03/27/2010 05:12 am ET Updated Nov 17, 2011

Disappearing Acts: When friends are gone after a diagnosis of bipolar disorder


Dear Dr. Levine,

I am reeling from the awareness that certain friends who meant a great deal to me have abruptly turned their back on me now that I have revealed and declared my struggle with mental illness. I was diagnosed with a form of bipolar disorder after weathering several years of depression alongside "up" periods. When it was just garden-variety depression, I believe the problem had been more acceptable to these individuals, who are mostly male.

Now, having spent almost two weeks in hospital, the tables have turned and folks have run for the hills. I mean nothing: No phone calls, no cards, unreturned e-mails. These relationships, mind you, go back almost 20 years. I've spent most of my time being the "counselor" to these folks. Still, for the most part, I gained a lot from the relationships: mentoring, laughter, contacts, learning, etc.

So I'm not sure how to proceed from here. My self-esteem is shot-to-be-damned, and I really haven't much patience right now for the childish ways of grown people. Over the years, I've observed that people who "hide" from others' adversity find some way to wheedle back in after it seems like the coast is clear. I'm pretty clear about cutting these folks off, since there's really nothing to be salvaged except my self-worth. I am angry, and I can't guarantee that I still won't be angry when they inevitably return to my world. How would you suggest I handle this?



Dear Alone:

When someone has a serious medical condition, deciding whether or not to tell others is never straightforward. This is compounded when it comes to disclosing mental or emotional disorders because of the pervasive misunderstanding, stigma and discrimination commonly associated with disorders of the brain. As you found out, there is even a pecking order among mental illnesses. People are generally more understanding and accepting of depression and anxiety disorders than they are of bipolar disorder, schizophrenia, or schizoaffective disorder. This is simply because of the dismal lack of mental health literacy among the general public.

In considering whether or not to tell, it's important for someone to think through whom to tell (the answer might be different for different family members, friends, employers and acquaintances) and how much information and detail to provide (e.g. the name of the disorder, the nature of the treatment, specific vs. general information, etc.). Decisions like this are deeply personal. Ultimately, individuals need to make decisions that feel comfortable to them! There is no right or wrong.

Getting back to your specific situation: You made the decision to be candid with friends whom you trusted, hoping they would understand and rally around you. This wasn't the case so I understand your disappointment. But consider the possibility that these friends weren't ill-intentioned. They may simply have felt uncomfortable and didn't know exactly how to react or what to say---because they don't understand bipolar disorder, its course, or its treatment.

Perhaps, you could seize this as a teachable moment, focusing on one or two of the individuals with whom you feel closest, and helping them better understand your experience. After you speak, you could also direct them to online resources for information such as one of the booklets made available from the National Institute of Mental Health or from the National Alliance on Mental Illness.

Being hospitalized for a mental disorder often feels like a setback to that individual (although it shouldn't be that way!). Admittedly, it is an unplanned disruption to work, study, and/or friendships. You say your self-confidence is shattered--so give yourself the gift of time and allow yourself to slowly get back into a normal routine. Try to hold back your anger towards your friends, which may turn out to be misplaced. You may find that some of these friendships were tenuous and aren't worth resurrecting but I sincerely hope that at least a few of them will be recoverable.

You signed your letter "lonely." Simultaneous with working on your old friendships, you may want to get involved in a support group such as those sponsored by the Depression and Bipolar Support Alliance. This will allow you to meet other people who have struggled with similar issues and who can support you as you get back on your feet. I hope you also have the benefit of a relationship with a mental health professional who can help you get over this trauma.

Remember that lifting the veil of secrecy and shame that shrouds brain disorders can only be accomplished one person at a time. I applaud your honesty as well as your posting this letter.

Warm wishes for your recovery,

P.S. In my book (co-authored with Jerome Levine, MD), Schizophrenia for Dummies (Wiley, 2009), on P. 216-222, there is an extensive section on "Breaking the News," the pros and cons of disclosing mental disorders. Since it provides far more detailed advice than I could post here, you may want to glance at the book in the library. Although our comments in the book are focused on schizophrenia, they are just as pertinent to bipolar disorder.

Have a question about female friendships? Send it to The Friendship Doctor.

Irene S. Levine, PhD is a freelance journalist and author. She holds an appointment as a professor of psychiatry at the New York University School of Medicine and her book about female friendships, Best Friends Forever: Surviving A Breakup With Your Best Friend, was recently published by Overlook Press. She also co-authored Schizophrenia for Dummies (Wiley, 2008). She blogs about female friendships at The Friendship Blog.
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