7 Signs of Unfriendly Fighting

By Marie Hartwell-Walker, Ed.D.

Roger and Robin have been married and fighting for 8 years. They both say they don’t like it. They both claim it’s the other’s fault. They both say they love each other but they can’t stand the fighting. On the brink of divorce, they’ve made the first agreement that either can remember, to come to therapy.

During the first session, they do me the favor of having a fight. It really is helpful. I get to see up close what it is that they do to make sure that a fight goes nowhere. Not surprisingly, there’s a pattern to it. Roger and Robin have become experts in the tactics of unfriendly fighting. Any conflict quickly spreads in all directions except the original one. Perhaps you recognize the signs.

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12 Ways to Make Friends

By Therese Borchard

I was really sad to read that so many readers don’t have four friends whom they could ask to compile lists of positive qualities in order to star a self-esteem file. It seemed that almost one-fourth of the comments on the message board of my “Video: My Self-Esteem file” pointed to the sad reality that many people are without a large group of friends.

Although I have experienced almost every other symptom of depression, I have been able to, for the most part, escape loneliness–except for those months when I couldn’t describe my thoughts and feelings to anyone because they were so ugly.

I think that I have been blessed with so many good friends throughout my life not because I’m so popular, but because I’m really nosy and I lack many of those social graces and proper boundaries that a polite person has.

In the first five minutes of meeting someone, I usually cover my entire psychiatric history. That can be good and bad. It works those afternoons like yesterday when a mom approached me and said, “You look so calm with your children,” and I laughed out loud and said, “I don’t think so, I’m just heavily medicated.” We talked for another hour and covered what meds we were taking, our dosages, what doctors we see, what psych wards we had visited, how long our menstrual cycles last, and what we tell other people with regard to our mood disorders: me … everything, her … nothing.

A success!

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12 Ways to Care for a Depressed Person

By James Bishop

The person with depression usually can’t see a way forward. They may fervently believe that nobody can help them, and life is pointless. That doesn’t mean that they’re right, and there are plenty of things that you can do to help. The type and amount of care that you can give will depend on your relationship with the person, but here are some ideas.

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8 Ways to Help Your Bipolar Loved One Cope

By Therese J. Borchard

Depression and bipolar disorder are often family diseases.

Everyone sharing a kitchen and a bathroom is affected. In fact, in his book “Understanding Depression,” J. Raymond DePaulo Jr., M.D., writes that “depression … has a much greater impact on marital life than rheumatoid arthritis or cardiac illness. One study found that only severe forms of cancer affected a family as adversely as depression or bipolar disorder.”

My manic depression could have easily wrecked my marriage and my relationships with my two children. Instead, we emerged as a tighter, stronger unit. How? Here are eight ways Eric, my husband, helped me cope – tips for families on how, exactly, to hang in there with a loved one who has been diagnosed with bipolar disorder.

1. Educate yourself.

I remember the afternoon of my first severe panic attack. I phoned Eric at work as my breath grew shallow and my heart pounded as if I were having a heart attack. I was sure I was dying. As soon as he walked through the door, he stared at me suspiciously. My limbs were in place, and I seemed to be functioning just fine. What was the problem?

“You don’t understand,” I explained. “I thought I was dying! It was the most frightening experience I have ever had.”

What convinced my spouse that my bipolar disorder was an illness, not a weakness? Tons of research. The reams of paper that I printed out and asked him to read. The psychiatric evaluations he witnessed. The group therapy and family sessions he attended and the conversations with other spouses of persons with bipolar disorder.

Education is always the starting point because until a spouse or daughter or friend of a manic-depressive understands the illness, it is impossible to say and do the right thing. Do your own research by going online to National Alliance of Mental Illness or to Depression and Bipolar Support Alliance, or by doing a Google search of the words “bipolar disorder”.

2. Learn how to talk to your loved one.

Eric doesn’t say much when I’m clutching tissue paper, crying my eyes out. And he’s hesitant to speak when I’m manic (not that I would let him get in a word). When I don’t want to get out of bed in the morning, he reminds me why I need to. And when I’m revved up, he’s the voice of reason telling me why a spontaneous trip to New York isn’t smart.

Anna Bishop, wife of blogger James Bishop (findingoptimism.com) has some wonderful advice for the loved one of a manic depressive on what to say and when:

When James becomes ill he turns into a different person. I say goodbye to my husband, so to speak, and hello to bipolar James. In a depressive episode he becomes highly irritable and usually itches for a fight. Early on he will often make comments to bait me. “All I do is work, work, work, to support your lifestyle and your precious social group.” You can imagine what a red rag to a bull that comment is.

At this point I have 2 options:? 1. Take the bait, have a messy fight and accelerate his downswing, or? 2. Grit my teeth and say “it’s the illness speaking”. If I can do that then I have a much better chance of diffusing the situation. A comment like “You sound stressed about work – let’s talk” has better results and sometimes can even stop the mood swing.

3. Make some rules.

You know all the fire drills in primary school you prayed would happen during the math pop quiz? All those times the school administrators rehearsed what, exactly, would happen in the case of an emergency? Families of bipolar persons need them as well: a plan of action for those times when the bipolar person is sick.

In order to design such a strategy, the manic depressive and her loved one must compile a list of symptoms – like the smoke and burning smell of that make-believe fire in the third grade-and what action should follow them, like “call the doctor.” Each family will have a different list of symptoms and a different model of recovery, because no two illnesses are exactly alike.

Eric and I have agreed that I will call my doctor after two consecutive nights’ sleep under five hours, or after three days of crying spells. A friend of mine told me that he and his wife have agreed that she will see her psychiatrist if she hasn’t gotten out of bed for three days.

4. Plan for emergencies.

As part of the above plan of action, you should consider what should happen when the bipolar person is very ill. “When you are dealing with a disease that has the potential to become life-threatening, the last thing you want is an improvised response to an emergency situation,” writes Francis Mark Mondimore, M.D. in his book “Bipolar Disorder: A Guide for Patients and Families.”

Part of your plan should include a list of people who you can call for help. Of course, it is recommended that the bipolar person be working closely with a psychiatrist, and that he know how to get in touch with the psychiatrist after hours, and in case of emergencies. It’s also a good idea to know which hospital the psychiatrist works with, or if the doctor will work with any hospital in the area. Ask friends, doctors, and family members for their recommendations about hospitals and mental-health practitioners.

Also, the red tape of insurance issues is often too overwhelming to process at the time of the emergency, so get familiar with the details of your medical insurance coverage for psychiatric illnesses right now. Know the terms of hospital coverage, especially, and how much the patient is expected to pay out of pocket for various services.

5. Listen.

“When people are talking,” writes Rachel Naomi Remen, “there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it.”

When I think back to the days when I was very ill, crying and shaking at the dinner table and at preschool functions with the kids, no response was as appreciated as when someone simply listened. Suggestions came off as condescending, even though I know they were meant to be helpful. Advice was annoying. Many times I just needed to be heard, to be validated.

Don’t hesitate to say nothing because silence often speaks the most loving message.

6. Go gentle.

I can’t count all the times I have tried Eric’s patience with the reckless highs and debilitating lows of my bipolar disorder. When I get fired up and want to sign up for 60 new activities – not to mention losing my car keys, cell phone, and purse – it’s difficult for him not to get annoyed. But because he places my exasperating behavior in the proper context of an illness, and sees them as mere symptoms of a disease – rather than careless and self-absorbed actions – he is better able to go gentle with me.

Moreover, a little kindness and gentleness toward your loved one-especially at those times that you feel incapable of affection and care- goes a long way to aid recovery.

7. Laugh together.

Humor heals in so many ways. It combats fear, as it loosens anxiety’s death grip on your heart and every other living organ. It comforts and relaxes. And recent studies indicate that humor also reduces pain and boosts a person’s immune system.

“Laughter dissolves tension, stress, anxiety, irritation, anger, grief, and depression,” says Chuck Gallozzi of personal-development.com. “Like crying, laughter lowers inhibitions, allowing the release of pent-up emotions. After a hearty bout of laughter, you will experience a sense of well-being. Simply put, he who laughs, lasts. After all, if you can laugh at it, you can live with it. Remember, a person without a sense of humor is like a car without shock absorbers.”

Humor also aids communication, and if there is one thing besides education that is absolutely essential for a healthy relationship with a bipolar loved one it’s good communication.

8. Get support for yourself.

Caregiving is draining. Even when you are protecting yourself with the armor of regular sleep, healthy meals, and essential time-outs from your sick loved one, caring for a person still takes a toll on your physical and mental health.

“It can be exhausting to live with a hypomanic person and frustrating to deal with a seriously depressed person day after day,” says Dr. Mondimore. “The changes and unpredictability of the moods of someone with bipolar disorder intrude into home life and can be the source of severe stress in relationships, straining them to breaking point.”

That’s why you need support as much as your loved one. You need to talk to people who have lived with a manic-depressive, and be validated by their experiences. Spouses and family members of bipolar persons should consider therapy for themselves, as a way of processing all the stress. You may also benefit from checking out support programs for spouses and loved ones of the mentally ill, like National Alliance for Mental Illness, that are available today.

Schizophrenia 101: For Family Members and Friends of a Schizophrenic

A patient’s support system may come from several sources, including the family, a professional residential or day program provider, shelter operators, friends or roommates, professional case managers, churches and synagogues, and others. Because many patients live with their families, the following discussion frequently uses the term “family.” However, this should not be taken to imply that families ought to be the primary support system.

Patients with schizophrenia may need help from people in their family or community in numerous situations. Often, a person with schizophrenia will resist treatment, believing that delusions or hallucinations are real and that psychiatric help is not required. At times, family or friends may need to take an active role in having them seen and evaluated by a professional.

The issue of civil rights enters into any attempts to provide treatment. Laws protecting patients from involuntary commitment have become very strict, and families and community organizations may be frustrated in their efforts to see that a severely mentally ill individual gets needed help. These laws vary from state to state; generally, when people are dangerous to themselves or others due to a mental disorder, the police can assist in getting them an emergency psychiatric evaluation and, if necessary, hospitalization. In some places, staff from a local community mental health center can evaluate an individual’s illness at home if he or she will not voluntarily go in for treatment.

Sometimes only the family or others close to the person with schizophrenia will be aware of strange behavior or ideas that the person has expressed. Since patients may not volunteer such information during an examination, family members or friends should ask to speak with the person evaluating the patient so that all relevant information can be taken into account.

Ensuring that a person with schizophrenia continues to get treatment after hospitalization is also important. A patient may discontinue medications or stop going for follow-up treatment, often leading to a return of psychotic symptoms.

Encouraging the patient to continue treatment and assisting him or her in the treatment process can positively influence recovery. Without treatment, some people with schizophrenia become so psychotic and disorganized that they cannot care for their basic needs, such as food, clothing and shelter. All too often, people with severe mental illnesses such as schizophrenia end up on the streets or in jails, where they rarely receive the kinds of treatment they need.

Those close to people with schizophrenia are often unsure of how to respond when patients make statements that seem strange or are clearly false. For the individual with schizophrenia, the bizarre beliefs or hallucinations seem quite real – they are not just “imaginary fantasies.” Instead of “going along with” a person’s delusions, family members, or friends can tell the person that they do not see things the same way or do not agree with his or her conclusions, while acknowledging that things may appear otherwise to the patient.

It may also be useful for those who know the person with schizophrenia well to keep a record of what types of symptoms have appeared, what medications (including dosage) have been taken, and what effects various treatments have had. By knowing what symptoms have been present before, family members may know better what to look for in the future. Families may even be able to identify some “early warning signs” of potential relapses, such as increased withdrawal or changes in sleep patterns, even better and earlier than the patients themselves may. Thus, return of psychosis may be detected early and treatment may prevent a full-blown relapse. Also, by knowing which medications have helped and which have caused troublesome side effects in the past, the family can help those treating the patient to find the best treatment more quickly.

In addition to involvement in seeking help, family, friends, and peer groups can provide support and encourage the person with schizophrenia to regain his or her abilities. It is important that goals be attainable, since a patient who feels pressured or repeatedly criticized by others will probably experience stress that may lead to a worsening of symptoms. Like anyone else, people with schizophrenia need to know when they are doing things right. A positive approach may be helpful and perhaps more effective in the long run than criticism. This advice applies to everyone who interacts with the person.

Coping Guidelines for Family or Friends

1. Establish a daily routine for the patient to follow.
2. Help the patient stay on the medication.
3. Keep the lines of communication open about problems or fears the patient may have.
4. Understand that caring for the patient can be emotionally and physically exhausting. Take time for yourself.
5. Keep your communications simple and brief when speaking with the patient.
6. Be patient and calm.
7. Ask for help if you need it; join a support group.

Sources:

National Institute of Mental Health

John M. Grohol, Psy.D.

What to Do When You Don’t Know What to Say

A close friend approaches you with a complicated problem that doesn’t have an easy solution. What do you do? If you simply express sympathy, you are not helping to solve the problem. If you try to give advice, it may seem like an attempt at a “quick fix” and appear as if you don’t understand the situation. You want to help, but you don’t want to intrude. What do you do?

You can help others arrive at their own solutions without being judgmental or intrusive by performing the following tasks:

• Help sort out concerns. Clarify the problem. Prioritize concerns and needs.
• Consider options. Identify what can be done. Discuss the advantages and disadvantages of alternatives.
• Develop a plan. Focus on the best possible course of action. Plan carefully.

Sorting out concerns:

Before you can begin to help others to solve problems, you must first allow them to explore their own thoughts and emotions. You can facilitate this process by asking open-ended questions that begin with “What” or “How.” Ask direct questions that encourage another to talk about the specific problem.

Summarize what the person says to you and repeat it back in your own words. Hearing you voice those concerns will help your friend to look at the situation more objectively, and to gauge how well he/she is communicating true feelings.

Once you have identified all of the problems that your friend wishes to address and all of the emotions involved, you can begin to explore options.

Reviewing options:

To help your friend identify possible courses of action, use three questions:

1. What have you tried?
2. What have you thought about trying” and
3. As we talk, what other possibilities come to mind?

Now, have the individual describe the advantages and disadvantages of each one. As the guide, be sure to get the person to look at the pros and cons. of each option.

Developing a plan:

Once your friend has decided on the best option, it is time to develop a plan. A good plan is negotiated together, focused in the present, specific and realistic.

After settling on a practical strategy, wrap up the problem solving process by having the person describe the plan. Be sure to seek clarification of any uncertainties or misunderstandings that become known during the person’s summary.

The real help is in ‘being there’

Always end the discussion by expressing interest in how things progress. This gives the person added motivation to follow through with the plan. Stay involved.

Being a guide gives you the ability to respond effectively to others in decision-making situations, even when you have no answers of your own. This systematic process can help you and the people you care about make important decisions seem more manageable.

By Jane Framingham, Ph.D.

How to Tell Your Friends You Have Bipolar Disorder

Note: This article was written by a teen for teens, but the advice can also apply to anyone who is the situation of deciding whether to talk to a friend about having bipolar disorder and choosing what to say. The following is the perspective of one person — symptoms of instability and the nature of the illness can vary. Also, what someone might choose to share with friends will vary as well.

Talking to your friends about bipolar disorder is often a difficult matter and is something that should be handled with great care. The first thing you need to do is assess your friendship with the person. How much do you trust the person? Can you trust the person with your emotions? Will this person spread your feelings around the school?

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How to Explain Bipolar Disorder to Others

How do you explain your, or a loved one’s, condition to others? Here are a few sentences to help you organize your thoughts. Choose the most appropriate explanations and modify as needed.
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A Partner and Family Guide to Dealing with OCD

DO’s

DO: Be Supportive. Talk about the Obsessive Compulsive Disorder. Listen to the loved one. Try to be understanding during stressful time’s and praise any improvements made during treatment. Try and improve the sufferers self-esteem, confidence, and boost their self-image. Encourage the individual by letting them know that they are NOT alone and that treatment for OCD is available. Work with the Professionals and the individual in setting workable guidelines to follow at home. Encourage the OCDer that there are OCD medications and behavior therapy programs for Obsessive Compulsive Disorder to help them and assure them them their symptoms can be reduced significantly. Suggest that they join a Support Group with you or by themselves.

DO: Be Consistent. Set rules for behavior and stick to them. As much as possible it is important to keep a normal family routine. All communication about and guidelines must be consistent, clear and simple.

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How Family and Friends of Those with Bipolar Disorder Can Help Themselves

Bipolar Disorder is an illness that affects the entire family – mothers, fathers, sisters, brothers, grandparents, aunts and uncles, husbands and wives, and children.

Manic and depressive behaviors come with lasting and very stressful consequences for both patients and their families. Families suffer directly through the exhaustion of suicidal crises, the emotional and medical risks associated with sexual infidelities, and the financial damage that comes with unrestrained spending and abandonment of any long-term financial plan. The family’s focus may be shifted entirely onto patients in a dysfunctional manner that deprives other members of attention that they need in order to feel valued and important.

Children of bipolar patients learn that their affected parent is unstable and adapt by being careful in their behavior and language. Young children are prone to believing that their parents’ mood swings are their fault, creating new sources of stress within the family. When the affected patient is a child, siblings may feel jealous of their ill sibling creating an unpleasant and exhausting home life in which parents are always refereeing interactions.

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