CHAPTER 12
Family Matters
My wife Roberta . . . is quiet, strong. She knows the school calendar and remembers the mortgage. She leaves me notes in the morning. She says the kids will be fine, that they take after her side on this, my family’s disease. They’ll have, she said, the best of both worlds and I want to believe her.
But I want to be ready. I’ve seen both my parents drown in the sickness. I’ve seen my brother sink down. I’ve denied my own madness and I’ve loved it almost to death. All my life I’ve heard my family blame each other, some devil, some church, genetics and shrinks. We come up for air but never swim home. We’re ashamed and afraid of our minds. I want to believe my wife and not worry. I want to get strong and show my kids how. I want my family fearless and proud.
—David Lovelace, Scattershot: My Bipolar Family
Bipolar disorder doesn’t just affect the person diagnosed with BD, and doesn’t just affect you, the partner: it affects everyone in your family, directly or indirectly. And because bipolar disorder has a genetic component, there is a possibility that members of your partner’s family are also struggling with BD, and that your children may now or someday be dealing with BD in their own lives. There is even the possibility that you also have BD, or are dealing with other psychological and emotional issues.
As we noted in the opening chapter, psychiatric disorders—including depression, anxiety, BD, and other disorders—are very common. In addition, many of us have a tendency to emotional instability, even if we don’t have a diagnosable disorder. This is part of being human; it is just more extreme in families where there is BD.
HEALTHY FAMILY GUIDELINES
Helping your partner manage her illness is important, but it should not rule your life or your family’s life. Most people with bipolar disorder can have full lives, including family lives.
In many ways, the tools that will help your partner maintain stability are the same ones that help any family live and grow in healthy ways. However, these tools are even more important where bipolar disorder is involved, because symptoms and episodes of illness can be brought out by physical and emotional stress or unhealthy habits. Help your partner pay special attention to the following areas. (All of this advice is good for you, too, as it will help you maintain your physical and emotional health.)
Physical Health
• Each of you should have a medical doctor who knows you well. Have regular checkups and treat all illnesses that arise.
• Maintain a healthy weight.
• Eat regular meals, with a diverse diet of healthy foods. Nutritional deficiency may increase the risk for an episode of illness.
• Exercise regularly—ideally, every day at the same time. Regular activity rhythms have been shown to protect against bipolar episodes. Setting aside a time to exercise together with your partner can be effective for both of you, as you are more likely to keep your commitment if you work out together.
• Have a sleep routine that includes regular hours for going to bed and waking up, and get the right amount of sleep, usually a good eight hours a night. Maintaining a consistent daily rhythm of activities and sleep has been shown to help stabilize BD. It has also been shown to increase energy and alertness and improve mood in those without an illness.
• Avoid alcohol for your partner and limit it for yourself. Avoid all “recreational” drugs. They will destabilize your partner’s illness and they will put you at risk for emotional problems.
Emotional Health
• Set healthy expectations and boundaries for work and in relationships and stick to them.
• Learn and practice effective communication techniques with family, friends, and colleagues.
• Plan regular enjoyable and relaxing activities, and make sure you all take regular vacations and time off from work.
• Have a sport or hobby you each enjoy, and make special time to practice it.
• Learn a technique for relaxation—meditation, reading, painting, music, or another activity that helps you be calm.
Family Health
• Try to eat meals at a regular time and together as a family.
• Structure time and activities together so that everyone feels a part of the family and knows what to expect of one another.
• Include your partner as a full member of the family, not as the “sick” one.
• Plan regular family and individual meetings to discuss how everyone is doing. Address everyone’s concerns, and let everyone feel heard.
Being Prepared
• Post all emergency phone numbers—911, your partner’s doctors, the local hospital—where everyone old enough to use them can see them.
• Have a plan, and make sure everyone in the family knows what he or she is supposed to do in case of emergency, including specific plans for action if your partner is confused, agitated, or unresponsive.
• Make sure your children know they can and should tell you if they see something that worries them. (Make sure your partner knows the children are part of this plan.) Try to create an environment where everyone, not just your partner, can share their concerns about others or their own problems with others in the family.
• Make sure your children have a safe place to stay and people to care for them if that should become necessary. Make sure, too, that your children know there is a plan for their safety and comfort, should you have to leave the house in an emergency to take care of your partner.
WHEN YOUR PARTNER IS NOT THE ONLY ONE IN THE FAMILY WHO IS BIPOLAR
You may have another bipolar member of your family—parents, aunts or uncles, brothers or sisters—in addition to your partner. If they have been diagnosed and are dealing effectively with their own issues, that’s probably all that should concern you.
Frequently, however, other family members have undiagnosed illness. Their behavior may be sending up red flags for you, but they may be unaware that their problems point to BD, may be in denial that anything is wrong at all, and may actively resist and resent any efforts on your part to help them.
Except under special circumstances of guardianship (see Chapter Eleven), you can’t exercise control over another adult. If your parent or sibling, or those of your partner, are or could be bipolar, think about whether a discussion would prove valuable. This may be easiest if you know the person well and know how best to approach him or her. Anything you say may be taken as a criticism, so phrasing is important.
It may be best to try to get into a discussion with your Aunt Jessie, for example, about the time she started yelling at the bride about her choice of dress during a family wedding. You might tell her how upsetting that was to other guests, and asking for her point of view on what happened that day. Your aunt may not be aware that she did something that worried others, and may even feel comfortable enough to tell you that she often feels unwell or out of control. If she is open to the possibility that she may have a problem, she will be more likely to accept advice and seek help.
If she cannot see or accept that she may have a problem, that could be part of the illness, and no amount of explaining or examples from you will change her mind. Rather, it will probably just make your relationship more tense. Nonetheless you needn’t accept the relationship on these terms. You don’t have to agree with anything your relatives say that seems “wrong” to you, and you don’t have to look the other way at behaviors you feel are inappropriate. You can calmly state your observations or disagreements, or set limits in ways that make your position clear, without engaging in arguments or undue criticism. You can let them know you care and that you want to have a good relationship and these are the reasons you are telling them what you see. Some of the communication techniques we discussed in Chapter Eight may be useful here.
If the spouse of someone in your partner’s family who appears to have untreated bipolar disorder approaches you for advice, proceed carefully. For example, if your sister-in-law tells you she is worried about her husband, your partner’s brother, ask if she and her partner have discussed this possibility. If they haven’t, ask why not. Encourage them to make this an open issue if they can. Ask if they have educated themselves about bipolar disorder and how to deal with it. If not, encourage them to do so. Sharing your experiences can be useful, if your partner knows that you are doing so. Offering to help, yourself, is generous, but be careful about taking on additional responsibility, unless you have the time and emotional resources to handle more obligations.
Try not to engage in conversations behind someone’s back, if those conversations could include the person you are trying to help. If you must give advice about someone else, remember that you are getting information from only one person—not from the person about whom you are talking. Avoid the temptation to engage in merely criticizing the person you are discussing, as opposed to seeking ways to understand and help that person. Keep reminding the person who is seeking your advice that there are ways to bring up most issues with his or her partner. It is important not to play the role of expert, but to advise, or help, the person who has approached you to get professional aid in dealing with problems related to illness.
WHEN YOU HAVE A BIPOLAR CHILD
If you suspect your child has BD, do your best to get a thorough evaluation and an accurate diagnosis. As criteria for the diagnosis and treatment of bipolar disorder in children are controversial, even among experts, an appropriate evaluation may include a second opinion. Bipolar shares some similarities with other disorders, and children, especially, can easily be misdiagnosed and either inappropriately or inadequately medicated. Also, children misbehave, are moody, have unusual thoughts, and have sleep problems—all symptoms of BD—for many reasons. Just because your partner is bipolar doesn’t mean your child is too. Nonetheless, the risk of bipolar disorder is higher in a child of a parent with bipolar disorder. You should be alert to the possibility that inappropriate thoughts or behaviors or problems in school or relationships could be due to BD and could be treatable.
If your child has been diagnosed as having BD, educate yourself as much as possible about childhood bipolar disorder. Symptoms and treatment are not exactly the same as in adults. There is a great deal of literature for parents of bipolar children, including books, Web sites, and online forums that provide information and emotional support. Especially for the treatment of children, it is important to find a psychiatrist who is an expert both in childhood disorders and in bipolar disorder. In addition to the general advice in Chapter Three about finding a psychiatrist, the resources listed in “Youth Mental Health Organizations” are also useful.
Early Onset BD
Childhood bipolar disorder—known as early onset BD—is associated with more pronounced symptoms and more frequent mood swings (throughout life) than BD that first becomes evident in adults.
Youth Mental Health Organizations
Active Minds on Campus
(202) 332-9595
American Academy for Child and Adolescent Psychiatry
(202) 966-7300
Child and Adolescent Bipolar Foundation
Federation of Families for Children’s Mental Health
Juvenile Bipolar Research Foundation
(866) 333-JBRF (5273)
E-mail: info@jbrf.org
Although much is being studied and discovered, there are still many unknowns regarding BD in childhood and much controversy about treatment, especially with regard to medication. Learn as much as you can about children and medicine, and about the particular medication your doctor recommends. If your child is on medication, learn about and keep an eye out for troubling or dangerous side effects—not only at the beginning of treatment but also after any dosage changes or additions—and stay in touch with your child’s doctor regularly.
If you do have a bipolar child, or children, it would probably be wise to talk with your child’s teachers. You may need to make special arrangements to accommodate the effects of medications, reduce stresses, or handle difficult behaviors.
There are no perfect children; psychiatric disorders are common in children, as they are in adults. The U.S. Surgeon General estimated that at least one out of five children has a psychiatric disorder serious enough to require treatment, so your child is not alone. Also, there is unprecedented awareness today about bipolar disorders in children as well as in teens and adults. There are effective medications and treatments. Many people with BD are successful in life, and many successful people have BD. Your child may be one of them. You can help by providing your continuing love and support, just as you would give any child.
Should You Have Children If One or Both of You Has Bipolar Disorder?
Bipolar disorder tends to run in families. If you are planning to have children and this possibility is a matter of concern for you, have a talk with your family doctor or ob-gyn. He or she may suggest genetic counseling. In the end, however, the decision is up to you and your partner. Among the factors you need to consider are the following:
• Bipolar disorder has a genetic component (see Chapter One), and your children would be at increased risk of illness. Are both you and your partner prepared for that possibility?
• Many people who have BD are good parents. But parenting is stressful. If you are trying hard to manage the stress in your life, you should factor this into your decision.
• Pregnancy can precipitate the first or new symptoms of bipolar disorder. So plan the timing of pregnancies with your psychiatrist, make sure your ob-gyn knows if you have BD, and watch for symptoms.
• A bipolar woman who is pregnant will need to be carefully monitored by her doctor. Certain medications can harm a fetus, and these will most likely need to be adjusted or replaced.
The Bipolar Teen
Adolescence is difficult for everyone, and bipolar teenagers in particular often get into substance abuse, sexual exploration, and other risky behaviors. If you’re the parent of a bipolar teen, you’ll need to keep a particular eye out for these dangers. Keep the lines of communication open: talk to your children and, above all, listen. Seek support from other parents of bipolar children and teenagers.
Teenagers are not adults. They still need effective parenting: to support them and to set boundaries and help them keep to their limits. You are responsible for them. Even when they tell you to get out of their lives and you are tempted to do just that, remember: you are the parent and the responsible adult.
Find a provider who will counsel your teen privately but will also maintain appropriate and responsive contact with you, the parents. Be involved. Monitor your teen’s behavior and stay in direct contact with his or her doctor.
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LIVING WITH BD
Martin’s Family
My older daughter, Vanessa, was diagnosed with bipolar disorder at fifteen after she tried to kill herself. Even though my wife had been diagnosed some years before, and we knew this was a possibility, we were taken by surprise. We just hadn’t seen signs that anything was wrong.
Our youngest daughter, Rayanne, took it really hard, but we made sure she got counseling—in fact, the whole family was in counseling—and things seemed more or less okay with her. She got good grades, had a nice boyfriend, and got into a good college.
She loved the dorm, loved school, and we relaxed. For a few months, everything seemed to be going great for her. Then all hell broke loose. She called, hysterical, in the middle of the night, saying she’d been kicked out and we had to come get her right away. We later found out she had acquired a reputation as the wildest girl in the dorm—she’d get drunk, she’d get stoned, and she’d sleep with everybody. Boys, her professors, townies . . . She never went to class. We were stunned. She’d always been a quiet girl, a good student.
My wife and I were devastated. I guess being away from home, without structure, and with the pressures of school . . . it was just too much for Rayanne.
She moved back home so we could try to get this thing under control. Both our daughters are doing okay now, fingers crossed. We all feel really fortunate that our daughters are both alive and trying their best to cope with this thing.
WHEN YOU HAVE PROBLEMS OF YOUR OWN
It is possible, if not probable, that you brought your own problems to your relationship with a bipolar partner. Epidemiologic studies suggest that it’s not unlikely that you suffer from some level of depression or anxiety, for instance. It’s not just a matter of these conditions being common; people with mood disorders are also more likely than average to marry other persons with mood disorders, including BD.
Although, for some, caregiving and busy-ness provide needed focus, if you tend toward depression, caring for a partner with BD probably won’t enhance your overall spirits. The same holds for anxiety and related disorders: bipolar symptoms and behaviors can make ordinary life much more trying for everyone in the household. Make sure your own condition is evaluated and treated, with medication if needed. Learning cognitive-behavioral and relaxation techniques to deal with your own stress can help you calm anxiety and cope with the pressure and worry of having a bipolar partner.
WHEN BOTH OF YOU ARE BIPOLAR
It’s not uncommon for both members of a couple to have bipolar disorder. The most likely reason seems to be a phenomenon that epidemiologists and other scientists call assortative mating—that is, we tend to gravitate toward others who are like ourselves.
If you and your partner both have bipolar disorder, you’ll have some advantages and some disadvantages. One big advantage, of course, is that if you learn about your illness and your options, you can help each other: reminders about medication and appointments, or suggestions about calling the therapist may less likely be met with resistance than if only one of you were ill.
You can also watch for, and help minimize, your partner’s “triggers.” You’ll possess an inherent understanding of the challenges, and may know almost exactly how your partner feels, especially if you have the same type of bipolar disorder. (Because bipolar 1 is less prevalent than bipolar 2, it’s less likely that both members of a couple will be bipolar 1.) Forgiveness and understanding might also come easier.
Your situation also holds potential disadvantages. If you are both ill at the same time, you may urge each other into dangerous behavior without the safety of a well partner to caution or stop you.
During episodes of illness, the ill partner will be less equipped to look after the other partner, and vice versa.
At the same time, as noted earlier, you’re in an excellent position to help your partner. You can, ideally, take turns, one watching out for the other during episodes of illness. It is therefore more likely for you than for other couples that each of you does his or her fair share in the relationship. Make sure, however, that you have others to rely on, and plans for what to do if both of you are ill at the same time.
It is not wrong for both of you to see the same doctor if you both have the same illness. Often, this is the doctor who prescribes your medications. However, you will probably each benefit from also having someone you don’t share to talk with about your problems. Often, this is a professional therapist.
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LIVING WITH BD
Marylou and Tim
My husband, Tim, is bipolar, but he’s not my first bipolar relationship. My last two boyfriends before him were bipolar too. I actually went years without realizing this, or even thinking about it. I was used to butting heads with my boyfriends, yelling and screaming about stuff, dealing with their addictions and depressions . . . and I was really hooked in to what I saw as the good times, what I later came to realize was the manic sexual energy and a life of exciting, sometimes dangerous, activities.
Then I noticed that when I tried to talk to my friends about my relationship woes, they’d give me some pretty strange looks. Apparently, not everyone had to deal with this kind of stuff. Not all women are attracted to extreme men.
Tim started seeing a psychiatrist, and got medicated, and started to get stabilized. Then, I was upset! He seemed kind of boring to me. At about that point, I could see I needed my own therapist.
In therapy, some stuff came out, and I realized that my mom had probably been bipolar—not diagnosed, of course—and my granddad as well. After many years of exposure to mania, this kind of behavior just seemed normal to me. I didn’t know it wasn’t ordinary. Turns out, I may be bipolar, too, and that may explain some of what I want and choose to do.
My therapist is helping me understand why I have such a drive to keep repeating this kind of relationship. I’m learning a lot about myself. Some of it is scary, but I feel like I’m finally getting some control over what I do. I thought about leaving Tim, but then I thought, now? When we’re both actually starting to get better? I truly love my husband. We just fit together. I’m determined to make it work. Continuing couples therapy, medication for both of us, trying to talk instead of argue . . . whatever it takes.
WHY DID YOU END UP WITH A BIPOLAR PARTNER?
Just as some bipolar qualities represent the worst that one can bring to relationships, others are positive and can attract powerfully during courtship. To wit: bipolar illness can make your partner daring, sexy, animated, successful, confident, optimistic, fascinating, and more.
People who suffer from bipolar disorder also tend toward high vitality (at least sometimes), creativity, and even brilliance. Some partners describe an almost magical quality to their bipolar spouses’ behavior or conversation, at least during times when they are not experiencing deep depressions. Many people who are bipolar exhibit abundant charm, humor, or “the gift of gab” when they are manic; and during depressive phases, they may be perceived as having a kind of “romantic” broodiness.
Are certain kinds of people more likely than others to end up with bipolar partners? As of now, no one knows for certain—but, based on observation, it certainly seems so. Some people, as we’ve said elsewhere, are attracted to the charm and excitement and confidence of a person in a manic or hypomanic mood. Others romanticize depression, seeing in it a sign of a deeply sensitive nature rather than an indication and symptom of unhappiness or pain. And if you have been raised by parents (diagnosed or undiagnosed) with bipolar or other emotional or mental disorders, then unpredictable, wild, and even dangerous behavior may seem like the norm. This is what you expect from a relationship; and when you get it, it may feel satisfying and rewarding or comfortable and familiar—a feeling of “coming home.”
Often, partners of people who have bipolar disorder are smart and creative themselves; it is therefore not hard to understand why they would appreciate those qualities in others. One thing’s a practical certainty: chances are, the bipolar person in your life is, at the very least, interesting.
You Are Not Alone: Online Resources for Bipolar Disorder
The most important thing to remember is that you are not alone. There are many other people in your position, and a number of excellent online services (listed here in alphabetical order) are available to help you out:
• The National Alliance on Mental Illness:
NAMI.org
The future holds great promise for our growing understanding of bipolar disorder and for helping the individuals who live with it. But you don’t have to wait for the future to begin living a healthy, constructive, hopeful life with the bipolar person in your life: your partner. We hope this book has given you a deeper understanding of bipolar disorder in general, the role it plays in each of your lives, and the support that is out there for both of you as you work together to live with BD.
We urge you to continue to educate yourself about bipolar disorder. Continue to ask your partner’s doctor about new medications and other therapies that may soon become available. Keep asking questions of doctors and therapists about any concerns you may have. Encourage your partner to work on new coping skills, and continue to work on your own. Care for yourself so that you can care for your partner. Don’t neglect to get appropriate support or to take time for yourself. Keep up caring communications between you and your partner. Treat this illness with determination. You can live a healthy, productive, and loving life with someone who is living with bipolar disorder.