When Someone You Love is Bipolar

The following interview with Dr. Cynthia Last and her husband, authors of "When Someone You Love Is Bipolar," is reprinted with permission of Guilford Press.

1. Dr. Last, in your book you candidly admit that although you were originally diagnosed with bipolar disorder in your early 30s, you didn't accept it until 10 years later. Why is denial so pervasive among bipolar sufferers? How can spouses convince their loved ones to get the help they need?

One reason that denial is so common is because being diagnosed as bipolar is extremely scary! Many people have preconceived notions about the disorder that stem from how it has been portrayed in the media, where the most severely ill cases often are used as illustrations. No one wants to be labeled with a condition that looks "crazy." But what we now know is that bipolar illness really is a spectrum of disorders, including manifestations of the illness that are much milder than the characterizations we've seen in movies and on television (I am fortunate to have one of the milder versions of the disorder, although during the rough times in battling the illness I didn't typically feel fortunate.) One way partners can help get their loved ones to break through their wall of denial is by doing what I refer to as "the family tree exercise." Since bipolar disorder tends to run in families, acknowledging the presence of the illness in relatives often serves as a "wake up call" for the person who has had trouble accepting the truth.

2. Bipolar disorder brings up tough questions about day-to-day living, such as should we travel for the holidays? And can we still enjoy wine with dinner? How can couples work together to address these issues?

Most experts in this area believe that sticking to a regular routine or schedule and abstaining from alcohol are essential components to achieving mood stability. This can make travel and even moderate drinking difficult. However, every person is different and it's important for couples to make decisions based on their specific experiences. Even if it appears that a bipolar person can have an alcoholic beverage from time to time without any seemingly negative consequences, alcohol is completely out of the question during a mood episode (either depression or mania). Alcohol worsens and lengthens mood episodes; even worse, it also dramatically increases the risk of suicide, which is disproportionately high among people with bipolar disorder (at one time or another, about 25% of bipolar individuals make an attempt on their own lives). Spouses can play a huge role in supporting their partners' sobriety by abstaining from alcohol themselves.

3. What are some common early warning signs of depression? Of mania? In the early stages of a mood episode, what can spouses do to help prevent the spell from escalating?

There are many possible early warning signs for depression, including, fatigue, change in appetite, and a general lack of enthusiasm. Early signs of mania may be irritability, excessive spending, and accelerated speech. Warning signs vary from person to person. What's important is for spouses to know their partners own idiosyncratic early warning signs so they can be alert for them and share their observations with their partners. Once recognized, couples may be able to "nip the problem in the bud" by using the early intervention plans for depression and mania outlined in my book.

4. While bipolar disorder is a profoundly challenging and painful mental illness, Dr. Last, you do believe it has some benefits. What are some of the positive effects of being bipolar?

Much has been written about the relationship between creativity and bipolar illness. Historically it has been documented that an inordinately high percentage of writers, artists, and musicians have had the disorder. Some characteristics of manic and hypomanic states--such as increased drive and productivity, the ability to take risks, and a heightened sense of self-confidence--may help the creative process. Some bipolar people worry that medication will stifle their creative energy, but in my professional experience, while this is true for some, many find just the opposite--their work is even better once their mood has been stabilized.

5. Nobody likes taking medication. Often, bipolar sufferers stop taking their pills because they feel they don't "need" them anymore, or because they can't stand the side effects. How can spouses help their partners stick with their treatment program?

Medication is essential to bipolar health--there is absolutely no way around this. Unfortunately, lack of medication compliance is a common problem among bipolar people, so it often becomes a bone of contention between partners. When partners maintain that they don't need medication anymore, spouses can draw their mates attention to specific, problematic events that occurred when their loved ones were taking "medication holidays." If an unpleasant side effect is to blame for the medication discontinuation--like weight gain, which is a complaint I hear frequently--spouses can help their mates by together taking on lifestyle changes that can lessen the problem (in this case, embarking on an exercise program or a healthier eating style together as a couple).

6. Following a set routine has been shown to increase mood stability. What are some easy lifestyle changes couples can make that will have a lasting, helpful impact?

Having regular meal and sleep-wake times are very important. However, the ability to fall asleep at a regular, reasonable hour often is difficult for bipolar people. Avoiding stimulating activities--such as exercising, watching a scary movie, or working on a mentally taxing project--just before bedtime is essential. Instead, suggest that your partner wind down with a hot bath, relaxing music, or a cup of chamomile tea.

7. Supporting a bipolar partner is hard work. How can spouses take care of themselves? What are some good coping strategies?

First and foremost, it's crucial that spouses take time for their own needs (and not feel guilty about doing so!). If they don't, they often become so consumed with their partner's illness that they "lose" themselves. Devoting time to individual hobbies and interests allows well-needed breaks and prevents physical and emotional depletion. I also recommend that stressed spouses consider joining one of the many support groups that exist for people who have bipolar partners to get the help and support they need.

8. Mental illness is a very personal matter. What should couples grappling with bipolar disorder tell their friends and family? What, if anything, should they tell their employers?

Deciding what to tell friends and relatives depends on a number of factors, including how close your partner is to the person, whether the person is someone you and your mate feel you can trust, and determining if there is any advantage to letting the person know. In some cases, it may be sufficient to simply say, "____ hasn't been feeling well."

However, if the friend or relative is already aware that your spouse has bipolar disorder, it may be easiest to say that your partner has had a recurrence of the illness. The situation can get much stickier when it comes to an employer--after all, this is the individual who signs your partner's paychecks. If your mate is having a mood episode and is unable to work see if it is possible for him or her to use vacation time. But if there is no vacation time available or it can't be taken on short notice, a medical leave may need to be considered. In this case the employer will probably become aware that your spouse's illness is psychiatric in nature since it likely will be your partner's psychiatrist who documents the reason for the leave.

9. Barry, in the book's foreword, you wrote that you firmly believe Dr. Last's illness has made you "much closer and stronger than other couples." Can you give some examples?

Cynthia and I are very appreciative of our relationship and, therefore, we virtually never take each other for granted. We also work hard to support each other's individual personal and professional goals. Although bipolar disorder is a fact of our life together, it doesn't define our lives or our relationship. My wife and I firmly believe that other "bipolar couples" can achieve this as well.

10. Surviving the aftermath of a mood episode presents its own challenges. What are some things couples can do to preserve trust, rebuild intimacy, and move forward together?

Seeing your partner beginning to stabilize after an episode of mania or depression is an enormous relief. Still, mood episodes can have serious repercussions (financial, legal, social, to name just a few) that linger long after they are over. Couples need to find ways to deal with the emotions they are feeling so they can put the past behind them. Support groups and therapy can be useful in this process. Also, instituting measures designed to prevent similar, adverse circumstances from occurring again can help create a greater sense of security going forward.