Read an Excerpt
When Someone You Love Is Bipolar
Help and Support for You and Your Partner
By Cynthia G. Last
The Guilford Press Copyright © 2009 Cynthia G. Last
All rights reserved.
Does Someone You Love Have Bipolar Disorder?
Shelly is extremely worried about her fiancé, Peter, who has just been diagnosed with bipolar disorder. For the past couple of months he's been acting very strange, like a person she doesn't even know. His mood changes at the drop of a hat: one minute he's really cheerful and boisterous, the next irritable and angry and picking fights with her. He's hardly been sleeping, too, but instead of being exhausted he says he feels "wired" and that his thoughts are rushing through his head. Shelly believes this must be true because Peter is speaking really fast and tripping over his words; she can't even get a word in edgewise.
Shelly knows that Peter has had depressions in the past, but what he's going through now doesn't look like depression. What does it mean that Peter has "bipolar disorder"? Shelly thought they'd get married and have children one day, but now she's really concerned about their future.
Bipolar can be a very scary word, especially when it's used to describe someone you love. I know because as a psychologist I diagnose the illness in my practice and see the reactions of people and their families. I also know because my husband and I have had to hear the word applied to me.
When I was first told that I had bipolar disorder, I reacted with shock and disbelief. "I'm a manic–depressive?" I incredulously asked my doctor. "How is that possible? I have a husband, a career, and friends. There must be some mistake." But there was no mistake. My husband was equally stunned but, as is typical for him in the face of adversity, put on a brave face. Still, he couldn't hide the fact that, like Shelly, he was worried for our future.
Having diagnosed and treated bipolar disorder for so many years, it never ceases to amaze me how I "missed" my own diagnosis. I put the word missed in quotation marks because, in all honesty, I think I really did know what was going on with me; I just didn't want to face it. After all, nobody—including psychologists—wants to have bipolar disorder. But after years of blaming situations and other people for my mood swings, I finally had to face the undeniable truth—it was me, or rather my illness, that was to blame.
Externalizing blame is a way bipolar people try to make sense of what's happening to them. And it's also one of the reasons so many people with this illness go undiagnosed. They insist nothing is wrong with them and then refuse to see a mental health professional. Your partner even may say, "It's not me that has the problem; it's you!"
But you know it's not you. In fact, if you're like many spouses and partners of bipolar people, you have a temperament or personality type that's very different from the bipolar experience. If I had to put forth an educated guess (a guess based on 25 years of experience with bipolar people and their mates), I'd say that you're a fairly even-keeled, predictable person by nature, one who tends to "minimize" things as opposed to overreacting. Essentially you likely are, if you will, the proverbial calm in the middle of the storm. You also, if you are like a lot of the mates of bipolar individuals whom I've met, a "caregiver," a person who derives satisfaction from taking care of others. These qualities—your steadfastness and caregiving nature—may be partly why your mate picked you as a partner. It also may be partly why you picked your mate: you found your partner's personality exciting and the relationship offered you an opportunity to express your nurturing side.
But I don't mean to overgeneralize. It's true that opposites don't always attract. You may, in fact, have been drawn to your partner's lively temperament because it resembles, in some ways, your own. In that case, if your partner is just moving into a depressed phase for the first time, you may feel like you've been blindsided, neither able nor willing to deal with the downside of mood swings.
Living with and loving somebody who has bipolar disorder is a daunting task. You may be the type of person who has the emotional strength to readily take on the difficulties that bipolar disorder presents. Or maybe you don't view yourself as particularly strong, steadfast, or as a natural nurturer; right now you just feel overwhelmed and confused. Either way, I expect that no one has given you guidance in how best to meet the challenges you've been handed.
Fortunately, because of both my professional and personal experience with this illness, I'm in a position to help. In this book I offer a wealth of practical strategies and suggestions for you to use at times when you want to help your mate but just don't know how, as well as emotional support for you during times when you just don't feel up to the task. But before getting to this, the very first step is to make sure your loved one really does have bipolar disorder and that the type of bipolar disorder has been identified correctly.
No one welcomes a diagnosis of bipolar disorder. It's a serious illness that has the potential to devastate individuals and wreak havoc in families. But if your loved one does have the illness, your opportunity to have the life you both want so badly rests on getting—and accepting (see Chapter 3)—the diagnosis.
Although it can feel like your life is over, being diagnosed with bipolar disorder really is a beginning. It's the beginning of making sense of the emotional roller coaster ride your loved one has been on, and it's the beginning of getting help—the right kind of help—for the illness. That's what happened for my husband and me, and it's what I expect will happen for you and your partner too.
Normal and Abnormal Moods
Manic–depressive illness—as bipolar disorder originally was called—was first described in the late 1800s by Emil Kraepelin, a German psychiatrist. If you've seen the movie Mr. Jones with Richard Gere, you have a good idea of Kraepelin's conceptualization of the disorder. The film shows a young man, untreated for his bipolar disorder, having ups and downs at the farthest ends of the continuum—suicidal depressions and psychotic (out of touch with reality) manias.
While the movie contains a good enactment of severe, psychotic manic–depressive illness, our understanding of the disorder today is much broader than this. The thinking now is that there is a spectrum of bipolar disorders that includes different forms of the illness, some of which are much milder and far less dramatic than the type Mr. Jones had. I am lucky (although at times in battling this illness I don't always feel so lucky) to have one of the milder, less disruptive forms of the disorder.
What Is a Mood?
Regardless of the form bipolar disorder takes (I'll get into the types later on), it always is first and foremost a disorder of mood. What is a mood? While there is no clear-cut or consensual definition of what a mood is, most professionals in this area probably would be comfortable with the idea that it's a pervasive, persistent emotional—or feeling—state. Feelings (happy, sad, angry, bored, jealous) can be fleeting, but when they last and color most everything we perceive and do, we're talking about a mood.
Certainly we all experience good and bad moods—periods when it feels like things are going well and others when we feel a little blue. Variations in mood may occur for no apparent reason, like waking up on the "right" or "wrong" side of the bed, or they can be reactions to events, like when something positive or negative happens.
For people with bipolar disorder, changes in mood go way beyond this norm. Instead of giving them a pleasant feeling of well-being, the ups can make them feel too "high" or irritable, causing difficulty in their relationships or getting them into trouble. During the down periods they are way down—severely depressed, sometimes even to the point of near incapacitation or preoccupation with suicide. When moods are extreme and go in two different directions like this—"up," the manic or hypomanic (mildly manic) state, and "down," the depressed state—bipolar disorder likely is to blame.
What Do Changes in Mood Look Like during Mania and Hypomania?
The mood that is experienced during mania and hypomania is elevated or irritable, or, as for Peter, who I talked about at the beginning of this chapter, both. At its extreme, an elevated mood can be euphoric, a state of elation or ecstasy. This feeling has been described by some of my patients as similar to what it feels like to fall in love. Sometimes the mood is "higher" than normal—it's elevated, "too happy"—but not to the point of euphoria. For me it's what I'd describe as very "upbeat."
During manic or hypomanic times your partner may be very jovial, joking around in a way that's not typical for him (like being silly or making puns), smiling and laughing a lot (more than usual), singing out loud (possibly even when no music is playing), or walking with an unusual gait, like with a skip or at a very quick pace. You might hear comments from your partner about how "wonderful" things are or how "really great" he feels even though nothing in particular has happened.
An elevated mood can, however, change to an irritable, angry mood, or even rage in some bipolar individuals, or the mood disturbance can be entirely irritable with no "high." You may find your partner gets into altercations easily, not just with you but possibly with strangers as well, and may even seem to be looking for fights. Your partner may be insulting to others (or, on the other hand, feel easily insulted or slighted) or yell or scream readily. Sometimes the belligerence turns from verbal to physical, and your mate can end up in physical confrontations that may result in run-ins with the law. For others with the disorder anger is not this intense, but they consistently are very easily irritated or annoyed and extremely edgy. When I get this way, my husband says that I'm "impossible to talk to."
What Does a Depressed Mood Look Like?
By contrast, the predominant mood in depression is sadness. People have different ways of communicating this feeling. Your mate may use the word "sad" or say she is feeling "depressed," "low," "blue," or "down in the dumps." Sometimes, instead, the feeling is described as emptiness, numbness, or extreme boredom. Some people say the experience is like being trapped in a tunnel with no light at the end. Or a person may say it feels like there's a black cloud or veil over his head. Your mate may describe feeling emotional pain that's unendurable, which patients have described to me as feeling similar to having one's heart "broken." Instead of verbalizing these feelings, your partner may exhibit tearfulness as a sign of what's going on inside.
Abnormal moods, while necessary, do not by themselves indicate that someone has bipolar disorder. To have bipolar disorder, a person must have mood episodes—distinct periods of time that are marked not just by abnormal mood but by other symptoms as well.
Manic and Hypomanic Episodes
The symptoms, including abnormal mood, of mania and hypomania are listed in the sidebar on the facing page.
According to our psychiatric diagnostic system (from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, which had its last major revision—DSM-IV—in 1994), manic and hypomanic episodes are defined by a persistently elevated or irritable mood plus three or four of the other symptoms listed in the sidebar: three symptoms if the mood is elevated, four symptoms if the mood is irritable. Also, all of the symptoms must occur during the same time period. For a hypomanic episode, the symptoms must have persisted for at least 4 days; for a manic episode, 7 days unless there has been a hospitalization, in which case any length of time counts as an episode.
Mania and Hypomania: What's the Difference?
As you can see from the sidebar, the symptoms of manic and hypo-manic episodes are exactly the same. You might be wondering, then, what the difference is. Actually, there are three differences you should know about. First, hypomanic episodes do not interfere with functioning—like the ability to work or to relate to other people—to the extent that manic episodes do. For instance, in my case, as I'll talk about in more detail later on, my hypomania does not negatively impact my work life.
Second, hypomanic episodes never, by definition, contain psychotic features—that is, delusions (irrational, unfounded fixed beliefs) or hallucinations (hearing, seeing, smelling, or feeling something that is not there)—while manic episodes frequently do. Third, and finally, hypomanic episodes never necessitate a hospitalization; manic episodes, on the other hand, sometimes do, to prevent the person from harming him-or herself or someone else (see Chapter 8).
Actually, hypomanic episodes can be extremely pleasant for people whose moods are more elevated than irritable and who are not plagued by the consequences of serious risk-taking behavior. And it's not only pleasant for the individual who is experiencing such a mood. Hypomanic moods can be infectious. Other people often love being around gregarious, witty, self-confident individuals whose "feel goods" seem to rub off on them. (I believe, in fact, that it was my hypomanic self that my husband fell in love with and that this is the self he still sees when he pictures me in his mind.)
To better understand what mania and hypomania are like, let's look at some of the things spouses and partners of people who are having these kinds of episodes have had to say about their mates:
"My wife is constantly tooting her own horn, telling me and other people how great she really is. This is so unlike her!"
Increased self-confidence or an exaggerated sense of self-importance ("grandiosity") is common in manic and hypomanic states. In mania the grandiosity may become of delusional proportion, where the person believes he or she has some special power or knowledge, or is—or has a significant relationship to—a very important or famous person.
"He's sleeping only 4 hours a night but is filled with energy."
A decreased need for sleep—not just getting less sleep but needing less sleep—is very characteristic of mania and hypomania. In mania the sleep disturbance usually is more profound (very little or no sleep) than in hypomania.
"My wife seems to get distracted by the littlest thing."
Getting easily distracted by extraneous stimuli in the environment can occur during manic and hypomanic episodes. Your mate may have trouble with concentration because he or she loses focus easily, attending to unimportant sights and sounds.
"He's usually a very careful driver, but now he's speeding all the time and driving very offensively and aggressively."
Manic and hypomanic people are, let me say, in an "accelerated mode." They may think faster, talk faster, walk faster, and, as in this case, drive faster. In fact, you may hear your partner say that things aren't happening fast enough, encouraging you to "move along" more quickly in whatever you are doing.
The reckless road behavior is, though, not just a reflection of the faster pace that's present in mania and hypomania. It's a risky behavior that has the potential for negative consequences—traffic tickets, automobile accidents, or even worse.
"My wife has become obsessed with work, but I have to say she's getting a lot done."
Increased productivity—at home, school, or work—can be a benefit of hypomania, as long as it remains goal directed (focused on a specific worthwhile purpose) and doesn't become too obsessive (where other responsibilities are ignored because of overinvolvement in a single activity).
"He's spending money like it's water."
Spending too much money—that is, spending that's above one's means—is a common concern of the mates of bipolar people. During manic and hypomanic episodes your partner may go on spending sprees or engage in excessive gambling. Like reckless driving and other types of risky activities, this is an impulsive behavior that reflects bad judgment, the consequences of which can be painful and long lasting (the accumulation of large debts).
"She's calling lots of people she hasn't talked to in years."
Increased sociability and gregariousness frequently occur in manic and hypomanic states. You may notice that your partner is e-mailing an abundance of people or talking excessively on the phone, or making many more social plans than usual. Sometimes the increased gregariousness takes an inappropriate turn—being overfriendly to strangers or making phone calls in the middle of the night.
"His sex drive has gone way up."
Some people have an increased libido when manic or hypomanic. During these times your mate may want more frequent sexual contact with you. It's also not uncommon for men, in particular, to compulsively visit strip clubs or become excessively involved with pornography. Having extramarital affairs is a sexually motivated risk-taking behavior that also can occur (I'll talk more about this in Chapter 8).
"She's very restless, pacing, can't sit still, wringing her hands."
Physical agitation can occur in both manic and hypomanic states, but it's likely to be more severe in mania. For example, during hypomania your mate may be very fidgety and complain of feeling restless but can sit in one spot for a period of time. Manic agitation is harder to miss—your partner may be pacing the floors nonstop, unable to sit in one place for very long, and/or wringing her hands.
Excerpted from When Someone You Love Is Bipolar by Cynthia G. Last. Copyright © 2009 Cynthia G. Last. Excerpted by permission of The Guilford Press.
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