This is a wonderful support group! The more I learn the better I feel and they give us a lot of great information. It’s also wonderful to talk with others going through the same thing. What we are learning gives me a whole new perspective on this brain disorder and also on what I can expect and how I should act and react.
One of the important things I am learning is that this is a brain disorder. Research has been able to document the areas of the brain that are affected by bipolar disorder and show that there are biological causes for it.
Anosognosia: Affects 40-50% of those with bipolar disorder. What is it? Impaired awareness of illness - this means that the person doesn’t realize that they are sick. They believe their delusions are real. This does not mean they are in denial.
Oliver Sacks wrote “It is not only difficult, it is impossible for patients with certain right-hemisphere syndromes to know their own problems…And it is singularly difficult, for even the most sensitive observer, to picture the inner state, the ’situation’ of such patients, for this is almost unimaginably remote from anything he himself has ever known.” It is difficult to understand how a person who is sick would not know it.
What causes it? Damage to specific parts of the brain, especially the right hemsphere - frontal lobe and right parietal lobe.
What helps it? Medication helps
This is a major problem because it is the single largest reason why those affected won’t take their medications. Without medications the symptoms become worse. Lack of treatment can lead to hospitalization, homelessness, jail or prison and increased violent acts against others because of the untreated symptoms.
Problem-solving and Limit Setting (from our NAMI Family to Family class)
1. Think about past experience -
Make a list of things have you tried so far
For each attempted solution, what has happened?
Stop trying solutions that haven’t worked
2. Options - try to come up with 6 or more ideas
List all the ways you could handle the problem
Pick one option to try
Make sure to know Who will do What and When
3. What if
Pick one or more other options in case the first one isn’t possible
Again clarify who, what and when
Limit Setting
When do you use Limit Setting?
For any behavior you have tried to tolerate, but just can’t.
What can you expect when you use limit setting?
A. Your ill relative will probably get angry.
B. Your relative will test your limit setting skills
C. Consistently checking the behavior and following through with consequences will be difficult and will require self-discipline.
D. You have the right to establish house rules and can expect to do so if you use limit setting skills.
E. You cannot expect to have power to control your relative’s behavior. This unrealistic expectation will only serve to leave you feeling defeated, angry and frustrated. Example: You can set limits on your relative’s pot smoking in your house, but you will not be able to stop them from smoking pot.
How do you set limits?
A. Pick ONE problem behavior. (Heads of the home must agree on the problem and the limits or this will not work)
B. Be as specific as possible about the problem behavior.
C. Be very specific about what you will and will not tolerate in terms of that one, specific problem behavior.
Think of a Consequence that meets the following conditions.
1. It is meaningful to your relative.
2. It will be possible for you and other involved people to carry out this consequence when your relative tests you. Drastic consequences are very tough to carry out.
Inform your relative of what you will and will not tolerate, as well as the consequences for the intolerable behavior, when your are BOTH emotionally calm
Answer your relative’s questions to clarify the plan, not to defend it or argue about it – unless part of your plan is to negotiate it with your relative before you decide on a final plan.
Consistently check on whether or not your relative is behaving within the tolerable limits you explained to them.
Make every effort to consistently carry out the consequences as it was explained to your relative whenever they exhibit the behavior you told them you would not tolerate. (Consistently and successfully carrying out your plan will make your relative more likely to be respectful and responsive next time you set limits.)
This one is good, too- Effective Limit Setting
1. Goals - regain authority over the household. Create an environment that’s comfortable and manageable for you and other family members. Do not attempt to control your ill relative’s life outside your home (I’m not sure if this one applies to you)
2. Attitudes - Effective limit-setting requires a spirit of determined toughness, not kindly persuasion or angry criticism. Nagging is especially unproductive.
3. Tactics - Focus your efforts on one or two aspects of behavior that especially trouble you. Ignore other matters until you have these issues under control. Focus on behavior you can consistently monitor and influence. Determine consequences for non-compliance that will inconvenience your ill relative yet will not be too onerous to administer.
4. Communication - Clearly state expectations for appropriate behavior and consequences for non-compliance. Expect that these limits will be tested and you will have to administer consequences. Unilaterally inform him that you will do A if they do B. Do not engage in lengthy discussions for the appropriateness of your expectations. In your home the family member who is ill needs to learn to live with your idiosyncrasies.
5. Byproducts of Effective Limit-Setting. Besides establishing a more livable family environment, effective limit-setting greatly enhances the credibility of family members and an lead to more productive discussions of other issues
Nov. 2 - Guidelines for empathic understanding
l. Don’t criticize. People struggling with any sort of mental illness are very vulnerable, and cannot defend themselves against direct personal attack. Try to be supportive, and keep negative or nagging remarks to an absolute minimum. If there is one single standard to work for in your relationship with an individual with a brain disorder, it is to respect, and protect, their shattered self-esteem.
2. Don’t press; don’t fight; don’t punish: Perhaps the best statement along these lines comes from a wise parent, Joe Talbot:
“With this disease there is no fighting. You may not fight. You just have to take it and take it calmly. And remember to keep your voice down..”
3. If you want to influence behavior effectively, the best thing to do is ignore negative behavior as much as you can, and praise positive behavior every chance you get. Many reliable studies indicate that criticism, conflict and emotional pressure are most highly related to relapse.
4. Learn to recognize and accept the primary symptoms, and the residual symptoms, of a person’s brain disorder. Don’t try to “shoot down” a person with mania. Tell them that they are not “terrible” for the things they did when they were manic, etc. This kind of support relieves a lot of guilt and anxiety, even when someone is still in denial.
5. Don’t buy into the stigma all around you. People with mental illness are not “bad”, or ill because of some failure of character. They are simply ill.
6. Lessen your demand for support from your ill relative. People with mental illness become very “self’ involved when so much of their identity and self-respect is at stake. They often cannot fulfill normal family roles. Seek additional sources of emotional support for ourselves when there is mental illness in the family. Then our loved ones will feel less guilty for letting us down.
7. Having made these necessary allowances, treat people with mental illness just like anybody else. Set the same limits and expectations that would exist if they were well. All persons require rules of conduct and cooperative standards to live by.
8. It is important to encourage independent behavior. Ask your ill family member what they feel they are ready to do. Plan for progress in small steps. Progress in mental illness requires flexibility; it means giving up our zeal for progress measured by normal standards. There is lots more danger in pushing than there is in waiting.
9. It doesn’t help us to cling to the past, or dwell on “what might have been.” Accept that mental illness is a fact in the life of someone we love, and look ahead with hope to the future. People come out of these illnesses; people get better. Family members can help keep the future alive.
10. Every time our relatives “get better” and show improvement, for them it means that they are moving back into a risk position. It’s important for us to be very patient in wellness, just as we are in illness. People recovering from mental illness still have the awesome task of accepting what has happened to them, finding new meaning in life and constructing a way of living that protects them from becoming ill again.
11. Empathy must also extend to each of us who struggle to understand and encourage those we love who have mental illness. Remember: We can only try to do our best. Brain disorders go through hard, intractable periods where helping those who suffer them is often very difficult to do. We can hope, we can assist, we can keep on trying, but we can’t produce miracles.
12. Families tell us that the most important “grace” one learns in the process of caring for people with mental illness is forbearance, synonymous with tolerance, charity, endurance and self-restraint. Do not criticize yourself if you sometimes cannot muster up these graces when you are feeling frightened or frustrated. For a11 of us, coming to terms with changed life circumstances in serious illness is a huge adjustment. We do know that empathetic understanding will deepen and enrich our relationships with our relative suffering from a mental illness.