Q. My wife has been diagnosed as bipolar II. She talks non-stop, alienates people, buys needless things, and often stops her medication. Tell me more about bipolar II and how I can help her.
A. Bipolar disorders (formerly called manic-depression) are divided into bipolar I and II. Bipolar I patients fluctuate between depression and mania. When people are in a manic state, they often have such bizarre behaviors or thought processes that they are hospitalized or even arrested. One bipolar patient I treated took off her clothes at the drivers’ license bureau because she was not waited on promptly.
Bipolar II patients do not have full blown attacks of mania. Instead they have hypomania, which means that they have behaviors that are unusual and erratic, but rarely result in hospitalization. Because people in a hypomanic state enjoy the highs and increased energy that are a part of the disorder, they are often in denial about the condition. Many will say, “I feel great; I don’t need medication.” Hypomanic symptoms such as talking incessantly, losing social control, unpredictable anger and overspending, make life difficult for others. Yet people in a hypomanic episode rarely notice the problems that their behaviors are causing.
Both bipolar I and bipolar II patients have periods of depression that alternate with the mania or hypomania. During the depressive state, you may find that your wife sleeps more, experiences a loss of pleasure and seeks isolation. It is at this stage that bipolar patients usually choose to seek medical help. However, since they enjoy the hypomania, they may not disclose these episodes. This purposeful lack of disclosure can make it difficult to diagnose or to treat them.
There are several ways you can help your wife. It is important that you encourage her to stay on her medication. Speak with her physician or psychiatrist if possible and seek the assistance of other family members. Counseling sessions can also provide both of you with some practical ways of dealing with her condition. Additionally, there are several websites such as webmd.com that provide excellent information on bipolar II.
Q. My 24-year-old son who lives at home has been diagnosed as bipolar. His manic episodes are especially frightening. What can I do to help him?
A. The most important help you can give your son is to be certain that he has been seen by a psychiatrist or a physician who treats bipolar patients. He needs the reassurance that under most conditions, being bipolar is manageable if he stays on his medication, gets adequate sleep and avoids unnecessary stress. In fact, I often compare bipolar disorder to diabetes or hypertension. It should be treated just as you would a physical condition, not as a condition that labels one as mentally unsound.
Your son and you need to recognize his triggers for the beginning of a manic or hypomanic episode. For some patients, one of the first signals is disturbance of sleep patterns. You may find him pacing around the house at night or suddenly waking you with “brilliant” ideas. The sooner the episodes can be addressed, the less disruptive the disorder will be for both of you.
You do not mention if your son is bipolar I or II, so I suggest that you research reputable websites such as the National Institute for Mental Health and the National Alliance on Mental Illness (nami.org) which has groups for patients and family members. Contact them to find one in your area. I also suggest that you read “An Unquiet Mind” by Kay Redfield Jamison. With medication and psychotherapy, she has controlled her bipolar disorder to become co-director of the mood disorders clinic at Johns Hopkins Hospital.
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Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City where she maintained a private practice. She now teaches psychology at Southeast Arkansas College. E-mail your questions to firstname.lastname@example.org. The questions will not be answered personally, but could appear in a future column. There will be no identifying information and all e-mails remain confidential.