Couple Interview

This is a recording of an interview with a couple where the wife has bipolar disorder. They discuss some of their struggles they experience and some of the tools they use to cope with their struggles.

A Brief History

The history of Bipolar disorder dates back to the first known records of ancient Greece where findings of present-day scholars have been able to conclude that there were accounts of Bipolar Disorder. Some history of Bipolar Disorder can be traced by the discovery and use of Lithium for treatment of Bipolar Disorder. The following video not only gives a brief history of Lithium and its use in the treatment of Bipolar Disorder, but it also depicts the earliest accounts and recognition of Bipolar Disorder.



In the late 1940’s the research among clinicians focused on the treatment of the first real known mental illness at that time, Schizophrenia. As research methods, treatment, and understanding of the human brain and chemical interactions developed and improved, Bipolar Disorder was classified and became a separate mental illness which was recorded in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1957 which was developed by the American Psychological Association (an organization officially established in 1921 which now is the primary source of research discovery in both the understanding of symptoms and treatments of mental illness worldwide). Since its first definition, the understanding and development of both the illness and the treatments for it have progressed to what it is today. There are still many more milestones to cross in this area for both clinicians and therapists in the treatment and management of the disorder, but the first steps are always knowledge, recognition, and understanding. Congratulations for taking those first steps toward treatment and management!

Next to Normal

A clip from the musical Next to Normal.

Fro

Next to Normal is a rock musical with book and lyrics by Brian Yorkey and music by Tom Kitt. Its story concerns a mother who struggles with worsening bipolar disorder and the effect that her illness has on her family. The musical also addresses such issues as grieving a loss, suicide, drug abuse, ethics in modern psychiatry, and suburban life.

Next to Normal received several workshop performances before it debuted off-Broadway in 2008, winning the Outer Critics' Circle Award for Outstanding Score and receiving nominations for Drama Desk Awards for Outstanding Actress (Alice Ripley) and Outstanding Score. After an Off-Broadway run, the show then played at the Arena Stage in its temporary venue in Arlington, Virginia from November 2008 to January 2009.

The musical opened on Broadway in April 2009. It was nominated for eleven 2009 Tony Awards and won three, Best Original Score, Best Orchestration and Best Performance by a Leading Actress in a Musical for Alice Ripley. It also won the 2010 Pulitzer Prize for Drama, becoming just the eighth musical in history to receive the honor. The previous musical to win the Pulitzer was Rent, in 1996, which was also directed by Michael Greif. In awarding the prize to Kitt and Yorkey, the Pulitzer Board called the show "a powerful rock musical that grapples with mental illness in a suburban family and expands the scope of subject matter for musicals."

From Wikipedia

Lyrics to read along:

DIANA (spoken)
You know, really?
What exactly do you know?

DAN (spoken)
I know you're hurting. I am, too.

DIANA
Do you wake up in the morning and need help to lift your head?
Do you read obituaries and feel jealous of the dead?
It's like living on a cliffside not knowing when you'll dive.
Do you know, do you know what it's like to die alive?

When the world that once had color fades to white and gray and black.
When tomorrow terrifies you, but you'll die if you look back.
You don't know.
I know you don't know.
You say that you're hurting, it sure doesn't show.
You don't know.
You tell me let go.
And you may say so, but I say you don't know.

The sensation that you're screaming, but you never make a sound.
Or the feeling that you're falling, but you never hit the ground.
It just keeps on rushing at you day by day by day by day.
You don't know, you don't know what it's like to live that way.
Like a refugee, a fugitive, forever on the run.
If it gets me it will kill me, but I don't know what I've done.

DAN
Can you tell me what it is you're afraid of?
Can you tell me why i'm afraid it's me?
Can I touch you?
We've been fine for so long now
How could something go wrong that i can't see?
Cause I'm holding on
and I won't let go
I just thought you should know

I am the one who knows you
I am the one who cares
I am the one who's always been there
I am the one who's helped you
And if you think that I just don't give a damn
Then you just don't know who I am

Could you leave me

GABE
Hey dad, it's me.

DAN
Could you let me go under?

GABE
Why can't you see?

DAN
Will you watch as I drown

BOTH
And wonder why

DAN
Are you bleeding?

GABE
Are you waiting? Are you wishing? Are you wanting all that she can't give?

DAN
Are you bruised? Are you broken?

GABE
Are you hurting? Are you healing? Are you hoping for life to live?

DAN
Does it help you to know,

BOTH
Well so am I

DAN
Tell me what to do.

GABE
Look at me.

DAN
Tell me who to be.

GABE
Look at me.

DAN
So I can see

BOTH
And you’ll see

DAN
I am the one who holds you

GABE
I am

DAN
I am the one who'll stay

GABE
I am

DAN
I am the one

DAN
Who won't walk away

GABE
I won't walk away

DAN
Yeah, yeah, yeah
I am the one who'll heal you

GABE
I am

DAN
And now you tell me that I won't give a damn

GABE
You do give a damn

DAN
But I know you know

BOTH
Who I am
Yeah, yeah, yeah, yeah

DAN
That's who

BOTH
I am
Yeah, yeah, yeah, yeah

DAN
That's who

BOTH
I am
Yeah, yeah, yeah, yeah


DAN
That's who I am
Cause I'm holding on

GABE
And I won't let go

BOTH
Yeah I thought you should know
I am the one who knows you
I am the one who cares
I am the one who's always been there
Yeah, yeah, yeah
I am the one who needs you
And if you think that I just don't give a damn,

DAN
Then you just don't know who I am

DIANA
You say you hurt like me
You say that you know
Oh, you don’t know
I know you don’t know
You say that you’re hurting
I know it ain’t so
You don’t know
Why don’t you just go?
‘Cause it lays me low
And I’m saying

DIANA
You don’t know

DAN
Who I am

DIANA
You don’t know

DAN
Who I am

GABE
You just don’t know who I am

DAN
Who's crazy, the husband or wife?
Who's crazy to live their whole life
Believing that somehow things aren't as bazaar as they are?

Who's crazy, the one who can't cope?
Or maybe, the one who'll still hope?
The one who sees doctors or the one who just waits in the car?

And I was a wild twenty-five,
And I loved a wife so alive.
But now I believe I would settle for one who can drive.

DR. MADDEN
...The round blue ones with food, but not with the oblong white ones.
The white ones with the round yellow ones, but not with the trapezoidal green ones.
Split the green ones into thirds with a tiny chisel, use a mortar and pestle to grind…

DIANA
My psychopharmacologist and I.
It's like an odd romance:
Intense and very intimate, we do our dance.

My psychopharmacologist and I.
Call it a lover's game.
He knows my deepest secrets.
I know his... name!

And though he'll never hold me
He'll always take my calls.
It's truly like he told me
Without a little lift, the ballerina falls.

CAST
Do doo doo doo doo doo doo doo doo doo.

DR. MADDEN
Goodman, Diana: Bipolar depressive with delusional episodes.
Sixteen year history of medication.
Adjustment after one week.

DIANA
I've got less anxiety but I have headaches, blurry vision, and I can't feel my toes.

CAST
Ahh, ahh, ahh, ahh.

DR. MADDEN
So we'll try again. Eventually, we'll get it right.

DIANA
Not a very exact science, is it?

CAST
Zoloft and Paxil and Buspar and Xanex, Depacon, Chronaphin, Ambien, Prozac,
Ativan calms me when I see the bills.
These are a few of my favorite pills.

DIANA
Ooh, Thank you, doctor, Valium is my favorite color. How'd you know?

DR. MADDEN
Goodman, Diana: Second adjustment after three weeks.
Delusions less frequent, but depressive state worse.

DIANA
I'm nauseous and I'm constipated, completely lost my appetite and gained six pounds, which, you know, is just not fair.

CAST
May cause the following side effects, one or more:
Dizziness, drowsiness, sexual dysfunction,

GROUP 1
Headaches and tremors, nightmares and seizures.

GROUP 2
(unknown), constipation, nervous laughter, palpitations,

BOTH
Anxiousness, anger, exhaustion, insomnia, irritability,
Nausea, vomiting,

DIANA
Odd and alarming sexual feelings

CAST
OH! And one last thing:
Use may be fatal.
Use may be fatal.
Use may be fatal.

DR. MADDEN
Goodman, Diana: Third adjustment after five weeks.
Reports continue: mild anxiety and some lingering depression.

DIANA
I now can't feel my fingers or my toes. I sweat profusely for no reason.
Fortunately, I have absolutely no desire for sex.
Although, whether that's the medicine or the marriage is anybody's guess.

DR. MADDEN
I'm sure it's the medicine.

DIANA
Oh, thank you, that's very sweet, but my husband's waiting in the car.

DAN
Who's crazy, the one who's half gone?
Or maybe, the one who holds on?
Remembering when she was twenty, and brilliant and bold.
And I was so young, and so dumb.
And now I am old.

DAN
And she was wicked and wired.
The sex was simply inspired.
Now there's no sex, she's depressed
And me, I'm just tired, tired, tired, tired
Who’s crazy
The one who’s uncured
Or maybe the one who’s implored
The one who has treatment, or the one who just deals with the pain

DIANA
And though he'll never hold me
He'll always taken my calls
It's truly like he told me
Without a lift the ballerina falls.
My psychopharmacologist and I...
He’s at every sight I lie
Without you I die
My psychopharmacologist and I


DAN
They say love is blind...
But believe me, love is insane.

DR. MADDEN
Goodman, Diana: Seven weeks.

DIANA
I don't feel like myself. I mean, I don't feel anything.

DR. MADDEN
Hm. Patient stable.

Communication Tips

Basic Communication Guidelines
NAMI Family to Family Education Program

1. Use short, clear direct sentences. Long, involved explanations are difficult for people with mental illness to handle. They will tune you out.

2. Keep the content of communication simple. Cover only one topic at a time; give only one direction at a time. Be as concrete as possible.

3. Do what you can to keep the “stimulation level” as low as possible. A loud voice, an insistant manner, making accusations and criticisms are painfully defeating for anyone who has suffered a mental breakdown.

4. If your partner appears withdrawn and uncommunicative, back off for a while. Your communication will have a better chance of getting a desired response when your relative is calmer and in better contact.

5. Assume that a good deal of everything you say will “fall through the cracks.” You will often have to repeat instructions and directions.

6. And partner will not as readily misinterptret it.
Communications are our “boundries” in dealing with others. Make sure your boundries are sturdy and clear.

“I” Statements vs. “You” Statements

People coping with mental illness are often intensely self-involved and distracted. Many times they are not remotely aware of our feelings and responses. “I” statements get their attention.

“I” statements announce that we have strong feelings. If our patner is clear that we are angry or upset, they will realize they have “hit our limit.” Broadcasting our limits calmly and firmly signals them that they need to back down. It’s easier to reach an agreement when your partner hears exactly how you feel. “I” statements do this job.

“I” statements also communicate that you are ready to take the initiative, to bring the issues out into the open, to stand your ground.

“You” statements sound like you are pointing a finger at the other person, accusing and blaming. Your message will not get across if your relative is placed in a defensive position.

“I” statements are useful when you want to express negative feelings, make a request, and give positive feedback.

“When you pace in the front yard I get uncomfortable. I would feel better if you would not do that any more.”

“I want you to wash your dishes. I feel releaived to know the kitchen will be clean when I get home from work.”

“I like your hair pulled back. I am happy when I see you taking care of yourself.”

Reflective Responses

With reflective responses you are staying with the feelings that have been communicated. This means you are going to listen for the emotional content of what you are hearing rather than getting upset about the words that are spoken. You are reflecting on the essential part of your partner’s communication.

Airport Metaphor: Whatever runway your partner “takes off” on, you come in on the same runway. You do not land on another runway.

“My food is poisoned.” “It must be frightening to think someone is trying to hurt you.”
“I’m never coming back.” “It must seem like getting out of here is sometimes the only thing to do.”

John Gottman’s Four Horsemen of the Apocalypse

CRITICISM CONTEMPT DEFENSIVENESS STONEWALLING

These are four unhealthy ways we sometimes communicate with others. When we can learn to recognize that we are responding to our partener in such ways we can begin to retrain the way we communicate with eachother.

John Gottman’s Stress-Reduncing Conversation

1. At the end of the day take turns talking about the day while the other just listens.
2. Don’t give unsolicited advice.
3. Show genuine interest.
4. Communicate your understanding.
5. Take your part partner’s side.
6. Express a “we against others” attitude.
7. Express affection.
8. Validate emotions.

RELATE

RELATE was developed by the Marriage Study Consortium at Brigham Young University. Founded in 1979, the Marriage Study Consortium is a non-profit organization with the specific tasks of developing research and outreach tools that can be used directly with the public and that can be used to gather information about relationships. The consortium consists of a group of scholars, researchers, family life educators, and counselors from varied religious and educational backgrounds who are dedicated to strengthening and understanding premarital and marital relationships. RELATE is the most comprehensive premarital/marital assessment available. The first version of this instrument was developed by Wesley R. Burr and was called Marital Inventories (1980).We are only using and focusing on a small portion of the assessment dealing with communication.
For more information or to take the entire assessment as a couple, go to

www.relate-institute.org

There is a $40 fee to take the entire assessment, but the results are the most accurate gauge of your marital satisfaction.The following are questions we are considering for this program dealing with communication:

The responses you'll want to consider when asking how true these statements are for you and also for your spouse, consider the following responses:
Very often for me, Often for me, Sometimes for me, not very often of me, or not all for me:

Empathy
In most matters, I understand what my partner is trying to say.
I understand my partner's feelings.
I am able to listen to my partner in an understanding way.

Love
I include my partner in my life.
I find my partner physically attractive.
I admire my partner.
I show a lot of love toward my partner.
I find my partner to be very intelligent
My partner and I share many of the same interests and hobbies
I find my partner’s values to be very appealing

Clear Sending
When I talk to my partner I can say what I want in a clear manner
I struggle to find words to express myself to my partner
I sit down with my partner and just talk things over
I talk over pleasant things that happen during the day when I am with my partner.
I discuss my personal problems with my partner.

Soothing
When I am in an argument, I recognize when I am overwhelmed and then make a deliberate effort to calm myself down.
While in an argument, I recognize when my partner is overwhelmed and then make a deliberate effort to calm him/her down.
I've found that during an intense argument it is better to take a break, calm down, and then return to discuss it later.

Noncritical
I don't censor my complaints at all. I really let my partner have it full force
I use a tactless choice of words when I complain.
There's no stopping me once I get started complaining.

Respect
I have no respect for my partner when we are discussing an issue.
When I get upset I can see glaring faults in my partner's personality.
When my partner complains, I feel that I have to "ward off" these attacks.
I feel unfairly attacked when my partner is being negative.

Non-Withdrawal
When we get in an argument I find I want to ignore my partner.
I have been withdrawing more and more from the relationship.
I don’t feel like I have the energy to keep fighting for this relationship.
I don’t want to respond at all to my partner when we argue.

Not Overwhelmed
Whenever I have a conflict with my partner, I feel physically tense and anxious, and I don't think clearly.
I feel physically tired or drained after I have an argument with my partner.
Whenever we have a conflict, the feelings I have are overwhelming.

Expressed Emotion

Expressed Emotion (EE)

This concept is made up of two important elements:

1) The level of emotional involvement among family members including displays of inappropriate intrusiveness, distress, and self-sacrificing behaviors toward the afflicted family member.

2) The degree to which family members display critical attitudes and/or make hostile comments towards the mentally ill family member.

Research shows that individuals dealing with mental illness are more likely to relapse when they live in a family environment where EE is high.

Why is this the case?

Experts suggest that family members who are high in EE hold different beliefs about the patient and the problems associated with their illness in that they blame the person for their abnormal behavior. Those low in EE tend to perceive such behaviors to be out of the patient’s control and a consequence of the illness.

So What?

Scholars therefore recommend that families take a “flexible attributional stance” where the patient’s behavior is neither attributed completely to the illness, making all behavior out of their control, or the personality of the individual, implying that they could easily change their symptoms. Finding a healthy balance and ability to distinguish between the two can help families be less critical of their ill relative.

Basic Symptoms of Bipolar Disorder

Basic Symptoms of Bipolar Disorder

Mania:

Emotional- Euphoric, elevated (high),or irritation (critical, argumentative, stubborn).Physical- Insomnia or lack of need for sleep, staying up all night. Increased appetite. Sudden weight loss. Increased sex drive. Lack of sensitivity to heat, cold, hunger, thirst, pain, injury.

Behavioral- Increases in goal-directed activity either socially, sexually or at work. Participation in impulsive, pleasurable behaviors with painful consequences such as excessive spending, sexual recklessness or foolish business investing. Disorganization, uninhibited intrusiveness, creativity. Angry, enraged.Cognitive- Short attention span, difficulty concentrating, rapid thoughts or “flight of ideas”, inflated self-esteem, importance or power. Distorted memory.

Depression:
Emotional- Sadness or irritation. Loss of pleasure and interest in normal, daily activities.

Physical- Changes in weight due to poor or increased appetite. Altered sleep patterns; either too much or too little. Agitated, fast movements such as pacing or restlessness, or severely slowed movements. Lack of energy and extreme fatigue. Loss of sex drive.

Behavioral- lack of motivation and task performance. Withdrawal and isolation. Lack of attention to hygiene and appearance, No desire to interact socially.

Cognitive- Inability to think, remember, concentrate. Indecisiveness and inability to remember. Dwelling on guilty feelings or thoughts of worthlessness. Suicidal idiation.

Myth Busters

1) Mental illnesses are often genetically inherited. FACT

Mental illness is often genetically inherited and there is a higher chance of getting an illness if a person has close relatives with a specific condition.

2) Mental Illnesses are common. FACT

Approximately 25 million Americans are affected by mental illness each year including 7.5 million children and teens. 1.2% of the population suffers from Bipolar Disorder specifically.

3) Mental illness is caused by poor parenting or weak personal character. MYTH

Mental illness is genetically influenced and biologically based, not the cause of inadequate parenting, sin, lack of self control, or personal weakness. NO ONE IS AT FAULT!!!

4) Recovery from mental illness is highly unlikely. MYTH

Mental illness is treatable! Appropriate medical care and rehabilitation enable many to recover enough to live productive lives.

5) Severe mental illness is not preventable or curable at this point in time. FACT

There is no known cure or prevention for mental illness as of yet.

6) Mental illness is a biologically based disease/disorder of the brain. FACT

Mental illness is genetically influenced and biologically based. NO ONE IS AT FAULT!!! Biological brain disorders interfere with the normal brain chemistry and functioning that influence behaviors.

7) People suffering from mental illness brought it upon themselves. MYTH

Mental illness is not the cause sin, lack of self control, or personal weakness.

NO ONE IS AT FAULT!!! Biological brain disorders interfere with the normal brain chemistry and functioning that influence behaviors.

8) The illness is completely out of the control of the person suffering from it. FACT/MYTH

Mentally ill people have control over some behaviors that influence the severity of their symptoms and the consequences connected to them. (examples include: choosing to take medication as prescribed, maintaining a regular sleep schedule, and other suggestions given by trained professionals.) They are not, however, in control of the presence of symptoms and emotions related to having a mental illness such as feeling depressed or suicidal, feeling extremely elated or invincible, being in an alternate reality etc.

9) Someone is always to blame for the presence of mental illness. MYTH......NO ONE IS AT FAULT!!!

10) The mentally ill are highly violent and dangerous. MYTH/FACT

Mentally ill people who take regular medication properly are no more aggressive than the rest of the population and are even withdrawn or passive. However, those who are untreated are 6 times more liable to commit a violent act and this number increases severely when substance abuse is added to the picture. Past violent behavior is the best predictor of the likelihood of future acts of aggression in each individual.

11) Inquiring about a person’s suicidal intentions increases their actual risk of committing suicide. MYTH

Acting on suspicions of suicidal plans in the mentally ill can save lives. When individuals divulge information about their feelings of worthlessness and desire to end their lives, it often gives them relief and helps them feel accepted and cared about when someone is willing to listen to them.FACT