Nearly 1 percent of people suffer from bipolar disorder (sometimes referred to as "manic depression"). Bipolar disorder is a mental illness major mood swings of mania (bipolar I) or hypomania (a less intense form of mania called bipolar II) and depression.
We see in the press that Catherine Zeta-Jones has admitted herself to a hospital for treatment of what has been identified as bipolar II: This form of bipolar disorder can produce considerable distress as well as difficulty meeting life's demands -- but without (yet) resulting in a full blown manic attack.
People with bipolar disorder, I or II, with good treatment, self-care and supportive family and friends can -- and do -- live full and productive lives. Without effective treatment, bipolar disorder can have a devastating effect on the person and their family, relationships and work.
What Might Bipolar Disorder Look Like to Family or Friends?
Because bipolar disorder involves both depressive and manic states, either mood problem can herald the recurrence of the condition. But I will focus here about what you might see during an emerging manic or hypomanic episode. In fact, mania typically progresses from excitement to hypomania and, if not controlled, can escalate to mania. So what you will see first is probably hypomania.
Over the course of days to weeks, your family member or friend starts sleeping less and less. He or she seems to have rather unlimited energy and is full of ideas. At first, the person may be funny and pleasant to be around, but soon that mood will become more irritable and unstable. Your loved one may start drinking more or using drugs secretly -- a very common problem in people with bipolar conditions. If the person was on medication for bipolar disorder, he or she has probably stopped taking it (causing the problem to come back) or will want to discontinue because it can dim the feeling of excitement, a very desirable, though problematic, feeling for someone with this illness.
Money may be missing from where you keep it or from your bank account. Bad judgment is common during a hypomania, or in a full manic state: Your loved one may spend money recklessly and engage in risky behaviors, including casual (and unprotected) sex, gambling, driving at high speeds, and frequenting neighborhoods and settings where no good is known to happen. Your loved one may accuse you of being boring, oppressive, or ruining his or her life or hopes. As time goes by and if the illness is not treated, the excitement mounts and a person will be unable to get anything done; behaviors can become progressively more threatening to the safety and wellbeing of the family. Commonsense talk seems to go when you try to reason with the person who is now ill.
What Can You Do?
Faced with mounting evidence of serious problems and a family's efforts at reasoning defied, with worry and love driving them, a family may want to push harder, insist that their loved one faces facts -- does something! Tempers can escalate and each side digs in more deeply.
The first thing you can do is what not to do, which is to not get into fights with your loved one. This may be the hardest prescription of all. What can work is a combination of listening and leverage. There is much to say about this, which I do in my book for families. I believe that all behavior, even illness behavior, serves a purpose. We just may not know yet what it is. By listening and asking questions, you may find out -- not by crossing swords.
Leverage is about a family being a two-way street: You get and you give. As a family or friend, what supports are you providing? Like a cell phone, money, car, even a place to stay. These are leverage points that can be used to negotiate for what needs to be done. What does a loved one need to do -- ultimately in their interest -- to continue to receive money, use the car, or stay together?
Avoiding a fight is not the same thing as being disengaged. In fact, it's staying just as involved -- in a different way. It is hard to not get into a fight, you may need help.
The second thing, therefore, is don't go it alone. Mental health problems, including addictions, are among the most common medical problems that exist. That means that there are others -- in your extended family and among their friends and co-workers -- who have been down the same road.
Who can you confide in? Is there a spouse, brother, sister, aunt, uncle, friend, or someone who has had a depression, addiction, traumatic disorder or other mental problem and is open about it (and, thankfully, more people are)? That's someone to turn to. You can turn to a primary care doctor or clergy, someone who has known your loved one for some time. Families can turn to school counselors or employee assistance programs at work. Advocacy organizations, like a local chapter of the National Alliance on Mental Illness (NAMI) or the Mental Health America (MHA), are terrific resources that I almost always suggest; these organizations are staffed by experienced and trained people. NAMI has families who have been there. These organizations provide information and referral, by phone or in person. And they are free!
Don't go it alone. This lesson has been learned with every persistent illness, including diabetes, colitis, cancer, Alzheimer's and countless other conditions. Mental disorders, including bipolar disorder, are no different.
Third, learn about the mental health system of care, its treatments, its rules and how to work with and bend the rules. I am not talking about going to psychology graduate school. I am talking about becoming an informed and vocal advocate for your loved one. Health care in general -- not just mental health -- now demands informed and assertive families and consumers.
Fourth -- and this is also hard, but no different from illnesses of all sorts -- you will need to think of managing the illness as more of a marathon than a sprint. Managing all but short-term illnesses (like infections or broken bones) means taking a long view. Sticking with it.
A family's morale and determination will be tested. "Never, ever, give up." While often difficult to predict, a person's involvement in care or their illness improves. Mental health professionals have seen this again and again. You need to know this. Don't lose hope, don't give up. Take the long view, in your mind and with your efforts.
Recovery is a word that does not only apply to addictions. Recovery is about having a life of meaning, purpose, dignity, relationships and contribution. It is what we all want, and it is possible with mental illnesses like bipolar disorder, and the many other faces of mental illness.
As we watch how Ms. Zeta-Jones manages her illness, there may be much to learn from someone so talented -- so successful, and yet ill -- about how to not let bipolar disorder, or any mental or addictive disease, derail or destroy a life or a family.
Dr. Sederer's book for families who have a member with a mental illness, The Family Guide to Mental Health Care, is now available.
The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
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