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Family and Relationship Fallout

We may have depression or bipolar, but our loved ones suffer from it.

One of the cruelest aspects of depression and bipolar disorder is the incalculable damage it inflicts upon unsuspecting families. Mothers and fathers, husbands and wives, sons and daughters, brothers and sisters - these tend to be the forgotten parties.

From time to time, I get emails from family members or friends of those who are depressed or have bipolar disorder, and invariably I wind up saying: "The best thing [your husband, child, etc] has going for [him or her] is you."

This came through loud and clear when I visited a personal website called Living with the Dragon. Kristall, a single mom with a small son, had the mixed blessing of falling in love with Mark, not yet diagnosed bipolar. Following an episode in which he went off into the night with his father's shotgun, he was misdiagnosed as depressed and given Prozac. He soon went manic, then manic with mixed features. One night, he turned up on Kristall's door in a rage and broke three of her ribs, then overdosed on Ativan. Kristall had seen something on Oprah about bipolar, and with this knowledge she succeeded in getting Mark correctly diagnosed. That was two years ago, with many meds changes to follow. Though Mark was by no means fully stabilized, he and Kristall married in May, 1999.

"People ask me," she writes, "why I choose to stay with him through his pain, hostility, and anger at his disease, and all I can say is that I love hem and try not to get his illness confused with him. He is a wonderful, creative man, an excellent stepfather, and for the most part (lol) a very good husband."

A parent doesn't have the luxury of considering leaving a bipolar child. Martha Hellander, executive director of the Child and Adolescent Bipolar Foundation, revealed the results of a 2001 poll of 723 of CABF’s members. Most significantly, 97 percent of those who responded were women, indicating where the burden of responsibility for raising a bipolar child rested.

Fifty-nine percent of the sample had a family history of depression, 49 percent a family history of bipolar. The levels of stress reported by the parents were "off the charts." Sources of stress included: anticipating rages (walking on eggshells), child unable to do self-care or chores, less time for parental self-care, less time for marriage, less time for parental friendships, child unable to do homework.

The stress list is a long one, also including: witnessing self-harm or suicide attempts by the child, less time for other children, child’s raging in public, parent’s own depression, verbal abuse from child, and - to add insult to injury - accusations from family, friends, or school of bad parenting.

Insurance problems are also stressful, as is finding a doctor to take concerns seriously, plus stigma, parent’s headaches, and fear of disclosing the disorder. Last but not least are: absenteeism due to the child’s illness, parent’s physical illness, loss of job due to the child’s illness, and the breakup of marriage due to the stress of the child’s illness.

Families Under Siege

The Burden of Sympathy by David Karp PhD (Oxford, New York) tells of mental illness from the point of view of the families. Listen to this candid admission from one distraught mom: "Sometimes I think it would be easier if he had cancer. His disease is so dreadful."

And from a wife: "There are times when I feel like, God, maybe my life would be better off if I wasn't with him."

The author, a sociologist at Boston College, sat in on meetings at a friends and family support group of the Manic Depressive and Depressive Association of Boston, and interviewed 60 participants.

The initial catastrophe of a crisis or diagnosis, Dr Karp tells us, is tempered by the family's optimism in their own abilities to provide support and in medical science. Heroic measures are possible in the early going because "sympathy margins remain wide and caregivers often believe that once an emotionally ill person realizes how much he or she is cared about, they will get better."

And a few pills, they assume, will fix everything. "Oh, medication - wonderful," says the mother of a schizo-affective son. "You know, my husband was glad. I mean 'Oh, this is going to fix him. Everything will be fine.'"

Many families turn out to have this kind of good fortune - or at least achieve a result everyone can live with - but these weren't the people Dr Karp talked to. "The realization that a family member's mental illness may never go away is a crucial identity turning point in the caregiver's career," he writes, "because it forces to the surface of consciousness an array of emotions that previously may have been dimly felt."

Many parents have to face the pain of letting go of their dreams for their children, and with it, their own life expectations. "As weeks become months or years," Dr Karp tells us, "caregivers nearly always come to feel greatly frustrated by the persistent, ongoing trauma of mental illness. They find it harder to muster the compassion felt during the early stages of the illness. It is also harder for them to avoid feelings of anger and resentment."

"Sometimes I hate her," an overwrought mother tells us, "but mostly I don't hate her. Mostly I'm angry at what she does. I mean I'm angry at the behavior. I don't hate her. I hate the behavior and I'm angry at the behavior."

Other times, the anger is directed at a system that seems deliberately put in place to inflict as much suffering as possible, or against the individuals who are a part of that system. In the words of one mother: "I was really angry at the psychiatrist Monday night. He's never met any of us and he said to me, 'You should all be in family counseling.' And I wanted to say, 'How the hell do you know this? How do you?' How dare he say we need family counseling. What does he know?"

Ultimately, though, comes acceptance, for when all is said and done that's the only way to cope over the long haul. As one mother put it: "You know, I just want him [to be] happy and stable ... He is a wonderful kid. He's pure. I just look at him as this innocent, good kid. This is how I see him and it doesn't matter to me what he does in life."

Undoubtedly, there would have been times when that same mother would have felt like giving up on her boy. Many families do, and who could blame them? The author had the good fortune to talk to the ones who hung in there. These individuals may not be representative of all families, but they are definitely people you'd like to get to know better.

Saving the Relationship from Depression Fallout

A blissful honeymoon soon deteriorates into a marital cold war. Loving Husband has morphed into Nightmare on Elm Street, with things deteriorating from bad to worse, culminating in a public mad scene in a restaurant and exit stage right on the distressed wife’s birthday.

The vignette is from depression writer Anne Sheffield’s latest offering, "Depression Fallout: The Impact on Couples and What You Can Do to Preserve the Bond." The author is a veteran of both her own and her mother’s depression. "There is no way properly to describe the anguish a depressive can put his family through," says depression survivor Mike Wallace of 60 Minutes in the book. "Gloom, doom, no love, no real communication, short temper, and leave me alone, fault finding."

Telling Mr or Ms Hyde that something is wrong, however, can be as delicate a procedure as diffusing a bomb. Avoid the straight-out, "You many be clinically depressed," Ms Sheffield advises, and try something along the lines of, "I’ve been noticing lately that you’re not sleeping well at night. Are they working you too hard at the office?" From there, one looks to gradually break down the elaborate defenses and nudge Cleopatra Queen of Denial into an open discussion. Personal presentation helps, Ms Sheffield adds, hair in place, good shoes. "Selling" depression to an unwilling partner, after all, is pure marketing.

Fine, you’ve got your partner to talk. Now what? Saddam under the same roof is making your life miserable in a thousand ways, but Ms Sheffield suggests starting with a list of four specific items, such as "No arguing or angry displays in front of the children." Nonspecific instructions to lighten up or think positive, she warns, "might as well be issued in Chinese." When being verbally abused, it is better to leave the room, she advises, than joining battle, which is self-defeating.

Once your partner has bought into his or her diagnosis, there are many ways of assisting with his or her recovery. But depression can be contagious, a result of the loss of self-esteem and stress that comes from living with Miss or Mr Congeniality. For both your own good and your partner’s, then, Ms Sheffield advises, it is crucial to put yourself first. A wide range of coping skills can help, but what is important, according to the author, is mastering the skills that are within your reach. Instead of running five miles a day, for instance, it might be more realistic to take a daily walk. "To whatever extent possible," she urges, "put some psychological and physical distance between you and your sad mate."

That psychological and physical distance may ultimately involve sleeping in a single bed in another state, but there is life after depression fallout, Ms Sheffield concludes. Bailing out on Hamlet doesn’t mean ending up like Ophelia.

Managing Your Bipolar Loved One

Until recently there was no book specifically related to bipolar I this writer was aware of That changed with the 2004 publication of "Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner" by Julie Fast and John Preston PsyD. The book is not exactly brain science, but it does offer some very practical suggestions:

The authors provide a very detailed inventory of bipolar behavioral symptoms (including anger and a host of others that don't appear on the DSM-IV) and encourage partners to collaborate on putting together their own lists. Once you the two of you know what you’re up against, it may be possible to respond to the first signs of unusual behavior before they spin out of control. The authors first advise building on what has worked in the past, as well as acknowledging what hasn’t worked.

Then the significant other needs to learn to respond rather than react, such as instead of saying, "What’s your problem?", try something along the lines of, "I can see that you’re angry. How can I help you?" This can become a bit problematic when your partner has just blown $5,000 on a stupid chair and you’re the one seething with anger, but these situations - and other bipolar catastrophes - can often be avoided by strict daily adherence to ironclad check-in procedures.

The authors devote a whole chapter to mood triggers, and place strong emphasis on partners working together to reduce the stress in the living environment, from keeping work and social obligations under control to more discriminate TV viewing to proper diet, sleep, and exercise. "Root trigger" is a term they have come up with to define a trigger that may set off other triggers, such as - bad news from work followed by a poor night’s sleep resulting in a miserable day at work building into anger that leads to a serious domestic quarrel and triggers thoughts of life not worth living. Recognizing the root trigger as it occurs and mobilizing quickly can spare both partners a lot of grief.

Ultimately, the authors acknowledge, you may have to make some very tough decisions. "Maybe you have lived in crisis for so long," they write, "you haven’t had the chance to examine what your future will look like realistically, if you stay with your partner. What do you need to do to create the life that you want?"

That’s a question only you can answer.

Protecting the Kids from Depression and Bipolar Disorder

William Beardslee MD of Harvard and Boston Children’s Hospital has worked with families for more than 20 years, and has authored one landmark study on the effect of parental mood disorders on children, plus numerous other studies. He also lived through the trauma of his sister’s severe depression and suicide. His 2002 book, "Out of the Darkened Room: When a Parent is Depressed," can be likened to the internet - you may be able to get by just fine without it, but once you have it, it is hard to imagine life without it.

"When parents become depressed," Dr Beardslee begins, "they bear a double burden. Even as they wrestle with the darkness that clouds their lives, they must struggle to maintain their roles as guardians of their children’s future. Making matters worse, depression is often mystifying both to the sufferer and those around them."

Depression, Dr Beardslee asserts, is a family illness which psychiatry still treats as an individual illness. The children who are kept in the dark must cope with the disruptions their parents undergo, themselves becoming an at-risk population. What is at stake starts with a consideration of three factors: 1) Depression in one or both parents; 2) Other problems parents face, such as alcoholism or anxiety; 3) Difficulties earlier in the child’s life, such as problems with learning to read.

With none of these factors present, says Dr Beardslee, six percent of children get depressed. The number doubles to 12 percent with one factor present, but with all of them in play an alarming one half of all children become depressed. In Dr Beardslee’s words: "The message is: Get help for yourself before depression can lead to the ‘negative chain’ of other events that, together, can harm your child. Build your child’s protective resources and do not let your depression cascade into the multiple risk factors that can undermine your child’s health."

"Breaking the silence" is Dr Beardslee’s term for getting a parent’s depression out into the open, where the illness is freely discussed among all the family members. Given the nature of depression to make one uncommunicative, this is often easier said than done. Together with your partner, Dr Beardslee advises, decide what should be discussed and not discussed. Try to show your children that the two of you are united in caring for them. Keep in mind that kids at different ages will deal with the matter very differently. One six-year-old, for instance, was afraid she might catch her father’s depression by using his toothbrush.

Reassure your kids, Dr Beardslee goes on to say, that you will be okay and the illness will not overwhelm your family. Emphasize that no one is guilty or to blame. Speak to the positives, and talk about the illness and its treatment. Tell your children what actions you’re taking (such as getting treatment), discuss events your children have witnessed, talk about things that are unusual or upsetting, and help your children feel comfortable enough to talk about things that frighten them.

"Open, ongoing communication," Dr Beardslee concludes, "is the foundation of the resilience we want in our kids," not always easy when kids tend to be kids, but that’s the point - family adversity may result in our children growing up fast, but it shouldn’t rob them of their innocence and childhoods.

Updated Aug 10, 2004, reviewed Feb 15, 2008

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