Ever wished you had your own panel of experts to take your problems to? Or ever wondered what the average person in the street would do—or has done—in the same situation as you? That’s what our Second Opinion segment is for. Give us your problem, dilemma or question: we’ll get the opinions of Open House listeners based on their life experience, and then one of our experts will give you pointers on what you can do next.

THIS WEEK'S SCENARIO:

Lucinda’s a mum and a wife, whose husband has recently been diagnosed with bipolar disorder. It’s the type that causes him to be extremely social, happy and communicative out in public, but then very inward and withdrawn at home.
 
This man works in a very social sort of profession, where he leads and looks after a lot of people. But this often leaves him emotionally drained–and when he retreats into silence at home, she and the kids at times can feel like its their fault...

Lucinda and her husband are pursuing professional medical help, but Lucinda would still like to hear your ideas on how best to support him, relationship- and family-wise, in this new challenge.

Has someone close to you been diagnosed with bipolar? Do you have any words of advice or encouragement for Lucinda?

• If you have experience with a loved one who has bipolar disorder or other mental condition, what has been the hardest thing for you?
• What practical advice or encouragement would you give to Lucinda?
• How can she help to make life more liveable – for the whole family – her husband and her children too?
• What are the positives she can find in this?
• Lucinda’s family are churchgoers - How can the church support them? 

EXPERT RESPONSE - Sue Bartho, Clinical Psychologist

What Bipolar Disorder is.
 
 The essential feature of BPD is the occurrence of one or more Manic episodes, which have often, but not always, had episodes of depression between them.  This is not just having highs and lows, and because it does seem to have become a quite popular diagnosis over the last few years, we need to be very clear about what defines a Manic episode.
 
A manic episode is defined by:
1.    At least one week, where
2.    there is a very elevated, expansive or irritable mood with at least 3 of the following:
            -  inflated self-esteem or grandiosity
            -  decreased need for sleep (feel rested after only 3 hours of sleep)
            -  more talkative than usual or pressure to keep talking
            -  flight of ideas or feeling that thoughts are racing
            -  distractibility
            -  agitated or intensely active
            -  excessive involvement in pleasurable activities that have high potential for harmful risk (ie unrestrained shopping sprees, sexual indiscretions or foolish business investments
3.  This mood disturbance is sufficiently severe to cause marked impairment to occupational functioning or social relationships, or to necessitate hospitalisation, or there are psychotic features (delusions or hallucinations).
 
Having a manic episode can be an enormously positive experience.  One feels energetic, witty, enormously confident, visionary and unstoppable, and so with this disorder, there is often a lack of insight in to how inappropriate their behaviour is becoming and a reluctance to take medication to eliminate the symptoms.
 
What Bipolar Disorder Isn't
 
As mentioned, it's not just having highs and lows.  It is this elevation of mood that has become destructive to other relationships.  eg the individual is at risk of ruining their reputation with inappropriate or bizarre behaviour.  It can also become destructive to themselves because they are at risk of causing themselves serious financial, legal or physical harm.
 
If there is a significantly elevated mood for 4 days or more, that is not causing damage to occupational or social functioning, this called a hypomanic episode, and if it occurs with episodes of depression, it is called Bipolar 2 disorder.
 
A psychiatric diagnosis like this is an adjective, and not an identity!  It describes a spectrum of symptoms that commonly occur together and is useful as a form of shorthand amongst professionals.
 
Principals for Lucinda to Consider
 
1.    Go with your husband to his psychiatrist to be able to hear for yourself what is being suggested, and maybe even get a second opinion about the diagnosis.  You may need to become his co-therapist, if he wants you to, in managing medication and cultivating insight into his behaviour.
 
2.    I would encourage him to see a counsellor or psychologist who can teach him techniques to take care of himself emotionally, eg relaxation strategies for when he is getting too wound up; setting limits on his emotionally expenditure so he has something left for the family.
 
3.    Don't you take responsibility for him.  This can be very tricky for well-meaning spouses, but he must take responsibility for -  his health
                        -  his role as husband
                        -  his role as father
He can't use his diagnosis as an excuse for all manner of bad behaviour. Don't get into roles of carer and patient.  Give him invitations to take responsibility for himself, eg "What can I do to support your health plan?"
 
4.    Good communication is crucial.  It is great if husband and wife can talk together about what each needs in the relationship, and how they can work together to create their family.  In reality this can be very hard, especially if there has been history of conflict or hostility.  This is another area where professional help can be valuable.
 
I'm frequently encouraging wives with withdrawn husbands to persevere with gentleness, charm and assertiveness!  Do encourage him with words of praise and affirmation for all that he does do in your home and relationship.  Refrain from criticising, but instead reflect on one thing you would like to ask him to do differently, and then gently, firmly, talk to him about that.  Plan date nights, prioritise sex, pray together, share your life with him.
 
5.    Be careful of your own Self-Talk, ie the interpretations, conclusions and meaning that you attribute to his words and behaviour  will profoundly affect how you feel about him, and about yourself.
 
Useful Websites for Self-Help Groups and Self-help information:

Depression and Mood Disorder Association of NSW - www.dmda.mentalhealth.asn.au
SANE Australia - www.sane.org
Association of Relatives and Friends of the Mentally Ill - in NSW, phone 02 9805 1883 or 1800 655 198
 
Useful websites for More Information on Bipolar Disorder:
www.DforDepression.com
www.blackdoginstitute.org.au
www.crufad.org (Clinical Research Unit For Anxiety Disorders)
www.beyondblue.org.au
www.mhcs.health.nsw.gov.au (NSW Department of Health website)