A Healthy Partnership
How to Support Your Bipolar Spouse
- What is bipolar disorder?
- Clues to recognize undiagnosed bipolar disorder
- Getting help for bipolar disorder
- What you can do for your bipolar spouse
- What can you do for yourself
- Additional resources
Table of Contents
Marriage is already an exercise in compromise and communication, but how do you cope when your spouse is bipolar?
We all experience ups and downs: it’s a normal part of life. A person with bipolar disorder, however, is experiencing these highs and lows on the scale of the most extreme roller coaster you could ever imagine. It is a roller coaster that can end up going faster and faster, with the bipolar rider having no control over their emotions and behaviors when they’re riding the super highs or down in the very lowest of the lows.
Dealing with these extreme emotions is exhausting for the sufferer and for those around them. But as the vows say: “for better or for worse, in sickness and in health.” You have to always keep in mind that bipolar disorder is a mental illness, not a means by which your spouse intends to destroy your marriage. At the same time, you can be supportive of your bipolar spouse without necessarily following them into the extremes of their moods. In this way, you can both come out the other side on a positive note.
What is bipolar disorder?
Let’s start with the basics: Understanding what you are dealing with is the first step to being supportive and helpful to your bipolar loved one.
Bipolar disorder is a mental illness that is also known as ‘manic depression’. It is characterized mainly by extreme mood swings. A person suffering from bipolar disorder can swing from highs to lows quite quickly and unexpectedly, for hours or days at a time, sometimes longer. The episodes of highs or lows are what are known as ‘recurrent’: that is, a person who experiences a manic depressive episode is almost 100% likely to experience it again. It is a rare instance indeed when a person has one episode in their lives, never to be repeated.
During a high, a person might be hyper, extraordinarily happy, and basically running themselves ragged trying to do everything at once. The behavior can escalate to recklessness however, which is when it becomes more dangerous to the person suffering from the disorder and those around them. Irrational and irresponsible behaviors can stem from the feeling that they can do no wrong. Typically, a person on this kind of manic high will be irritable, rather than ‘happy’.
In a low, that same person will be depressed and unable to appreciate the things they normally would. They are totally lacking in energy and hope. (Source) These lows, at their most extreme, can lead to thoughts of suicide.
So you can see that, left untreated, bipolar disorder can be at best frightening and difficult to manage and at worse, deadly. Regrettably, many people who suffer from bipolar disorder fail to recognize the impact their extreme moods have on the people around them, to say nothing of themselves and don’t seek out treatment. Very often, a person has established coping mechanisms, like substance abuse, to deal with it and will go undiagnosed for years.
The exact cause of bipolar disorder isn’t known. What is known is that it is related to an imbalance in neurotransmitters in the brain and is genetic. A person with bipolar disorder is likely to have a parent or sibling who also has the disorder. (Source)
Clues to recognize undiagnosed bipolar disorder
Someone having a ‘meltdown’ or a depressive period following an emotionally triggered life event (divorce, death…) is not a sign of bipolar disorder. Neither is the relatively normal moodiness that comes with hormonal changes (read: every teenager who has ever lived). That doesn’t mean they don’t require treatment or help, but a ‘one off’ situation is not the way bipolar disorder is distinguished from other mental illnesses.
Bipolar disorder is distinguished from depression in the way it varies from it. For example, a person with depression who is not bipolar would not necessarily see a big improvement in their mood when something positive takes place in their lives. A bipolar person could be pulled from the low into a high by something good happening.
The first and most important clue is a family history of diagnosed bipolar disorder. If your spouse has a first level relation (parent, sibling) with bipolar disorder, they are going to be predisposed to suffer from it. This by no means indicates an absolute: a bipolar parent does not always have a child who becomes bipolar. But the existence of a genetic connection is a strong indicator.
Other signs and symptoms of bipolar disorder:
- Hypomania — this is defined as “an emotional state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior for at least 4 days.” (Source)
- During the manic state:
- Anxiety to the point of being incapacitated by it; creating a feeling of lack of control.
- High level of self-importance and inflated sense of abilities
- Decreased sleep
- Decreased appetite
- Racing thoughts
- Decreased concentration
- Poor or rash financial or business choices
- Aggressive behavior
- Intensive / obsessed attraction to pleasurable activities
- During the depressive state:
- Increased sadness / hopelessness
- Decrease in interest in usual activities
- Social isolation
- Inability to finish projects / work
- Increased lethargy
- Low self-esteem
- Increased negative or controlling thoughts
- Increased mentioning of suicide
- That this state is not related to substance use or abuse (eg: alcohol or drugs)
Getting help for bipolar disorder
Treatment for bipolar disorder, despite the unknown origins of the disorder, is fairly simple: a solid combination of psychotherapy and medications can help most sufferers balance their moods through most days. The medications used include mood stabilizers and atypical antipsychotic medications. Psychotherapy is used both as a method of handling the symptoms and to teach and encourage the use of self-help methods, so that a patient can recognize the symptoms of an episode and stabilize themselves.
There are three levels of treatment:
- Acute, where the goal is to stop the symptoms;
- Continuation, where the goal is to prevent the symptoms from the current episode from returning;
- Maintenance, where the goal is to prevent future episodes.
The first step is to seek the advice of a psychiatrist or psychologist. A first episode of bipolar disorder can often start with depression. The sufferer seeks treatment for this and finds that their period of depression is followed by a period of mania. The irony is that pharmaceutical treatment for depression can actually trigger mania in some people, so the actual disorder that the person is suffering from—bipolar—is missed in the diagnosis.
NOTE: if your spouse is exhibiting symptoms that could be life threatening, including aggressive behavior, psychotic symptoms (eg. hallucinations or delusions) or is suicidal, consider the situation to be an emergency and obtain an evaluation by a physician immediately, either with their own doctor or at the hospital emergency room.
As with all mental illness, there is no one perfect blood test to get the diagnosis. A series of interviews and psychological tests will form a picture for a mental health expert upon which a diagnosis is formed. For someone to be diagnosed as bipolar, as with any other mental illnesses, the impact of the disorder must be significant enough that it interferes with daily life and functioning, both socially and in terms of work / studies.
The challenge for many spouses of bipolar sufferers is ensuring that your spouse sticks to the treatment. An effective course can lead a sufferer to think that they are ‘cured’ (they aren’t) and lead them to discontinue the program of medication and therapy that were prescribed.
Ultimately, these treatments are just that: a treatment of the symptoms. Bipolar disorder is viewed most often by medical professionals as a chronic condition. Most people affected by bipolar disorder will need to continue treatments, in some form or another, throughout their lives. That said, most people—80-90%—have a positive response to treatment as long as their medications are managed and followed on an ongoing basis.
What you can do for your bipolar spouse
Learn about the disorder — Spouses who are uncomfortable with the diagnosis may sometimes seek to dismiss it or ignore it rather than face up to reality. This could ultimately be a dangerous course of action. The better path is to read about the disorder, attend family therapy, talk with other spouses of bipolar sufferers, perhaps join a support group.
Learn about your spouse’s triggers, the things that can or usually do set off an episode. Learn also about the things that seem to encourage stability. Mood swings are often affected by specific triggers and the lack of them are similarly affected by other things. Noting what seems to calm your spouse or what occurs or doesn’t occur in periods of calm can help you determine the correct environment to soothe them when you need it.
Learn to talk about the disorder — Intrinsic in learning about the disorder is learning how to talk about it and to your spouse, if they are in the middle of an episode. The key is to remember that it is not your spouse talking to you when they are gripped with a manic high or depressive low: it’s the disorder. Fighting with a disorder is pointless and responding in anger will only result in your making statements that you might later regret. It’s better to be prepared with statements that are intended to diffuse a situation, rather than escalate it. Taking the bait, so to speak, won’t help either of you.
And when in doubt,
Don’t be afraid, don’t put up a defense against us, don’t brace yourself for something bad. Be there to talk and support. It may not be pleasant, personally I can be downright mean when in a bad frame of mind. But you’ll both be glad you were there. (Source)
Listen attentively and laugh as often as you can — we often hear when people are speaking but are we always listening? There’s a difference. Often, that is all a person who is suffering needs: to know that someone is listening to them. Not making suggestions, not always trying to fix things. Just being there.
Humor is said to be the best medicine, and it’s true that it can help to loosen anxiety’s grip on us: “Laughter dissolves tension, stress, anxiety, irritation, anger, grief, and depression…” (Source)
Keep track of medications and appointments — as we said earlier, a bipolar sufferer who is feeling better might be inclined to drop their medications or skip therapy appointments. Don’t let them. Taking an active role in helping your spouse manage the disorder is appropriate and possibly even necessary.
Develop coping mechanisms and rules — find ways to cope with the results of the symptoms. For example, if your spouse tends to go on spending sprees while in a manic episode, you might need to keep hold of the credit cards. If their driving becomes erratic or overly aggressive, it’s time to keep hold of the car keys. Establishing some rules when they are in a calm state can help you both deal with the times when the disorder takes over. For example, you could have the rule that two successive days of refusing to get out of bed means that your spouse needs to call their doctor. It sounds a bit ‘mechanical’ but having processes in place can help you go into reactive mode rather than trying to reason with the illness. (Source)
Part of these processes needs to be planning for an emergency. If your spouse’s behavior suddenly becomes unmanageable, even life threatening, you need to have a plan in place: who to call, after hours numbers, which hospital to go to that is connected with your psychiatrist, the terms of your medical coverage and so on. Scrambling for this information in the middle of a crisis will only aggravate the situation, so like the boy scouts say: be prepared!
What you can do for yourself when you have a bipolar spouse
Take care of you — as much as your spouse needs your support, you are no use to them if you don’t take care of yourself. Remember an airplane’s emergency instructions: always put your oxygen mask on first, before you help others. This is true in any situation of caregiving.
Sometimes taking time for you means taking time away: a trip for a weekend without each other, an overnight at a friend’s house. Just some time where you are not worried about your spouse and can focus on you.
Find a support group — whether that’s an organized group of spouses of persons with bipolar disorder or a group of friends, find those people who will be there for you, as you are there for your spouse. (Source)
Remember why you love them — your spouse is not their illness. They, and you, are so much more than that. Keeping photos about or other momentoes will remind you about your love for them and help you to keep the bonds of marriage strong, even during the lowest lows.
Protect yourself — if your spouse has discontinued or is refusing treatment, you must protect yourself and your children, if you have any. The highs and lows of bipolar disorder, left untreated, can result in verbal, emotional and even physical abuse. You have to encourage your spouse to seek out or return to the treatment that they need. How? By calmly pointing out what you are seeing. Use ‘I’ instead of ‘you’ when you are talking to them. For example: “I can see that you are hurting. I want you to feel better. I have found out what may be troubling you. I think that a new treatment plan will make you feel better. I want you to know I believe in you and that you will be better. I have this information I would like to share with you.” (Source). Starting sentences with ‘you’ sounds accusatory, a tone best avoided when trying to explain your position.
Ultimately, a marriage is give and take. Mental illness can make it feel like there’s a lot more take from your spouse than give but it’s important to always remember why you took those vows and what they mean to you. Your spouse is not their illness. They are a person who needs love and care, just as you do, just as we all do. Take the time to learn what you can do to help them and tell them what you need too. Above all else, keeping the lines of communication open is the surest way to keep your marriage healthy and happy.