Bipolar ruins relationships

Bipolar Relationships: What to Expect

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Ups and downs are natural in any romantic relationship, but when your partner has bipolar disorder it can feel like you’re on an emotional rollercoaster. Not knowing what to expect each day is stressful and tiring. Over time, it wears on the relationship.

Understanding why your partner acts out sometimes or becomes withdrawn is the first supportive step you can take in strengthening your relationship. Learn exactly what a bipolar diagnosis means, how it could affect your partner’s behavior and what you can do to foster a healthy, stable relationship.

What does it mean if your partner is bipolar?

Bipolar disorder is a mental health condition marked by intense mood changes. People with the illness switch back and forth from mania or hypomania (an emotional state of being energetic and gleeful or sometimes aggressive or delusional) to having episodes of depression.

The lifelong condition tends to run in families, although the cause of bipolar disease is unknown. However, it can often be successfully managed through treatment. There are two primary types of bipolar disorder:

Bipolar 1

Bipolar 1 is a more severe form of the illness and is defined by manic episodes that have one of these characteristics:

Hallucinations, delusions or paranoia
Hospitalization required for safety
Impulsive behavior with significant consequences

“When people are manic, they pursue pleasurable activities with great enthusiasm and with no regard for the consequences,” says Jennifer Payne, M.D., psychiatrist and director of the Women’s Mood Disorders Center at Johns Hopkins Medicine. “They may gamble, spend excessive amounts of money, use drugs or become promiscuous.”

Bipolar 2

People with bipolar 2 experience hypomanic episodes, which still include out-of-character behavior but aren’t as extreme as those with bipolar 1. Hypomanic episodes may include:

Increased energy and drive.
Rapid speech.
Decreased need for sleep.

“During hypomanic episodes, a partner with bipolar 2 may obsessively pursue sex with you or others,” says Payne. “They may stay up all night and have lots of wonderful ideas they want to tell you about at 3 a.m.”

Treatment Challenges

Bipolar disorder is usually treated with a combination of medications and therapy. However, successful treatment can be a challenge since many people miss the euphoria and energy of manic episodes.

Often people with bipolar disorder view these elevated mood states as their best selves — when they’re the most productive or creative — and will stop treatment in order to experience that again. Sometimes those with bipolar disorder will even intentionally trigger a manic episode.

“Lack of sleep is a trigger of manic episodes for a lot of people,” says Payne. “Sometimes patients with bipolar disorder will deliberately skip getting the sleep they need in order to initiate an elevated mood state. For example, a person might want the high energy that comes with a manic episode to get a project done.”

The key to your partner’s successful management of the illness is a commitment to continuing treatment and ongoing communication with their psychiatrist. This can take place at therapy sessions, during regular checkups or whenever necessary to discuss troubling symptoms.

Many people with bipolar 1 do well on lithium, a mood-stabilizing drug. Those with bipolar 2 may not fully respond to medications often used to treat bipolar disorder. If that’s the case for your partner, it’s important for them to continue to work with their psychiatrist to find an effective treatment.

Being in a Relationship with Someone Who Is Bipolar

There are certainly challenges in any romantic relationship, but bipolar disorder can make things especially difficult in various aspects of life:

Intimacy

It’s common for people with bipolar disorder to desire frequent sex during manic or hypomanic phases. Your partner may initiate intimacy much more than normal, or masturbate or use pornography more frequently than usual. Those with bipolar disorder may also engage in risky behaviors such as unprotected sex or extramarital affairs while manic.

During episodes of depression, your partner may avoid sexual contact altogether. This can be confusing or feel like rejection, especially if your partner recently desired lots of sexual activity during a manic or hypomanic period. Many medications for bipolar disorder can also lower sex drive.

Work

Your partner’s ability to perform well at work can be affected by bipolar disorder. Severe mood swings, along with manic symptoms such as poor judgement and impulsivity, or depressive symptoms such as low energy and disinterest make it tough to find and maintain a job. Stressors at work may also trigger or exacerbate your partner’s symptoms. If your partner can’t hold down a job, this could put more pressure on you to provide financial support until their illness is well-managed.

Parenting

Many people consider parenting the most stressful (albeit rewarding) job of their lives. But any kind of stressor — good or bad — has potential to trigger manic or depressive episodes for people with bipolar disorder.

In addition, the erratic behavior associated with bipolar disorder can be confusing and scary to children, who look to parents to provide stability. Helping your partner get and maintain treatment to control symptoms is crucial for providing a safe and secure home for children.

How to Make a Bipolar Relationship Work

It takes effort to keep any relationship strong, but it can be especially challenging when your partner has bipolar disorder. Payne offers these recommendations:

Go to Couples Counseling

Couples counseling is essential for working through upset over a bipolar partner’s actions. It’s common for someone with bipolar disorder to hurt and offend their partner. When someone is first diagnosed, there are often relationship issues that need to be addressed. Couples counseling can help you:

Understand that there’s an illness involved in the hurtful behavior.
Forgive the behavior that happened during an altered mood state.
Set boundaries with a partner about maintaining treatment.

Get Involved with Treatment

Ask if you can be involved with your partner’s treatment, which may include occasionally going to the psychiatrist together. Being a part of your partner’s treatment has multiple benefits, including:

Gaining a better understanding of the illness.
Providing additional insight for the psychiatrist.
Learning to spot signs of impending episodes.
Alerting the psychiatrist about mood changes.

Even if your partner hasn’t signed off on you exchanging information with their psychiatrist, you can still report worrisome signs (the doctor just won’t be able to tell you anything). This gives the doctor a chance to make quick medication changes that may help your partner avoid being hospitalized.

Practice Self-Care

Self-care gets a lot of buzz these days, but nowhere is it more important than when you’re caring for someone with a serious illness such as bipolar disorder. It’s essential to dedicate time to your own physical and mental health, whether that’s going to a support group, talking to a therapist or attending a yoga class.

Being in a healthy relationship with someone with bipolar disorder requires not only careful management of their illness, but also setting aside time to take good care of yourself.

Bipolar Disorder and Relationships: When to Say Goodbye

People with a diagnosis of bipolar disorder experience extreme shifts in mood that can result in manic or depressive episodes. Without treatment, these shifts in mood can make it difficult to manage school, work, and romantic relationships.

It may be difficult for a partner who hasn’t been close to someone with bipolar disorder to understand certain challenges.

While bipolar disorder may present challenges, it doesn’t define your partner.

“Mental illness does not mean a constant state of debilitation, but rather there could be episodes of more difficult times,” said Dr. Gail Saltz, clinical associate professor of psychiatry at the New York-Presbyterian Hospital Weill-Cornell Medical College.

“Even if there is a period of more struggle, the goal would be to get them back to a stable state and maintain that.”

The disorder also has positive aspects. People with bipolar disorder may exhibit “high creativity, at times, high energy, that allows them to be original and thoughtful,” said Dr. Saltz. She noted that many CEOs have bipolar disorder and share these attributes.

While the disorder has no cure, treatment can effectively manage symptoms and help to maintain stability. This can make it easier to carry on relationships and to promote long, healthy partnerships.

However, it’s also possible for a relationship to be unhealthy even when one partner’s bipolar symptoms are effectively managed. Some people may face challenges that make it difficult to be in a relationship.

Here are some things to consider if you’re thinking of ending a relationship with a partner who has been diagnosed with bipolar disorder.

It’s possible to have a healthy, happy relationship with someone living with bipolar disorder. However, there may also be specific indicators that suggest taking another look at the relationship.

Dr. Saltz said that several signs may indicate an unhealthy relationship, particularly with a partner who has been diagnosed with bipolar disorder:

feeling that you’re a caretaker in the relationship
experiencing burnout
sacrificing your life goals, values, and needs to be with your partner

Your partner stopping their treatments or medication could also be a cautionary sign for the future of the relationship. Also, as with any relationship, you should never feel that your partner is putting either you or themselves in danger.

Unhealthy signs go both ways. A person diagnosed with bipolar disorder may see red flags from their partner, too.

“A partner who is stigmatizing and very negative about mental health issues, which is unfortunately fairly common, may be a difficult partner to have,” said Dr. Saltz.

“They may be often condescending or dismissive of you, [saying things like] ‘You don’t really have bipolar disorder,’ [which can] undermine your treatment,” she added. For a partner diagnosed with bipolar disorder, this may be a time to take another look at the relationship.

There are several things you can try to preserve the relationship.

First, remember why you’re in the relationship. “You probably got involved with this person and picked this person because there are lots of things that you like and love about this person,” said Dr. Saltz.

She suggested educating yourself about bipolar disorder to better understand the condition. It also helps to learn to recognize signs of depression or hypomania so that you can advise your partner to talk with their healthcare provider if needed.

Dr. Saltz also recommended encouraging your partner to continue treatment and taking any prescribed medications.

“Sometimes, when people have been stable for a while, they’re sort of like, ‘Oh, I don’t think I need any of this anymore.’ Usually that’s a bad idea,” she said.

Dr. Alex Dimitriu, founder of Menlo Park Psychiatry & Sleep Medicine, said that you can also support your partner by offering “gentle, nonjudgmental supervision and guidance” and encouraging healthy behaviors.

These behaviors include:

getting sufficient, regular sleep
using minimal substances
exercising
performing simple, daily mood tracking
practicing self-awareness
taking medications as prescribed

Additionally, he suggested that your partner identify three trusted people to check in with (you may be one) if they’re feeling off.

“Let those people then provide an average sort of score, and say, ‘Hey, yeah. ‘You are a little hot-headed, or you are a little down,’ or whatever they may offer,” he said.

You should immediately reassess any relationship that has become threatening, and take care of your safety. Beyond that, if unhealthy signs continue or grow worse, it may also be time to think about ending the relationship.

When to say goodbye

Dr. Dimitriu advised against breaking up when your partner is having a manic episode.

“A lot of times, I think there’s nothing that you can say that will convince the other person [of] anything, if they’re really on the mania side,” he said.

“The biggest thing, I think, actually, is to delay the breakup if that’s happening and just have a cooling off period,” he added.

After that, “Don’t make big decisions unless your three [identified and trusted] friends have said that you’re in an even place. And that includes the relationship.”

Consider seeking support

If you do break up, Dr. Saltz recommended making sure your partner has emotional support, and if you’re able to connect them to a mental health professional, that would be helpful.

If you have the contact information of their therapist you may leave a message, although be aware that their therapist may not be able to talk with you due to the Health Insurance Portability and Accountability Act (HIPPA).

“You can leave a message with their therapist saying basically, ‘We’re breaking up, I know this will be hard, and I want to alert you to that,’” she said.

She also advised paying attention to any thoughts of suicide. According to a 2014 research review, around 25 to 50 percent of people with bipolar disorder will attempt suicide at least one time.

“If a person in any circumstance makes a threat of suicide, that is an emergent situation. You should take away any means that you’ve seen currently available for them to do that and take them to an emergency room,” she said.

“That’s a concern even if you are breaking up with them.”

Be understanding

You can attempt to be as supportive as possible during the breakup. Still, Dr. David Reiss, a psychiatrist with offices in Southern and Central California, said that some people may not be receptive because they feel rejected.

“They may not be capable of ‘working through’ a relationship ending in an effective way, and mature ‘closure’ may not be impossible,” he said.

“Be kind, but not overbearing, and realize that once you are ending the relationship, your kindness may not be welcome anymore, and that’s OK.”

“Don’t take it as a personal attack,” he added. “Acknowledge that how the other person reacts, and their ability to maintain even a superficial or polite relationship after a perceived rejection, may be inherently limited and beyond your control.

“Do try to be compassionate, but be ready to have that compassion rejected without taking it personally.”

Any breakup is likely going to be difficult, especially if you had a long-term commitment to your partner. Dr. Reiss said that this situation may lead to feelings of guilt.

“If you start feeling guilty when the reality is that you had not made the commitment the other person implicitly expected, your guilt will trigger anger, depression, etc. in both yourself and in the other person and make it worse,” Dr. Reiss said.

He added, “Work through your own guilt as much as possible before, during, and after the breakup.”

It’ll also take time to heal. Dr. Saltz suggested doing your best to learn from any relationship that didn’t work. “It’s always good for you to review for yourself why you chose this person, what was the draw for you,” she said.

“Is that something that, in retrospect, you feel good about, or does it fit some pattern that hasn’t been good for you? Just try to learn from a relationship that didn’t ultimately last and understand more about yourself in that regard.”

You can absolutely have a healthy, happy relationship with a partner who has been diagnosed with bipolar disorder.

The condition may bring both positive and challenging aspects to the relationship, but you can take steps to support your partner and to help them manage their symptoms.

If you notice unhealthy signs in the partnership that aren’t improving, you may seek to break up. You may try to be supportive during the breakup, but don’t take it personally if they don’t accept your help.

As with any relationship, focus on learning from the experience as you move forward.

Love and bipolar disorder - Bipolar.su

How to maintain a relationship with a patient with bipolar disorder?

Managing any romantic relationship, whether it be courtship or marriage, can be a very difficult task. And if bipolar disorder is also involved in the relationship, with its roller coaster mood swings, the relationship will become even more problematic and require a certain amount of stress.

Jim McNulty, 58, married at 1970 year. According to him, at first everything was just fine. The courtship looked absolutely normal, Jim and his wife got along very well. Then the mood swings started. During the manic phase of the illness, he could spend much more than he could afford. Then Jim's mood changed dramatically, and he was drowning in the abyss of depression. Such wild leaps had a negative effect on marriage and, moreover, began to threaten the complete ruin of the family.

In the end, Jim signed over the house to his wife to financially protect her and their two young children. The result of the struggle between love and illness was the victory of bipolar disorder. Jim's wife asked him to leave as she could no longer cope with her illness.

Relationships and Bipolar Disorder

When people decide to start a relationship, they hope for stability. But the manic-depressive psychosis of one of the partners can destroy such expectations and seriously complicate the relationship. A person, especially not treated, is prone not only to mood swings, but also to changes in personal qualities, relationships, which can jeopardize the constancy that is the basis of relationships.

In addition, not all sufferers of manic-depressive illness show distinct phases of mania and depression. But when such episodes occur, sufferers can give vent to their feelings and destroy relationships.

During a manic state, a person can lose his sanity, which will lead to unreasonable spending, infidelity, alcohol and drug abuse, even problems with the law are not ruled out. Therefore, the phase of mania in one of the spouses can be extremely detrimental to relationships, since the patient is capable of actions that threaten the financial condition of his partner and personally him and his health.

The other pole is depression. This state makes a person withdraw, abandon everyone and everything around him. Such moods are very upsetting for the partner, because he is trying to pull the patient out of his shell, but has practically no chance of doing so.

For those who have a partner with bipolar disorder, we recommend reading the book “Why is it so difficult to be with you. How to love people with neurosis, depression and bipolar disorder.

Dating, love, and bipolar disorder

Bipolar disorder can be a problem early in a relationship. When you first meet someone you like, it's natural to want to make a good impression. Therefore, immediately reporting an existing illness will not be the best solution for a favorable start to a relationship. There is always a fear that by such a confession you can scare a person away and lose the opportunity to meet someone else. On the other hand, you still have to let your partner know about your illness.

Doctors advise not to talk about your psychiatric problems on the first date. But if you feel that the attraction is mutual, you want a serious relationship with this particular person, you need to dot the i's.

Knowing what can trigger cycles of hypomania, mania, and depression, and paying attention to warning signs that you are entering a new phase of your cycle, can go a long way in helping you avoid unpleasant situations in new relationships. After all, the more the patient is aware of the features of the manifestation of his cycles, the greater the responsibility he will be able to take on. Some common symptoms of upcoming changes in mood include restless sleep and increased or decreased activity levels.

Marriage and Bipolar Disorder

Events ranging from work stress to financial problems can lead to strife and friction in a marriage. But when one of the spouses has a manic-depressive psychosis, minor stress factors become enormous. This explains why at least 90% of marriages where one of the partners suffers from bipolar disorder eventually break up.
Jim McNulty has witnessed the destruction of not only his own marriage, but also the marriages of many other patients. He led a cheerleading team for almost 19years. During this period, he met a dozen couples who came to the meetings of a group of people whose relationships were torn to shreds. Jim believes that bipolar disorder puts a lot of extra strain on a relationship, especially if the person is unaware of their condition and has not been diagnosed.

How to make relationships better?

Having a love relationship when you are suffering from bipolar disorder is really difficult. But not impossible. To save a relationship, and subsequently marriage, requires constant work on yourself by both partners.

The first step to take is to see a doctor and treat the disease. Your doctor may prescribe mood-stabilizing drugs, such as lithium medications and antidepressants, to help relieve your symptoms. Therapy with a qualified psychologist, psychiatrist or social worker is also important. Thanks to this treatment, you can learn to control your behavior, which brings stress to your partner. If your spouse agrees to go through the entire course of treatment with you, this will help him or her better understand the reasons for your actions and learn how to respond to mood swings in the right way.

In addition, if your spouse is directly involved in your treatment, this will bring the couple even closer.

Although you may want to climb into your cocoon when you are depressed, and when you are manic you feel like the king of the world, it is important to be able to accept help when it is offered. It can be helpful to draw up a contract that spells out in advance under what circumstances and in what condition you will agree to help from your partner.

For the spouse of a person with bipolar disorder, knowing the best time to offer services includes recognizing the states and moods of the wife or husband. It is important to learn to understand the emotional throwing of a partner and to be on the alert all the time. Jim McNulty is now married to a woman who also has bipolar disorder. When one of them notices that the other is getting depressed, Jim or his wife ask how he or she is feeling, how he or she can help. Such gentle and unobtrusive attention helps both to be in order.

There are several other methods that can revive relationships:

You should take medicine exactly as prescribed by the doctor and do not miss appointments with him.
Sign up for support groups
Manage stress the way it works for you. It can be journaling, long walks, music. It is necessary to balance the time spent on work and rest.
Stick to sleep patterns.
Eat right and exercise.
Avoid alcohol and caffeine.
Seek help immediately if you have thoughts of suicide or self-harm.

Summary

Don't Go Crazy: How Treatment Partners Help People with Bipolar Disorder

March 30 is celebrated as Bipolar Day around the world. With this disease, it is important to monitor mood changes, which can be difficult to do alone. The founder of the Bipolar Association, Masha Pushkina, has collected stories of people who are helped by treatment partners.

At the initiative of public organizations uniting scientists, doctors and activists, every year on March 30, World Bipolar Day is celebrated. The date chosen was the birthday of Vincent van Gogh, an artist who, according to researchers, was the embodiment of a "bipolar genius."

With bipolar disorder, a person lives either in a state of strong emotional upsurge and arousal (mania), or in depression. According to world statistics, about 2% of people suffer from bipolar disorder in various forms. This means that in Russia there are at least three million bipolar people - this is about half of St. Petersburg.

In most cases, this condition responds well to medication. But, unfortunately, many do not seek help or do not know how to find it. Without treatment, the disease progresses and ultimately leads to sad consequences: loss of family, job, disability in general, and in almost every seventh case, suicide.

These consequences can be avoided. The peculiarity of bipolar disorder is that the onset of remission depends not only on the doctor and medications, but also on the behavior of the patient himself. Very often, bipolar people provoke seizures "with their own hands." The mood of people with BAD (bipolar affective disorder. - Note ed. ) is very unstable, the balance is fragile, and mania or depression can be “started” in dozens of ways: the psyche is easily shaken by psychoactive substances, alcohol, lack of sleep, too intense work, travel, and even falling in love. So, a short time after the next course of treatment with powerful drugs, the person again ends up in the hospital. And each new attack reduces the chances of a long remission, affects social status, and even more painfully - self-esteem.

The experience of people with mental disorders around the world has proven that you are much more likely to cope with difficulties when you are supported by people who understand your problems and condition, but do not look at you as a patient. As practice shows, such a person can be not only a partner or close relative. An old friend, and even a person with whom you have never met in person, can help you get through the darkest times. Masha Pushkina, especially for Afisha Daily, spoke with several bipolar people about those in whom they found their support. The result is a story not about illness, but about friendship and trust, which can defeat even madness.

Yana, 31 years old

Housewife, collects books and is fond of confectionery

Purposefully, I didn't find out about the ways of support anywhere, everything turned out quite naturally. I have been sick for 15 years. The first person who looked after me was my best friend, and now it's my husband.

When my hypomania (a mild degree of mania, which is characterized by a constantly elated mood. - Approx. ed. ) accelerated into a full-fledged mania (this state is also characterized by a one-sided attraction to some topic, sometimes accompanied by delirium. - Note ed. ), it became clear that I needed to be looked after. A friend began to pay attention to repetitive patterns of behavior in one phase or another, and we decided together to find out what helps in such cases. I think my friend was afraid to take responsibility for my condition, but she turned out to be generous and selfless. When I got married, a friend passed this knowledge on to her husband, and he already supplemented it, based on his own experience. The husband initially knew with whom he connects his life. He says it didn't scare him.

I have obsessions during my manic episodes. My husband does not argue with me at this time, but he also does not feed them, trying to redirect my stormy energy in a different direction. You can’t argue, because the result will be the opposite: I will finally get stuck on the idea, I will consider that I must prove it at all costs, even if the whole world is against me, and there are enemies and conspiracies around. If this does not help, the husband agrees to discuss all these things, but at the same time tries to slow down their implementation by offering to draw up a specific and detailed plan. Sometimes it takes me a long time.

For example, I always want to move somewhere. Right now, and why aren't we packing our things yet? My husband tries to make me write down what are the pros and cons of different cities, what attracts us to them. As a result, I sit for hours on different forums, make lists, think about how we will arrange our life, calculate the budget for different countries of the world. There is also a manic passion for travel, but after preparation, we usually implement these plans. And many years ago, in a fit of mania, I bought an apartment - with a mortgage, with hellish payments. Then it took a long time to resolve this situation, but, fortunately, everything worked out well.

My husband began to chart my mood. I also manage it, and we check the results so that they are objective. Quarrels due to the fact that the husband takes on the role of the elder often arise in the manic phase (never in depression). Then I become very suspicious, any attempts at control cause rage. But now the husband has learned from experience, so he does not react to attempts to unleash a conflict. With obvious attacks of rage and auto-aggression, he uses holding therapy (long strong hugs. - Note. ed. ). We have seen this in autistic children, this is how their parents influence them.

When I'm depressed, he doesn't comfort me, because it's pointless, but tries to give reasonable arguments that this period has always ended and this time will also pass soon. We look at mood charts for the past months, discuss the duration of the attacks: two weeks have already passed and, judging by past experience, it should get better in a couple of weeks.

Such support from her husband helps in many ways. When I was being treated by two doctors, taking all the medicines, I didn’t have such support, everything was very bad. Over time, I stopped disappearing from home in a manic state and inflicting serious injuries on myself. All my super-ideas remain on paper in the form of graphs and tables, I don’t even have time to start putting them into practice, so that later I don’t have to deal with the consequences with the whole family.

Alisa, 27 years old

Biologist

To be honest, I don't always find understanding from my healthy environment, I often faced condemnation, devaluation of problems. But from a person who has a similar experience, you won’t hear “don’t invent”, “you can’t feel so bad”, “take a walk and it will pass”.

It just so happens that my best friend also suffers from bipolar disorder. I did not look for support in specialized communities where patients communicate, we met by chance. My friend is much older, he has much more life experience, and he was able to become a real mentor for me. Not once did his actions worsen my condition - I hope that he can say the same about me.

When I'm on the rise, I feel uncomfortable when he tries to slow me down and reduce my passions. But as soon as this state passes and I again take a sober look at the situation, each time I thank him for trying to stop the revelry and disgrace. My friend himself is currently not being treated, but he never imposed his position on me, and when I turn to doctors, he supports me in this.

I told the doctor about this source of support - he is exclusively for it. Before meeting a friend, I had suicidal attempts, but during the entire time of our communication I never tried to say goodbye to life. When you know that there is a person who will understand everything and share warmth (while even my own family repels me), that there is a place where you can come in any condition and where they will accept me without unnecessary questions and teachings, this is a source of great strength. and hope.

When I was expecting my second child, I was depressed. My husband did not yet fully understand the features of the disease and did not want to admit obvious things - this added problems, and my emotional state became extremely difficult. It seems that only thanks to the participation of my friend, I did not do anything to myself and successfully endured the pregnancy. The child was named after him.

Sergey, 49 years old

Freelancer

At the height of the depression, I was looking for any available support and ended up in an online group of anonymous debtors (people who have taken on large loans). One of the participants drew attention to my condition and said that I urgently need medical help. Despite the fact that she lives in the USA, we began to communicate regularly via Skype. Olga literally brought me to the hospital and helped me prepare for the treatment.

Americans are a pragmatic people, many young and healthy people have folders with wills and instructions in case of their death. They also approach mental difficulties calmly and thoroughly. It is common practice for the patient to draw up detailed instructions in advance. In the United States, there is a practice of issuing Treatment Agreements for people with mental illness (Treatment Contract). This document is needed so that family, friends and doctors recognize the symptoms of deterioration in time and take into account your experience and wishes in the treatment. Typically, such a document contains: a list of trusted people; signs of a normal state; signs of an approaching episode; symptoms of mania and depression; actions that trusted people should take to help a person get better and keep him from destructive acts; plan of action in case of an emergency (for example, a suicide attempt). who and what will be done in case of his hospitalization, so that he can be treated without anxiety for household chores.

In a period of severe depression, there is a struggle inside a person between the craving for death and the desire to live - and many external things can outweigh in one direction or another. Every clue is important to help you get out. It is very difficult for one to cope with all this.

I madly didn’t want to go to the hospital and wouldn’t have made up my mind myself, until the last I hoped that somehow everything would go away on its own. But under the supervision of a friend, I drew up a preparation plan: warn the customer at work, arrange to look after my cats. Reported to her about every step. But then he could no longer simply “escape” [from hospitalization], because he felt obliged to both her and the doctor. During depression, one's own life has no value, but the people dear to me, the promises made to them, do.

At the most difficult moment, Olga became my “outer brain”, which told me what to do when I didn’t understand anything myself. After I was discharged from the hospital, I turned to four friends for support. Usually we call each other once a week, I tell what my condition is. It is important not only to chat online, but also to hear the voice, you can understand a lot from it. Friends immediately pay attention, if I suddenly disappear and stop calling, then something is wrong.

I think it is possible to find such a person if you set such a goal. Take a closer look at people in support groups, religious or other communities - those who understand what compassion and mutual assistance are. This must be an internally mature person, ready to take responsibility for you in a difficult situation. If this person has similar problems, then he will better understand your experiences. For this reason, relatives are far from always suitable: they themselves can panic, seeing how bad you feel, choke you with their anxiety, overprotection.

It is necessary to establish the frequency of communication and observe it. And of course, in no case should you parasitize on someone else's kindness. The support system works when you yourself take responsibility for your life, and do not outweigh it completely on another.

Anna and Valeria, 21

Students

Anna: After a major depressive episode four years ago that almost ended in a suicide attempt, I started looking for information on [support]. I managed to find a guide in English for relatives and friends on how to behave with such a person. I have sent this list to all my friends so that they have an idea of what is happening to me. For the past few years, Lera has been monitoring my emotional state on a daily basis, and if, in her opinion, it goes beyond the norm, she tells me about it. Lera just asks every day how I'm doing, and if she sees that I'm reacting strangely, she wonders if something happened. At first, it was very difficult, because, in principle, I did not like to regularly share personal experiences. But by regularly receiving feedback, I can imagine the dynamics: do the pills help, how long do the side effects last, does the depressive phase go into a moderate and severe degree, do I lose my critical thinking during hypomania.

Valeria: We gradually established a very trusting relationship. Anya studied the topic of bipolar disorder up and down, and I read the articles that she sent me. The diagnosis did not change anything for me, because it remained the same. After that, we already discussed some formalities (for example, who to call in case of an emergency).

Anna: I asked Lera to watch for hypomanic manifestations in which I lose an adequate assessment of my actions: impulsive night walks, alcohol begin.

Valeria: My friend is a very responsible and conscious girl who takes care of herself, her health and her wallet. Before buying something expensive, she asks for my advice - and then we are already sorting out the situation. We can entrust accounts to each other and not worry. I also know where and to whom to run in cases of exacerbation.

Anna: I react badly to prohibitions and reminders of illness. Yes, I periodically have to turn to relatives for help, change treatment or take long breaks, but I expect mutual respect so that they don’t look at me through the prism of the disease.
When the mood is unstable, harsh phrases like “the disease speaks in you”, “these are not your real emotions” cause persistent rejection, even when they are true. The line between accepting a loved one's illness and identifying him with a diagnosis for healthy people is extremely thin. Therefore, those who were able to grope it deserve great respect.

Anna: In the last year, I go to see the doctor with my parents. When the doctor notices that I may not be able to do it alone, she duplicates the instructions and advice for them. I, in turn, am a friend. The doctor has repeatedly emphasized that the change of episodes is more noticeable from the outside.

Valeria: We don't have any kind of hierarchy in relationships, so there is no pressure when one makes decisions for another. This is not eating each other's emotional resources, but complementing and supporting.

Anna: The main danger in a relationship with a person with a serious illness is to fall into codependency. This format is equally bad for both the "controller" and the "subordinate". Unfortunately, I have been in such relationships before. It is worth maintaining mutual respect and treating each other as equals. Illness should not dominate a relationship. In difficult episodes, it temporarily comes to the fore, but you should always remember that you are not a disease.

Anna: I have memory problems: I don't remember some episodes. In such cases, I can ask Lera for help. If you remember the last weeks, then these are regular reminders to call the doctor. In mixed episodes, this becomes an acute problem, because I can suddenly change my mind or forget. Against the backdrop of a severe episode, I may develop psychosis, and this is the most dangerous thing in the disease. Thanks to our format, I manage to avoid such exacerbations almost always.

The advantages of observation from a loved one are an early response and the fact that he knows the patient's usual behavior very well and can notice even small changes. The main disadvantage is that normal friendly communication risks turning into constant monitoring of symptoms. Not every mentally healthy person is able to remain within the boundaries of reason.

It is important to agree in advance, before an attack, what is an undoubted sign of worsening condition (for example, persistent insomnia), and what does not need to be given special attention (for example, loud indignation at something that you do not like). In a difficult situation, often a loved one begins to behave not as an equal, but as a “healthy” and “knowledgeable”. Not all relationships stand this test.

There is also a variant of "buddy" (when two people with mental disorders look after each other. — Note ed. ) - it is good precisely because it is the true request of the patient and more equal relations without mixing roles. But I don't know the buddy support system.

To choose a person you can rely on in a critical situation, take a closer look at your surroundings. Above all, a high level of trust is needed. Your assistant should be open to nonjudgmental and open dialogue and at the same time emotionally stable and resistant to stress.

Support is essential for every person - very often, and we, mental health professionals, need it. And with bipolar disorder, this problem is especially acute. At the initial stages, those closest to you often ignore the presence of the disease, and friends advise you to either "pull yourself together" or, conversely, "relax", sometimes with the help of alcohol. When it becomes obvious to everyone that the “condition” will not go away on its own, urgent hospitalization is already required. The saved patient receives the "stigma".

Psychiatrists then make it the responsibility of the uninitiated next of kin (parent or spouse) to monitor any changes in the patient, and they really try to do so. At the level of "laughing out loud - hypomania has begun, upset - depression." As a result, psychiatrists begin to treat quite normal human emotions based on complaints from relatives... and the circle closes.

For this to change, mental health literacy must play a major role.

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