Bipolar Disorder and Family Therapy

by Carol E. Watkins, M.D.

Most professionals agree that Bipolar Disorder is a biologically-based mental illness. Medication is a critical part of the treatment. However, the emotional swings, the medication side effects, the disruptions in work or school all take place within an individual-and that individual usually lives in a family.

Mark was having a successful season in his sales job. His boss then increased his responsibilities. Mark began to work extended hours and go without sleep. While his sales were phenomenal, he was irritable and even threatening to his wife and children. After two days without sleep, he got into an argument with a police officer and was arrested. His wife had to leave the children with a neighbor to meet her husband at an emergency room. A week later, still somewhat manic, he was discharged. His wife and family were afraid. Who was this man who was coming home to live with them?*

An episode of mania or depression can make a familiar family member seem like a stranger. The experience can be frightening and disorganizing for the entire family. In such a state, the family members may become hostile, fearful and controlling. They may blame themselves or the affected individual.

Bipolar disorder may involve long periods of remission between episodes. Everyone can be lulled into a false sense of security. This fosters denial of the illness and premature medication cessation. Some individuals who are usually quite responsible may temporarily lose their insight during the early stages of an acute episode.

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Family therapy can help the entire family unit regain healthy relationships after a period of mania or depression. It can help the patient and family identify and deal with the stresses that may trigger acute episodes. The patient and family may need to distinguish the patient’s long-term personality traits from an exacerbation of the bipolar disorder. On one hand, the patient and family need to work through denial and learn to accept this as a biological condition. However, excessive vigilance, relating every personality quirk to the illness, can be counterproductive.

Families do not cause bipolar disorder, but they can do a lot to support treatment, speed recovery, and help the individual identify early recurrence.

Carol E. Watkins, M.D.

*Vignette is fictional but typical of actual cases

Read more: The Effects of Bipolar Disorder on Family and Friends

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