Living with Someone Who s Living with Bipolar Disorder A Practical Guide for Family, Friends, and Coworkers CHELSEA LOWE BRUCE M. COHEN, MD, PhD
Living with Someone Who s Living with Bipolar Disorder
Living with Someone Who s Living with Bipolar Disorder A Practical Guide for Family, Friends, and Coworkers Chelsea Lowe and Bruce M. Cohen, MD, PhD
Copyright # 2010 by Chelsea Lowe and Bruce M. Cohen. All rights reserved. Published by Jossey-Bass A Wiley Imprint 989 Market Street, San Francisco, CA 94103-1741 www.josseybass.com No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at www.wiley.com/go/permissions. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Web site is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information that the organization or Web site may provide or recommendations it may make. Further, readers should be aware that Internet Web sites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. While the accounts contained herein are factual, details contained in personal histories have been altered to protect the privacy of the individuals involved. Jossey-Bass books and products are available through most bookstores. To contact Jossey-Bass directly call our Customer Care Department within the U.S. at 800-956-7739, outside the U.S. at 317-572-3986, or fax 317-572-4002. Jossey-Bass also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Library of Congress Cataloging-in-Publication Data Lowe, Chelsea. Living with someone who's living with bipolar disorder : a practical guide for family, friends, and coworkers / Chelsea Lowe and Bruce M. Cohen. p. cm. Includes bibliographical references and index. ISBN 978-0-470-47566-9 (pbk.) 1. Manic-depressive illness Popular works. I. Cohen, Bruce M. II. Title. RC516.L69 2010 616.89'5 dc22 2009033973 Printed in the United States of America FIRST EDITION PB Printing 10987654321
To our agent, Gina Panettieri you rock! and to my six parental units Chelsea Lowe To my mom and dad, who both in their own ways spent their lives caring for others Bruce M. Cohen
CONTENTS Preface ix Introduction xiii Part One Understanding Bipolar Disorder 1 1 What Is (and Isn t) Bipolar Disorder? 3 2 A Brief, Colorful History (and Some Science) of Bipolar Disorder 19 3 Getting an Accurate Diagnosis 35 4 Understanding Medication 53 5 Understanding Psychosocial Therapies and Medical Treatment Options 71 Part Two Living with Your Partner 87 6 Building a Support Team 89 7 Bipolar Disorders and the Workplace 107 8 Communication and Coping Skills 127 9 Coping with Negative and Dangerous Behaviors 147 v
vi Contents 10 Sex, Intimacy, and Relationship Issues 161 11 Suicide Attempts, Hospitalization, and Commitment 177 12 Family Matters 193 Appendix: Excerpts from the DSM-IV-TR Diagnostic Criteria for Bipolar Disorder 209 Notes 233 Resources 237 About the Authors 245 Index 247
PREFACE My very first psychiatric patient had a form of bipolar disorder. She was a brilliant young woman whose illness had disrupted her life, her career, and her relationships. Fortunately, her symptoms first waned and then vanished in the face of comprehensive treatment. Her astonishing experiences of mood swings and delusions followed by sanity, of wild behaviors and speech that resolved to reveal a wise and thoughtful wife and mother convinced me that I wanted to spend my career trying to understand and improve care for people with this fascinating condition. For more than thirty years, I have specialized in the psychiatric treatment of patients with bipolar disorder. I have helped care for thousands of patients, and run a major hospital dedicated to those with psychiatric disorders. As a researcher, I have sought and still actively seek to develop new and better treatments. I have written many articles and chapters, both on my own work and to guide others studying and treating bipolar disorder. Along with many others in my field, I have kept looking for better ways to help. ix
x Preface Early in my career, I recognized the importance of including partners and relatives of the patient in my own care of those with psychiatric illnesses. Often my patients brought their partners to appointments; sometimes they were brought by their partners. I soon learned that things almost always went better when a partner was involved: I got more information; my patient got more help and support. After all, patients don t just need doctors. Yes, they need a thorough personal evaluation, followed by professional monitoring and treatment; but they also need a well-organized life. All these needs are best addressed with the involvement of people who care enough to learn about the illness and be part of the overall plan of treatment. When Chelsea Lowe asked me to contribute to this book written to address the needs of the partners of people living with bipolar disease I thought she had a wonderful idea, and I was glad to help. As I spoke to patients and their partners, relatives, and friends, I had come to see the effects of bipolar disorder on them all. I realized that partners wanted to be involved and supportive, but didn t know how. They needed to know what was happening, what would make things better, what was dangerous and might make things worse, what roles they could play. Because they were affected, they needed to know; because they cared, they wanted to help. Most people, however, know little about psychiatric disorders, and much of what is portrayed in movies or books serves a dramatic point and may not be accurate. There are many factual books, good ones, from brief to encyclopedic, on bipolar disorder. Some of these are listed in the Resources section at the end of this book. Mostly, these books were written by doctors or patients and for doctors or patients. Few, if any, were written for the partner of someone with bipolar disorder. Although much of what we each need to know is the same, not everything is. Partners have different experiences, a different role, and different needs than doctors or patients.
Preface xi This book is written specifically for partners of people who suffer from bipolar disorder. We know from our own experiences that accurate information and good advice on bipolar disorder can lead to better relationships and more productive lives. We hope the information in this book will provide you with a solid foundation of understanding and will give you and your loved one useful guidance and assist you in understanding your options and accessing the resources you need. Bruce M. Cohen
INTRODUCTION Bipolar disorder, or BD, is common many millions of people around the world have it, and millions more are diagnosed with it each year. We know from surveys that a great many people suffering from bipolar disorder go undiagnosed. Most of us, whether we realize it or not, know someone who is living with bipolar disorder a colleague, a roommate, a friend. And many people live with someone who is living with BD a partner, a parent, a child. Being part of the life of a bipolar person can be difficult, confusing, and frustrating. If we don t understand the disorder and how it affects our loved one, our relationships can easily spin out of control. The symptoms of bipolar disorders plural, because BD has many forms can range from the wild behavioral extremes of mania (outrageous confidence, spending or gambling away fortunes, embarking on ill-conceived affairs, quitting steady work to pursue an irrational dream) to the quieter but equally troubling consequences of severe depression (immobilizing fatigue, deep sadness, overwhelming self-doubt, and loss of pleasure). xiii