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Important information for relatives

Guiding principles for relatives of those suffering from bipolar disorders

(1) General behaviour
The relationship with depressive or manic members of the family cannot be "regulated" from outside. Nevertheless, relatives attain a wealth of experience over time which can be expressed. There is no standard mode of behaviour and therefore also no simple advice. It always deals with a walk on the tightrope between proximity and distance, intervention and autonomy, overpowering presence and neglect. Before everything else, however, it deals with the balance between the respect for the needs of others and for one's own boundaries.

(2) Avoid excessive demands
You can only provide support as long as you personally remain stable. You can only be helpful if you pay attention to your own limits and learn to recognize and to avoid excessive demands. Excessive demands strengthen the emotional tension, the feelings of guilt in the others, their aggression against either him/herself or others, and this subsequently results in depression or mania. Even if it does not appear so, you can rest assured that the person opposite has fine antennas for you and this aspect of excessive demands. Not wanting to admit your own burden makes you sick and doesn't make your partner any healthier.

(3) Small steps
In cases of depression, initiative, self-confidence and energy can be lost to such an extent that even simple things can no longer be accomplished. As a rule, it is not as if depressive persons do not want to, although they could, but they can't even desire to. Superficial encouragement and requests to finally get it together consequently go beyond the problem itself. The general standards are overridden as a result of the depression. Try to avoid making reproaches and reduce your demands. Even if separating them sounds somewhat artificial, blame the illness when in doubt and not the person. Let your partner be involved in your activities, if it is at all possible, but be satisfied with small steps.

(4) Preserve autonomy
If the person opposite can no longer do anything, it is tempting to do everything for him/her, since you can do everything more quickly anyway. And by doing so, it even costs fewer nerves. If the other in his/her mania threatens to do everything wrong, from your point of view, it is obvious that one then wants to quickly take everything in one's own hands. If you take over too much or too quickly, however, this can further promote the depressive or manic process. Consider that it is always necessary to preserve autonomy. Help there, where it is really important to you personally (e.g. hygiene), and intervene or get yourself help in situations where it becomes threatening for you.

(5) Sympathy
Individuals in depression, before everything else require emotional support, presence and sympathy. Pity pulls one down, but sympathy lifts one up. It is not without reason that those people who suffer from depressions have given up precisely this feeling. They need a small piece of internal independence in order to be able to endure this feeling of sympathy. You can be certain that your partner senses and values your emotional support, but you must reckon with it, that he/she cannot express this and respond as actively as otherwise. Perhaps you can endure the dry spell of one-sided emotionality better if you remember times during which this might have been the other way around, at least to some extent? If there were such times, you should also have no qualms about reminding your partner about them.

(6) Knowledge about temporal limitations
Depressions and manias are limited temporally. They have a beginning and an end, both with and without the aid of medications. The problem is only that the sense of time is clearly altered in depressive and manic phases. The momentary condition appears to your partner, in spite of knowing better, as if it is lasting eternally. And that makes him/her either despaired or delighted. Providing knowledge concerning the temporal boundaries of these phases can give them hope and strength. Nurture them with this knowledge and repeat it again and again.

(7) Biographical significance
Despite their physical momentum, depressions always have a biographical significance and therefore also a history of the relationship. In every life there are injuries, and in each relationship there are reciprocal illnesses, which can contribute to the development of depressions or manias in sensitive persons. Consequently, depressions and manias are windows which are well worth looking through. Frequently, this is only possible following the acute phase and sometimes more easily with the help of a third person.

(8) Handling one's own slight
Depressions are also to be understood as aggression directed inwardly. Even if you are not the real recipient at all, you will get to feel that in one way or another. Depressions, however, also have an offending effect otherwise: The depressive child fails to meet expectations, the depressive mother is a strain and causes fear, and the depressive partner refuses to allow any emotional access. In the event of a mania, your own illness is still perceptible directly. Your partner can say or do hurtful things, your child or one of the parents can shamelessly show what they are made of. Sometimes a certain internal distance is helpful; but be careful to avoid that the door becomes slammed shut too firmly. Acute phases are not a good time for making final decisions. The knowledge that the unaccustomed manner in your partner is a part of the illness can provide some relief. However, at this point you need active support, i.e. persons you can trust and with whom you can express yourself. That can be a girlfriend or boyfriend or, alternatively, also a pastor or a therapist. In addition, you can also find relief with family groups.

(9) "Take it easy for a change"
Depressions and manias are common phenomena. They have a lot to do with exaggerated expectations and norms regarding performance, flexibility, attractiveness and eternal youth. Persons who tend to develop depressions and manias are usually especially susceptible to the normative pressure of our society. Depressions force the person who is affected and his/her relatives to examine the usual standards of performance. Even if this is only conditionally possible during the acute phase, you can also help your partner with small things at the present by not "beating him/her to death" simultaneously with all of these norms. The recognition that it is neither necessary nor possible to always make everything right for everyone, is equally true for both parties involved.

(10) External help
Encourage your partner to get help from elsewhere. Do not be shy to argue that you would be glad to divide your burden or responsibility with somebody else. Neither psychotherapy nor a medicinal therapy can eliminate the depression or mania at a single blow. However, the burden can become decreased for all partners involved. Thoughts of suicide must be taken seriously and can be an occasion to insist on external help.

(11) Accept your errors
Everyone is aware of depressive and, at least in part, of manic times. As relatives of those afflicted, you are exposed to particular burdens, which can make one depressive, all the more so if you plunge too far into "manic" activity. After all, you are "only" a person as well. Your powers are limited. And your partner may know this as well; at any rate, he/she can sense this anyway. You will occasionally react differently than you had planned due to exhaustion or simply in anger. You are certain to make "errors". Manic and depressive persons, like everyone else, require authentic human encounters. These include both weaknesses and errors. If you stand openly to these, you will be able to save your partner some feelings of guilt.

(Source: T. Bock, Achterbahn der Gefühle, Balance – Buch und Medien Verlag, Germany)

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