I knew very little about bipolar disorder when my son was diagnosed. My knowledge was limited to the assumption that there were tremendous, manic highs…followed by deep moments of despair. I don’t know how I came upon this preconceived notion…but I’d never realized that depression could manifest itself in the form of annoyance and intense irritability.

Extreme, prolonged, intense irritability.

Yikes.

I’d written off T’s seething annoyance as everything from fatigue to hormones…and I still believe that a lack of sleep is a recipe for disaster. Or at minimum, it sets the stage for one hell of an argument.

I’ve learned over time that arguments with T are frequently dramatic, regularly intense and oftentimes draining. I used to panic at the depth of his anger…I’d have this sense that our relationship was on the brink of devastation and I’d fear that we’d never be the same again.

I’ve since realized that like a summer thunderstorm, his anger is powerful…but it blows over quickly. I also recognize that most of the time, my unconditional love makes me the perfect verbal punching bag for his frustration and mood swings.

And yet. This is the same guy who’s wickedly creative, with a wry sense of humor and the ability to deliver a joke with remarkable comedic timing. He’s charming, sensitive and will spend an inordinate amount of time helping a friend work through his problems, without any expectations or agenda. He cares deeply…about everything.

That intensity seems to be at the crux of his personality. There is no middle road with T…he moves at warp speed and lives his life with unbridled passion. You can’t help but to get caught up in his enthusiasm…to find yourself being swept up in the wave of emotions that make up a typical day in his life.

This spectrum of characteristics makes T one complicated guy. Being in a relationship with him can be exhausting…and exhilarating all at the same time. He challenges you to love him for who he is…and he has high expectations for himself and those around him.

If I said I didn’t have some concerns for his future, I’d be lying. T can be unrealistically impulsive…and he’s very much a fly-by-the-seat-of-your-pants kinda guy. I’m not sure how that will translate into adulthood. I hope that with age, he may become a bit more practical…and a bit less reckless. But I hope he can maintain the qualities that make him the unique and extraordinary person I’ve grown to love.

As I’d expect, there may not be a middle of the road…for it’s all or nothing in the world, according to my amazing, complex boy.

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This is the second of two posts written by Kathryn on loving someone with bipolar. The first post is Your Mood Swings are Giving Me Whiplash.

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Are you looking for ways to help someone with depression?

Our electronic mood charts are very effective in helping people work out the triggers of their depression, the early warning signs of new episodes, and the most effective strategies, specific to them, that they can adopt to stay well.

In a nutshell, they give people the tools to be proactive with their mental health.

Please take a look at our mood chart apps, and consider purchasing a license for the person you care for.

I love my children.

It’s ironic how I feel the need to open with a disclaimer…but parenthood has not turned out to be the fairytale experience I’d imagined. Maybe it’s never wise to go into any situation with pre-conceived ideas of how it should go…you’re just setting yourself up for a whole lot of confusion.

I’d always wanted children, so after two surgeries to correct infertility and two unexplained back-to-back miscarriages, I’d begun to wonder if motherhood was something I’d ever get to experience.

The irony that our first-born son was diagnosed at 2 ½ with autism is not lost on me. Neither is the quirk of fate that led me to discover I’d become pregnant with our second-born son right around the same time.

The night T was born, he lay on the table as they cleaned him up and he screamed as if in excruciating pain. It was alarming. I remember asking the nurse if something was wrong and she replied, “No honey…nothing’s wrong. He just wants to be picked up. You are going to have your hands full with this one.”

Truer words were never spoken.

T has always been a willful child. I’d chalked most of his mood swings up to being a second-born, especially since his brother required quite a bit of attention. It wasn’t until around age 10 that we first heard the word bipolar. By this time, he’d become obstinate, irate and at times, downright belligerent. I remember wondering how a child so young could feel everything so…deeply. And, if he had to feel angry and upset…then so did I. He gave new meaning to the phrase “you always hurt the one you love”. I felt like I walked around with a permanent knife sticking out of my back…with a sign that said “twist here whenever you like! I’m here for you, babe!” He’d perfected early on the ability to use his words like weapons. That, combined with his above average IQ meant a whole lot of hurtful words that almost always hit their mark.

One day, around his 11th birthday I was taking him for a “Part 3” of a psych evaluation. He initially refused to get out of the car. When I finally cajoled him into entering the medical center, he refused to follow any of the doctor’s directions. He then made a crucial mistake: he casually announced to me that he’d rather kill himself and me…than ever deal with any of this again. He’d said it so matter-of-factly. If this was a mood swing, we’d hit rock bottom.

The doctors took his threat seriously and sent him to a psychiatric hospital for an unprecedented (by today’s insurance get ‘em in, get ‘em out as quick as possible practice) 7 ½ weeks of treatment. During that time, they tried an array of medications, talk-therapy (the doctors and parents talked, T simply sat there and dozed) and group therapy. In the end, he was released with a diagnosis of bipolar and was on several medications for the mood swings, including lithium.

Today, T is almost 18 years old. He graduates from high school in June and plans to go to college. Medication and diagnosis are always in the background, but he’s still done well in school, has a circle of a few very good friends and even has a serious girlfriend.

Still, the mood swings persist. I’d say 80% of the time he’s a fun-loving, witty, dynamic, creative, fabulous kid. But if he’s tired (and he often has trouble sleeping), he makes Jekyll and Hyde look like Bambi and Thumper. He’ll become challenging and combative and will argue circles around you…seemingly reveling in the experience of the argument more so than looking to make an actual point. His frustration and sense of entitlement are palpable…and intense. Arguments with him leave me feeling bloody, exhausted and immeasurably concerned for his future.

And then, it passes. Hours later, he’s calm…will probably have gotten in a long nap…and he’s apologizing for the outburst. My witty, loving son has returned. It’s like the sun peeking through the clouds after a surprise, intense thunderstorm…and the air is fresh and sweet…and full of…hope.

I’ve got a good feeling that he’ll be okay. As for me, my love for him allows me to practice the parental-refined art of selective amnesia when it comes to healing the emotional scars left by his razor-sharp words. That, and a lifetime supply of antibiotics…and I hope to be just fine as well.

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This is the first of a couple of guest posts on loving someone with bipolar. The second post is Loving Someone with Bipolar. Thank you Kathryn!

The majority of visitors to this blog don’t come in the front door. They bypass all of my content and go straight to the 5% or so that my wife Anna wrote. Her content receives more than half of all traffic.

Why?

She would say my writing is lousy. I think it’s because she writes from the perspective of a caregiver. Some of her posts have struck a chord with other caregivers, of which there are an awful lot, and gone viral. Well, mini-viral.

Looking after yourself as a caregiver is a big, often unacknowledged issue. Depending on the source, somewhere between 1/5 and 1/3 of caregivers for people with chronic illnesses have mild to severe depression. I have no doubt that the range is higher for the caregivers of mentally ill folk.

There is a good set of slides on Beliefnet written by Therese Borchard, called 12 Depression Busters for Caregivers . If you are caring for someone I recommend it as an easy, humorous and very helpful read.

Here is an excerpt from “Secure Your Own Oxygen Mask”:
It always goes back to the ten-second spiel you get right before your plane takes off. “In the event of an emergency, an oxygen mask will drop from the compartment above you. Please fasten your own mask before assisting others.” Or, on Southwest airlines, they say, “Now would be a good time to choose your favorite kid.”

Click to read more of 12 Depression Busters for Caregivers.

by Kate McLaughlin

This is a very helpful, practical article if you are caring for someone with a mental illness. It really gets to the heart of how you can understand, support and help, while also looking after your own health.

“If you have a family member or friend who’s been diagnosed with a mental illness, you’re probably wondering what you can do to help. Although new forms of therapy and medication make it possible for many individuals to lead full, independent lives, the support of family, friends and peers remains an essential element in the recovery process.”

…read more on supporting a loved one with a mental illness

Mental Health Best of the Web

I read a Psych Central post a few days ago “Hating the Illness Not the Afflicted”. The context was alcoholism but it struck a chord with me.

It took me years to learn a valuable secret for coping as a caregiver. I  wish someone had let me in on it earlier – it would have saved hours of frustration, bitterness and resentment. I would have seen myself as a wife and not just a caregiver for a lot of this time.

The secret is simple to understand but hard to live out – you have to separate the illness from the person.

Why simple? When James is being totally unreasonable and horrible, I pause for breath and think about the big picture. Is he sick? Is he like this when he is well? Is this consistent with his true character? Is this the man who I married? Asking these questions helps me to see what is really going on.

It’s hard. When he is irritable he is very hurtful. I want to take the bait and yell back – to let my anger fly and exact my revenge. It’s difficult to let things go through to the keeper, ignore his needling and concentrate on the sickness. It’s hard to forgive and move on when I’m hurt.

And it’s hard to not take it personally. It’s hard to overlook the way that our lives have changed to accommodate his illness. It’s hard to think that bipolar will never go away.

But it’s also simple. I direct my anger at the illness and that leaves me free to love him and build our relationship. It’s simple to forgive when I know that he doesn’t act this way when he is well. It’s simple when I remember that James is a person with bipolar, he is not Bipolar itself.

Separating the illness and the person. That has been my secret to being a caregiver and a wife and managing well.

The person with depression usually can’t see a way forward. They may fervently believe that nobody can help them, and life is pointless. That doesn’t mean that they’re right, and there are plenty of things that you can do to help.

The type and amount of care that you can give will depend on your relationship with the person, but here are some ideas.

1. Understand the illness.

Learn all that you can about depression. The better you grasp the illness, the more effective you will be in giving your care and understanding. It will help you to understand why the person behaves the way they do, and better equip you to respond appropriately.

2. Seek Appropriate Treatment

This is such a far-reaching, wide-ranging topic that I would be foolish to give advice. Suffice to say that it will be helpful for you to explore the treatment options available in your area and suggest to the person that they need professional help. It might be helpful for them if you go along to the first or subsequent appointments. Often a person actually feels relieved to hear a diagnosis and know that they are sick and that they can be helped. This was really true for me.

If he or she won’t admit they need help then explain why you are concerned and perhaps provide them with some helpful written information to chew over.

3. Provide Emotional Support

Your partner or friend needs patience, care and understanding. They have a real illness, and just like someone with cancer they can’t just “snap out of it”. If they could, they would. Saying things that show ignorance about the illness is counterproductive and will reinforce their negative thinking.

The best way to communicate is to empathise, listen more than talk, and ask questions like “How can I support you?” or “How can I help?”

4. Keep the Illness Separate

The illness and the person suffering the illness are not the same thing, so keep them separate. When they express pessimism, anger, frustration, or sadness, it is the illness talking not the person. If you separate the two you will find it easier to cope emotionally. It will help you to be a more effective caregiver.

5. Listen Non-Judgmentally

Don’t try to talk a depressed person out of their feelings, no matter how irrational they sound. This is likely to compound the problem. It is better to remain neutral and say something like “You are obviously really suffering with this. What can I do to help you feel better?” Keep your suggestions, solutions and advice for another time. My wife has also found that posing suggestions as a question helps me to have some ownership of the solutions. It stops me feeling nagged too!

6. Make a Plan

Help the person to make a plan for coping with depression. Identify things that trigger or worsen the depression and things that make it better. Think through and list the ideas formally on paper. Help them to put this plan into action. Some positive, helpful things to include are getting to bed early, having adequate sleep, exercising regularly, drinking plenty of water and eating healthy foods. The plan will be an evolving document as things change, so be prepared to re-visit it on  a regular basis. I often need my wife to remind me what works for my health as sometimes I go off track. This is a key role that the caregiver can play.

7. Look after yourself

As a caregiver you are likely to be under stress. You need to care for yourself by taking time out and recharging your batteries. Find other friends or relatives who you can talk to and rely on at a pinch. Sometimes you will need a sounding-board to keep things in perspective. Make sure you continue to live your own life as well, and spend time doing things you enjoy. My wife loves her part-time job for many reasons, but high on the list is escape. Although she is working, it’s a great mental break for her when home life is dominated by my illness. 

There are services that provide education and support for caregivers. Through information sessions and support groups, you can talk to people who are in a similar position.

8. Organize their medicines

If your partner or friend is taking medicine for depression then it is crucial for them to follow their prescription. Too many people go on and off their anti-depressants depending on how they feel. This all but eliminates their effectiveness.

I take medicine at night without any problems, but if it wasn’t for my wife handing the pills to me I would never take them in the mornings. She also fills my scripts and tells me when to go to the doctor for more. It’s not laziness; it’s just the nature of depression. More than once I have spent hours in bed staring at my pills, but not had the mental energy to actually take them. If your partner or friend is not complying with their prescription, try to find out how you can help.

9. Support network.

Introduce the idea of joining a support network for depression. This will give them an outlet for discussing their problems and receiving input, and help them to discover that there are other (normal) people experiencing similar problems. There are depression support groups everywhere. Make sure that you find one that is positive and focused on recovery. Inward looking, pessimistic groups can be unhelpful.

10. Get out and About

One of the most therapeutic things that a depressed person can do is step out the front door. Natural light is very beneficial, especially early in the day. Exercise also has proven benefits. Something as simple as taking a walk or gardening should lift the person’s mood. Anything low-key that involves going out can also help; seeing a movie, meeting friends, or going out to eat, just to name a few ideas. The most effective way for me to get up and out the door is to take the kids to school. There is a set time to go, which gives me routine, and the kids are great company.

11. Help with daily tasks

When your body is heavy and your mind is dark, there is nothing harder than the burdens of everyday life. Something that seems minor to you may be an insurmountable task to your friend or partner. Ease their burden by helping with the daily load – running errands, doing the shopping, cooking, taking the kids out for a couple of hours. You may be surprised to find that helping with a very simple chore could relieve them of a lot of stress. 

We had an old mattress that needed to go to the tip. My wife asked me to take it there for months, and over time it became a source of tension. But my thinking wasn’t rational and the thought of going to the tip overwhelmed me. When she understood what was really going on she asked a friend to take it. That was a huge relief to both of us. 

12. Spend normal time together

Just spending time with the person lets them know that you care and want to understand their problems. Enjoy the reasons for being their companion in the first place. It’s important that they live as normal a life as possible. Help them to do this by carrying on your relationship with them in a normal fashion. Don’t let everything get dark and serious. Find some positive things and try to enjoy them together.

The points above are general by necessity. They don’t fit all circumstances, but I hope that you find at least a few helpful ideas.

I’ve just read a very helpful article at Psych Central that is in the same vein. Helping Someone with a Mental Health Concern is written by psychiatrist John M. Grohol. Of particular interest to me are his insights on effective listening and empathizing with a mentally ill person. It is invaluable advice for someone in a caring role.

To read the article click here.

Professor Cummins from Deakin University has been researching the well-being of different societal groups for the last 6 years. The studies measure the degree to which different people are satisfied with their lives.

In the most recent study (October 2007) 3,750 caregivers were asked questions about health, relationships, safety and community involvement. A caregiver was defined as someone who looks after a frail, disabled or mentally ill relative.

According to the study caregivers have the lowest level of well-being of any group in the community. Further, the rate of moderately depressed caregivers was found to be 56% (general population is 6%), while almost 40% exhibited severe or extremely severe depression. As you can imagine the typical caregiver suffers a high level of dissatisfaction with life. And this is even in the presence of mitigating factors like a high income or being in a relationship.

This is tragic stuff. It really highlights to me the importance of looking after yourself as a caregiver. Have boundaries, have breaks without feeling guilty, maintain some part of your life that is separate from the person you’re caring for, build a support network (formal or informal), or join a support network, and find somewhere to fit in a bit of fun.

As a caregiver you need to stop yourself falling in a heap. You need to be resilient to mental illness, and you are far more effective in giving care to another if you remain healthy yourself.

I’ve written a lot about being a caregiver in my last 4 posts, but in this one I’d like to share with you the book that really saved my own sanity. It is “Loving Someone with Bipolar Disorder” by Julie A. Fast and John D. Preston.

In the first few months after James’ diagnosis I read a lot of material to educate myself. The problem was that most of it was factual information on depression and bipolar, but it didn’t tell me how to manage practical things like James’ irritability. The info simply described the symptom without ideas for its management.

From pages 1 to 2: “This book can provide you with the tools you need to be a resource and support for your partner instead of a crisis manager and constant caretaker.” This is exactly what I needed!

The book was written specifically for caregivers. Julie Fast has bipolar disorder, as does her partner of 10 years, and the result is a book with real insight.

At its heart is the idea of creating a holistic treatment plan.

The first aim is to develop a symptom list that you can use to identify when your partner’s behavior starts to change. Once that has been worked out the second aim is to create a “what works list” to treat those symptoms before they progress to a full blown episode. The third step is to work out what triggers the symptoms in the first place. These are often outside events, situations or behaviors that once modified or eliminated really make your partner far more stable. Once you understand the triggers well, then the goal is to stop the mood swing from starting in the first place. If it does start then the “what works list” comes into play.

Of course this strategy requires recording your partner’s behavior over time e.g. by keeping a journal.

The rest of the book focuses on the needs of the caregiver. (Obviously your partner achieving greater stability is already a significant help).

The chapter on “Your Emotional Response” starts you on the road of looking after your own needs. It discusses issues like anger, grief, guilt and feeling trapped. For me, it was almost a springboard for seeing a counselor.

The chapters on work, money and sex cover practical issues that cause distress. They were all helpful chapters, but for me the chapter “The Hard Truths” had more impact. This chapter really lays it on the line and forces you to face the reality of your relationship. Are you prepared to stay with your partner if things don’t change? Tough reading.

My favorite chapter is “The Bipolar Conversation”, which teaches you how to avoid pointless fights when you partner is baiting you. The book ends with “Laughter and Joy”, an inspiration to leading a normal life again. From this I learned to structure in happy times in our lives.

A brilliant book. It may be about bipolar, but the application is much wider and relevant to all mood disorders. It would greatly help any caregiver living with a depressed partner.

Here is the link to the book on Amazon (not an affiliate link).

The best thing about the book is the practical ideas for helping an ill person. They are not platitudes like “If there is anything I can do…” but ways to be proactive with providing your support.

The book is focused on the chronically ill, and applies to the whole range of mental illnesses, but it would also be relevant to helping friends in any kind of need.

With the author’s permission I’m listing my favorite twenty.

3. Put meals into disposable containers and attach a note saying “This doesn’t need to be returned.”

5. Arrange for your friend’s kids to have a night with your children.

15. Treat her to a gift of movie rentals via postal mail through a service ($7-15 a month).

18. Mop the floors.

21. Ask, “Do you have an errand I can run for you before coming over?”

42. Don’t say, “Let me know if there is anything I can do.” People rarely feel comfortable saying, “Yes, my laundry”. Instead pick something you are willing to do and then ask her permission.

44. Buy a magazine subscription for her on her favorite topic.

59. Say, “I’d like to bring you dinner next week. Would Monday or Tuesday night be better?”

81. Ask her if she wants to house-sit when you are on vacation. New surroundings may feel like a mini-vacation.

116. Take her kids for a movie and ice cream.

152. Watch your friend’s children so she and her spouse can have a night out.

180. Ask her if she’d like you to help rearrange her furniture for a fresh feeling in her house.

197. If a massage would feel good (it doesn’t always), give her a gift certificate for one.

199. Help her with her children’s birthday parties – but don’t take over; let her make all the decisions.

304. Clip cartoons that will make her smile.

316. When you leave ask, “Do you have mail I could drop off for you?”

406. Talk about normal everyday things, not just the illness.

424. Help her children pick out gifts for her on special occasions like Mother’s Day.

462. Go with her to the doctor and then go get coffee or lunch afterward. Medical visits get lonely and depressing.

468. Teach her how to use the Internet so she can learn more about her illness from medical websites.

The book is available by direct purchase from the Rest Ministries website.