Being married to a spouse who has bipolar can be difficult at times because you never know what emotion they will express and how they will respond to different situations. To help understand common challenges someone faces with a spouse who has bipolar and tips for coping with a spouse with bipolar, I have interviewed psychologist Jennifer Garfein.
Tell me a little bit about yourself.
“I am a licensed psychologist working in Denver, Colorado. I trained at the University of Denver, Graduate School of Professional Psychology and completed an internship and post doctorate at Montreal General Hospital in Quebec. I have spent the past six years working in community mental health care, three of which I led a group entitled the Bipolar Education and Skills Training (BEST) class. I currently have a private practice where I see individuals, and family members of those, diagnosed with bipolar disorder.
What are some challenges someone may face from being married to a spouse who has bipolar disorder?
“Because individuals with bipolar disorder can swing between a wide range of emotions, it can be difficult for them, let alone their spouse, to anticipate and respond to those emotional swings. To give a sense of what those mood episodes can look like, I have defined them below:
When someone has a manic episode, it can range from mild (formally termed “hypomanic”) to severe with symptoms which may include feeling euphoric, sleeping only a few hours per night without feeling tired, speaking fast, having racing thoughts, acting impulsively, and taking risks. Individuals in a marked to severe manic phase have been known to spend money impulsively and extravagantly, to drive fast, drink and use drugs, have increased sex drive, and/or struggle with psychotic symptoms (i.e. delusions of grandeur, hearing voices, etc.).
From the perspective of a spouse, periods of hypomania may actually be positive. The bipolar partner may be more productive, sociable, and sexually vivacious. The Bipolar partner may have the added energy to get special projects done, be extra supportive or enthusiastic with family, or have creative inspirations. On the other hand, some individuals become irritable during hypomania or self-absorbed in their euphoria, either of which can be alienating to a spouse. At the extreme of the continuum, some people experience severe manic episodes, which end in emotional or financial ruin. In this situation, the spouse may feel victimized by the partner’s destructive actions, unable to accept the illness or repair the marriage.
When someone has a depressive episode, depressive feelings can range from feeling down to having suicidal impulses. He or she may be plagued with anxiety and guilt, have chronic fatigue, feel hopeless and helpless, and be despondent or tearful. It is not unusual for people in a depressed episode to go to bed, withdraw from family and friends, and/or neglect their obligations at home or work. In some cases, people can become psychotic during a severe depressive episode.
From the perspective of the spouse (actually of both spouse and partner), periods of depression may be the more difficult mood with which to cope. The bipolar partner is hurting with an emotional pain that is very real but has no specific cause. It may feel to a spouse like he/she is alone again with the bipolar partner absent from daily life; withdrawn into a bedroom and neglecting chores or shared responsibilities. It may also feel like the bipolar partner is less able to cope with stress, becoming more easily overwhelmed and unable to function in crisis.
In either a depressed or manic episode, individuals may have sleep changes, weight changes, difficulty concentrating, and difficulty functioning at work due to absences or poor performance. All of these symptoms provide clues to a spouse that the bipolar partner may be experiencing a mood episode.
It is notable that there are also times when people with a diagnosis of bipolar disorder are neither depressed nor manic, experiencing periods of normal mood. There are no specific issues associated with normal mood, other than recognizing and enjoying the relatively calm times.”
What type of impact can those challenges have on the marriage?
For the spouse of an individual with bipolar disorder, mental health issues may have a greater or lesser impact on the relationship depending on: (1) the severity of the partner’s mood swings and (2) how well the partner is able to manage the symptoms. Marriage is sometimes considered a balancing act, one which ideally responds to the strengths and weaknesses of each spouse. In the case of a spouse with bipolar disorder, dealing with mood swings is a necessary part of the equation. In the case of mild or moderate swings, there may be little impact on day-to-day functioning of the marriage, with the bipolar individual having a bit more or less energy than usual, a bit more or less interest in their partner, and bit more or less motivation. That individual may be very aware of having to cope with a hypomanic or depressed mood, but may be able to contain their internal struggle.
In other situations, when a partner has a severe mood swing, (and not everyone with a bipolar diagnosis has severe swings, although many people experience one significant mood episode which initially brings them in to treatment), there may be greater consequences for the spouse. In the manic direction, people are known: to spend their savings on business schemes; to max out credit cards on shopping sprees; to drive fast and get multiple tickets in a short amount of time; to drink or use drugs to excess; to become enraged to the point of violence; to feel unusually sexual and have affairs; or to become psychotic. The consequences for the spouse of someone with a severe manic episode can thus be financial stress, fear of the person hurting him/herself or someone else, fear of the partner’s ability to stay monogamous in the marriage, and concern about his/her ability to stay connected to reality.
In the case of a severe depressive episode, a bipolar partner may: become withdrawn and hopeless; stay in bed for days at a time; refuse to go to work or be around people; become psychotic; or think about, plan, and/or attempt suicide. The consequence for the spouse can thus be (again): financial stress; fear of the person hurting or killing him/herself; and concern about his/her ability to stay connected to reality.
In cases where a spouse’s bipolar disorder is not so mild that the symptoms go unnoticed, nor so severe that the couple is thrown into crisis, there may be other challenges. Specifically, the challenge of knowing when the bipolar disorder is causing tension versus internal issues in the relationship or external stressors. At times, a spouse may not know whether their partner is having a mood episode or feeling unhappy in the marriage, in particular. For instance, a partner who is depressed and has difficulty concentrating on responsibilities, feels sexless, is not talking much, and has little energy. In this situation, his or her spouse may be left feeling uneasy about whether the depression reflects the bipolar disorder or some dissatisfaction in the marriage. In some cases, spouses feel frustrated by what they perceive to be “laziness”, “passive aggressive behavior”, or “lack of effort” from their depressed partner. It can be difficult for a spouse, without insight into bipolar disorder, to remain connected to their partner, accepting periodic mood episodes without attributing some personal meaning to them.”
How can someone cope with a bipolar spouse?
“By and large, couples in which one person has a bipolar diagnosis function much like other couples; each person learning how to support the other while also taking responsibility for oneself. These are topics of continuous negotiation and renegotiation in most every relationship. It helps to understand the idea that a bipolar partner’s mood can change without a trigger from the environment; thus, mood changes are not necessarily to be taken personally. It can be a great relief to dis-identify from a partner’s moods, offering support but not taking responsibility for the bipolar partner’s internal struggle. The trick is to remain open for the times when that partner feels there is a marital issue to be negotiated; to avoid assuming the illness is speaking and minimizing his or her feelings.
Educating oneself about the illness is one of the most important steps for coping with bipolar disorder. This is true for both the person with the illness and the spouse. Treatment for the illness includes an ongoing combination of education, group support, individual therapy, and medication management. It is truly ideal if a spouse participates in the education and support aspects of treatment. Together, partner and spouse can plan around mood episodes and make arrangements in the case of a severe mood episode. For instance, a wife with bipolar disorder who typically cleans the house and cooks for herself and her husband makes a point of cooking more when she is manic, freezing the extra meals, and cleaning the house thoroughly. When she is depressed, she withdraws to her bedroom and allows herself the space to pass through it without self reproach. Her husband accepts her moods and feels comfortable flowing with his wife’s up’s and down’s.
In another example, a husband has an agreement with his wife that he will only spend a limited amount of money when he is manic and that he will hand over his credit cards to her for limited periods of time when it is evident he is losing self control.
In yet another situation, during a first manic episode, a wife put herself into debt, lost her job, and cheated on her husband. She was briefly hospitalized, then started regular individual therapy and medication management. Although her actions were alien to her, they had a devastating impact on her husband and on the marriage. They responded by seeking couple’s therapy and educating themselves to understand what she had experienced; struggling together to negotiate her degree of responsibility for her actions.
How can someone cope with a bipolar spouse?
“Individual therapy and support groups are two valuable resources for a spouse struggling with a bipolar partner. Support groups offer confidential discussion with other people who have mentally ill family members. Individual therapy offers the relationship of a professional who can provide supportive feedback and ideas for coping with the specific and deeply personal issues which arise in the context of a marriage.
If the bipolar partner is not in treatment, it is highly recommended that the spouse encourage him or her to get involved as soon as possible, for his/her sake and the sake of the marriage. Community mental health centers are great for accessing multiple resources at once; typically they provide medication management, group therapy, individual therapy, and couple’s therapy.
Thank you Jennifer for doing the interview on coping with a bipolar spouse. For more information on Jennifer Garfein or her work you can check out her website on www.garfeinpsyd.com.
Recommended Readings:
Bipolar Disorder
Tips For Identifying Bipolar Disorder in Your Teen
7 Ways To Get Into a Happy Mood
