Living with bipolar disorder

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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

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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 controlthe 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.

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• 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 ones 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.

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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

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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 ones health care provider
  knows exactly what is going on dont be afraid
  to ask for professional help in responding to
  your loved ones 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

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• 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

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Taking control by helping the loved one to --
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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.

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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

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Enhance life with enjoyable things

• Pursue a hobby or interest
• Make it a priority to find time for things he or
  she enjoys doingthings that provide a sense of
  peace or achievement

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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 caffeineboth are known
  to interfere with sleep patterns

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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.

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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

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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

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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.

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• 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.

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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.

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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?

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• 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.

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• 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.

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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

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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.

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• 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.

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• 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 ...

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.