Someone close with bipolar disorder: understanding and supporting

1. Before you begin

It is two in the morning and the living-room light is still on. Your husband is repainting the bookcase, the radio playing in the background, and he is explaining to you, with an enthusiasm you had not seen in him for a long time, that he is going to start a business, that he has already rung three former colleagues and ordered the equipment. He has slept four hours in three nights, and he has never seemed so full of life. When you tell him you are worried, he gets angry: for once he is doing well, and you want him to sink back down. Six months earlier, this same man could no longer get out of bed and kept telling you that he was a burden to everyone.

Perhaps it is your daughter, admitted to hospital at twenty after a week that nobody could make sense of, or your mother, who people used to say had "a difficult character". You wonder what you should have seen, what you must do now, and how far you have the right to get involved.

Three things, straight away.

Bipolar disorder is an illness, not a personality trait. What you saw during the episodes, the anger, the spending, the wounding words or the collapse, belongs largely to the illness. That does not make those moments any less painful, but it changes the way to respond to them.

It can be treated, and treatment is measured in years. The long-term treatment, meaning the one taken continuously, even when all is well, is medication: it reduces the number and severity of episodes. Psychological approaches are added to it, and those that involve the family are among the best demonstrated for preventing relapses, that is, the return of an episode.

Your role is real, and it has limits. You can learn to spot the first signs of an episode, help write a plan in advance, contribute to a climate that calms things down and protect what needs protecting. You cannot prevent an episode on your own, and you do not have to become anyone's guard.

2. Bipolar disorder, in plain words

An illness of mood and energy

Bipolar disorder disrupts mood, energy, sleep and thinking, in periods that doctors call episodes. Between two episodes, the person may be well for months or years; during an episode, they change, sometimes to the point of being unrecognisable. The illness affects more than one person in a hundred worldwide. It often begins between late adolescence and the age of about thirty. It used to be called "manic depression", because mood swings sometimes upwards, sometimes downwards.

The high phases: mania and hypomania

Mania is a period, most often lasting at least a week, during which energy and activity rise abnormally. The person sleeps very little without feeling tired, talks fast, jumps from one idea to the next, takes on project after project and feels capable of anything. They may spend money they do not have, make abrupt decisions or drive dangerously. The mood is not always cheerful: in many people, it is irritability that dominates. In the most intense forms, the person may lose touch with reality and believe they have been given a mission or that they are being persecuted: these are then called psychotic symptoms.

Hypomania is a less intense, and often shorter, form of the same thing. The person is more active and more confident, sleeps less, and goes on functioning. They often experience it as a good period, and that is what makes it hard to spot: nobody seeks help because they feel well.

The low phases and mixed states

Bipolar depression resembles other depressions: a dulled mood, a loss of desire, a tiredness that rest does not repair, a feeling of being useless, sometimes thoughts of death, and sometimes a need to sleep much more than usual. It also happens that the two poles mix: the person's mood is very dark, but they are agitated, their thoughts race and they no longer sleep. These states, called mixed states, are often hard to recognise, and they are the ones in which the risk of suicide is highest (section 14). If your loved one seems to you both desperate and wound up, let their psychiatrist, the specialist doctor who treats them, know quickly.

Between episodes, and the two forms

Many people get back to the way they functioned before; others are left with a somewhat low mood, tiredness or difficulties with attention and memory. This is not laziness, and it is not necessarily the start of an episode. Doctors distinguish type 1, in which the person has had at least one full-blown mania, and type 2, made up of hypomanias and depressions. Type 2 is not a mild form: depressive symptoms often take up a great deal of room in it (section 4).

What it is not

Changing mood several times a day, or going from laughter to tears after an argument, does not make bipolar disorder. The episodes of this illness last days, weeks or months, with a change in sleep and energy. Rapid emotional instability, triggered by relationships and present since adolescence, points rather to another disorder, which our programme When emotions overflow: instability and borderline personality describes. Only a psychiatrist can tell the difference, and the two sometimes coexist. This guide is one of a series of three guides for families and friends, built in the same way: if borderline personality disorder or schizophrenia affects your loved one or another member of your family, Someone close with borderline personality disorder: understanding and helping and Someone close with schizophrenia: understanding and supporting explain each of these disorders and what you can do day to day.

---