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Tuesday, February 9, 2016

Mending Relationships

REPRINTED with Permission:

Mending relationships.

Relationships strained to the breaking point are the trailing ghosts of bp. But that doesn’t mean repair is out of reach.

By Elizabeth Forbes

mend-relationships If only life came with a reset button. One push and voilĂ : Relationships unraveled by the behaviors of bipolar disorder would knit themselves back together.

Of course, it’s not that easy to mend what’s broken—but it’s not impossible, either. What bipolar symptoms put asunder, effort and understanding may repair.

Not all rifts can be mended, and sometimes letting go of the relationship is the best way to move forward. Yet healing can happen through a commitment to self-care on one side, education and acceptance on the other, and lots of communication to work through hurt, anger and fear.

When Barbara B., 53, and her husband, Gary, 57, separated after nearly 15 years of marriage, she was pretty sure the split would be permanent. Gary’s escalating bursts of rage, coupled with a growing emotional distance felt by both partners, had eroded the El Cerrito, California couple’s bond to a thread.

Both mania and depression often leave those with bipolar “unable to interact with the people around them,” explains Mamdouh El-Adl, MD, MRCPsych, an assistant professor in the Psychiatry Department at Queen’s University in Kingston, Ontario, and a clinician and researcher at the Providence Care Mood Disorder Research and Treatment Service.

“They don’t seem interested in maintaining the relationship, and this can be misperceived by other people,” he says.

Before Gary got his diagnosis of rapid-cycling bipolar I, Barbara interpreted his out-of-touch reactions to her problems as impatience and lack of sympathy, especially after her father died in 2003. When Barbara had to store boxes of her father’s belongings in the garage, for example, Gary complained there was no room for his car.

Bipolar-Depression-2That sense of disconnection deepened in the months that followed, just as the angry tirades Gary directed at Barbara were getting more frequent and more extreme. Looking back, Gary sees a combination of causes: extreme stress at work; disturbed rest from untreated sleep apnea; and antidepressants he was taking for unipolar depression, diagnosed a few years earlier. Getting an accurate diagnosis, which happened shortly after they separated in 2004, opened the door for real improvement—and for the couple’s reconciliation two years later.

As someone with a mood disorder herself—she was diagnosed with depression and anxiety in her 20s—and with a background in psychology through her work as a medical writer, Barbara didn’t see the bipolar diagnosis itself as a deal-breaker. The key for her was whether Gary was getting treated for the illness.

“I was really impressed with how Gary made a lot of effort to get better,” she recalls. “He was really good about medication. If any symptoms cropped up, like depression, he would talk to his psychiatrist about it. He became much more emotionally engaged once he was treated.”

Committed to Care
Experts agree that a relationship frayed or fractured by the fallout of mood swings can’t really be repaired until the ill person commits to recovery.

“In order to have a healthy relationship, you have to take care of yourself,” says clinical psychologist Cynthia G. Last, PhD, author of When Someone You Love is Bipolar: Help and Support for You and Your Partner (Guilford Press, 2009). “It’s not your fault that you’ve got the illness, but it is your responsibility to take care of it.”

Mamdouh El-Adl lays out three steps to mending relationships. First is getting treatment, with medication as the cornerstone upholding therapy and lifestyle changes. Second, those involved with the ill person should also learn about bipolar. Third, once a stable mood state is achieved, issues in the relationship must be resolved, perhaps in counseling.

“It is a long-standing process,” he says, “and requires a lot of work.”

During their separation, Barbara and Gary began seeing a couples counselor weekly. In the year before they reunited, they tested the waters by going on dates—“gradually learning to trust that things had gotten better,” as Gary puts it. Still, it was hard when both of them were depressed.

“At times we felt almost hostile toward each other,” he says.

“The only thing that could keep us going was knowing from experience that we would feel different later,” he adds.

Barbara says there are still times when it feels as if Gary’s not fully present in conversation, or seems depressed and unresponsive, but now they’re careful not to let such situations fester.

“We are very honest with each other,” she says. “That’s one thing we fall back on. We’re open about talking about our issues, whether in therapy or other ways.”

Reaching out
Time and talking is what brought Sheryl, 37, and her best friend back together. The two women have lived across the street from each other in rural Minnesota for more than a decade, but between 2004 and 2007 they didn’t speak.

Sheryl was diagnosed with bipolar II in 2001, but it took six years before she got serious about managing the illness. Meanwhile, as Sheryl found out later, her friend had also been diagnosed with bipolar and pulled back from Sheryl’s manic whirl for her own health.

“She never came out and said, ‘I have to cut it off,’” Davidson says about her friend. “She just stopped [being around]. And mania is such an egotistical thing, I never noticed.”

Bipolar-Marriage Sheryl managed to carry on her nursing career despite rapid-cycling mood swings, but by 2006 she faced losing her home to foreclosure and her kids to conservatorship. (She has a son, now 17, and a daughter, 10). That’s when she finally embraced her medication regimen, began weekly visits to her counselor, and learned all she could about her illness and coping strategies. At that point, she was ready to reach out to her neighbor. It took months, she says, to re-establish their friendship.

“It was baby steps,” Sheryl explains. “A five-minute phone call here, touching base, ‘How was your day?’ … building up a rapport again, and finally sitting down and asking, ‘What happened?’”

Now the pair have become a support group of two, running depression interventions if the mail piles up or watching each other’s daughters if one of them needs some quiet time to head off hypomania.

“To think I almost lost the one person I can sit and talk to for an hour,” Sheryl muses. “I almost lost that good friendship because of not taking care of myself.”

Hope for the best
There is another relationship Sheryl hasn’t been able to repair. At 13, her son moved to Nevada to live with his father, far from the drama and unpredictability of Sheryl’s unmanaged bipolar. Trying to work things out with him has been difficult because of the distance, she says, but he’s also made it clear that he’s not interested in bridging the gap.

Totting up the relationships lost to bipolar can unleash withering emotions like grief, regret, guilt, even self-hatred. Sheryl says that for her own mental health, she’s learned not to think about what her illness has cost her.

“I can’t dwell,” she says. “It was a good few years of torturing myself over it until I said, ‘I can’t.’”

Instead, she works to forgive herself for the hurt she’s caused, acknowledge that damage was done, and accept that some breaks can’t be healed no matter how sorry she is about what happened.

“I do believe in a sincere apology, and in some relationships it will go a long way to repairing things,” she says. “In others, maybe not so much.… But if an apology is not accepted you need to be able to walk away for the moment and not let it hinder your progress.”

What bipolar symptoms put asunder, effort, and understanding may repair.
The sad truth is, people with bipolar can extend an olive branch to those who’ve turned away, “but they’re not really the one that does the mending,” says Cynthia.

It’s up to the other party to decide whether or not to trust and try again—and the outcome often depends on how open friends and family members are to learning about and understanding the illness.

Kansas-resident, Charlie, need only compare the mothers of his two children. The women’s different attitudes toward his bipolar disorder have shaped his relationships with their children, leading to an ongoing estrangement from his daughter and a continuing connection with his son.

The 61-year-old was incorrectly diagnosed with depression in 1983, shortly after his daughter was born. By then, however, his marriage to her mother was deeply troubled. It didn’t help that he had walked out a few weeks before the birth, a move triggered in part by the stress of impending fatherhood. Although he moved back in briefly, the couple was divorced within months.

He had married again by the time his diagnosis was changed to bipolar II, in 1984. Learning about the illness and how to manage it was a joint project—until he ended that relationship six years later, when his son was two, due to the misguided promptings of manic euphoria.

Although Charlie had visitation rights with his daughter, he says her mother shut down any communication about his bipolar and how it affected his behavior. He sees the same unyielding mindset carried down to his daughter, now 28, who rarely communicates with him.

By contrast, his son’s mother managed to get past her bitterness after their divorce —though it took two years and her remarriage to a mutual friend—and proved a supportive partner during their shared custody.

Bipolar-Forgiveness“It’s not so much that I did great things,” reflects Charlie. “I apologized, but it really happened because of who she was and what she wanted as much as me trying to make things better. You can’t repair a relationship if the other side doesn’t want to.

“The fact that she lived with me and had gone through all that stuff … she understood once she got through the anger,” Charlie adds. “Whereas with my daughter’s mother, she never, never did.”

He says that tolerance—shared by her new husband, who had also been through the diagnosis and early recovery process with Charlie—made it possible to reestablish a respectful relationship, speak openly about the persisting ups and downs of his illness, and nourish the connection with his son, now 22.

It’s up to the [injured] party to decide whether or not to trust and try again.
If Charlie was immobilized by depression, she was flexible about putting off custody visits. If Charlie disappeared on an impulsive jaunt, she would explain to their son that it was part of the illness.

Charlie stays in regular contact with his son, but he’s learned to shield their relationship from the depression and impulsively that still beset him despite the best efforts of medication and therapy. At those times, he says, “I tend to stay away. I’ll have just brief contacts, keep it simple and uninvolved.”

Prevention’s best
Learning how to safeguard a connection from the troughs and tempests of bipolar, as Charlie does with his son, may be the most important part of reweaving relationships. In some cases, an ounce of prevention can head off a break in the first place.

After all, it’s not always the other person who severs a bond: The person with bipolar may be the one who turns away from a relationship. In toxic or overly stressful situations, that’s a healthy move.

Sheryl, for example, ended one romantic relationship that she felt was an “energy suck,” with nothing left over for the other people in her life or for her own needs.
“It’s a matter of measuring how much stress you can take in a relationship,” she explains. “Every relationship has stress, whether it’s with a parent, a friend, a child, a lover. It’s how much stress versus the benefits.”

Then there are situations where misunderstood or unmastered emotions play a role. That’s what happened when Charlie left his son’s mother: He says he interpreted the self-absorbed rush of euphoria as lack of love for his wife. And that’s what happened when Annette of Nova Scotia, stopped speaking to the sister she’d felt closest to.

Annette, 41, says her volatility damaged a lot of relationships before she was diagnosed with bipolar II in 2005. Even at her job as an administrative assistant, she would lay into co-workers and superiors without thought of the repercussions.

What soured things with her sister, however, was Annette’s reputation for blowing things out of proportion rather than an actual blowup between them.

When a friend of the family began behaving nastily to Annette, she started telling others that the woman was not as nice as she seemed. Her sister assumed Annette was overreacting as she’d done so many times before, and Annette angrily broke off their connection.

In the three years they weren’t speaking, Annette got her diagnosis and started cognitive behavioral therapy. She learned a great deal about her emotions and reactions.

“Before, the only feelings I knew were mad, upset or OK,” she says. “I didn’t know all the levels of hurt and anger. If I was mad, I couldn’t realize it was really because I was hurt. I just let things build up until I was angry.”

Annette says that when she decided to reach out to her sister, they rebuilt their relationship even stronger than before through “communication, forgiveness and understanding.”

Treatment has also given Sullivan tools to resist her rages. Deep breathing often helps. So does getting away from the situation, perhaps by going for a brisk walk. “Then, when I’m alone, I type,” she says. “I type my little heart out until all the rage is out.”

None of that would be possible without her medication, though. Now, she says, “when I feel that rage burning, I can at least see through the haze a little bit and realize, ‘This is what’s going to happen if you do this.’ I’m more aware of the consequences of yelling at my boss.

“Prevention,” she adds, “is much easier than damage control.”

Picking Up The Pieces
Cynthia G. Last, PhD, a clinical psychologist in Boca Raton, Florida, has both personal and professional experience with the strains bipolar disorder can put on relationships.

Last has bipolar II. At 54, she’s been managing the illness successfully for two decades. In her mid-30s, though, before she was correctly diagnosed and fully engaged in treatment, she “made a bad judgment” and left her husband for a year.

When something of that magnitude occurs, she says, the person who’s been wronged has some work to do if the relationship is to survive. Last gives her husband’s understanding attitude and nurturing spirit a great deal of credit for their marriage’s longevity.

Bipolar-Relationships About serious transgressions, she notes, “[The injured party] is not going to forget it, but they need to get past it. And the only way to get past it is [to find] a solution so it doesn’t happen again.”

The person with bipolar must address the root cause of damaging behaviors by managing the illness, she says, while the other partner must put safety measures in place.

That might mean cutting off credit cards and PayPal accounts for someone who tends to run up debt during a manic episode, Last explains, or “maybe writing a contract that the [person with bipolar] will stick to this, this and this treatment.”

Finally, to get past lingering hurt, anger and mistrust, “the well partner may need some support from a pastor or a therapist or a support group,” Last says. “And it will take time to heal.”

Monday, February 1, 2016

Love or Fear? Which is it?

REPRINT with permission from the Author James Chapman - Guest Blog Post

Love or Fear?  Which is it?  Originally published in Positive Life NSW - Talkabout Magazine by James Chapman

G'day. My name is James.  I'd like to share with each of you reading this now a bit about myself and the journey my life has taken living with HIV and now AIDS.  I have a few years behind my belt on this subject.  I turned 52 this April 2013.  Out of that number of 52, 30 or so years have been living, breathing, thinking, consuming, dealing with, and working my head around all of the things it means to be human living with HIV/AIDS.

HIV/AIDS is now a part of a generation of people who know of it, fear it, get stigmatised by it, and also those that share their compassion, love and empathy towards anyone living with this dis-ease.  I was a young man living in Los Angeles, California at the bright young age of 21, eyes wide open.  I had moved from Western Pennsylvania where life was very different.  Sexuality was not on offer or talked about.  LA was a whole new experience beyond my understanding.  I have memories of what it was like only to have to deal with issues like homophobia, hate and violence towards us because we were different sexually and able to express it openly.  That's the part all people have trouble with.  Public affection men to men, it's still a taboo and has stigma attached to it.  Fear.

Then along came HIV/AIDS to turn the disco party into funeral celebrations to replace the get together we all enjoyed.  I have buried so many men I can't remember them all.  I am the only person I know of from the first wave of people (early 80's) I knew who became infected with HIV.  I spent nearly all of my 20's being a carer for people living with HIV/AIDS.  It's just what I did.  So many people needed help, even fewer willing to help.  Fear, do you feel it?  It divided rooms on any given day.  I was the man in the middle.  I was the connecting link between family who never knew the partner or boyfriend or lover, or son.  Remember we were living in a time when everyday was a ? mark.  We knew nothing full stop, more fear.  During those years, waking up was just fraught with fear.  You didn't need to think about, it was 360 degrees, just pick from anywhere.  Within a few years after the first wave of men dying, I witnessed the 2nd wave of men dying.  We still had only a limited knowledge and education on what things were and how to treat.  Decisions one makes along the way makes all the difference.  Remember you are in the driving seat.  Are you in focus?

I have lived through the worst of times and the best of times.  In 2007 I was diagnosed with HIV Encephalopathy.  I was not expecting to live long enough to write a story like this, let alone get all the words out and make some sense.  I have learned how to re-do everything in life that most people take just part of living.  I had to work at learning how to do the simple things in life like walk, talk, speak and to think.  My cerebellum had been severely affected and was facing an uphill struggle to recover.  I live with other physical & mental disabilities and difficult for my treating physicians to work together on this; we got there in the end.  Living with HIV/AIDS means you learn or not, to develop one of the most important relationships you can have with, your doctors.  Do you live in fear of them?

Do you live in fear or love when you share with a potential sexual partner that you live with HIV?  This is not about rejection folks.  It's about how much self-love do you have for yourself.  By failing to address openly with potential partners that you live with HIV creates stigma-yours.  One aspect of self-love is what it brings us internally to us, the knowing that you are doing the right thing and not just for the other person but for you.  It's an act of loving yourself.  Imagine what it would be like if we all were to adopt.  Wearing a condom wouldn't carry the stigma it currently does.  We would just wear one automatically.  So, that leads to the age old question of why do we do things that sabotage ourselves?  We have everything going in life and when it comes to sex, we could do things differently with a different outcome for the betterment of all.  It's simple to say and harder to put into existence.

Change your perception and the world changes with you.  Courage to me means being alright to ask someone to wear a condom (love) not to worry what the other person will say or do (fear).  Love or Fear?  Does fear ever stop you from making what you know to be the best choice for you in any moment?

We have been conditioned as men to believe that we don't need to wear condoms.  Men don't wear condoms, remember?  We are strong and tall.  HIV is now the least of the worries among blood borne virus disease.  You can choose to not wear a condom out of the right to freedom of choice.  Is it your freedom of choice to give it to another?  We currently are seeing untreatable syphilis and gonorrhoea.  This was produced out of freedom not to wear a condom.  Smart of us, huh.  We did it to ourselves too.  People think we are bright.  I wonder on that one these days.  What do you believe?  That's what's important here.

Ending HIV is possible.  It starts first and foremost with you, not the idea that I can take a pill.  Be the change from the inside.  Make a difference to you and it will reverberate to others.  Be all that and more...I dare you.  Be different.  Speak Up & Out and live in Love and not Fear.  You CAN make a difference.