The following 5 articles are taken from the Finding Optimism blog. They are written from the perspective of a carer, looking after someone who is mentally ill, and they explain some of the reasons why we developed the Optimism software.
The Depression Dialog
It’s really hard being a carer when all you want to be is a wife, husband, partner, or friend. It’s important to have strategies to deal with different situations and remain in your normal relationship as much as possible. This is what I want to work through in these posts.
I’ve learned over time that James and I can relate to each other in a rational manner even when he is ill. This has been a learning process; it hasn’t always been the case. And I still often feel like I’m walking on egg shells depending on the severity of the episode.
The key strategy that I’ve learned is how to talk to James when he is sick, either high or low. When he becomes ill he turns into a different person. I say goodbye to my husband, so to speak, and hello to bipolar James. In a depressive episode he becomes highly irritable and usually itches for a fight. Early on he will often make comments to bait me. “All I do is work, work, work, to support your lifestyle and your precious social group.” You can imagine what a red rag to a bull that comment is.
At this point I have 2 options:
1. Take the bait, have a messy fight and accelerate his downswing, or
2. Grit my teeth and say “it’s the illness speaking”. If I can do that then I have a much better chance of diffusing the situation. A comment like “You sound stressed about work - let’s talk” has better results and sometimes can even stop the mood swing.
Lately I’ve also been able to say “Let’s talk before you get stuck in a negative cycle of thinking.” This is huge progress for us. It usually results in a fairly sensible conversation.
James says some very hurtful things to me when he’s depressed, but I only tell him how he’s hurt me when he’s better. I wait until he is rational and can deal with it, rather than inflame the situation further when he is ill. I’ve also learned not to take his bait so personally, as I’ve come to recognize it for what it is.
It’s important to know that I couldn’t do this if I didn’t recognize the start of a mood swing. You need to listen to what is really being said before you reply to comments. Is the person sick? Are they really asking for help? Is this a normally held opinion? A few seconds of thought can save a lot of heartbreak.
Know the Enemy
Know the enemy. Sounds awful, doesn’t it? But I’m talking about the illness, not the person who is sick. When that dawned on me, that the illness is the enemy, I started to have more control over my anger and resentment. Why? Because I had something I could fight, and yet still love my husband James. I’m not saying that he isn’t responsible for his behavior; but I could now explain it, or most of it, by his illness.
Our third child was born in 2003 just as things were at their worst. James had left another job, he had a go at crashing his car, and our other kids were showing signs of distress. I had to think about leaving him for a while to protect myself and the kids emotionally. I felt alone, scared for our future and worried sick.
It was at about that time that he was diagnosed with bipolar, which prompted me to thoroughly research depression and bipolar. There is an awful lot of junk out there, so I sifted through until I found some great sources. Then I learned as much as I could. The best thing about this learning process was a much better understanding of the illness, so I was less frightened and more assertive in handling his behavior.
The resources that I relied on most are:
Loving Someone with Bipolar Disorder by Julie Fast. This book helped me more than any other. It is written for carers and has great, practical solutions, especially in the area of talking to each other. James was on board with the idea of trying the suggestions in the book so that helped. Most of the content is readily applicable to depression. It’s a love it or hate it book. I love it. I’ll write a review as the last post in this series.
Dealing with Depression by Gordon Parker. I continue to rely on this book for my medical understanding of mood disorders. James reviewed the book in an earlier post.
Black Dog Institute. I use this website for finding all kinds of reliable information on mood disorders. The Black Dog Institute is headed by Gordon Parker (above).
The next break through was keeping a diary of James’ moods and things that happened each day. I did this every night for almost 2 years. It sounds a bit keen I know, but it was also therapeutic. After only 3 months or so, I was able to see patterns of behavior emerging. His illness was looking somewhat predictable! The progress over those 2 years was very slow, but just having some noticeable improvements gave me hope. I could stop living from day to day, wondering what would hit next. Also, and even better, I was able to see what was triggering his mood swings. Things like certain foods, certain people, and certain social situations.
Armed with this knowledge we started changing our lives to avoid triggers. This is an ongoing process, but James continues to get better. We completely removed some problem triggers so they no longer have an impact, and he also copes better with the triggers that remain. I hope that we don’t sound perfect. The process is ongoing, and there are still many times when bipolar ruins things. But now that I know my enemy I can “attack” it, and get on with being James’ wife.
Trigger Unhappy
I used to get so mad with James when he had major mood changes. Trivial little things seemed to set him off, but I saw no rhyme or reason to the whole mess. I staggered from one day to the next, not knowing what was coming, feeling like a punching bag.
In my last post I wrote about the diary I kept for 2 years; it was the key to working out what caused James’ mood swings. We made some breakthroughs just by reading it back from time to time, but most progress came from charting the data in an Excel spreadsheet. This gave us a clear, visual way to see the relationships between triggers and symptoms. We discovered a couple of major depression triggers this way, and also found that small things that were minor irritations would snowball with other events added in.
The trick for us was to discover which triggers were the most important ones, where the threshold was before they would have an impact, and what we could do to reduce their effects.
Here’s an example. We used to have a busy social life. Through my diary, I began to notice that 2 days after a meal out, James would spiral downwards very quickly and experience a period of depression for 5 or 6 days. It was a very strange, but consistent pattern. We eventually discovered that certain food additives were a trigger; things like preservatives, artificial colors and artificial flavors. Adjusting our lifestyles and upending our diets was difficult, but by doing so we pretty much eliminated one of his major triggers.
Another example is our “feral hour”, around dinner time when the kids are tired, hungry and cranky. Very loud noise is another trigger, since it causes James to become very irritable. If it becomes all too much he will disappear until the kids are calm again. He can now recognize when his irritability is rising, and so takes preventative action. The key is that we have agreed that he can do this when needed, so I don’t feel resentful for lack of help. Leaving me to handle “feral hour” alone is better than suffering another bout of depression.
This knowledge continues to be very helpful to us. We know the little things that can snowball, and we take action when, or before, these little things happen. It’s a preemptive strike, so to speak. Whenever a trigger or potential trigger comes along we have a specific plan to remove its effects. As a result James’ depressive and manic episodes have become more intermittent.
Keeping Your Mind Together
I’ve been asking James to take our old mattress to the waste dump for about 4 months. Today, I decided enough was enough. I asked an understanding friend (whose husband also has depression) to help me transport it. She has a car with roof racks. It took a while but we got it onto the roof, and tied it down with baling twine. It was not exactly satisfactory, but James had taken the rope to work and left it there.
So we drove that way and the mattress stayed on for about a mile before sliding. We checked it, and checked it again, and continued like this until we were nearly there, when a truck passed us with speed and the mattress flew off altogether. (Queen size by the way.) The twine was still intact, but the mattress handles were shredded. So we eventually limped in to the dump, mattress carefully balanced on top and hazard lights on. It was a funny experience and we had a lot of laughs.
I’ve written about this because it says a couple of things about how I handle my role as a carer.
Know the limits of what your partner or friend can do
Removing a mattress was overwhelming for James. He put it off, and ignored it, and put it off some more. The reason was that the task - mental as much as physical - was insurmountable to him. It’s quite different from laziness, as anyone with depression will know. But the mattress was stopping me from getting to my wardrobe and it had to go. My frustration was building up, despite knowing what was going on in James’ mind. I decided to just do it myself rather than let it become a big issue. That’s not to say I’m being a doormat. When I stop and think about it I recognize what’s happening under the surface and take a practical approach.
My support network is crucial
I have a small network of friends who will help me in this sort of situation. Through bitter experience, I know that some people are understanding about mental illness and others are not. My close friends are. I also know not to wear them out, so I share my problems around. They give the emotional support I need when I’m not getting it at home. They let me vent, they help me in practical ways, and they still share good times with me. They also think highly of James even though they know how awful he can be. That’s very important to me. I’m very fortunate as a carer to have supportive people around me. I know that many people are struggling along without much help. I can’t emphasize enough how important it is to develop those supportive relationships, for friendship, for emotional support and for practical help for things like moving mattresses.
My mental health is crucial
I have to be proactive about having time out, having a break from the intense times, and even some fun. I used to feel guilty about this, but it’s actually wise to keep looking after your own health. My family are good with giving me practical help, like taking the kids, when I need to do something on my own.
Learn to forgive and grieve
It’s easy to feel sorry for myself, but I’ve learned to forgive and move on. James forgives me for a lot of things too; it’s not a one way street. I’ve had to mourn the life that I thought James and I were going to enjoy together. He is not at all like he was when we married. But I always remind myself that I should be thankful for what we have, and what I have, and not dwell on what we don’t have, and to pray on all occasions.
Loving the Person You Care For
I’ve written a lot about being a carer 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 carers. 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 carer. (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 carer living with a depressed partner.
Here is the link to the book on Amazon (not an affiliate link).