Family & Friends of Those with Bipolar: Help for Helpers

To stay strong in your supporting role as a caregiver, it’s imperative to learn the facts about bipolar and find your fellow “birds of a feather.”

Different Degrees of Support & Impact

Being the primary support for a family member with bipolar may involve little more than watching for warning signs of a mood shift. At the other end of the spectrum, though, it may mean monitoring medication compliance, taking point with mental health professionals, and dealing with extreme behavior while also shouldering financial and household responsibilities.

As with many other chronic health conditions, bipolar affects everyone in the family. When a person grapples with notorious swings and symptoms, emotional strain and extra duties also take a toll on their parents, partners, and adult children.

The “nearest and dearest” often make crucial contributions to a loved one’s ability to successfully manage bipolar. No one benefits if the backup system falters. So if you need to “be there” for someone with bipolar, taking care of your own well-being is vital.

Studies have shown that family members of people with bipolar disorder tend to be at increased risk of both physical and mental health problems—especially depression—because of increased stress, says Lesley Berk, PhD, a clinical psychologist affiliated with Deakin University and the University of Melbourne in Australia. (In some cases, a hereditary predisposition for mood disorders may leave the support person especially vulnerable.)

Berk helped develop a website specifically for family members and friends. It’s called Bipolar Caregivers, reflecting a common blurring of terminology. “Caregiver” brings to mind someone who provides day-to-day oversight and hands-on aid for a loved one with Alzheimer’s disease, cancer, or the like. While the demands on someone who has a family member with bipolar are not the same, there’s enough overlap to make the use of “caregiver” widely accepted.

People who counsel caregivers often trot out the analogy of airline passengers in an emergency, who are told to “make sure their oxygen masks are securely fastened before assisting others.”

“My daughter’s doctor always told me that I had to take care of myself because we did not need two sick people in the house,” recalls Nancy S., whose children are now adults.

So what can you do for yourself, and what can others do for you, that will allow for your needs to be met while you’re taking care of someone else’s?

Get the Facts

First, you need to know what you’re dealing with.

“Most caregivers … just need basic information as to what’s going on with their loved ones, why the relationship had suddenly changed, and how they can deal with it,” Berk explains.

There are plenty of resources, both in print and online, to begin basic self-education about bipolar. (Our page “Bipolar in Depth,” at bphope.com, has a list of links to key mental health organizations.) Berk’s website (bipolarcaregivers.org) offers a downloadable guide that includes two chapters on self-care for caregivers.

She also recommends seeking help from local mental health agencies and community groups.

In the US, the National Alliance on Mental Illness (NAMI) has a 12-week program targeted for the people around the individual with bipolar. Jenifer C., whose husband was diagnosed with the illness a decade ago, got “lots and lots of great information” from NAMI’s Family-to-Family course.

The curriculum gave her an overview of mental illness and the medications used to treat it. She also took part in role-playing games designed to put the support person in the shoes of the individual with bipolar, “which was a really good way for me to understand mental illness a little more,” she says.

Anne, a Toronto-area resident who has a daughter with bipolar, attended an eight-week group for relatives that was sponsored by the Centre for Addiction and Mental Health (CAMH). She learned more about her daughter’s symptoms and where they fell on the spectrum of severity. She also came to understand how draining living with the illness can be.

“A part of the group’s discussion was about taking care of yourself, so that you’re not pulled into that abyss,” she explains.

Just being able to have somewhere to talk openly about the daily ins and outs of her situation was a relief, she says. Others in the group “will give you useful, practical coping techniques,” she explains. “And you get some sympathy, frankly.”

Flock Together—Find Other Supporters

The kind of peer connection Anne describes helps reduce the sense of isolation that can be common among family members who assist someone who lives with a diagnosis.

“A big thing is to make sure you’re not doing it by yourself—that’s very isolating and exhausting,” says Julie Totten, president and founder of Families for Depression Awareness. “Try to build a network of people to help you.”

Totten says a family therapist who is knowledgeable about the ramifications of bipolar can be another outlet to help you feel less alone. However, you get a different kind of feedback from “been there, done that” fellow travelers.

Nancy, whose daughter and son have bipolar, facilitates a family-and-friends support group in the Boston area. It’s a place where “you can tell your difficult stories and nobody is going to judge you,” she says.

If someone in the group feels guilty about getting angry when faced with challenging behaviors, Nancy will ask who else has had those same feelings.

“Every hand in the room will go up,” she says. “The person who brought that up will feel validated and supported.”

A group needn’t be exclusive to bipolar to be helpful. When Jenifer moved to rural North Carolina about five years ago, the nearest option was a Christ-centered recovery group. She worried that this more generic “umbrella ministry” wouldn’t be a good fit, but soon found that simply having a place to vent about whether her week had been good or “crappy” made her feel better.

“Knowing that I could keep the focus on me and not so much on him … has been one of the big things that helped me,” she says.

Peer support doesn’t even need to be face-to-face. Online groups, such as the Depression and Bipolar Support Alliance’s monthly cyber meeting for family and friends, provide a similar exchange of advice and affirmation.

Step Back & Prioritize Yourself

Making sure the diagnosis doesn’t monopolize your life is also important. Nancy emphasizes the importance of having enriching activities outside the helper role. For example, she makes it a point to spend time with friends who have no connection to the mental health community.

“You have to have your foot in the ‘normal’ world,” she says.

Of course, life at home can be “normal” when the person with bipolar is stable or managing symptoms. Then there will be times of crisis when self-care for everyone goes out the window.

When problems are acute, as Nancy puts it, “you have to take care of your kid, you have to stay up all night sometimes, and sometimes more than one night in a row. At some point, you can—you have to—take time for yourself, go to movies, go away for the weekend.”

Even during the crisis, she adds, it’s a good idea to plan something small for yourself every day, such as a walk or talking on the phone to a friend.

(Paradoxically, Jenifer found mental relief by focusing in on her situation. Her counselor recommended that she start journaling—“just getting it out of my head and on to paper so I don’t focus on it too much.” That therapeutic writing grew into her ebook In Sickness and In Health.)

Take a Break & Invest in Yourself

The theme of “me time,” when you can step away from your helping role and recharge, is a recurring one in conversations about caregiving. This can take many forms, from a relaxing bubble bath to an absorbing hobby. Exercise, yoga, and gardening have known therapeutic benefits for mental health beyond just providing a break.

Work provided a respite of sorts for Jim N. because job demands kept him busy, he recalls.

At home, “I would work out and I would try to block my mind with activities and hobbies and other things…. We can’t live every minute of this illness,” says Jim, whose 58-year-old daughter has been dealing with severe symptoms since age 19.

Recruiting other relatives, close friends or paid assistants frees up time and lowers stress levels. Jim says his family is fortunate to have a nurse who has been visiting his daughter for the past 10 years or so, and his other daughter has stepped in to provide support when she’s able.

Get Back to Basics

Let’s not forget that your loved one is, after all, your loved one. When that person is stable or managing symptoms, “us time” can be a source of satisfaction. Berk says she and her colleagues found in their studies that relationships need to be nurtured with “bipolar-free” activities.

It’s true that the person you love will never actually be “bipolar-free,” since the disorder is chronic rather than curable. But remembering that there is more to that spouse, child or parent than the happenstance of illness may make it easier to hold yourself up when things feel overwhelming.

Sustaining her marriage matters to Jenifer, who strengthened her relationship with her husband by attending a weekly Celebrate Recovery group together.

“I’m in it for the long term,” she says, “in sickness and in health, no matter what.”

Nancy draws strength from thinking about what she gets, not just what she gives. She has come to see the illness in her family, however unwelcome, as the medium that made her more compassionate, a better listener, and more appreciative of small blessings like a beautiful day or a good meal.

“If you can find the strength to hang in there,” she says, “it will be worth it.”

Printed as “Help for Helpers,” Winter 2014

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