Challenge: You’re unprepared for a manic or depressive episode.
Often couples aren’t completely prepared for an episode to occur, said Jennine Estes, MFT, a marriage and family therapist who owns a group practice called Estes Therapy in San Diego. This might be because you haven’t talked about what to do when an episode starts, or you don’t have permission to speak to your partner’s medical team, she said.
This “typically causes the relationship and both people to spiral out of control in reactive and survival ways.” Both of you might panic. You feel helpless and try to exert more and more control, trying to manage your partner’s every move, while they feel trapped and berated, and get worse.
What can help: The key is to sit down and create a written plan you both agree and feel comfortable with. It might include these components:
- Reflect on the signs your partner displays before and during a depressive or manic episode, Estes said.
- Have an agreement that if any of these signs appears—even the smallest sign—your partner must see their therapist and doctor for a medication evaluation, she said. Your plan also might specifically include you stating your concerns without blame, Nowland said: “I’m noticing _______, I feel ________; what I would like is for you to call Dr. Q.” If your partner hasn’t taken action within an agreed upon timeframe—one or two weeks—then the next step is for you to contact the doctor, she said: “I’ve raised my concerns about _______, I’m feeling _______, and in order to look after myself, I’m going to call Dr. Q.”
- Sign a medical release form to let you communicate with your partner’s therapist and doctor when concerns arise, Estes said.
Estes also recommended creating a plan for yourself. For instance, you might focus on self-care, such as attending yoga classes, meeting up with friends, meditating and seeing your own therapist. You might reach out to loved ones for support. “Typically, there is shame around a partner struggling with bipolar disorder,” she said. And when you keep your shame and feelings a secret, the shame only festers, chipping away at your relationship. Lastly, you might journal to help you express and make sense of your emotions and any overwhelm triggered from not having your partner present.
Challenge: An episode rattles your relationship.
When your partner is having an episode or has been hospitalized, they naturally become unavailable to you. They can’t give you emotional support or meet your needs. Of course, “they don’t choose to be unavailable,” Estes said. They’re struggling with a very real illness. But it can still hurt the relationship — until repair can happen.
That is, partners tend to go into survival mode, trying to juggle doctor appointments, care for their partner, finances and any other household responsibilities, she said. This leads you to close yourself up emotionally and stop replying on your partner for support.
What can help: After an episode occurs, it’s critical that you communicate with each other and repair any issues. “If a repair hasn’t occurred, the relationship can become distant and grow into hostility,” Estes said. She suggested the following: Your partner needs space to share what the episode was like for them. Which is hard because it requires that you hold your “own pain, sadness, and fears and continue to support.” But it’s vital.
Once there’s stability, slowly start talking to your partner about your pain. (“People heal the more they are heard and understood,” Estes said.) It also might be difficult for your partner to hear your pain, because they’re immersed in shame or fear of having another episode. This is when it’s necessary to see a couples therapist, who can help both partners sort through their emotions and provide a safe space to openly discuss them.
Finally, your partner must take their treatment seriously, and see their therapist and doctor. If they aren’t committed to their mental health, Estes noted that it sends the messages: “You can’t count on me,” “I won’t make it safe,” and “You are on your own and will need to take care of yourself.” Which leads to you putting up your emotional armor, becoming defensive and blaming, and turning away from your relationship, she said.
Nowland stressed the importance of both partners taking care of themselves. This includes monitoring (and reducing) your stress levels; eating nutrient-rich foods; engaging in physical activities you enjoy; getting restful sleep; and seeking support from others.
Similarly, remember that “you are a separate person and you don’t have to ride the same emotional roller-coaster ride as [your partner].”
Focus on increasing the positives in your relationship, Nowland said. Prepare for the tough times by “stock[ing] up on love, affection and appreciation to weather those storms.”
Try your best to remain patient and hopeful. “Bipolar may not be curable, but it’s one of the most treatable mental disorders,” Dalton-Stern said. Try to be empathetic, compassionate and non-judgmental both with yourself and your partner, she said. Allow yourself “to come to a place of greater acceptance, while making your partner feel unconditionally accepted regardless of their disorder.”
Nowland regularly talks to partners who don’t have bipolar disorder about the serenity prayer: “Grant me the serenity to accept the things I cannot change, the courage to change the things that I can and the wisdom to know the difference.” It’s critical, she said, to learn acceptance and surrender — which is different from resignation. She talks about surrendering to “what is,” and using practices such as meditation, yoga and mindfulness and support groups to help. When you’re able to shift your mindset, it’ll change how you approach your partner and your relationship, she said. “Accepting what we can’t change and changing what we can is something all couples could benefit from.”
Bipolar disorder comes with many challenges. Which can be exhausting and overwhelming and confusing. Both you and your partner may feel helpless and devastated. But you can navigate these challenges by being prepared, working as a team, surrounding yourself with genuinely supportive people (which might include a therapist) and repairing any issues as soon as possible.