Last week, Joe posted a piece entitled “Bipolar Dilemma: Insensitive Jerk or Irresponsible Oaf?” in an attempt to spark a discussion and collect insights on what to do when you sense that your loved one with bipolar is exhibiting symptoms of mania or hypomania. This week, Dr. Fink weighs in.

Dr. Fink Replies…

This dilemma lies at the heart of so much of the strife that families living with bipolar disorder face every day. I don’t have any magic answers – I suspect that people living with these challenges have creative solutions that will be more helpful to others than anything the doctor might have to offer.

I do have a couple of thoughts though about strategies for problem solving in these situations – and problem-solving is actually at the heart of it. Approaching the issue as a problem to be solved rather than a judgment or comment about your loved one with bipolar disorder is usually the more productive approach:

1. Identify the problem as the illness not the person. Consider approaching your loved one with a question or observation about the illness, such as: “It seems as if maybe the depression is starting to hurt you again – do you think that is true?”
2. Keep the focus on fighting the enemy (the illness) together – not fighting or judging the person. You and your loved one with bipolar are on the same team – externalizing the concerns related to the illness and working together to identify specific problems and possible solutions. Really listening to your loved one, even when their emotional symptoms are strong, is crucial.
3. Focus on specific problems to solve rather than on general comments. For example you might say something like this: “I’ve been noticing that you seem to be having a lot more trouble sleeping than you were last week – are you noticing that?” Avoid statements such as “I think you are manic” or “I think you are depressed.”

Overall, work toward keeping the illness as the bad guy and approaching specific problems as a team. Of course, sometimes the illness will have such a strong hold on your loved one that no approach will be effective, and then you will need to seek professional guidance regarding safety issues. If the problems are not safety related, it may be that they can’t be solved until the episode settles on its own or when your loved one is able to work collaboratively again on solving the problem.

When this happens try to direct your anger and frustration on the illness – not the person you love who is suffering. When your loved one seems to be thwarting your efforts to help, it’s usually because they can’t not because they won’t. People with bipolar disorder don’t want their lives to fall apart due to the illness, and they don’t want to cause problems in your life, but bipolar disorder hurts everyone involved – try to keep that on the front of your mind.

MC’s suggestion of setting up a plan ahead of time is excellent. (See “Bipolar Dilemma: Insensitive Jerk or Irresponsible Oaf?” to read about the strategy she and her husband follow.) Often, the key to defusing a tense situation is to plan ahead and agree together to handle it a certain way before the situation arises. Writing everything down as a sort of “contract” or plan of action clarifies everyone’s role and holds everyone accountable to at least some degree. With a plan in place, everyone can act more rationally and less emotionally to stabilize the situation and obtain whatever help is needed.

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    Last reviewed: 29 Sep 2009