Monday, June 17, 2013

Bipolar dilemnas

Now, I don't have bipolar disorder. I have my own demons, but not this one, Thank Gd! That said, I've lived with a bi-polar girl for three years and have come to recognize that tactlessness is often a two way street. So, here:

8 things not to say to someone who's bipolar:

  1. "So in the morning you'll be fine, right?" Yes. No. Maybe. See, once my mood's gone off the rails, anything can happen. It's possible that I'll raise the dose of something or add something in for a night and wake up in the morning feeling perfectly fine, but it's also possible that recovery will take weeks, especially if my meds weren't adjusted properly to begin with. Alternatively, I might wake up the next morning in a normal mood but feel like a zombie because of the medication's side effects.
  2. "Have you tried antidepressants?" No, I haven't, or if I have, bad things happened. See, when you give bipolar people antidepressants, they go manic. Imagine that in your brain there's a chemical switch. In depressed people it has 2 settings, depressed and normal. In bipolar people it has 3 settings, depressed, normal, and manic. Antidepressants flip that switch from the lowest to the highest setting, regardless of what you intended "highest" to be.
  3. "Have you tried [insert alternative/additional therapy here]?" Just to clarify: bipolar disorder is a chronic biochemical imbalance in the brain. If what you're pushing makes some kind of sense, I might consider it, but the best it will do is make me feel slightly better or give me a coping mechanism. It won't make the problem actually go away; only medicine and psychotherapy can do that. Yes, prayer is wonderful, and God is a great listener, but doctors are His healing hands.
  4. "This is happening to you because you [insert vice(s) here]. If you'd just [insert virtuous thing(s) here], you'd be fine." If you're lecturing me about getting enough sleep, you are likely correct. If you're lecturing me about anything else, then yes, I will feel better overall, but it won't stop me from having random biochemical blips that make my mood go nuts. Oh, and have I mentioned that you sound obnoxiously self-righteous?
  5. "I have no idea what to do with you." There's a very simple solution: ASK! I will probably know what I need from you, and if I don't, that's my problem not yours. If what you mean is more along the lines of "You need more help than I can give you" or "I don't have the energy to deal with you all the time," then you should have said so, albeit gently.
  6.  "When's the last time you took your meds?" in response to a strong emotional reaction. I am a human being with the same basic emotional responses as everyone else. Please do not pathologize my feelings and/or brush off an outburst as the product of a diseased mind until you have talked to me and tried to understand what I'm reacting to and why. If you're still concerned, watch for other signs of an altered mood, and let me know if you see them.
  7. "OMG I feel so bad I didn't know what life is like for you I'm so sorry that I reacted like that!" or "I feel so useless that I can't help you!" Odds are that you said this in reaction to my explaining how being bipolar can make my life hell and/or how it changes things even when I'm not actually cycling. Odds are that when I explained this to you, I was looking for support. You have just turned the tables and made it about you and how you're a bad friend, thereby forcing me to expend energy that I may not have had in order to reassure you that it's ok. Fail.
  8. "You're crazy." This is the worst thing you can say to someone who's bipolar, especially one who's crashing. If I'm having constant crazy mood swings, I already feel like I'm losing my mind and am scared of winding up in a psych ward. The last thing I need is for you to validate my fears. 
8 things someone with bipolar disorder canNOT say unless they want to be confronted with items on the above list:

  1. "I'm just going through a manic phase right now/I just went through a phase, but I'll be good now." Look, I appreciate the update, but the stuff you did when you weren't thinking straight is still stuff you did. Excuse me for hoping you'll apologize, try to pick up the pieces, or come back to normal and deal with your stuff ASAP.
  2. "I'm trying new meds right now. I'll be a bit loopy for the next few days." Look, you probably meant to give me a heads up and explain that until your meds are stabilized you're not going to have a lot of control over your behavior. But keep in mind that if you're going to clue me in on your cycle of meds and how they aren't working and how therefore you're going to be acting in strange and hurtful ways, you open yourself up to comments and criticism about them. Would you rather I criticized the effects of your medication or yourself?
  3. "My meds aren't really working. My psychiatrist is thinking of trying something new." At this point, yes, I will suggest alternative methods of handling yourself or developing coping mechanisms because what you're trying isn't working and the hardest thing you can ask me to do, as a friend, is to sit back and watch you hurt yourself and those around you.
  4. "I just didn't feel like eating today/ wanted to stay up until 3:00 am reading and have to be up at 7 am tomorrow/ so I'm too tired to manage things." At this point, if I'm stuck doing all the dishes AGAIN, because you felt too tired to do them, then yes, you probably will get a request to take better care of yourself.
  5. "Hey, can I talk to you about x, y, z, a, b, fact, can you just listen to my whole alphabet of problems that I will do very little to solve, but the kvetching will make me feel better? Every day or so?" At that point, I will be frustrated. If you're having difficulties and not trying to fix these problems - what's the point of my listening? 
  6.  "Oops, I did that because I was manic/depressed/skipped meds." If I'm told that strange and hurtful reactions are the result of mismanaged medications, then "When's the last time you took your meds?" is my checking that you just pulled something because of a chemical reaction that you cannot help instead of a deliberate attempt to be hurtful. 
  7.  Saying, "you have no idea what I deal with," then going on to explain it, is likely to get me to agree with you. In such a case, then, how would you like your apology?
  8. "I'm having constant mood swings and I'm doing stuff that's hurting you, but it's not my fault because I can't control myself."  Sweetheart, I have to ask: in that case, what do you define as crazy?
You are now probably wondering what the correct responses are, particularly to someone who's crashing. So I give you, in no particular order... 
10 things TO say to someone who's in a bipolar cycle:
  1. "I'm there for you."
  2. "What can I do to help you?"
  3. "I've noticed you doing x, y, and z, and I know that those can be signs of an altered mood. Are you ok?"
  4. "Let's make a plan for how you're going to get through this."
  5. "I know that you're having a hard time right now and can't perform normally. Normally I would ask you to do x, y and z. How much of that is actually reasonable to ask of you right now?"
  6. "You know I'll always be there for you, but I'm not a substitute for a therapist. When are you seeing your therapist next?/How about we look into options for finding you counseling?"
  7. "You know I want to be there for you, but I can't do it 24/7. Why don't we make a list of other friends you can confide in?"
  8. "I know things look impossible right now, but I promise you that you can do this. You will come out the other side and feel normal again. It may take time, but it will happen."
  9. "The voices telling you [insert negative things here]? Those are the bipolar demons talking. They're liars who sit there and mock you. Don't listen to them."
  10. "I can't make the demons go away, but maybe I can help you quiet them down for a little while."

And sometimes, the best response of all: No words, just a hug and a listening ear.

At the same time, having a mental disorder is no excuse for some of the stuff that gets pulled "because you just couldn't help it."
At the end of the day - I don't know. It's a hard topic. It's hard for the people suffering, and it's hard for those around them as well.

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