Even when I was fighting with my husband, or so manic I seemed to be flying, there was a part of me that dispassionately observed what was going on and knew it was crazy. But I couldn’t stop my actions. I said, “Self, you’re nuts. You need to stop this,” but I’d keep right on doing whatever crazy stuff I was doing. It takes more understanding than most people have to realize that the person cannot control his or her actions when they are manic or depressed. Not having control of your moods means not having control of your actions.

—Jane Thompson, Sugar and Salt: My Life with Bipolar Disorder

Although it’s doubtful that your partner’s symptoms would disappear if there were no stress in his or her life, certain situations—such as travel, lack of sleep, and conflict—seem to contribute to triggering bipolar symptoms. Thus it’s important to avoid, minimize, or at least plan ahead for such situations. A relationship with less conflict will help your partner keep his moods stabilized and will help you relax, knowing that the likelihood of an episode of illness has been reduced.

Of course, no one can completely avoid stressful situations and unpleasant moods; they are just more potentially dangerous when bipolar disorder is a factor. Sharing feelings and observations can reduce the possibility that unaddressed disagreements and tensions will grow into major conflicts, and can help each member of a couple feel more comfortable in the relationship. Planning ahead can help avoid unnecessary stress and save each member of the couple from being faced with making important decisions urgently and without carefully considering the alternatives.

Many of us take life as it comes and avoid the difficult conversations. This approach is generally not conducive to healthy communication, and it’s especially unwise with bipolar disorder. Finding the time and ways to talk about things, particularly difficult things, is crucial.

Not just any time is right. Knowing when you can and can’t talk about problems is important. Adapt the advice in this chapter according to your partner’s diagnosis and current symptoms. For example, if your bipolar 2 partner is angry, you may be safe trying to fend off a verbal attack through communication and coping skills. However, if your partner has bipolar 1 disorder, your reaction may need to be different. It is more likely that his anger may become rage, and rage could spiral into dangerous behavior, including physical violence. (See Chapter One for more about bipolar 1 and bipolar 2 diagnoses.)

Communication Basics

• DO listen attentively and with respect.

• DO couch any necessary criticism as positively as possible.

• DO praise your partner often (and honestly).

• DO avoid physically threatening gestures or behaviors, such as shaking your fist or invading your partner’s space.

• DO stick to the topic at hand.

• DO say what’s on your mind, but say it without blame or insult.

• DO keep your voice calm and modulated.

• DO give your partner the “last word.”

• DON’T interrupt.

• DON’T make threats.

• DON’T bring up past or unrelated conflicts.

• DON’T blame or belittle.

• DON’T get involved in circular or no-win arguments. Know when to stop.

STRATEGIZE AND SET LIMITS AHEAD OF TIME

When your partner is already showing symptoms of a manic or depressive episode, it may be difficult to make yourself heard and understood. One technique that has proven helpful for many couples in which at least one member has bipolar disorder is to sit down together between episodes—when your partner is stabilized—and discuss symptoms and their possible triggers, as well as what steps each of you should take if symptoms reappear.

For example, your partner’s symptoms might include such behaviors as pressured talking or paranoia. If you see evidence that your loved one is headed toward a manic episode, but she dismisses your concerns—not uncommon with BD—you can use your list to remind her that what she is experiencing (or what you are seeing) is a symptom and that there is an agreed-on plan of action that should be implemented. Often, this plan is just alerting your partner’s doctor.

Strategize

Work on conflicts and plans for dealing with them each time the disorder is under control. During those calmer times, review your past experience and the success of your plans for dealing with symptoms. Ask your partner for suggestions about how to deal with typical disagreements.

In any kind of clash, but particularly where bipolar behaviors are concerned, prior planning can spare you from making decisions in an atmosphere of haste or threat and will help avoid unforeseen, uncontrolled, and unwanted consequences. Be clear with your partner about what kinds of behaviors will require you to call for help from doctors or even the police.

Set Limits

You should review acceptable and unacceptable behavior and discuss consequences—ideally, before conflict occurs. Let your partner know that behaviors such as verbal and physical abuse are inappropriate and dangerous, and that you will not tolerate them. You will probably both agree that they should not be tolerated. With these ground rules in place, you can more effectively, or at least more comfortably, walk away from an outburst, request a “time out,” or call for help.

For example, Mika received a call from her bipolar boyfriend right in the middle of a class. For the hundredth time, he’d gotten into a panic about a work problem that in actuality was probably of little consequence. She apologized to her teacher and classmates and brought her cell phone out into the hall—where she made the mistake of trying to reason with the man. She pointed out that the situation he was worried about had come up many times before; that if things got so bad that he lost his job, they would cope; and that she was, after all, busy at the moment—as he well knew. The boyfriend did not calm down. His call only served to agitate them both. And Mika missed the rest of her class.

A firm, noncommittal approach might have worked a lot better. If they had agreed on limits beforehand, the conversation might have gone like this: “I know you’re upset, but I’m in class now. I can’t take another call until my class is over. I should be home by noon, and we’ll talk about it then. I’ll see you soon.” Then she could end the call without feeling she had not addressed the issue at hand.

EFFECTIVE COMMUNICATION STRATEGIES

Communication between even the most calm and rational partners can be problematic. Misinterpretation is common. Add the perceptual, cognitive, and emotional difficulties of a psychiatric disorder, and misinterpretation is almost a given. Nonetheless, you might be surprised how often the basic rules of effective communication, consistently applied, can transform a no-win argument into meaningful discussion and eventual understanding and agreement.

Even couples who are not dealing with BD have problems communicating—and it’s hard not to react in kind when you’re being verbally attacked. If you’ve ever been short-tempered or mean to your partner, if you’ve ever said something like “Stop acting like a baby!” or had an interchange that led to statements like “I’m an idiot? You’re the idiot!” you’re certainly not alone—BD or no BD. Forgive yourself, forgive your partner, and then learn some effective ways to communicate.

At first, unfortunately, you will probably be the only one practicing effective communication skills. At least one of you needs to be in control; and because your partner is most likely to be out of control during the heat of the moment, you would be wise to step up and take charge of guiding the change in the style of the discussion. And you should start with the expectation that improvement will take patience and practice.

That means you can’t use one technique, get frustrated when it doesn’t work, and give up. Recognize that you are in this for the long term and that there will be a learning curve for each of you. But with repeated effort, and perhaps coaching and guidance from individual or couples therapy, you will both begin to make progress. An open-mindedness to take suggestions and try alternatives, and persistence in attempting to find the right approaches for you and your partner, will often lead to improved communication and a happier, more rewarding relationship.

In addition to the information in this chapter, aimed specifically at bipolar couples, many books have been written about interpersonal communication. In fact, communication techniques intended for parents and children may come in handy in other relationships, too. We list a number of communication books in the Resources at the back of this book.

The following techniques are generally helpful in communicating and may be especially important when interactions are complicated by symptoms and episodes of bipolar disorder.

“I” Statements

“I” statements give you a way to frame your comments to reflect the way you feel, without placing blame. For example, it’s quite common to blurt out in frustration, “You’re always so negative! Why can’t you say anything nice to me?” But, as you know from experience, this kind of comment is more than likely to put the other person on the defensive. A better comment, and one that reflects where your anger is really coming from, is this: “I feel frustrated when you say things like that to me, and it makes me not want to be around you.” Or you may snap, “Stop talking at me like that! Can’t I get a minute to myself?” A better response would be, “I need some time alone right now.” The former statement is heated and may be taken as insulting. The latter is calm and matter-of-fact.

It’s not always easy to frame “I” statements in the middle of an argument, but with practice, you will get better at it. It’s worth putting some effort into trying. Corny as “I” statements may sound, they really work to defuse anger. Instead of being challenging or accusatory, they are statements of your feelings and concerns and invite the other person to see things from your vantage point.

If What You’re Doing Isn’t Working . . . Try Something Else!

Although everyone’s situation is different, this bit of solid advice really does apply to everyone: If what you’re doing isn’t working, try something else. Often the “something else” can be something quite simple. Solutions to problems frequently appear when people just take the time to consider doing things a different way.

For example, one bipolar man whose wife worked at home would return from his office each evening, head for the kitchen garbage pail and then get angry, escalating into a full-blown rage. His wife felt that she had enough household chores and that this one was his.

His wife grew to dread their evening routine: every night, her husband would come home, check the garbage, then curse (continued ) and complain because he felt there was too much of it—again. She wasn’t prepared to take out the garbage herself, but she did find something quite simple to change: one day, she simply asked him to take the garbage out in the morning, when he generally felt more agreeable, instead of at night, after the stresses of the day. Problem solved.

Listen and Reflect Back

Listening to what your partner is saying and reflecting back what you heard in your own words show that you are paying attention to what your partner is saying and at least trying to understand. Listening and reflecting also allow your partner to clarify her point if you misunderstood her. Instead of engaging in an argument, ask your partner to tell you why she’s angry. Then let her know what you heard.

Share Feelings and Understandings

Try letting your partner know that you truly understand what he’s saying, and that you are taking it seriously. For example, “Oh, I think I understand something I didn’t understand before—you’re upset because you feel like I don’t listen to you. Is that what you’re saying?”

You can also make your partner feel better understood by acknowledging his feelings, adding something like, “I know that makes you feel really bad. I’m sorry if I hurt your feelings.”

Talk to Solve Problems, Not to Win Arguments

Stick with this kind of communication and use all the tools we’ve discussed, if necessary. Don’t let your discussion devolve back into the same old competitive argument you always have. You’re not trying to win an individual victory; you’re trying to achieve an improvement in your relationship.

Be the leader in helping your conversations evolve into opportunities to share experiences and feelings, and into discussions of mutually acceptable solutions to problems. Continue to bring the conversation back to what is being done and said in the here and now, and keep seeking to find and reinforce areas of understanding.

Offer Sympathy

If your partner is irritable, he is likely to be feeling very sensitive to every little nuance. This means he is more likely to take offense or misinterpret. Always bring yourself back to basics—don’t react to the words; do attend to the underlying issue. He’s feeling overly sensitive, he’s uncomfortable, he needs and deserves sympathy. For example:

YOUR PARTNER: What? Why are you looking at me like that?

YOU: I just want to know what you might like for breakfast.

YOUR PARTNER: Nothing. I’m not hungry. Leave me alone.

YOU: I’m sorry you’re not feeling too great, honey. Would you like to talk about it?

YOUR PARTNER: No.

YOU: All right. I’ll check back with you later. In the meantime, please let me know if you change your mind.

Remember that bipolar disorder is sometimes quite variable from hour to hour, and even minute to minute. If this technique fails, you can make a note of how long the average episode or conflict lasts, and remind yourself that, in time, it will likely be over.

Communicating Through E-mail

In some cases, e-mail holds distinct advantages over spoken communication. Although it’s true that it’s harder to convey tone in e-mail than in spoken conversation, e-mail and other written interactions allow you to think about what you want to say and to stick to the issue at hand. If you’re unused to communicating this way, give it a try, especially if you often find conversations devolving into arguments. E-mail can delay or buffer reaction to certain characteristics in a relationship that may be troublesome at the moment, such as tone of voice. Although e-mail can convey this tone, it allows the recipient to read it when ready and to respond when willing. It’s an easy way to avoid an immediate, emotionally driven response.

SUPPORTIVE STRATEGIES

The underlying message of good communication with your bipolar partner is this: even if your partner frequently blames you, launches verbal attacks, refuses to speak, pouts, or makes life unpleasant in similar ways, limit your reaction. Your partner is probably not so much angry at you as not feeling well and not able to contain his feelings. What he says and does when he is not feeling well is more a reflection of his mood than of his underlying opinion of you or anyone else. Don’t mistake the illness for the person.

Once you’ve done that, and you’re no longer reacting to symptoms as if they were intentions, then what? Here are some good coping strategies you can employ to make further progress.

Use Positive Reinforcement

Positive reinforcement—rewarding good behavior, praising even small acts of kindness or any constructive act—is among the most valuable strategies of supportive interaction. Initially, it may feel strange to praise simple things that your partner should be doing naturally—taking medication regularly, helping with housework or child care, or earning a living—but do it anyway: compliments are rarely wasted. This is good advice in any relationship, and indispensable when living with someone diagnosed with BD.

Voice Your High Expectations

When people know our expectations are high, they tend to want to see that we’re not disappointed, that we retain our positive image of them. When things get sticky, such statements as “I’ve always known you to be respectful” or “I’m sure you didn’t mean that unkindly, but it felt unkind” can go a long way to helping your partner see the interpersonal consequences of things he might say or do, rather than remain unaware of or defensive about his statements or actions. Again—good advice in any relationship, and effective when dealing with BD. (Conversely, never express your reaction as disappointment—“I’m so disappointed in you; I expected more.” This will only make your partner feel worse and share less than he or she already does.)

Turn Negatives into Positives

For example, replace the hurt accusation “You never touch me anymore” with a compliment: “I miss those wonderful back-rubs.” If you have doubts about how this works, imagine your partner saying positive things to you and reflect on your feelings.

Avoid No-Win Situations

No-win questions—including “Catch-22s” or “double-meaning statements”—are verbal dilemmas: choices between equally unappealing alternatives. Clearly, answering a question like “Are you a complete idiot?” with yes or no is a losing scenario for you. A better choice is to answer with a serious question: “Do you see me that way?” or “What’s wrong? Can I help?” Your partner is speaking this way out of frustration; don’t respond the same way. Your answer needs to help defuse the situation.

Avoid Inappropriate Anticipation

Inappropriate anticipation is another conversational trap. In this situation, one person hears a message that has not been spoken and responds to that. For example:

YOUR PARTNER: I think I’ll have a wedge of that cheese I like.

YOU: Oh. Okay.

YOUR PARTNER: Something wrong with that?

YOU: No. Not at all.

YOUR PARTNER: Well, why are you acting like that?

YOU: Like what?

YOUR PARTNER: All weird. What’s the matter with the cheese? Does it smell bad? Well, thanks a lot. Now I’ll never eat that kind of cheese again! Or:

YOUR PARTNER: Are you still planning to put up those storm windows?

YOU: Yeah, I guess so. Why?

YOUR PARTNER: Well, you promised you would!

YOU: So . . . ?

YOUR PARTNER: Now, you’re saying you won’t. You’re breaking your promise!

In both examples, the responder gives too vague an answer (“Oh. Okay” and “Yeah, I guess so”), and the initiator reads negative messages into it. This may not seem fair—and it might not be a problem if you were having a conversation with a nonbipolar friend. But in a relationship with a person diagnosed with BP, it can be a real issue. Remember, one of the symptoms of bipolar disorder is finding hidden meanings, often threatening ones, in normal events or interactions.

Definite replies can sometimes avert this conflict. If your response was clear and still misunderstood, or was unclear but received an excessive reaction, go over the conversation with your partner calmly: “Wait a minute. I think I might have given you a mistaken impression. Let’s go over what we said to make sure I explained my position as well as I could have.”

Act “As If”

You’ve probably heard the phrase “Fake it ’til you make it.” Twelve-step programs also call this acting “as if.” It’s not a new idea. At the turn of the twentieth century, the American psychologist and philosopher William James was famous for this advice. He wrote, “If you want a quality, act as if you already had it. Try the ‘as if’ technique.” The premise is simple but powerful: when you act the way you would like to behave—patient or concerned or grateful, for example—you are actually practicing that behavior. Over time, this can develop into your natural response.

For example: you’re both expected at an event, and your partner, as so often happens, is terribly late. On top of that, he’s lost his car keys—again. Your worst-case-scenario response is to say, “Again? I can’t believe it! You always do this!”

To which he might respond, “You probably hid them somewhere, under your mess!”

The outcome? You never get to the party, and you’re both furious.

Instead of expressing frustration, try this. Act as if you had all the patience in the world. Offer to help search, but if he wants to search alone, let him search for as long as he needs. Calmly sit down and watch television or read the paper. Tell him again that you’re still willing to help but that you’re also willing to wait. You’ll be ready whenever he is. Yes, it reinforces the behavior you’re trying to discourage; but it also expresses your compassion toward a person who truly can’t control his disorganized behavior. Even better, by pretending to feel relaxed and magnanimous, chances are you really will begin to feel this way. And you are also modeling the same calm, accepting behavior you would like to encourage in your partner.

LIVING WITH BD

Heather and Max

My husband, Max, can really hold it together around a lot of people, but in private, he’ll just dump his mood on me. We’ll be at a party and everything will be great, he’ll be socializing, but as soon as we’re out the door, he’ll say something cutting. It was crazy making at first.

Finally, I figured out he felt free to do this because he felt safe around me. He knew I wasn’t going to leave him because of it—I loved him. But I really didn’t like it at all. I didn’t like being someone he could feel free to dump on, and frankly I didn’t think it was helping him—when he was calmer, he felt terrible about it, too.

We’d been talking about ending our marriage for a few years—it just seemed like we always spiraled down into the same old issues. But when I was able to respond to his criticisms in a healthier way—my therapist’s words—it actually made me feel empowered. Even if I was just silent, and stopping myself from saying something horrible back, or running to the bedroom in tears, or slamming the door, I felt like I was in charge: I was doing something to change the nature of our interaction. And it did make a change—just modulating my response was such a shock to him that he began treating me with more respect.

One great trick to help me restrain myself is this one I learned in a support group. Every time he’d go off on a rant, that would be my signal to reward myself. I’d be quiet and just count. For example, I’d promise myself ten minutes of guilt-free Internet time wasting for every one of his muttered curse words, or a dollar spent on something I enjoyed for each cutting remark. You’d be surprised how fast those rewards could add up!

I know things will never be perfect, and that these episodes will happen from time to time, but I feel calmer about them now, more able to handle them and myself. And I think my being calmer is helping him be calmer, too. I’m looking forward to this next phase in both our lives.

COPING WITH MANIA

The best way to deal with virtually any treatable illness is to catch and address it early. Extra vigilance is needed in dealing with BD, because people experiencing the beginnings of mania typically feel good—which hardly makes them inclined to seek help. Two great indicators of impending mania are lack of sleep and speed talking or pressured speech. At the first sight of these symptoms, implement a plan of action, ideally one you and your partner have discussed ahead of time.

If your partner starts talking a mile a minute and won’t tolerate any interruption, make an appointment—or at least schedule phone time—with her treating doctor. Together you may be able to head off a serious episode of illness or at least make plans to cope with the episode.

Take a Break

It can be exhausting living with a person who is bipolar, particularly if symptoms are common and when you feel that you are putting out a great deal of effort and not seeing immediate results. In this case, a short break from your partner might give you a much-needed change of perspective. If you have the time, take a walk outside. If you can, you may even want to arrange for a mini-vacation by yourself or with a friend for a day or more.

Even if you’re able for only a few minutes to get away from a partner who’s behaving badly, do it. Take a break: go into another room, listen to your favorite music, pet your dog, watch a favorite video clip.

React Calmly and Rationally, Even to Rants

Some people who have bipolar disorder tend to “go off,” ranting at you or at others. This can be upsetting, no matter how many times you have experienced it, and your impulse may well be to yell right back. This won’t lead anywhere good. There are better strategies you can employ.

The best way to deal with a partner who is ranting is to stay calm and rational yourself. Let your partner feel heard and understood, then see if you can work toward a desired outcome.

For example, if your partner calls you a controlling bitch because you ask if he’s going to his psychiatrist appointment, resist the temptation to answer in kind. Take a deep breath, if needed, and say something along these lines: “I know you feel as if I’m nagging you, but it’s important to me that you keep this appointment. We’ve had problems with you making, and then breaking, plans.” You might add: “What would be a better way to remind you?”

Also remember: grumpiness can be tolerated, but if you feel unsafe, get yourself and your children away from your partner immediately. If the situation appears urgent, take her to a hospital right away or call for help. (See Chapter Eleven, “Dealing with Emergencies.”)

LIVING WITH BD

Mel and Elaine

Even though Elaine sees a psychiatrist regularly, takes Lamictal, and has had a reduction of symptoms, I wouldn’t consider her “all better.” Depending on the episode, she might have anywhere from six to ten of the symptoms listed for bipolar in the DSM-IV manual.

When she’s “high,” it’s pretty unpleasant. One of the most frustrating things is, there’s no rational discussion of the situation possible. She treats my suggestions and questions like attacks on her. Frustratingly, most of the anger and irritation she feels when “high” she does not recall when not high. When she’s “low,” she promises to be less nasty and hostile and more reasonable and less accusing—but when she’s “high” she forgets all about this or dismisses those vows as having been made under pressure.

There’s such a complete personality change that it’s as though she is someone else entirely. Nearly all the characteristics that attracted me to her—her kindness, her sense of humor—are absent when she’s high.

One thing that does work for us is to spend time away from each other during her manic phases. If I can be away all or a large part of a day, that can help me deal with her symptoms when we’re together. And it’s just the same if she goes away. We both have more patience for the times we need it.

COPING WITH DEPRESSION

Episodes of depression are more common than mania and can precede an episode of mania. They often begin with low mood or sadness; a decrease in interest, pleasure, and activity; and lowered confidence and drive. Even mild depression usually brings trouble with sleep, including feeling fatigued and sleeping too much, or trouble obtaining restful sleep. Any of these signs requires that your partner seek the counsel of his treating doctor. Addressed early, a long or deep bout of depression may be avoided.

For deep depression—your partner talks about suicide, stops eating, or can’t seem to get out of bed—a consistent, loving pressure to get to a psychiatrist is essential. Stress the advantages for your partner—he could feel much better soon—rather than for you or other family members. However, if symptoms are serious and threatening to job or relationships, take action quickly. If symptoms are threatening to life, the situation is urgent: immediate action is critical. If necessary, take your partner to a hospital for treatment. (See Chapter Eleven for details on how to cope with this emergency.)

If your partner has already been in treatment for six months or more and still shows signs of obvious depression or mania, you could suggest that she bring up changing medications or dosages, ask for a consultation, or explore looking for a new provider. You might want to attend a session with her, in case the doctor, for whatever reason, isn’t getting a clear picture of her situation.

Sometimes, perhaps because of memory problems or embarrassment, people who have bipolar disorder have difficulty reporting events accurately. In fact, studies show that most patients—not just people with BD—frequently minimize their symptoms when talking with their doctors. Some people do this because they are afraid of tests or treatments; others may be reluctant to offend the doctor by suggesting that treatment isn’t working. Often they just don’t want to be seen as ill.

If your partner is afraid of the consequences of starting or changing treatment, suggest that getting a consultation on alternative treatments does not necessarily mean he has to start them. Also keep in mind that people who are depressed often think negatively, and out of hopelessness may reject any help offered, and those who are manic may reject help because they do not feel they are ill. Don’t yield your position if you see clear symptoms. Steady, respectful encouragement often leads to success. Abandoning the attempt to get treatment always ensures failure.

Basic Coping Skills

1. Keep your sense of humor and encourage your partner to do the same: This does not, of course, mean being indifferent to your partner’s needs or suffering, or ignoring your own problems. It does mean paying attention for things that are ironic, absurd, or just plain funny about your situation, and enjoying as much of your experience and as many of your interactions as possible.

2. Don’t take things too personally: We can only see the world as it relates to us, and we tend to interpret everything as being about us; but most things aren’t. Your partner may be out of control, but you don’t have to be. Learn to detach from your partner’s behavior and to mentally separate your partner from his or her symptoms. When your bipolar loved one goes into a rant or becomes irrationally irritable, this behavior is a symptom—like coughing or running a fever. As long as you’ve done all you reasonably can to help manage the illness medically, it’s important to keep some emotional distance when unpleasantness starts.

3. Expand your world: Look to your support team, your friends, positive family relationships, volunteer activities or paying work, creative pursuits, and whatever else you enjoy as a supplement to your primary relationship. Maintain friendships and interests outside your home. If you make your spouse your only friend, and your home life your only interest, you’ll find yourself unnecessarily limited, frustrated, and without the means to relieve your frustrations.

4. Get adequate rest, exercise, and nutrition: This is good advice for anyone. Even if you can’t ensure these for your partner, make sure to get them yourself. You will not only set a good example but also find it easier to cope if you’re well rested, well nourished, and in generally good health.

5. Set clear boundaries: Bipolar is a serious disorder. You can’t refuse to accept a partner’s delusions or depression, but you can refuse to accept such behavioral symptoms as verbal sniping or physical abuse. Discuss and make clear which behaviors are acceptable and which are not.

6. Cultivate patience: If you don’t always have patience with your partner, start by having patience with yourself. As you cultivate patience, it will grow. Living with another person is hard. Living with a person who has bipolar disorder is that much more so. You can expect some difficult times. Patience will make them easier to endure.

These are only basic guidelines for improving communication and interpersonal behavior in a relationship. Chronic marital problems generally respond well to professional therapy. If poor communication and bad interactions have become problems in your relationship, you’d be well advised to consider short-term couples therapy. In the next chapter, we’ll explore techniques for dealing with life issues that can trigger negative or even dangerous behaviors.