Just thinking about the people in my social circle, it quickly becomes clear where I might turn to for support, for fun, for advice, and so on. Put another way, there are some people I’d keep at arms-length when it comes to say, keeping something confidential, but I know they have strengths in other areas.
If I were having a stressful day, I’d prefer to spend it with people likely to have a positive effect on my mood. Having people around to offer up different sorts of support is incredibly valuable. Those little moments when someone says: “Here; I’ve made you a coffee. Take a break,” or “I’m going that way, I’ll pick it up for you,” can make such a difference.
When it comes to mental health issues, leaving support to chance is risky. The key to effective support is knowing who to turn to, who is reliable, and what they can do to help. Many people with bipolar disorder know how valuable different types of support can be, but this may require some advance discussion and agreement over what counts as support and what is fair and reasonable to expect, which isn’t always as easy as it sounds.
Many years ago I knew a patient whose normal behavior was never to drink alcohol. Unfortunately, in his build up to a hypomanic episode, he would seek out his brother to accompany him on drinking sessions, which would often lead to other forms of risky behavior. The brother took offence when it was suggested he was actually colluding in unhelpful activities. From his perspective, he was simply there to protect his brother from getting into even worse situations. This was just one example of a complex family relationship, which at one level appeared to provide a form of protection, but not in a direction that was helpful for the patient.
Asking for support
Hypomania can be a difficult time for everyone concerned. If you are the person affected it’s a period when offers of help or advice are likely to be received with some level of offense or outright indignation. After all, you’re feeling energized and expansive. Why are these people telling you to slow down or calm down when there’s so much to do and not enough hours in the day? It’s a tricky one because sometimes only the people who really know you understand it’s an imbalance in your normal behavior. But the lack of sleep, the likelihood of risk-taking, and the very real prospect of coming down to earth with a bump and lapsing into depression are all too real.
The time to make plans and give permission to trusted family or friends to intervene is when you are well. Support plans can be arrived at through negotiation. There may be some things your helper is and isn’t prepared to do and these need to be sorted out. Their intervention, for example, may be as simple as alerting your clinician about their concerns. Of course the clinician needs to be kept in the loop and agree to this as a workable option.
Independence versus dependence
You may need to consider other risk-reducing strategies, such as the best ways of managing your money. By definition these are all intrusions into your independence but an effective strategy will prevent you from making decisions you later regret. Finding a system that works best for you may require some compromise. It may also put pressure on loved ones who only have your best interests at heart, which is why discussion and agreement is so important. An agreement has to be workable and pragmatic. Don’t expect people to keep up their end of a deal if you become abusive or aggressive. This may be your illness talking but that doesn’t necessarily make it easier or more tolerable for those around you.
Support strategies are ways of preparing for certain eventualities. Even effective strategies may not prevent mood changes but they may help to circumvent or even prevent symptoms from worsening. With bipolar disorder, medication is key to mood balance. So if medication has been stopped or reduced because of unwanted side effects, or for some other reason, it’s essential to get clinical involvement.
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Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.