The day-to-day future for someone with bipolar disorder (BD) is hard to predict. BD is a mood disorder defined by sometimes rapid, often hard to predict mood swings that range from major depression to extreme mania. One day a person can feel totally worthless. The next, that same person may feel euphoric with unlimited power and boundless energy. On a different day, the person may display behavior that mixes elements of depression and mania.
How long these states — known as depressive, manic, or mixed episodes — last varies, and their occurrence is random. Someone might go from a depressive episode to feeling perfectly normal. Then after weeks or even months of normalcy, slide back into a deep depression. Loving someone and paying attention to what’s happening can help. But depending on how severe an episode is, love and attention won’t always be enough to keep that person out of the hospital or safe from harm.
More than one life at stake
Serious illness takes a toll on both the sick and those who care for them. With mental illness, that toll is larger. Bipolar symptoms are unpredictable, strong, and destructive. They can damage or ruin relationships. They can block someone from going to school or cost someone a job. They can also lead to aggression, severe injury to self or others, and suicide.
At the same time, family members, especially those who serve as caregivers, have increased risk of both physical illness and poor mental health. Stress, fatigue, depression are common challenges. A caregiver may try to self-medicate by drinking too much, overeating, or smoking.
A diagnosis of bipolar disorder affects the whole family, not just the person with the illness. Behavioral scientist J. LeBron McBride, PhD, in an essay in Annals of Family Medicine, describes how mental illnesses such as BD can consume a family’s identity. Mental illness has a stigma. A family may fear the shaming or repercussions that can come with it. To protect the mentally ill person as well as the family reputation, there’s a tendency to withdraw and become isolated.
That isolation can shut the family off from its resources as well as cause it to lose sight of its strengths. The isolated family, McBride says, can become so entangled in the mental illness that the illness becomes their identity.
A family-based response
McBride suggests a “narrative framework” in a “caring environment” is one way to address both family and individual isolation. He is writing to family physicians, doctors who specialize in treating whole families. Because they already treat people in the same family, he considers them good candidates for creating a safe space for the entire family. That space would be somewhere family members can share their stories and vent their frustrations. The doctor can listen, ask questions, and, McBride says, “offer hope.” Families could find new options and ways to cope as well as learn about resources.
Treatment for BD involves a combination of medication and psychotherapy, also called talk therapy. Medicines help control symptoms and reduce the disabling effects of mood swings. Talk therapy provides support, education, and guidance for people with BD and in some cases their families. One type of therapy sometimes used is family-focused therapy or FFT. It treats entire families along with the person with BD. And it can do much of what McBride urges in his essay.
Family members attend FFT sessions with the patient over a period of about nine months. Together, they learn about BD and its symptoms and what to expect. They also learn the signs of an approaching episode or relapse as well as strategies for prevention and ongoing management. Another part of the therapy focuses on learning to communicate with each other and managing conflict within the family.
But there are some key differences between what McBride describes and FFT. First, FFT is one of several forms of therapy used to treat BD. That means it may not be available to everyone. The biggest difference, though, is the “framework.” FFT focuses on learning. What is the disease? How does it show itself? How can it be controlled? What’s its impact on the family, and how can family members communicate and deal constructively with conflict? The framework is educational. The priorities are set.
“McBride, though, calls for a narrative framework that acknowledges the individual and sometimes very different perspective and needs of each family member. Each has a story based on the impact BD has on his or her life. These are stories about fear, concerns, loss, frustration, anger, and hope. Telling and acknowledging them creates an environment in which family members can learn how to grow and move beyond the isolation separating them from the outside world and each other.
One family’s story
In the same journal where McBride’s essay appears, Satya Rashi Khare, MScN, tells her story of growing up with a father with bipolar disorder. One of the things she learned is that mental illness “is not a patient illness but rather a family illness; one that requires a whole family approach to treatment.”
Everyone in her family was treated by the same family physician, but he addressed her father’s BD only with Satya's parents. He never raised it with her or asked how she was coping. When her father died, she knew the chaos that comes with mental illness had kept her from being able to tell her father about the love she felt for him. She couldn’t see past his disorder, but, she says, “I could have with the proper support.”
Caregiving takes its toll. But so does just living with someone with bipolar disorder. If someone in your family has been diagnosed with BP, keep these two things in mind:
- Don’t be afraid to talk with your doctor about the disease and how you are coping with the “chaos” it brings. And when you do, ask your doctor for help finding someone you can talk with on a regular basis. Even if you’re not the caregiver, you still have plenty to deal with.
- Encourage your family to do the same. And suggest that at the very least you work together to find a support group that can help you learn to talk with one another.
Also, check out the NAMI Family-to-Family program from the National Alliance on Mental Illness. It’s a free 12-session educational program for family, significant others, and friends of people living with mental illness. The course covers topics ranging from managing crises to self-care to understanding the impact of mental illness on the entire family.