Hi, I’m [river in Ireland] (*cue twelve-step group greeting here*), and I have bipolar disorder, also known as manic depression. To people who have known me for a long time, this isn’t usually much of a shock. Actually, I take that back. People who have known me and been close enough to have seen some rough times aren’t usually that surprised. As for everyone else, my friendly and talkative exterior can hide pretty much anything I want it to. I’ve had to use this skill a lot in the past because I have had some people find out that I have bipolar and not be very nice about it. I think my favorite comment was that I was ‘demon-’ or ‘spirit-possessed’. *roll eyes* Others think I’m not as much fun anymore since I have begun taking medication that doesn’t allow me to bounce off the walls like I did before. Still others think I’m just a freak. Of course, I was pretty freaky before, but that’s not the point. 
The point is that people with bipolar disorder can be quite complicated; things can bother us that won’t bother ‘normies’, and our medications and treatment can take a lot out of us. The disorder is very complex and there is more being learned about it all the time. There are various different symptoms or signs that can be mistaken as something else entirely, which makes it really difficult to figure out. It can really screw with someone’s life. For instance, it wasn’t uncommon when I was first diagnosed to get four hours a sleep a night for two weeks straight and clean the house up and down at 3 am**…only to crash the next week and not shower or leave my bedroom for two days. That’s not even counting the episodes where I was crying and throwing things one minute and dancing a jig the next (only a slight exaggeration), with major swings like this happening in the same day. It’s kind of hard to hold down a job when your boss can’t figure out what planet you are going to be from one minute to the next! That’s not even talking about the medications and their side effects-I’ve been through several changes and can’t even keep track of them all. One of the medicines that worked the best for me also gave me shakes so bad I had to see a Parkinson’s doctor. Another gave me gas you wouldn’t believe, and still another made me gain so much weight that I was nearly too fat to fit into my wedding dress! And you know what’s scary? I’m one of the luckier ones, because I can even take medicine; I know some people who haven’t been able to find anything that doesn’t mix badly with their other medications, assuming they can find something that does anything at all. Bipolar has a strong tendency toward comorbidity-meaning, it often occurs alongside other similar disorders. I’ve lost friends and had others change how they relate to me, although I have had some actually come closer because they had similar problems and felt I wouldn’t judge them. Generally, though, it’s one of those things you don’t really understand very well unless you have it yourself. In this spirit, I thought it might be fun to give sort of a ‘guide’ on the care and feeding of your bipolar friend. So, let’s get started:
Let the other person bring it up. I personally don’t mind talking about it with some people, but there are others I would just as soon not know. It’s not really anyone’s business, unless I choose to *make* it their business. The same might hold true for your friend, especially if she is newly diagnosed or has had a rough time with it. This is especially true in work situations; there is so much misinformation and stigma out there that the last person many people want knowing about something this personal is someone who has control over their future! Asking respectful questions when you are alone might be okay if you know she doesn’t mind talking about it with you, but when dealing with a group, let her bring it up first. It’s not usually relevant to ‘normal’ conversation, and a lot of people can be downright nasty and judgmental. I learned this the hard way. 
Do your homework. You don’t have to become a medical scholar or anything. However, it will help you to better understand and therefore support your friend if you have an idea of what is going on with her. Again, this disorder is very complicated, and there are several different varieties. However, the impressions often given in the media and in fiction are just that-fiction. The movies have a way of misrepresenting things to make them more interesting. If you do read up on it, look to more factual and neutral sources. About.com has an extensive section about the disorder and the methods of treatment written in language a ‘regular person’ can understand.
There very well might be changes in your friend that you might find irritating; knowing where they come from can help lessen the annoyance. For instance, my memory isn’t as good as it once was. Since I have the ‘racing thoughts’ that often go along with bipolar, a lot of the time I won’t remember something as simple as instructions or the name of someone I met five minutes ago. It’s not that I’m not thinking, it is that I am thinking too fast. Well, to say ‘thinking too fast’ and ‘of too many things at once’ might be more accurate. I might repeat things, not realizing I had already asked the same question or told the same story before. I know this can be frustrating, but understanding that this is part of the disorder often helps. Think about it, aren’t you more sympathetic to the person walking slowly in front of you if you see that the person has a cane? It’s the same thing with us. This doesn’t mean that we should be able to get away with whatever we want to, but if you know where something is coming from it is often easier to help with it.
And please, for the love of God/Vishnu/kittens/whatever, do not assume or imply that a person could ‘be better’ if they only tried harder/had enough faith/thought positively/got themselves together/got rid of sin, etc. I know from personal experience how much this can hurt. It’s great that you care enough to give suggestions, and some of those things can help. In fact, therapy or thought-reprocessing are often an essential part of our recovery, especially for those who also have substance abuse problems (a good 30%-60% of us***). Please understand that this doesn’t m,ean you shouldn’t talk to the person about God or their religion, either. However, this is very important-bipolar is a medical disorder. It’s really no different from arthritis; a condition that can be managed but not cured, and isn’t brought on by anything the person did. I understand that some people have religious views that anything can be cured or healed by the hand of God. I also understand that some people find a lot of comfort in spirituality. I myself have a pretty strong faith, although it has faltered at times. Faith, spirituality and a connection with something larger than myself and outside myself has been a big part of my life, even though there are times when I am depressed and feel completely cut off from God. But think about it like this; If God made this planet and everything on it, then how did the doctors get their talent and what are the medications made of? To use a rather ubiquitous and annoying cliche, think outside the box, people. Perhaps a person can be healed supernaturally, and many times the illness will go into a sort of ‘remission’ where no symptoms show. Believe me, sometimes I would love nothing more than to have it all magically taken away. Think about it, wouldn’t most people like to be rid of a condition that bothers them, at least on some level? Unfortunately, this isn’t the way it happens for a lot of us. Most of us have to take some sort of medication or have some sort of therapy at some point in our lives…getting these things is not a sign of failure. This isn’t due to any lack of character or faith on our part, although some will think this at first; I certainly did before I knew what was really going on. Being told these things by people who said they cared about me was one of the most painful things I have dealt with thus far because it knocked a huge hole in my faith in God, which was one of the main things that kept me going. It has been rather difficult at times to regain any sense of this, and I still haven’t in some ways. This is pretty common.
If someone is not religious, it can still hurt to be told things like ‘oh, you just need to think positive’ or such things. When depression hits, some people find it hard to get up the energy to think, period. They would like nothing more than to be able to think positively, but they simply can’t see anything past the darkness around them. Reminding of positive things is good, but please understand that it isn’t usually ‘enough’ for someone who has a mood disorder; other forms of professional treatment are also needed. I know I probably sound bitter, and I don’t mean to give a guilt trip, but I just wanted to give an idea as to how hurtful such statements can be.
Don’t beat yourself up if you don’t understand everything your friend is going through. Half the time, she probably won’t understand it either. The fact that you care enough to try to understand and learn about it all means a lot.
Don’t assume facts not in evidence. This is somewhat related to the previous point. A good rule of thumb is not to assume something is due to/related to the bipolar (or complications from it) unless you are told that it is. I have a friend who means well, but she thinks she can ‘read’ me. It seems that anytime I am sick or cranky or *gasp!* I get angry or irritated with her, she asks about my medications or doctors or whatnot. I guess it could be compared to the way the guys we went to high school with assumed that we were having our periods when we got annoyed with them-sometimes it might be PMS, but sometimes they were seriously being annoying! I guess it would be one thing if I were eating corn chips and watching Monty Python one minute and started screaming and swearing the next. However, that is not how it usually plays out. I’ve often been asked about my medication when I’ve gotten bothered with my friend when she said something completely out of line or asked a question that really isn’t her business. I know it can be really touchy and confusing when we seem to be in a bad mood for a long stretch of time or when we can’t talk about a particular subject without going off. Believe me, I understand that this can be scary! I don’t blame anyone for asking or thinking our disorder is at play, because sometimes it is. My wedding, for instance, was a big trigger when my friend was trying to help me organize things for it. The point is, however, not to use knowledge of our disorder as a catch-all to explain every mood or comment when our reaction to something might be the same a reasonable person could have.
Know when you’ve done all you can. There are going to be times when we need more help than you can provide. Keep in mind that our disorder has a strong medical element and thus we will sometimes need that type of help more than anything else, or more than we are presently getting. For example, one person I know had to be involuntarily committed to a 72-hour emergency mental health hold because she was dissociative, screaming and threatening to kill herself. In her home state, the police had to be called out to the house because she was causing a major disturbance. I don’t remember if it was her husband or her father who had her committed, but I do remember that she pitched a huge fit and wanted nothing to do with it. However, involuntary commitment was what was needed to protect her from herself and others from her. Not all cases will be this extreme, but parts of our disorder can only be effectively dealt with by medical and mental health professionals. It’s not your fault, please remember that. It’s a medical problem. We might say or think you are abandoning us or that you just want to get rid of us by handing us off to professionals, and we might hate you for it for a while. Hell, you might even learn some new expletives. Please know that you are giving us what we need by referring us to someone who can give more help, regardless of what we might say. We’ll thank you for it later, but even if we don’t, still know that you have done the best you could do. You need to care for yourself too.
Above all:
Have compassion. We didn’t ask for this. It’s like I once told my husband, ‘Remember that however difficult it is to be *with* me, it’s probably at least that much more difficult to *be* me. That doesn’t mean that you have to put up with whatever we want to throw at you (literally or figuratively), but that does mean that you should try to understand that it isn’t *us*, but the disordered parts of us, that are causing problems. If you need to get away-temporarily or for good-then by all means do so, but please know that we’re not happy with ourselves either.
If you’ve gotten this far, I want to thank you for taking the time to read this. It really does mean a lot that you care enough to try to learn how to help. Hopefully one day, we can return the favor.
**Yes, as a matter of fact, I did have the cleanest house in the Research Triangle area. No, I won’t clean yours.
***source-About.com, bipolar disorder-http://bipolar.about.com/od/alcoholsubstanceabuse/Alcohol_Substance_Abuse.htm
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