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.

Bipolar mania can really foul up the family dynamic. One minute, your family is cruising along on autopilot, and the next minute you're in a tailspin. It can begin innocently enough with a barely perceptible increase in irritability and criticism, and then quickly escalate into knock-down, drag-out conflicts, all of which contribute to worsening the mania.

In Bipolar Disorder for Dummies, we talk a little about the differences in how bipolar mania is seen from the outside as opposed to how it is experienced from the inside. Inside, a person experiencing mania may feel... I am amazing! Everything is wonderful! I can do anything and everything! I have all the answers! My ideas will revolutionize the world! Sleep is only for people who have nothing better to do! Everybody loves me! Outsiders may have a completely different perspective, saying or at least thinking...

I work at home. My wife (who has bipolar) works for the local school district. Several times during the year are difficult for us. It seems, for example, that when we "spring forward" for daylight savings time, we almost invariably spring into mania. We do okay over the summer. When she returns to work in the fall, sometimes we do okay, sometimes not. The Christmas break is also usually a bad time.

Mania isn't usually a pleasant feeling, but hypomania can be. It can make you feel like you're on top of the world - highly creative, energetic, effervescent... all that good stuff. Unfortunately, mania tends to follow with all its bad stuff - irritability, anger, conflicts, maybe even paranoia and hallucinations, and then sometimes the big crash into depression. Treatment can level out the highs and lows, when it works, but people who've experienced those highs often miss them.