 
The Bipolar Family Cure: How to End the Arguing, Overspending, Lying, Anger, Manipulation and Irresponsibility

By John Z. Ford

Disclaimer

All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review. This book is a work of non-fiction, but names, characters, places, and incidents either are products of the author's imagination or are used fictitiously. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered, and is not a substitute for professional advice or other expert assistance that may be required for a person's individual situation. The service of competent professionals should always be sought.

Table of Contents

Chapter 1: Introduction

Chapter 2: This Is WAR and You Are a General

Chapter 3: Common Strategy Mistakes

Chapter 4: History and Basics of Bipolar Disorder

Chapter 5: Signs and Symptoms of Bipolar Disorder

Chapter 6: Causes and Diagnosis of Bipolar Disorder

Chapter 7: Treatment for Bipolar Disorder

Chapter 8: Medication Compliance

Chapter 9: Triggers to a Bipolar Episode

Chapter 10: Management of Bipolar Disorder

Chapter 11: Helping Your Loved One

Chapter 12: Handling Supporter Anxiety and Worry

Chapter 13: Finances and Money Problems

Chapter 14: Sex and Your Relationship

Chapter 15: Dealing with Anger, Lying, and Manipulation

Chapter 16: Cognitive Behavioral Therapy (CBT)

Chapter 17: Avoiding Caregiver Burnout

Chapter 18: Supporting the Supporter

Chapter 19: The Red Line and Enabling

Chapter 20: Winning Ways to Keep Going

Chapter 21: There IS Hope

Chapter 22: Find Hidden Resources

Chapter 23: Conclusion

BIBLIOGRAPHY

# Chapter 1: Introduction

I want to commend you and offer my congratulations on getting this book! It was a brave step indeed. But first, let me thank you for doing what you do with your family. . . because rarely as a supporter of someone with bipolar disorder do you get any credit.

This book collects the results of over ten years of experience helping and supporting people with bipolar disorder. That experience comes not only from my own role as a supporter of my own mother, but also hundreds of others whom I personally helped with issues concerning their loved ones, as part of many bipolar support groups. I've also been in contact with thousands of others.

When you add all this together I've actually gathered over 1,000 case studies on bipolar supporters! That's how I learned exactly what to do, when to do it, what not to do, and all the solutions and strategies which successful bipolar supporters use all over the world. I compiled their experience, along with my own, into this comprehensive book. This book CAN give you back your normal life, help you regain control over your time, and (believe it or not) live stress free.

So let's begin our journey together...OK?

First of all, to help you appreciate where I'm coming from and why I'm passionate about helping others struggling to support someone with bipolar disorder, let me share my own family history. My mother has bipolar disorder, and I am her primary supporter. I therefore very deeply understand what it's like to support someone with bipolar disorder. I not only have firsthand experience...but also an in-depth knowledge of bipolar disorder from years and years of research.

Like you, I'm all too aware of the devastation that bipolar disorder causes in our families. My family made MANY horrific mistakes handling my mother's bipolar disorder until I decided to find a way to genuinely help her and the millions of other individuals and families who live with this awful problem.

I started supporting mom in the late 1990s. In the early 2000s, she got sick. We figured out that she had bipolar disorder and other mental illnesses.

During this time, I also started to attend several mental health support groups. A man there indicated that I had to learn how to be a great supporter to help my mom.

From that point forward, I was devoted to helping my mom and learning how to be a great supporter.

Eventually I realized I needed to know:

  * What my mom had
  * Why she had it
  * What I could do to help her
  * How to find people to help her
  * How she could help herself
  * What kind of doctors she needed
  * What other kinds of people she needed to help her
  * What help was available in the community
  * What kind of medicines she should be taking
  * What she needed to do to get stable
  * Whether other people with these disorders were successful
  * What they did to get successful
  * How to set up a great future for her
  * Whether she would always have episodes

At the time, my father had a heart condition and I didn't want to overly involve him because stress could kill him, so I became my mom's primary supporter. Because of my experience with her and all the research I did about her disorder, as well as all the other people I talked to, I became a sort of "expert" on bipolar disorder.

I started meeting other supporters and people with bipolar that needed help so I started coaching and supporting them as well.

From the mid to late 2000s to mid-2010s, my mom did well. She had about ten great years but then relapsed again. Later on in the book you will find out how she could have so many great years and then relapse.

In the last decade, I started coaching:

  * A woman with bipolar disorder
  * A woman supporting a child with bipolar disorder
  * A man supporting a mother, brother and sister with bipolar disorder
  * A man supporting a father with schizophrenia
  * A woman supporting a sister with bipolar disorder
  * A woman supporting a son with bipolar disorder
  * A woman supporting a sister and many family members with bipolar disorder.

I noticed that people were making the same mistakes and those with success were doing similar things. I started privately sharing success tips, do's and don't's with the students.

From 2010-2013, my mom had some mini-episodes here and there, but because of my coaching her as well, she did relatively well over those years, never needing to be hospitalized.

In 2013, my mom started acting strange again and had to be hospitalized. She then went on to be hospitalized eight times in only a few years. It took massive effort and investigation to figure out how someone could go from doing great for so many years and having an episode one time every seven to eight years to having an episode every few months. Later you will discover why.

Eventually I helped to stabilize my mom. It took a lot of time and energy, and a lot of effort on my part.

For the last decade, I have been coaching a number of people including my own mom. Some have done great. Some have done terrible. I have carefully tracked, analyzed and recorded the good, the bad, and the ugly to share with others.

While I was glad to have helped my mom and so many others, I realized that while there was a lot of information on bipolar disorder itself, there were virtually NO books available to help their family members... the people who SUPPORT the person with bipolar disorder. I'd also learned from firsthand experience a book like that was desperately needed.

I wanted to create a book that contained all my results to help millions of people. I figured I could give it away and help many people avoid the nightmare that myself and numerous other people went through.

My goal is to make things easier for you, to help you avoid what I have endured, and to teach you what I learned, all in this comprehensive book. I have worked hard and hope you enjoy it.

Recently, I did a search on Amazon.com for books specifically for the bipolar supporter, and found just three! Can you imagine? Three! And there are millions of bipolar supporters out there, struggling daily with the issues of coping and dealing with a loved one with bipolar disorder.

So I saw the need for a book written for the bipolar supporter that addressed these issues, which also provided basic background on bipolar disorder itself. In other words, if there were to be just one book to help a bipolar supporter who was trying to cope and deal with a loved one, I wanted this to be it.

So that's my goal for the book you're reading right now. Call it a "one-stop shop" for everything you wanted to know about bipolar disorder, as well as the specific issues you will be dealing with as a supporter...

This is something no other book provides you.

Before you start, think about your mission in reading this book. Your mission should be your purpose. In your case, your mission should have to do with learning more about bipolar disorder and how to help your loved one. But it could also have to do with learning how to help yourself, so I've included important information on that as well.

You should also consider your objective for your mission. In this you set some goals for yourself, as you just read that I set for myself. For example, you could set a time frame in which to read the book, or in which to apply the principles set forth within it.

For a FREE worksheet that helps you set appropriate, achievable goals for stability with your loved one with bipolar please visit www.BipolarFamilyCure.com

# Chapter 2: This Is WAR and You Are a General

I love studying military theory. Many years ago I read a book on nuclear war called The Wizards of Armageddon by Fred M. Kaplan and I could see how it can relate to bipolar disorder.

You may not have thought of it this way, but you are in a war with bipolar disorder. You need to think of yourself as a general in this war. And in that light, strategy is crucial.

Most supporters don't stop to consider strategic principles in their war with bipolar disorder. That's why they are not only losing the battles they are facing, but the war itself.

They don't question their routines or the way they do things – they just go along doing them the way they've always been done. They don't consider that consistently doing things the same way and failing is the reason they're losing the war. And they don't consider there may be a better way... having a strategy!

Most supporters do not actually strategize; therefore, they keep facing the same problems over and over again. Problems with anger, rage, lying, money problems, not achieving goals, etc.

And if they strategize at all, they don't do it often enough (or deep enough), nor do they plan ahead for enough of the inevitable problems bipolar disorder creates.

My family didn't have a plan at all. They just kept doing the same thing day after day. This is the polar opposite of what a good general does in the military: Strategic thinking and planning; i.e., the setting of goals and the development of long-range plans to reach those goals. When you think and plan strategically, your goals determine what actions you take today, tomorrow, and in the days, months, or years it may take to successfully complete these goals.

Strategic thinking can help you cope with a constantly changing environment, and your goals can change along with it, because you can be flexible.

Unfortunately, most supporters don't use strategic thinking. Therefore, they make constant strategic mistakes. Here are some of the most common:

  * They don't get their loved one diagnosed.
  * They don't get their loved one into treatment.
  * They don't insure that their loved one takes their medication.
  * They don't get a good doctor for their loved one.
  * They don't make their loved one go to the doctor.
  * They are too cheap to hire a good therapist.
  * They invest money in the wrong places.
  * They don't take over the finances.
  * They are too cheap to buy books or courses to learn about bipolar.
  * They don't attend a bipolar support group.
  * They don't form a support system.
  * They isolate themselves.
  * They don't take care of themselves first.
  * They only think day-to-day and not of the long-term.
  * They are not positive thinkers.
  * They don't get involved with their loved one's treatment.
  * They give up hope for recovery.

In general, the worst strategic mistake supporters make is not doing the right things, or not doing anything at all!

To be a good strategist, you need to be able to look at the big picture, but you also need to be able to see the details as well, and you need to be able to jump back and forth between the two. Most supporters can't do that.

A good general gathers intel (intelligence/information) from a multitude of different sources. Could you imagine if he didn't do that? He'd have to "fly blind," wouldn't he?

You need to gather intel as well. Gather it from as many sources as you can to gain the best strategic advantage.

Many people simply overcompensate for their problems, which leads to real difficulties with strategizing. When a general overreacts to problems on the battlefield, he is not proactive, but reactive. You don't want to be like that – you want to be proactive.

Say you're facing inappropriate rage in your loved one. Imagine if you kept reacting to their rage with anger of your own, instead of strategizing exactly how to react to diffuse their anger; such as staying calm and reflecting their feelings back to them, or telling them you will discuss the issue with them at another time when they are not so angry.

Sometimes supporters focus on the small picture when they should be focusing on the bigger picture. My mom used to do this thing I called the "sidetrack." She would get you focused on the wrong thing. For example, she'd get fired, then claim the boss mistreated her. She'd say the boss did this and that, making them seem terrible. So we'd focus on that, which was entirely the wrong thing to do. We should've been getting that doctor more specific information on what was going on. For years, my dad, myself and hundreds of people I've spoken to in similar situations were unknowingly focused on the wrong thing. Bipolar patients are very good at making this happen!

I can't emphasize enough how important it is to take the time to strategize. A general who doesn't take the time to strategize is "flying by the seat of his pants," and quickly finds his army dead in the water.

And remember: Strategic thinking is not natural, so you'll need to make an effort.

You need to get to the root of the problems and fix them there. If you allow your loved one with bipolar to distract and confuse you, you'll wind up trying to fix cracks in a dam without addressing the structure of the dam itself. Soon water will be gushing all over the place!

The problems created in your family by your loved one with bipolar will quickly overwhelm you if you don't strategize and fix them at the root.

Developing your strategic resources means you prepare what you need ahead of time in order to accomplish your goals. In your case, your goal is to stabilize your loved one with bipolar. To do this you'll need to be sure they can afford a caring, available, and accessible doctor... plus the right medication and psychotherapy. Those are the basics. You must strategically set up your situation so this can happen.

Now I want to discuss the seven pillars of strategic thinking, which were developed by Leo, from www.actualized.org.

They are:

1. Strategic Intent

2. Strategic Analysis

3. Strategic Preparation

4. Concentration of Force

5. Detailed Execution

6. Adaptability

7. The Study of Principles

Strategic Intent has to do with your view of the future, and how it influences the actions you take today, tomorrow, a year from now, ten years from now, etc. You have an ultimate plan, so that everything you do lines up with that plan, that purpose. Imagine that you are the general in this war against bipolar disorder. In order for you to win the war, everything you do, every battle you fight, must advance you towards your ultimate purpose of winning that war.

Strategic Analysis is where you analyze the battlefield and all the threats and opportunities, weaknesses and strengths it presents. Then ask yourself if you are using all necessary resources effectively toward winning the war against bipolar disorder. And you must always keep in mind the fluidity of the battlefield; i.e., its ever-changing nature. Your strategy must be flexible enough to adapt as the battlefield evolves.

Strategic Preparation is what you do to build up your "strategic reserves." If you don't do this, you will only be limiting yourself, and you will lose the battles you are facing. You have to prepare! You have to train through hard work and discipline, always keeping the ultimate purpose in mind of winning the war. This will take solid and firm planning on your part, using the capabilities that only you have. These will work to your advantage, but only if you plan ahead.

Concentration of Force is what the military terms that "decisive point where you break through into victory." You'll need to find the exact point where you can "break through to victory" in your war against bipolar disorder. Find your "enemy's" weakest point, and strike there, using all the force at your command! Strike from your position of strength, always, at the weakest point, so you have the greatest leverage, and you will win your battles! And remember, your enemy is not your loved one, it is their bipolar disorder.

Detailed Execution is what you do after you have determined your plan, after you have gotten together all your resources, and know where your "concentration of force" is going to be. Leo says, "A great plan, poorly executed, leads to disaster. Great execution with no plan also leads nowhere... You need both." I agree with him.

Adaptability has to do with how flexible you are in your strategy for the war. You cannot have the same strategy for the whole war and expect to win – you must be adaptable, because remember, your situation is constantly changing, and you must constantly change with it. Therefore, you must adapt to the changing situation. What works for you today might not work for you tomorrow. Be willing to try something else.

The Study of Principles describes your need to study not only the principles of war, but to study other principles as well; such as: psychology, sociology, history, etc. Then you will have a more well-rounded approach to your life in general and your war with bipolar disorder in specific. It will also help you with your relationship with your loved one. You not only need to learn and use these principles now, but for the rest of your life.

In my opinion, the most important of these pillars of strategic thinking, when it comes to the war against bipolar disorder, is adaptability.

Many times, you're dealing with unknown variables. For example, you may never know what mood your loved one will be in when you wake up in the morning. So you have to be able to adapt to unpredictable mood swings.

You have to be flexible in how you deal with bipolar behavior, too. Sometimes you even have to scrap your plans entirely and try something new if what you're doing isn't working.

You need to take your cue from business. Some of the most successful businesses started out with one idea of how to do things, and when that idea didn't work, they went in a totally different direction and made a lot more money!

Leo gives a perfect example of this using PayPal: "PayPal, as a business, started out as mobile payment processing for palm pilots, and that of course, didn't work, and then they got the bright idea, 'hey, why don't we just email each other payments. Let's create a system that allows people to email each other money' and then they came up with PayPal – generated billions of dollars – but, see, they were flexible enough to change. Because if they had just stuck with their original idea, they would have gotten nowhere – would have gone bankrupt."[1]

I've prepared a FREE cheat sheet which helps you implement battle lessons from the greatest military events in history at www.BipolarFamilyCure.com

# Chapter 3: Common Strategy Mistakes

There are several strategic mistakes people supporting loved ones with bipolar disorder commonly make. Let's talk about the most common ones.

The first strategy mistake supporters employ is not having a strategy at all. Many supporters simply don't have one, in any way, shape, or form. If we look at our analogy to "winning a war" and "being a general," we know it wouldn't make any sense at all for a general to start a war with absolutely no strategy, goals, or objectives. One of the biggest mistakes people make is basically acting at random over a period of time, which ends in a disaster. It wastes their time, their loved one never really gets the help they need, and they essentially spin their wheels in a very nonproductive, even harmful fashion.

The next strategic mistake supporters make is destroying themselves in the process of trying to help their loved one. They do SO much that they forget to care for themselves. Some examples: You're supporting someone with bipolar disorder so you don't show up to your job, you don't sleep, you don't eat, and you get stressed out all the time... which ultimately makes you sick. You might even get fired.

The next big strategic mistake is getting stymied by privacy laws in your attempts to help your loved one. This happens when you call their doctor, but the doctor says they can't talk to you because there's a privacy law. If you're in the United States, it's the HIPAA law; if you're in other countries, there are different names for these laws but they function essentially the same way... dead end road blocks if you don't anticipate and deal with them beforehand.

The worst thing to do in these cases is nothing.

Remember, in virtually every case, regardless of what law is in place, you can SEND information on somebody to the doctor. The law prevents the doctor from communicating with you, but YOU can communicate with them.

You can get on the phone or write a letter, email, or text to explain what's going on. Stand firm and tell the doctor or therapist or treatment team that you know they can't tell you anything about the patient in return, but you want them to have this information in order to help your loved one. Sometimes you may have to get an attorney involved.

Another strategy mistake is being a weak supporter, and I will call that being a weak general. There are many supporters like this, my own father included. He was a great person, so strong in all aspects of his life, except when it came to supporting and helping my mom help herself with her bipolar and personality disorder.

My dad would cave; the doctors would say just one simple thing like "we can't talk to you," and that was it. My dad would never push; he just gave up. I, on the other hand, employ a strategy of going all out. I will let these doctors and therapists have it, send 10-15 page letters by certified registered mail. I will email, fax, text message, and send letters. I will let people know I mean business. I will let them know that, if they tell me things, I will double check, triple check, quadruple check. I will make sure it is right. If it's wrong, I will come back hard on those people.

I have an objective, and that objective is to help my mom get stable again, be successful and have a great life. There are some people that are interfering with that objective. In war, we call these people "collateral damage."

I like to start a thing which, in war, would be called graduated reprisals. That means I start nice and I escalate. For example, once I tried to talk to the social worker who was supposed to communicate with me every few days about what was going on while my mother was in the hospital. I would call kindly and courteously to leave a message. The social worker would never pick up the phone. I did this many times; my mom was in the hospital for several weeks. The social worker would not call me back.

I had to remind myself of this strategy; then I wrote a letter to the head of the hospital and her boss. I said in the letter that she didn't get back to me like she should (according to the hospital's own policies and procedures) and she should be immediately fired because she's terrible and wasn't doing her job. That's exactly what I put in the letter, and it took less than 24 hours for them (and her) to get back to me. They were all sorry and she updated me regularly after that.

You have to have an objective, you have to focus on that objective, and that objective for most people is to help their loved one be independent, to be stable, to be successful, to live a great life, and to get back to their old self. That is generally the objective. Stay focused and be tough; you must find and lead good people (psychiatrists, therapists, treatment teams), just like George Washington did.

Another big mistake is setting up the wrong objective. Some people don't want to be long-term supporters. Let's say you're moving away from your loved one or you live in a different state. Your objective may be to get them independent of you, on a good track, so you are not involved. You must remember what your objective is. Do you want bipolar disorder to consume your life for the next 20, 30, even 50 years? Some people do have that as a plan. They have no other plan, so that becomes the plan by default. You have to have a clear objective.

Another strategy mistake is not watching the finances. This is a huge mistake. My father was amazing at watching finances...except when it came to my mom's bipolar disorder. He would watch every single thing –both saving and making money. When it came to my mom, however, he never even questioned a single expense she had from her bipolar disorder.

At some point, when my mom was ill, she would go and buy thousands of dollars of groceries, bring them home, throw them away, and repeat the process 2-3 times per month. Her grocery bill, at its highest, was $3,000. This was 10 years ago, during a particular episode in the mid-2000s. My dad wouldn't even look at it. He wouldn't even think about it! He would try to save money in all areas, other than my mother manically wasting money.

Imagine how crazy it is to try to make and save money, only to offset someone buying $3000 of groceries and throw it away as soon as they got home! That sounds incredible, I know, but that was the truth. Until I stepped in and took all my mom's credit cards away from her, stopped all that, and got her to the hospital, this had gone on for close to a year. At that point, I told my dad we had to guard the finances, especially when it comes to my mom.

Now, with supporters, there are two kinds of thinking on this. There's "watch your loved one with the finances" and them not overspending, withdrawing your credit or checking accounts and so forth, but there's also watching your own finances. You can destroy your finances by getting fired from your job because of poor attendance, acting erratic at work, lashing out at your boss, or making irrational decisions at work, all because of your loved one's bipolar disorder.

Another strategy mistake is assuming the treatment is great. Many, many supporters assume treatment (and the treatment team) are terrific without checking on them. I call this outsourcing the treatment. Most likely, you're not going to be your loved one's doctor because you're not a psychiatrist or any sort of treatment professional. However, one mistake made time and time again is to assume everyone's doing a great job and not checking up on them. It's like a business. It's like a war. A general is not going to assume everyone's doing a great job and never look at a single report or ask a single question. You need to hold the treatment team accountable.

Another mistake, strategically, is not reporting symptoms or even side effects. You can report to the doctor, the therapist, and the treatment team side effects and symptoms YOU are seeing. Remember, they might not be able to communicate back, but you can certainly send information to them and they'll have to look at it. Send all this information by certified regular mail to ensure that they get it. This way, they'll know you are serious, and there is a paper trail so they can't pretend they didn't receive it. (This makes them accountable).

Another strategic mistake is wasting time arguing with your loved one. It's a waste of time but, unfortunately, I sometimes violate this one, too. I do argue with my mom. She drives me absolutely crazy! I'm just being honest, but it's a struggle for me. She'll say, for example, that I'm not a good son, that I don't care about her, and why won't I give her money? Money is the big thing to my mom; it's like a drug to her. If you give her a credit card or cash, she spends it on nonsense. It makes her feel good for a short period of time, which is bad for her. So we argue about money, but I know I shouldn't – it is a waste of time.

Another strategic mistake is not employing the Ronald Reagan strategy of "Trust, but verify." You trust your loved one and their treatment team, but you still verify what they tell you. Everything has to be checked - the doctor, the therapist, the medication. What prescription did the doctor write? Is it being filled correctly in the pharmacy? Is your loved one really going to therapy? Are they really doing what they're supposed to be doing?

Another huge strategic mistake, and this could apply to your whole life, is listening to people who have absolutely no idea what they're talking about with bipolar disorder. Talking to other mentally ill people who are not well, talking to friends, religious people, or even random people who give unsolicited advice will NOT help.

For example, a common piece of advice is to "Pray about it." Prayer is great but prayer without action is not going to work. This is why if you're broke and have no job and you just sit at home and pray for a job and money to come through your door, it's never coming because obviously God is never going to reward people on this earth if they don't use the tools He gave them.

You have to be very careful with suggestions like this; they're like cancers in your mind. They can lead you off track. Instead, talk to people who know what they're talking about, who have experience. Talk to people who are going to give you good guidance.

Another huge strategic mistake is fixing all the person's problems after their episode. This is a very bad idea, even if they're just in the middle of an episode, because they never learn from it. One of the greatest pieces of advice I ever got came when my mom ran up massive debt during a manic episode.

I was going to pay off her debt by going to her mother, myself and another family member. I thought we could split it three ways and give her a clean, fresh start. This wonderful social worker/therapist told me not to pay anything, to not fix any of it, and let my mom deal with it. That's what I ended up doing and I have to tell you – it worked!

After that, my mom never ran up debt again because of the torture of having to pay it all back. It took her years to pay it all back and, she eventually told me, she never wanted to experience that feeling again.

Another strategy mistake is ultimately not realizing that this is a long-term war. I'm not sure anyone can ever win the war against bipolar once and for all. I'm inclined to say no; even that it's like the war on terror—it will go on forever. It may be subdued and it may be very small, but it will be there.

I have several people who have worked for me for more than ten years who have bipolar disorder. They've done great, but both they and I have a readiness. If something happens, we have a plan. You have to realize the war will never be won. You're not going to get a letter from your loved one's bipolar disorder saying "I give up! I'm going away and I'm never coming back again!" It's just something you have to manage and realize that, strategically, every hour, which becomes a day, a week, a month, even a year, where your loved one is stable is setting you up for the next episode. You let your guard down, you let the systems fall apart.

That's what happened to us. My mom was great for about ten years and then all the systems went out the window. She went into another major catastrophic episode. And that was after a great ten-year run! You've got to maintain vigilance; you must keep the systems.

Fortunately, with today's technology, your phone can send you reminders to check things. It makes sense to set a reminder to check in with the doctor periodically, check with your therapist, ask your loved one some questions, take a look at the pharmacy bill to see if medication is being paid for and taken, etc.

Setting reminders to check your loved one's stability is important for handing things in the long haul. Think about a general who now is in charge of a country he has conquered. The war may be sort of over, but he must still maintain the peace. Maintaining the peace (stability in your loved one) is a task that must be done. For some, it is tougher than the original task of establishing the stability.

Although there are many strategy mistakes that a supporter can make, they can be avoided if you are aware of them.

For a FREE checklist of the most common strategic mistakes, and a worksheet which helps you avoid them... please visit www.BipolarFamilyCure.com

# Chapter 4: History and Basics of Bipolar Disorder

Bipolar disorder can actually be traced all the way back to a Greek physician named Aretaeus of Cappadocia, who was a physician and philosopher in the time of Nero or Vespasian (1st century AD) in Greece.

The ancient Greeks and Romans coined the terms "mania" and "melancholia," which are what we call manic and depression today.[2]

Robert Burton's 17th Century book, The Anatomy of Melancholy, discusses the use of music and dance in treating melancholy. Most notably, The Anatomy of Melancholy provides early reports of depression.[3]

In 1854, Jules Baillarger and Jean-Pierre Falret independently presented descriptions of what we now perceive of as bipolar disorder to the Académie de Médicine in Paris. Folie à double forme ('dual-form insanity') is what Ballarger called it, and folie circulaire ('circular insanity') is what Falret called it.

In the Early 1900's, Emil Kraepelin, an eminent German psychiatrist, presented his concepts in a book called Manic Depressive Insanity and Paranoia, which detailed the difference between manic depression and praecox (now known as schizophrenia). His classification of mental disorders is still used by mental health professionals today.

Three researchers, Carlo Perris, Jules Angst, and George Winoku, working during the 1960's (independently), published findings that showed the difference between unipolar depression and bipolar disorder.

Then in 1980 the American Psychiatric Association decided to refer to it as "bipolar disorder" instead of manic depression in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, as it is known today.

According to the National Institute of Mental Health (NIMH), bipolar disorder is "a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks."[4]

The World Health Organization states that bipolar disorder is the sixth leading cause of disability in the world.

According to CNN.com, "About 2.4% of people around the world have had a diagnosis of bipolar disorder at some point in their lifetime, according to the first comprehensive international figures on the topic. The United States has the highest lifetime rate of bipolar disorder at 4.4%."[5] With a population of over 324 million people according to the U.S. census, that would mean that bipolar disorder affects over 14 million people in the United States alone.

There are three major types of bipolar disorder: bipolar I, bipolar II, and cyclothymia, and there are distinctive differences between the three.

Bipolar I

Bipolar I is the most serious form of bipolar disorder. With this type of bipolar, you find at least one manic or mixed episode, but your loved one may also have had a major depressive episode before.

Bipolar II

Bipolar II is not a milder form of bipolar I, but a separate diagnosis. With this type of bipolar, you find at least one depressive episode and hypomanic episode (a less severe form of mania). There will be more hypomanic episodes than depressive episodes, and your loved one will not have a full-blown manic or mixed episode.

Cyclothymia

Cyclothymia still has the highs and lows of bipolar I and bipolar II, but they won't be as extreme as the ones you find with the other types of bipolar. Between these highs and lows, your loved one may feel stable and fine.

Hypomania

Hypomania has episodes that are less severe forms of mania. It has the elevated moods of mania, but they are not as extreme. You will also find other symptoms in common with mania, such as decreased need for sleep; however, these will not cause as much disruption in your loved one's life as the mania would.

Mixed Episodes

Sometimes a person with bipolar disorder can have elements of both mania and depression at the same time. This is called a mixed episode. One of the differences, though, is that your loved one would feel agitation instead of euphoria like they would feel with usual mania.

Psychosis

According to the Mayo Clinic, psychosis is a severe episode of either mania or depression (but not hypomania) that results in your loved one's breaking from reality and suffering delusions (false beliefs) and hallucinations (seeing or hearing things that aren't there).[6]

Take a FREE Quiz to help you remember the basic types of bipolar disorder so you can quickly identify and take action if you see them in your loved one at www.BipolarFamilyCure.com

# Chapter 5: Signs and Symptoms of Bipolar Disorder

When there are changes in your loved one's behavior, thoughts, or feelings, these can be warning signs that they may be going into a bipolar episode. If you get to know your loved one's warning signs, you can help them prevent a full-blown bipolar episode. Knowing the symptoms of bipolar mania and depression will help you do that.

The Diagnostic and Statistical Manual on Mental Disorders, published by the American Psychiatric Association (DSM-V), says that a manic episode must last at least a week and must have at least three of the following symptoms:[7]

  * high self-esteem
  * little need for sleep
  * increased rate of speech (talking fast)
  * flight of ideas
  * easily distracted
  * an increased interest in goals or activities
  * psychomotor agitation (pacing, hand wringing, etc.)
  * increased pursuit of activities with a high risk of danger

The DSM-V states that a major depressive episode must have at least four of the following symptoms. They should be new or suddenly worse, and must last for at least two weeks:

  * changes in appetite or weight, sleep, or psychomotor activity
  * decreased energy
  * feelings of worthlessness or guilt
  * trouble thinking, concentrating, or making decisions
  * thoughts of death or suicidal plans or attempts

In addition to the symptoms laid out in the DSM-V, there can be hidden signs that are warning signs to a bipolar episode in your loved one. Here are some of them:

Hidden Signs of Bipolar Disorder

  1. Expansive gestures

If your loved one starts being "extra nice" to you, doing things that are out-of-character for them, these can indicate the beginnings of a manic episode.

  2. Inability to complete To-Do-List

If your loved one is stable, they should be able to complete the tasks you outline on a simple To-Do List for them. However, if they are entering a manic episode, they might get caught up in some of the tasks, to the exclusion of others.

  3. Changes in taste

Your loved one (like anyone) has a certain taste or style in clothes. If you see them change this style, it could be a warning sign that they are going into a manic episode. They might also change their taste in food or other things as well. This could also be a sign.

  4. Snapping at you

If your loved one is stable, their mood should be on an even keel. But if they start snapping at you, this could be a sign of irritability, which could indicate the onset of a bipolar episode.

  5. Being more talkative than usual

One of the signs of mania is talkativeness, or pressured speech. If your loved one seems to be more talkative than usual, especially if they change from topic to topic, they might be going into a manic episode.

  6. Problems at work

One of the characteristics of bipolar disorder is that it makes it harder to function in the workplace. Your loved one could have issues such as attendance, inability to focus, and problems with coworkers (or their boss), which could indicate a bipolar episode.

  7. Alcohol or drug abuse

Many people with bipolar disorder also abuse alcohol and drugs. They use alcohol to try to feel better when they're depressed, and to slow down when they're manic. If you see this in your loved one, they might be in an episode.

  8. Sneaky behavior

Your loved one might begin to do things behind your back if they're in an episode. For example, they might "borrow" your credit card and go on a shopping spree or begin an illicit affair if they're manic.

  9. Sleep problems

If your loved one is in a manic episode, they might not be sleeping as much because they don't feel they need as much sleep; however, if they are in a depressive episode, they might sleep all the time but still not be rested.

  10. Lying and manipulation

One of the biggest hidden signs of bipolar disorder is lying and manipulation. Sometimes, in a manic episode, your loved one will do things they wouldn't normally do if they weren't in an episode. Then they might try to cover up for it by lying. Sometimes they will deliberately try to manipulate you.

Difference Between Bipolar I and Bipolar II

Many people wonder about the difference between bipolar I and bipolar II disorder. There are several differences between the two disorders.

For one thing, you don't have to have had a depressive episode with bipolar I, where you have to with bipolar II.

To receive a diagnosis of bipolar I disorder, you need to have had at least one full-blown manic episode; whereas with bipolar II, you experience hypomania instead of full-blown mania.

One major difference between the two is that with bipolar I, you can have mixed episodes, but with bipolar II, you won't have mixed episodes.

Specifically, the main difference between bipolar I and bipolar II is whether or not you experience mania: if you do, you have bipolar I; if you don't, you have bipolar II.

For a FREE assessment checklist to help identify the various signs and symptoms of a bipolar episode please visit www.BipolarFamilyCure.com

# Chapter 6: Causes and Diagnosis of Bipolar Disorder

Here is one very important thing you need to know: bipolar disorder is NOT your loved one's fault. It is a brain disorder that involves many factors, including biology and environment. The specific cause of bipolar disorder is not exactly known. Neurochemical, genetic and environmental factors probably all play a role in the development of bipolar disorder.

An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder. Serotonin is one of these neurotransmitters, and it is connected to many body functions such as sleep, wakefulness, eating, sexual activity, impulsivity, learning, and memory.

Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. There is a 10%-25% chance of developing bipolar disorder in children with one parent who has it, while children who have two parents with it have a 10%-50% chance. There is a 10%-25% chance for one sibling to get the disorder if a non-identical twin sibling has it.[8]

Research shows that if one identical twin has bipolar disorder, the other twin has a greater chance of developing the disorder than another sibling in the family. There is a 40% to 70% chance for an identical twin of a twin with bipolar to also get the disorder.[9]

Studies at Stanford University researching the bipolar genetic connection discovered that when one parent has bipolar disorder, the children are more likely to get it as well. The study found that 51% of the children of a bipolar parent had a psychiatric disorder; i.e., major depression, bipolar disorder, or attention deficit hyperactivity disorder (ADHD). An interesting aspect of the study was that there was a greater chance for the parents with bipolar disorder who had a childhood history of ADHD to have children with bipolar disorder rather than ADHD.[10]

Children can also be surrounded by environmental factors that can influence whether they are at greater risk of developing bipolar disorder. These may include living with a parent who leans toward mood swings or actually has bipolar disorder, alcohol or substance abuse, financial problems, sexual indiscretions, and hospitalizations.

A life event can trigger a bipolar episode in a person who was otherwise not at risk of developing bipolar disorder. This can be something like marriage, a death in the family, a major move, starting a new job or losing a job, a serious physical illness (or hormonal imbalance), extreme stress, etc.

It's normal to wonder, "Does my loved one have bipolar disorder, or is this just their personality?" All the self-tests in the world are only an indication that your loved one has bipolar disorder. Only a medical or mental health professional can diagnosis a person with bipolar disorder.

A diagnostic exam for bipolar disorder generally consists of the following:

Psychological evaluation – The doctor or psychiatrist will conduct a complete psychiatric history. Your loved one will answer questions about their symptoms, the history of the problem, any treatment they've had before, and their family history.

Medical history and physical exam –No lab tests currently exist that can physically detect bipolar disorder, but any doctor will most likely do a complete medical history and physical exam that will rule out other explanations for the symptoms your loved one may be experiencing; such as thyroid problems, which can cause mood swings.[11]

In addition, the doctor will want to talk to you and other family members and friends about your loved one's moods and behaviors. Many times, you are more objective than your loved one and can give a more accurate accounting of the situation, because you can see things that your loved one may not see (or may be in denial of).

Bipolar disorder can often be missed and go undiagnosed because its symptoms can appear as other disorders.

Depression (unipolar depression/major depression) is the most common misdiagnosis. Being misdiagnosed with depression can be a dangerous problem because the treatment for regular depression and the treatment for bipolar disorder are entirely different. In fact, antidepressants, the usual treatment for regular depression, can actually make bipolar disorder worse and cause the person to go into a manic episode.

Other common misdiagnoses are: attention deficit disorder (ADD or ADHD), anxiety disorders, and borderline personality disorder.

I've read that as many as 20 percent of adults with bipolar disorder also have attention deficit hyperactivity disorder (ADHD).[12] Many of the symptoms are similar between both of these disorders (such as distractibility, frequency of interrupting conversations, and agitation), so a person can be diagnosed with ADHD and the bipolar diagnosis can be overlooked.

Anxiety disorders, such as generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder (PTSD), are common in people with bipolar disorder. It has been shown that about 70 percent of people who have bipolar disorder also suffer from increased anxiety.[13]

Borderline personality disorder is characterized by poor self-image and unstable interpersonal relationships. However, it is also typically associated with impulsivity, anger and irritability, mood swings, and self-injurious behavior. Some of these characteristics are also seen in bipolar disorder. Although some people can have both disorders, many times people are diagnosed with the borderline personality disorder, missing the bipolar diagnosis completely.

For a FREE diagnostic cheat sheet with all the various co-occurring diagnoses along with bipolar disorder please visit www.BipolarFamilyCure.com

# Chapter 7: Treatment for Bipolar Disorder

There is no cure for bipolar disorder at this time; however, there is treatment for it. Treatment consists of medication and therapy.

Effective treatment for bipolar disorder can relieve your loved one's symptoms, reduce the frequency and intensity of bipolar episodes, and restore their ability to function.

It can help your loved one reach their goals, build on the strengths they have and the things they can do, and help them live their life without the interference of bipolar symptoms.

Once you suspect that your loved one has bipolar disorder, finding the right doctor is crucial to making the final diagnosis. You can choose either a psychiatrist or a psychologist; however, there are differences between the two.

A psychiatrist is a medical doctor who specializes in dealing with the diagnosis and treatment of mental disorders. Like all medical doctors, a psychiatrist can prescribe medication for your loved one. Although a psychiatrist may ask about your loved one's condition and progress, state of mind, etc., they are not a therapist. Therefore, they may not show interest in these things and only stick to diagnosis and medication follow-up for your loved one, leaving the other issues for the therapist.

A psychologist is not a medical doctor, but has a PhD and deals with the diagnosis and treatment of mental disorders. A psychologist uses non-medical therapies such as talk therapy (cognitive behavioral therapy). However, the psychologist is not able to prescribe medication, and will refer your loved one to a psychiatrist for this.

NOTE: Although your loved one's primary care physician may have made the original diagnosis of bipolar disorder, a medical doctor will usually defer the final diagnosis and prescription of medication to a psychiatrist, so don't be surprised if your loved one's doctor refers them to one.

Finding the right psychiatrist to treat your loved one is not always easy, and you may not "strike gold" on your first try. Some people have to go through several psychiatrists before they find the right one.

Try to find one who:

  * Has experience with bipolar disorder
  * Is open and honest
  * Is caring and empathetic
  * Spends adequate time during visits
  * Is receptive to questions
  * Let's you be involved in your loved one's treatment
  * Treats you and your loved one with respect
  * Is available in an emergency

Try to avoid an assembly-line doctor. Sometimes even one who meets these criteria can have so many patients that they begin to see them as "all alike" and uses a "cookie cutter" treatment for all of them. If you feel your loved one is getting this type of treatment, do not hesitate to find another doctor.

Treatment for bipolar disorder is best given by a psychiatrist who is skilled in treating the disorder. But you may also deal with a treatment team that includes a psychologist, social worker, case manager, and/or nurse practitioner.

Depending on your loved one's needs, treatment may include any or all of the following:[14]

  * Emergency treatment. Many times your loved one will need emergency treatment right away. This usually means the onset of medications. The doctor or psychiatrist will prescribe what they need. They may also begin therapy right away as well, especially if they are in a hospital setting.
  * Continued treatment. Bipolar disorder is a lifetime illness, and your loved one will need long-term maintenance of their disorder. If they don't, they will continually remain unstable and will suffer many unnecessary bipolar episodes.
  * Outpatient programs. Your loved one's doctor may recommend an outpatient or day treatment program for your loved one, usually following a hospitalization. An outpatient program provides close supervision while helping your loved one recover from a recent bipolar episode.
  * Substance abuse treatment. If your loved one is abusing alcohol or drugs, they'll also need treatment for this. If they don't, they won't be able to maintain any long-term stability with their bipolar disorder.
  * Hospitalization. Sometimes hospitalization is the only answer, especially if your loved one is homicidal or suicidal, or if they have lost touch with reality. Hospitalization provides the closest supervision possible, along with daily therapy and close monitoring by a psychiatrist until your loved one is no longer in crisis.

The primary treatments for bipolar disorder include medication and therapy, but may also include education and support groups.

Research indicates that people who take medications for bipolar disorder are more likely to get better faster and stay well longer if therapy is also a part of their treatment.[15] Therapy can teach your loved one how to deal with the issues that are brought about because of their bipolar disorder, including relationships, work and home life, and self-esteem. Therapy can also help with alcohol and drug problems.

Three types of therapy are especially helpful in the treatment of bipolar disorder:

  1. Cognitive behavioral therapy
  2. Interpersonal and social rhythm therapy
  3. Family-focused therapy

Cognitive Behavioral Therapy (CBT)

CBT looks at the relationship between thoughts and actions, and how these are affected by your emotions. Many times your thoughts are negative, leading into negative actions, and CBT helps you to change this pattern. Of the therapies used for bipolar, CBT is the one used most often, because it helps them with the management of their disorder, reduction in symptoms, and fewer episode triggers. (See ch.15 for more information on CBT.)

Interpersonal and Social Rhythm Therapy (ISRT)

This therapy helps your loved one with issues involving interpersonal relationships. It helps them reduce the stress in their life and, because stress is a trigger to bipolar episodes, it helps reduce mood swings and episodes.

People with bipolar disorder are believed to have overly sensitive biological clocks (known as circadian rhythms), which are thrown off by disruptions in daily patterns of activity, also known as "social rhythms."

Social rhythm therapy focuses on stabilizing social rhythms such as sleeping, eating, and exercising. When these rhythms are stable, the biological rhythms that regulate mood remain stable too, thus helping the mood swings of bipolar disorder.

Family-Focused Therapy (FFT)

Living with someone with bipolar disorder is not easy, and marital as well as other relationships can be difficult to maintain because of it. FFT helps by addressing the issues revolving around the family and the home environment, using education about bipolar disorder and methods geared toward improving communication.

Whichever type of therapy you and your loved one choose to manage their bipolar disorder, it is very important to find the right therapist for them.

The search for a therapist should begin with a phone consultation. If your loved one is able to do this part themselves that is preferable; however, if they are not, then you will have to do the consultation for them.

The phone consultation is when your loved one will explain their condition and state what they expect from therapy. It is also the time for them to ask questions of the therapist; such as their education and experience with bipolar disorder.

Many times, a phone consultation can eliminate a therapist as a viable mental health professional for a person. If your loved one is not comfortable with the therapist for any reason, try another therapist.

Your loved one can do a face-to-face consultation instead; although, there can be a charge for this (usually less than the charge for a regular office visit). Sometimes it is easier to judge whether they will be able to get along with the therapist this way.

In many cases these days, you may be able to check out your prospective therapist by researching them online using Google.

You will need to find a therapist who is easily accessible. If your loved one has to travel a long distance or deal with traffic hassles each time, they are less likely to keep appointments or, even if they do, they may arrive already stressed and unable to share.

You need to find a therapist who is affordable. The cost of therapy should not be another financial burden; otherwise, it will just be another stressor for your loved one and can make their bipolar disorder worse.

If finances are an issue, perhaps the therapist can work out payment on a sliding scale with you, or a payment plan. If not, maybe spacing out the visits would be possible.

All therapists are not licensed, and this is okay. However, if you choose to see a licensed therapist, check their license. You can contact your state licensing board to see if the therapist's license is current and if it is in good standing. You are also able to check if there have been complaints filed against the therapist. In most states this information can be found online.

Sometimes, even after someone has chosen one therapist, they feel the need to change that therapist. There are various reasons for this: you don't feel comfortable with them for some reason; you don't feel like they are listening to you anymore; you feel like they are talking more than listening to you; you can no longer relate to them; etc.

Complementary Treatments for Bipolar Disorder

In addition to traditional therapy treatments like Cognitive Behavioral Therapy, Interpersonal and Social Rhythm Therapy, and Family-Focused Therapy, there are other complementary treatments available for bipolar disorder; such as:

  1. Light and Dark Therapy
  2. Mindfulness Meditation
  3. Acupuncture

Light and dark therapy – This centers on the person's biological clock. When this "clock" is disturbed, it can disrupt their sleep and wake cycles, making their bipolar disorder worse. This therapy manages light exposure, thus regulating the body's biological rhythms. With someone who has bipolar disorder, their mood swings can then be reduced. Restricting artificial light for ten hours every night creates an environment of regular darkness, and this is a major part of this type of therapy.[16]

Mindfulness meditation – Mindfulness meditation can help your loved one with their bipolar depression and other symptoms of their bipolar disorder. Mindfulness uses aspects of yoga to focus awareness on the present moment and break negative thinking patterns.

Acupuncture – This complementary treatment is still under research. Some people have found that it has helped them by lessening their bipolar symptoms, and some have found that it has helped with their stress.

Medication Treatment for Bipolar Disorder

Most people with bipolar disorder need medication to reduce their bipolar symptoms and prevent episodes.

Everybody is different, so different medication is prescribed for different people. The most common medications prescribed, however, are mood stabilizers and antipsychotics.

Dosages may also differ. Don't be surprised if the psychiatrist changes your loved one's dosage, or even the medication entirely, from the medication and dosage they started with when they were first diagnosed.

The psychiatrist will work with your loved one to find the right medication to help manage their bipolar disorder. Because everyone responds to medication differently, they may have to try several different medications before finding one that relieves your loved one's symptoms.

With medication treatment, it is important for your loved one to keep the following points in mind:[17]

Don't stop taking your medication. Continue taking your medication, even if you feel better. It is the medication that is making you feel better, after all. In order to prevent episodes, you will need to take your medication on a long-term basis.

Check in with your doctor often. Certain medications required frequent follow-up with your doctor, along with blood tests for therapeutic levels in your bloodstream. Checking in with your doctor often will help them monitor you and your medications, making sure you are taking the right medications and in the right dosages.

Medication is not a "quick fix." It takes TIME to get the right medications and in the right dosages to manage your bipolar disorder. The medications you will ultimately be on will probably not be the ones you start off with. Be patient, and work with your psychiatrist on this.

Be very careful with antidepressants. Antidepressants are, historically, not advised in treating bipolar depression, as they can trigger a manic episode. If you are going to take antidepressants, make sure you are being closely monitored by your psychiatrist, and that you report any side effects to him.

Many of the side effects of bipolar medication initially considered extremely bothersome will diminish over time. While medications and individuals are all different, bipolar medication side effects that tend to diminish include: drowsiness, dizziness, headache, diarrhea or constipation, nausea, indigestion, or blurred vision.

It is crucial that, no matter the side effects, your loved one should NEVER stop taking their medication unless advised by their doctor! Stopping their medication will lead to a bipolar episode and, in some cases, even to death.

Supplements

There is some controversy over whether supplements are actually effective in helping people with bipolar disorder. I, personally, do not take a stand in this controversy. I only present these supplements in the interests of comprehensiveness. These are the most common ones:

Omega-3 fatty acids – You can find various studies on whether omega-3 fatty acids help people with bipolar disorder; however, there is no definitive study that supports this theory. Omega-3s have been shown to improve the cardiovascular system, but there has been nothing to show that it directly affects bipolar disorder's characteristic mood swings.

St. John's Wort and SAMe – Supposedly, this supplement will help with depression, but there is no study to support the claim. In fact, like any supplement, there is the possibility that it could interact with your loved one's medications, and for that reason it can be very dangerous. The staff at the Mayo Clinic warns that it can also trigger manic episodes in some people. They say the same thing about S-adenosyl-L-methionine (SAMe), an amino acid used as a supplement. SAMe also supposedly aids depression; however, there is no evidence it can control bipolar mood swings.[18]

Chinese medicine or herbal remedies – These remedies are popular in some circles, but there is no proof that they really work. There have been NO scientific studies to show the effectiveness of these remedies. Be careful of ads that claim to cure bipolar disorder, as there is NO cure for bipolar disorder at this time. Herbal remedies are not regulated by the FDA so you don't really know exactly what you are getting with them.

IMPORTANT NOTE: The best warning I can give you about supplements is this: If your loved one does choose to take supplements, they should be used in addition to their regular bipolar medication and NOT instead of their medication. And they should only be used with their doctor's knowledge.

Electro-Convulsive Therapy (ECT)

Electroconvulsive therapy (ECT), commonly known as "shock treatments," is a procedure where you undergo general anesthesia, and small electric currents are run through your brain, triggering a small, harmless seizure.

ECT is used when other treatments have failed. For example, when your medication is no longer effective. Sometimes the doctor will suggest ECT if it is too risky to take medications, such as during pregnancy.

ECT is basically considered a safe treatment, although it may cause some short-term side effects, including memory loss. These side effects do go away over a short period of time, though.

If you are considering ECT for your loved one, you should discuss possible benefits and risks of the procedure with your loved one's doctor.

Hospitalization

Sometimes the best of treatment can fail, and hospitalization is necessary. Hopefully, your loved one will recognize the necessity of hospitalization and will agree to go voluntarily. But if your loved one needs help and their judgment is so poor that they don't realize how out of control they are, you may have to get help in having them hospitalized against their will.

Hospitalization is necessary when your loved one is a danger to themselves or others. In fact, at this point hospitalization is no longer a choice – it is the law.

Jay Carter, Psy.D., and Bobbi Dempsey, in their book Complete Idiot's Guide to Bipolar Disorder, cite the criteria whereby a person is considered dangerous to themselves or others:

  * "They have made threats to another or attempted to inflict harm or have inflicted harm on someone.

  * They are unable to meet their own basic needs (or those of dependent minors) for food, person hygiene, health care, housing, and personal safety and there is a 'reasonable probability' of serious physical harm coming to them without care and supervision.

  * They have attempted or threatened to commit suicide and there is 'reasonable probability' that they will make a suicide attempt without care and supervision.

  * They have mutilated or attempted to mutilate themselves (or others) and there is a 'reasonable probability' another attempt will be made without care and supervision.

  * They are incapable of exercising self-control or of making sound judgments in conducting the responsibilities of everyday life without care and supervision in such a way that they are a danger to themselves or others."[19]

One thing to consider is that it may be better for your loved one to go to the hospital rather than to go to jail.

Hopefully, your loved one will agree to go into the hospital of their own accord (willingly). This is called voluntary commitment. The disadvantage to voluntary commitment is that your loved one is free to leave any time they want to (although the facility may have rules such as having to leave during daytime hours or having to give notice so the necessary paperwork can be done).

Since manic episodes affect judgment, people suffering through them are often hospitalized against their will, and this is called involuntary commitment. Laws about admitting people to the hospital involuntarily differ depending on where you live. Your local mental health service or your loved one's psychiatrist should be able to help you with information on involuntary hospitalization.

Consider the following case study:

CASE STUDY:

Bill's wife, Michele, had bipolar disorder, but had been stable for quite a long period of time. Bill was a good supporter, however, and still watched Michele for signs and symptoms of a bipolar episode.

When Michele started losing sleep, Bill was concerned. He talked to Michele about it, but she said she would get more sleep, and not to worry about it.

Michele started getting more and more agitated, and Bill got even more concerned. Again, he tried to talk to Michele about it.

"Honey, I'm noticing that you're starting to show some signs of a manic episode. Do you think we should take you to the hospital?" he asked her.

Michele got very upset, and begged Bill not to take her to the hospital. She had had a bad experience the last time she was at Peninsula Hospital. She made him promise that he would never take her there again.

One day, Bill came home to find that Michele had mutilated her arms and hands with her nails. She was extremely upset and totally incoherent. He immediately took her to the hospital and had her involuntarily committed for being a danger to herself.

At the hospital, Michele's medication was adjusted, and within five days, her manic episode was under control and she was sleeping normally.

After she came home, she confronted her husband about the hospitalization.

"Why did you take me to the hospital? I thought you promised!"

"I promised never to take you back to Peninsula," he said. "I never promised not to take you to St. Mary's."

After discussing his reasons for taking her to the hospital, Michele agreed that it had actually been the best thing that could have happened to her and that, given the same circumstances, she would want him to do the same thing.

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My best advice to you concerning the hospitalization issue is to sit down with your loved one when they are NOT in an episode and discuss this together, determining what your loved one would want you to do if they were a danger to themselves or others. They may even have a preference of which hospital they would want to go to in such a case, and that would be good for you to know.

Making plans with your loved one in advance about what to do if they become very ill can help to give them some advance control over events if they need to be treated in the hospital in the future.

Although they may have a preference for which hospital they would like to go to in case of an episode, this may still be a matter of insurance. Make sure you check out ahead of time, during your planning stage, whether their preferred hospital is covered by your insurance.

But what can you do when your loved one refuses treatment? The best thing you can do is to tell your loved one what you're feeling and the behavioral changes you've seen in them. Hopefully, this will convince them that they need help.

Another thing you can do is to "marshal the troops." There is strength in numbers. Get other family members and your loved one's friends together for an intervention, and have them express their feelings and share their observations of your loved one's behavior. Maybe your loved one can argue with you, but they can't argue with everyone saying the same thing.

If you have children, you can tell your loved one how their behavior is affecting the children, and ask them to get help "for the sake of the children."

Marlee Fisher, in her book 70 Signs of Depression, advises to say to someone in the throes of depression something like, "Maybe it's time you had this checked out. I love you and recurring depression can be easily managed with the proper care. More importantly, I know you deserve to feel better and to be happier than you are."

For a FREE, thorough checklist of bipolar disorder treatment options please visit www.BipolarFamilyCure.com

# Chapter 8: Medication Compliance

The National Institute of Mental Health (NIMH) states that bipolar disorder results in 9.2 years' reduction in their life expectancy, and as many as 20% (1 in 5) of people with untreated bipolar disorder WILL kill themselves.[20]

There is an association between untreated bipolar disorder and violence as well. For example: On Feb. 7, 2001, an untreated patient with bipolar disorder fired several shots at the White House before being wounded in the knee by the Secret Service. A former West Point cadet, he had been fired from his job at the IRS and claimed the government was persecuting him.

In 1998, there was a study done by Stephen Strakowski and colleagues at the University of Cincinnati, College of Medicine. They discovered that, during the year following their first hospitalized episode, 59% of patients with mood disorder were either "partially nonadherent" (didn't take their medications consistently) or "fully nonadherent" (quit taking their medications).[21]

There are many different reasons why a person with bipolar disorder has problems staying on their medication or chooses to go off it completely. The excuses not to take bipolar medication may be as varied as the people to whom the medication is prescribed. However, if you become familiar with the most common excuses, you can know better how to combat them.

If the medication can control the person's bipolar disorder, why would they not want to take their medication? You need to know why they don't want to take their medication if you are going to try to get them to take it.

If you ask them why they don't want to take it and you get a vague answer such as, "I don't know," then you have nothing to go on. However, if they give you a more specific answer when you ask them, it will probably come in the form of an excuse.

Some excuses for not taking bipolar medication are:

  * "I'm feeling fine now, so I don't need it."

It's easy for a person with bipolar disorder to see their need for medication during a bipolar episode; however, once the episode is over and things are under control, they can sometimes believe that they no longer need that medication.

The way for you to combat this is to tell them that even though they feel better, they still have bipolar disorder. Remind them that it is the medication that is making them "feel fine," and that if they want to continue to feel that way, they need to continue to take the medication.

  * "I don't feel any better – the medication isn't working."

It takes time for medication to work – recovery doesn't happen overnight. For some medications, it takes time to develop a therapeutic level in the bloodstream. In other cases, it may be that the dosage needs to be adjusted.

If your loved one does not feel any better after a certain length of time, they need to tell their doctor. The doctor can increase the dosage of the medication, or switch them to a different medication that may work better for them.

  * "I feel like a zombie – I miss my high periods."

In a manic episode, a person can feel a sense of euphoria, and once they are on medication, they may miss that sense of euphoria, that "high high." After a while, they will adjust to the new lifestyle, but they may need to get used to life without mania.

On the other hand, they may feel over-sedated, which can indicate a problem with their medication. If this is the case, they can see their doctor and he can reduce the dosage on their medication or switch their medication if necessary.

  * "I forget to take it."

This is a very common excuse, especially for the newly diagnosed. However, there are things that can be done to combat the problem:

    1. Use a pillbox that has daily compartments in which to store the pills. Keep it in a place where it can be easily seen. If your loved one is not sure if they have taken their medication, they simply have to look in the compartment to see if it is empty or not.

    2. Have your loved one set the alarm on their watch or cell phone to remind them when to take their medication.

    3. Your loved one can associate taking their medication with another activity that will remind them to take it, such as their first cup of coffee in the morning, or at bedtime every night. Then they will get in the habit of taking it.

  * "I can't stand the side effects."

This is probably the biggest excuse for not taking medication, especially gaining weight. However, there are ways to combat the side effects, and your doctor can help. For example, if dizziness is the problem with morning medication, they may have your loved one take the medication in the evening instead.

Most side effects are tolerable, or at least avoidable (such as weight gain). Sometimes all it takes is a dosage adjustment to make the side effects manageable.

NOTE: If your loved one does feel that the side effects are intolerable, have them contact their doctor and talk to him about changing their medication.

  * "I can't afford it."

This is no longer a valid excuse, as there are ways to get medication even if you can't afford it. Many times the doctor can give you free samples of the medication if you ask for it.

Also, sometimes the drug manufacturers will provide the medication at little to no cost to you. Just contact the drug manufacturer and ask about a Patient Assistance Program for the prescribed medication.

Rx Outreach is a non-profit pharmacy whose mission is to provide affordable medications. You can find them at: http://rxoutreach.org/.

Sometimes family and friends can help you with the cost of medications if you ask them. Churches and other community organizations sometimes can help as well. Don't be afraid to reach out to ask others for help.

Your loved one may have other objections or concerns that are not exactly excuses. For example, they may express a concern about stigma. If they do, you can tell them that managing their bipolar disorder with medication is nothing to be ashamed of, and is not a sign of weakness. They may express a concern about addiction, but you can tell them that the only addictive medication prescribed for bipolar is anti-anxiety medication (Benzodiazepines), and that can be controlled by the doctor.

For a FREE way to help ensure your loved one with bipolar disorder stays on their meds please visit www.BipolarFamilyCure.com

# Chapter 9: Triggers for a Bipolar Episode

Triggers are outside situations and events which lead to bipolar disorder symptoms. These can be positive or negative.

Symptoms are the end result, but triggers are the root of the problem. If you can get to the root of the problem, you can "head things off at the pass" and prevent your loved one from experiencing the symptoms or, in other words, going into a full-blown bipolar episode.

Depending on the path your loved one's bipolar disorder takes, triggers can lead not only to bipolar episodes, but also to panic attacks and even suicidal thoughts and/or psychosis.

At first, it may be difficult for you to learn what your loved one's bipolar triggers are. Sometimes they are small, almost unnoticeable things (unless you're looking for them). Sometimes they are things that wouldn't bother you at all, but really upset your loved one. Given time, however, you will be able to determine what your loved one's specific triggers are.

There are some triggers that are common to most people with bipolar disorder. Here are some of the most common:

  * What goes into your loved one's body

Food, drink, and even drugs can be very strong triggers. If your loved one has a problem with anxiety, for instance, drinks that contain caffeine can be a trigger to more anxiety. If your loved one has a problem with depression, alcohol (being a depressant by nature) can make that depression worse. Drugs, even some over-the-counter drugs, can make your loved one's condition worse as well.

  * Excessive spending and poor financial decisions

When headed for a manic episode, your loved one may begin spending more money and/or making poor financial decisions. If you are having financial problems to begin with, this can be a trigger in itself.

  * Upsetting or stimulating media

Your loved one needs to be careful what they watch and listen to, as this can be a trigger for some people. For example, if your loved one has a problem with anger, an upsetting news broadcast or violent movie can aggravate that anger.

  * Unstable relationships and toxic people

Certain people can be a trigger as well. Confrontations can be triggers to episodic behavior. If you notice that your loved one gets nervous or stressed when they are around certain people, then they will have to avoid these people. If there is a strained relationship between the two of you, it must be resolved in order not to trigger more bipolar symptoms.

  * Medication instability

Medication is crucial to your loved one's stability. If they begin showing signs of a bipolar episode, check to make sure they are taking their medication. When someone with bipolar disorder goes off their medication, or there is a problem with their medication, it can be one of the biggest triggers to an episode.

  * Disruption in sleep

Your loved one should be going to sleep at the same time every day and waking up at the same time. In addition, they should be getting 8-9 hours of uninterrupted sleep each night. If you start noticing their sleep habits change, it can be a trigger. Too much sleep can be a sign of a depressive episode, while loss of sleep can be an indication of a manic episode.

  * Too many responsibilities or obligations

Some people, bipolar or not, have problems with saying "No." But for someone with bipolar disorder, this can become a trigger to an episode. If you notice that your loved one may be over-obligated or has more responsibilities than they can handle, they may also begin showing symptoms of a bipolar episode, and you will know that this is a trigger for them.

  * Stressed environment

Your loved one needs to be in as stress-free an environment as possible. Some people get anxious when the environment around them is too noisy (in a restaurant, for example), or too cluttered and disorganized (your home, for example). Your loved one may even get stressed being in a crowded grocery store. If so, this is a trigger for them.

  * Upset routine

A stable routine is the best thing for your loved one. They may get upset if that routine is changed, even slightly. They may be used to things being a certain way, and have come to depend on that. If your loved one is showing signs of instability, look and see if something has changed in their routine.

Your loved one may have triggers that are not on this list. You will know they are triggers by the way your loved one acts when certain events happen, they are in certain situations, or they are around certain people.

The most serious triggers tend to be work-related stress, physical illness, death of a loved one, a move, marriage, or birth of a baby. In addition, catastrophes such as 9/11 or Hurricane Katrina can be a trigger to a person with bipolar disorder.

It is impossible to protect your loved one from all stress. Although certain stressors which trigger their bipolar symptoms should be avoided, not all stress is avoidable.

Your loved one needs to find ways to manage their stress (i.e., exercise, talking things over with someone, stress reduction exercises, meditation, hobbies, etc.). However, there are things you can do to help your loved one reduce their triggers and maintain a lifestyle that helps them to stay well.

One thing you can do is help your loved one identify what their triggers are. Discuss with them (when they are NOT in an episode) what they think their triggers are, and offer your opinion of what you think their triggers are. Also, you can both look at past episodes and get a good idea of what "set them off." This will give you a good idea of your loved one's triggers.

Positive strategies your loved one may use to reduce stress and stay well include:

  * Taking their medication as prescribed.
  * Adhering to their treatment plan.
  * Having a regular sleep schedule.
  * Maintaining a routine.
  * Exercising at least three times a week.
  * Avoiding negative media.
  * Setting realistic goals.
  * Restricting intake of caffeine, alcohol or drugs.
  * Eating a healthy diet.
  * Practicing stress reduction exercises.
  * Having hobbies.
  * Having a positive attitude.
  * Avoiding toxic people.

One of the biggest triggers to a bipolar episode is stress, and one of the best ways to combat stress is to be positive. Using positive affirmation cards is a good way to do that. For a FREE set of affirmation cards specifically written to help overcome bipolar disorder episode triggers please visit www.BipolarFamilyCure.com

# Chapter 10: Management of Bipolar Disorder

Living with bipolar disorder requires certain adjustments. Like recovering alcoholics who avoid drinking or diabetics who take insulin, if you have bipolar disorder, it's important to make healthy choices. Doing this will help your loved one keep their symptoms under control, minimize mood swings, avoid bipolar episodes, and take control of their life.

Managing bipolar disorder starts with proper treatment, including medication and therapy. But there is so much more your loved one can do to help themselves on a day-to-day basis.

These things can help your loved one influence the course of their bipolar, enabling them to take greater control over their symptoms, to stay stable longer, and to get well quicker after an episode:

  1. Get involved in their treatment
  2. Monitor symptoms and moods
  3. Reach out to others
  4. Develop a daily routine
  5. Manage stress
  6. Watch what is put in their body

Your loved one should be a full and active participant in their own treatment. They should be in close contact with every member of their treatment team and have open communication with them. You should also be a full and active participant in your loved one's treatment, being just as familiar with their treatment team.

Your loved one should learn everything they can about bipolar disorder. They should become an expert on the illness. The more they study up on the symptoms, the easier they can recognize them in themselves, and research all their available treatment options. The more informed they are, the better prepared they'll be to deal with symptoms when they occur and avoid bipolar episodes. You should also be just as educated as your loved one, so you can help them.

You and your loved one should become partners with their doctor or therapist and be part of the treatment team in the recovery process. Don't be afraid to voice your questions or opinions. You have an important part in this, after all. Don't expect an immediate cure (there isn't one), but have patience with the treatment team and your loved one's progress.

Reaching out to others and building a good, strong support system is very important to good management of bipolar disorder. Sometimes, having someone to turn to is not a matter of them "fixing" you, but simply a matter of them being a good listener.

Members of a support system can include:

  * Family members
  * Friends
  * Treatment team
  * Clergy and church members
  * Support group members
  * Boss or coworkers
  * Members of the community
  * Neighbors

Having a support system will keep your loved one from becoming isolated, and keep loneliness and depression at bay. No one says your loved one has to be a social butterfly, but they do need to avoid isolation.

They may also want to explore networking opportunities on the internet. There are many social networking sites, like Facebook, that cater to virtually every need, interest, and age group. While socializing online is one option to consider, this type of communication should be balanced with face-to-face connections.

It is important for your loved one to build structure into their life. Developing and sticking to a daily routine can help them stabilize their mood swings and avoid episodes. They need to include set times for sleeping, eating, socializing, exercising, working or volunteering, doing hobbies, and relaxing.

Routine is very important to a person with bipolar disorder, as upset in routine (as we discussed in the last chapter) can be a trigger to a bipolar episode.

Another thing that is very important for your loved one is to stick to a regular sleep schedule. They should go to sleep at the same time every night and wake up at the same time every morning, getting 8-9 hours of uninterrupted sleep every night. Too little sleep can lead to a manic episode, and too much sleep can be indicative of a depressive episode.

They should avoid or minimize napping, especially if it interferes with their sleep at night. Exercise and other strenuous activity should be avoided late in the day, as this could interfere with sleep. Also, no caffeine after lunch or alcohol at night, as both of these can interfere with sleep as well.

Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes your loved one may experience. Aerobic exercise is especially effective at treating depression. Your loved one should exercise at least three times a week for at least 30 minutes each time. Even walking is considered exercise if done on a regular basis.

Your loved one should eat a healthy, nutritious diet, and you can help with this. There is an undeniable link between food and mood. For best mood, they need to eat plenty of fresh fruits, vegetables, and whole grains and limit their fat and sugar intake. They should space their meals out through the day, so their blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should be avoided. Other things to avoid include chocolate, caffeine, and processed foods.

Your loved one should absolutely avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your loved one's emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with bipolar medications. Attempts to self-medicate or numb their bipolar symptoms with drugs and alcohol only create more problems.

Your loved one should be cautious when taking any medication. Certain prescription and even over-the-counter medications can be problematic for people with bipolar disorder. As previously mentioned, they need to be especially careful with antidepressants, as they can trigger mania. Other drugs that can cause mania include over-the-counter cold medicines, appetite suppressants, corticosteroids, and thyroid medication.[22]

As previously discussed, your loved one needs to keep stress to a minimum. This is crucial to good management of their bipolar disorder. Yoga, meditation, tai chi, deep breathing, stress reduction exercises, and keeping a stress-free environment (you can help with this) are all ways to accomplish this.

Productivity is also very important. If they cannot handle a regular full-time job, they can consider working a part-time job, starting a home-based business, or volunteering.

People with bipolar disorder need to manage their time effectively, so they have enough for themselves and their family and friends, as well as for doctors' appointments, therapy, and support groups, and work or a volunteer position, as well as other commitments.

Poor time management or too many commitments can lead to stress that your loved one just does not need. They need to learn to manage their time effectively. There are time management courses they can take to teach them this skill, or they can read articles on time management on the internet.

Hobbies are important for a person with bipolar disorder to have. They are a good release for their natural energy and creativity. Gardening, car repair, knitting, cooking/baking, stamp and coin collecting, hunting/fishing, photography, and scrapbooking are good examples of hobbies.

One very important thing to include in a discussion of management of bipolar disorder is relaxation and fun. It's important that your loved one also include some relaxation and fun in their daily activities, or their bipolar disorder will overwhelm them and it can even lead to depression. It is also a great stress reliever. The Bible says that laughter doeth good like a medicine! (NOTE: We will have a longer discussion of this topic at the end of this chapter.)

The Bipolar Stability Equation

There is something I call the Bipolar Stability Equation which affects EVERY person with bipolar disorder and is critical to its successful management. In the Bipolar Stability Equation there are certain variables, like the things I have just discussed: support system, routine, sleep, exercise, diet, medication, stress, productivity, time management, hobbies, and relaxation and fun.

As long as these variables are in order, your loved one will experience stability. If just a couple are out of line, such as cheating on their diet or missing a few days of exercise, there may not be too many problems. But if too many variables are out of order, such as missed medication and increased stress, stability can be threatened.

That's what happened to my mom at one point. When we looked back and analyzed the episode, we realized that she had stopped going to her support group and church or even calling her friends. She was hardly getting any sleep at all for days at a time. She was not getting any exercise, and she had practically stopped eating, or eating very infrequently and not watching what she ate. She was not doing her job very well at all, and she could not concentrate on anything. She had even stopped working in her garden.

But the worst thing of all was she'd stopped taking her medication. Is it any wonder she went into the worst bipolar episode of her life? According to the Bipolar Stability Equation, she had EVERY variable out of whack!

You can use the checklist on the next page to monitor your loved one's Bipolar Stability Equation, and if you see too many variables out of line, you can get them help immediately to avoid a bipolar episode:

Bipolar Stability Equation Variables Checklist

______Support System

______Routine

______Sleep

______Exercise

______Diet

______Medication

______Stress

______Productivity

______Time Management

______Hobbies

______Relaxation and Fun

There are two more important things you and your loved one should have if you want to manage their bipolar disorder: a Relapse Prevention Plan and a Bipolar Emergency Plan. These may sound contradictory, but I find it's better to "hope for the best, but plan for the worst."

Relapse Prevention Plan

The most important part of relapse prevention for your loved one is that they remain on their bipolar medication, taking it religiously. That is their best defense against having a bipolar episode. However, sometimes even the best medication can't prevent an episode from happening – sometimes there are "breakthrough" episodes. I know a woman who was stable for 12 years and then had an episode hit her out of nowhere! Can you imagine? 12 years!

A bipolar episode begins with changes in behavior in your loved one. So the first step in any Relapse Prevention Plan is to be vigilant in watching for signs and symptoms of a bipolar episode. In other words, watch carefully for changes in your loved one's behavior. You cannot afford to take their stability for granted – you must always watch for signs and symptoms.

The first step for your loved one is to notice any changes in their mood, which signifies an oncoming episode. They should then acknowledge these changes and reach out for help. However, they are not always aware of these changes, or are too ill by the time they notice them, so it still may be up to you to notice them and take action.

The next step in a Relapse Prevention Plan is to have a good, strong support group in place. These people will know your loved one best, and can help you to notice when your loved one is exhibiting signs and symptoms of a bipolar episode. Then you can get your loved one help before they go into a full-blown episode.

The last step in a Relapse Prevention Plan is to keep a Mood Chart or diary/journal. This will help track your loved one's moods, sleep, medication changes, and any other important notes on a day-to-day basis, so that you can note patterns as they develop and hopefully head off a bipolar episode before it begins. There will be more about a Mood Chart in the next chapter.

Bipolar Emergency Plan

Despite your best efforts, there may be times when your loved one experiences a relapse into full-blown mania or severe depression. In crisis situations where safety is at stake, you may have to take charge of your loved one's care. Such times can leave them feeling helpless and out of control, but having a crisis plan in place allows them to maintain some degree of responsibility for their own treatment.

A written Bipolar Emergency Plan would include:

A list of emergency contacts – doctor, therapist, close family members and friends (if desired)

A list of all medications your loved one is taking, including dosage information

Allergies that any treating doctor or hospital would need to know about in order to treat your loved one

Medical conditions \- include information about any other health problems your loved one has

Treatment preferences – where your loved one would prefer to go for treatment

Authorization for treatment – your loved one can give permission for you to obtain treatment for them and/or authorize you to make decisions on their behalf

It is best if the Bipolar Emergency Plan is first discussed between the two of you, during a time when your loved one is NOT in an episode. You can add anything to it you think is important, even if it is not listed above. Your Bipolar Emergency Plan can be tailored to your individual needs.

Now I would like to elaborate on the topic of relaxation, fun, and the management of bipolar disorder.

I got this email one day, and I think it is important to include for the purposes of this discussion:

Hi John,

My name is Margaret, and my husband has bipolar

disorder. I hate to say this cuz it sounds kind of

selfish, but it's been a very long time since we've

had any fun together.

He's been so depressed that it was starting to get

to me too. So the other day I stopped after work

and had a few drinks with some coworkers.

When I got home, the house looked like a cyclone

had hit it, and my husband was in a rage. He yelled

at me, saying I had no right to do what I did

and leave him all alone.

We got into a big fight. And I felt so guilty for

leaving him alone while I went out and had a good

time without him.

My question is this, should I feel guilty? Should

I just have stayed home with him and not gone out

after work?

\--------------------------------------------------------------------

This email does not describe an uncommon situation, believe it or not. Many supporters feel guilty if they have fun outside of their loved one and their "bipolar world."

It may be very hard for you to have fun if your loved one has bipolar disorder. You may feel guilty if you do. It could be that you haven't had any fun in your relationship in a very long time.

In many relationships where the loved one has bipolar disorder, it can seem as if the disorder has completely taken over their lives and their lives are so serious all the time. Fun is just never an option.

How can it be, when they are completely under the control of bipolar disorder and its symptoms?

The good news is it doesn't have to be that way! Yes, bipolar disorder is an incurable disorder, but your loved one is not in an episode ALL the time! There are times between episodes – sometimes long periods of time between episodes. And as they get better, the periods of time between episodes will become even longer.

And there is room for fun! Creating fun can even become a part of your loved one's treatment plan.

If your loved one continues taking life too seriously, it may lead to another bipolar depressive episode, and that is the opposite of what you want. If you, as the supporter, have NO fun in your life, you will not be any good to your loved one – you MUST have laughter and joy in your own life as well.

I know a married couple where both of them have bipolar disorder. And even though they're married, they have "Date Night" every Friday Night (as long as they are not in an episode).

They don't necessarily do anything extravagant or expensive, but they do something they enjoy. Sometimes they just rent a movie and place a blanket on the floor and snuggle up together. But they have fun together. That's the key.

When was the last time that you had fun? Placing some distance between your loved one and their bipolar disorder can be an important part of healing.

This is not about ignoring the difficult realities of living with bipolar disorder. It's not about ignoring the fact that your loved one has bipolar disorder. It's about having fun along the way while you make changes; while your loved one gets better.

For a FREE guide to making a Bipolar Emergency Plan please visit www.BipolarFamilyCure.com

# Chapter 11: Helping Your Loved One

While the clinical care for your loved one lies in the hands of a psychiatrist and other health care professionals, your involvement as the supporter is of vital importance. Your major concern is to ensure your loved one realizes they've got a mental illness and need treatment to get better.

You must continue to learn and become highly educated about bipolar disorder. You must learn everything you can about the disorder and learn from other successful supporters. Becoming educated helps give you realistic expectations and coping options.

Too many supporters make the mistake of only doing this in the beginning, when their loved one is first diagnosed, but not continuing the practice. You need to remain vigilant with this, or your loved one will pay the price.

You can never learn too much, and new information is always being put out there. There are books that have been written that are good sources of information, with new books being written every day. Especially helpful are the autobiographies written by survivors and supporters coping and dealing with bipolar disorder, just like you.

Another good source for you is the National Alliance on Mental Illness (NAMI), which you can find at: www.nami.org. They publish many free pamphlets to which you can get access and which will educate you tremendously.

You can also get education at bipolar support groups. NAMI is one such group, but you may be able to find one specifically devoted to bipolar disorder online and/or in your local area.

At a bipolar support group, you will find other supporters like yourself to whom you can relate, as they're very likely going through the same things you are. They might have some very good advice from their own experience.

The internet is always a good resource for education too. Bipolar Central is a good place to go for information on bipolar disorder. There are hundreds of articles for both supporters and survivors. You can go to Bipolar Central at: www.bipolarcentral.com.

As you seek to become educated about bipolar disorder, don't be narrow-minded. Borrow from other areas. For example: did you know fast food originally copied the idea of a drive-through from the banks?

There's much to be gleaned from studying areas not strictly related to bipolar disorder. In doing my research about my mom, one such area was dealing with teenagers who didn't necessarily have the disorder. Their specific problems were similar to my mom's, and I got some great ideas in the "how to manage your out-of-control teenager" literature about setting boundaries, for example.

As a supporter to a loved one with bipolar disorder, you need to get involved with their treatment and become a part of their treatment team, as previously discussed. In working with the doctor and other health care professionals, it is important to give them all the necessary information up front in order to insure the best possible care for your loved one.

Keeping a good record will help you to have this information for them, whether it is audio, video, or written. Speak it, have it transcribed, hire a writer, or however you need to do it, but make sure there is an accurate record of your loved one's history.

Working with your loved one's doctor, you will want to watch your loved one's medication and side effects closely. Report any adverse side effects to the doctor immediately.

Your loved one will probably want to be on the least medication possible, so you will want to find a doctor who believes in this concept and who will work with you. Your loved one may need to be on a higher dose initially, but can be titrated down eventually.

Help your loved one to do things which reduce stress and maintain health. The more they are stress-free, healthy, and stable, the less medication they will need.

Medical Release of Information

This is a form that allows you to be involved with your loved one's treatment. It will allow your loved one's doctor and treatment team to release medical information to you, such as what medication your loved one is on.

Make sure you have your loved one sign this form when they are stable and NOT in an episode, as that will make things easier for you. We did not do this with my mom, and it made things much harder.

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act, or the HIPAA, was endorsed by the U.S. Congress in 1996. The HIPAA, also called the Standards for Privacy of Individually Identifiable Health Information, gave the first national regulations for how a person's personal health information should be managed.[23]

HIPAA establishes standards that all healthcare professionals must abide by, giving patients control over their own private information. It helps to ensure that the information doesn't get out to the wrong person or in the wrong way.

HIPAA is better known as the Privacy Law, and what it means to you is that your loved one's doctor may refuse to talk to you, citing this law. However, this does NOT mean that you cannot communicate with him by other means.

The HIPAA Loophole

Although the HIPAA Law prohibits your loved one's doctor from communicating with you, it does NOT prevent you from leaving messages or emailing the doctor with information you feel is important for him to know for your loved one's treatment. He may not respond back to you, but at least he will have this information.

Following are some tips on coping and dealing with a loved one with bipolar disorder, especially if they are newly diagnosed:

  1. Acknowledge your needs.

If you devote your time, attention, and affection solely to your loved one's needs to the exclusion of your own, you will find yourself burning out or, at worst, resenting your loved one. You must not only acknowledge your own needs, but you must see that they are met. Take care of yourself, so that you are able to take care of your loved one.

  2. Accept your loved one's bipolar disorder.

If your loved one is newly diagnosed, then you must accept this diagnosis before you can go any further. They may be in denial that they have an illness, but you cannot be, if you are going to help them manage their disorder – if you are going to be a good supporter, which is what you want to be.

  3. Keep your loved one separate from their disorder.

Your loved one is NOT their disorder. They may seem different when they are in an episode, however. So you need to learn to separate your loved one from their disorder. There will be times when they will say or do things that are not "them." This is their bipolar disorder talking, and not they themselves.

  4. Respect your loved one.

Your loved one is struggling enough with their bipolar disorder to worry about losing your respect right now. Self-esteem may be an issue with them. Show your respect to them, without overdoing it (they will see through that). They may also be receiving stigma from other people for having a mental illness, so they may need your respect even more during this time. Respect them for who they are, not who they were or what they had accomplished before they were diagnosed with bipolar disorder.

  5. Love them unconditionally.

No matter what, love them. Not just when times are good, but when times are bad, too. Love them unconditionally. When all else is said and done, love is the best medicine of all. Your loved one's struggle is a hard one, filled with mood swings, medication, doctors, psychiatrists, therapists, support groups, and a world turned upside down with a disorder that they may or may not understand themselves. They need your love now more than ever, and they need to know they can count on you.

  6. Do not make bipolar disorder your only focus in life.

The main focus of both of your lives should now be the management of your loved one's bipolar disorder; not the bipolar disorder itself. You have to understand and realize that bipolar disorder is a lifelong illness and, although there is no cure, it can still be treated with medication and therapy. Still, it is not what defines your loved one. Your loved one is a person with a unique personality who is capable of living a stable, successful life. Surround your lives with all that life has to offer, not bipolar disorder.

  7. Avoid being an enabler or codependent.

You are a supporter. You cannot "help" your loved one continue to exhibit unacceptable behavior. You cannot allow your loved one to get away with things like manipulation, saying they can't do things when they can, and not taking responsibility for their own lives and behavior. It is absolutely necessary that your loved one takes responsibility for themselves, their actions, and the consequences of their behavior during bipolar episodes.

  8. Never let down your guard.

People with bipolar disorder can easily slip into their old habits, like not taking their medications, not exercising or eating properly, isolating, or exposing themselves to too much stress, all of which can lead to bipolar episodes. Always be aware and knowledgeable of where your loved one is at with their bipolar by taking careful note of any changes in mood, and watching for triggers, signs, and symptoms of an oncoming episode.

The Bipolar Mood Chart

A Bipolar Mood Chart is a very useful tool which can help both you and your loved one to monitor their bipolar disorder. For example, it is one way of identifying triggers and of recognizing patterns in bipolar disorder.

The Bipolar Mood Chart allows the person keeping it to keep important information together in one place—such as: mood, sleep patterns, weight, medications, and any events which may have influenced their mood that day. They can also note patterns as they emerge, which might otherwise go unnoticed. The important thing is these things can be noted as they happen, so they don't go on too long.

You can also keep a Bipolar Mood Chart for your loved one that simply charts their moods and sleep patterns, which will help you to track whether they seem to be going into a bipolar episode or not. Then you will have something tangible to present to their doctor.

After you keep a Bipolar Mood Chart for a few months, you may even be able to use it to "predict" the future—you may note similarities from month-to-month, or patterns on your Bipolar Mood Chart which appear over time. For example, some people's mood changes are affected by the seasons.

There are mood charts available online for you to download and use, or your loved one's doctor may have one that he can give you.

The Top Five Mistakes

We're constantly hearing about the mistakes that the person with bipolar disorder makes, but here I want to look at the top five mistakes that I think many bipolar supporters make, because these can be just as dangerous to their loved one.

  1. To be in denial

The biggest mistake a bipolar supporter can make is to be in denial of their loved one's bipolar disorder. If they do this, they will be reluctant to get their loved one the help that they need, and their loved one will not be treatment compliant. They may not even be taking the medication they need to take, and this could lead to fatal consequences.

  2. To do nothing

The next biggest mistake a bipolar supporter can make is to do nothing, thinking that the problem will just fix itself. This kind of thinking can also be very dangerous for your loved one, as it is false thinking – to do nothing is simply that: do nothing. It will do nothing to "fix" your loved one. You MUST do something to help your loved one in order for them to get better – otherwise they are just the elephant in the living room. They ARE there, but nobody is doing anything about it.

  3. Reacting instead of being proactive

Being reactive means you let bipolar disorder run the show, while being proactive means YOU run the show – i.e., you are in charge of the disorder, it's not in charge of you. One of the biggest ways you gain control is with knowledge. Get educated about bipolar disorder, in every way you can. If you don't have knowledge about bipolar disorder, how can you fight it? When bipolar supporters don't know what to do, their loved ones can run rough shot over them.

  4. Not realizing how serious bipolar disorder is

Bipolar disorder is serious enough to lead to frequent hospitalization and even death (suicide). This disorder can destroy families. It can destroy lives. Bipolar supporters need to realize how devastating this illness is not just for their loved one, but for their whole family. Some bipolar supporters don't take it seriously enough, until they're sitting in a hospital waiting room.

  5. Not realizing your loved one can be "normal", stable, and successful

Some bipolar supporters give up on their loved ones too soon, and believe they will never get better. NEVER give up hope on your loved one. With your love and support (and a lot of work on your loved one's part), there is ALWAYS hope for stability and recovery. It won't happen overnight, it will take time, and there will be set-backs and probably more episodes before it happens...but your loved one CAN become stable, normal, and successful.

When your loved one is actually in a bipolar episode, your help is crucial. The most important thing you need to do is to help them get treatment. As soon as possible. You need to stay calm though, and be reassuring, so they too can remain as calm as possible. Listen and observe, so you can monitor their symptoms.

If your loved one is currently suicidal:

  * Get immediate help: Contact your loved one's doctor or therapist. If they are in immediate danger of harming themselves (or anyone else), call 911 and/or take them to the closest Emergency Room.
  * Don't leave them alone: If you cannot be with them, arrange for someone else to keep them company.
  * Remove whatever means to attempt suicide you can (e.g. lock away medicines and remove knives and guns).
  * Contact a suicide or crisis helpline.

Not all people with bipolar disorder attempt suicide, but the risk is much higher than in the general population. I've read that up to 50% of people with bipolar disorder attempt suicide at least once.[24]

As a supporter, there may be things you can do together with your loved one to reduce the risk of suicide.

One of the things you can do is recognize warning signs. A warning sign is something the person says or does that makes you think they may be intending to kill themselves in the near future. Things to note are:

  1. Are there changes in their mood or behavior that may indicate they are thinking of killing themselves? They may express suicidal thoughts through actions rather than verbally. For example, they may withdraw from friends and family, make a will, give away possessions, show increased recklessness or use of alcohol or drugs. They may even have a sudden mood elevation, as if a burden has been lifted (now that they've made a decision to kill themselves).
  2. Have they expressed an intention to kill themselves? They may threaten to kill themselves or just casually mention their intention to do so. They may write or talk more about suicide or death in general. Take anything they say about feeling suicidal seriously.
  3. Do they have a plan to kill themselves? If they actually have a plan to commit suicide, they are serious. You need to get them help immediately.

Don't avoid talking about suicide with your loved one just because you think it is a sore subject or because you don't want to offend them. If you think your loved one might be suicidal, ask them directly if they have any thoughts about suicide. It could literally be a matter of life or death. If they do, then discuss their suicidal thoughts and listen without judging them or trying to "fix" them.

Your loved one could be at increased risk for suicide if they have previously had suicidal thoughts or if they have attempted suicide before. Just coming out of an episode is also a time where they need to be watched.

They are also at risk for suicide if someone in their family has died by suicide, if they have had a number of previous bipolar episodes or hospitalizations (and/or have had symptoms between episodes), have a substance abuse disorder, and/or live alone.

NOTE: Sometimes a person can commit suicide even without these risk factors, so watch your loved one carefully for any indication that they are thinking of killing themselves.

Sometimes, despite our best efforts, we cannot stop our loved ones from killing themselves.

Consider the following case study:

CASE STUDY:

Deborah was a beautiful, 44-year-old woman with bipolar disorder. She had a wonderful husband of 21 years, who loved her very much, and was a good supporter to her.

She had a loving family, and they were very close, especially her sister, who was like a twin to her even though she was a couple years older.

Deborah was very popular, and had many friends. She also had a very successful internet business that she worked from home. She had many clients from all over the world, who liked and respected her.

Unfortunately, she went off her bipolar medications, and had gotten progressively out of control.

One day she ran some errands, made a few phone calls, laid down on the bed, and shot herself in the head with a gun.

She left no suicide note. Her husband, friends, and family were devastated. They wondered how she could do such a thing? They had had no warning whatsoever.

\--------------------------------------------------

The support a person with bipolar disorder needs after an episode varies from person to person. You will learn what your loved one needs as they progress from episode to episode. Unfortunately, only time will help you with this.

If your loved one was in a manic episode, they may be ashamed or embarrassed about some of the things they did while in that episode. They may not want to be reminded of those things or to discuss it with you. If this is the case, you need to be respectful of their wishes.

Ways to support your loved one after an episode:

  * Don't bug them if they seem to need more sleep than usual to recover from a manic episode.
  * Instead of asking can you can help, just ask what you can do to help.
  * Do things with the person rather than for them, as this will increase their independence.
  * Try to be available to support them (as much as you can), but don't be overly dominant.
  * Remind them not to try to "take on the world" all at once.
  * Let them recover at their own pace.
  * Involve them in family activities so they will feel a part of things.
  * Help them to set small, manageable goals.
  * Watch them for signs of suicidal thoughts or intentions.
  * Be a good, healthy example for them.
  * Keep a positive attitude, and encourage them to have one, too.
  * Offer help if they have problems remembering things or concentrating.
  * Help them get to their appointments.
  * Discuss ways to prevent future episodes from happening.

## The Post Episode Analysis (PEA)

The Post Episode Analysis is actually something I came up with to help supporters and survivors cope with their bipolar disorder.

It is something you do in the aftermath of a bipolar episode that will help you with future episodes.

After an episode, you sit down with your loved one, and you analyze the episode. You ask yourselves questions, like:

  * What caused the episode?
  * What triggers led up to the episode?
  * What were the signs/symptoms of the episode?
  * What signs/symptoms did we miss?
  * What could we have done to prevent the episode?
  * What can we do to prevent one in the future?
  * What did we do wrong?
  * What did we do right?

The object is to learn how to prevent episodes in the future. It can mean the difference between just going into a mini-episode and going into a full-blown episode requiring hospitalization.

It helps to put this in writing so you have a tangible record of the results of your PEA and also so, after some time, you can observe a pattern in the episodes and hopefully, avoid them in the future.

One of the most important skills you can have as a supporter to a loved one with bipolar disorder is in the area of communication. And the best way for you to communicate with them is through actively listening to them.

There are several ways to effectively listen to your loved one, but the most important thing to remember is to listen not only to what they ARE saying, but to what they are NOT saying as well.

  1. One of the most important ways you can listen to your loved one is to tune out all other distractions. In fact, you can show you are actively listening to them by letting them see you turn off the television, CD player, or car radio and turn all your attention to them. 
  2. It's natural to want to "fix" the situation or to offer your opinions and suggestions, but that is probably not a good idea. Your loved one just needs you to listen to what they are saying. They don't necessarily want an answer to their problems right now – they may just be sharing thoughts and feelings. If you offer advice, they may just shut down and stop talking.
  3. Whenever possible, talk about things in person and not over the phone. This will give you the opportunity for eye contact. Maintaining eye contact is a very important part of showing your loved one that you are listening to them. If they notice you being distracted, or looking away too often, they will get the feeling that you aren't interested in what they are saying. On the other hand, if you can keep eye contact, they will feel as if they are the center of your attention.
  4. Listen more than talk. Don't think about the next thing you are going to say while your loved one is talking. Just listen. That way you can answer your loved one when they ask you a question. And if you are offered a chance to talk, you can stay on topic, because you have been listening to what they have said.
  5. Encourage your loved one to continue talking when they pause or struggle with what to say. Use words or phrases such as "um hmm," or "go on," or "that's interesting." But don't always jump in just because there is a pause in the conversation – sometimes this can be a comfortable silence for your loved one. Allow them this time before encouraging them to continue.
  6. Note what your loved one is NOT saying, not just what they do say. Note their nonverbal cues. These might include fidgeting or other body movements. Other examples are: voice inflection, sighs, or facial gestures. If anything seems out of order with what they're saying, ask, "What are you feeling?" and go from there.

Whenever you are trying to effectively communicate with your loved one, avoid using phrases that include toxic words such as "always" and "never." These will assuredly lead to a fight.

Try to use "I" phrases instead of "you" phrases, as these will not seem as accusing to your loved one, and will not put them on the defensive; again, avoiding a fight.

For example, do NOT say:

"You never get off the couch to help me do anything around here!"

Instead, say something like:

"I would really appreciate it if you would help me with the chores around the house."

For a FREE worksheet on the top 5 mistakes bipolar supporters make and what to do about them please visit www.BipolarFamilyCure.com

# Chapter 12: Handling Supporter Anxiety and Worry

Supporter anxiety and worry is a HUGE problem when it comes to coping and dealing with a loved one with bipolar disorder. It's one of the leading causes of supporter burnout.

In order to be a successful supporter, and for your own mental and physical well-being, you must learn how to handle anxiety and worry.

Some of the things supporters worry about are:

  * Will we be able to find a good doctor/therapist?
  * Will my loved one agree to treatment?
  * Will they stay on their medication?
  * What if they stop taking their medication?
  * Will they ever be themselves again?
  * Will they always be like this?
  * Will things ever be normal again?
  * Am I catching my loved one's bipolar disorder?
  * Am I crazy?
  * Will I be able to handle this?
  * Is my loved one lying to me?
  * Why is my loved one so angry?
  * Why is this happening to me?
  *...and many other things.

So many things to be worried about! Think of all the nervous days. The sleepless nights. The anxiety-filled moments. The stress-filled life. The endless frustration. Until you ask yourself, "When will it all end?"

Do you see why I say you must learn how to handle anxiety and worry? Otherwise you will end up needing treatment yourself. In fact, if you are already at that place where the anxiety and worry has gotten to you, I suggest that you see a psychiatrist or therapist and get treatment for yourself before things get worse.

One of the worst side effects of being a constant supporter for your bipolar loved one is "rumination". Rumination is more than just the deep thinking about something. It's when you think of something over and over again and can't get it out of your head. This can be extremely stressful.

While reflecting on a situation can be helpful and even very effective, rumination can be both physically and mentally harmful. It is more about brooding and being negative than problem solving.

Have you ever found yourself worrying about what you could/should have said or done in a particular situation? That's ruminating. Especially when you don't let it go, and think about it obsessively. If stress is not reduced, it can lead to high blood pressure, stroke, and even heart attack.

Rumination can definitely take a toll on you, both physically and mentally. Because it raises your stress levels, it involves cortisol (the stress hormone in your body), which is harmful to you physically.

In addition, rumination tends to be negative, leading to negative thoughts, which can lead to depression. When you are depressed, you will no longer be proactive, an important part of being a good supporter.

Rumination has been associated with self-destructive behaviors, like binge eating, which just makes more stress for you.

One of the best things I've found to do when I'm anxious or worried about my mom's situation (and how it will impact me) is to think about something else. Even Thomas Edison practiced this principle! He said, "I've always found, when I was worrying, that the best thing to do was to put my mind upon something, work hard, and forget what was troubling me."[25]

If you distract yourself from the anxiety and worry, it will lessen your stress and make you feel much better. You could try watching a funny movie, visiting family, going out to lunch with a friend, or just taking a long drive in the country. Some people find reading a good book a welcome distraction from the stress in their lives.

If you find that worry is a real problem for you and even distraction doesn't help, try scheduling a block of time, say a half-hour to an hour, to actively think about your situation and consider some possible solutions to your problem. This is much more productive than simply wallowing in the anxiety and emotional pain associated with rumination. Then you can "postpone your worry" when you think about it outside of your designated time.

Talking about your anxiety and worry might help you as well. If you are not able to talk to a friend or family member, perhaps you can talk to a clergy person or a therapist.

If all else fails, try writing about your anxiety and worry in a journal. Sometimes writing down your thoughts and feelings can help you get them out and confront them in a constructive way. Journaling is a positive way to cope and deal with anxiety and worry.

Remember there are things you can control, and things you cannot control. Concentrate on the things you can control, and don't worry about the rest. Especially your loved one – ultimately you have no control over them or their actions. You only have control over yourself and your reactions to them.

Sometimes the problem can lie in the fact you are ruminating over the past or are anxious about the future. You can remedy this by practicing mindfulness. Mindfulness is where you concentrate only on the present moment; facing the situation as it is, not how you would like it to be.

Using mindfulness, you can observe your emotions, without reacting to them. You can simply look at them objectively without being judgmental.

When you start to worry about something, ask yourself the following questions:

  * "Is this something I can do anything about?"
  * "Is this something I can do anything about right now?"

If this is NOT something you can do anything about, then there is no use worrying about it at all. LET IT GO. If it is something that you cannot do anything about right now, then there is no use worrying about it right now. Consider it at another time, when perhaps there is something you can do about it.

For a FREE Supporter Worry Questionnaire to help assess whether you are indeed worrying too much—and what you can do about it!—please visit www.BipolarFamilyCure.com

# Chapter 13: Finances and Money Problems

One thing that many people do not anticipate (or do not give enough attention to) when they are dealing with bipolar disorder is the financial burden it can put on you and your family. Even if they do face financial difficulties, they don't know what to do about them.

You may be deeply in debt because of your loved one's bipolar disorder, or you might have to support your loved one because they can't stay stable enough to work.

Financial problems are common with bipolar disorder. This can be dangerous, as the stress can lead to a bipolar episode.

Some people have even had to claim bankruptcy because the financial responsibility becomes too great for them. Therefore, it is necessary not only to acknowledge financial problems, but to do something about them, so you don't end up declaring bankruptcy yourself.

The problem is, when a person is in a manic episode, they are often prone to excessive spending. Then, when the episode is over, you are left with credit card bills, cleaned-out checking and savings accounts, and other financial problems.

Bipolar disorder is also, in and of itself, an expensive disorder to have, with both direct and indirect costs involved.

Following are just some of the problems people with bipolar disorder face financially:

  1. Lack of insurance
  2. Co-pays
  3. Difficulty affording medications
  4. Unsuccessful business investments
  5. Inability to work at a regular job
  6. Overdue bills

So what can you do about it?

It may be necessary for you to instill a system of financial protection on a long-term basis. For example, you may need to be the one to handle all the finances, management of the bank accounts, bill-paying, etc.

If your loved one has a problem with spending using credit or debit cards, then it may be necessary to have them go on a cash-only system. You can cut up the credit cards or at least make them inaccessible to your loved one.

If your loved one is in an episode, you can call the credit card company immediately and ask them to suspend your credit card privileges temporarily. You don't have to tell them that your loved one is in a bipolar episode, you can just say you want to limit your spending for a while. That will suffice.

Your bank account is another problem area. When your loved one is NOT in an episode, see if they are agreeable to having two checking accounts – one just for paying bills, and the other for "whatever," that would have just a small amount in it.

The one for paying bills could be in just your name, so that when your loved one goes into an episode, they would not have access to the majority of the household money. At least this way you can be assured that you would have enough money to pay your bills, should your loved one go into an episode.

If you're in a lot of debt and can't see your way out, consider contacting a nonprofit, free credit counseling service, such as Consumer Credit Counseling Service (which has local branches across the country), to help you make a budget and pay your bills.

Many people with loved ones with bipolar disorder ignore the problem until it's too late, and then they get angry with their loved one. You need to learn to be observant. Look for purchases that seem out of the norm – even small ones.

Use a "wait and discuss" system for large purchases. Make sure your loved one does not have enough cash for large purchases, so they will have to discuss the purchase with you before making it.

Invest in non-liquid investments such as CDs. That way your money will not be accessible to your loved one.

One time I spoke to someone who questioned how bills and unpaid debts could be creating so much stress in a person with bipolar disorder and their supporter. I told them it could be it's not the bills and debts themselves causing the stress, but that the person with bipolar disorder may not have the skills to cope with and overcome these types of money problems. Worse yet, the money problems might be a result of a spending spree from when they were in a manic episode, so part of it might be the stress from worry and guilt.

They may even feel shame involving their supporter for what they've done. Then the stress, worry, and guilt (as well as the money problems themselves) might be enough to trigger the person into another bipolar episode. It can be a vicious cycle.

When my mom was in her worst bipolar episode, I found her amidst a pile of bills so high and wide that they totaled thousands upon thousands of dollars! She just hadn't paid them.

At that point, she no longer had the skills to pay them, so they multiplied. That's when I had to step in and take over her finances and, believe me, it was a mess to untangle all those bills! It took me a long time.

Money problems aren't just hard on the person with bipolar disorder, they are also hard on the supporter. Your loved one can run up so much debt that they can feasibly run you into bankruptcy. Then talk about stress!

If you live with someone who has bipolar disorder, it's just a fact of life you will have money problems. In fact, many people who live in a household where a family member doesn't have the disorder have to deal with money problems, so it's just that much worse for someone who does. With money problems, there always comes stress.

When you're living with a loved one who has bipolar disorder, unfortunately, there will always be money problems. If you follow my suggestions, at least you can get a handle on preventing some of them.

For a FREE Budgeting Worksheet for both your loved one with bipolar AND yourself please visit www.BipolarFamilyCure.com

# Chapter 14: Sex and Your Relationship

S-E-X...That little three-letter word that nobody wants to talk about. But if you are trying to cope and deal with a loved one with bipolar disorder, then sex can be a bigger problem than you ever thought possible.

Depression can kill the sex drive. It is not uncommon for those with bipolar disorder to go for months or even years with little to no interest in having sex. How can this impact your loved one?

Following are some reasons for their loss of interest in sex:[26]

  * They feel unattractive and undesirable.
  * They just can't handle it right now.
  * They are feeling too emotional or depressed.
  * They want to be left alone.
  * They have no sex drive.
  * They can't get an erection or achieve orgasm.
  * They are too tired or don't have the energy for sex.
  * They can't experience pleasure from anything right now, including sex.

Following are some reasons for your loss of interest in sex with your loved one:[27]

  * They don't take care of themselves (i.e., grooming) any more.
  * Symptoms from their bipolar disorder turn you off.
  * They have gained a lot of weight from their medication.
  * You can't get an erection or achieve orgasm.
  * You have trouble seeing them as a mate; they seem more like your child.
  * They were unfaithful.
  * They have rejected your sexual advances so many times you have given up.

These are some of the reasons why you and your spouse may be having intimacy problems.

One of the biggest points I just made is the one about having trouble seeing your spouse as your mate because they seem more like your child. This could be because you've fallen into a caretaking role instead of a supporter role.

Maybe when you married them they didn't have bipolar disorder, or at least they weren't diagnosed yet. You entered into this relationship as most couples do – as partners. However, your roles changed as your spouse became ill, and you became more of a caretaker.

If you find that you've become the caretaker, ask yourself the following questions:

  * Do you really need to be doing all that you do for your spouse? Are there things you do that they could do for themselves if you gave them a chance?
  * Is this a role you tend to assume in relationships? If so, what about the role is fulfilling for you? Are there other ways you can meet these needs which might be better for you and for your relationships?
  * What does your spouse do to bring out your caretaking behavior? How can you respond to this other than by "taking over?"
  * If your spouse does require some degree of care, are other resources (individuals, organizations, facilities, etc.) available, or that could be made available, which could make things easier for you?
  * How can you help your spouse be more independent? What skills can they develop that will enable them to do more on their own? How can you help them develop these skills?
  * What do you do to take care of your own needs?

If your spouse is very ill at times, understandably you will have to take on the role of caretaker during those periods. Just be sure that you don't extend this level of assistance beyond what is necessary – in other words, know when to go back to your supporter role.

Your loved one may also have periods of hypersexuality during manic episodes, and this could also affect your relationship. Hypersexuality means having an acutely increased interest in sex and more frequent sexual urges.

One of the main signs of hypersexuality is the inability to achieve sexual satisfaction despite a lot of sexual activity.

Other signs of hypersexuality include:[28]

  * A sex drive that is out of control
  * Many sex partners
  * Continuous affairs
  * Using sex to numb emotions
  * Excessive masturbation
  * Risky sexual behaviors
  * Preoccupation with sex
  * Increased interest in pornography

Hypersexuality is a troubling and challenging symptom if you have bipolar disorder. According to the Sexual Medicine Society of North America, anywhere between 25 to 80 percent of people who experience mania also experience hypersexuality. It also appears in more women than men.[29]

Sexual promiscuity can be equated to self-medicating, like using alcohol or drugs. It stimulates the dopamine receptors in the brain – the "feel good" neurotransmitters.

Problems with hypersexuality during a manic episode include risky sexual behavior and promiscuity, STDs, and pregnancy.

Having an affair can seem like a betrayal to you, but ask yourself if your spouse would do this if they were not in a manic episode. This may help you to better cope with it and help you to forgive your loved one.

Consider the following case study:

CASE STUDY:

Sam and Ellen were married. Ellen had bipolar disorder, and Sam was her primary supporter.

When Ellen would go into a manic episode, she would become very energetic, and more highly aroused – more interested in sex than usual.

One day, after Ellen had been in a manic episode, Sam found out that she had had an affair when she was in the episode.

He didn't know what to do. At first he was extremely angry. Then he was hurt. Then he was just really, really sad.

Sam knew he had to talk to Ellen about it, but he wasn't sure what to say. In church, the pastor preached about forgiveness all the time, but he just wasn't sure he could forgive her for her unfaithfulness.

After thinking about it, he told his wife:

"I feel betrayed, and really hurt by your affair. But I realize you wouldn't have done it if you weren't in a bipolar episode. I have decided to forgive you. This doesn't mean I can forget what you did – that might take me a little longer to get over. But at least I forgive you."

Things weren't perfect between Ellen and Sam, but at least it was a start.

\-----------------------------------------------------

IMPORTANT NOTE: If this story is familiar to you and you are struggling with forgiving your loved one for an affair, I advise you to keep the lines of communication open. If necessary, involve a professional (therapist or counselor) who can help you get through this.

When most people hear the word "intimacy," they associate it with sex; however, the two are quite different. Although you can be intimate when you have sex, you can certainly be intimate without having sex – especially when it comes to bipolar disorder.

Intimacy can be quite different than having sex. It can include any of the following:

  * Hugging
  * Kissing
  * Holding hands
  * Snuggling
  * Romance
  * Being close
  * Talking together

Even laying together naked in the bed without having sex can be considered an intimate act, and many people in a bipolar relationship do this. They report feeling just as close to each other as if they had actual intercourse.

The point is that intimacy is more than just the sexual act. Although sex is the physical expression of an emotional love, intimacy without sex can achieve the same ends. Part of the joy of being best friends, of being intimate, is enjoying each other's company.

I know a married couple, who both have bipolar disorder, yet they do something special to keep the excitement (intimacy) alive in their marriage. Every Friday night, they have "Date Night." This Date Night doesn't have to be anything extravagant, or even expensive.

As a matter of fact, they tell me that they don't even have to go out to have a good time. One of their best Date Nights, they say, was getting a pizza and playing Backgammon! Yet it was intimate – just the two of them, enjoying being together.

Here are some suggestions for intimacy:

  * Take a long walk together, holding hands 
  * Look at photographs of yourselves 
  * Listen to quiet, soothing music while holding each other 
  * Watch a video while snuggling on the couch 
  * Have a "slumber party" on the living room floor 
  * Tickle each other until you've laughed yourselves silly 
  * Give each other a backrub 
  * Take a bubble bath together 
  * Take a long shower together, washing each other's back 
  * Sit together quietly, just holding hands 
  * Talk about the good times you've had 
  * Talk about your hopes, dreams, and wishes 
  * Talk about everything and nothing

These are just some suggestions for intimacy, but you know each other best. I'm sure you can come up with more on your own.

For a FREE worksheet to help plan the ideal romantic evening with your loved one with bipolar, please visit www.BipolarFamilyCure.com

# Chapter 15: Dealing with Anger, Lying, and Manipulation

You may observe many strange behaviors while supporting a loved one with bipolar disorder. In fact, you almost definitely will. Your loved one may go for periods of time acting "normal," and then suddenly start acting very bizarre, possibly even frightening you. You may ask yourself questions like, "Why is my loved one so agitated?" "Why is my loved one so angry?" "Why is my loved one acting the way they are?"

You may have a loved one who, under normal circumstances, is the most patient and understanding person you know, yet when they enter a bipolar episode, they become easily agitated, short-tempered, angry, and/or even go into a rage or become violent.

These are symptoms literally hundreds of supporters have observed when their loved ones go into an episode.

"Why is my loved one so angry?"

First of all, don't take this personally. It is probably just a result of their bipolar disorder. They may be in, or going into, a manic episode. Many people think of a manic episode as "extreme happiness"; however, it can also mean more irritability, agitation, anger, or even violence, than is normal for your loved one.

A person in a manic episode might also exhibit delusions (false beliefs), hallucinations (seeing or hearing things that are not there), and/or paranoia (thinking that other people are "out to get them"). These things can also cause your loved one to seem angry at you.

Your loved one may also express a general unhappiness with their life, but this is not your fault – it may indicate a depressive episode. Their anger may run out of steam and they may run out of energy, and you may watch them become depressed. If you do, be aware they may be going into an episode.

Your loved one's anger in a depressive episode may come from the fact they're unhappy about the way things are, instead of the way they want them to be. This could be stemming from frustration on their part, and an inability to change the circumstances.

They may be angry because they are out of control. This can be conscious or unconscious, caused by the bipolar disorder. A bipolar episode can definitely cause a loss of control, which is very difficult for someone who is used to being in control all the time. Therefore, anger may be the result.

Even if your loved one is not in a bipolar episode, they may still experience feelings of anger. For example, they may be feeling frustrated, and this may come out in anger, or they may just be angry that they have bipolar disorder at all. Many people with the disorder feel this way, especially in the beginning, when the diagnosis almost turns their whole life around. It takes some getting used to, and takes longer for some than others.

Although it may seem like your loved one is angry at you, they may be angry at themselves for getting bipolar disorder in the first place. They may not understand it is not their fault. You can help them with this by educating yourself (and them) on bipolar disorder.

So why do they take their anger out on you?

Probably because you are there. They may get angry at you over something you've said or done, but it may be out of proportion to the actual event. This, too, is part of their bipolar disorder.

The best thing you can do is NOT fight back when they get angry, no matter how much they are yelling at you. Yelling back or fighting back will only make your loved one angrier, and you will lose anyway.

Anger is always the symptom of a problem. For those who have anger stemming from bipolar disorder, it can range from mild to extreme.

Often, there is no particular trigger that sets off anger. Rather, the person may simply wake up feeling angry. In other instances, the person may be sensitive to particular actions that make most people angry. Then again, they may get very angry, even overreact, in a situation where most people would not get angry, or only get slightly irritated.

Following are some suggestions of what to do when your loved one is angry:[30]

  1. Stay calm, and speak in a quiet voice; this will force your loved one to listen to you.
  2. Do not lose control, especially since your loved one is probably already out of control. 
  3. Do not approach or touch your loved one, as this might "set them off."
  4. Make sure you have a way of escape in case things get too out of control.
  5. Do not give in to any demands; stick to your limits.
  6. Try to determine the root of the anger (if it has a rational cause you can address).
  7. Do not argue back or raise your voice; this will only escalate the situation.
  8. Acknowledge their feelings and say that they have a right to feel that way.
  9. Tell them that you are trying to understand what they are going through.
  10. Protect yourself from injury should your loved one become violent; leave if you must.

One of the symptoms of a bipolar manic episode (or impending one) is that your loved one may get extremely angry at you, rage at you, or even become violent – even if they never have before. I am about to tell you the fastest way to deal with your loved one's bipolar anger.

It's called de-escalation. I know – it's a big word, but it's a simple concept. All it means is that you can gain control over a situation that is out of control by using this method.

First, let's discuss what de-escalation is. It is a way of calming down your loved one and his anger so he doesn't make matters worse, and so things do not get violent. De-escalation is a method you can use to ensure your own safety. It is also the fastest way to deal with your loved one's bipolar anger.

Next, let's talk about your goal. In order for this method to work, your goal should be to eliminate, or at least decrease, your loved one's anger, instead of further enraging him.

Therefore, you must do everything in your power to calm him down, and to de-escalate the situation.

Let's look now at some methods of calming your loved one down:

  * Make your voice softer

One way to calm your loved one down is to make your voice softer. This forces your loved one to have to stop and listen to what you are saying. Try yelling at a person that you aren't sure is hearing what you have to say!

  * Stay calm yourself

The calmer you are, the better your chances are that your loved one will get calm as well – maybe not right away, but given time, this can work. It will at least keep your stress lower, and give you more chances to think of a way out.

  * Don't fight back

Every instinct in you may be telling you to fight back, but you must resist this urge. No matter how angry you may feel at the time, fighting back will only make your loved one angrier, and will escalate the situation, instead of de-escalating it.

  * Don't feed your loved one's anger

You have been through this before. Don't do any of the things that, in the past, have fed your loved one's anger. In other words, if you have said things that have made him angry, don't say them now. If his words have hurt you before and he is saying them again now, don't react – this will just cause him to get angrier.

  * Don't take it personally

I know this may be difficult, but don't take anything your loved one says personally. He is just ranting and raving, but it does not mean it is directed towards you. This is just part of his bipolar mania. Let the words and the anger just bounce off you. Don't let yourself feel your own anger, hurt, resentment, and any other negative feelings you may be feeling at the time.

  * Disengage or walk away

If you can, disengage from your loved one by making a phone call. Better yet, find an excuse to walk away from it. Go to the bathroom. Get a tissue. Get a drink of water. Anything to get you out of the room for a few minutes. This act will force your loved one to take a few minutes and have to think about what's going on and what they are saying (or want to say), and hopefully will calm them down.

  * Wait until the storm passes

Just as someone who is drunk eventually passes out, your loved one will eventually "spend" his anger. Wait until his "anger storm" runs out of steam, no matter how long it takes. As long as you de-escalate in the ways I have outlined here, it should not take very long, and things should go back to normal fairly quickly.

Lying and Bipolar Disorder

One of the problems which often arises with the issue of lying and bipolar disorder is the patient has no memory of what happened during their bipolar episode – so, for example, when they wake up in jail or in the hospital, they may not know how they got there or why they are there.

When it comes to you, their supporter, they may say or do things during their episode you remember quite well, so when the discussion of the event comes up, you think they are lying about it.

You may even feel anger at your loved one, or accuse them of denying that the event ever happened. You may think your loved one is trying to get out of the consequences, even if it is as small as a simple apology to you.

Your loved one, however, may not have any idea of what you're talking about! They may get defensive at being called a liar or even get angry with you. They may actually not have any memory of the event at all, which is common for someone in a bipolar episode; so, in fact, they are not lying to you, as much as it may seem that way.

On the other hand, there are some people with bipolar disorder who will take advantage of the fact that they have been in a bipolar episode and will lie on purpose to try to avoid accepting the consequences of their behavior and actions. This is wrong and, if it is happening to you, your loved one must be held accountable.

Whichever the case, lying is very common when it comes to bipolar disorder, so if you feel as if your loved one is lying to you, chances are that you are, indeed, experiencing this phenomenon.

If lying and bipolar disorder is an issue for you – i.e., if you have a loved one who has lied to you – you first need to figure out if they have lied because they just don't remember what happened during their bipolar episode, or if they have lied to you on purpose to cover up something.

If they've lied to you to cover up something, you may feel hurt at first, but by being forgiving and understanding, they may feel closer to you in the long run. If they just don't remember what happened during their episode, then it's not really lying, it's just poor memory, and not meant to hurt you.

Seldom will someone with bipolar disorder deliberately lie to others. If they do, it is usually because they feel threatened, frightened, or defensive, and may be trying to cover it in what appears to be a lie.

A deliberate lie would be if your loved one says, "I don't have bipolar disorder." In this case, they are definitely lying, because you know that they have the disorder.

They may also state something like, "My doctor said I can go off my medication."

Be wary if your loved one says something like that, as it is most likely not true. Remember the old adage, "If something seems too good to be true, it probably is."

If you have any concerns about what your loved one tells you, and/or you believe they are lying to you (especially about medication or something that their doctor or therapist told them), check with the doctor or therapist yourself.

Manipulation and Bipolar Disorder

Manipulation is another issue that occurs with bipolar disorder. I know I found this in my mom's case. Manipulation is a way to influence someone with indirect, deceptive, or abusive tactics.

You may not even realize that you're being manipulated when it does happen. It could go on for so long that it seems natural to you. In my case, it had been going on for my entire life.

Manipulation may seem helpful or even friendly or flattering, as if the person has your highest concern in mind but, in reality, it's to achieve an ulterior motive. Other times, it's veiled hostility, and when abusive methods are used, the objective is merely power.

The most common forms of manipulations that people use are: guilt, complaining, denying, blaming someone else, pretending ignorance or innocence ("Who me?"), bribery, undermining, mind games, emotional blackmail, "forgetting," fake concern or sympathy, apologies, flattery, and gifts and favors.[31]

Manipulators often use guilt by saying directly or implying, "After all I've done for you," or always behaving helpless and needy.

Passive-aggressive behavior can also be used in manipulation. Typically, passive-aggression is a way of expressing hostility. "Forgetting" on purpose conveniently avoids what you don't want to do and gets back at the person, such as forgetting a lunch date, or returning books to the library. Sometimes this is done unconsciously, but it's still an expression of anger.[32]

When used as a weapon, physical or emotional abandonment – the silent treatment – is the ultimate power play. This, too, is a form of manipulation.

If this sounds like your loved one, then they are being manipulative.

The first step to dealing with this problem is acknowledging it. Confronting your loved one about it may not necessarily be the best thing to do, as they may deny it, especially if they are not consciously aware that they are doing it (especially in the case of passive-aggressive behavior).

Remember who you are dealing with, and that it may be because of their bipolar disorder, which is not their fault.

Being aware of the problem, you can combat it. An excellent way to do this is by "moving your buttons."

Consider the following case study:

CASE STUDY:

Marilyn was a single mom who had a son named Tyler. Because he was a teenager (and probably because she was a single mom), Tyler was constantly pushing his mom's buttons.

Marilyn would come in tired and frustrated from work, and all she wanted to do was relax before having to make dinner. Tyler would come out of his room and pick fights with her constantly, over seemingly inconsequential things, but the next thing Marilyn knew, she was running into her bedroom crying.

Marilyn was dating Bob at the time, who one day witnessed this scene. He told her, "Move your buttons."

"What are you talking about?" she asked him.

"Move your buttons. He keeps pushing them, so move them. You know when you react to the things he says, so the next time he says something that would usually upset you, just ignore it. Don't react to it. If necessary, just ignore him or leave the room if you have to, but do NOT get upset."

Marilyn "moved her buttons" and it worked! Tyler eventually stopped his provocations and Marilyn no longer ran into her bedroom crying after a confrontation with her son.

\------------------------------------------------------

Being aware of manipulation is key to combatting it. Staying in control of your thoughts and emotions is the way to avoid being manipulated.

NOTE: Don't fall for bipolar bait: My mom and many people with bipolar disorder who are not stable throw out phrases, statements or do things to get you to be mad or engage them. This is called bipolar bait. Do not take it. They are just trying to get you to react emotionally to what they say, so they can "win" the argument. They are trying to get you to engage, to argue, to play the game. When you take the bait, you wind up in an endless loop of fighting, anger, arguing, time wasting, stress, etc. Over and over again. Just stay calm and rational, and do not react emotionally. Reject their bipolar bait as just what it is.

For a FREE worksheet to help you deal with your loved one with bipolar's anger, lying, and manipulation please visit www.BipolarFamilyCure.com

# Chapter 16: Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people understand the thoughts and feelings that influence behaviors.

It is a form of therapy that is the most widely used for treating mental disorders. CBT focuses on developing coping strategies to solve problems and change negative thinking and behavior.

CBT was developed from the ideas of Albert Ellis, the founder of Rational Emotive Behavior Therapy, and Aaron Beck, the founder of Cognitive Therapy. CBT focuses on solutions, encouraging people to challenge distorted ways of thinking and change destructive patterns of behavior.[33]

CBT consists of: ways to change negative thoughts and actions into positive ones; facing things realistically; learning useful strategies; and homework.

There is a great need for CBT for bipolar supporters, who may tend to negative thinking and, therefore, to negative actions and behaviors. CBT can help them to change their thinking and their reactions/behavior.

The root of CBT lies in the idea that behavior is closely tied to the thoughts behind it. For example, if you have negative thoughts about something, it may turn into a great fear of it, and your behavior will be affected; i.e., you will avoid that situation (even if it is a positive one).

The goal of CBT is to re-train people so that they have better control over their thoughts and emotions, turning negative ones into positive ones, and therefore changing their behavior.

Because CBT is usually a short-term treatment option, it is often more affordable than some other types of therapy.

According to the British Association of Behavioral and Cognitive Psychotherapies, "Cognitive and behavioral psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behavior. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self-help material."[34]

There are a number of specific types of therapeutic approaches that involve CBT that are regularly used by mental health professionals. These types include:

  * Rational Emotive Behavior Therapy (REBT)
  * Cognitive Therapy
  * Multimodal Therapy
  * Dialectical Behavior Therapy (DBT)

Many times, a person can experience thoughts that are incorrect because their origin was faulty. Therefore, negative behavior ensues, affecting all aspects of their life.

For example, a person who does not think well of themselves, might have difficulty forming friendships, and have trouble in school or at work.

In the first stage of CBT (called functional analysis), the therapist works with the person to look at their wrong beliefs. They need to do that in order to see how these beliefs affect their behavior.

The second part of CBT centers on the behaviors that stem from these beliefs and the new skills that can be taught to improve them. For example, the person who has difficulty forming friendships would learn how to have better self-esteem.

In most cases, CBT is a process that helps a person take gradual steps towards a behavior change.

CBT is well-suited for people looking for short-term treatment that does not necessarily involve medication (although it can be used in addition to medication). One of the greatest benefits of CBT is it helps people develop coping skills which can be useful both now and in the future.

Through the help of their therapist, someone undergoing CBT will learn how to identify their distorted ways of thinking and how this influences their feelings and subsequent behavior. Thus, they learn to monitor their thoughts and have a large part in changing their own behavior (reactions to situations). For example, they might keep a journal about their thoughts and feelings as part of their homework for CBT.

The result is that the person helps to change their own undesirable behavior. For example, someone who is has problems with interpersonal relationships may be set a homework assignment just to meet a friend for coffee and talk.

One way to evaluate a behavior using CBT is to use what is called the "ABC Model of CBT," which was originated by Albert Ellis and called the "ABC Technique of Irrational Beliefs."[35]

Ellis evaluated a behavior according to its "Activating Event, Beliefs, and Consequences." The activating event is the originating situation; the beliefs are the ensuing thoughts; and the consequences are the resulting behavior. He uses a three-column table to record this evaluation.

Ellis believes that it is not the activating event (A) that causes negative emotional and behavioral consequences (C), but rather that a person interprets these events unrealistically and therefore has an irrational belief system (B) that helps cause the consequences.

EXAMPLE:

Mary is upset because her friend canceled their lunch date. The Activating event (A), is that the lunch date was canceled. The Belief, (B), is that she must not be a very good friend if her friend canceled their lunch date. The Consequence, (C), is that Mary feels rejected.

After irrational beliefs have been identified, the therapist will often work with the person to challenge the negative thoughts on the basis of evidence from the person's experience by re-interpreting it in a more realistic light. This helps the person to develop more rational beliefs and healthy coping strategies.

A therapist would help Mary realize that there is no evidence that just because her friend canceled their lunch date, it means she does not consider her a good friend. Mary wants to be considered a good friend, and this is a good thing, but just because a lunch date is canceled does not mean she is being rejected.

If she realizes that a canceled lunch date is disappointing, but not awful, and that it means she is maybe inconvenienced a little, but not rejected as a person, she may feel frustrated, but not rejected. The frustration is a healthy negative emotion and she can learn to deal with this without having an irrational reaction to it in the future.

Common Events Supporters Face That CBT Could Help:

  * Need doctor right away
  * No transportation to doctor
  * No money for treatment or medication
  * Loved one won't take medication
  * Loved one went off medication
  * Loved one refuses treatment
  * Loved one threatening suicide
  * Loved one attempted suicide
  * Loved one hurt someone
  * Loved one had an affair
  * Loved one got STD
  * Loved one got pregnant
  * Loved one arrested/in jail
  * Loved one maxed out credit cards
  * Loved one invested in bad scheme
  * Loved one sleeping all the time
  * Loved one won't get out of bed
  * Loved one withdrawn
  * Loved one won't groom themselves
  * Loved one fighting all the time
  * Loved one violent
  * Loved one destroying relationships

For a FREE worksheet to help you make the most of Cognitive Behavioral Therapy (CBT) techniques with your loved one with bipolar disorder, please visit www.BipolarFamilyCure.com

# Chapter 17: Avoiding Caregiver Burnout

It is not uncommon for caregivers to feel a variety of emotions and stress, including guilt, anger, helplessness, and pressure.

At a time when the need for social and emotional support is the greatest, caregivers often face feelings of isolation that jeopardize their health and well-being.

Caregiving can be stressful. Sustained, elevated levels of the stress hormone cortisol can put caregivers at risk of physical health problems.

Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude -- from positive and caring to negative and unconcerned.

Research has shown that women who are caregivers to spouses are more likely to have high blood pressure, diabetes, and high cholesterol and are twice as likely to have heart disease as women who provide care for others, such as parents or children. In addition, women caregivers also may be less likely to get regular medical checkups, and they may not get enough sleep or exercise.[36]

Caregiver burnout isn't like a cold. You don't always notice it when it is happening. Like Post Traumatic Stress Syndrome (PTSD), the symptoms of caregiver burnout can begin surfacing months after a traumatic episode.

The following are symptoms of caregiver burnout:[37]

  * Depression
  * Feeling tired all the time
  * Loss of interest in work
  * Problems at work
  * Withdrawing from friends and family
  * Increasing alcohol and drug use
  * Increasing fear of loss or death
  * Difference in eating patterns
  * Difference in sleep patterns
  * Feeling helpless
  * Feeling hopeless

Often, caregivers are so busy caring for their loved one that they neglect their own physical, mental, emotional, and spiritual wellbeing. The demands on a caregiver's body, mind, and emotions can easily seem overwhelming, leading to fatigue and hopelessness and, ultimately, to burnout.

Other factors that can lead to caregiver burnout include:[38]

  * Confusion of roles – It can be hard when suddenly you become a caregiver instead of your normal role. Then you may find it hard to distinguish this role from being a husband or wife, son or daughter, sister or brother, friend, etc. This can be very confusing.
  * Lack of adequate resources \-- Many caregivers become frustrated by not having enough money, resources, and skills to effectively manage their loved one's care.
  * Unrealistic expectations \-- Many caregivers want to be a positive influence on their loved one, but sometimes this just cannot happen.
  * Unreasonable demands – Many times, a caregiver will place unreasonable demands upon themselves, because they overemphasize their responsibility as a caregiver.
  * Don't recognize burnout \-- Many caregivers don't see when they fall into burnout and can even reach the point where they cannot fulfill their role as a caregiver.

Some stress can be good for you, as it helps you cope and respond to a change or challenge. But long-term stress of any kind, including caregiver stress, can lead to serious health problems.

Some of the ways stress affects caregivers include:[39]

  * Weak immune system. Caregivers under stress may have weaker immune systems and therefore are more susceptible to illnesses. Even a flu shot may no longer be effective for them. It can also make recovery from operations more difficult. 
  * Weight gain. Research shows stress causes more women than men to gain weight, and that being overweight raises your risk for other health problems, such as: stroke, heart problems, and diabetes. 
  * Anxiety and depression. Studies show that women who take upon the role of the caregiver are more likely than men to become anxious and depressed. Then they are more prone to other health problems, such as stroke and heart disease. 
  * Increased risk for health problems. High stress levels can increase your risk for other illnesses, such as: diabetes, arthritis, heart problems, or cancer.

Here are some steps you can take to help prevent caregiver burnout:[40]

  * Talk to someone, such as a friend, family member, or clergy person about your thoughts and feelings.
  * Talk to a professional. Most therapists, social workers, and counselors are trained to help people cope with their emotional issues.
  * Accept your feelings. Having negative feelings (e.g. anger, frustration) is normal for a caregiver. It does not mean you are a bad person or a bad caregiver.
  * Set realistic goals, and understand you may need help with your responsibilities as a caregiver.
  * Ask for help if you need it; don't try to do everything yourself.
  * Take advantage of respite care services. Respite care can provide a break for you, from a few short hours to a short stay in a nursing home to a stay in an assisted living facility.
  * Be realistic about your loved one's bipolar disorder.
  * Don't neglect your own needs because you're too busy seeing to your loved one's needs. This is not being selfish; it is a real necessity in order to remain an effective caregiver. 
  * Know your limits and watch that you don't exceed them. Realize that you could easily fall into caregiver burnout.
  * Educate yourself. The more you know about bipolar disorder, the better you will be able to help your loved one deal with it.
  * Have a sense of humor. Try to look at the lighter side of things, and laugh as often as you can. Humor can help you deal with the stress that you face on a daily basis.
  * Stay healthy by sticking to a nutritious, healthy diet, exercising regularly, and keeping a good sleep schedule.

The most important point mentioned above is don't neglect your own needs. In fact, you must take care of yourself first, or you will not be able to take care of your loved one.

Think about this: you know how when you fly on an airplane they give you pre-flight instructions? They always talk about putting on the oxygen mask in case of an emergency, right? Well, they tell you that if you are flying with a young child to put on your mask first, and then put on your child's mask. That's so that you can better take care of your child. It's the same thing if you are a supporter to a loved one with bipolar disorder and you are trying to avoid caregiver burnout.

Joining a support group might be a good thing for you as well. Support groups are made up of people with a common problem (such as bipolar disorder, in this case) who come together regularly to share information and to commiserate with each other.

These groups are usually free, although some do ask for a small donation to help cover room rental or to cover the cost of coffee and refreshments.

Support groups are different from group therapy. They are led by the members themselves, rather than by a therapist.

Support groups can provide emotional strength, coping tips, information about medication experience and treatment outcomes, and sharing of feelings which reflect your own.

Because the same people usually attend support group sessions, you will probably even form some friendships as well as gain support.

Many support groups even have speakers from time to time, such as doctors or other members from the medical community, who can help you with questions concerning bipolar disorder.

You should be able to find a support group in your local community by asking your loved one's psychiatrist or therapist. If not, search websites such as NAMI.org (National Alliance on Mental Illness), DBSAlliance.org (Depression and Bipolar Support Alliance), and others that deal in mental health.

For a FREE Caregiver Contract you can sign with yourself to combat burning out from your loved one's bipolar disorder please visit www.BipolarFamilyCure.com

# Chapter 18: Supporting the Supporter

"When one is sick, two need help."

\--Marlee Fisher

Pablo Casals, the world-renowned cellist, said, "The capacity to care is the thing that gives life its deepest significance and meaning." It's essential that you receive the support you need, so you can maintain that capacity to care.

When done in the right way, caring for a loved one can bring satisfaction and even joy to both you and your loved one. But you both need support.

As I said before, you need to take care of yourself first. If you devote your time, attention, and affection solely to your loved one's needs to the exclusion of your own, you will find yourself burning out or, at worst, resenting your loved one. You must not only acknowledge your own needs, but you must see that they are met. Take care of yourself, so that you are able to take care of your loved one.

I know that some people will disagree with me on this point. They may think it's selfish to put themselves first, to put themselves before their loved one. But I would say to you if you DON'T put yourself first, you won't be an effective supporter, family member, friend, co-worker, etc.

It is definitely not a matter of being selfish but, instead, a matter of "best practices."

Every supporter is different, but best practices for you might include:

  * Going to your own therapist
  * Attending your own support group
  * Keeping in close contact with your friends and family
  * Having a social life
  * Doing things outside the home separate from your loved one
  * Doing things that you enjoy
  * Having hobbies
  * Being of service to others besides your loved one
  * Being active in church or a civic organization
  * Volunteering for a worthy cause
  * Taking care of yourself physically
  * Taking care of yourself mentally
  * Taking care of yourself emotionally
  * Taking care of yourself spiritually
  * Keeping a positive attitude
  * Improving your self-esteem
  * Bettering yourself
  * Learning more about bipolar disorder
  * Learning something new

You will also want to build a support system of your own, just as your loved one must do.

Members of a support system can include:

  * Family members
  * Friends
  * Treatment team
  * Clergy and church members
  * Support group members
  * Boss or coworkers
  * Members of the community
  * Neighbors

Having a support system will keep you from becoming isolated, and keep loneliness and depression at bay. No one says you have to be a social butterfly, but you do need to avoid isolation, as caring for a loved one with bipolar disorder can overwhelm you and take over your life if you let it.

You may also want to explore networking opportunities on the internet. There are many social networking sites, like Facebook, that cater to virtually every need, interest and age group. This will also keep you from "over-focusing" on your loved one's bipolar world.

You may prefer to provide your own support by using various techniques to de-stress. The following list is just a sampling of the kinds of activities you can try to gain some peace and to restock your personal resources:

  * Exercising or doing sports
  * Socializing with friends
  * Doing relaxation or stress reduction exercises
  * Listening to soothing music
  * Doing yoga and meditation
  * Pursuing a hobby
  * Using aromatherapy
  * Taking a bubble bath 
  * Reading a good book
  * Getting a massage

Another thing you may want to do is to attend a Family-to-Family program sponsored by the National Alliance on Mental Illness (NAMI).

NAMI Family-to-Family is a free, 12-session educational program for family and friends of people with mental illness. Research shows that the program significantly improves the ability to cope and problem-solve of the people closest to the person living with a mental illness. NAMI Family-to-Family is taught by NAMI-trained family members who have been there, and includes presentations, discussion and interactive exercises.

You can find out more about the program at: https://www.nami.org/Find-Support/NAMI-Programs/NAMI-Family-to-Family

If you're distracted, burned out, or otherwise overwhelmed by the daily grind of caregiving, you'll find it harder to have a close connection with your loved one. That's why it's vital that while you're caring for your loved one, you don't forget about your own needs. Caregivers need care, too.

There are specific things that caregivers of loved ones with a mental illness need; emotional, mental, and physical.

Emotional needs of caregivers

Take time to relax every day and learn how to de-stress when you start to feel overwhelmed.

Talk with someone who will help you to see your situation in a better light. They will help you to lighten your load, sometimes just because they care about you.

Keep a journal. Sometimes just writing down your thoughts and feelings can help you to see things more clearly.

Take care of your spiritual self. Pray, meditate, or do another spiritual activity that makes you feel part of something greater than yourself. Try to find meaning in both your life and your role as a caregiver.

Watch out for signs of anxiety, depression, or burnout and get professional help if needed.

Mental needs of caregivers

Stay social. Avoid isolation by visiting with friends and family often, nurturing close relationships.

Do things you enjoy. Hobbies can help keep stress to a minimum and are a good outlet for energy.

Maintain balance in your life. You need to maintain a good balance between your work life and your home life. Also a balance physically, mentally, emotionally, and spiritually.

Take regular breaks from your caregiving responsibilities, and give yourself an extended break at least once a week.

Build a support network. The broader your support network, the better. Not just family and friends, but also members of your support group, church or civic organization, neighbors, etc.

Physical needs of caregivers

Exercise regularly. Try to do at least 30 minutes of exercise, at least three times per week. Exercise is a great stress reliever.

Eat a nutritious, healthy diet. It is well-known that when you eat healthier, you feel healthier. It also helps you to keep your stress levels down to a more manageable level.

Avoid alcohol and drugs. Alcohol and drugs can really interfere with your ability to do an effective job in your caregiving role. Instead, try dealing with the situation without the use of substances.

Keep a good sleep schedule. Go to sleep at the same time every night, and wake up at the same time every morning, getting at least 8-9 uninterrupted hours of sleep every day. This will keep your energy level high and able to handle stress.

Get regular checkups. Go to the doctor regularly, and stay healthy, so you can take care of your loved one. You also need to be a good example to your loved one, and if they see you doing this, they are more apt to as well.

According to expert Ruth Wolever, PhD, clinical health psychologist and research director at the Duke Center for Integrative Medicine, Duke University School of Medicine, it's important for caregivers to think about a mission statement for themselves — in other words, what do you want from your life? Taking care of a loved one with bipolar disorder might be a really important part of that mission, but you'll probably have other parts as well. You need to get a better idea of your own goals and desires so you can have things clear in your mind when demands are made of you by your loved one.[41]

She also says you need to "validate your efforts," meaning just because your loved one may not say thanks to you for the things you do for them, doesn't mean you shouldn't pat yourself on the back for them here and there.

For example, say your loved one has been in a depressive episode and has not gotten off the couch for a month or groomed themselves in weeks. Yet today, with your encouragement, they have gotten off the couch and taken a shower. Congratulate yourself for a job well done!

It is important for you to keep your priorities in order. For instance, it is more important for you to go to bed on time at night than for the house to be spotless.

There is an expression that says, "Keep the main thing the main thing." The main thing in your case can be summed up in one word: BALANCE.

The life of a supporter to a loved one with bipolar disorder is not an easy one. Most of your energy is spent caring for your loved one, your family, and others. For you to remain emotionally healthy, you need to stay balanced.

You need to balance your professional, family, social, and personal responsibilities. In there somewhere there also needs to be room for you.

You also need to have balance physically, mentally, emotionally, and spiritually, as I previously discussed. Think of it as a chair with four legs. If one of the legs should break, the chair can still stand; however, if two of the legs are broken, so is the chair.

You need to care for yourself, because you can't count on anyone else taking care of you. It's nice when your loved one takes care of you, as they do during normal periods. What happens, though, when your loved one is unstable, like during an episode, and it is your turn to care for them? Unless you yourself are stable, you will not be able to care for your loved one.

I know I keep stressing this, but it is a very important point: you must care for yourself and your own needs. You must feel secure in yourself, in who you are, and in your own capabilities.

Do things that you enjoy. Take time away from your responsibilities as a supporter. For instance, you could take a day off and visit a spa and just be pampered! If you can't afford a spa, you could just get a manicure – you'll still feel pampered, after all.

There was a time when you had hopes, dreams, and wishes. Don't give up on them just because you are a supporter now. You can still care for someone else as long as you care for yourself first.

Can You "Catch" Bipolar Disorder?

This email was sent to me, and I wanted to share it with you, because you might have the same question:

"John,

Me and my wife used to have a good relationship, but

it's gotten worse lately. Or I should say I've gotten worse

lately. I've been more depressed than I was, and I feel

worse than I used to. She's gotten worse, of course, but

I know that's because of her bipolar disorder. What I'm

wondering is, can you catch bipolar disorder?"

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Living with someone who has bipolar disorder can sometimes make you feel as if you are living in a world of your own. A world so bizarre that no one would believe what was happening if they hadn't experienced it for themselves.

That's why I'm not surprised that supporters have asked me some odd questions, such as the one this man asked me in his email:

"Can you catch bipolar disorder?"

You may have noticed at times that you act the same way as your loved one, and wondered if your loved one is to blame. Or you may get depressed, and wonder if you have caught the depression from your loved one, like the man in this email.

This is perhaps the most common scenario when you are supporting a loved one who goes into depressive episodes.

Many supporters have complained to me that they have caught their loved one's bipolar disorder.

But can you "catch" your loved one's bipolar disorder? Can this, in fact, be a real phenomenon?

I decided to research this, and in all my research into this topic, I will tell you that I have found no factual basis for the claim. However, I did find a study that backs up why supporters might feel as if they are catching their loved one's bipolar disorder, and I can tell you about that study.

There was a study called "The burden on informal caregivers of people with bipolar disorder" done in 2005 by some researchers at the University Department of Psychiatry, Warneford Hospital, Oxford, UK.

The abstract of their research talked about the different quality of burden caregivers of people with bipolar disorder may experience than that which is seen with other illnesses. They call the concept "caregiver burden," and for one thing, they say that it is associated with depression.

Another thing they said was that "caregivers of bipolar patients have high levels of expressed emotion, including critical, hostile, or over-involved attitudes."

These two aspects of caregiving can "team up" to give the supporter a subjective feeling of having caught their loved one's bipolar disorder when, in fact, it could be the result of caregiver burden.

If you are depressed, or if you are suffering from caregiver burden, please seek help by seeing a mental health professional such as a psychiatrist or a therapist. The important thing to know is that you do not have to suffer needlessly.

For a FREE Guide to Building Your Own Support System Please Visit www.BipolarFamilyCure.com

# Chapter 19: The Red Line and Enabling

"If I see a problem I jump right in and help. But I finally realized that whether she's messed-up on the credit cards again or offended yet another friend, I can't keep saving her from herself. I just can't run far enough, fast enough to get out ahead of her quick enough to head off the next disaster."

That's what one supporter said in Marlee Fisher's book, 70 Signs of Depression. But it may very well be your lament as well.

In her book, she refers to accepting continued abuse as being your loved one's "emotional pincushion," and says that you should not behave as if you were.

She says, "You are not required by law, religion, family ties or marriage vows to endure verbal abuse, mental abuse or manipulation. Nor should you."

And being on eternal, automatic rescue mode can drain the best of us because even when your loved one isn't in immediate need of rescuing it's likely your physical systems remain tense and always on the alert for the next crisis.

There has to come a point where you put your foot down. Where you refuse to stand for any more of your loved one's unacceptable behavior. This is called the Red Line.

The Red Line concept stems from the idea of the line in the sand, which is the line your opponent cannot go past. Supposedly, this saying is only about fifty years old; while, before that, people would talk of drawing the line, and they would mean "making a distinction," which is what we now understand as "setting a limit."[42]

You need to let your loved one know when they are about to, or have, crossed the boundaries of your personal endurance; i.e., when they have crossed the Red Line you have set.

Consider Irene's story:

"Mom, I've told you before, I won't stand for your talking to me this way."

"What way?" her mom said. "I'll talk to you any way I damn well feel like it!"

Irene thought, "I wouldn't put up with anyone else talking to me this way; why do I put up with it from her?"

She was so frustrated. Yet again. It seemed like she was in a perpetual state of frustration and anger any time it came to dealing with her mom.

She wanted to have compassion on her because of her bipolar disorder, but she was about out of compassion – her mom had "used her up," with her continued bad behavior and mistreatment.

Whenever she would go visit her mom, Irene had to listen to her myriad complaints of physical ailments, slights from the neighbors and her "so-called friends." Everything was about her and the world that revolved around her. She might ask how Irene was doing, but would quickly turn the conversation back around to her, not even giving Irene a chance to tell what was happening in her own life.

Each time, Irene would think, "She is so self-centered! I can't believe I fall for this every time! Why do I even bother. She doesn't care about anyone other than herself."

Her mom had diabetes, yet she would continually eat cakes, cookies, and chocolate. Many times she went into diabetic episodes, where the paramedics had to be called to the house to help with her sugar regulation.

"Mom!" Irene would exclaim in exasperation after yet another one of these episodes. "If you don't stop eating sweets, you're going to die!"

"Well, it's my business what I eat. I can do whatever I want," her mom would always answer her.

The worst thing was that she was in denial of her bipolar disorder and kept believing she was well, so she kept messing up her medication. This led to episode after episode, and she was hospitalized THREE times in ONE year!

Each time, she would want Irene to go visit her; yet when she arrived, her mom would get physical and push her away, yelling at her to leave her alone.

"You'd think I would learn," Irene would think, "but she rooks me in every time. Each time I think it's going to be different this time, but it's not. She's never going to change. She's just going to get worse."

Her dad would give her mom an allowance each month so she would have spending money throughout the month. But she would go through the money before the end of the first week and be asking for more! This would go on month after month, and Irene had to hear about it from her dad.

"What does he want me to do about it?" Irene would ask herself. "She won't listen to me. She'll either deny it or get defensive and get mad at me for even getting involved."

Irene was sick of her mom's antics. She was sick of her mom's bipolar episodes and having to visit her in the hospital where she was just rejected time after time. She was sick of being put in the middle between her mom and her dad. She was sick of her life being totally disrupted because of her mom.

Her mom never made an effort to change any of her bad behavior, and Irene was at the end of her rope.

She gave her mom an ultimatum.

"Mom, your behavior is totally unacceptable. I am giving you three months to change it. You need to treat me better, with the respect that I deserve. I want you to treat me the way you would treat a friend. I deserve it. And I want you to stop complaining. I want you to take care of your diabetes and stop eating sweets all the time, so you stop having diabetic episodes. I love you, and I don't want you to die. And I want you to take your bipolar medication every day. I mean, every day! Without fail. And I want you to see a psychiatrist and a therapist, and to take your bipolar disorder seriously. That's it. If you don't do these things within three months, I'm out of here. I mean it. I'm moving out of state. You won't be able to see me ever again."

Irene really thought that the threat of not ever seeing her again would make her mom change. Unfortunately, it didn't. Three months later, Irene moved from Florida all the way to Tennessee. She calls her mom to check on her, but she has vowed to never go back to Florida to see her.

\-------------------------------------------

Are you at the Red Line with your loved one? Have you reached the point where you want to give them an ultimatum like Irene did? It's sad to say, but many supporters have had to leave marriages because of infidelity and bankruptcy, and other irreconcilable differences due to bipolar disorder.

If you do set a Red Line with your loved one as Irene did, you need to consider the following points:

  * Be clear about the behaviors you want your loved one to change.
  * Be concise. Don't overwhelm them with demands they can't meet.
  * Make your demands well-defined.
  * Be fair.
  * Set a definite time frame.
  * State the consequences if they do not make the changes.

If you do not set definite boundaries with your loved one, you could be enabling your loved one's unacceptable behavior.

Enabling is when you unknowingly "help" your loved one continue exhibiting unacceptable behavior.

Consider Joy and Peter's story:

Joy and Peter had a son with bipolar disorder. Their son would go into manic episodes and when he did, he seemed to always get himself into trouble.

This may not have been so bad, except his kind of trouble always landed him in jail. Then he would call his parents to bail him out.

Joy and Peter would bail him out of jail every time, of course, because he was their son, and they didn't want him to suffer.

Unfortunately, their son just kept going into manic episodes, getting into trouble, and getting arrested and put in jail. Then Joy and Peter would bail him out. It was an endless cycle.

Nothing changed. The cycle just continued. Their son never got any help for his bipolar disorder. And his repeated arrests just kept draining Joy and Peter's finances.

\---------------------------------------------

But let me ask you something: What do you think would have happened if just one time Joy and Peter did not bail their son out of jail?

Oh, I'm sure he would have been angry. Maybe even yelled at them or called them names. Had to stay in jail.

But without his parents continuing to enable him, he would have been forced to get help for his bipolar disorder.

Here's another case study:

Charlie's mom used alcohol and drugs to self-medicate her bipolar disorder. Things had gotten so bad that their relationship had totally disintegrated to the point that Charlie felt that he had to do something.

So one day, he told his mom that if she didn't stop using alcohol and drugs, he would never speak to her again.

It wasn't easy. She went into rehab. It was awful! It was the hardest thing she ever had to do in her life.

But she did it because of the threat of her son never speaking to her again. That she could not bear. It was all she kept in mind during the hardest times. It was what motivated her to get clean and sober and get her bipolar disorder under control.

It worked! And now she has been clean and sober for 12 years and episode-free for 10 years! And she and Charlie are closer than ever.

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A Pyrrhic victory is a victory which takes such a devastating toll on the victor it is the same thing as if they actually experienced defeat. Someone who wins a Pyrrhic victory does win in some way; however, the toll it takes cancels out the win.[43]

Do you feel like you've been in a war with your loved one and their bipolar disorder? Do you feel like you've won some battles yet the war just hasn't been worth it and you are so beat up that you are ready to admit defeat?

At what point do you exclaim, "Enough is enough!" and totally give up on your loved one?

The term pyrrhic victory is used as an analogy in fields such as business, politics, and sports to describe struggles that end up ruining the victor. But here's a personal example:

Melissa was married to Phillip, who had a severe case of bipolar disorder. Because of his frequent manic episodes, their finances were a shambles, and Melissa had to go back to work.

Problems arose when Phillip began calling her 10 and 12 times a day at work, for no particular reason. Her boss told her if he didn't stop disrupting her at work, he would not be able to keep her on.

Melissa explained to Phillip what her boss had said, and begged him to stop calling her at work so many times a day. Unfortunately, he continued to do it, and she lost her job.

Luckily, she was able to get another job right away, but Phillip did the same thing again and she lost that job, too.

Melissa ended up going through EIGHT jobs in ONE year! All because of her husband and his manic behavior. They ended up going through a bankruptcy and financial ruin.

Melissa couldn't take it anymore, and finally she divorced Phillip. It wasn't that she didn't love him; it was just that she saw no end to the battle. She would be able to get jobs; she just wouldn't be able to keep them. She would never be financially secure.

\--------------------------------------------------

Here is another situation where a supporter declared "enough is enough":

Walter and Carol had been married for six years and although she knew he had bipolar disorder when she married him, she didn't think it was a problem, because he hadn't had an episode for all those years. She thought his bipolar disorder was "cured."

Boy, was she surprised when he started changing seemingly out of the blue! He started losing sleep. He seemed to have endless energy. He had all kinds of ideas and big plans for their future, plans that she knew would never come to fruition.

Then she found out that he had invested his 401(k) and all their savings into a foolish business venture behind her back which totally backfired on him, and he lost ALL their money!

Carol hit the roof! She realized she'd been ignorant of the damage bipolar disorder can cause, and she determined to be more educated about the illness. She also took charge of their finances immediately. Walter sought help for his bipolar disorder and his medication was changed, and his symptoms subsided.

For a while Walter was stable. Carol thought the worst was over. But then Walter started going into rages, picking fights over nothing. It was awful! Carol could never figure out what caused these fights, so she couldn't figure out how to stop them. But from the knowledge she had gained from her bipolar research, she knew this was caused by his bipolar disorder, and that he wasn't thinking rationally, and was again in a manic episode. So it was back to the doctor for Walter.

Then one day Walter got arrested and put in jail. He'd been fighting. Carol thought, "That's not like Walter!" But then she realized he'd fallen into the pattern of not sleeping again (along with the other manic behavior) and realized he was in another episode. Walter's medication was adjusted again.

That was bad enough, until the day that he turned the violence on her. That was when she put her foot down. She insisted he go into anger management. Unfortunately, that didn't help, and whenever he would go into a manic episode and start to rage, he would get violent.

Carol loved Walter, but she feared he would just get worse, so she left him.

\------------------------------------------------

If you are in a situation like Carol, where your loved one has turned violent and physically abusive, I encourage you to leave the situation. It is not a matter of whether you love them or not; it is a matter of personal safety. NO ONE deserves to be abused.

Here is a true story:

Kellie and Bill had been having problems in their marriage. Among other things, Bill had been working 15 hour days and Kellie had been working 12 hour days. They were hardly together at all any more. Especially not for intimacy.

Bill didn't think it bothered him to go so long without sex, until he went into a manic episode and went to a prostitute.

He didn't tell Kellie about it and even forgot about it himself, thinking it was just a one-time thing.

Then one day Kellie went to her doctor and found out she had a sexually transmitted disease. She was devastated!

She confronted Bill about it, and although he admitted what he had done, she found she just could not forgive him his infidelity.

They were unable to reconcile their differences, and Kellie finally divorced Bill.

\-------------------------------------------------

You may get to the point where, like Kellie and the others, you are so tired of the battle that you are ready to give up the war. If so, don't blame yourself. It is not your fault. You need to take care of yourself and your own well-being.

Chances are, the desperate measures you take will force your loved one to get the help they need for their bipolar disorder.

You may feel guilty for "forcing the issue" with your loved one in this manner. If you do, you may need to seek out a therapist to help you deal with it.

For a FREE Self-Assessment to See Whether Your Loved One Has Crossed the "Bipolar Red Line" Please Visit www.BipolarFamilyCure.com

# Chapter 20: Winning Ways to Keep Going Before Your Loved One Crosses Your Red Line

There is no success without some suffering involved. In fact, it has long been thought, "the greater the suffering, the greater the reward." There is a direct correlation between the misery you suffer and the extent of your eventual success.

Even the Bible says, "In the world ye shall have tribulation..." (John 16:33KJV). The more tribulation (trouble or adversity) you suffer, the more you learn.

Emerson said, "When man...is pushed, tormented, defeated, he has a chance to learn something; he has been put on his wits, on his manhood, he has gained facts, learns his ignorance, is cured of the insanity of conceit; has got moderation and real skill."

You can't fail as long as you keep trying. Remember the old adage, "If at first you don't succeed, try, try, try again."

As long as you don't give up, you are not failing. Thomas Edison was not successful with his light bulb on his first try! Walt Disney suffered through a bankruptcy and a breakdown. Milton Hershey went bankrupt. H.J. Heinz was forced into bankruptcy before his company was ever successful.

Experience leads directly to higher levels of success. You can use your past experience with your loved one to be more successful with them now and in the future.

Just know that, like in war, things will get tough. Some people rely on prayer. Every major religion has prayers that can be said to help people through the tough times.

Christians use The Lord's Prayer:

"Our Father who art in Heaven,

Hallowed be Thy name.

Thy kingdom come, Thy will be done,

On earth as it is in Heaven.

Give us this day our daily bread,

And forgive us our trespasses,

As we forgive those who trespass against us.

And lead us not into temptation,

But deliver us from evil.

For thine is the kingdom, and the power,

And the glory, forever, and ever.

Amen."

In addition, there are many Scriptures that help them; like the following:

"No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it." (1Cor.10:13NIV)

Many people, regardless of their religion, take comfort from The Serenity Prayer, by Reinhold Niebuhr:

"God, grant me the serenity

To accept the things I cannot change

The courage to change the things I can

And the wisdom to know the difference."

You need to be mentally tough in this war with bipolar disorder. There are some principles that the Navy SEALs use that I practice myself.

They use a technique they call The Big Four. You can read about this in an article at: http://cristivlad.com/the-big-4-navy-seals-technique-conquering-fear-panic/.

The Big Four consists of:

  1. Goal Setting – When you face stress, or are in a situation that causes you anxiety, your amygdala (that part of your brain that protects you) fires off. You can use goal setting to control this. Think of things you want in your future, and this will help balance you.
  2. Mental Rehearsal – Another word for this is visualization, where you run something over and over again in your mind, preparing yourself to battle it in real life. So if you imagine all the ways you might have to fight your loved one's bipolar disorder and then the ways you will deal with it, you will be better prepared when you face those situations.
  3. Self-talk – This article states, "We know from research that the average person speaks to himself more than 400 words per minute." By making this self-talk positive instead of negative, you will be better able to face the situations that confront you.
  4. Arousal Control – This has to do with the way you breathe when you feel anxious in a stressful situation. SEALs use controlled breathing, using slow inhales of breath, which will get you better oxygen and help you to think better, and slow exhales of breath, to relax you.

When you are facing a stressful situation involving your loved one, stress breathing can definitely help you cope with things better. Imagine being able to stay calm in light of an escalating rage when your loved one is fighting with you.

Another thing you can do, if you are on the phone with your loved one and they are beginning to get out of control, is to hang up the phone. You can even get off the phone by telling them you have another call, or simply saying, "I've got to go," or, "we'll talk about this when you are calmer."

If you are physically in the situation with your loved one, you can leave it, making up whatever excuse you have to in order to leave the room (or house).

If you need to, you can "take leave," in military terms. Even generals have time off the battlefield and don't fight for time on end without breaks. You can go away for the weekend to a motel (check online for discounts), friends, family, anywhere. Stay away for a period of time, until you "recharge your batteries."

You need time off. You can't keep "taking fire" day after day with no break. This was a huge mistake that I made one time when my mom went into an episode. I am  
lucky I was younger and had the energy to win the war. But you need to look at your own situation and consider this as an option.

A Gratitude List

Finally, you should create a gratitude list. This is extremely important. Many times when supporting a loved one with bipolar disorder your problems can seem insurmountable. You lose so much time. You feel terrible. You worry. You don't sleep. You lose a lot of money. Maybe you even get fired or your job is "on the ropes."

You need something to remind yourself things aren't as bad as you think they are. That's when you go to your gratitude list.

It may not look like it at first, but if you think about it, you can always find something to be grateful for. These things will make up your gratitude list.

You can use a pen and paper to create your Gratitude List, or keep it as a Word document on your computer (this would be easier to update as you go from day to day).

A gratitude list can be as general or as detailed as you want it to be, as long or as short as you want to make it. In the beginning, it will probably be shorter, as it may be hard to think of things to put on it; however, it will be easier as you go, and will become longer as you think of more things to put on it.

When should you do your gratitude list? Anytime that is convenient for you, as long as you do it consistently. Addictionblog.com says, "It's been proven that documenting thankfulness just before bed produces a more restful night's sleep and sweeter dreams."

The simplest way to make a gratitude list is to put the title at the top of the page (Gratitude List), and then begin numbering down the page, listing the things you are grateful for. The order doesn't matter. Neither does spelling (you are the only one who will see this list, after all). Just brainstorm and write down your thoughts as they come to you.

In addition to keeping a Gratitude List, listening to success stories from bipolar survivors and supporters can be very encouraging for you and give you hope. I offer these in my courses/systems, and thousands of supporters have taken advantage of this opportunity.

For an inspirational bipolar success story Please Visit www.BipolarFamilyCure.com

# Chapter 21: There IS Hope!

In all the time I have been a bipolar supporter, I have talked to or heard from over 1,000 people with bipolar disorder or supporting someone with the disorder.

Let me tell you, I have heard some real horror stories! But I've also heard some AMAZING success stories!

There IS hope for people with bipolar disorder. Even some of the absolute worse cases can recover!

Consider these case studies:

CASE STUDY #1:

Randy was a 56-year-old man who had been in and out of prison his whole life, starting as a teenager.

He started breaking into houses at 14 years old on a dare, but later did it for the "kick." He loved the rush he got by doing something illegal like that – it was like a "high" for him.

Over the years, he did it many, many times. Unfortunately, he always seemed to get caught!

While at first he was tried as a juvenile, it wasn't long before he was tried as an adult for breaking and entering and sent to prison. It seemed just as soon as got out for one stretch, he was caught again and sent back for another. He couldn't seem to help himself! He had to get that "high."

He couldn't explain why he felt the need to break into houses. He told the prison counselor that he could go periods of time and be "good," feeling what he called "normal," but then he would start to feel agitated and irritable, on edge, "ready to make his move." And he would be off once again.

At his last incarceration, Randy was diagnosed as having bipolar disorder. He was given mood stabilizers, and his "edginess" went away. He no longer had the desire to break into houses, and was able to stay out of prison.

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CASE STUDY #2:

By the time Lenore was diagnosed with bipolar disorder, she had gone through FIVE divorces! She just couldn't understand why she kept getting married, when it never worked out for her.

She would get into these "moods" where she felt really "high," really excited, and she would meet someone. They would go out for a short period of time, and then they would get married!

Of course, they never stayed married for very long. She just couldn't keep it together enough to be a good wife. It was like "buyer's remorse" to her – she would come out of the "mood" and find herself married, and think to herself, "How did I get here?" and get divorced shortly thereafter because, of course, she never loved these men.

Shortly after stabilizing on her bipolar medication, Lenore met another man with bipolar disorder who had been stable for many years. They went out for a LONG time, and then they got married. They have now been married for over TEN years!

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CASE STUDY #3:

Ashley was a full-fledged alcoholic and drug addict by the time she was 25. She had no idea she actually had bipolar disorder and was self-medicating her symptoms with alcohol and drugs. All she knew was that she needed them to feel as close to "normal" as she could get.

She was always high or drunk, never really aware of what she was doing, or who she was with. She did many things to support her habit, even turning to prostitution.

Things got really bad when she got addicted to heroin, and then she got Hepatitis-C from using a dirty needle, almost losing her life in the process.

A sympathetic doctor referred her to a psychiatrist, who finally diagnosed Ashley with bipolar disorder and put her on medication to help her.

She went into rehab for her alcoholism and drug addiction. It was a struggle, but today she is clean and sober and stable with her bipolar disorder.

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CASE STUDY #4:

Cynthia looked like the "girl next door" on the outside. She was very outgoing, got along well at work, had many friends, and was close with her family.

But no one knew what went on behind closed doors.

Cynthia would go into deep, dark depressions, fantasizing about killing herself. She would have to drag herself to work and "put on her work face" most days.

It was so hard to act like everything was great when she was depressed like that.

She had her first baby when she was 22. She was so depressed that her mother had to come live with her to help her take care of the baby, because she just couldn't do it. She was diagnosed with postpartum depression.

But a year later, Cynthia was still going through the depression. And two years later, she still suffered periods when she could barely get out of bed.

Then came her first suicide attempt. She took a bottle of pills. Luckily, her husband came home in time to call the ambulance, and she was rescued. But everyone was concerned.

She was hospitalized, and diagnosed with major depression.

There were two more suicide attempts before Cynthia was finally diagnosed with bipolar disorder, but she was finally put on medication and with that and therapy, she is happy and productive today.

She has not even thought about suicide in many, many years.

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CASE STUDY #5:

Cheryl was a happily married woman with three children and an ideal life. She lived in the suburbs in a beautiful home. She had no problems. Except for one thing.

A couple times a year, she would "fly off" into these wild "episodes," where she would spend an excessive amount of money, draining their checking accounts and maxing out their credit cards.

The worst thing was, she would also have affairs. She thought she could keep them from her husband, but they lived in a small town, and word got around. Especially when her husband got herpes, and she had to tell him what she had done.

Her husband begged her to go into marriage counseling with him to try to save their marriage, because he was having a hard time with her spending and having affairs.

Cheryl agreed to go to counseling.

The therapist told them she didn't think the problem was in their marriage, she thought Cheryl actually had bipolar disorder and these were manic episodes. The therapist referred them to a psychiatrist, who confirmed the diagnosis.

Cheryl and her husband worked out the issue of her affairs, but after going on medication for her bipolar disorder, she never had another affair. And they worked out a system where her husband was in control of the money so she could no longer go on spending sprees.

She has been stable for many years now, and they are again as happily married as ever.

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CASE STUDY #6:

Spencer struggled through school. He was very moody. Some of his teachers even called him morose. He was diagnosed as depressed at the age of 16 and put on antidepressants, but they didn't help at all.

He got married at 24, but that was a struggle, too, and the marriage didn't last long. They seemed to fight all the time.

Jobs were difficult for him, too. He didn't seem to last at any one for very long. He couldn't seem to get along with his coworkers or his boss. But the biggest problem was that his depression would get so bad that sometimes he couldn't get out of bed and had to call in sick. This would happen so often that he would get fired from the job for absenteeism.

Because he didn't have steady employment and couldn't keep up with the rent, he kept getting evicted from apartments everywhere he lived.

Spencer ended up homeless and living on the streets, which is where his parents found him. They convinced him to come live with them where he would at least be safe.

He stayed with them for the next two years, so depressed that he couldn't get off the couch, hardly ever even taking a shower.

One day, his parents got him a computer, and he read an article about starting a home business. He was intrigued, but did nothing about it at that time. Yet the seed was planted.

Eventually Spencer decided to get help, and went to see a psychiatrist for his depression and told him that antidepressants hadn't helped him. The psychiatrist diagnosed him with bipolar disorder and gave him mood stabilizers, which brought him out of the depression.

He remembered the article on starting a home business, and began an internet business. That business grew, and now is a multimillion dollar business!

\--------------------------------------------------------

CASE STUDY #7:

Mark's anger had gotten him in trouble his whole life. He could go long periods of time and be "normal," but then he would fly off into rages, getting into fights with everyone around him.

Everyone just figured he was "short-tempered," and tried not to provoke him. They avoided him when he was in one of his "moods."

He never felt like anything was his fault, though. Half the time, after the "episode" was over, he couldn't even remember why he'd been angry in the first place!

But the truth was, it wouldn't actually come out of the blue. He had problems with insomnia, so sometimes he would lose sleep, even for days at a time. Then he would get really agitated and irritable. Then the rages would inevitably follow.

Mark was on his third wife and sixth job before he went for help. It was only because his wife was threatening to divorce him and his boss was threatening to fire him that he decided to see what was going on.

The psychiatrist asked him a bunch of questions, and decided that these rages were a result of bipolar manic episodes, and prescribed him some medication to help him.

These days, Mark's anger is under control. He has even undergone therapy to deal with some of the issues that may have "set off" his anger at times. His marriage is better than ever, and he even got a promotion at work!

\------------------------------------------------------------

CASE STUDY #8:

Susan was first diagnosed with chronic major depression in her twenties and was given antidepressants. She felt like they just made her worse, so she stopped taking them. Of course, her depression didn't get any better. So she suffered for years.

She had a relatively normal life. She finished her college degree, got married, had children, etc. But periodically, she'd go into these awful depressions where she could barely function.

At 30 years old, she started seeing a therapist, who said she was suffering from unipolar depression, and suggested she go to a psychiatrist for antidepressants. She figured she was older now, so she would try them again. Of course, they didn't work.

At 35, she went to another therapist to try to figure out why she kept starting projects but never finishing them. She was diagnosed with Attention Deficit Hyperactive Disorder (ADHD).

At 42, a psychiatrist said she had Obsessive Compulsive Disorder (OCD).

Then she started seeing and hearing things, and was diagnosed with schizophrenia.

With all these diagnoses, she was put on different medications. It was hard to tell what symptoms were actually symptoms and what was from the medications themselves.

Susan was frustrated. She didn't know what was wrong with her, but she was starting not to trust any of the therapists or psychiatrists.

Finally, at 45, she went into such a bad depression that she tried to kill herself by cutting her wrists. This landed her in the hospital.

There she was finally diagnosed with bipolar disorder, taken off her other medications, and put on the right medication.

Susan has been stable now for EIGHT years!

\------------------------------------------------------------

CASE STUDY #9:

Diana was really becoming a handful. She had always been "colorful," a real "individual." She never cared what anyone thought of her; she just did whatever she wanted to. And sometimes that was some really bizarre things!

When she was a teenager, she took her parents' car and raced it down the main street of their town. It was a wonder she didn't get into an accident or run it off the road! But she just laughed her head off as if she didn't have a care in the world.

Another time she was a passenger in the car with her older sister and she just grabbed the wheel and started laughing hysterically!

Then one time with her brother driving, they got into a fight, and she threatened to jump out of the car. He didn't believe her, so she opened her door and at 45 miles an hour, she stuck her foot and half her body out the door before he pulled her back in the car.

At one point, she got caught shoplifting. When confronted by her parents and asked why she did it, she said, "I just wanted to see if I could get away with it!"

She almost didn't graduate from high school because she skipped so much. She had to go to summer school just to get her diploma.

As she got a little older, she started going to bars and picking up guys. She wasn't even very particular. She was very promiscuous. She got pregnant at 21, but she never married the guy.

Here she was, a single mom struggling to make ends meet at a dead end job working at a convenience store. She was always "borrowing" money from her mom and dad just to pay her bills. She could never get caught up. But that didn't stop her from going out to the bars!

One day her dad told her he would not give her any more money unless she saw a therapist about her impulsive and risky behaviors. She felt that she had no choice but to do it, so she went.

Diana was more surprised than anyone else to find out her behavior was actually a part of bipolar disorder called mania, and it could be controlled by medication.

Today Diana's mania is well under control, and she is in a nursing program at the local community college.

\-----------------------------------------------------------

CASE STUDY #10:

Ron had been diagnosed with bipolar disorder after a long battle with depression. He had been on a trial-and-error of round after round of medication, until they found a combination that finally worked for him.

Unfortunately, after a while, the medication stopped working, and he became depressed again.

The doctor tried another medication, and that worked for a time, but then it, too, failed.

This happened for years. He would go on a new medication, it would work for a while and keep his depression at bay, but then the medication would stop working and inevitably his depression would return.

Ron was frustrated, and very, very depressed. He had practically given up all hope of ever getting out of his debilitating depression.

He talked to his psychiatrist about it. He told him he was sick of going on all these medications, just to have them fail. But he was also sick of being depressed!

His psychiatrist told him there was one thing they hadn't tried yet – ECT. He said that ECT had proven successful in breaking through depression when medication had failed, and asked if he was willing to give it a try.

Ron tried the ECT, and it worked! Today he is on a medication that works, and he is depression-free.

\-------------------------------------------------

Maybe you have just read about your loved one in one of the case studies above. Maybe you have thought, "They'll never get better!"

If so, take heart. These are some of "the worst of the worst," and even they have gotten better!

Recovery is possible, no matter how bad things seem right now. In many cases, it is just a matter of finding the right medication.

Just don't give up. If one medication doesn't work, try another one. Or, if medication has failed, try ECT like Ron did. Then your loved one can be a success too!

For a FREE Guide to Visualizing Your Loved One with Bipolar's Success Story (So It Can Become More Likely) Please Visit www.BipolarFamilyCure.com

# Chapter 22: Find Hidden Resources

In order to be a good supporter to a loved one with bipolar disorder, you need to find hidden resources that are local to you. This will be of invaluable aid to you and your loved one.

There are many great resources all over, especially local to you; however, they are generally bad at marketing themselves, and so they are what I call "hidden resources."

Here's how you can find them:

  * Call hospitals

Make a list of all hospitals within a one- to two-hour radius of you.

Then start calling the mental health or psychiatric departments of

those hospitals. Ask them for resources to help you and your

loved one.

  * Check NAMI

Check the National Alliance on Mental Illness (NAMI) website at:

www.nami.org for information and resources. They have a

phone number you can call to reach a local NAMI chapter, and

the local chapter will be able to give you local resources.

  * Check DBSA

Check the Depression and Bipolar Support Alliance (DBSA)

website at: www.dbsalliance.org for a listing of a support group

near you. They can give you resources that can help you.

  * Google keywords mental health support and your city

If you Google the keywords mental health support and your

city, this should bring up local resources that will help you

and your loved one.

  * Check with therapist and psychiatrist

Check with your loved one's therapist and psychiatrist, and

any other mental health professional (and caseworker or

social worker) that is part of your loved one's treatment

team for local resources that can help you.

  * Check with family, friends, and others

Check with everyone you know who might know of any

resources that might be able to help you.

You need to be targeted in your approach, no matter who you are talking to. Know what you are asking for, and be specific. Make sure to say you are seeking help for a loved one with mental illness, specifically bipolar disorder.

NOTE: If the person you are talking to does not know of any resources that can help you, be sure and ask them if they know of anyone else who might know. They may be able to lead you to someone else who can help you.

For a FREE Resource Finder Checklist for Bipolar Supporters Please Visit www.BipolarFamilyCure.com

# Chapter 23: Conclusion

So where do we go from here? What kind of future can I promise you as a supporter to a loved one with bipolar disorder?

Well, there is still no cure for bipolar disorder, although there is research being done for it on a daily basis. Simply go to the National Institute of Mental Health (NIMH) website at: https://www.nimh.nih.gov for a listing of clinical trials. You may even be able to find one being done in your area in which your loved one may want to participate.

Although the best hope for recovery from bipolar disorder is medication and therapy, there are many things that your loved one can do for themselves to manage their bipolar disorder, as we discussed in this book.

As a supporter to a loved one with bipolar disorder, you have a great responsibility; however, you need to take care of yourself as well, or you can easily suffer from caregiver burnout, and then you won't be able to take care of your loved one at all. In fact, as I have repeatedly stressed, you need to take care of yourself first. It is not a matter of being selfish – it is a matter of being smart. Remember this: ultimately your loved one's disorder is their responsibility and the quality of your life is your responsibility.

You want to be the best supporter you can be, I understand that. I know, as I am coming from the same place, being a supporter to my mom. With that in mind, I hope this book has been a help to you.

When I was first starting out, there were few books on bipolar disorder at all, much less one that spoke to the issues that I needed to know as a supporter to a loved one with the disorder. I hoped to rectify that with this book. In addition, I have covered topics that have never been discussed before in relation to bipolar supporters, and I hope they have helped you.

Unfortunately, there are no statistics on how many people have recovered from bipolar disorder, because it is a "lifetime disorder." However, that does NOT mean that you should ever give up hope for your loved one!

With proper management of the disorder, your loved one can live a normal, productive, successful, and happy life, despite having bipolar disorder. And you can help, as a supporter.

Be encouraged! There has been much discussed in this book that offers you information and support in your role as a caregiver and a person that will help you cope and deal with a loved one with bipolar disorder – things you can take with you into the future.

I wish you success.

PS – Be sure to download ALL the free cheat sheets, worksheets, and guides for those who support a loved one with bipolar disorder at www.BipolarFamilyCure.com

BIBLIOGRAPHY

  * Bipolar Caregivers. Accessed on March 26, 2017. http://www.bipolarcaregivers.org. 
  * Bipolar Central. Accessed on March 26, 2017. http://www.bipolarcentral.com/. 
  * "Bipolar Disorder Community". Healthy Place. Accessed on March 26, 2017. http://www.healthyplace.com/bipolar-disorder. 
  * "Bipolar Disorder". Help Guide. Accessed on March 26, 2017. https://www.helpguide.org/home-pages/bipolar-disorder.htm. 
  * "Bipolar Disorder". Mayo Clinic. Accessed on March 26, 2017. http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/home/ovc-20307967. 
  * "Bipolar Disorder". National Institute of Mental Health. Accessed on March 26, 2017. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml. 
  * "Bipolar Disorder". WebMD. Accessed on March 26, 2017. http://www.webmd.com/bipolar-disorder/
  * Carter, Jay and Bobbi Dempsey. Complete Idiot's Guide to Bipolar Disorder. New York: Alpha Books, 2009.
  * DBS Alliance. Accessed on March 26, 2017. http://www.dbsalliance.org. 
  * Dunleavy, Brian P. "What Is Bipolar Disorder?" Everyday Health. Accessed on March 26, 2017. http://www.everydayhealth.com/bipolar-disorder/guide/. 
  * Fast, Julie A. and John D. Preston. Loving Someone with Bipolar Disorder. Oakland, CA: New Harbinger Publications, 2004.
  * Fink, Candida and Joe Kraynak. Bipolar Disorder for Dummies. New Jersey: Wiley Publishing Inc., 2005.
  * Fisher, Marlee. 70 Signs of Depression. Loose Leaf, 2002.
  * Haycock, Dean A. The Everything Health Guide to Adult Bipolar Disorder. Blue Ash, OH: Adams Media, 2010.
  * Last, Cynthia. When Someone You Love Is Bipolar. New York: The Guilford Press, 2009.
  * Legg, Timothy J. "Bipolar Disorder". Health Line. September 27, 2016. Accessed on March 26, 2017. http://www.healthline.com/health/bipolar-disorder. 
  * Lowe, Chelsea and Bruce M. Cohen. Living with Someone Who's Living with Bipolar Disorder. San Francisco: Jossey-Bass, 2010.
  * Mental Help. Accessed on March 26, 2017. https://www.mentalhelp.net. 
  * Miklowitz, David J. The Bipolar Disorder Survival Guide. New York: The Guilford Press, 2002.

Please Review This Book

Having helped thousands of people with bipolar disorder and their supporters has taught me a lot about being a supporter to a loved one with bipolar disorder. And I've done my best to share the techniques and strategies I've learned with you in this book.

But I'm just learning my way as an author...

That's why I need your help.

It would be immensely helpful to me if you could write a review for this book and publish it on Amazon.

To write the review, go to my book page on Amazon...

RateBipolarFamilyCure.com (this url will redirect you to Amazon)

Scroll down to the reviews section.

And just write an honest review (good or bad) and give my book as many stars as you think it deserves.

Thank you in advance,

John Z. Ford
* * *

[1] Leo, "The Seven Pillars of Strategic Thinking", Actualized.org, Accessed on April 2, 2017, http://actualized.org/

[2] Brian Krans and Kristeen Cherney, "The History of Bipolar Disorder", Healthline, Accessed on March 26, 2017, http://www.healthline.com/health/bipolar-disorder/history-bipolar.

[3] Ibid.

[4] "Bipolar Disorder", National Institute of Mental Health, Accessed on March 26, 2017, https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.

[5] Amanda Gardner, "U.S. Has Highest Bipolar Rate in 11-Nation Study", CNN.com, March 7, 2011, Accessed on March 16, 2017, http://www.cnn.com/2011/HEALTH/03/07/US.highest.bipolar.rates/index.html.

[6] "Bipolar Disorder", Mayo Clinic Health Library, July 6, 2016, Accessed on March 29, 2017, https://www.riversideonline.com/health_reference/Disease-Conditions/CON-20027544.cfm

[7] "Bipolar Disorder", Mayo Clinic Health Library, July 6, 2016, Accessed on March 29, 2017, https://www.riversideonline.com/health_reference/Disease-Conditions/CON-20027544.cfm

[8] "Bipolar Disorder: Who's at Risk", WebMD, Accessed on March 26, 2017, http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-whos-at-risk#1

[9] "Causes of Bipolar Disorder", WebMD, Accessed on March 26, 2017, http://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-causes?rdspk=active#1.

[10] Ibid.

[11] Melinda Smith, Jeanne Segal and Robert Segal, "Bipolar Disorder Treatment," Help Guide, December 2016, Accessed on March 26, 2017, http://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-treatment.htm.

[12] Chelsea Lowe, and Bruce M. Cohen, Living with Someone Who's Living with Bipolar Disorder (San Francisco: Jossey-Bass, 2010).

[13] Ibid.

[14] "Bipolar Disorder", Mayo Clinic, Accessed on March 26, 2017, http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544.

[15] Melinda Smith, Jeanne Segal and Robert Segal, "Bipolar Disorder Treatment - Therapy", Help Guide, December 2016, Accessed on March 26, 2017, http://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-treatment.htm#therapy.

[16] Smith, Segal and Segal, "Bipolar Disorder Treatment - Therapy," Help Guide, December 2016, Accessed March 26, 2017. https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-treatment.htm#therapy.

[17] Ibid.

[18] Dean A. Haycock, The Everything Health Guide to Adult Bipolar Disorder (Blue Ash, OH: Adams Media, 2010).

[19] Jay Carter and Bobbi Dempsey, Complete Idiot's Guide to Bipolar Disorder (New York: Alpha Books, 2009).

[20] "Bipolar Disorder Statistics," Depression and Bipolar Support Alliance, Accessed on March 26, 2017, http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_bipolar_disorder.

[21] David J. Miklowitz, The Bipolar Disorder Survival Guide (New York: The Guilford Press, 2002).

[22] Melinda Smith, Jeanne Segal, and Robert Segal, "Bipolar Disorder Self Help", Help Guide, December 2016, Accessed on March 26, 2017, http://www.helpguide.org/articles/bipolar-disorder/bipolar-support-and-self-help.htm.

[23] What Is HIPAA?, Accessed on March 26, 2017, http://whatishipaa.org/.

[24] K. R. Jamison, "Suicide and Bipolar Disorder", Journal of Clinical Psychiatry 61 Suppl. 9 (2000): 47-51, Accessed on March 26, 2017, https://www.ncbi.nlm.nih.gov/pubmed/10826661.

[25] "Power Up Passages", Motivational & Inspirational Corner, Accessed on April 2, 2017, http://www.motivational-inspirational-corner.com/powerup2.html?id=685&startrow=22

[26] Kimberly Read, "The Impact of Bipolar Disorder on Sex", Very Well, September 25, 2016, Accessed on March 26, 2017, https://www.verywell.com/bipolar-disorder-and-sex-380585.

[27] David Oliver, "Supporting a Bipolar Spouse", Bipolar Supporter Blog, June 12, 2016, Accessed on March 26, 2017, http://www.bipolarsupporter.com/bipolarsupporterblog/supporting-a-bipolar-spouse/.

[28] Kelly Connell and Valencia Higuera, "Bipolar Disorder and Sexual Health", Health Line, Accessed on March 26, 2017, http://www.healthline.com/health/bipolar-disorder/sexual-health#Overview1.

[29] Ibid.

[30] Samantha Gluck, "Bipolar Anger: How To Handle Your Bipolar Relative's Anger", Healthy Place, June 10, 2016, Accessed on March 26, 2017, http://www.healthyplace.com/bipolar-disorder/bipolar-support/bipolar-anger-how-to-handle-your-bipolar-relatives-anger/.

[31] Darlene Lancer, "How to Spot Manipulation", PsychCentral, 2014, Accessed on March 26, 2017, http://psychcentral.com/lib/how-to-spot-manipulation/.

[32] Ibid.

[33] David Bohnam-Carter, "CBT Techniques to Beat Negative Thinking", DavidBohnam-Carter.com, Accessed on March 26, 2017, http://www.davidbonham-carter.com/cbt-techniques.html.

[34] Kendra Cherry, "What Is Cognitive Behavior Therapy?", Very Well, October 10, 2016, Accessed on March 26, 2017, https://www.verywell.com/what-is-cognitive-behavior-therapy-2795747.

[35] "ABC Model of CBT", Psychology On, Accessed on March 26, 2017, http://psychologyon.wikispaces.com/ABC+Model+of+CBT.

[36] "Caregiver Stress", WomensHealth, January 2017, Accessed on March 26, 2017, https://www.womenshealth.gov/publications/our-publications/fact-sheet/caregiver-stress.html.

[37] M. Ross Seligson, "Caregiver Burnout", Caregiver, Accessed on March 26, 2017, http://caregiver.com/articles/caregiver/caregiver_burnout2.htm.

[38] "Recognizing Caregiver Burnout", WebMD, Accessed on March 26, 2017, http://www.webmd.com/women/caregiver-recognizing-burnout#1.

[39] "Caregiver Stress", WomensHealth, January 2017, Accessed on March 26, 2017, https://www.womenshealth.gov/publications/our-publications/fact-sheet/caregiver-stress.html.

[40] "Recognizing Caregiver Burnout", WebMD, Accessed on March 26, 2017, http://www.webmd.com/women/caregiver-recognizing-burnout#2.

[41] Janene Mascarella, "10 Ways to Care for the Caregiver", Everyday Health, October 15, 2008, Accessed on March 26, 2017, http://www.everydayhealth.com/bipolar-disorder/care-for-the-caregiver.aspx.

[42] Dot Wordsworth, "What, Exactly, Is a 'Red Line'?", The Spectator, June 8, 2013, Accessed March 26, 2017, http://www.spectator.co.uk/2013/06/that-red-line-were-not-supposed-to-cross-what-exactly-is-it/.

[43] "Pyrrhic Victory", Wikipedia, Accessed on March 26, 2017, https://en.wikipedia.org/wiki/Pyrrhic_victory.
