Rabbi Yonasan Bender LCSW - Psychotherapist
As far as psychological disorders go, Bipolar Disorder is a common problem families face. About 2% of the population are diagnosable with another 2.5% having strong characteristics. That’s 1 out of every 22 people you know. Naturally, that statistic feels a lot larger when that 1 is a family member. The idea mental health challenges are family problems and not individual problems seems cliched to some, but for families tackling Bipolar Disorder this thought cuts deep.
The dramatic swing of a frightening mania to a suicidal depression with an eerie calm that follows feels like standing in the eye of a Hurricane. The winds have died down and you hope the worst is over but you know it’s too quiet – the other side of the storm is coming. In the wake of the storm, families are left with two questions while picking up the pieces of the financially crippling gambling spree or the hospitalization costs: Am I at fault and will this happen again?
As far as the first question goes, no. It’s not your fault. Small relief when answering the second question – chances are extremely likely. But, not so fast. There’s a better question to ask: can I make a difference to keep this from happening again? Absolutely. Take it from those living on the coast, hurricane season always comes but powerful steps can be taken to protect yourself and your loved one if it happens. 90% of people with Bipolar Disorder will have frequent recurrences throughout their life. This adds up to three episodes and five hospitalizations every 10 years. However, research has also shown that while medication is unquestionably necessary for this illness, the protective measures families can develop to guard against the next storm has an even greater positive impact. Combined, these two solutions can help your loved one live a normal life. So, what can you expect from Bipolar Disorder and what can you do to weather this storm?
What Can You Expect?
Bipolar disorder effects a person’s nervous system that launces them into manias and depression over a period of months, weeks, and sometimes even days. It’s as if the nervous system is a sports car without brakes. It doesn’t take much normal life stress to get the emotional engine revved up and will take time for it to fall back to O. While this is a fair way of thinking about it, there is a lot of variation in what that looks like. For some, the swings are narrower and less chaotic. For others, one side of the equation is more vicious than the other. On average, symptoms manifest between the ages of 18 and 20 but can begin developing as early as 13.
Clinicians break up Bipolar Disorder into three stages: 1) The initial escalation where your loved one is having trouble sleeping, is uncharacteristically irritable, much more active, and seems really “off” or “weird” 2) the manifestation of the illness escalates where your loved one starts behaving in an out of control, grandiose, and shockingly impulsive and harmful ways and 3) in the final stage your loved one may even have delusions or full on hallucinations. After such a wild ride the person gears down into a depression that, for some, can become a suicide risk.
Recovery after each episode is not simple. Even for those few who have had a full recovery, they constantly struggle at work and in their relationships. As few as one in three hold down a full-time job with over half unable to work outside of sheltered settings. Sure, half are fully over the initial episode after a year but only 24% are ever able to “get back” to their pre-episodic levels of functioning. Even worse, in the first two years 40% of people drop medication use. When looking at the full lifespan, that number is hiked up to 75%. Being vigilant about medication use is key and well worth the effort – it’s the first and easiest line of defense but, interestingly enough, isn’t the best line of defense. This is where you come in.
What Can You Do to Weather the Storm?
Once the proper type and dosage of medication is worked out, which can become a part time job requiring numerous visits to the psychiatrist, your family member has a shot at functioning reasonably well. That aside, there are two things you can do to make the recovery lasting and effective – get educated and enter therapy.
Reading this article is an awesome start. The more you know the better equipped you’ll be to handle the curve balls this disorder throws at you. Dr. David Miklowitz, one of the top researchers and clinicians in this field, has two indispensable books: The Bipolar Disorder Survival Guide and The Bipolar Teen. Also check out the National Alliance on Mental Health at www.nami.org or The Depressive and Bipolar Support Alliance at www.dbsalliance.org. These international organizations will help you get connected to accurate information and support.
The most important thing to keep in mind is there is a difference between your loved one and the disorder. They are still the person you know and love. One of the biggest challenges is figuring out where the disorder ends and the person’s genuine personality begins, but there is a difference. Yes – some of the things they will say and do is going to be scary and will hurt but it’s also not really “them.” The more you know the easier it will be to see that.
Medication is essential but even more powerful than medication is your stability, love, and support. That’s no small feat. There are a lot of different therapies out there but the approach that’s been shown to be the most effective is any Bipolar focused family therapy. One good example is Dr. Miklowitz’s Family Focused Therapy. Not only is this approach superior to individual treatment, but it simultaneously improves the lives of all the other family members. The bottom line is by enlisting the entire family’s help by teaching extremely practical stress reduction strategies, a known primary trigger for Bipolar episodes, everyone can lead better lives.
Dealing with Bipolar disorder is a lifelong process but it doesn’t have to run anyone’s life into the ground. Like Hurricane season, other storms might come. However, with these two strategies, education and family therapy, those episodes will become rarer, much less intense, and much shorter in duration… Blips on the weather channel’s radar screen – a small chance of rain early on but otherwise clear skies for the foreseeable future.
Rabbi Yonasan Bender LCSW graduated from Hebrew University’s School of Social Work. He works with adults, couples, and children from his private therapy practice in Jerusalem. He holds several semichos from Rav Yitzchok Berkovits, shlita. To share your thoughts, experiences, questions, or a different perspective, you can reach Rabbi Yonasan Bender LCSW at 053-808-0435 and at [email protected] or check out his website at www.jerusalemtherapy.org.