Living with bipolar disorder… family, friends, loved ones – and how to help

1. Living with bipolar disorder… family, friends, loved ones – and how to help Kurt Weber, PhD Mental Health America – Brown CountyBemis International Center St Norbert College May 13, 2008

2. Caring for loved one with BD (stolen from Seroquel web site) • two general principles • 1. During a bipolar disorder episode, your loved one is not in control—the disease is often in control. • Someone with bipolar disorder does not have control of his or her mood state during an acute episode. Control of feeling and behavior is simply not possible in the same way that it is for people who do not suffer from a mood disorder.

3. 2. Your loved one may lack insight into his or her illness. • Someone with bipolar disorder may not realize he or she is experiencing an episode. Although medication improves awareness of illness in most patients, a person with bipolar disorder may still be relatively unaware or completely unaware of his or her behaviors. You may want to discuss these issues with your loved one’s health care provider. Talk about the types of behavior your loved one has displayed in the past. Ask about behaviors you can expect in the future, along with advice on how to handle specific situations.

4. What your loved one may be feeling • during a depressive episode • low energy • feelings of worthlessness or hopelessness • experience abnormal sleep • during a manic episode • have excessive energy • experience out of control spending • exhibit poor judgment

5. Coping strategies for you • If you notice that your loved one is showing signs of a relapse, there are some actions that may be appropriate for you to take • Make sure your loved one’s health care provider knows exactly what is going on; don’t be afraid to ask for professional help in responding to your loved one’s behavior • Make sure other family members and friends know what is going on and are prepared to help out • Do your best to help your loved one fulfill essential responsibilities, such as child care and paying bills

6. Do your best to keep your loved one safe if his or her behavior seems harmful • Keep yourself safe; if your loved one becomes aggressive or abusive, get help immediately • Realize that hospitalization may be required for a severe relapse • Remember to be supportive and loving in your actions and your language

7. Taking control… by helping the loved one to --

8. Take medication as prescribed • Some medications may cause unpleasant side effects in certain people • Some people with bipolar disorder may miss the “high” feeling that comes with a manic episode • Other people may also have problems with alcohol or drug abuse that make them less likely to take their medicine as prescribed • to have medication work effectively, your loved one must take it exactly as his or her health care provider instructs. • Sometimes sticking with a medication regimen is easier with the help of a family member or a close friend.

9. reduce stress • stress may trigger episodes of bipolar disorder • Get more exercise • Relax and take more down time • Share household or family responsibilities • Avoid conflicts

10. Enhance life with enjoyable things • Pursue a hobby or interest • Make it a priority to find time for things he or she enjoys doing—things that provide a sense of peace or achievement

11. Get regular sleep • sleep problems are common with bipolar disorder • getting too much (hypersomnia) • or too little (insomnia) • if your loved one is having sleep troubles he or she should • Talk with his or her doctor • Try to avoid alcohol and caffeine—both are known to interfere with sleep patterns

12. Eat healthy • The food your loved one eats can affect his or her health, energy, and even mood. Sugary foods, alcohol, or caffeine may negatively affect moods. Foods such as vegetables, fruit, oil-rich fish, and whole grains may help with stability.

13. Be prepared for a future episode • bipolar disorder is a lifelong illness • know and recognize the possible signs of an upcoming episode • have a plan in place • Contact information for doctors and pharmacy • list of medication names and dosages • Insurance information, such as plans, coverage, and approved roviders • Contact information for support groups or crisis lines • Taking action every day to help manage symptoms is something your loved one can be proud of • can find peace of mind and hope for the future

14. set goals • loved ones to consider the following when setting and working toward personal goals • Think about what steps need to be taken to achieve each goal • Break big goals down into smaller ones • Set reasonable timetables • Share long-term goals with others who can provide support, such as family members, friends, and health care providers

15. suggestions for spouses • “Do not blame my BP for every argument that we have -- spouses do have faults, too, and I'm not always to blame, although my moods do contribute to my share.” • “Please do not tell me how I feel. You aren't in my head and have no concept of the craziness that sometimes goes on. Own your feelings and I'll own mine.” • “Please hold me when I'm scared but don't know why. Don't ask questions -- just be emotionally available to listen.”

16. “Please forgive me when I verbally attack you, because the guilt that is felt afterward is absolutely horrible and I never really intend to hurt you in any way. The guilt is sometimes punishment itself.” • “Please don't expect me to do well every day if I happen to have one or two good days. This is a blessing in itself.” • “Please know that if I mention suicide, many times it is because I don't want to be a burden to you. I don't really want to die but want to end the pain. Just let me vent and that can help. If it doesn't stop, please take me to the hospital.”

17. more suggestions for spouses • Try asking a question rather than making a statement • Let your spouse know you want to understand • Ask how your spouse feels, then repeat what he or she says in your own words, then say, "Is that right?" • Such reflecting skills not only will make your spouse feel that you really do want to understand, but also give you a better chance of achieving understanding.

18. dealing with inappropriate anger • Out of the blue your husband or wife may verbally attack you, saying things that wound you or sting you to anger in return… • How do you know when the attack is bipolar disorder speaking and when it is not?

19. Generally, if what is said has little basis in fact • "You always argue for half an hour when I ask you to put the trash out!" when you don't argue at all • look to the illness and forgive the words and the anger.

20. Responding with anger will only make things worse. • Of course, it's not that simple. Time and experience will help you tell the difference. • if such incidents are happening too frequently, your BP spouse should see his or her psychiatrist or therapist.

21. Family members (continued) • They may seem like they don't care, but… • one may realize they are just not able to do what you need • and if that's the case, it will help you to understand why and hopefully forgive them for their own limitations • you may find out that they just need the guidance only you can give them

22. What is supportive behavior? • “Treat me as you would any other. I am a lesbian, but don't treat me any differently. I am Jewish, but don't treat me any differently. I am a diabetic, but don't treat me any differently. I am a mother, a daughter, a friend, a wife and at my very core, just like everyone else. Treat me as you would any other. “

23. “Each situation is different. However, I believe in tough love. Mental illness exhibits itself in lack of responsibility, so you cannot avoid the fact that someone is going to have to be there - not as a guard or a boss, but as someone who cares and can advise when needed. Tough love, with a touch of discipline is the best, but it must be moderated into teamwork. Education about the disorder is a must, too.”

24. “I would appreciate it so much if my friends and family would allow me to not meet anyone's expectations if I tell them I don't feel well. And I would like them to come over without asking me, just to hang out. I may not feel like doing anything but sit in silence, but I personally feel better if someone is there. I guess I'd like them to read my mind, too, but ...”

25. “Just don't treat us like we're dumb or can't do anything for ourselves. Let us make our own decisions, no matter how stupid the decision is. Let us have our own lives and encourage us to work. Too many people think we should just sit back in life on disability and go to treatments all day. I want more for my life. I want more for my family. I have self-esteem, too.”

26. “Please think of my bipolar illness the same as you would heart disease, cancer, hypertension. It is a real illness with complications just like any other. Don't be offended if I am mean or act out of character when manic, or clam up and avoid you when I'm depressed. If I'm active and able to accomplish things one day, don't assume I'm lazy and worthless if I can't function the next day.”

27. “Treat me with respect and let me be as responsible as I can be. Encourage me but don't push me. Unless I become dangerous to myself or others, let me make decisions. Even though I have this illness, I am still a person in my own right and I have self esteem. Be there when I need you; help me when I'm sick; and please know that I love you.”

28. “All I want is for my family and spouse to treat my disorder as a real medical illness and not a fault. RECOGNIZE it as an illness ... PLEASE. And don't use it to suit your own purpose in an argument and to blame all my actions on the illness.”

29. “To me, being supportive would be taking the interest, care and time to educate oneself about the illness; helping the person in their various moods rather than blaming them; forgiving them for actions or words they may do when high and the little they may do when low; and taking an interest in their everyday lives like any normal family member or caregiver.”

30. “Please don't call me "crazy" or "nuts." Every time my husband and I get into an argument -- without realizing it, he silently drills this into my subconscious.”

31. Does this mean that family members have to be supermen or women to deal with BP in the family? It may feel that way. • If the situation is taking a tremendous toll on you, consider therapy for yourself. Family counseling may be an option. • And if nothing works, and you have to get out -- do what you must to take care of yourself. Sometimes there's no other choice. • Do not tolerate violence. No one should. A violent bipolar person should be hospitalized immediately. We offer this series to family members to help you, not just your bipolar loved one. • Anything that decreases tension, adds to harmony, or prevents disruption will benefit you and your whole family.

32. As much as you read about bipolar disorder, your loved one will still surprise you. Not everyone can be trusted to live life "independently and freely," but many people with bipolar disorder can. • There will be times when you don't know whether to step in or not. If your best effort makes your loved one seem out of control, for example, it may be time to call his or her psychiatrist. Experience will come in time.