No, really, you can't do it all.

July 11, 2007 6:06 PM

Wife is bipolar and in the manic part. She's taking meds and her doctor has ordered her off work for a week while she ups her meds and ordered her to quit several activities which she enjoyed doing, though they stressed her. She's getting depressed and unfocused. How can I help her?

Her shrink has told her to quit doing her volunteer church stuff, which she was increasingly getting involved in, on top raising our teenage daughter and having a full time job. Evidently the stress of all this can trigger a manic, so the doctor is telling her to quit the church stuff. This depresses the wife and makes her angry. Since she's in a manic, she feels as though she can do everything, even though logically she knows she can't. This is her first major manic in years, so we're a bit outta pratice on how to deal with it.

What can I do to help her through this hump? Are there particular activities that can help a maniac bipolar mind stay occupied? If you're bipolar and know one, how do they come to terms with feeling like they can do anything when they logically know they can't? or how can you help them remember that they are sick before they start doing harm or damage (nothing dangerous per se, just crazy money spending or trying to take on the world). This has always been a blind spot for me and I'm kinda outta mydepth, which is ok, 'cause she has a shrink and all, but I'd still like to help her.

Please don't tell me to leave my wife or that I'm terrible person for not understanding this better, we're having a rough enough time as it is. Just a little help and advice please.

posted by MichaelKnight to health & fitness (12 comments total)

The stress of it all would get to a lot of people, not just someone who is bipolar, and I can certainly feel for your wife.

That said, taking off work and lessening the things she finds most stressful seem like good ideas, but if church stuff is something she really enjoys, she might just want to give the doctor a call and say, "I'm actually feeling a bit worse, can I just keep up the church stuff and still take time off of work, etc. instead?"

The point is to cut down on stress, and to realize she can't do it all (the hardest point, as you point out, for the manic part of her), not to do nothing at all. It may be the doctor will allow her to continue just the church work (provided your work allows you to help with teenage daughter, too).
posted by misha at 6:33 PM on July 11, 2007

Does she have to completely quit the church work? Or can she carve out a more manageable piece of it while delegating some to others? You know, "I'll coordinate the ushering volunteers in August if you'll do September" or "I'll write about the fundraiser for the bulletin if you write about youth programs."

It seems a shame to give up something that is helping her feel involved and connected to a community. Why not try to work with her to help her identify a reasonable middle ground where she's neither running everything, nor sitting home bored?
posted by Miko at 6:42 PM on July 11, 2007

I have experience with this. Has your wife experienced a psychotic break, or is she exhibiting the signs of going there? It sounds like the latter, but if it's the former, you should consider hospitalization.

If it's the latter, which it sounds like it is, she should absolutely heed her psychiatrist's advice about dropping the church activity until she has time to adjust to her new dosage. During that period of time, encourage her to get active and join her in her activities - running, yoga, going to the gym, going out for walks, going for drives with you as the driver, preferably - this may help burn off excess energy and help her get to sleep. You might also buy her a journal and a pack of pens and encourage her to write out whatever she's thinking and feeling. Maybe pick up some stationary so she can write to friends and family members, as well. You might also suggest she start a list of projects she wants to work on with regard to the church for when she's feeling better in a week - if she can feel connected to the church while she's away, that may ease her anxiety. Call her pastor and have him call and chat with her; this will also help her feel connected to her church.

Also, if she does any sort of handwork or hobby like crocheting, needlework, knitting, what you have, encourage her to start up a project. If she likes cooking, encourage her to prepare meals and help her in the kitchen. Crossword puzzles, lots of reading material, jigsaw puzzles might also engage her mind and help her focus on a project that won't take her out of the house and add stress. Also, make yourself available be to her to talk. She may talk your ear off, but bear with her. She may be frustrated, annoyed, nervous and jump from topic to topic - just hang in there and follow her cues. Whatever you do, just keep encouraging her to take her meds and follow the doctors advice - she will eventually calm down once her medication kicks in.

Good luck. You're doing the right thing and I promise you she will eventually begin to settle down. I completely understand how draining and taxing this is for both her, you and your daughter.
posted by TryTheTilapia at 7:13 PM on July 11, 2007

Honestly, unless she really enjoys her fulltime job and/or absolutely has to work fulltime I'd cut back on that before the church stuff.

She needs to have something in her life that she ENJOYS. If cutting back on stress means cutting out all the things she WANTS to do, well, that ain't gonna cut it.

Have her stay out of the sun as much as possible (or wear expensive sunglasses if she must be out there) and have her make sure her sleep patterns are regular-bedtime the same time every night, arising the same time in the morning.

Journaling is good. After awhile she will be able to tell from changes in her writing style where she is in her bipolar cycle.

No stimulating tv before bedtime-or at all, right now. Calm music, maybe. If she exercises make sure it is something like walking-now is not the time to do pedal-to-the-metal interval work.

And honestly, when one is hypermanic you CAN get a lot done. She just needs to make sure she is getting enough sleep. THAT IS JOB ONE.

(Been there, done that, now recovered. )
posted by konolia at 7:52 PM on July 11, 2007

How do her colleagues at church react to the manic behavior? If they are unable to deal with it then she does need to back off. My grandmother is bipolar and alcoholic and when my mother became her conservator I found a letter from one of the charities in which she had been heavily involved requesting that she stay away.
posted by brujita at 9:15 PM on July 11, 2007

Hm, better church groups than compulsive shopping or other destructive behaviors, IMO.

I have unfortunately way too much experience living with a bipolar person (mother). Also unfortunately, I was a kid, and didn't know what to do or what was going on. Please, please help your teenage daughter to understand this, or it could impact her for years to come. When mom is in a manic phase, I hope you can take over more of the parenting. I still have nightmares about mom furiously cleaning the house only to physically attack me when I "messed something up" (like leaving a soda can on the coffee table). She deeply regrets this, and I've forgiven her, but in my case there was no one to step in and take over. I think any stability and routine that you can provide will be helpful.
posted by desjardins at 9:26 PM on July 11, 2007

I think your family might really be helped by connecting with NAMI (National Alliance on Mental Illness) at www.nami.org. They have groups that educate and support family members, and separate ones for the people struggling with mental illness. It's all free, and a wonderful resource. You don't have to be in a group - you can just find the local group near you and give them a call. They have all sorts of material to help understand the various conditions, and could probably even have someone who's been through what you're going through give you a call, if you wish. Everybody there is either a family member or a "consumer" (the one with the mental illness). I just started speaking to groups about my story, and go out with someone who has a family member with a mental illness. Everyone I've met in NAMI is caring, compassionate, and eager to help in any way they can. I encourage you to give them a call.
posted by la petite marie at 10:52 PM on July 11, 2007 [1 favorite]

Thanks for the responses.

She's given up the major responsibilities at church and has assumed background advisory positions. She can't cut back on work on working fulltime. There has been no psychotic break, although the reshuffling of her meds is driving her nuts, making her wonder if she should be hospitalized until she settles down. Everyone adores her at church and is extremely sad to see her go (accept for the unchristian bitch who coveted her comitee chair). When she's on a manic she is of no harm to anyone except herself. The kid is away for the summer, knows her mom is bipolar and deals with it ok.

Getting enough sleep is a problem, as she's manic and can easily get by on 2 or 3 hours. She's taking prescribed sleeping pills to put her down, which mostly work. She's just depressed at the moment, but agrees with the doctor's assessment that she needs to cut back on the church stuff.
posted by MichaelKnight at 12:32 AM on July 12, 2007

Getting by on 2 or 3 hours sleep will be fuelling the mania, if my experience is anything to go by. Like konolia said, getting good, regular sleep is Job 1.

Job 2 is eating well-balanced, nutritious means, preferably low-GI. Manic + blood sugar spikes = more manic.

Provided you both make sure she's attending to Jobs 1 and 2, and provided she's taking her doctor's advice re. meds and amount of activity, and provided her doctor is kept fully up-to-date about how she's doing, I can see no harm in encouraging her to apply the incredible focus, energy and drive that mania can give her to whatever project she finds most rewarding.

Feeling like you can do anything is wonderful. It's really only after the mania is over that the memory of having ridden so fast and so close to the edge becomes deeply scary.

The best thing you can do for her right now, in my opinion, is be her trusted reality checker. If she asks you questions with answers that seem completely obvious - stuff you'd expect her to know, and not ask about - take the questions seriously, and give her dead-straight answers. Part of the can-do-anything feeling is simply forgetting some or all of what you know about reality-based constraints; gentle reminders can be a real help.

There is nothing at all wrong with you asking her for help when you start to get scared or worn out; even though she's manic, you're still her beloved, and she will help you as best she can.

Best of luck to both of you. It's a scary roller coaster to ride, as well as to drive.
posted by flabdablet at 5:40 AM on July 12, 2007

gah. Nutritious meals, not means.
posted by flabdablet at 5:40 AM on July 12, 2007

One of my friends who is bipolar is very specific about using her crafting (stamping and scrapbooking) as a form of therapy. Perhaps having a hobby she can enjoy on her own terms (i.e. by herself, whenever she needs it, and not dependent upon other people like the church activity) would be helpful. She can focus her mania (or depression!) and not have to answer to other people about how it compares to stuff she does when she's more balanced.
posted by Madamina at 9:12 AM on July 12, 2007

Posted on behalf of another mefite...

First: Of course you're not a terrible person for not understanding this better. And there's no need to break up your family over this; families live with this everyday.

Now, regarding your wife's situation. As someone living with biopolar, I've had to deal with this problem myself in the not-so distant past. A year ago my psychiatrist ordered me to essentially take two weeks from work. I was in a hypomanic state where I was experiencing many of the classic signs of a manic episode with depression mixed in. My manic swing had lasted for two months at that point and was getting progressively worse. In the past my mania had been "productive," despite the toll it took on my personal life. (I wrote each of my two masters theses in ten days, for example--not an experience I would recommend to anyone.) So, despite my better judgment, I had spent May and June trying to "work" my way out of my mania. My doctor and I tinkered with my medication to try and bring the situation under control, but there was the side of me none the less that was convinced that I could try and ride this manic wave so that I might get out of my depression as well as having a boom in productivity at work. As you might guess, it worked about as well as the kinds of plans that that many bipolar people hatch during manic episodes.

So my doctor upped the dosages on my medication significantly and ordered me to take two weeks off. In my case, since my wife and I don't have kids, that meant focusing entirely on my home life and any other activities that might relax me. So I spent more time doing things that ordinarily relaxed me but that I didn't often have time for because I had overbooked myself. For instance, I went to the movies a number of times, I got a chance to read for pleasure instead of only reading for work, and I got a chance to take some extra time to experiment in the kitchen. (Cooking as a hobby I find quite enjoyable; when I'm trying to rush to make dinner on top of 50 other things nothing irritates me more.) I was also told to exercise a little more to help keep my mind and body on a more even keel. (Not to exercise a lot more, mind you; the back, foot, and knee problems I have are testament to what a bipolar individual can do when s/he's on a literally manic workout program.)

I can't lie and say that it was easy to check out of some parts of my life for two weeks. It was in fact quite hard; admitting to yourself that you're manic enough that you need to change your behavior radically to handle a episode can be very, very difficult. I imagine that your wife's situation is somewhat similar, since you noted that she understands the situation on a rational level but "knows," in her manic mind, that she can solve these problems just by pushing forward and doing everything.

Here's my advice, based on my similar (but not entirely the same) situation. I think she needs to cut out the volunteer church stuff for now and for the foreseeable future. The last part is essential for two reasons. First, being social (and I would include volunteer work in this category) can, in a number of instances, help keep a bipolar person on an even keel. So if she enjoys volunteering, and especially if she has developed or strengthened friendships this way, then continuing as an active member of the congregation is important. But just not now. The church work can be a positive part of her life, but only if she's able to fit it into the other commitments she has in her life. And she just can't, in the midst of a manic episode, make a realistic assessment of how to budget her time and energy so that she can stay happy and healthy.

There's a second reason why cutting back on the church work is very important right now. One of the side effects of thinking that you can do it all and trying to do it all is that you often end up doing many things poorly. A frenzy of activity isn't really conducive to success. (Although you say that she's getting unfocused, I have a suspicion that she's been a little unfocused in these different parts of her life for a little while now. That's one of the parts of a manic episode that creeps up on you: you can be so active that you don't even realize that you're not doing things as well as you used to do them.)

And right now it looks like the hierarchy of priorities is family, work, and church. Getting out of a manic episode often entails cutting out the lowest priority activities in your life until you are able to get back into the normal range and then slowly reincorporating them in a safe and sane way. Her relationship with your daughter, it seems to me, has to come first. No matter how well the two of you as parents handle these episodes or how understanding your daughter is, your wife's condition is always going to put a strain on the other members of the family (you included). Admitting this doesn't mean that you're unfeeling, it just means that you're human. It also means that when your wife's in a manic episode you need to pay special attention to putting family first. Spending too much energy on lower priority activities is going to hurt her ability to doing the most important part of her life well.

You could also make a similar case for her professional and volunteer lives as well. Trying to do it all at work (or everywhere else) may very well hurt your wife's performance on the job, which could have consequences depending on how bad things get. And it's even true for her church work, too. As I said above, volunteering sounds like an important personal and social activity for her. But trying to take on too much might well hurt relationships she's built there and make it more difficult for her to thrive as a member of her church community when she comes down from this mania. Bipolar can damage friendships as well as family and work relationships; sometimes it's better to step away for just a little bit before this happens.

None of this means that your wife ultimately needs to stop being a participant in this volunteer community--or, for that matter, becoming an active member of other communities she might join in the future. But it does mean that she'll have to pick and choose realistically which communities she's going to belong to and how much time she can give each one. I think that in the short term this is going to mean stepping back from this one activity for a little while until she can reincorporate it into her life in a healthy way. I wish her, and you, and your daughter the best of luck here. This is a difficult condition for all involved. But it need not damage your wife's life or the relationships she has with those around her.
posted by diamondsky at 1:29 PM on July 12, 2007