Bipolar Disorder & The Power of Reconnection
The ups and downs of bipolar are not limited to those diagnosed with the disorder.
By Irene S. Levine, PhD
When serious mental illness strikes a family, it often seems as if the road to recovery is filled with one insurmountable hurdle after another: recognizing and accepting the diagnosis; accepting the need for treatment and getting help; finding an acceptable treatment regimen that works and sticking with it; and re-establishing a stable and satisfying lifestyle that minimizes the risk for relapse.
Despite these land-mines, the future has never looked more promising for individuals diagnosed with bipolar disorder. The past decade has brought new medications, improved psychosocial treatments, and greater public awareness and advocacy. Yet, one of the most important tasks in the process of recovery is still too often overlooked: finding ways to repair—or to replace — the fractured friendships and unraveled relationships often associated with the disorder.
“Bipolar disorder is an illness of isolation ,” says Lydia Lewis, president of the Depression and Bipolar Support Alliance (DBSA). “Relationships are not only helpful; they can be life saving.”
Numerous studies confirm that social ties are essential to anyone’s sense of well-being, physical health, longevity and ability to handle stress. For those who are diagnosed with bipolar disorder, having a support network can improve treatment outcomes and lessen the risk of relapse.
Understanding is key
“Everyone has to become familiar with the symptoms of bipolar disorder because nothing can be done until a person is
diagnosed,” says psychiatrist David Fassler, chairman of Walden Behavioral Care in Waltham, Massachusetts.
“The more open people are in talking about the illness, the easier it will be for them to understand changes in mood and recognize the importance of ongoing support from families and friends. The more the general public learns about bipolar disorder, the more tolerant and understanding people will become,” says Dr. Fassler.
“When there’s ignorance about the disorder and it’s not even diagnosed, it’s seen as a character weakness or personality flaw. This leads to a great deal of friction and blame,” says Lewis.
The strain on social ties
“Symptoms of depression or mania—as well as the rapid fluctuations or mixed moods that occur with bipolar disorder — can wreak havoc on relationships,” says Lewis . “It’s hard to deal with someone who is one way one moment and different the next.”
When people are depressed, they may lack the interest and energy necessary to sustain close friendships, even those that were once meaningful to them. Instead , they may opt to spend long periods of time alone, unable to reach out for support or accept it when offered. During the acute phase of the illness, irritability, self-centeredness, and lapses in judgment can easily engender anger and resentment.
“Close and important relationships are often severely disrupted and tested by an acute episode of illness,” says Dr. Fassler. “When someone has a friend or colleague who is suddenly acutely manic, or who is making accusations that don’t seem to make sense, it can be confusing and frightening.”
The stress on families
Bipolar disorder can also take an immeasurable toll on families. “Reckless behavior, such as gambling or overspending, can undermine a family’s financial security. Families live with the fear that their relative might take their life or that the individual will succumb to drug or alcohol abuse. The fact that we d o n’t have parity in insurance cove rage for mental illness causes some families to spend their entire retirement or education savings on hospitalization or other treatments,” says Lewis.
With a disorder that’s cyclical and that tends to recur, many families have a hard time figuring out when a relative’s mood problems are so severe that they need to intervene. Lewis draws the line when it comes to danger to self or others. “It is
imperative that family members know when a person with bipolar disorder is in danger and needs to be taken to an
emergency room,” she says .
Intimate relationships between life partners are often affected by symptoms of the disorder; by concurrent substance abuse problems; and by side effects of medications (which can include diminished arousal, desire and sexual functioning). Sometimes, family, friends and co-workers feel like they have no choice but to walk on eggshells—or in order to maintain an even safer distance — to walk away.
Self-esteem is damaged by the stigma, especially in the case of young people. Just as someone is finally ready to recover, feelings of worthlessness, embarrassment and self-doubt emerge ; problems that are exacerbated by side effects of psychotropic medications, which can include acne and weight gain. These are added challenges that need to be overcome as an individual moves towards recovery.
A step at a time
“The experience of building good relationship skills within the family can help people gain and maintain new friendships with others,” says Lewis.
“It is extremely helpful when a family member or friend can help find a way to make the person comfortable enough to openly discuss what they are going through,” says Ross Szabo, 26, of Los Angeles. Diagnosed at the age of 16, Szabo is director of youth outreach for the National Mental Health Awareness Campaign.
“This will help turn confrontation into conversation and start to build relationships,” says Szabo. “One of the biggest impediments to relationships is the tendency of someone with a bipolar disorder to lie, suppress thoughts, or not want to burden others with what they are experiencing,” he says. “If someone doesn’t want help, it is important for a family member or friend to let the individual with bipolar disorder know that they care about them and that they are not alone.”
“Families must realize that it isn’t their responsibility to make a family member well,” says Lewis. “They can ask their relative direct questions and try to find out exactly what they want and need. For example, they can help someone prepare for a visit with a physician or talk therapist, remind them of questions to ask, or urge them to get a second opinion if symptoms aren’t getting better.”
Reconnecting with others
Balancing everyone’s feelings and needs in a family is no easy task. “It takes time and effort to work through and regain the equilibrium of relationships,” says D r. Fassler.
“Don’t reject family members and friends who are willing to be part of your life again,” says Lewis to those recovering. “No one is perfect and we all have made mistakes we regret. You don’t have to be ashamed of your experiences. You’ve gone through a medical illness like other medical illnesses.”
“And don’t be discouraged if old friends are unwilling to reconnect,” she says. “They’re present your old life and may not fit into your new one. Take the opportunity to look for new friends —through shared interests like craft classes, reading groups at your library, hobby clubs, classes at the local community college or YWCA, or participation in churches or synagogues. The chances are good that the first time you try and build new friendships, you’ll feel uncomfortable. But if you keep trying, you’ll begin to feel more comfortable.”
“Start slow and pace yourself,” says Lewis. “You may find it somewhat scary at first, but by setting small goals, you can achieve them. Consider joining support groups of people who have gone through similar experiences; these people have been there and can share their successes. You can develop a great base of friends within a support group.”
In fact, DBSA (www.dbsalliance.org) offers more than 1,000 peer-run support groups for individuals with mood disorders that are run by volunteers. Members learn about community resources to help them cope with their illnesses and they derive comfort in knowing that they are not alone.
The groups provide a forum to ask questions, to express feelings, to learn techniques to manage mood disorders, and to get honest feedback.” The National Alliance for the Mentally Ill (NAMI—www.nami.org) also offers a network of consumer- run support groups. NAMI-C. A.R.E. is a peer-based group that is not specific to any one psychiatric illness. Local departments of mental health or nearby psychiatric facilities may also be able to help families identify support groups for bipolar individuals and their family members.
In some communities, family psycho-education groups—involving patients, family members and professionals—work towards the common goal of recovery and prevention of relapse. The groups meet weekly, for up to nine months, to assist families with problem-solving and communication skills.
Internet chat rooms and online support groups are another potential resource for connecting with other people. “Online support can be a great thing,” says Lewis, “But we urge people to make sure these services are being offered by someone or an organization that is highly reputable. There’s a lot of misinformation on the internet, especially about bipolar disorder.”
Clearly, relationships are integral to successful recovery. “Bipolar disorder is extremely treatable,” says Szabo. “Having friends or family members who can help you make adjustments outside of therapy is crucial.”
“One of the gifts of going through this disorder is that you can gain clarity about who you really are ,” says Lewis. She sums up her advice in three words: “ Just be yourself.”
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Maintaining a positive attitude while reconnecting
■ Don’t blame yourself or others for your illness. Mental illnesses are no-fault diseases of the brain. People around you may appear either over-protective or else not caring enough. Remember that they are swimming in the same uncharted waters as you.
■ Be honest in expressing how you feel and take time to listen to the feelings of those around you.
■ If you feel alone and don’t have many intact relationships, take small steps to reach out and create new ones. When you have the energy, make a phone call, write a note, or send an email.
■ Place yourself in situations where you can meet new people: join a gym, take a continuing education class, or volunteer in your community. Don’t expect too much of yourself too soon.
■ After an acute episode, it’s natural to focus on your own losses, but try to remember that your illness has also had an impact on others. Acknowledge the help of those around you and show appreciation.
■ Bipolar disorder often co-occurs with substance use disorders. Because it’s easy to fall back into old habits, steer clear of people or situations that serve as triggers for substance abuse.
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Printed as “The power of reconnection”, Fall 2004