Bipolar disorder can put an enormous strain on relationships with family and friends. When you're depressed, you may isolate yourself from the people who care about you. When you're manic or hypomanic, you might frighten or alienate them.
But relationships with friends and family are crucial to staying healthy with bipolar disorder. You need to keep the lines of communication open. Here are some suggestions.
Mixed episodes in bipolar disorder are a form of mental illness. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed episodes experiences both mood "poles" -- mania and depression -- simultaneously or in rapid sequence. Technically, mixed episodes are described only in people with bipolar I disorder (not bipolar II disorder), although this distinction is expected to change as the psychiatric diagnostic classification system is currently...
Educate family and peers. Your friends and family may not know much about bipolar disorder, or they may have a lot of wrong impressions. Explain what it is and how it affects you. Talk about your bipolar treatment. Unfortunately, some people may be skeptical or unsympathetic. Back yourself up with brochures or printouts that you can give them. Tell them you need their help to stay well.
Create a support team. Obviously, you don't need to tell everyone you know about your bipolar disorder. But you also shouldn't rely on only one person. It's much better to have a number of people you can turn to in a crisis or when you need help (such as transportation or child care while you go to a doctor's appointment). Placing all the responsibility on one person is simply too much.
Make a plan. You need to accept that during an episode of mania or depression, your judgment might be impaired. You could really benefit from people looking out for you. But loved ones also need to be careful not to push too hard. You don't want to feel like every move you make is being scrutinized. So work out distinct boundaries. Decide how often friends and family should check in and what to do if things are getting out of control. If you become manic, you might agree that your loved ones should take away your car keys or credit cards so you don't do anything reckless. If you become suicidal, they certainly need to know how to get emergency help. Coming up with an explicit plan will make everyone feel better.
Listen. After all that you've been through, you may not want to hear the concerns of your family and friends. But the fact is that having bipolar disorder does affect the people around you. During a manic or depressive phase, you may have upset people whom you care about. So try to hear them out and see things from their point of view. If you've hurt people, apologize. Reassure them that you didn't mean to act the way you did, and emphasize that you're getting treatment.
Talk to your children. If you have kids, you should find a way to tell them what's happening. They're likely to sense that something is wrong anyway; keeping them in the dark might just make it scarier. Explain bipolar disorder in a way that's appropriate for their age. Say that it's a disease that affects your mood, but that you're getting treatment for it.
Reach out. Bipolar disorder can make relationships hard. When you're depressed, you may want to retreat from the world. If you've just come out of a manic phase, you may not want to face people whom you treated badly. Either way, it's easy to let some friendships slip away. Don't let it happen. Force yourself to get together with other people, even if it may be hard at first. Isolating yourself is the worst thing you can do.
Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text Revision. Washington, D.C.: American Psychiatric Association, 2000. The Nations Voice on Mental Illness. Depression and Bipolar Support Alliance (DBSA). American Psychiatric Association. National Institute of Mental Health. Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002. WebMD Medical Reference in collaboration with The Cleveland Clinic: Bipolar Disorder. Muller-Oerlinghausen, B. The Lancet, Jan. 19, 2002; vol 359: pp 241-247. Kaufman, K. Annals of Clinical Psychiatry. June, 2003; vol 15: pp 81-83. Compton, M. Depression and Bipolar Disorder, ACP Medicine.