Will love really keep you together? Well … yes. Love PLUS these secrets to a successful, long-term relationship from four couples living with bipolar disorder.
by Donna Jackel
What’s the secret to a successful relationship? For answers, we turned to four couples who illustrate key aspects of maintaining a long-term, satisfying partnership while living with bipolar disorder. (Since both individuals live with bipolar even if only one has a diagnosis, seeing yourselves as a team is a given.)
Sammi & James: Knowledge is power
When Sammi S. and James of Wyoming, fell in love 16 years ago, she didn’t waste any time telling her new beau about her bipolar II diagnosis.
“I’ve worked as an advocate for NAMI for 20 years,” says Sammi, who is 38. “I am very upfront about my diagnosis because it does affect everything.”
Although experts and individuals weigh in on either side of the “tell/don’t tell” debate, clinical psychologist Kathleen Cairns, PhD, recommends revealing your bipolar diagnosis early in a relationship as a sort of barometer for the future.
“You’ll learn if the person is compassionate, whether they can they deal with you. Otherwise, they will feel deceived and you will have wasted your time on someone who is not going to be there for you,” says Cairns, who has private practices in Connecticut and California.
“It’s very important your partner understands everything about bipolar disorder—that it’s an illness of the brain, not a weakness,” she adds.
Before meeting Sammi, James knew little about mental health issues. So he attended NAMI’s Family-to-Family course, which is designed to give family and friends information about symptoms and treatments and solid coping skills.
“Having the tools to understand your loved one’s illness is huge,” says James, 42, a plumbing supplies salesman.
Shane McInerney, MD, a psychiatrist specializing in mood disorders, takes it a step further: “It’s important to gain awareness not only of the illness, but the unique nature of your partner’s illness.”
Experts stress that it’s usually easier for the people around you to recognize when your behavior changes in ways that presage a mood shift—and the more they know about your particular red flags, the better the odds of heading off a full-blown episode.
That’s why McInerney likes to have both partners in his office when he’s explaining how to use a mood tracker—a tool for recording patterns of sleep, activity levels, and mood symptoms.
“Regular use of a mood tracker builds up a rich amount of information about the patterns of a person’s bipolar illness. Then the couple can discuss potential triggers—such as overwork or disputes with colleagues—before an episode happens,” says McInerney, an assistant professor of psychiatry at the University of Toronto and a staff psychiatrist at St. Michael’s Hospital.
James has become adept at detecting Sammi’s mood shifts and knowing how to help. For example, he’ll alert Sammi when she becomes “too happy”— an early sign of approaching mania.
“He’ll tell me, ‘You’re at 10 and I need you at 5,’” she explains.
When Sammi becomes quiet and stops confiding in James, he knows she’s becoming depressed. He goes on high alert to make sure her mood doesn’t progress to a harmful point.
“I do everything I can to get her back to a ‘normal’ state. I try to get her to eat, sleep, take her pills, go for drives. I take her to her mom for a visit. I hug her, love her,” he says. And they go for long walks with their beloved Border Collies, Bug and Dazey.
For her part, Sammi has come to trust and accept James’ observations.
“In the past, I’ve gotten defensive,” she admits. “I didn’t want to hear it.”
While Sammi’s moods still can be unpredictable, that’s only a part of all that she and James share.
“We have a great life,” she says. “It doesn’t have to be dark or so bright that you can’t see. It can be in the middle.”
Jacob & Drea: Loving communication
For some couples, bipolar symptoms erupt after the relationship is already established. Jacob and Drea, who live in Arizona, with their infant daughter, had been married for four years when Jacob entered an extreme manic episode.
“I quit my job, I wasn’t sleeping, I was hallucinating, making really unrealistic goals. I had no fuse before exploding in anger,” recalls Jacob, 36, who was diagnosed in 2012 with bipolar I and generalized anxiety disorder.
Even before Jacob was diagnosed and started medication, Drea went into help mode. She called on both their mothers for assistance and encouraged Jacob to seek therapy.
“Drea was my rock. She didn’t tell me I was stupid, or lazy for quitting my job. She would hold me when I was so down or afraid of what I saw, and rightfully scold me when I would start acting aggressively.”
Jacob is thankful he doesn’t swing to those extremes anymore, and “eternally grateful she stuck with me those first couple years. I really don’t know where I’d be now without her support,” he says.
Marriage counseling helped Drea and Jacob cope with some aspects of Jacob’s illness. He says it was “invaluable”—not least because the therapist helped him appreciate the effect his symptoms had on Drea.
McInerney notes that participating in talk therapy together allows couples to work out a mutually agreeable approach to issues like how the person with bipolar would like the other person to respond to symptomatic behavior.
“For instance, if I notice you’re irritable, how would you like me to point it out to you? Do you want me to leave a note or tell you outright?” says McInerney, taking the role of the partner without bipolar.
Another benefit for Jacob was learning the communication skills to “fight fair.” For example, “keeping it civil and staying in the moment, rather than dragging in past conflicts.” Avoiding saying, “You do it, too,” when one person gets upset about something the other one is doing. Taking time to cool off when emotions run high, then regrouping to calmly discuss how each of them is feeling.
The bottom line, says Jacob, is to remember both parties are working toward the same goal—and that you’re together in the first place because you love each other.
“Everything else is built off of that,” he says.
Drea, 36, says she makes it through their rough patches by remembering “the fun times, all the moments when we were happy and didn’t have to struggle through the moments of bad days.”
She stresses that for a healthy relationship, couples must communicate openly, often, and in a judgment-free atmosphere. When she’s at work as an elementary school teacher, the two use an instant message app to keep in touch.
When Jacob has a bad day, he knows he can talk it through with Drea.
“She allows me to be mad, to a point, and get out what’s bothering me,” he says. “If she doesn’t feel that what’s bothering me is legitimate, she tells me…. I mostly want someone to listen to what I’m feeling and help me get through that initial surge of emotions until I can rein it in and think logically.”
Says Drea: “We have become so connected to each other, we can tell when the other is off. Through that we remain united because we do understand what the other is going through.”
Armand & Teri: Compassion and patience
Giving and caring go both ways in a healthy relationship. For nearly 20 years, Armand and Teri of California, have lived that creed. Armand, 45, needs extra support at times when he’s beset by bipolar symptoms. At other times, he’s there for Teri when she’s dealing with her own mental health issues.
There was a learning curve early in their marriage, like the time Armand became manic after a medication change.
“He was paranoid, speaking fast, talking around the clock, and wanting me to sit and listen to all of it,” recalls Teri, 44.
Teri remembers feeling alarmed because she didn’t understand what was going on. She read up on bipolar and spoke with Armand’s psychiatrist. Now when Armand is unstable, Teri offers compassionate advice.
“I have to remind him, ‘I care about you. I’m not trying to control you,’” she says.
Sometimes she needs to gently persist, since Armand admits he can be deaf to her feedback.
“When I’m depressed, I don’t always see it as something that needs to be fixed right away,” says Armand. “I lose track of time. I will slumber through life. Teri will be able to recognize patterns: ‘This is not you. There is something else is going on here.’”
Cairns notes that’s a common pattern.
“Often people around you will notice your symptoms better than you do,” the psychologist says. The key is to trust your team so you can catch the symptoms early before it turns into full blown mania or depression.”
If Armand depressive mood persists for a week or more, Teri will suggest he make an appointment with his therapist or see if his medication needs to be adjusted. And Armand appreciates it when she reminds him of all that’s good in their lives.
“That really helps,” he says.
Likewise, Armand steps up when Teri experiences visual or auditory flashbacks related to post-traumatic stress disorder.
“The instinct is to push everything away and get safe, but isolation amplifies the disorder, over time,” says Teri. “I have to fight [that urge to isolate] and Armand helps me have courage.”
Says Armand: “I try to encourage Teri to be present, to try and breath and remember she is in a safe place,” he says.
When Teri told him she felt disconnected from everyone—even their twin daughters—Armand took her to the doctor and discussed with his own therapist what he could do to help and how he could avoid triggering his wife.
Teri and Armand say the key to their happy marriage is not taking one another’s behavioral symptoms personally.
“Go easy on yourself and the person you care about,” says Teri. “Take care of each other, but give yourself a break. We’ve learned so much compassion and patience.”
Paige & Joseph: Emotional awareness
Staying sensitive to painful emotions anchors the household of Paige and Joseph of California, who’ve been married for 28 years.
Shortly after she stopped nursing her fourth child in 2005, Paige fell into a suicidal depression as feelings of being overwhelmed, alone and worthless spun out of control. She ended up in the hospital, where she got a diagnosis of bipolar II.
“I didn’t realize how desperate she was feeling,” Joseph says. “She wasn’t talking about it.”
Joseph had to come to terms with his own emotional reactions, too. When Paige was first hospitalized, he recalls, “I was trying to make sure our [family] held together while everything was falling around us. I was in survival mode. And keeping busy allowed me to postpone a lot of emotions I was feeling.”
Logically, Joseph knew it was an illness that had taken Paige to extremes and removed her from the family. Yet he admits that being left to wrangle a houseful of kids ages 12 months to 15 years old—including two with special needs—alongside his job as a game designer, dealing with doctors, and worrying about his wife, stirred some resentment nonetheless.
Cairns points out that during episodes of instability, partners in a support role may be pushed into “overgiving” and neglect their own needs.
“Resentment happens when someone forgets to take care of themselves first,” she says. The common result: burnout. “That’s why therapy and support is equally important [for both partners].”
Ideally, Cairns says, the individual with bipolar should have a well-rounded support team—including a psychiatrist, psychologist, other family members, and at least one close friend. For the spouse or partner, that can take some of the emotional and practical pressure off.
Cairns also recommends setting aside time for activities that reduce stress, whether yoga, a meditation practice, painting classes, or regular exercise.
Joseph recharges by tinkering.
“I always have a project—I paint, build stuff, [fiddle with] new technology—anything that allows me to fixate on something other than [the chaos] going on around me,” he says. “If you have time to cool down and think things through, it really helps a lot.”
So has family counseling, self-education, and connecting with other parents of special-needs kids. Using an emotion chart—pointing to what they were feeling in the heat of the moment—proved worthwhile in easing the family’s interpersonal dealings.
“Now, it’s really easy for us to say, ‘Wow, that really hurt my feelings,’” Joseph notes. “I’ve gotten much better at drawing out how people in our family are feeling. ‘Why are you mad? What’s going on? Where’s this coming from?’”
Skills learned in cognitive behavioral therapy help Paige weigh whether her angry or negative feelings have any validity. She also keeps a daily “truth journal,” writing out positive observations about herself, family and friends when she’s stable that she can use as contrary evidence when negative self-talk overtakes her emotions.
The interior decorator also made a pact to accept her husband’s input as another powerful corrective to her self-critical inner voice.
“She’ll say things like, ‘I’m a bad parent,’ or, ‘I’m doing horribly at work,’ and I’ll tell her, ‘Here’s these five other great things your boss said about you,’” says Joseph. “I make her realize this is her bipolar affecting her—not what’s going on in the world.”
“I trust what Joseph says, that he has my best interests at heart,” Paige says. “He has never given me any reason not to trust him, and that’s why it’s so easy to love him. Trust, truth and love equals hope.”
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Pointers for partners
Some key advice culled from mental health experts and couples themselves:
Avoid blaming. It’s important to acknowledge that bipolar disorder is a legitimate brain-based condition that requires treatment and self-management. It’s no one’s fault. Hurtful or upsetting actions during mood episodes spring from the illness, not the person’s usual character.
Acknowledge the loss. It’s normal for both partners to feel grief, anger, sadness, or guilt over how bipolar will affect the family and plans for the future. You’ll need to accept that the life you originally imagined now looks different, but also that it can still be wonderful.
Get informed. It’s equally important for both partners to learn about bipolar symptoms, typical triggers, and coping responses. Self-education should make it easier to not take mood symptoms like irritability personally, but rather to recognize them as early warning signs of an episode.
Take responsibility. Having bipolar is not a free pass to act out. The individual with bipolar must commit to do the work required to reach stability (to whatever degree that’s possible).
Set boundaries. Sometimes there’s a fine line between encouraging and enabling. And being supportive and patient doesn’t mean blindly putting up with symptomatic behaviors that feel threatening, like abusive language, or can be damaging to the family, like overspending. Agree together on what crosses the line and what consequences will click in—and what preventive measures make sense.
Printed as “Love Stories”, Fall 2017