loved one to the hospital during a severe manic phase.
Coping with bipolar disorder is not always easy for family and friends. Luckily, support groups are available for family members and friends of a person with bipolar disorder. Your doctor or mental health professional can give you some information about support groups in your area.
Understanding, Recognizing Symptoms of Bipolar Disorder
Never forget that the person with bipolar disorder does not have control of his or her mood state. Those of us who do not suffer from a mood disorder sometimes expect mood-disorder patients to be able to exert the same control over their emotions and behavior that we ourselves are able to. When we sense that we are letting our emotions get the better of us and we want to exert some control over them, we tell ourselves things like "Snap out of it," "Get a hold of yourself," "Try and pull yourself out of it." We are taught that self-control is a sign of maturity and self-discipline. We are indoctrinated to think of people who don't control their emotions very well as being immature, lazy, self-indulgent, or foolish. But you can only exert self-control if the control mechanisms are working properly, and in people with mood disorders, they are not.
People with mood disorders cannot "snap out of it," much as they would like to (and it's important to remember that they want desperately to be able to). Telling a depressed person things like "pull yourself out of it" is cruel and may in fact reinforce the feelings of worthlessness, guilt, and failure already present as symptoms of the illness. Telling a manic person to "slow down and get a hold of yourself" is simply wishful thinking; that person is like a tractor trailer careening down a mountain highway with no brakes.
So the first challenge facing family and friends is to change the way they look at behaviors that might be symptoms of bipolar disorder - behaviors like not wanting to get out of bed, being irritable and short-tempered, being "hyper" and reckless or overly critical and pessimistic. Our first reaction to these sorts of behaviors and attitudes is to regard them as laziness, meanness, or immaturity and be critical of them. In a person with bipolar disorder, this almost always makes things worse; criticism reinforces the depressed patient's feelings of worthlessness and failure, and it alienates and angers the hypomanic or manic patient.
This is a hard lesson to learn. Don't always take behaviors and statements at face value. Learn to ask yourself, "Could this be a symptom?" before you react. Little children frequently say "I hate you" when they are angry at their parents, but good parents know that this is just the anger of the moment talking; those are not their child's true feelings. Manic patients will say "I hate you" too, but this is the illness talking, an illness that has hijacked the patient's emotions. The depressed patient will say, "It's hopeless, I don't want your help." Again, this is the illness and not your loved one rejecting your concern.
Now a warning against the other extreme: interpreting every strong emotion in a person with a mood disorder as a symptom. The other extreme is just as important to guard against. It's possible to jump to the conclusion that everything the person with the diagnosis does that might be foolish or risky is a symptom of illness, even to the point where the person is hauled into the psychiatrist's office for a "medication adjustment" every time he or she disagrees with spouse, partner, or parents. A vicious cycle can get going wherein some bold idea or enthusiasm, or even plain old foolishness or stubbornness, is labeled as "getting manic," leading to feelings of anger and resentment in the person with the diagnosis. When these angry feelings get expressed, they seem to confirm the family's suspicion that the person is "getting sick again," leading to more criticism, more anger, and so on. "He's getting sick again" sometimes becomes a self-fulfilling prophecy; so much anger and emotional stress get generated that a relapse DOES occur because the person with the illness stops taking the medication that controls his or her symptoms out of frustration and anger and shame: "Why bother staying well, if I'm always treated as if I were sick?"
So how does one walk this fine line between not taking every feeling and behavior at face value in a person with bipolar disorder and not invalidating "real" feelings by calling them symptoms? Communication is the key: honest and open communication. Ask the person with the illness about his or her moods, make observations about behaviors, express concerns in a caring, supportive way. Go along with your family member to doctors' appointments, and share your observations and concerns during the visit in his or her presence. Above all, do not call the therapist or psychiatrist and say, "I don't want my (husband, wife, son, daughter, fill in the blank) to know that I called you, but I think it's important to tell you that..." There's nothing more infuriating or demeaning than to have someone sneaking around reporting on you behind your back.
Remember that your goal is to have your family member trust you when he or she feels most vulnerable and fragile. He or she is already dealing with feelings of deep shame, failure, and loss of control related to having a psychiatric illness. Be supportive, and yes, be constructively critical when criticism is warranted. But above all, be open, honest, and sincere.