Family and Friends Continued….

Next, try to reduce the following in the relationship:

1)      Critical comments:
Be mindful of your expectations and don’t hold too tight to them. Avoid expressions which find fault, pass judgment or point out problems. Watch for the word “should” in your mind and in your words.  Try not to communicate that things “should” be different: they aren’t. 

2)     Scrutinizing mood:
While it is important to monitor mood, too much focus on this may come across as a critical attitude.

After your relative has recovered from an episode, respond to their emotions like you would to a person without a mood disorder.  Don’t be too quick to evaluate whether each emotion represents an episode or a medication reaction.

Relatives are often the first to pick up on the early signs of an episode.  However, it is impossible for anyone to determine if a few hours of emotional change represent a mood disorder or not.  Keep in mind that “mood” refers to changes over days or weeks, while “emotion” refers to changes over minutes or hours.  Remember that emotions, in themselves, are not disorders.  Since we live life day-by-day, or hour-by-hour, it’s important to step back and focus on the big picture when evaluating mood.  As you develop this perspective, establish a way of communicating with your relative or their doctor that doesn’t lead them to feel overly scrutinized. 

3)     Trying to win or resolve arguments:
Too much talk stresses the mind, particularly if it’s already worn down by a mood episode.  Remember that irrational arguments are normal during mood swings, and try to let go of the wish to resolve fights verbally.  It is much better to preserve sleep and rest than to try to come to a resolution about a fight.  Time often heals conflict better than words.  Often the best move is to physically separate when a fight gets too intense.

4)     Overinvolvement:
This happens when you blame yourself for their illness or their behavior.  While this is a natural and caring reaction, particularly if your child has a mood disorder, it can be an added stress on your relative.  Mood disorders can cause people to feel guilty, controlled or like they’ve lost their self.  Overinvolvement from relatives tends to intensify these emotions. 

A face can convey anger, hostility and criticism, as seen below:

angry_woman hostility anger

 

 

5)     Hostility:
Hostility is an attitude of contempt for the person with a mood disorder. It causes relatives to blame the ill relative for all the problems the illness brings.  Certain beliefs can cause hostility to build up over time.  These beliefs begin as thoughts that are totally normal to have.  The important thing is to watch these thoughts and not take them too seriously; don’t let them get ingrained.  Some examples of these thoughts are:

“They wouldn’t be like this if they tried harder”
“They don’t want to get better”
“They just want an excuse for their behavior”
“They may have a disorder, but they can control their behavior… I saw them control it with friends last night!”

It is tempting to believe that your relative has self-control because there will be brief times of normal mood even during an episode.  Also, it is common for the worst moods to come out only around family.  In public, the depressed person may perk up and the manic person may stop fighting.  These changes are not necessarily in the patient’s control and still reflect biological changes in the brain.  Different neurotransmitters will circulate in the brain depending on who they are around.  Context is very important to mood.  As an analogy, consider Parkinson’s Disease, which causes people to be unable to move.  Patients with Parkinson’s can suddenly rise and walk when a new image is presented to them, such as a row of red squares on the floor.  This, however, is not a reliable cure for what remains a serious disorder of muscle control.

The message in all this is not that you should accept everything your relative does during a mood episode. Actually, it is crucial to know your limits and have a plan of action if a situation becomes dangerous or destructive. That involves action, not words. 

The message in here is about words and non-verbal behavior, and the importance of avoiding daily expressions of criticism, argument and hostility. This advice is not easy to follow, so go easy on yourself if you fall behind. Practice helps. Meeting regularly with a counselor can also keep you on track as you build the skills to help a loved one with a mood disorder.  It is not easy.

—Updated 4/5/14 by Chris Aiken, MD

Links:

Give input on your relative’s progress & symptoms

Getting help in a crisis

When family members refuse treatment

When a loved one has bipolar disorder (PDF document)

Bipolar Care Givers.org a site for family

Guide to talking with a loved one about suicide

Bipolar Disorders (Mood Treatment Center site)

The expression below communicates optimism, a key ingredient to recovery from any illness:

optimism

Scientific note:
The part of our brain which reads other people’s faces is also the part that gets disrupted by mood disorders. This is why I have emphasized faces and non-verbal behavior.  Emotional faces have a physical affect on the brain: they can be healing or harmful.

For the curious, the part of the brain which does this is the amygdala-cingulate network, pictured here:

Coritical limbic connection