Checking In With a Bipolar Loved One: A Guide

Talking about mental illness is hard no matter what, but you can make it easier

Every few months, my mom and I have the “mania talk,” a well-meaning but exhausting procedure that feels more like an interrogation than a discussion. Everything — including my sleep schedule, eating habits, and propensity for housework — is on the table.

Usually, it ends the same way: a reminder to always take my medication, to go to my therapist, to schedule that long-delayed psychiatrist appointment.

This ritual isn’t to excoriate me, though it often feels that way.

It stems from the fact that no one in my family, including me, recognized the signs last time.

“Last time” is the last time I lost my mind, completely and utterly, for five months. In October 2013, I began a rapid descent into a life-threatening psychotic episode that required multiple hospitalizations, and ultimately changed everything about me, from my brain to my very being, what I see as my essence. My diagnosis of bipolar disorder went from being a small part of my life to everything that mattered.

It is hard to explain a psychotic episode to someone who has not experienced one, especially because psychotic episodes often cause memory problems. In addition to common manic behaviors like complete insomnia, overspending, uncharacteristic gregariousness, wandering, and aggression, I lost complete touch with reality.

The best way I can describe this is that my brain began to weave a completely different narrative to real life.

This included beliefs about having had Bluetooth installed in my head, being gang-stalked on a crowded bus, and being terminally ill.

The worst, and most dangerous delusion, sounds surprisingly banal: I believed that I was a torchbearer for the Special Olympics. However, this delusion becomes far more terrifying when I tell you that I walked 13 miles from my house in the Bridgeport neighbourhood of Chicago to Navy Pier, in the middle of the night, in subzero temperatures.

In a story that sounds completely made-up but I promise is true, I knocked on the doors to the Field Museum and the Shedd Aquarium at 3 am until walking to Navy Pier, where by some miracle, a janitor let me in.

I twirled and wandered around the building for perhaps 30 minutes until a police officer showed up and waited with me until the buses began to run around 4 am.

It is truly amazing that I did not freeze to death, get hit by a car, be hurt by a stranger, or even get shot by police, a tragically common danger for mentally ill individuals.

As my family says, my guardian angel must have been watching very close that night.

I would share all that I can remember about that terrible time in my life, but it is deeply painful to recollect, much less to share. Even though I know it was not my fault that I had a psychotic episode — especially because I was entirely medication compliant before, during, and after my episode — I still feel a deep shame when I think back on this period.

The stigma of mental illness has coloured my thinking about my condition ever since my diagnosis, and it is incredibly tenacious.

Even though I have not experienced a relapse since 2014, retaining stability even during the second-worst time of my life — my sexual assault and subsequent fight for justice — the spectre of my psychotic episode haunts me.

It informs every facet of my life, from life-changing decisions like where to work and live to minor things like the foods I eat and the shows I watch (or refuse to).

Every day, multiple times a day, I must check in with myself. I have to monitor every mood and behavior, trying to relate it to some mythical baseline “me,” a normal “me” that only exists in abstract. Am I laughing too much, talking too much, acting too friendly? Do I want to join that group because I really would enjoy it, or is it gregariousness from mania? When I decide to take a walk late at night because I can’t sleep, am I wandering, walking too far? And speaking of sleep, if I’m not sleeping well, is it a harbinger of mania or garden-variety insomnia?

You can imagine this constant self-observation is exhausting. It’s no wonder that even the most well-meaning “mania talk” from one of the people who love me most on this planet can feel demeaning.

I can hear the bratty teenager in my head shouting, you think I haven’t thought of that?

But then I take a deep breath and remember something very critical about bipolar: I really may not have noticed my own slide into mania.

In all psychotic-spectrum disorders, the mind plays a truly diabolical trick, reducing self-awareness as symptoms escalate. You might see an interview with someone clearly suffering from psychosis who seems completely unaware that anything is wrong with them.

Psychotic support groups are filled with agonized posts from families begging to know how they can help their loved one see the truth. Sadly, you can’t — not without medical intervention.

So as much as “mania talks” might irritate me, they are a necessary evil in preventing episodes. However, this doesn’t mean they have to feel like pulling teeth.

Here are some things I’ve learned about check-ins that I hope can help other families make discussions of symptoms a positive experience, a moment to show care and appreciation rather than judgment.

Assume the person is doing their best.

The easiest way to get a mentally ill person on the offense is to insinuate that they aren’t trying to manage their symptoms. You must remember that as difficult as dealing with a mentally ill loved one may be, it is immeasurably harder for the person actually experiencing it.

For example, many mentally ill people (and mentally healthy people too!) struggle with cleanliness and hygiene. Cleaning even part of a room can seem a daunting task, especially considering the energy-zapping and concentration-draining power of many psychiatric medications. Body dysmorphia, a common symptom in PTSD, can make it so you don’t even want to look in the mirror, much less step in a shower. None of these things mean that a mentally ill person is being “lazy:” what seems like a molehill to the average person could be Everest for a mentally ill person.

This doesn’t mean you can’t be annoyed with untidiness or unbrushed teeth. It does mean, however, that you should talk openly about what your loved one is struggling with and presume that it isn’t because they don’t want to do something, but because right now, it’s beyond their abilities.

Focus on facts and concrete behaviors.

As we all know, there is nothing more annoying than a hazy criticism that cannot be proven or disproven. For example, you can claim someone is being “defiant” or “oppositional,” but unless you can actually point to an incident, this is unhelpful at best and genuinely hurtful at worst. Instead, try to point to provable, definable behaviors, like sleep patterns, eating behaviors, spending trends, and so on.

It is much more helpful to say, “I’ve noticed that you haven’t been sleeping much lately but you still seem to have a lot of energy. Have you been feeling tired at all?” Not sleeping but not feeling tired is a very common, and very definable, a symptom of mania, while being rude or defiant isn’t. This isn’t to say that you can’t point out that your loved one has been more confrontational lately, but you should lead — and focus on — objective actions rather than subjective reactions.

Take the long view, with a wide-angle.

This can be tricky because mania or psychosis can develop very rapidly, so you don’t want to take too long of a view. However, it is more helpful to look at trends and the whole picture of a person’s behavior rather than single incidents.

Everyone has bad days, mentally ill people included, and so looking at a single day or even a few days of crabbiness, insomnia, or shopping sprees is not going to provide much information. The key is to consider whether the behavior has consistently shifted from what it was before.

Consider external factors.

This is especially true right now as we are all dealing with unprecedented social unrest. Everyone is on edge, mentally ill or not, and so your loved one being unusually surly is, sadly, to be expected. But even in times of relative tranquillity, life factors like jobs, relationships, and physical ailments (sadly comorbid with mental illness) can cause changes in behavior and mood.

When considering whether your loved one is manic or psychotic, you must factor in the rest of their life situation.

Do they feel safe at home? Are they in a stable routine? Are life circumstances allowing them to get adequate rest, nutrition, and recreation? Is money tight or are they worried about job security?

Again, mentally ill people are people, and they react to life stressors just like anyone else would.

Do not bring up the past unless it is absolutely pertinent.

Trust me, your loved one remembers the bad times just as much, if not more, than you do, even if they can’t give you a play-by-play of what happened.

Constantly referring back to past incidents is not productive unless you are doing a direct comparison of what happened then versus what is happening now. This especially true if it is something that has already been discussed in detail.

All that repetition of these discussions will do is put your loved ones on guard and make them feel ashamed.

Approach from a proactive, rather than accusatory, stance.

This is connected with the first point of assuming the best from your loved one, but it also has to do with how you discuss their behavior and your concerns.

Consider it a time to check-in and workshop the current approach to their mental wellness instead of a recitation of everything they’ve done wrong or that is annoying you.

Recently I’ve been struggling with Night Eating Syndrome, something that is more common with bipolar disorder.

The first time my mom and I discussed this, I was embarrassed and hurt that it was even being brought up, especially as I’ve been dealing with self-image issues related to weight gain.

However, the second time it came up, we talked through some possible solutions, like keeping the fridge stocked with healthy and low-calorie foods so that even if I did slip up, I could mitigate the effects.

It is not helpful to simply recite a rota of potentially damaging behaviors if you are not willing to discuss possible solutions.

Depending on whether your loved one is actually manic or not, it might not even do any good because they will lack the self-awareness to recognize what you’re pointing out.

However, sharing possible interventions can potentially prevent further deterioration, even if it will not actually stop the manic episode.

Do not intervene without consent, even if that consent is conditional.

Making plans during periods of stability is essential, including legal documentation of these plans. This is when it is appropriate to discuss past episodes, as they can serve as a blueprint for how to intervene next time, even if the next episode is not exactly the same. Most bipolar people will have a constellation of symptoms that regularly appear, and if you are aware of these, you can take targeted steps to address these symptoms as they occur.

For example, if your loved one struggles with overspending, they can set up alerts that tell them when their credit card hits a certain balance or when they’ve spent a certain amount of money in a given period. If you fear your loved one won’t tell you when they get these messages, you can discuss having you added to the account so you can monitor changes (though you should consider this carefully as it can impact your own credit score).

This is also why it is very important that loved ones educate themselves about bipolar symptoms, including reading narratives from other bipolar people. If you don’t know that something is a potential symptom, you can’t be vigilant for it, and you may dismiss it as unrelated. For example, for about a year or so before my psychotic episode, I would experience episodes of catatonia. Sometimes my body would move in weird ways that I couldn’t control, or I wouldn’t be able to move despite being conscious. My family and I thought that these episodes were medication reactions or something else; I even spent four days in a seizure unit at Northwest Memorial Hospital to rule out epilepsy.

It was only after my psychotic episode that I learned that this catatonia was a prodrome of psychosis, and can precede a psychotic episode by months, as it did for me. Unfortunately, no one connected the dots, and I was even accused of malingering by medical professionals, or of using illegal drugs (a sadly common reaction to psychotic symptoms). My family and I had absolutely no idea that this is a potential symptom of bipolar: we didn’t even know the term for what was happening to me.

Without knowledge of all the possible symptoms of bipolar, it is tragically easy to miss the signs. Awareness of potential symptoms, especially prodromes, can allow for immediate intervention to prevent a full psychotic episode. This is critical, not just because psychotic symptoms are potentially life-threatening, but because psychotic episodes do lasting harm to brain structure, and the longer an episode lasts, the greater likelihood of relapse.

These last two points are the hardest to accept and the hardest to act on, but arguably the most important.

Mental illness is an explanation but not an excuse.

This can be difficult to delineate and threatens to veer into victim-blaming, but it’s also a very critical point to understand. Essentially, bipolar — or any mental illness — does not give a person carte blanche to be a jerk to anyone and everyone. It also does not absolve a person of responsibility for their behaviors, including during a psychotic episode.

Ultimately, we are all responsible for our own lives, even if we don’t like every aspect of that life. I did not ask to have bipolar, and it isn’t my fault that my brain short-circuits. However, these are the circumstances that I’ve been given and it’s my responsibility to take care of this condition as well as mitigate any harm I may do to others.

I won’t deny that it absolutely sucks to have to clean up the pieces of your life after something terrible happens that is beyond your control. However, almost all of us will ultimately face a tornado in our personal lives, whether it’s an accident, a messy divorce, a traumatic incident, or the untimely death of a loved one. It will not help us move beyond the situation or grow as a person to play the victim and use it as an excuse to hurt others.

Understanding bipolar and psychotic-spectrum disorders helps to contextualize behaviors that can be truly terrifying and debilitating. They also provide an opportunity to develop better coping behaviors, to learn how to better manage symptoms, and to become a resilient, stable individual. Mental illness can also be a wonderful catalyst for personal growth, turning us into true assets to our communities through deeper compassion and awareness. But this can’t happen when you or your loved one is in a victim mentality.

Ultimately, your loved one is responsible for themselves.

This is something that is discussed a lot in Twelve-Step programs and treatment for codependency: you cannot save someone from themselves. All the love in the world can’t motivate someone to get better or to take care of themselves, as much as we wish otherwise. That motivation must come from within.

It’s a sad fact that bipolar disorder and other mental illnesses often come with self-sabotaging behaviors, which can be either a symptom of the illness itself or brought on by shame and stigma. This is especially true when bipolar is comorbid with other problems like drug addiction, and it’s made worse when the individual is resistant to treatment, whether that is therapy, medication, or a mixture of both.

Unfortunately, many individuals reject treatment, even if they know it’s best for them. This can be due to the often extreme side effects of psychiatric medications, like rapid weight gain, dyskinesia, serotonin syndrome, neuroleptic malignant syndrome, and extrapyramidal symptoms. I will not discount these complaints, as many of these side effects can be truly terrifying, even life-threatening. Others may be resistant because of the stigma of psychiatric treatment, believing that drugs are crutch or that they can manage bipolar on their own. Others may not be resistant at all, but simply cannot afford medication and therapy.

You can try to remove barriers to treatment as best you can and you can be supportive and try to help them manage their symptoms. But unfortunately, at the end of the day, it is not your life, it is theirs. They must take accountability for how they choose to deal with their illness: you cannot fix them or force them to take treatment.

For many of us, this is an intolerable reality; after all, no one wants to watch their loved one self-destruct. But it’s an inescapable truth. You trying to take control of their treatment may help in the moment, but it will ultimately fail or even make it worse in the long run.

This is why it is essential that you seek support for yourself and your loved ones, so that you can manage your own responses and prevent codependency. I would not say that bipolar is a “family disease” like alcoholism, but it undeniably has huge effects on the entire family system. For your own well-being, you need to prioritize caring for yourself. As is said so often in therapy, you need to put your own oxygen mask first or you can’t help anyone else.

I hope this has been a helpful guide for helping your bipolar loved one or a loved one with any other mental illness. I wish you smooth sailing for your next mania talk.