***Please remember that I am not a doctor and these answers represent my opinions and should not be seen as a substitute for medical advice. ***

Let's start out with a story about cabbage.

(A conversation between my mom and myself a few days ago)

Mom: Why don't you put some cabbage on your salad?

Julie: I want to have cabbage on my salad but it is just too hard to do it.

Mom: Julie! It's too hard to have cabbage? What is your problem?

Julie: It's not just cabbage, Mom! It's getting it out of the fridge. Taking off the old leaves, finding a place to cut it, making sure the knife is clean, slicing it, putting it on the salad and then cleaning up the cutting board. It is too much right now.

Mom: It really is just cabbage, Julie. Why does everything have to be so hard for you?

Julie: Mom. It is not a *normal* thing! It is not a cabbage thing. It is *bipolar* thing. It is an overwhelmed thing. It has nothing to do with cabbage. Things are hard for me because I have a book deadline and I have bipolar disorder.

Mom: Ok. I understand it a bit better when you put it that way. Would you like me to do the cabbage for you?

Julie: I would like that a lot! I have so much going on right now I can not think about cooking.

A few days later I asked her, 'Mom, of all the mood swings you know I have now and you have seen in the Health Cards, what is the hardest one for you to understand?' She answered, 'The anxiety and how you tell me you get overwhelmed so easily.' I understand why she feels this way. She has depression herself, so she understands that. I have talked to her about mania and psychosis and though she has no idea what they feel like- she can see they are a side affect of bipolar disorder- but my anxiety and feeling overwhelmed seem so arbitrary to her. I have it on some days and on others I am fine. Some days she can ask me to do something and the next time she asks the same thing it makes me sick. She never knows what she is going to get from me! (Poor Mom!)

The moral of this story is that you, as a friend or family member need to understand that bipolar disorder is complicated. You really don't have to understand all of the terminology or even empathize with us, but you do have to have tools to help you deal with us. I am just simply baffling to her. I can see it when she looks at me. I can see it when she has to once again change her behavior so that I don't get sick. I can see it is hard on her, but the only thing I can do is constantly work on myself to stay well and give her as much information as she needs to help our relationship stay stable when we are together. You as friends and family members have such a hard job. When people with bipolar disorder are sick, it is the friends and family who have to somehow read our moods and behaviors and know what to do to help us get well. We may not say this enough- but THANK YOU!

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Ten things friends and family members NEED to know about those of us with bipolar disorder.

10. If you blame us or put us down or get impatient or angry with us for bipolar disorder behavior it simply makes us SICKER! Impatience never got us out of bed or made us less depressed. Anger never made us stop spending when we are manic. Kind and realistic rules and limits do help. Telling us that you will not and can not live with us if we don't treat bipolar disorder first does help. But helping us help ourselves is the best gift you can give us.

9. Understand that we can not help you do things when we are sick. You may need help around the house, with the kids, the bills, the laundry, etc. Deep down we know that, but sometimes we are too sick to do anything. Help us get well and then we can help you around the house more. Help us get well and we will be a good friend, partner, daughter, son, grandson, granddaughter and parent. If you expect us to be able to do normal things when we are sick, then you will only get more upset with us. If you expect us to treat bipolar disorder first- that is reasonable and something we can work on together! Then we can do the laundry and the dishes with pleasure. We can have fun in life.

8. Depression is very motivated. I don't know if there is a more successful illness in the world. It is a champ, a winner! It sets goals and follows through with its goals. 'I want Julie to be really sick and down on herself today. I want her to stay in bed, eat junk and cry buckets of tears.' And it sure does do a good job! Depression is serious and motivated and strong. Without the right tools it is impossible for us to fight it. WE ARE NOT LAZY! WE ARE NOT SLACKERS! WE ARE NOT DUMB, WEAK OR FAILURES! We are sick. Learn our individual signs of depression by using the Health Cards and help us fight it. If depression is motivated and successful, then we all have to get motivated and successful. If you see us sitting on the couch doing nothing day after day- don't get on our case for being on the couch. Get some tools to help us get off the darn couch! Get motivated, serious and strong, just like depression. Then teach us how to do this. Help us find the right mix of medications, alternative treatments and lifestyle changes that make depression the failure instead of making us look like failures. We need your help to fight this illness. We need your love to beat depression.

7. What you do in YOUR life makes a huge difference in how we experience our bipolar disorder symptoms in OUR lives. This is not fair on you, but it is a reality. It should be that you can do what you want and we can lead our own lives and let you be you - but people with bipolar disorder can not simply separate themselves from the things you do. If you are stressed and unhappy and unhealthy, you have to know that it affects us greatly.

6. Bipolar disorder is a disability. It is not recognized in that way right now, but it will be more so in the future- many of us are dis-abled from leading the life we want and you want us to lead. We simply can't function like other people can function. We can't snap out of it, therapy our way out of it or just get on with it- whatever the 'it' is you want us to do. WE HAVE TO LEARN WHAT WE CAN DO AND WE NEED YOUR HELP! Please know that stress makes us sick- good stress, bad stress, stress that is none of our business- all stress makes us sick. Can you look at us differently? Can you see us as people who have an illness that often makes us unable to be 'normal'? Can you hug us, love us and help us even when we make you scared, angry and embarrassed? Please help us turn a disability into an opportunity.

5. This illness is not about you. We are not trying to punish you or ruin your life. We do not want to treat you badly. It is a side effect of bipolar disorder when we change our moods. This does not make it ok- and it does not mean that it will not cause huge problems for you, but it is not about YOU at all.

4. If we are manic, we really can not help spending money. It is part of the illness. It is a proven symptom of mania. We need your help in creating checks and balances so that we can prevent manic spending sprees. If you are blind to what we are spending when we are well and then suddenly notice the $5000 we spend during a manic episode and then get angry, it is not fair. Please be consistent and help us monitor our money at all times so no one is caught unawares again.

3. Medication side effects really, really suck. They often make us fat, tired, sick, scared, suicidal, seemingly stupid and angry. We need help in adjusting our meds and telling the doctors what we need. It is not ok to have these side effects and when we are in the middle of them and a doctor is telling us just to 'wait and see how things go,' we feel helpless and want to give up. Help us find different medications and holistic treatments that do not have so many side effects. Advocate for us if we are intimidated by our doctors. Help us eat a bipolar friendly diet.

2. Many of us with bipolar disorder can not work like 'normal' people. We can not go to the office or keep a 9-5 job. It simply makes us too sick to function. Many of us have had a different job every year because we want so badly to fit in and be like everyone else. The reality is that we need to find alternative ways to support ourselves and we truly need your help. Please understand that we WANT to be productive- we just have to find a different way of being productive. Going to an office really is not everything. If we need disability, help us get disability and understand that it is so very humiliating for intelligent people like us to have to get help from the government because we can't work. Never, ever make us feel guilty because we can't work! Help us find work that is non stressful, fun and helps us be independent. And if you are supporting us because we can not work- thank you so very, very much.

1. People with bipolar disorder are intelligent, funny, creative, free thinkers, different, loving and kind - WHEN THEY ARE WELL. People with bipolar disorder are demanding, sad, annoying, scary, self centered, all over the place, uncaring, dangerous, and crazy - WHEN THEY ARE SICK. In order to help us be all of the good things, bipolar disorder must be treated first. Use the Health Cards, use the tips in Bipolar Happens!, any other books you may have and a good holistic health care team to help us treat the illness first - for the rest of our lives. This is the ONLY way for us to have a good relationship. Because bipolar disorder does not want any of us to be happy. Friends and family are so important in the lives of people with bipolar disorder. We do not need you to take care of us- not at all- we need you to help us take care of ourselves: Take care of yourself first, get the right tools and then show us that you are willing to join us in our goal for a stable life. Always take care of yourself, but NEVER GIVE UP ON US!

******************** An email I sent a few days ago:

I hope you are having a great weekend. Things are BETTER here. I got sick again due to the family issues around my brother and that lost me a few days. I am so conscious of the writing time I lose when I get ill. So, I looked at the triggers and made some changes. I stopped decaf coffee totally. I am really trying to cut back on sugar- especially chocolate. (Oh! this is not fair!) I talked with my brother and told him that I can no longer sit and listen to him talk about what's wrong. It is time for him to make changes and to stop driving all of us bonkers. He understands the bipolar thing- but only after I tell him a million times that I can not deal with the stress he puts in my life.

Families! Julie

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AAAAAAAAH!

Ask! What does it feel like to have bipolar disorder?

Ask! Are you depressed today? How can I help?

Ask! What medications are you taking and what side effects are you having?

Ask! Are you suicidal?

Ask! Can you tell me more about psychosis? I am not sure what it means.

Ask! How does it feel to be on disability?

Ask! Are you having trouble in school because of bipolar disorder?

Act! If you see that your loved one is sick, get out the Health Cards and do something about it.

Help: We get too sick to help ourselves. We need you.

AAAAAAAAH!

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Siblings

Siblings can feel so left out. A sick brother or sister can take ALL of a parent's energy. Putting your son or daughter in the hospital leaves little time for anything else. But you have to make time for other children and one way to do this is to involve the siblings in the care of their brother or sister by using the Health Cards. You have to talk - you have to be honest about bipolar disorder and the role it plays in your family. It is like the unwelcome guest or the elephant in the living room- no one wants to really talk about it. You have to use words like suicide and psychosis and hyper sexuality and cutting. You have to say things like, 'I am so scared when she is in the hospital. What if she dies?' Or, 'I can't do this alone kids. I need your help with your brother. I am scared I am going to lose my son.' You have to have a mantra for the family that sounds something like this:

Bipolar disorder is an illness. It is not a choice. It is not on purpose or directed at us as a family. It has very specific symptoms that are the same for all people with the illness and though they are scary and often a cause of terrible strain and fear in our family- it is still just an illness like diabetes or cancer. We have to work together as a family to help our brother/sister get better. We have to learn what we can, take care of ourselves and constantly remember- bipolar disorder is an illness, not a personal reflection on our family.

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Tips for friends and families:

* Start a check in plan with your family. A check in is when you decide that you will ask yourself some questions about bipolar disorder on a regular basis. Choose a date and write it randomly on the calendar. Start with every two weeks. Simply write the words 'check in' on any day that week. A check in reminds you that bipolar disorder has to be monitored for the rest of your loved one's life. Yes, it sucks. Yes, it is not fair. Yes, it is sad. But checking in will prevent so much trouble and pain. A check in can mean what ever you want it to mean. Here is an example of my check in. (I write 'check in' randomly on my palm pilot.)

Where am I bipolar wise? Am I slightly up or down?

How is my spending? Am I seeing any spending changes that may mean I am getting manic?

Am I doing anything now that may make me sick in the future such as staying up too late or working too much?

How are my relationships? Is there friction because of my mood swings?

Have I seen my doctor lately? Do I need to call her?

These are just some of the examples of a bipolar check in. If we can check the oil in our cars every 3000 miles - we can certainly check in on bipolar disorder every few weeks. Family members and friends can check in and see signs that the person with bipolar disorder can not see. This prevents the episodes that seem to come out of nowhere. The check in lets you see that bipolar disorder episodes are NEVER random. Never.

* Help us turn our disability into an opportunity. Understand that many of us can not lead the life you wanted for us. Help us learn what we can do and help us excel in that area.

* Tell us at least five things every day that we do well. Tell us that you love us. Tell us that you understand how hard this illness must be. It takes our dreams and our health if we do not take care of ourselves every day. This is our job and it is hard. Praise us for it. Just say to us, 'It must be so hard to deal with bipolar disorder and life in general. I think you are amazing.'

* Take care of yourself so that you can be there when we have a crisis- then maybe we will finally be well enough to help you when you are in a crisis! As the author Stephen Covey says, 'If you are all things to all people, you are soon nothing to everyone - including yourself.' Take care of your life and your spirit. We appreciate it.

* Learn the difference between us and the illness. The illness sounds like this: You don't love me! Nobody loves me! Just leave me alone. Let's go to Vegas! Don't tell me when to sleep and not to sleep! I can stay out all night if I bloody well want to! I have to have some space. Life is crowding me! I want to die! You are the problem in my life! I just need you and everyone else to let me live how I want to live. Let's parteeeee!

Here is the language of the real us: I need your help today. I do not feel that great. Thank you. You mean so much to me. I am trying to get better. I know that this must be a terrible strain on you, but things will get better once we use the Health Cards and get my meds stabilized. Thank you. I love you. You help me so much and I am grateful.

* Have a bipolar free zone. There has to be a time when all of you do something together that does not involve bipolar disorder. If your loved one is in the hospital- then do it with the family members who can participate. You can't put your life on hold for this illness. It will break the family in too many ways.

* Decide to respond to bipolar disorder instead of reacting to it.

* Ask for help if your loved one is in crisis. You simply can NOT do this alone. It is too scary and too stressful. Be honest and tell people you need support.

* Remind doctors and other health care professionals that you are a VERY important part of the healing process and you need to be included in your loved one's treatment plan.

* If you are a parent with a young child who has been diagnosed with bipolar disorder, do lots of homework. Is the diagnosis really correct? What are the other possibilities? Could behavior modification and diet changes take the place of some medications? You are your child's most important advocate- become a holistically educated advocate.

* Set clear and loving limits for us. Know when enough is enough. If you have done all that you can - you will have to know when to stop and take care of yourself and your other family members.

* Watch Dr. Phil (for those of you outside of the United States- this is a television program where an amazing therapist literally does therapy on TV.) Record the program and watch it as a family. All of the tips he gives for dealing with life's problems translate to dealing with bipolar disorder as a family. (I am not saying use this as a replacement for therapy- I am saying use this as a tool of many.) Read books that have nothing to do with bipolar disorder and everything to do with you. A good place to start is the book First Things First by Stephen Covey.

* Treat bipolar disorder as a family project. Learn about it. Create Health Cards for the whole family. Talk about the latest treatments. Know the drugs and their side effects. Research alternative treatments that can be used with drugs. Learn about the effects of diet and exercise on bipolar disorder. Get educated! Even very young siblings can be taught positive and helpful ways to help someone stay stable. Young siblings absolutely must understand that bipolar disorder behavior comes from an illness and has nothing to do with them.

* As a friend with someone with bipolar disorder- learn what you can, set limits for yourself and then ask how you can help. It is ok to leave a situation for a while if it is too stressful for you - but please do not give up on us if we are trying to get better. We need friends.

* Get really real about genetics! If you have a family member with bipolar disorder you will probably find other people with bipolar disorder or other mental illnesses in the family. This means that any children born into this family have a genetic predisposition for bipolar disorder and other mental illnesses. Do not have a child blindly. Have a child realistically.

* Help for bipolar disorder symptoms can come from odd places- such as from the wisdom of Tiger Woods- the world's greatest golfer.

'I let a perfect shot stay fresh in my mind, providing a positive image for future reference. Those images are critical when the game is on. They may even be the difference between success and failure.'

What are your positive thoughts about the future of the person you love who just happens to have bipolar disorder? How can you project them into today's situation?

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Some tips from Jeanette - A mother in Arizona, USA

Things we can do to help people with bipolar disorder:

  • Not take it personally-- the bipolar is not aimed at us, they really aren't mad at us. You can't hold grudges about the mood stuff, even when it lasts for a long time.
  • Stand up for ourselves-- I have said to my kids and siblings, 'I won't be talked to that way-- I know you feel like s**t right now (or that you're pretty mad), but I'm not going to be treated that way. You can write me a letter if you need to get it off your chest or we can talk later but I have to leave (or go out of the room) because this isn't fair to me.
  • If the person with bipolar disorder cannot be an advocate for themselves, and it is my job (I am the parent for my children) then I will be the advocate. This means for years I would go to each teacher, the dance class, the painting class, the Boys and Girls Club, and explain that Sally Sue has a mood disorder that sometimes causes her to act a little differently and then I'd give a high level of what would be good and what would be bad and when I should be contacted and what alternatives might be used for problems. I have also done this for older relatives, my older sisters. Everyone needs an advocate.
  • Make sure the person has something fun or creative to do when they are bored or in one of those moods where nothing else is going to work. Sometimes they need to be alone and mentioning maybe they want to finish that drawing or repot those plants, bake that new recipe sometimes reminds them they might be better off apart for a bit and helps them to refocus.
  • Remind them of their successes. Sometimes it's the little things like you got that toilet handle fixed for me and I couldn't figure it out or you always could teach the dog new tricks better than anybody. Also, it takes a lot of ingenuity and effort to get through the depressed moods and keep going to work or school. I've praised my bipolar family members for having the energy to keep it up.
  • You already know this-- signs of cutting or self abuse need medical help immediately.
  • Things that don't work:

  • Don't yell back or try to argue-it just makes you both miserable. We've learned it is easier to say things like 'that's a different way of looking at it' or 'I can see why you might feel that way'.
  • Taking responsibility for their crappy moods, actions or results.
  • Never hit a kid with bipolar disorder (not that I did this, but my ex sure did and it is a terrible disaster).
  • Bringing up past bad moods, actions, results-- always got to keep moving forward.
  • Buying a kid stuff when they are manic or bad depressed-- boy did I fall for that one before I realized what the heck was going on.
  • Thanks Jeanette!

    This article has been provided by Julie Fast, October 19/02