Bipolar (Manic Depressive) disorder, as well as unipolar mood disorders such as depression, are conditions that affect millions of people.
Not only do individuals living with these illnesses experience their difficulties firsthand, but their loved ones are also significantly affected and often left feeling helpless. Especially during acute episodes, both the patient and their relatives may struggle to understand what is happening and experience intense fear and distress.
A situation that is completely beyond control unfolds, and neither the patient nor their relatives can intervene. Experiences during the first episode can be remembered for a long time and may have a traumatic effect on family members. Throughout the course of the illness, individuals may feel confused, hopeless, helpless, or angry. Feelings of guilt, shame, fear of stigma, and social withdrawal may arise—both as symptoms of the disorder and as additional emotional burdens for patients and their loved ones.
Especially in inpatient psychiatric units, following acute episodes, relatives often cannot understand what has happened or what will happen next. When they are not adequately informed, unrealistic thoughts and fears may develop, causing them to perceive the illness in a distorted way.
The following points must never be forgotten:
- Your loved one’s illness is not your fault, nor theirs. This is not fate or misfortune—it is an illness.
- Support, understanding, and offering hope are good places to start.
- Every individual experiences this illness differently; therefore, directly asking the patient what they need can be very helpful.
- During hospitalization, the patient may express anger, resentment, or aggression toward you. Remember: your experience as an observer is entirely different from their experience as someone living through the episode.
- First and foremost, mood disorders have organic bases and are no different from other medical illnesses.
Medication refusal, treatment compliance, family dynamics, the patient’s ability to receive support from family when needed, their willingness to accept this support, the presence of childlike dependency traits, their inner psychological resources for understanding and managing the illness, the ability to sense and identify early manic episodes, and communicating these signs to family members—all demonstrate that personality structure plays a significant role alongside the illness itself.
Never forget that mood disorders influence a person’s attitudes, beliefs, and values.
During the illness—and especially at its onset—patients may experience thoughts and feelings that are completely opposite to their usual attitudes and values. Therefore, do not judge them. (For example, a young woman who was extremely respectful and polite toward her father before the episode behaved in a completely disrespectful manner during the attack, using language contrary to her previous values.)
During manic episodes, excessive spending, rapid speech, flight of ideas, believing they will accomplish major things in a short time, thinking they will make groundbreaking inventions, going days without sleep, and aggressive behaviors are common. As mania approaches, noticeable shifts occur in behavior patterns, thought processes, and emotional responses.
At these points, family members of individuals with this illness must be particularly attentive. Over time, relatives begin to recognize these changes and identify them as early signs of an episode. At this stage, the patient—who has not yet developed insight—may reject the idea that anything is wrong. This is where the responsibility of family members becomes crucial. The first episode is always full of uncertainties, and immediate medical attention is necessary.
The most dangerous aspect of mood disorders is the high risk of suicide attempts. These attempts are common in such patients and often carry a high likelihood of resulting in death.
Suicide attempts during mania tend to be impulsive and sudden. The individual may believe they are invincible and that nothing bad can happen to them. During depression, however, due to anhedonia (inability to feel pleasure), attempts may be more severe and more likely to succeed.
As with all patients, any expression of suicidal thoughts must be taken seriously. Dismissing them as “attention seeking” can lead to deep regret later.
Initially, such individuals should be informed that these thoughts may be symptoms of the illness; afterward, referral to professionals should occur as soon as possible.
Suicide attempts may be carried out by various means: taking high doses of prescribed medication, using firearms, or hanging. Mood disorder patients can act without thinking and may attempt suicide unexpectedly. There have been cases where patients have attempted suicide even in secure inpatient units despite staff supervision.
Family members should receive information about the illness from the professionals treating the patient, read reliable literature and brochures, and educate themselves.
Family members should not interpret patient behaviors through a moral lens. Many symptoms are part of the illness itself. A previously conservative individual may engage in uncharacteristic sexual behavior during an episode or donate their entire property during a heightened manic state.
Caring for these patients requires patience and understanding. Relatives must stay one step ahead of the symptoms; if early signs of an episode are noticed and addressed promptly, hospitalization may even be avoided.
Mood disorders include biological components, emotional and cognitive changes, behavioral shifts, and require psychological support, family guidance, and ongoing monitoring.
Bipolar means “two poles,” referring to one pole dominated by “mania”—elevated mood and heightened energy—and the opposite pole of depression, characterized by sadness and negative thoughts and emotions.
Mania represents the upward direction—intense “pleasure and excitement”—whereas depression represents the downward direction—“loss of pleasure.”
This illness often requires long-term medication and regular monitoring. Some patients discontinue treatment after a temporary improvement, which may result in severe relapse and hospitalization.
Treatment includes psychological therapies, supportive interventions, and family counseling—all essential components.
As mentioned earlier, despite its biological basis, individuals with this illness also have personality structures and psychological organizations that influence how the illness manifests.
Alongside medical treatment, psychological support helps patients cope with the illness, accept it, take responsibility, understand their self-structure, and reduce the frequency of episodes. (In my experience treating such patients in inpatient settings, I observed that therapy significantly reduced hospitalization rates.)
