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.
5. Listen.
“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.
