Living with someone with a mental illness can present a unique set of challenges, and bipolar disorder is no exception. Depending on whether your loved one is manic or depressed, he or she might feel like a completely different person. You may become stressed or strained by the disruption his illness causes in your life, and health, relationship, or financial problems can follow.
It’s normal to want to get involved. After all, your loved one’s decisions affect you – if they go on a spending spree or stop going to work for a week, you’re the one who has to come up with rent at the end of the month. Fortunately, there are a number of strategies you can take to help your loved one as well as return order to your own life.
1. Take Care of Yourself
In order to help your loved one, you’ll first you have to take care of yourself. If you’re worn thin and running on empty, you won’t have any reserves left to offer. Make sure to tend to your own needs – for example, if your loved one’s erratic behaviors have made friends start to keep their distance, find time to see them on your own. Don’t forget about hobbies or neglect your usual healthy habits.
2. Get Plenty of Rest
Sleep is particularly important, especially if your loved one’s mania has you up at all hours. If you’re also not sleeping well, you’ll be less prepared to deal with the challenges that bipolar disorder presents.
3. Put Safeguards in Place
It’s also important to safeguard your physical and financial safety. For example, if your loved one’s driving grows risky during a manic episode, then insist on driving or decline to be a passenger in her car. Money can also be a major problem. If you are dependent upon your loved one in order to pay rent or bills, then secure your payment ahead of time. Set up automatic deposits from an account that isn’t easily accessed, or if finances are coming from a third party, arrange to get the money from them directly. If you have access to joint accounts, consider placing limits on credit cards purchases or cash withdrawals.
Surveys report that people with bipolar disorder are almost twice as likely to get fired or laid off from their job, so having a plan in place for financial stability is important.
4. Practice Mindfulness
Don’t neglect your spirit. Many people who watch a loved one develop bipolar disorder feel guilt or shame, thinking that their actions (or lack thereof) might have caused the person to become ill. This couldn’t be farther from the truth – bipolar disorder is a condition caused by the biology of the brain with a strong genetic basis. Release yourself from the burden you carry; you haven’t done anything wrong.
Understanding that bipolar disorder is a medical condition and nobody’s fault can help you weather the tough times. You may also feel frustration or resentment, and blame yourself for not being up to the task of dealing with your loved one. Remember that you’re doing your best with the resources you have available. It’s normal to sometimes feel anger towards your loved one, especially if she has refused to get medical treatment for her condition. The National Institute of Mental Health (NIMH) reports that 78 percent of people with bipolar disorder are not even receiving minimally adequate treatment, and 44 percent of people with bipolar disorder are not receiving any treatment at all.
Lack of insight and lack of self-awareness into the nature of the condition are very common symptoms of the manic stage of bipolar disorder. Many people don’t have the ability to understand what is wrong while they are in that state. It’s not their fault. Wait until mania passes to have conversations about getting treatment. That is also the right time to express how their actions made you feel.
5. Set Limits
Figure out where your limit lies. You’ll do what you can, but past a certain point, you have to choose to protect yourself. From the start, make it very clear to your loved one what lines absolutely cannot be crossed if he or she wants your continued support. Have an exit strategy prepared if your loved one refuses to get help.
6. Figure out your level of involvement
How involved are you in your loved one’s life? Dealing with a bipolar spouse with whom you have already built a life is a very different situation than dealing with a bipolar housemate. Evaluate both how much support is needed and how much you are realistically able to offer.
Minimal involvement might start with offering to get in touch with someone who is better able to help when things get bad. Increased levels of involvement could include helping the person spot when he is beginning to enter into a manic or depressed state, helping him remember to take his medication, or driving them to the doctor. If you have permission, you might even speak with his therapist yourself – the outside perspective you can offer can be invaluable for a treatment provider to more fully understand what’s going on.
7. Educate Yourself
The more you learn about bipolar disorder, the more you can help your loved one. After living with your loved one and her illness for as long as you have, you may be in the best position to detect the signs of a mood cycle beginning.
- Sleeping less or frequently being awake at night
- Talking too quickly or jumping to tangential topics
- Starting several new projects at the same time
- Taking more risks or acting more impulsively than usual
- Spending impulsively or without regard for finances
- Unrealistic belief in one’s own abilities or importance
- Impaired grasp of personal limitations
- Inappropriate or unrealistic good mood
- Short temper or irritability
- Sleeping more than usual or during the day
- Losing interest in activities or abandoning projects
- Mentioning or complaining about pain more often, such as muscle aches, stomach pains, and headaches
- Talking about having suicidal feelings or preoccupation with death
- Withdrawing from social functions
- Unexplained crying spells
- Changes in eating patterns, such as frequently overeating or forgetting to eat
- Lethargy or loss of motivation
- Feelings of guilt, shame, or worthlessness
- Sad mood without apparent cause
While you might be the first person to spot these changes, it’s also important not to read signs of mania or depression into every action your loved one makes. Not only can this come across as patronizing, but it also redefines your relationship with your loved one to be only about her illness. Whatever your relationship, this is a person that you independently value for reasons far beyond anything to do with her condition.
8. Come up with a contract
Don’t wait until your loved one becomes symptomatic to talk to them. Mania can reduce his self-awareness, and depression can impair their ability to take action as well as make him more likely to feel that he is being criticized. Instead, approach them during one of the in-between states, when they are most stable.
Remind your loved one that you support him, and while you may not understand what they are going through, you’re here and want to help.
Essentially, you want to create a contract with your loved one. You will agree together that if a certain warning sign appears, it’s time to take a certain action. It may be symptom-specific, such as locking away firearms if suicidal feelings appear, or agreeing to hand over car keys if impulsivity worsens. Or, you may work out a colored light system, with each color corresponding to a level of concern. For example:
- Green light: All is well.
- Yellow light: I’m seeing a few small signs of mania or depression. Try to keep this in mind and be particularly careful.
- Amber light: I’m seeing worrisome warning signs. It’s time for you to go in and see your doctor.
- Red light: I’m extremely worried that something bad will happen, right now. You’re coming with me to the emergency room and/or I’m calling 911. Don’t hesitate. Studies report that 25-50 percent of people with bipolar disorder attempt suicide at least once.
Whatever system works best for you and your loved one, it may be useful to make a tape recording or video of the person to play later. Playing it back can be a powerful reminder of the contract you made.
9. Recognize Co-Occurring Disorders
Finally, keep in mind that many people with bipolar disorder have co-occurring conditions like ADHD and anxiety, which can intensify or aggravate bipolar symptoms. Substance abuse is also common. A study by the ECA reports that 56 percent of people with bipolar disorder abuse or are dependent on drugs, and 44 percent abuse alcohol.
10. Suggest Online Counseling Services
With advances in technology, online counseling, telehealth and teletherapy services are becoming more common and effective forms of mental health treatment. Addiction treatments were once restricted to in-person meetings, but can now happen anytime and anywhere with a reliable internet connection.