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When Someone You Love is Bipolar

posted by Beyond Blue

when someone you love is bipolar.jpgThe following interview with Dr. Cynthia Last and her husband, authors of  “When Someone You Love Is Bipolar,” is reprinted with permission of Guilford Press.

 

1. Dr. Last, in your book you candidly admit that although you were originally diagnosed with bipolar disorder in your early 30s, you didn’t accept it until 10 years later. Why is denial so pervasive among bipolar sufferers? How can spouses convince their loved ones to get the help they need?

One reason that denial is so common is because being diagnosed as bipolar is extremely scary! Many people have preconceived notions about the disorder that stem from how it has been portrayed in the media, where the most severely ill cases often are used as illustrations. No one wants to be labeled with a condition that looks “crazy.” But what we now know is that bipolar illness really is a spectrum of disorders, including manifestations of the illness that are much milder than the characterizations we’ve seen in movies and on television (I am fortunate to have one of the milder versions of the disorder, although during the rough times in battling the illness I didn’t typically feel fortunate.) One way partners can help get their loved ones to break through their wall of denial is by doing what I refer to as “the family tree exercise.” Since bipolar disorder tends to run in families, acknowledging the presence of the illness in relatives often serves as a “wake up call” for the person who has had trouble accepting the truth.

2. Bipolar disorder brings up tough questions about day-to-day living, such as should we travel for the holidays? And can we still enjoy wine with dinner? How can couples work together to address these issues?

Most experts in this area believe that sticking to a regular routine or schedule and abstaining from alcohol are essential components to achieving mood stability. This can make travel and even moderate drinking difficult. However, every person is different and it’s important for couples to make decisions based on their specific experiences. Even if it appears that a bipolar person can have an alcoholic beverage from time to time without any seemingly negative consequences, alcohol is completely out of the question during a mood episode (either depression or mania). Alcohol worsens and lengthens mood episodes; even worse, it also dramatically increases the risk of suicide, which is disproportionately high among people with bipolar disorder (at one time or another, about 25% of bipolar individuals make an attempt on their own lives). Spouses can play a huge role in supporting their partners’ sobriety by abstaining from alcohol themselves.

3. What are some common early warning signs of depression? Of mania? In the early stages of a mood episode, what can spouses do to help prevent the spell from escalating?

There are many possible early warning signs for depression, including, fatigue, change in appetite, and a general lack of enthusiasm. Early signs of mania may be irritability, excessive spending, and accelerated speech. Warning signs vary from person to person. What’s important is for spouses to know their partners own idiosyncratic early warning signs so they can be alert for them and share their observations with their partners. Once recognized, couples may be able to “nip the problem in the bud” by using the early intervention plans for depression and mania outlined in my book.

4. While bipolar disorder is a profoundly challenging and painful mental illness, Dr. Last, you do believe it has some benefits. What are some of the positive effects of being bipolar?

Much has been written about the relationship between creativity and bipolar illness. Historically it has been documented that an inordinately high percentage of writers, artists, and musicians have had the disorder. Some characteristics of manic and hypomanic states–such as increased drive and productivity, the ability to take risks, and a heightened sense of self-confidence–may help the creative process. Some bipolar people worry that medication will stifle their creative energy, but in my professional experience, while this is true for some, many find just the opposite–their work is even better once their mood has been stabilized.

5. Nobody likes taking medication. Often, bipolar sufferers stop taking their pills because they feel they don’t “need” them anymore, or because they can’t stand the side effects. How can spouses help their partners stick with their treatment program?

Medication is essential to bipolar health–there is absolutely no way around this. Unfortunately, lack of medication compliance is a common problem among bipolar people, so it often becomes a bone of contention between partners. When partners maintain that they don’t need medication anymore, spouses can draw their mates attention to specific, problematic events that occurred when their loved ones were taking “medication holidays.” If an unpleasant side effect is to blame for the medication discontinuation–like weight gain, which is a complaint I hear frequently–spouses can help their mates by together taking on lifestyle changes that can lessen the problem (in this case, embarking on an exercise program or a healthier eating style together as a couple).

6. Following a set routine has been shown to increase mood stability. What are some easy lifestyle changes couples can make that will have a lasting, helpful impact?

Having regular meal and sleep-wake times are very important. However, the ability to fall asleep at a regular, reasonable hour often is difficult for bipolar people. Avoiding stimulating activities–such as exercising, watching a scary movie, or working on a mentally taxing project–just before bedtime is essential. Instead, suggest that your partner wind down with a hot bath, relaxing music, or a cup of chamomile tea.

7. Supporting a bipolar partner is hard work. How can spouses take care of themselves? What are some good coping strategies?

First and foremost, it’s crucial that spouses take time for their own needs (and not feel guilty about doing so!). If they don’t, they often become so consumed with their partner’s illness that they “lose” themselves. Devoting time to individual hobbies and interests allows well-needed breaks and prevents physical and emotional depletion. I also recommend that stressed spouses consider joining one of the many support groups that exist for people who have bipolar partners to get the help and support they need.

8. Mental illness is a very personal matter. What should couples grappling with bipolar disorder tell their friends and family? What, if anything, should they tell their employers?

Deciding what to tell friends and relatives depends on a number of factors, including how close your partner is to the person, whether the person is someone you and your mate feel you can trust, and determining if there is any advantage to letting the person know. In some cases, it may be sufficient to simply say, “____ hasn’t been feeling well.”

However, if the friend or relative is already aware that your spouse has bipolar disorder, it may be easiest to say that your partner has had a recurrence of the illness. The situation can get much stickier when it comes to an employer–after all, this is the individual who signs your partner’s paychecks. If your mate is having a mood episode and is unable to work see if it is possible for him or her to use vacation time. But if there is no vacation time available or it can’t be taken on short notice, a medical leave may need to be considered. In this case the employer will probably become aware that your spouse’s illness is psychiatric in nature since it likely will be your partner’s psychiatrist who documents the reason for the leave.

9. Barry, in the book’s foreword, you wrote that you firmly believe Dr. Last’s illness has made you “much closer and stronger than other couples.” Can you give some examples?

Cynthia and I are very appreciative of our relationship and, therefore, we virtually never take each other for granted. We also work hard to support each other’s individual personal and professional goals. Although bipolar disorder is a fact of our life together, it doesn’t define our lives or our relationship. My wife and I firmly believe that other “bipolar couples” can achieve this as well.

10. Surviving the aftermath of a mood episode presents its own challenges. What are some things couples can do to preserve trust, rebuild intimacy, and move forward together?

Seeing your partner beginning to stabilize after an episode of mania or depression is an enormous relief. Still, mood episodes can have serious repercussions (financial, legal, social, to name just a few) that linger long after they are over. Couples need to find ways to deal with the emotions they are feeling so they can put the past behind them. Support groups and therapy can be useful in this process. Also, instituting measures designed to prevent similar, adverse circumstances from occurring again can help create a greater sense of security going forward.

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  • Naia

    I am sorry but I think these psych diagnoses are over used and abused…with diagnosis of so called pscyh diseases…come prescribing of very harmful drugs. What is worse…dealing with your so called illness or suffering the harm from very dangerous drugs? How many of these diagnoses are from the results of living in our very abusive society…stalkers, abusive family members, pressure to succeed, greed, avarice, apathy…do I need say anymore? We have to move beyond drugs and find healing from within. Bipolar is built in aggression and anger from a life of abuses. How do Psychiatrists get off diagnosing every person that walks into their office with some sort of CANNED psych diagnosis…resulting in overprescribing of horrible drugs! These quacks are getting away with murder and people are not even aware of it…wake up sleeping America…you are being abused by the Psychiatric profession and it’s horrible greed!!!! These companies make Trillions of dollars while people die of horrible side effects…resulting in an increasingly more angry society…and it seems the drugs either kill or result in more neurosis!!!!

  • Constance

    Actually, I agree with what Naia is communicating. Most people I know with this diagnosis has had horrific lives and been exposed to traumatic situations. There is a place for medication but not in the sense we have taken it to in our country. Everyone deals with events differently just as every person learns differently. Lets get to the ROOT of the problem….the REAL WHY. Not just dealing with the sympoms.

  • Suzanne

    I am the first to say that there are many…many…in the psychiatric community who offer “canned” diagnoses, and who are only concerned in getting rich off of the pain of others. In my own opinion, far too many people are diagnosed with mental illnesses than who probably actually have them. Bipolar disorder seems to be the current flavor-of-the-month, along with ADHD for kids.
    But, it is irresponsible to pretend that these diseases don’t exist, and that it’s false that some people REALLY DO suffer from them. Some people with Bipolar disorder have had horrific childhoods. However, some have not. A lot of people have had horrific childhoods, yet do not exhibit Bipolar symptoms.
    For people who truly do suffer from BP, and who have endured traumatic experiences, these experiences only exacerbate the problems, but are not the sole cause(s). We’re getting on a slippery slope here when we start to insinuate ( or flat out state ) that these psychiatric illnesses are somehow “made-up” by the psych professionals, in order to make a buck. Like I said, I totally agree that there are many out there whose intentions are anything but good. But this attitude, frankly, only adds to the already unfair stigma that those of us who do deal with this disease on a daily basis have to deal with.
    I think we need to reach a happy medium here. Peace to all. :)

  • Nancy

    Mental illness is not pretty. It is much less pretty if medication is not used in the situations where it is appropriate. If you know of psychiatrists who are abusing the prescribing rights I suggest you turn them in to the medical society. Raging about society’s problems as being a cause gets none of us anywhere. But what is the solution.
    Any one with suspected bipolar illness should consider the actions that they can take to bound thier illness, should consider talking therepy to investigate the problems their illness may be causing them as well as the shcok to the ego of finding out you are not perfect, and should consider medication to see what if any medications are helpful. When it comes to drug therepy one should seek a doctor you trust to listen to your feedback as to whether a given drug is or is not helpful or appropriate. More than anyone, a patient knows what is happening. You have to advocate for yourself.
    Bipolar is what it is, and unfortunately it doesnt go away. The better you know yourself, the more you figure out what are your individual indicators that your mood in changing, the better off you will be long term. Paying attention to yourself, and treating yourself well takes discipline, something often lacking in BP people.
    The way I look at is after 20 years in the trenches (and 16 wasted years before diagnosis) that I am a person first and foremost, I am not an illness. As a person with an illness it is incumbent upon me to seek the best medical advice and made decisions that are appropriate for my life. BP is a highly individualistic illness, one that in many cases needs to be worked around. So what life is not all blue skies and candy, it really isnt that way for anyone. Life happens, you adapt. Rage all you want but you will never move forward till you get beyond blame.

  • Sandra

    As someone who lives with and cares for someone with this illness (for 17yrs now) Nancy says it well. It is ‘highly individualistic’ and self-awareness and acceptance helps to keep a better balance. Learning to adapt when ‘life happens’ may be harder for BP sufferers but it’s not an impossible goal. From my own experiances focusing on adapting along with proper medication goes a long way toward keeping healthy balance.

  • Heather Whistler

    This is such a great interview. My husband has bipolar disorder, and Dr. Last’s advice for spouses is right on. I particularly appreciated her points in #10, because after my husband recovered from his psychotic episode, I had two really serious anxiety attacks over the next 18 months that were related to the trauma I’d gone through as a result of his illness.
    For a long time, I felt the need to be the strong one and keep everything together, but that’s not a sustainable approach to marriage for the long haul. Couples therapy has been so beneficial for us.
    (I write about how John’s illness has affected our marriage at http://heatherwhistler.wordpress.com/ if you want to check it out.)

  • David

    I am bothered by the notion that someone “IS bipolar”. When someone has cancer, we do not say that person “IS cancer”. People “have bipolar disorder”. This is an important distinction because it is very easy for people with mental illness to allow their disease to define them. If a person is going to live successfully with a mental illness, it is critical that they acknowledge they “have” it, but not define themselves as “being” it. Making this distinction is what makes it possible for a person to recognize that they can treat, control, and exist as a “normal” person in spite of having a disease. Not unlike a person who “has cancer” is able to do. I say this as an individual who “has bipolar disorder” but who “is NOT bipolar”.

  • Dee

    Honestly, I had to walk away from my computer after reading the comments by Naia and Constance. I feel more peaceful retuning to this blog now with the responses from David, Heather, Sandy, Nancy and Suzanne.
    Naia, in your writing the rage, vitroil, misinformation and harsh judgements scream that you should seek and/or accept a diagnosis of bipolar depression in yourself. Those of us who live with this debilitating disease, are often better able to recognize “one of our own” than some psychiatrists, nurse practionars or others involved in our medical care. The over-the-top emotional reaction to this subject is an explosion of Anger and Fear. You may be entitled to an opinion, but not at the expense of facts. Who are you to judge us and the entire psychiatric community? This disease has been with mankind since the beginning of time.
    Constance, your shared feelings of anger and disbelief demonstrates the incrediable amount of ignorance and fear in our society. Despite the many strides and accomplishments of individuals, advocates and organizations within the medical,legal, political and social arenas, you serve to remind me (us) how much more needs to be done to educate and inform the public. ‘Why’ (Y) is just a letter in the alphabet. The root is genetics, it’s like getting blue, brown or green eyes. Trust me, not one of us wants this incurable disease. At least now,in this day and age,it’s manageable.
    Suzanne, consider these facts. 1 out of 4 people are living with a mental illness. That means there is virtually no family that isn’t impacted, someway or somehow by a mental illness. It’s estimated that 10% of the population have bipolor depression. Of this 10%, only 20% will seek diagnosis and treatment for this life-threatening disease. Of that miniscule percentage, 98% will go off their medication at some point. The non-compliance with young adults is even higher and so are the number of suicides or “accidents”. We are getting better at identifying, recognizing, assessing, and providing interverntion and treatment at earlier ages/stages of this devestating illness. Hense, the growing numbers perceived. The numbers will continue to spike with the military personnel returning from the current wars.
    Bravo!!! to Nancy, Sandra, Heather and David for sharing your insights and wisdom about yourselves and your spouses. Bravery and courage are the by-products of having bipolar or loving someone with this illness.
    Sadly, not everyone is fortunate enough to have a supportive spouse and family. So we must create other support systems, structures and outlets. My blog about living with bipolar can be found at
    http://www.tea-with-dee@blogspot.com. Peace!

  • http://lifebeyondbipolar@blogspot.com lifebeyondbipolar

    Mental health has become as touchy a subject as politics and religion. All I know for sure is that it took 15+ years of trial and error of diagnoses and medication to get me stable. Now I have a diagnosis of Bipolar Disorder II and am on great meds and I am stable. I am able to go to school, I am married and have a daughter, I can interact with others. Not to say that I never have an episode of depression or mania, but they are usually not severe. Mental health is not an exact science. It is a subjective science, doctors cant look at the brain and see what is going on. The doctor can only go on what the patient says and do their best to diagnose the problem. Sometimes they get it wrong. Like I said, it took 15+ years for me to be stable. I do know for sure that psychotherapy alone does not work for me. I have to be on medication. I’ve tried it. It just does not work for me. Perhaps some docs need to try harder I dont know. Nonetheless, mental illness affects over 25% of Americans today. That is a lot of people, and there are not enough docs out there. Offices and community centers are being over run by patients. Mental illness is something that must be “treated” it is not something you can “just get over.” It is a medical problem just like diabetes or heart disease.

  • R VanDette

    Please everyone who needs help go to truehope.com this can change your life. Best thing that has ever been available for Bi-Polar disease without the side effects. In our situation has been a God send – working so much better than pysch meds. and no side affects.

  • Chris

    Nice to hear some can live with this but in reality staying with my ex wife who is bipolar would have made my life miserable.There is no way around it it was a miserable existance. I had no idea what i was getting into.Personally I believe I was taken advantage of and people with this disorder should be very upfront abought life with a bipolar spouse.It was living hell.

  • Dee

    Having spent a lot of time studying the history of psychology and psychiatry, I have to agree with those comments that (angry or not) suggest being cautious about the current diagnostic standards. What is now “bipolar” was called frequently diagnosed asschizophrenia in the 1970s when my sister developed symptoms. It is now recognized that schizophrenia is an entirely different disorder.
    Things change. Based upon considering past behaviors (which is all we have to predict future behaviors), it seems highly likely that what is considered to be “bipolar” right now will be split into even more separate diagnosis, each requiring different meds, some of which don’t exist right now. And we will find that current meds were totally incapable of appropriately treating a large group of individuals, and may have caused unintended further symptoms. I am not arguing against either medicinal or talk therapy, but encouraging caution. Be careful in considering what “works” for you or your mate or your chld, and don’t just give in to the “professional” view. Good people make bad mistakes. Just sayin’.

  • Tina

    Well, well…
    Isn’t this interesting. Oh, this is gonna be fuuuunnnnn. *snicker* Especially, the message and “personal opinion” from Constance & Co.
    Seriously… I very much understand those that are upset. I having Bipolar 2 myself. Sometimes, being able to just see the humor in how so many are quick to judge and play the Prophet about other people’s lives. Just so sad how much ignorance and how many can be so arrogant about such a life challenging condition. From my own experience, I could just mention incidents and stories of what ridicule I had to confront and deal *trust me I got a million of them* with through friend’s, co-worker’s, health care providers. I just find it so hilarious how many compare our condition with all kinds of stuff. Just to name a few examples: religion, their own personal morals or life experiences, blah blah, blah. Wow! You people are just so smart and wise! If only I didn’t have that attribute. Maybe, because I haven’t studied science,psychology or neuron-biology? But, hey! I got and read really good analogy here that if I just did some inner-therapy and what not.
    Like for example a really great approach. Go more to the core and not deal so much with the symptoms. How fantastic! Just to bad that I took my friend’s advice of under going a in-depth psychologically orientated therapy (instead a behavioral therapy of what my very experienced Psychiatrist recommended) and just went on with just digesting the past. Oh that was a lot of fun! Six months of just running in a vicious circle. It amazes me that I didn’t have to go into the hospital, again (after the 8th) time in the past three years. Why go head on with the core of the problem where you just provoke one episode after the other and you are just locked into very severe symptoms that you can’tdissect the past. Why not get the symptoms under control so that you can try to deal with the inner core (if even that). Instead of viceverse? Plus, if you are able to do that. Please, tell me how and where you went to college and where you currently practice.
    So, all that are so quick to judge and blame the society on and what not. Obviously, you are part of “our and your society”. *scratching my head* Do yourself a favor and start educating yourselves. Then, maybe you can help change the world that we live in, today.
    Ableism:
    http://en.wikipedia.org/wiki/Disability_discrimination
    Sincerely,
    Tina

  • powell01

    I would just like to say I am living with Bipolar 1 disorder,and it is a living hell………It is true about all the manic epasodes,being suisidal,and all that,I have to say I have suisidal thought all the time and most of the time it is during a mood swing.Mood swings are my worst I can go from being fine to not being fine in a minuite,my mood swings are major I scream,cuss,throw things and some times I even want to hit.I have took alot of medicines I stop because I feel better or I am gaing to much weight or I sleap to hard I have to say sometimes I just want to believe nothing is wrong with me,but being bipolar and having a histerectomey dont mix trust me.I have been married and devorced because I made him so misserable,my relationships never last.Now I am in a relationship with some one for the past seven years and he likes to argue back with me when I am haveing mood swings and I get even madder I get so mad I cant even stand my oun skin………….!I feal sorry for my kids because I am always yelling or screaming I do that more than I smile after the episode goes away I cry wishing I could get better but no matter how hard I try I cant…I have been hospitalized once for really trying to kill my self and probley 4 times for just thinking it….I see why alot of people with this disorder break down and try these selfish things,I also under stand why because it would some times be easier that way because just the racing thoughts can drive you crazy.Every one can talk about this disorder all they want but you will never really know what kind of alful disorder this is unless it is you that has it..

  • http://AddaURLtothiscomment Kat

    Hi-

    Im 90% sure that my boyfriend is bipolar but refuses to notice that ANYTHING is wrong with him no matter how i try to bring it up. EVERYTHING is my fault and my problem. if i dont listen to him then he wont help take care of his son or there is always a consequence for someone not listening or going his way. i have become so depressed… any advice to make him notice the affect his flip outs and craziness are having on our family?

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