1. Never Give Up Hope: There is one piece of advice for anyone who loves someone with bipolar disorder – keep the faith and never give up.

2. Take Some Time: With bipolar disorder there are simply no quick fixes. The road to recovery is not a straight shot; it’s a winding path with delays, downtimes, and detours. Progress takes time. Be patient.

3. Face the Facts: Be willing to acknowledge that bipolar disorder is a legitimate, organic disorder. Saying something like, “It’s all in your head,” or “Just snap out of it,” denies that reality. As with diabetes or cancer, BP requires medical treatment and management. It is frequently unpredictable and can be gut-wrenching and scary.

4. Adopt the Right Attitude: The last thing a patient needs is misguided thinking coming from family and friends. More support is needed, not more shame. All too often, family members make a loved one feel as though it isn’t bipolar but rather a character flaw or something brought on by that person. Such thinking is harmful to the person facing BP who needs constructive feedback not destructive rhetoric.

5. Get Educated: People with BP often deny that anything is wrong and frequently don’t stay on their medications. It’s important to learn about these and other nuances of the disorder. An educated family member or friend is the best advocate and greatest source of support.

6. Treat Us Like Adults: Please remember that while someone who has BP may act like a child, there is an adult underneath. The world of the person who has BP can be full of chaos and confusion and low self-esteem. It can make a big difference when you continue to acknowledge and show respect for the grown human who is struggling behind all of the symptoms.

7. Give Us Some Space: Set boundaries and establish consequences that encourage those who have BP to seek recovery on their own, all the while expressing your concern and willingness to help. Be supportive, patient, and understanding – without being used. Effective encouragement is helpful; enabling is not.

8. Forget the Past: Focus on helping make tomorrow better. Make happy memories.

9. Take Care of Yourself: It’s important to develop coping skills. Only if you take care of yourself can you help.

10. Find a Healthy Balance: There are so many questions – “How much should I be willing to do?” “Should I use tough love?” “How long should we wait before we intervene?” BP is like walking a tightrope sometimes. You have to find a healthy balance when it comes to the support you offer. Learn to take things in stride, one day at a time. The more you know, the better equipped you are to offer the type of support that can make a positive difference.

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.

I know so many people are praying for my son and I know that God is in control of this situation. Your prayers mean so much to us and I know they have a profound impact. I like this scripture from Matt. 18:19 “Again, I tell you that if two of you on earth agree about anything you ask for, it will be done for you by my Father in heaven. 20For where two or three come together in my name, there am I with them.” If you want to pray in agreement with us, here are a couple of verses we are focusing on right now. Hebrews 4:12 For the word of God is living and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart. 13Nothing in all creation is hidden from God’s sight.

As I pray this verse I ask God to give the Drs. wisdom to distinguish the physical from the mental and to be able to nourish his spirit as well.

Psalm 119:105 Your word is a lamp to my feet and a light for my path.

A dear friend shared that a lamp shines only a small circle at our feet – it doesn’t show us the whole path - so sometimes we just have to take one step at a time, do one thing at a time. That is a huge comfort to me and I hope it will be to you as well.

There is a song by Mark Schultz called “He’s My Son”. Here are some of the words. You’ll see why it means so much to me.

He’s My Son
Down on my knees again tonight
Hopin’ this prayer will turn out right
There is a boy that needs your help
I’ve done all that I can do myself

Can you hear me? Am I getting through tonight?
Can you see him? Can you make him feel alright?
You can hear me. Let me take his place somehow
See he’s not just anyone
He’s my son.

Sometimes late at night I watch him sleep
I dream of the boy he’d like to be.
I try to be strong and see him through-
God, who he needs right now is you.
Let him grow old, live life without this fear.
What would I be, living without him here?
He’s so tired, and he’s scared
Let him know that you’re there.

Can you hear me? Can you see him? Please don’t leave him. He’s my son.

This has been an incredibly difficult year. Some days I feel I’m just hanging on by my fingernails it’s so hard, but God never gives us more than we can bear and He never leaves us to do it alone. Always when things are darkest He sends a ray of light, a person, a circumstance - something very tangible to see that He’s been there all along, loving and guiding us along the way.

Sept. 15 - Please pray that he will recognize his need for help. That he will want to seek help.

Sept. 20 - Please pray about his appointment with his new Dr. tomorrow - that God will work through her to shine a light into the darkness of his mind.

Despair: Wondering if your child is alive or dead, even for a day or a minute or an hour - that’s despair. The last couple of days have been hell. He went out of town and didn’t come home when he said he would. I couldn’t reach him and I was so afraid something terrible happened to him. Manic people have an affinity for antogonizing people. He was beat up earlier in the summer and suffered a broken nose and several stitches to his lip. I feared something similar could have happened to him there, only worse.

Hope: Luckily he told me the name of the hotel where he was staying and I found him. He’s definately delusional. I’m always amazed that he can appear ‘normal’ and even charismatic to strangers and draw them into his reality for a short time at least.

Despair: Apparently all of the money in his bank account is gone - he had about $6000 in there. He has two rooms reserved -one is number 2911, which he chose deliberately. He’s spending a lot of money and plans to spend a lot more. He doesn’t know when he’s coming home - he’s just going “where the wind blows him.”

When dealing with people who are depressed or manic it’s important to work together with them on treatment options when they are stable. They can agree to have family members watch for signs of a recurrence. Then they can help choose what kind of treatment they would like to receive if it becomes necessary - and possibly even give someone else legal power to take over their finances temporarily if they fall back into a manic or depressed phase. We’ll have to do that at some point in the future when he is stable. This manic phase has lasted several months now. I can’t even imagine how much he’s charging on his credit card.

Hope: He’s alive! I was so afraid. Now I need to find out how I can get him back.

Despair: I just talked to his Dr. friend and it sounds like he may not do the commital after all. He said it would be better for him to be treated somewhere close to where his follow-up would be and I can understand that. We need to get him to come back because they won’t extradite him. Now I have to figure out a way to do that as well. The pressure is all back on my shoulders - to get him back, get him some help, decide what help he needs. This Dr. still feels he should try just the meds first because involuntary commital is such a double-edged sword. I feel like that’s already been tried and hasn’t worked. Somehow the disappointment is so much greater after having just a taste of hope for help! I understand that forced treatment isn’t ideal. I just don’t think he’ll ever ask for it himself or if he can survive much more of this.

Why do I have to be the one to decide what to do? Where is everyone else? Last time he was this bad everyone said he needed help, but no one was willing to stand up and get it for him.

Hope: I know a lot of people are praying. I’m sure that’s why I was able to find him so easily and why he’s been back in contact with me. Knowing God is in charge of this situation helps a lot.

Sept. 2 - Hope: He’s in the hospital in Chicago and will be admitted for psychiatric care to the state hospital there. What a huge relief! A year ago I could never have imagined being happy to hear that my son was in the psych. ward. I don’t have to wonder if he’s dead or alive and I know he’s getting help. I’m praying God will send his angels to be his nurses and his doctors. This way we didn’t have to force him into treatment. When he’s well enough maybe he’ll realize the behaviors that got him there - the drinking, the manic episode. I pray then he’ll be motivated to do whatever it takes to get well and stay well.

Despair: I haven’t been able to speak to a Dr. there yet. I’m sure they are understaffed and overworked. I don’t want my son just to be a number, a face and not a person. They told me he’s demanding to be released early so they think he’ll only be there a short time. Hopes dashed again - this is so hard! I know what he needs isn’t going to happen in a 3 day weekend. I just have to trust and pray and wait and make a hundred phone calls.

Sept. 6 Hope: After calling literally 15 times (perseverance is the name of the game if you want to find help for your child) I was finally able to speak to his Dr. She said she doesn’t know yet when he will be released but that they will call us and tell us so we can go and get him. Now we’ll just have to convince him to come with us and we’ll have to get a commital in place when he is here.

Despair: He told us how he was injured. He fell off of a curb and hit his head and crawled into some bushes. He was very drunk. Someone stole the shoes off of his feet. That’s not how I see my son. I wish we could see before and after pictures of someone’s heart and soul. I see him before his addictions and illness took control of his life. I look at his little boy who looks so much like him. He’s so innocent, so bright, so full of potential with his whole life ahead of him. I remember my son like that. I believe God can restore him.

Sept. 7 Wow, for some reason I was stupid enough to think my comments to the Dr. were confidential. She told my son I thought he was suicidal and he’s “furious, betrayed”. He can’t see, doesn’t care, how hurt we are, how afraid we’ve been for his life. This is the sacrifice you make - their love for their life. I get to be the one he hates.

Hope: Sept. 11 He is back home now. They released him Friday night and he spent the night sleeping on the street with newspaper for warmth. He ran out of money and he was hungry so he called and asked his dad to go and get him. That was an answer to prayer! Some how some way people need to be able to control the finances of a manic person. He would never have been able to stay there as long as he did without credit cards and money in the bank. Now he has a huge debt he’ll have to repay when he’s able to work again.

A close friend recommended a different Dr. She’s a nurse and has worked with her at the hospital. She said she just returned from training in New York and is Christian and extremely caring. She wasn’t taking new patients but my friend got us a referral and he has an appointment in 10 days.

Now we’re back to the phase of watching to see what he is capable of doing - if he can or will take any steps toward his own recovery. Because of the way funding goes for different doctors and hospitals I’m praying he can make it for 10 days. It seems like such a long time to wait! 10 days. Pray for him.

Despair: Sept. 15 I don’t know if I can survive until the 21st. He continues to drink, probably use drugs, get more credit and spend more. I’m praying for some clear direction. I’m so ready to pack a suitcase and put it on the steps and lock all of the doors. I waver between that and desparately wanting to help. How do you help someone who doesn’t want help? What happens when you care more about their recovery than they do? What do you do when it’s all entwined with the illness and the abuse? I wish I knew where I could find the answers to those questions somehow.

Hope: I just keep reading and reading and trying to find anything, any ray of light to shine on what we should do in this situation. Little bits here and there help - like reading about Dual Diagnosis and how there is such a failure in the ‘establishment’ to treat it properly. How substance abuse and ‘mental illness’ are so compartmenatlized that there aren’t many effective ways to treat them both together. It reminds me not to expect too much. He hasn’t had a chance to get much help yet.
Following links to articles is good, too. This one is called A Mother’s Rant against Bipolar and it really hits home with how I feel - you can find it at http://www.willigocrazy.org/Ch06b5.htm
Here is part of it:
God-damned Bi-Polar! You took my son from me, and you took him from himself. I want you dead! I want you gone! The only way to kill you is with meds but, you bastard, you tricked him into thinking he doesn’t need them. You take over his mind and body, and what for? To no useful end. You’ve placed him in danger, and you make him think he’s trying to be independent. He can be independent and happy and safe without you, but you stop him. I hate you! I hate you!
You S.O.B., all you do is make him have demons. You’ve caused him to have accidents and to be hospitalized. It’s your fault! You’re useless — worse than useless. You’ve taken away his creativity, his brilliant mind. I want you dead and wiped out, never to return. Leave him alone! I want my son back. I want him to have himself back. I want him to be happy and productive and enjoy life. You’ve taken that from him. You prevent him from having a pleasant, safe life. I HATE you!
Lithium and Zyprexa would kill you and make you leave my son forever, but you won’t him let kill you. You’re devious and deceitful. You’ve caused him to take dangerous street drugs in his attempt to be rid of you. But you’ve fooled him again. You know that street drugs won’t get rid of you. It’s only Lithium & Zyprexa that will get rid of you and lift your lying veil from him.
Now he’s in a hospital again. Did the police put him there? No! You put him there — again. Now he owns nothing but disorientation and delusion. You’ve taken away his reasoning ability again. You’ve taken him again.
You lie to him. You make him think he can somehow live with you and without the meds. You’re nothing but lies and deceit. You won’t let him take his meds and get rid of you. Bi-Polar, I hate you!
I hate you!

Hope: Sept. 16 One thing that helps me cope as a family member is finding someone to talk to who knows what I am going through. Since NAMI’s website has been so helpful I keep looking there and I found they have discussion groups at http://www.nami.org/Template.cfm?Section=About_Medications&template=/Security/Login.cfm

It has helped so much to ‘talk’ to other people who are dealing with this!

Hope: Sept. 21. He went to see the new Dr. today and must have given consent for us to talk with her. She called tonight and sounded so nice - still wants to adjust his meds and have us make sure he takes them, etc.

Despair: Sept. 22 He came in so drunk at 2 in the morning. I didn’t get angry at him. I just told him he could move in with the guys behind us. At least he’ll be close and hopefully we can help motivate him to continue meds, etc.. Apparently the Dr. didn’t get his consent so when I told him I spoke with her he was pretty angry. Wish I would have kept my big mouth shut and just not said anything. He did sound like he liked her, but he doesn’t know if he’ll follow her recommendations to adjust his meds. He says he’s just fine. I took a movie of him to show him sometime so he can see what he was like. Stumbling around, mumbling incoherently. It’s so sad to see.

Sept. 30 He moved into the house behind us. We still see him pretty requently because he comes home to eat and shower, etc. He’s been working about a week and I think feels better about himself since he’s being more productive. I haven’t had a chance to talk with him about how he plans to attack the mountain of debt - think I’ll let his dad do that. I think we’re sort of in a holding pattern - he’s calmed down some from the manic, continues to drink in excess. It’s less stressful with him not here, but I do wonder if we’re getting a very clear picture of how he’s doing. He does seem better sometimes.

First of all you have to LEARN ALL YOU CAN about this disorder. Knowledge is power in this case. Check out the web pages I have linked to on the left - that is where I got this information.

Family is an important part of the treatment team and recovery process, but if your child is an adult you may not be able to speak with their Dr. without their permission. That is very interesting to me. I think as family members, we have so much we could tell the Dr. or counselors about what is going on, how our son is behaving, how much he is sleeping and eating, etc., and often they don’t ask, don’t allow us to speak to them because he is an ‘adult’. Well, he’s a very sick adult and when he’s not thinking clearly I feel we should be a very important resource for them in finding the appropriate treatment for him.

Fortunately for us our son agreed to let us speak to the Dr. and was open to me going to an appointment with him. I’m glad I have access to the Dr. now and can call him with concerns. If your adult child does not give consent for the Dr. to speak with you, you can still tell the Dr. whatever you think he needs to know. You can fax or send them information you feel might be important. I didn’t know that until someone told me. You can give them information, they just can’t give you any.

If your child is prescribed medication, find out what you can about it and the side effects it may have. I like this web site where you can see how treatments have been rated: http://www.remedyfind.com/hc-Bipolar.asp

This is the part I have to keep reminding myself of when his behavior is hurtful or disturbing:

“When ill, people with mood disorders can behave in ways that exaggerate or are out of keeping with their normal personality. When manic they may overspend or engage in sexual indiscretions. This causes a loss of trust, hurt, and embarrassment. They may also become more critical and sarcastic and say things that can be very hurtful.

Try to remember that this is a consequence of illness and not intent. Though it is difficult, don’t take comments made during the illness phase personally. However, it is important to talk about how their behaviour affected you when the episode of illness has passed . While the harm caused may not be intentional, it can still hurt. Opening up communication and restoring trust can take time. If your relationships are suffering, seek out the support of a trained counsellor.

Recovery takes time:

If someone you loved were hit by a bus and immobilized in a body cast you would not expect them to get out of bed and go to work. A serious episode of mania or depression can be just as disabling. It takes time to recover so be patient. Excessive demands, critical communications, and impatience can actually slow the process of recovery.

However, doing too much for the person or setting low expectations can also re-enforce their sense of worthlessness and incompetence. Treat them like an adult. Set reasonable expectations for participation in family responsibilities and work together to accomplish tasks. Your gentle encouragement, and praise for efforts made, goes a long way to help healing. Look for the good things that happen. Be patient, the illness will lift with time, care, and treatment.” Karen Largent

Nutrition: There are some good studies pointing to nutrition being a valuable help in treatment. Some were able to reduce or stop taking medications. This is a good web page with information about that: http://www.mcmanweb.com/article-113.htm and you can find plenty of others if you search.

What is Bipolar disorder?
Bipolar disorder, is a serious brain disorder. Also known as manic-depressive illness, it is a mental illness involving episodes of serious mania and depression. The person’s mood usually swings from overly “high” and irritable to sad and hopeless, and then back again, with periods of normal mood in between.
Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness and people who have it may suffer needlessly for years or even decades.
Bipolar Disorder is a disorder of mood caused by a chemical imbalance in the frontal lobe of the brain. During a manic episode, there is increased activity in the frontal lobe.
People with bipolar disorder are at risk of death - either by dangerous behavior in the manic state or by suicide in the depressive state.

What causes bipolar disorder? They don’t have all of the answers yet, but it does tend to run in families and may have some genetic predispositions.

Our son was addicted to dextromathorphan (found in cough syrups and called a Robo addiction because of the link to Robitussin Cough Syrup, which is available over the counter, by the way). He’s also an alcoholic and uses other drugs. Alcohol and many drugs are central nervous system depressants, which can lead to the development of mental illness. For some people alcohol and drug use is an attempt to ‘self medicate’ to alleviate the discomfort of depression or seek greater thrills during a manic high.
With Dual Diagnosis (see below) it’s kind of the chicken and the egg sort of deal. They’re not always sure if the addictive behaviors are a result of the disorder or vice versa.

Here are the symptoms of a ‘manic episode’. My son has them all, some worse than others.
• euphoria, feeling “high”
• agitation, edginess, irritability, restlessness
• racing thoughts, talkativeness
• increased energy, sleeplessness - some nights he gets less than 4 hours of sleep.
• inflated self-esteem; grandiosity; poor judgment
• reckless spending sprees or other activities with high potential for painful consequences - uncharacteristically poor judgement
• delusions or hallucinations - unrealistic beliefs in one’s abilities and powers
• drug or alcohol use - this is very often a problem with bipolar disorder. They go together about 2/3 of the time.
• increased sexual drive
• aggressive behavior - obnoxious or provocative behavior
• inability to concentrate well

In some ways, having a name for all of this helps. I’m still at the beginning stages of learning and I don’t yet know what my role is and how I can help him on his road to recovery. I found another good website (Thank you God, for the internet and the opportunity to access this wealth of information.) at http://www.nami.org/
I found a local number and spoke to a real woman who told me all about local classes and support groups and she’s going to send me some information. She was very nice and it was good to speak with someone who knows what I’m going through. I’m sure I’ll get involved in the classes and/or support groups. I’ve asked my son if he would consider a support group and he said he might give it a try. I hope he will and I hope it will be good or he won’t go back.

Dual Diagnosis - this is also my son. I used to think it meant being addicted to more than one substance at a time. I’m learning.
This information is from the NMHA web page at http://www.nmha.org/infoctr/factsheets/03.cfm

What is Dual Diagnosis?
A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis. To recover fully, the person needs treatment for both problems.

How Common Is Dual Diagnosis?
• Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness.
• Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

Which Develops First - Substance Abuse or the Emotional Problem?
It depends. Often the psychiatric problem develops first. In an attempt to feel calmer, more peppy, or more cheerful, a person with emotional symptoms may drink or use drugs; doctors call this “self-medication.” Frequent self-medication may eventually lead to physical or psychological dependency on alcohol or drugs. If it does, the person then suffers from not just one problem, but two. In adolescents, however, drug or alcohol abuse may merge and continue into adulthood, which may contribute to the development of emotional difficulties or psychiatric disorders.
In other cases, alcohol or drug dependency is the primary condition. A person whose substance abuse problem has become severe may develop symptoms of a psychiatric disorder: perhaps episodes of depression, fits of rage, hallucinations, or suicide attempts.

What is the Role of the Patient’s Family in Treatment?
With both rehabilitation for substance abuse and treatment for a psychiatric problem, education, counseling sessions, and support groups for the patient’s family are important aspects of overall care. The greater the family’s understanding of the problems, the higher the chances the patient will have a lasting recovery.

How Can Family and Friends Help with Recovery from a Psychiatric Condition?
They should be calm and understanding, rather than frightened or critical. They should be warm and open, rather than cool or cautious.

There Is Hope
As a relative or friend, you can play an important role in encouraging a person to seek professional diagnosis and treatment. By learning about dual diagnosis, you can help this person find and stick with an effective recovery program.
The more you know about dual diagnosis, the more you will see how substance abuse can go hand-in-hand with another psychiatric condition. As with any illness, a person with dual diagnosis can improve once proper care is given. By seeking out information, you can learn to recognize the signs and symptoms of dual diagnosis - and help someone live a healthier or more fulfilling life.

Dual diagnosis is one of the most difficult conditions to treat. Three things must be addressed - 1. The substances have to be controlled so the mood disorder can be properly diagnosed. 2. The mood disorder needs to be managed. 3. Life stresses need to be managed. Right now our son has all 3 of these completely out of control. His recovery will take time, love, patience, support, perseverance, prayer. He’ll need all the help he can get!

Oct. 3 - We went to our first Family to Family support group through NAMI tonight and I liked it. At first I didn’t think I would because the teachers were just reading the material to us, but as people began sharing it was good. Everyone there is dealing with a different disorder, but we all have something in common - our families are affected strongly by it. It’s just good to sit with a group of people who are there - who have been there.

I liked this from the material on Dual Diagnosis - it’s very good:

“When family members we love become addicted, they can no more resist using alcohol or drugs than they can willfully “cure” themselves from their biological brain disorder. People stricken solely with mental illness often struggle wtih life at the edge; having a dual diagnosis is life at the edge with someone trying to push you off.

The best response is empathy and compassion, rather than moralizing.

Successful treatment requires trust-building, the establishment of safety, stabilization of the mental illness, and finally, sobriety. This prescription is a tall order….

Also, the hallmarks of addiction treatment - confrontation, insistence on sobriety, willingness to let someone hit bottom to find motivation, can gravely endanger people with serious mental illness.

The new approach is integrated treatment, where the same doctor, or team, treats both disorders at the same time. In this model, initial sobriety is not expected; the treatment plan calls for a long period of engagement to educate clients about subtance abuse and stabilize their mental illness….”

My biggest struggle is always where to draw the line. How do I know what is helping and what is hurting? I think it’s good to know that we can draw a line, but it’s also helpful to read these things and learn. And maybe we’ll learn more about where the line should be, more about loving and supporting instead of trying to fix.

Living with a manic person is like trying to stand up in a hurricane - like the wind is always blowing 300 miles an hour and it’s all you can do just to stand up straight. It’s very draining. It’s hard to separate the person from the illness, to realize it’s a disease and not their choice to behave like an idiot. Anyway, I’m posting this in case there are others like me who may relate. Starting out in the dark is hard. Having a light to follow, to guide you on some path to understanding, helps. I’ll add more as time allows. Just being able to express the feelings I’m going through helps.

Want to know what rips your heart out? Seeing your child, someone you love with all your heart and soul, being turned into something/someone they aren’t. Manic behaviors - they make a person feel they are the center of the universe. It’s all about them. And they love being manic. They can’t see themselves like we do anymore. He feels ’special’, he enjoys the high, he feels it gives him a super-creative edge. He’s gone from being a loving son, husband and father to a self-centered ________. Who do I cry for? Me? Or him? For his wife and kids? I cry because I hate it that sometimes I have to stop and tell myself I don’t hate him, but that I hate what this disease has done to him. I hate it that he can’t just stop and be loving and kind again, can’t be ‘normal’ again. I hate this whole thing. I hate it that I can’t just love him back to normal or pray him back to normal or push him back to normal. I just don’t like this. (In case I haven’t said that enough). Well, wallow, wallow, wallow. It just hurts right now.

Aug. 27 Last night I just lost it. I did everything wrong. I got so angry at my son and I just couldn’t separate him from the sickness. Everything I’ve read or heard about what I should do I didn’t do. I didn’t stay calm, I was mad and I was not being nice to him. I was mad at the sickness for stealing my son from me. I was mad at him because he won’t go to a hospital, I was mad at myself because I was losing it. I started crying and I just couldn’t quit. I don’t know if it’s because I let it build up for too long or from lack of sleep or both. Perhaps it’s writing this stuff down. Sometimes I just don’t want to feel this. I know when it starts the floodgates will open, but I have to be strong and calm and on top of this so I can somehow find a way to help him. So I try not to feel.

I don’t know how he functions on the couple of hours of sleep he gets a night. I see what it does to me and it’s no wonder he can’t think straight. I want to monitor how much he sleeps so when I hear him come in at night I wake up and look at the clock. Then it’s a few hours later before he actually comes up to bed and I wake up and look at the clock and I can’t go back to sleep. It’s good praying time, but after awhile it catches up with me, I guess.

My son is so intelligent, so witty, so much fun to be around when he’s ‘well’. He has the most beautiful wife – inside and out – anyone could ever ask for. His children are so precious and sweet. His wife is such a wonderful mother and he has been a great dad. I loved seeing them parent those kids – it’s such a great feeling to see your children with their children. And those children are not just ‘cute’ kids, they are great kids. They are polite and respectful and loving with each other and so smart (I’m not just saying all of this because I’m their grandmother) I know a lot of it is because of their mom, but my son has contributed some good to their lives, too, I know. They love him so much. They want their family back together again. That breaks my heart.

Even now, as sick as he is, he tries hard to be a good dad and wants that more than anything. Yesterday, for the first time, he said he wasn’t being a good father and that his kids shouldn’t be around him. I know how that must make him feel. When the manic behavior cracks open the tiniest bit I see the self-loathing there, how much he hates himself. He feels like such a failure and he doesn’t want to fail anymore. He’s been so lonely and he goes looking for people, strangers who will admire him. We, his family, don’t know how to comfort him. Literally. I listen to his manic ranting and I don’t even know what to say. Should I act like it makes sense to me? Should I try to ‘shape him up’ with a verbal slap in the face? Neither, I think.

When I hear and see him like this it hurts so bad – it’s like watching a bird that has fallen out of the nest flopping around with a broken wing, trying to fly, unable to. He thinks he’s soaring through the sky just fine. I can’t even find the words for how much it hurts. And because it hurts so much I can’t really listen, can’t really open myself up to him, can’t comfort him. He’s too sick to decide to get well. He knows all of the things he should and shouldn’t do and I think he does try, but he can’t do it. If he won’t realize he needs to go to the hospital, we may have to put him there and I really don’t want to do that. I keep trying and trying to convince him he needs urgent help, but he feels that’s an accusation that he’s ‘crazy.’ He won’t do it.

We can’t let this go on. I told him he’s like a child on a merry-go-round. When it’s moving slowly it’s fun, but then it starts to go faster and faster and it’s not so much fun anymore and when it goes fast enough he’ll fly right off. He’s so close to flying off, but he’s convinced he can hang on, that he can slow that merry-go-round down himself. And in lots of ways he doesn’t want to slow it down too much, doesn’t want to lose the mania. That’s what he’s afraid of, I think. Afraid of going back to the black hole of loneliness and despair.

Today he came in and said, “I can’t die, I have too much to do.” That really frightens me. Why would he talk about dying unless he’s thinking about it?

Aug. 29 - There is hope on the horizon! My son has a friend who is a Dr. and I was able to speak to him on the phone. He truly cares about him and knows he needs help. He agreed to speak to him and tell him he must make some changes or he will commit him. He said he has power to do that and will do so. You can’t imagine what a relief that is! Just finding someone who is willing to take a stand with me. Thank you, God! He wants to first try to persuade him to take the additional medication the Dr. wanted to prescribe, but said that if he won’t do that he will do the commital. What a weight is lifted from my shoulders!