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Q:  This email turned out A LOT longer than I intended it to. I’ve been bottling up too much. I’m sorry. I hope you understand I’m in desperate need of someone who can help. PLEASE take your time to read it. I will be endlessly grateful. My boyfriend was diagnosed with Bipolar Disorder about 6 weeks ago. The first episode (manic) came right after we had a bad argument precisely because he had become cold, distant and hurtful in the way he was treating me. His episode came with delusions and hallucinations. He was arrested for getting violent with his neighbors. They took him in to a psychiatric ward at a University Hospital. Of course, they diagnosed him with bipolar disorder. His mom told me about the condition and immediately I started getting all the information I could on it. Fact sheets, brochures, web sites, books...EVERYTHING. I spent HOURS reading this stuff…. especially because the main thing I kept coming across was that loved ones should be informed, not give up and be patient. The more I read the more knew he really had this. I felt like I was reading his life for the past three  months.

 Our relationship has one main inconvenience though…it’s long distance. We haven’t been together for long…ab  out 5 months before he went into his first episode. But it had been the most beautiful 5 months in my life. We moved earth and sky to see each other…going to conferences and just finding ways. We saw each other at least once a month for 4-6 days at a time. I spent winter break with him. We really saw each other at that person that might be “the one”. Another detail that’s important about this situation is that he lives with his mother (he’s a 21 yr old college student).

After spending around 5 days in the hospital they let him go because he kept planning escapes every day and he kept saying he didn’t want to be there. The doctor said they couldn’t hold him any longer and they called his mother to pick him up. I was going to fly over…but he left the hospital before I could. While he was there I called him to his room twice…his mother said he was table enough to receive the phone call. He was very happy to hear from me…since our last conversation had been a terrible argument where he hurt  me like I’ve never been hurt before. The first thing he said was “do u realize how important you are to me?”. That moved my heart incredibly...he asked me if I loved him and I said yes. He asked me if I was with him and I said yes. Then he asked me to get him out of the hospital. I said I couldn’t because I wasn’t close and he said he knew that but I should find people that could get him out. I told him to slow down, to understand the doctors are trying to help him and no one can get him out until they say so…he got furious and he said “either you’re with me or your against me”. Then he hung up on me. Obviously he wasn’t stable. The second time I called him (same day they let him out) it went pretty much the same way. They let him out though…I still don’t know if they spoke to him about his condition or if they gave him medicine because he says they didn’t, but he remembers very little about what happened those days. He barely remembers talking to me. The day he got back home he called me. He seemed so relaxed…so different. I think the sedatives they had given him at the hospital had him that way. I tried not to ask too much or say wrong things. I asked him if he wanted me to visit, he said I should save the ticket for a trip we had planned about a yr ago to visit his home country. So I cancelled my flight. I didn’t want to go against his wishes. Each day he seemed to get better and worse at the same time. He was thinking relatively rationally…at least he wasn’t delusional or  paranoid anymore. But his mind was racing, he couldn’t rest, he was planning like crazy, he made sexual comments about other women and hurtful comments about our relationship and me. Since I knew what was happening I took it in... although it hurts anyway. I called his mom one day…after he told me he had just bought a ridiculously unaffordable car. She said he seemed fine…we just needed to give him space, no stress. I told her I thought he wasn’t’ fine. He needed to go to a doctor, get medicine. But she said not to take the things he said seriously. To ignore it. She didn’t have much time to talk and I didn’t want to push too much. I think she’s in total denial…and that’s not going to help. About two weeks later he started rationalizing more…he thought about the car, about how he can’t afford it, about how he needs to slow down, we spoke a little bit about what happened during the episode. Next day he was saying he was scared, he  felt alone.

That weekend we had our trip to visit his family in his native country. He hadn’t seen them in 10 years. His mom and sister were there too. For the first 3  days he was in and out of moods. I took it upon me (I still don’t know if this was the right thing) to tell him about his condition. But I would only do it if he was OK. On the second night he was very openly talking about what had happened, how he felt….and I very cautiously began telling him. He said it was scary but he was grateful I’d told him because he knew something wasn’t right. We kept talking about it, he asked questions. I reassured him that it was OK, that with proper treatment he can function as he always has. He listened, he even joked about it and he told me he loved me, and I told him I was there for him. He got better then, he stabilized. Every day we’d talk a little bit about it, most of the time he would bring it up. I decided to tell him about a book I had bought, Surviving Manic Depression, it wa  s very useful. I asked him if he wanted me to leave him with it so he could learn more about it. He said yes, he joked around about me reading it on the plane and people looking at me weird. At the airport when he was dropping me of he said he was scared and worried because he knew that when I left he wasn’t going to be able to sleep well again, that he wouldn’t be able to think as clearly, but all in all he seemed ok. I told him I was there for him. We were trying to arrange a way for me to be closer to him, possibly move in together pretty soon. That week was beautiful. He said things that reminded me of that man that had captured my heart so intensely, he basically said the contrary of every hurtful thing he’s said when he was hypomanic and manic. I felt good and I kept telling myself that I just needed to absorb those good things and let them be my strength for when there were bad things.

I left the country; he stayed a few days longer with his family. I tried calling him and nothing…nobody. When I finally got through he answered violently and said “Are you with me?”. I said, “Yes”. Then he said “OK, I’ll call you later” and he hung up. Then I called his mom and asked if he was OK, her tone was strange, she kept avoiding answers and only said “Yes” and “I’m glad you made it home safe”. I knew something was wrong. I called him again, he yelled “You’re on a time out, what do you want?” I asked him what I had done, why was I on a time out? He said “Because you left me with a book on Manic Depression” he told me not to call him again, to call him once a month for a year. Then he hung up again. After that I didn’t know what to do, although I knew it wasn’t my fault I couldn’t help feeling completely guilty over leaving that book. He was in a foreign country with different laws. I was  terrified. I was also scared his family, his mom, would blame   me also. My anxiety levels rose as high as ever. When I finally contacted him again after I knew he was back in the U. S. he wouldn’t pick up the phone. I called his house and his mom answered, she said he was resting, she had taken him to a doctor in the country and he had given medicine to reduce brain swelling. She didn’t remember the name. I wanted to talk to her, tell her to take him to a hospital, check that the medication wouldn’t be harmful. Explain everything I had learned but she couldn’t talk. He was waking up and she didn’t want to make him angry. All she said was that she was planning on going to a therapist for herself and she was thinking about taking him with her. She told me that all we needed to do right now was not bother him, let him relax, that what he needs in life is to rid himself of all these stress causing responsibilities. Still…she doesn’t understand the magnitude of this condition…I don’t know if she even recognizes he has a condition in the first place.

I wrote to him, texted him, left voice mails, all telling him how much I loved him, nothing else. Just so he knew I was still there for me. He called me about a week later. He was calm, he said he missed me. He felt strange with that feeling, but he missed me. Then he said he thought we needed some time out, a break, because he needed to let go of those things that are too much from him right now. It was hard to hear, but I was one of those things. He said he loved me, and times with me are great, but that’s just it…when he’s with me he’s ok, but when I’m gone he’s not good at all. He said he noticed that from the first time we were separated after meeting (we had spent a whole summer together at an internship program at that time). He felt dependent, a sickening and scary feeling like he needed me to survive, to have a good day. He said “you’re my good but your’re also my bad, and I need to get rid of that.” So I told him that I felt we had the chances of making it   work, that I would love for it to be like before, but if he felt he needed this then I respect it. He said he still loved me, and he always would somehow, even if it didn’t work out. I called him two days later, and he was Ok, not as calm, but not to “high”. Once again, he explained why he thought this was a good idea. I told him I understood, I was still his friend. I told him that I had cancelled the tickets to visit him for his birthday weekend; he has this whole series of parties and activities that weekend for his birthday. He said his heart sunk at that, because he really wanted me to go over. But then I asked him about the “time out”. He said, “well maybe you should come, maybe it’ll fix things”. I said I thought it wasn’t a good idea because if I was his good but also his bad then I wasn’t about to make him go into that “bad” again. I told him once he felt more stable…then. Then he thought about it more and he said “nah, maybe it’s not a good idea after all”. Besides, I’m going back to do the program again this summer so we’ll have plenty of time then if anything. And it gives him space for his time out.

After that we spoke again, and he was telling me he loved me, he felt good, tc. but he felt that maybe we weren’t ready for each other like I had said in the beginning (before we started I had told him I wasn’t sure if it was the right step, I had sort of recently been through a divorce). He also kept asking me if I was in the FBI, if I was an agent trying to stop his social movement. I reassured him NO. Then he told me he didn’t trust me, but he loved me and that was the only reason he kept me alive. He said these things sort of laughing it off, but there was some seriousness to his tone, not so much the “keep you alive” thing, but the questions about the FBI. Then he asked me what I thought (about ending the relationship), I told him I thought a lot of things but I didn’t think it was appropriate to say them. Then he got a bit angry and said that If he said them then why couldn’t I. He wanted to end the conversation, hung up, I called him back, he was angry. So I to  ld him I loved him, and if I had a choice I’d chose for things to be normal again, and we could be together, but that wasn’t the case, and he’d asked for a break. So he decided to leave us on a break. It seems he stopped taking his medication. I don’t think he recognizes the problem yet. And his mom only thinks all they have to do is just be stress free. That’s not enough.

Throughout all this my emotions have been terrible. I am seeing a psychologist because my anxiety levels have reached the point of panic attacks. I have had just wanted to literally die. I have felt terribly guilty. I am badly behind in my college work, my job, and my money (from all the traveling). She hasn’t put me on medication because she is afraid it’ll affect me in school, tests, etc. I have mixed feelings about what to do, I love him but I hate him for hurting me. I want to be with him, but at the same time I want to have a normal life. I want to be patient but I want to walk out. I want to stay but I want to forget. I have this faith that he’ll be OK and he can be normal again…but he seems to be rapid cycling; I’m talking one week manic, two days regular, another week manic. And my hopes just continue to diminish…I’m even scared of him sometimes. I know all the things he’s capable of; violence, cheating, suicide, etc. All of my friends, and my psychologist advice me to just forget about him. I can find something better, I deserve something better. The thing is, when he’s “normal” it’s paradise. It’s all I could ever wish for in a relationship. But that lasts three days, then it’s a nightmare. Everyone says to just let it go; “It’s not in your hands, you can’t do anything from this far, you’re not committed to him, you don’t even know eac  h other that well, you’re still on time to walk out before there’s even more pain, you’re butting in to something that his family needs to take care of”…and so on. The psychologist says I need to focus on stabilizing myself to make my life work, and forget him. She says if I chose to be with him I need to know this is for life. And she feels that I am not ready to make that type of decision. She thinks there are other reasons I’m with him besides love, like dependence, and a need for affection. I agree…but I also love him so much, I can’t just forget him. I can’t just give up. But at the same time I want to…but I don’t want to hurt him. I want to have hope, but with every conversation it diminishes. She doesn’t want me to talk to him, but I want him to know I support him. I don’t want him to think I forgot, or I don’t care. 

I got accepted into the University I wanted to get in to so we could be  closer. Accepting for me would mean to leave everything I have here and leaving for a University that costs more than 10 times what I pay now, moving to an expensive city and starting over practically. But I was willing to do this to be closer to him, we were going to live together. I don’t know what to do now. He doesn’t even want to be with me. I don’t know how to approach him, his mom, and the situation in general. Do I stop talking to him like my doctor recommends, do I stop calling until he’s normal, should I wait for him, do I forget about him and work on me, should I just forget about us having something romantic and just focus on being his friend, do I stay here and normalize my life and just be his friend, do I move over to his city and help him as his girlfriend? There are so many questions. As you have read there’s a lot of confusion, and it’s a difficult situation. I tried to summarize what happened and the emotions. I’m terribly sorry this took so long. I hope you understand that this is so difficult and I could really use a helping hand here. I’m so sorry for taking up so much of your time. I value every second you put into this. Thank You.

Dear V,

It sounds as though you have been exposed the hard way to many if not most
of the "clinical" and personal aspects of rapid cycling bipolar disorder.
Throughout your story, several things are quite worrisome.  Your boyfriend
remains unstable AND finally your physical and emotional health have suffered in spite of your love, concern and effort so far.  This does not
necessarily mean it is time for me to tell you to walk away or that you are out of options.  That is a decision for you to make.   You are right about several obvious things.  You have identified a pattern to your boyfriend's chaotic behavior-you may be able to use this to both your and his advantage.  You are also correct in thinking that untreated, ignored, and denied bipolar acting-out ALWAYS leads to trouble.  While stress control certainly contributes to an already stable situation it is likely to have little affect in stopping a manic episode in and of itself.

You need to accept that your relationship with this man has been impacted
by a treatable, but serious and often difficult, lifetime illness.  Most individuals in their manic phase, often feel ecstatic, make unwise decisions, engage in dangerous activities and have an unrealistic view of what's possible.  They DON'T see themselves as ill, or their reckless behaviors as problematic; therefore in that state of mind it is VERY difficult if not impossible to discuss illness and medications with someone who sees themselves irrationally as more than healthy.

There are many things about bipolar disorder that you may not like but you will have to face them if you want the chance to creat a stable relationship.  The key to your partners success is to treat his bipolar disorder first.  He must get on and stay on his treatment.  It requires patience and persistence to get the correct medications and dosages and once he feels improvement, he must continue taking his medication for the rest of his life.  Stopping his medication just because he feels better can throw him into a relapse which can impact his ability to return to his earlier level of funcitioning.  Bipolar disorder is a chronic disease, like diabetes, and requires CONSTANT treatment and re-evaluation. When and if your partner is capable of having a rational discussion with you, try sitting down and telling him what it is you need from you relationship and stick to your demands.  Explain in specific and objective terms that you need him to be the caring, warm and sensitive person that you used to see or still see periodically.  Don't be afraid to discuss his bipolar disorder with him as you have in the past.  Encourage him to get consistent treatment because the truth is your relationship likely depends on it.  If he becomes angry or refuses to change, then it's up to you either to accept this behavior from him or decide that you will leave.  If your partner is controlled by the illness, he may tell you that bipolar disorder is none of your business for example.  You can't force someone to do anything.  You can only take care of yourself.  If he will not talk to you about bipolar disorder, you have a decision to make.  You really can't change someone but you can make it clear what you need to him. Create a written treatment plan using the book suggested at the end of this response for yourself.  If your partner won't or can't use it after 3 or 6 months or little has changed, you can make your decision then.  Stay or go?

Your partner my be too ill to change at this time.  One option you have is to give this time in the hope that gradual positive changes will eventually ldea your partner to become more open to implement additional changes.  Don't give up your entire life waiting for this to happen-  this is not a healthy idea for any normal couple.

It sounds as though your partners family is in some denial and not helpful.  You have several options to try.  Try to educate your partners family and friends.  Teach them what triggers bipolar disorder and help them see that they play a role in this illness.

As suggested above, you need to get very clear and set boundaries about what you will and will not tolerate regarding untreated bipolar disorder, then you have to stick to what you say.  "I can't be with you if you're going to treat me like that....refuse to take you meds or talk to you doctor, etc."

When is enough, enough?  You still have a few other options.  You can take a break.  You can talk with your partners doctor about your options.  You can let other family members or friends take care of things for a while.  Give yourself some breathing space so you can think outside the crisis for a while.  When do you decide it's time to leave and find a more stable relationship?  No one can answer this question except you.

The following book is excellent reading for those partners of folks with
bipolar disorder:

"Loving Someone With Bipolar Disorder: Understanding and Helping Your Partner", Fast, J.A. & Preston, J.D., 2004.

David Schafer, M.Ed.
Staff Psychologist

Published April, 2006

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