Depression and bipolar disorder are often family diseases.
Everyone sharing a kitchen and a bathroom is affected. In fact, in his book “Understanding Depression,” J. Raymond DePaulo Jr., M.D., writes that “depression … has a much greater impact on marital life than rheumatoid arthritis or cardiac illness. One study found that only severe forms of cancer affected a family as adversely as depression or bipolar disorder.”
My manic depression could have easily wrecked my marriage and my relationships with my two children. Instead, we emerged as a tighter, stronger unit. How? Here are eight ways Eric, my husband, helped me cope — tips for families on how, exactly, to hang in there with a loved one who has been diagnosed with bipolar disorder.
1. Educate yourself.
I remember the afternoon of my first severe panic attack. I phoned Eric at work as my breath grew shallow and my heart pounded as if I were having a heart attack. I was sure I was dying. As soon as he walked through the door, he stared at me suspiciously. My limbs were in place, and I seemed to be functioning just fine. What was the problem?
“You don’t understand,” I explained. “I thought I was dying! It was the most frightening experience I have ever had.”
What convinced my spouse that my bipolar disorder was an illness, not a weakness? Research. The reams of paper that I printed out and asked him to read. The psychiatric evaluations he witnessed. The group therapy and family sessions he attended. And the conversations with other spouses of persons with bipolar disorder.
Education is always the starting point. Because until a spouse or daughter or friend of a manic-depressive understands the illness, it is impossible to say and do the right thing. Do your own research by going online to National Alliance of Mental Illness or to Depression and Bipolar Support Alliance, or by doing a Google search of the words “bipolar disorder” (or checking out the bipolar resources here at Psych Central).
2. Learn how to talk to your loved one.
Eric doesn’t say much when I’m clutching tissue paper, crying my eyes out. And he’s hesitant to speak when I’m manic (not that I would let him get in a word). When I don’t want to get out of bed in the morning, he reminds me why I need to. And when I’m revved up, he’s the voice of reason telling me why a spontaneous trip to New York isn’t smart.
Anna Bishop, wife of fellow blogger James Bishop (findingoptimism.com) has some wonderful advice for the loved one of a manic depressive on what to say and when:
When James becomes ill he turns into a different person. I say goodbye to my husband, so to speak, and hello to bipolar James. In a depressive episode he becomes highly irritable and usually itches for a fight. Early on he will often make comments to bait me. “All I do is work, work, work, to support your lifestyle and your precious social group.” You can imagine what a red rag to a bull that comment is.
At this point I have 2 options: 1. Take the bait, have a messy fight and accelerate his downswing, or 2. Grit my teeth and say “it’s the illness speaking”. If I can do that then I have a much better chance of diffusing the situation. A comment like “You sound stressed about work — let’s talk” has better results and sometimes can even stop the mood swing.
3. Make some rules.
You know all the fire drills in primary school you prayed would happen during the math pop quiz? All those times the school administrators rehearsed what, exactly, would happen in the case of an emergency? Families of bipolar persons need them as well: a plan of action for those times when the bipolar person is sick.
In order to design such a strategy, the manic depressive and her loved one must compile a list of symptoms — like the smoke and burning smell of that make-believe fire in the third grade–and what action should follow them, like “call the doctor.” Each family will have a different list of symptoms and a different model of recovery, because no two illnesses are exactly alike.
Eric and I have agreed that I will call my doctor after two consecutive nights’ sleep under five hours, or after three days of crying spells. A friend of mine told me that he and his wife have agreed that she will see her psychiatrist if she hasn’t gotten out of bed for three days.
4. Plan for emergencies.
As part of the above plan of action, you should consider what should happen when the bipolar person is very ill. “When you are dealing with a disease that has the potential to become life-threatening, the last thing you want is an improvised response to an emergency situation,” writes Francis Mark Mondimore, M.D. in his book “Bipolar Disorder: A Guide for Patients and Families.”
Part of your plan should include a list of people who you can call for help. Of course, it is recommended that the bipolar person be working closely with a psychiatrist, and that he know how to get in touch with the psychiatrist after hours, and in case of emergencies. It’s also a good idea to know which hospital the psychiatrist works with, or if the doctor will work with any hospital in the area. Ask friends, doctors, and family members for their recommendations about hospitals and mental-health practitioners.
Also, the red tape of insurance issues is often too overwhelming to process at the time of the emergency, so get familiar with the details of your medical insurance coverage for psychiatric illnesses right now. Know the terms of hospital coverage, especially, and how much the patient is expected to pay out of pocket for various services.
“When people are talking,” writes Rachel Naomi Remen, “there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it.”
When I think back to the days when I was very ill, crying and shaking at the dinner table and at preschool functions with the kids, no response was as appreciated as when someone simply listened. Suggestions came off as condescending, even though I know they were meant to be helpful. Advice was annoying. Many times I just needed to be heard, to be validated.
Don’t hesitate to say nothing. Because silence often speaks the most loving message.
6. Go gentle.
I can’t count all the times I have tried Eric’s patience with the reckless highs and debilitating lows of my bipolar disorder. When I get fired up and want to sign up for 60 new activities — not to mention losing my car keys, cell phone, and purse — it’s difficult for him not to get annoyed. But because he places my exasperating behavior in the proper context of an illness, and sees them as mere symptoms of a disease — rather than careless and self-absorbed actions — he is better able to go gentle with me.
Moreover, a little kindness and gentleness toward your loved one–especially at those times that you feel incapable of affection and care– goes a long way to aid recovery.
7. Laugh together.
Humor heals in so many ways. It combats fear, as it loosens anxiety’s death grip on your heart and every other living organ. It comforts and relaxes. And recent studies indicate that humor also reduces pain and boosts a person’s immune system.
“Laughter dissolves tension, stress, anxiety, irritation, anger, grief, and depression,” says Chuck Gallozzi of personal-development.com. “Like crying, laughter lowers inhibitions, allowing the release of pent-up emotions. After a hearty bout of laughter, you will experience a sense of well-being. Simply put, he who laughs, lasts. After all, if you can laugh at it, you can live with it. Remember, a person without a sense of humor is like a car without shock absorbers.”
Humor also aids communication, and if there is one thing besides education that is absolutely essential for a healthy relationship with a bipolar loved one it’s good communication.
8. Get support for yourself.
Caregiving is draining. Even when you are protecting yourself with the armor of regular sleep, healthy meals, and essential time-outs from your sick loved one, caring for a person still takes a toll on your physical and mental health.
“It can be exhausting to live with a hypomanic person and frustrating to deal with a seriously depressed person day after day,” says Dr. Mondimore. “The changes and unpredictability of the moods of someone with bipolar disorder intrude into home life and can be the source of severe stress in relationships, straining them to breaking point.”
That’s why you need support as much as your loved one. You need to talk to people who have lived with a manic-depressive, and be validated by their experiences. Spouses and family members of bipolar persons should consider therapy for themselves, as a way of processing all the stress. You may also benefit from checking out support programs for spouses and loved ones of the mentally ill, like National Alliance for Mental Illness, that are available today.