Friday, February 7, 2014

Dealing with Bipolar Disorder.

A person that lives with Bipolar Disorder or Depression comes to learn loss intimately. It is a constant battle in our mind to try and avoid tearing our lives, loves, and friendships down to the foundation. No one is perfect. We will periodically lose that battle and burn bridges. It is an unavoidable fact of living with a mood disorder or mental illness.
This document is aimed toward the person living with Bipolar Disorder, Depression, and their respective loved ones. I write it with the assumption that the Survivor will inevitably do incredible damage to their relationship; if it hasn’t happened yet, it will at some point. Therefore, we want to minimize the potential damage by developing an understanding of ourselves and how we affect our loved ones.
I will attempt to provide meaningful information for the loved ones and friends that are watching a special person in their life go through this. Watching a child, spouse, relative, or good friend traverse the spectrum of Bipolar Disorder or Depression can be incredibly painful. It is not uncommon to feel completely powerless to help that person in a meaningful way. That is not the case. Even your presence can impact someone soaring through the extremes of the Disorder. I aim to provide you with meaningful tools to help not only the Survivor in your life but allow the supporter to preserve themselves in the process.
If you found this document useful and would like to link to it or print it to hand off to someone, by all means. All I ask is that appropriate reference to is left intact.
- Dennis

1. Walk In The Other Person’s Shoes

It is not likely that you will ever truly be able to understand what the other person in the relationship equation experiences either with, or coping with, a Mood Disorder. We naturally look at the situation from our own perspective with preconceptions of what we think is correct. I promise you- there will eventually come a point where the Survivor in the relationship will do something so mind-boggling that it laughs in the face of the person you know and love. Counter-balancing against those acts requires an honest perception of oneself and the reality of the situation.

1.A - As A Supporter, I Need To Accept…

1. There will be times that the Survivor will do things that make absolutely no sense. Sometimes the only explanation will be “I don’t know, I was unwell.” Unfortunately, a lot of the time even we don‘t understand why we did something. It just made sense to us at the time.
2. The extremes of Bipolar Disorder and Depression will drastically warp the way the Survivor perceives the world. At times, the Survivor will behave almost like a different person to the point where you may not recognize their mentality. These are the times we do the most damage to our lives. Strive to not take their words or actions at face value during these unwell periods.
3. It is impossible and unreasonable for a person to give their all, 100% of the time. Identify your limits and how you can recharge after the Survivor goes through a rough patch. Do not expect perfection from yourself. Demand downtime for yourself for your own mental well-being.
4. Living with Bipolar Disorder or Depression is a reason, not an excuse. Do not allow yourself to be a doormat to abusive, hostile, or damaging behavior. Unfortunately, many Survivors fail to realize how negative their actions are due to how warped their perception is from what they live with.
5. You can only help someone that wants to help themselves. If they are not passionate about their mental well-being, they won’t be pursuing it with the ferocity they should. That generally equates to skipped appointments, missed dosages, lack of mood monitoring, and so on. A Survivor will not get well with a lazy approach.
6. Sometimes the only way for a person to realize they need help is for them to hit rock bottom. Sweeping up after the actions of an unwell Survivor is best done only if they are trying to get well. An unwell individual needs to see the fall out of their actions so they can understand that the way they are living is not going to work.

1.B - As A Survivor, I Need To Accept…

1. There are some people that cannot and do not want to understand. Unfortunately, these people include loved ones, friends, strangers, therapists, medical, and other mental health professionals. Develop a deep understanding of your illness, what it means to you, and what wellness means to you. Pursue it relentlessly.
2. People will blame you for your actions even if they are out of character. It is entirely unreasonable, and stupid, to think that “I have a Mood Disorder” is just going to wipe the slate on particularly heinous actions. If you do something that has an incredibly negative impact on someone you are close to, chances are good you’re going to hear about it again in the future even after apologies are issued. Don’t be surprised.
3. An apology for your actions is not an apology for living with what you do. Many people feel they should not have to apologize for their actions while unwell. That is ridiculous. A person should apologize because they caused problems or pain for someone they cared about. Personally, I refuse to ever apologize for BEING Bipolar but I will apologize for things I do while I’m in the extremes of the Disorder.
4. The person that attempts to “limit” the exposure of a Mood Disorder to close friends or loved ones is shooting themselves in the foot. On the one hand, yes you are insulating them from that side of you. On the other hand, how are they supposed to learn how to handle it and help you when the time comes? Chances are pretty good you aren’t hiding anything. You’re just making it more difficult on them and you by trying to keep it quiet. I find this to be most relevant with Bipolar parents trying to shield their children. The child may not know what’s going on exactly, but they certainly do pick up when their parent is unwell.
5. There is no reason that you cannot have a family, good friends, and positive social interactions. We require a different approach to life than normal minded individuals. We have to live differently- and there is nothing wrong with that. I reiterate, there is nothing wrong with being different. A Bipolar cannot approach life the same way as a person who is not and expect to maintain the same quality of life.
6. Everyone has a breaking point. Even the most loving, supportive, wonderful person in your life has a breaking point. Avoid smothering the supportive people in your life. If you need the companionship or help then by all means seek it. It is not necessary or wise to weave that person into all the minor struggles you deal with on a daily basis, even if they ask you to. Be certain to give those people space when they need it and provide support to them when you’re able to.

2. The Importance Of Motive Behind Unwell Actions

The actions of an unwell Survivor are not as important as the motivation behind them. An action we take is undoubtedly derived from how we are perceiving the world at that moment. The Survivor may entirely believe that the course of action they are taking is the best one at the time. Further down the road when they rebalance, they will be looking back on their actions in dumbfounded shock, wondering how they could have possibly thought their action was a good idea. The Supporter needs to have a clear idea of what they are able to forgive and what they cannot.
In the couple years before I was diagnosed, I was engaged. At the time, I did not understand exactly how Bipolar Disorder would twist my perception. Moving to be with her proved a strong enough trigger to send me rocketing around the spectrum. I began regularly gaining and losing jobs. When I lost a job, I was never able to convey what was going on in my mind that caused it to happen. I, instead, opted to lie to her about how I kept losing jobs knowing full well how much she valued an honest relationship. I lied because I knew she struggled with deep Depression herself. My brain convinced me it was the best approach because she wouldn’t be angry at me, I could still help her, and the “very next job I get, things will be different”.
My example could be viewed a couple of different ways. Yes, I did lie to her about a fairly serious matter. However, I was doing it because my unwell mind convinced me it was the best course of action for the bigger picture. I wasn’t doing it out of maliciousness or to cause any harm to her. To me, that is far more forgivable than if I had been lying to her about going to work and having an affair. My motive was not malicious.
If I was in her position, I would like to think that I would probably still be angry but able to forgive it due to the circumstances.
Very few things are simple when it comes to living with Bipolar Disorder and Depression. Trying to make them simple will doom that relationship in the long run.

3. A Reason, Not An Excuse

Using Bipolar Disorder or Depression as an excuse for terrible behavior to others completely erodes any sympathy or support you may have been able to secure. Greater problems arise when it comes down to close friends, family, or loved ones. Those close to the unwell individual may not know specifically what is wrong, but they can tell something is amiss. No matter how hard it is to deal with what you deal with on a regular basis, there is great difficulty for the people that care about you to powerlessly watch you go through it. It’s painful, hurtful, and sometimes frightening. Who likes to watch someone they care for suffer?
The simplest way to demonstrate you are taking responsibility for your actions while unwell is to own up to them and attempt to correct them. Sometimes, you will not be able to or the person involved is not able to handle the stress that comes with it. It’s unfortunate, but it does happen.
I do not feel that an apology says enough in many cases. In the event that I cause damage or loss to a person, if I cannot reimburse them financially I have offered to do work for them to even it off or at least tried to give them something of mine that was roughly as valuable. Actions speak louder than words. They show you actually care and are willing to sacrifice to mend the breach.
Never, under any circumstance, promise that you will never do a particular action again. You have absolutely no way of seeing how your perception will be warped in the future. The only thing you will accomplish with that claim is effectively setting yourself up to be a liar the next time you swing unwell- and you will eventually.
As a Supporter of the unwell, you will have to exercise your own judgment in determining if the Survivor is remorseful for their actions or not. Take the time to predetermine what is utterly unacceptable behavior and stick to it. That will help demonstrate to the unwell that there are serious repercussions to their actions. It may be enough to cause them to have a “Hey, wait a minute…” moment as they are escalating.

4. How Do I Help An Unwell Loved One?

Every Supporter will eventually run into a time when they need to help a Survivor having a crisis. The following section will deal with some of the most common in the form of suicidal thinking, escalations mania/hypomania, and depression.

4.A - Suicidal Thinking

Wrapping one’s mind around suicidal thinking is extremely difficult when you have not experienced it yourself. Suicide attempts or thinking typically build over time. The Survivor often feels they have reached the apex of what they feel they can handle. They look back and see only the pain, misery, and depression. They look forward and have lost sight of whatever hope they might have had for better days ahead. All they can assume is that the future will be the same as the past. In a weak moment, that will often kick the Survivor into a suicide attempt. Think of it as a switch being flipped from Off to On.
That person’s mind is stuck in the misery of the moment and will be so long as that train of thought (or switch being set to On) is allowed to roam unchecked. The most effective way to assist that person is to get their focus shifted in a different direction. Get them through that moment to a point where they will not be in such a vulnerable mentality. You can accomplish this in a number of ways. There are many cases when a person, for example, slits their wrist and then realizes that they do not want to die. Their action caused the metaphorical switch to reset to Off once they realized what they did.
Optimally, we want to see that metaphorical switch reset before the person engages in a destructive behavior. All the negative thoughts and feelings of whatever brought them to that point continues to fuel that impulse, thus we want to disrupt the fuel so the switch is not able to stay On. Some tactics for doing that:
- Ask the person about a very positive story of theirs or something they are proud of.
- Put their favorite show, movie, or music on. (Avoid sad or emotional media.)
or, my personal favorite;
- Tell a very embarrassing story about yourself.
In all cases, you are forcing their mind onto an entirely separate track. The person is either reliving something positive or wondering what the hell is wrong with you. Either way, they aren’t dwelling on suicidal thoughts, giving that switch an opportunity to reset.
My preference is to tell the person about when I got thrown through a front door by a 10 year old little girl who had 5 years of Karate under her belt. She didn’t know me and thought I was breaking in to her house. So she defended herself. I got destroyed by a 10 year old when I was 18. Usually it leaves a grin or an incredulous look on their face. Either way, suicidal thought process derailed!
The primary mistake Supporters make is looking at too wide of a picture. Focus on getting the Survivor through five minute increments until they reach a point when their resolve to commit suicide wanes. Just a minor interruption in the suicidal thought process can be enough to derail it completely. Seek professional help as soon as feasible if need be.

4.B - Depression

A person does not need to look far to find advice on how to handle a depressive person in their life. Most of what I read appears to be developed by either people that don’t experience depression or is from a clinical approach. Neither method is efficient for a Supporter. Clinical approaches should really only be used by people with a further understanding of that discipline to understand how it all ties together.
On the other hand, there are several well-meaning people that think because they have watched a loved one cope with mental illness that they understand it. It is not that simple. They understand what they witnessed and went through from their perspective. That is very useful knowledge but is not interchangeable with actually living with Depression or Bipolar Disorder. I applaud these people for at least trying.
Helping a person through a Depressive streak is about pushing them through this flurry of negative feelings. I feel the most effective way is to get them focused on the fact that they do not have to be depressed for the rest of their lives. Suicide attempts and self-destructive actions are primarily caused by a lack of hope for any change for the better.
- tell the person to think of their kids/family/friends/career/whatever. They already are and have been for a very long time. Suicide attempts typically occur when the misery finally outweighs the few good things that person perceives in their life. It does not accomplish anything useful in the mind of a severely depressed person.
- tell them there are paths to get better. Lifestyle changes, medication, even a different diet can have an effect on mentality. Even if one, or ten things, have failed; there are hundreds of other things to try. Instill in the Survivor that there is a strong reason to hope for a different tomorrow. The idea is to keep the Survivor from losing hope. Complete loss of hope for anything better in a dark moment will kick start self-destruction.

4.C - Escalation (Mania/Hypomania)

There is a large camp of Bipolar people that feel the escalated side of the Disorder is not necessarily bad. It is true that a person can ride the wave if managed well. This is also the reason that there is so much misdiagnosis of Bipolar Disorder. When you spend all your time morbidly depressed, ANYTHING is better in comparison. Many Bipolar people mistake the escalation as their normal state of mind. That’s just not the case.
Escalated thinking is very damaging because the person is making decisions based off their perception rather than what reality is. So what does that mean?
Have you ever been with a friend and noticed a beautiful dark car? One of you may point at it and say “That’s a pretty sharp black car.” while the other replies “No, that’s navy blue!” Both parties are seeing the same car. Due to lighting, angle, quality of eyesight, and any number of other things; both people are perceiving the same car in a different way. The absolute quality is that there is indeed a car there.
Enter a Bipolar thought process. I could look at the car and my brain tells me that ‘hey that’s a tank!’ So my response may instead to be to scream “tank!” and dive for cover.
Now if you witnessed that, you could say “Hey wait. That’s not a tank. That’s just a car.” Knowing that I’m Bipolar and I’m able to trust your word, I can use that as an anchor to reality. I can say, “Alright, this person I trust is telling me that there is no tank, it’s just a car.” and I can force myself to reassess the situation. What a Bipolar person’s mind is telling them seems very real to them no matter how ridiculous it might seem otherwise.
The result ranges from minor difficulties to the horrific. Strive to keep the difficulties minor by interrupting them and not letting the Bipolar person’s mind run away with their thought processes. The further along the person gets in an unwell thought process, the more difficult it is to derail it.

5. Interacting With An Unwell Loved One

Interacting with a mentally unwell individual can be a very stressful, trying experience. It is very easy to feel completely lost in how to reach the Survivor in some of their worst moments. A Supporter will need to exhibit a great deal of willpower and restraint when trying to meaningfully interact with a Survivor. Develop a deep understanding of what is and is not acceptable to you. There will be some things that are completely out of your realm of ability to handle; and that is alright. In the event that you feel meaningfully threatened or that a situation is moving past what you can handle, by all means involve authorities.

5.A - Interacting With The Self-Destructive/Suicidal

- Avoid apologizing. The Survivor is likely trying to not feel like a burden. Though “I’m sorry” is a show of sympathy, it will feel more like pity in the amplified state of the unwell mind.
- Words are not always needed. Sometimes the Supporter can have the greatest effect by simply being there for the person. Though we may pose questions, in many cases we know there are no answers. Don’t feel obligated to try and provide answers.
- Avoid “think of your family/work/school/whatever“. In the deepest pits of depression, these things are being enveloped in a black hole. Instead, try and focus their attention on making future progress. Assure them that there are many people fighting the same battles they are, and they are not alone.
- Do not let them dwell on hopeless feelings. Remind the Survivor they can get well and there are more avenues to explore regardless of what they have already tried. Mental health is an inexact science. The person will find something that works but they have to keep looking.
- If you feel the person is a tangible threat to themselves or others, notify authorities.

5.B - Interacting With The Escalated

- Know your limits and boundaries. The person has to know there will be repercussions to their actions. Being called names or getting screamed at does not bother me. However, I make it very clear that I will defend myself if I feel physically threatened; and I won’t be the slightest bit apologetic if I have to.
- Avoid pointed statements in general. Even in normal people, accusatory statements cause defensive walls to come up and significantly hinder communication. Do identify there are times when you will have to make a pointed statement to get your point across in a potentially threatening situation.
Example 1: (Avoiding pointed statements)
Survivor: “My neighbor across the street is spying on me, I know it.”
“Why would your neighbor be spying on you? They have their own life, family, and job to worry about. Is there a reason that you believe this or could you be getting unwell?”
“No. They aren’t.”
Example 2: (Using a pointed statement)
The Survivor is unwell but may not necessarily realize it. They have taken to wandering around the house with a knife.
“You cannot keep wandering around the house with a weapon. It is frightening and I will contact authorities for help because it is clear you are unwell and in a dark place at the moment.”
In both examples, you are forcing the Survivor to reassess their mental situation with new, external information. It can be enough to make them realize that something is amiss.
- Understand that an escalated mind can move in ways you cannot predict. No matter how ridiculous the person is acting or their statements, do not take them lightly. They are confusing reality in their mind which can prompt them to take any number of unreasonable or out of character actions.
- Try to introduce reality to the unwell person’s thought processes as much as you can. This provides numerous opportunities for that person to realize what they are experiencing is twisted at the moment.

6. Minimizing Damage

The time has finally arrived where the Survivor has not only burned all their bridges, but urinated on the ashes while screaming profanities across the chasm. Every single Survivor has at least one story where they did exactly that. Let’s delve into some effective ways to minimize and repair what damage we can.

6.1 - Lay groundwork while well.

When is the right time to let the people that need to know that you are Bipolar? I am personally mixed on the idea of how public a person should live with their Disorder. I choose to live openly about it because I’m well past the point of actually caring what other people have to think about it. I have no problem discussing the Disorder and the various things I’ve done while unwell. However, that is what is good for me. There are always people that do not want to understand.
I have found that there is a very, very large section of people that are either going through similar circumstances or are watching a loved one go through it. I’ve also heard plenty “my relative was Bipolar and killed themselves” stories as well. Mental illness is not rare. Society just does not address it at large. Thus, they do not always understand how to handle it when it does come into the forefront.
*Take the time to address the people that matter. Take the time to come up with your own but here are some examples:
In college? Get a letter of verification from your Doctor to have the Student Human Resources department put in your file. Discuss with a Student HR person that you are Bipolar and you want it to be on record for the future. That way if you swing unwell and have to miss a couple weeks of classes; you won't just be failed or kicked out. You do not have to inform every single one of your instructors or anyone else if you do not want to.
In a career? Get a letter of verification from your Doctor and have it filed with Human Resources. Talk to a Human Resources representative and your immediate manager to inform them you are Bipolar. A good rule of thumb is to just let your manager know that if you are acting extremely different than normal, you could very well be unbalanced. It's simple and easy to remember.
In a family? I believe that teenage children are old enough to understand and help to a limited degree. I am not suggesting to completely lean on them. They should know some of your easily identifiable indicators so they can suggest to you to evaluate your mentality. I have met many people that choose to try and hide what is going on in their mind from their children. Those people are deluding themselves. Your family will spend more time around you than anyone else. They may not understand what is going on, but they will know even if you do not tell them. They will grow to identify that pressured speech and that look in your eyes means it's time to steer clear for awhile.
In a marriage? Spouses are a tough one. If you are in a loving marriage then there shouldn't be a whole lot of difficulty in explaining what support you need, when, and why to your spouse. The problem is for the people trapped in loveless marriages or with someone who refuses to accept the reality of mental illness. Pick your battles. If they do not want to understand or help you, they will not. Evaluate the interaction between the two of you regarding Bipolar Disorder. Don't waste frustration and tears on a battle you cannot win.
The point of laying your groundwork while you are well is to demonstrate a proactive approach. You do not want to swing unwell then have to go back and try to justify your actions through the Disorder. It will result in a number of fights and skeptical thinking from the people you may have wronged during that unwell period. That may cause you to get unbalanced again and thrust you back into an unwell cycle. Minimize the damage ahead of time so you can have some calmer waters to get rebalanced in.

7. Should I Notify Authorities?

Contacting authorities or medical personnel for assistance can be a very mixed bag. There are pros and cons to the situation which I highly advise contemplating BEFORE you ever have to make the choice. Conventional wisdom dictates that a person should notify authorities or medical professionals in the event of an emergency. The problem with that statement is the word “emergency”. The minor ebb and flow of mood shifting with erratic thoughts is pretty normal for many Bipolar and Depressive people. In many cases, it really doesn’t indicate anything greater at work. Thus, we need to work to identify what actually constitutes an “emergency” with the Survivor in our life.
A person that arbitrarily contacts medical authorities to handle their loved one whenever they are slightest bit difficult is going to alienate that person. They will grow to resent you and probably act accordingly. The reasons are many. First, who really wants to spend a weekend in a psych ward for something they normally deal with? Second, assistance is not free; burying that person in debt is going to make it harder for them to make meaningful steps towards wellness. Third, emergency services are not designed to handle general fluctuations in a person and will not provide long-term benefit in a majority of cases.
There is a right time to contact authorities for assistance. It’s as simple as this:
Contact authorities if you feel that you, the people around you, or the unwell person is threatened with serious harm by their actions.
That is the most common unifying factor in a true psychiatric emergency. Being called a “mother fucking cock sucking liar” by someone that is normally loving and tender is hurtful but not cause for immediate alarm. A paranoid Survivor that is loving, tender, and sleeping with a gun under their pillow is definitely a reason to notify authorities before that person does something they will forever regret. You must learn what constitutes threatening behavior from the Bipolar individual.
In the event that you have to, stand by your decision and do not apologize for making it after the fact. When confronted, inform the person that you felt they were a real threat so had to act accordingly.

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