“Living with a partner who has untreated bipolar disorder is a nightmare. But living with a partner who manages bipolar disorder is actually quite amazing."

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Bipolar Disorder
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Last month, Kim Kardashian released a statement on her Instagram story addressing Kayne West's recent public behavior. She wrote, "As many of you know, Kanye has bipolar disorder. Anyone who has this or has a loved one in their life who does, knows how incredibly complicated and painful it is to understand." She explained that though she has never spoken about her husband's mental illness publicly before, she finally decided to speak up because of the "stigma and misconceptions about mental health." 

In other words, she spoke out because certain people who don't understand mental health have continued to tweet, laugh, and judge from the sidelines. They chide Kanye for his tweet storms and his campaign event in South Carolina, where he made headlines for controversial comments about his wife and kids. The teardown of Kanye's character was difficult to watch, particularly for people affected by mental health conditions in their own lives — which, considering 1 in 5 people in the US suffers from a mental illness, is a significant number of people. But, as Halsey, who has also spoken publicly about living with bipolar disorder, wrote on Twitter, "you can hate someone's actions or opinions without contributing to stigma that damages an entire community of sometimes vulnerable people all for a couple of laughs."

Knowledge is the cure for stigma. In my practice as a psychiatrist working with college students — who are of the age where bipolar disorder starts to reveal itself  (20-30s) — I have witnessed firsthand how the illness affects not only patients, but their loved ones. As a public figure, Kanye's life is bound to be scrutinized no matter what he does; but so openly battling mental illness isn't just difficult for him — it takes a toll on his family, too, who can feel sadness, anger, and often, helplessness. It is easy for people at home to blame family members like Kardashian for not "just getting Kayne help," but mental health treatment and the laws pertaining to it are complicated and nuanced. 

Here's what it's really like to love someone with bipolar disorder, and how family members can (and can't) help: 

What is Bipolar Disorder?

Bipolar disorder is a mental health condition that primarily affects your mood. Julie A. Fast, author of Take Charge of Bipolar Disorder, likes to tell people to think of it like "diabetes of the brain." With diabetes, she says, the pancreas has trouble regulating insulin; and in bipolar disorder, people "have a brain that does not regulate the chemicals that control the mood." She adds that while it looks completely psychological, it is actually brain-based and genetic. She also highlights that the disorder (which is mainly categorized as bipolar I and bipolar II) looks the same anywhere in the world.

Often, people think that having any mood swing means they are bipolar, especially because of how the term is used in the media. However, getting angry at someone for forgetting to pick up your dry cleaning, or crying after an argument with your mom, are not signs of bipolar disorder. Kevin M. Simon, M.D., Senior Child and Adolescent Psychiatry Fellow at Boston Children's Hospital/Harvard Medical School, explains, "Every day we have, I'd say, small swings in our mood. I can be happy, I can be sad, I can be frustrated … for any number of reasons throughout the day. However, when folks have prolonged mood symptoms that are of extreme nature," where they are depressed for more than two weeks, not motivated, considering self-injury, self harm,  and that is paired with a potential swing months later where they are extremely happy and require little sleep [for at least 4 days] — that is somebody that you may consider thinking diagnosing with bipolar disorder. Dr. Simon adds that in addition to the time frame, functional impairment is key, as the mood swings  must affect their work, school, and/or relationships to be diagnosed as bipolar. 

Justin Bullock, M.D.,  a second year internal medicine resident who has bipolar II, adds, "Bipolar is a gift and a curse. It enriches my life profoundly and has also made me suffer. I would never trade it in just as I would never trade my Blackness or gayness. Over time, I continue to work to manage it and learn to adjust my life for my condition."

What Are the Symptoms of Bipolar Disorder?

There are two symptom clusters for bipolar disorder that we think about: depression and mania.

  • Depression: Includes things like low mood, change in sleep (increased or decreased), not being interested in things you used to enjoy, guilt or hopelessness, fatigue, poor concentration, change in appetite (increased or decreased), and suicidal thoughts.
  • Mania: Alan Pean, who has bipolar disorder, describes his manic symptoms as most noticeable. He says, "It's like irritability beyond rational levels of irritability coupled with shortsightedness … There's also a sense of grandiosity, an unwillingness to see anyone else's perspective in thought — [an] 'I'm right and you're wrong' mentality about anything." Dr. Simon explains some may also be overconfident in an ability that they "have no basis in feeling confident about," or be so talkative that it can be difficult to interrupt them. They may also be disinhibited and making decisions that will put themselves at risk. This includes hyper-sexuality or spending a lot of money. Often, people think feeling good at all, especially if they have ever been depressed, is mania, but it is much more than that.

Christine Moutier, M.D., explains that bipolar disorder often goes undiagnosed and untreated in people for 10-15 years. This can be especially dangerous if they are engaging in risky behaviors; Dr. Simon points out that this danger is increased for Black men. He says they often aren't screened, and that people assume their symptoms are due to psychosis or substances instead of mental illness. He also says many people who might be in a position to assist are intimidated by the "stereotypes of Black men in America," such as the idea that they are more inclined to violence. Pean, whose parents are Black and Latino and who was shot during a manic episode in the hospital says, "My entire experience in Houston, as you know, was all one long experience with discrimination … the biggest myth [of bipolar] is that the condition is synonymous with violent behavior." 

What Does Treatment Look Like?

Treatment is often a combination of medication, therapy, and lifestyle changes. Dr. Simon explains that medications are often needed to help a person "have less mood instability" or try to help them not go into the lows of depression and the highs of mania. This is not easy, however, as medications can have side effects, and there might be a lot of trial and error to find the right one — as there was for mental health blogger Anja Burcak, who has bipolar I. Pean explains that while he takes Lithium, he, like many people with bipolar disorder, has struggled to take it in the past when he is doing well. He says, "That's probably the biggest issue for me, thinking I might not need them after consistently taking my meds for months, because they do work. Then you stop and you go back into this cycle of ups and downs. Word of advice to anyone with bipolar disorder, just take your meds."

There is also a common misconception that medication might dampen your creativity. Kardashian even commented on the link between creativity and bipolar in her statement saying, "Living with bipolar disorder does not diminish or invalidate [Kayne's] dreams and his creative ideas, no matter how big or unobtainable they may feel to some." Dr. Simon explains that the evidence does not suggest medications decrease creativity, and, in fact, you may be equally as productive or more productive, simply by not being so fatigued by depression or unable to do one project at time because of mania.

Medications are just part of the holistic treatment. Therapy is added to help with coping skills and to mitigate stress and lifestyle changes. 

What Loved Ones Can (and Can’t) Do:

Some people may have followed Kayne's story and not laughed, but instead thought he appeared to be struggling. Yet, not understanding the nuances of the mental health system, those people might have questioned why his family "just can't get him help," and inadvertently placed blame on them. Kardashian eloquently addressed this in her statement, writing, "Those that understand mental illness or even compulsive behavior know that the family is powerless unless the member is a minor. People who are unaware or far removed from this experience can be judgmental and not understand that the individual themselves [has] to engage in the process of getting help no matter how hard family and friends try." 

From my experience working in emergency and inpatient psychiatry, Kardashian is absolutely right about the limits of helping someone who is struggling, especially an adult. If a person is not acutely at risk to themselves or someone else, and their mental health condition does not interfere with them providing for their food, clothing, or shelter, they have to want to get help in order to move forward with treatment. Fast says family "can love the person with the mental health disorder and they can try to get them help, [but]... It doesn't matter if you're the richest person in the world, if you're famous. If someone like Kanye says, 'I'm not sick I don't need help,' they're going to listen to Kanye."

Families can try to plan ahead of time and work on things like safety plans and psychiatric advance directives, which allow a person with a mental health condition to state their wishes while they're stable in the event of a mental health crisis when they might not be able to vocalize it for themselves. Yet, as Burcak adds, and Kardashian's statement shows, "people really aren't going to get better sometimes until they make the decision to do it for themselves."

So, what can family do? Dr. Moutier advises families to engage with their loved ones about how to best support them when they are well, and ask to be included in a family meeting with a psychiatrist or therapist. The person struggling with bipolar can, however, tell their doctor what their family can and cannot know, and Dr. Moutier notes, "you need to respect that." However, that does not mean you cannot give observations you are seeing to the doctor via email or voicemail, even if privacy laws mean you cannot communicate directly with the doctor alone. One sided conversations can still be really helpful. 

Burcak says it helped her when loved ones took the condition seriously and educated themselves, but did not try to "fix me" or provide advice all the time (asking, "Did you take your meds?" is not helpful, says Burcak). Mark Lukach, mental health advocate and author of My Lovely Wife in the Psych Ward, adds, "Don't assume you know what is best for your loved one. You can only be a true ally and advocate if you take the time to listen to what they want and need."

Dr. Simon adds, "We have to be very mindful of the type of language we use when we are talking to [people] with a mental health condition like bipolar disorder. Be supportive, be validating, be encouraging, but do not be dismissive, do not be stigmatizing, and do not suggest that the person is behaving in the way that they are only because they have bipolar." 

Burcak explains that it is really important to not assume that emotions are always a symptom. In other words, she says, "I'm a person. I'm not bipolar disorder. My feelings are legitimate."  

How It Feels As a Family Member:

The feelings of family are also important to consider. As Dr. Moutier highlights, "Family members are hugely affected, from fearing for their loved one's health, job, and even their life, to feeling burned out when mood cycles keep happening; even with treatment, bipolar disorder tends to destabilize with more manic and depressive episodes."

Kardashian's statement eloquently explains the ripple effects of bipolar, as does Lukach's piece about his wife being psychiatrically hospitalized.  Here are some other thoughts by loved ones and those with lived experiences about their feelings: 

  • "The hardest thing is knowing that I gave this to my daughter. It's in my family. It's not her fault. I try to remember this when she gets sick and says nasty things or tells me to leave her alone. Bipolar illness is not an individual illness. It affects the whole family. It has a radius of about three layers every time a person with bipolar gets sick. It flies out of the person in all directions." Anna*, mother of a person with bipolar disorder
  • "It is just something that I grew up with, having a sister with bipolar disorder. As a kid, a lot of things were not said directly to me about her condition, but I still overheard things and was very observant. For example, manic features were pretty obviously odd, even if I couldn't put a diagnostic label on it. Things like excessive spending (odd purchases which seemed unnecessary), random spontaneous traveling (not knowing where she was sometimes), and grandiosity (grandiose delusion level) were features that stood out. I think it can be incredibly draining on family members emotionally, physically, and financially when a loved one is not properly diagnosed, not seeking treatment (e.g., secretly not taking meds, against hospitalization), and/or not getting effective treatment." Anonymous, 16
  • "Living with a partner who has untreated bipolar disorder is a nightmare. But living with a partner who manages bipolar disorder is actually quite amazing, as the person tends to have more insight than the [average] person. I find that being a partner of someone who consciously thinks about health is a real positive." Anonymous, 43

Lukach says, "mental illness is a shared experience … We focus exclusively on the patient, and that's obviously an essential part of treatment and recovery, but we often neglect the family members, friends, and caregivers who struggle just as mightily. Family members are often at the front lines of the long-term treatment for any mental illness, and yet they are given no training or support to handle the massive responsibility. The journey of a family member is not the same as the person with the diagnosis, but it is fraught with exhaustion, isolation, and frustration."

In the words of Kardashian, "We as a society talk about giving grace to the issue of mental health as a whole, however we should also give it to the individuals who are living with it in times when they need it the most" — and that includes the family.

*Last name withheld for privacy. 

Jessi Gold, M.D., M.S., is an assistant professor in the department of psychiatry at Washington University in St. Louis.