bipolar

Dear Dr. Levine,

I am reeling from the awareness that certain friends who meant a great deal to me have abruptly turned their back on me now that I have revealed and declared my struggle with mental illness. I was diagnosed with a form of bipolar disorder after weathering several years of depression alongside "up" periods. When it was just garden-variety depression, I believe the problem had been more acceptable to these individuals, who are mostly male.

Now, having spent almost two weeks in hospital, the tables have turned and folks have run for the hills. I mean nothing: No phone calls, no cards, unreturned e-mails. These relationships, mind you, go back almost 20 years. I've spent most of my time being the "counselor" to these folks. Still, for the most part, I gained a lot from the relationships: mentoring, laughter, contacts, learning, etc.

So I'm not sure how to proceed from here. My self-esteem is shot-to-be-damned, and I really haven't much patience right now for the childish ways of grown people. Over the years, I've observed that people who "hide" from others' adversity find some way to wheedle back in after it seems like the coast is clear. I'm pretty clear about cutting these folks off, since there's really nothing to be salvaged except my self-worth. I am angry, and I can't guarantee that I still won't be angry when they inevitably return to my world. How would you suggest I handle this?

Signed,
Alone

ANSWER

Dear Alone:

When someone has a serious medical condition, deciding whether or not to tell others is never straightforward. This is compounded when it comes to disclosing mental or emotional disorders because of the pervasive misunderstanding, stigma and discrimination commonly associated with disorders of the brain. As you found out, there is even a pecking order among mental illnesses. People are generally more understanding and accepting of depression and anxiety disorders than they are of bipolar disorder, schizophrenia, or schizoaffective disorder. This is simply because of the dismal lack of mental health literacy among the general public.

In considering whether or not to tell, it's important for someone to think through whom to tell (the answer might be different for different family members, friends, employers and acquaintances) and how much information and detail to provide (e.g. the name of the disorder, the nature of the treatment, specific vs. general information, etc.). Decisions like this are deeply personal. Ultimately, individuals need to make decisions that feel comfortable to them! There is no right or wrong.

Getting back to your specific situation: You made the decision to be candid with friends whom you trusted, hoping they would understand and rally around you. This wasn't the case so I understand your disappointment. But consider the possibility that these friends weren't ill-intentioned. They may simply have felt uncomfortable and didn't know exactly how to react or what to say---because they don't understand bipolar disorder, its course, or its treatment.

Perhaps, you could seize this as a teachable moment, focusing on one or two of the individuals with whom you feel closest, and helping them better understand your experience. After you speak, you could also direct them to online resources for information such as one of the booklets made available from the National Institute of Mental Health  or from the National Alliance on Mental Illness.

Being hospitalized for a mental disorder often feels like a setback to that individual (although it shouldn't be that way!). Admittedly, it is an unplanned disruption to work, study, and/or friendships. You say your self-confidence is shattered-so give yourself the gift of time and allow yourself to slowly get back into a normal routine. Try to hold back your anger towards your friends, which may turn out to be misplaced. You may find that some of these friendships were tenuous and aren't worth resurrecting but I sincerely hope that at least a few of them will be recoverable.

You signed your letter "lonely." Simultaneous with working on your old friendships, you may want to get involved in a support group such as those sponsored by the Depression and Bipolar Support Alliance. This will allow you to meet other people who have struggled with similar issues and who can support you as you get back on your feet. I hope you also have the benefit of a relationship with a mental health professional who can help you get over this trauma.

Remember that lifting the veil of secrecy and shame that shrouds brain disorders can only be accomplished one person at a time. I applaud your honesty as well as your posting this letter.

Warm wishes for your recovery,
Irene

P.S. In my book (co-authored with Jerome Levine, MD), Schizophrenia for Dummies (Wiley, 2009), on P. 216-222, there is an extensive section on "Breaking the News," the pros and cons of disclosing mental disorders. Since it provides far more detailed advice than I could post here, you may want to glance at the book in the library. Although my comments in the book are focused on schizophrenia, they are just as pertinent to bipolar disorder.

Dear Irene:

I came across your blog tonight. I am thankful. I am feeling desperate for some advice. I became good friends with a girl in the same town where I live. We met in February of this year. We hit it off right away. We became super close really fast. Had the same interests, desires and goals. Our daughters are 2 weeks apart. She became part of my family. We spent hours together in person, by phone or email. We took a trip to California together with our families.

Off and on I noticed she would shut down and ignore me for days. No call back, no response to emails, no texting back, etc. I thought it was odd but didn't think anything of it at the time. She claimed she wasn't feeling well, she was having marriage problems, etc.-excuses. Her marriage has been rocky since day 1. She is only married for less than one year. She is currently pregnant with her second child. Her husband and she go to marriage therapy every other week. Their communication is horrible from what she says.

She claims I "yelled" at her all the time. She blew up at me over the phone one night the end of Sept. I was shocked! Not one time did she lead me to believe that things were bothering her. I knew she was either having a bad day or not feeling well. I kept my distance, but at the same time tried to reach out in case she needed anything. She would ignore me for days, not call me back, not answer emails or texts. After a few days, she would call and pretend nothing is wrong when truly she was ignoring me on purpose. She brushed things under the mat. She never communicated her true feelings. She bottled everything inside and finally blew up at me. I had no idea.

I was crushed, disappointed, hurt, angry, etc. I considered her like my sister. I thought the world of her. I could talk to her about anything. It was devastating to hear her accusations. I don't feel I ever "yelled" at her...that's just not me. I think she might be bipolar because she was either really happy (on the high side) and other times she was sad, not wanting to talk to anybody (low side). It was extreme.

I tried to contact her, but she does not answer her phone. I sent her an email asking her to forgive me (even though I don't feel I did anything wrong), but she said she is "happy with the way her life is."

The hardest thing is that we have lots of mutual friends. We are the coordinators of a local moms group. Everyone is starting to notice that we don't talk and ignore each other. What am I suppose to tell our mutual friends? I am not trying to get girls on my side, but it has been extremely difficult to keep this from others. I truly care about her. I loved her and her family. I gave her everything. I hurt. I think about her every day. I wonder how she is doing, but can't contact her anymore. She truly slapped my face and said she doesn't need someone like me in her life.
I don't know what to do. Please help! Any advice is appreciated.

Signed,
Hurt Friend

ANSWER:

Dear Hurt Friend:

It sounds like over the course of your friendship you have observed that your friend may be facing a number of challenges/problems-that have nothing to do with your relationship with each other, per se. You've noticed that she:

• Has marital problems (which could make her feel ambivalent about becoming pregnant a second time)
• Is pregnant (which could be playing havoc with her hormones)
• Is parenting a toddler while she is pregnant (which can be challenging when things are stable)
• Has communication problems (and, specifically, has a hard time talking about little slights until they escalate and become big ones)
• Tends toward mood swings (whether or not they are symptoms of, or fall short of, a diagnosable mental disorder)

The two of you became very close within a very short period of time, perhaps because of all you had in common. You became fast friends before you really knew one another.

But even if you had known her longer, you don't always know what else is going on in another person's life. As you describe your friend, she seems to be a very moody person who gets upset over little things and who has a hard time resolving conflicts. When you first met, either her mood may have been more stable or it may have been more elevated-which can make someone extremely likable and engaging. Then, over time, you began to see her roller coaster personality emerge.

You sound like a very caring, understanding and forgiving friend. You have done everything you could possibly do to mend the friendship. Your friend may or may not be able to appreciate the friendship she has lost. There may be other things going on in her life that are consuming her.

In terms of seeing one another (which you inevitably will, if you live in the same town and have a child the same age) and handling your failed friendship with your mutual friends, my advice is:

1) Always act cordially to your friend when you meet (smile, nod or say hello).

2) Don't make any further efforts to mend the relationship unless your friend extends herself to you. Even if she does, be cautious and careful because the same thing may happen again.

3) If you are close to these mutual friends, you can say (one-on-one) that the two of you had a small tiff that you couldn't resolve. They will understand because this isn't that unusual.

4) Don't provide any details. Say it's nothing you want to talk about because you feel like it would be a betrayal. They will respect you for that.

5) Try to do things with other women so you have less time to think about the failed friendship. You deserve someone who is able to appreciate you.

Despite the hurt and pain, you just need to move on. With time, you will heal. Everyl friendship don't last forever, even the best of them.

Best wishes,
Irene