A loved one with a chronic illness affects the whole family. Grief over what is lost, anger over what has happened, guilt and shame over what is, and fear about what will be are all real, legitimate emotions that family members must deal with. Piled on top of the day-to-day struggle of handling the bipolar mood swings of your loved one, and the practical matters around dealing with a disability, the entire situation can quickly become an overwhelming black hole around which the entire family revolves. That is why finding support is as important for family as it is for patients. We hope that the following suggestions and resources will help you in your own lives.

1) Become an Expert

This is an easy, effective coping strategy for every member of the family, including children. It is far more frightening for young and old alike to watch the disease-induced behavior of a loved one without knowing the facts of the illness. Knowledge demystifies a terrible unknown, reducing something overwhelming to an illness that people can and do manage effectively every day. Knowledge will also help you understand your important place in your loved one's recovery plan. Education for the whole family can improve symptom management and medication compliance, help prevent relapses, and alleviate stress for everyone. The following links are articles to get you started - ask your doctor or a local mental health resource center to recommend other helpful items.

• Facts about Bipolar - a readable one-page article of important points that help to demystify this illness.
• Important things to know if your relative suffers from bipolar disorder - some basic statistics, probable outcomes, and a few things to watch for.
• Bipolar Disorder FAQs - answers to some questions you may have, including a basic working vocabulary for the disease.
• Understanding Depression and Manic-Depression (pdf file) - a good overview pamphlet, hitting the main issues of what the disease is, who gets it, how to treat it, what to watch for, and where to go from here. From the Depression and Bipolar Support Alliance.
• Causes of Bipolar - outlines bipolar disorder as a biological brain disease, contributed to by genetic abnormalities, brain chemistry, and certain stressful life changes.
• List of recommended reading (coming soon!) - some consumer-reviewed and recommended titles to get you started.

2) Allow yourself to grieve

Family member grief about the illness of a loved one might be caused by a combination of things. You might feel that something you did caused the illness, or somehow made it worse. You might feel that you are not doing enough to be supportive. However, it's also legitimate and healthy to grieve over what has been lost due to the disease - future aspirations, personality aspects, the capacity to function at a previous level. This does not make you a bad person, and it does not mean that you are rejecting your loved one for who he or she is now. As you acknowledge the reality of what is lost, you can eventually start focusing on what has remained intact, and even what has been gained, through this experience.

• Coping Tips for Family - things to consider as you deal with emotions and grief around your loved one's illness
• Bipolar Disease: Effects on Families - the reality of emotional, social, and structural changes that families go through with the diagnosis of bipolar disorder.
• Mental Illness: Info for Family and Friends - addresses common questions, concerns, and emotions, and provides suggestions for coping.
• Handling Guilt for friends and family of people with brain diseases.
• Recommended Books on coping with the burdens of mental illness for family and friends. From the schizophrenia.com website; however, most are applicable to bipolar or other psychiatric disorders as well.

3) Help with the recovery process

Family and friends have a unique, essential role in the treatment and recovery of a person with bipolar disorder. Family members especially are in the best position to observe changes in behavior, help track the effectiveness of medications, learn the warning signs of relapse, and make the living environment as supportive and stress-free as possible. As "inside observers" to the ill person's behavior, family can provide invaluable insight for the psychiatrists and other professionals concerned with effectively managing a loved one's disease.

Because poor insight (inability to acknowledge illness) is a hallmark of manic depression, a person may be unlikely to seek help for themselves when they need it, or faithfully take medications that help stabilize them. The seductiveness of mania is a particular problem of bipolar disorder - many people enjoy the euphoric highs and increased energy that come with a manic episode, and sometimes are reluctant to control them through treatment. During these times, family members remember that the "productivity" of mania is actually destructive and harmful, and they can help strongly encourage the ill member to stick with medication even when they feel it is unnecessary.

Communicate with the psychiatrist or other health care professionals involved in your loved one's treatment. Learn about long-term treatment and recovery plans, share what you know about your loved one's symptoms and your family's situation, and ask how you can best contribute.

• What can family and friends do to help? Suggestions from the Mood Disorders Society of Canada.
• Your family member has bipolar disorder and is refusing treatment - how families can help in this situation, and over the long-term.
• Note to Family and Friends - an excellent piece of writing by a woman who has BP about how family members can best help.
• Working within the health-care system - how to get better care for your loved one, and be involved in their treatment, by effectively communicating with the doctors. Written for schizophrenia.com, but applicable for many other disorders.
• The Family Psychoeducational Approach - an article by Dr. Dimitri Papalos, author of "The Bipolar Child." The importance of treating major affective disorders as "familial illnesses."

4) Learn to Recognize and Deal With Symptoms

You will begin to learn some particular "warning signs" that indicate your loved one may be headed towards a manic or a depressive episode. There are things you can do to help stabilize them, or barring that, help them through the episode as best you can. It can also be extremely difficult to live with the ups and downs of a bipolar relative - the following are some suggestions on how you can cope. Over time you will develop your own, or borrow ideas from other families in a support group.

• Handling an Ill Relative's Anger
• Some good things to say (and not to say) to someone who's depressed
• Family Information for Helping a Person Who Has Mania
• How to Avoid a Manic Episode - by Dr. Julia Mayo, Chief, Clinical Studies, Department of Psychiatry, St. Vincent's Hospital
  
• Family Information for Helping a Depressed Person
• Early Warning Signs of Relapse - a list compiled by family members/patients
• Limit Setting - there are some behaviors that are unacceptable under ANY circumstances. Take charge of these situations.
• Coping with Brain Disorders in a Crisis - from the Du Bois, IL chapter of NAMI
• When Your Loved One Stops Talking To You - suggestions for what to do next

5) Care for Yourself

You are a concerned and loving family member, not a miracle worker. There is only so much you can and should do. You cannot cure bipolar, you cannot perfectly control episodes, and you cannot make your loved one's decisions for them. Trying to be all and do all will eventually wear you out - at best, you will be of little further help to your loved one because you are so exhausted, at worst you will suffer from severe burnout, depression, anxiety, or despair. Please take care of yourself, first of all for your own sake, and second for the sake of everyone who loves and cares about you. There are resources out there to help you. Always remember that your life and happiness is your own responsbility and right, and that your loved one must take a similar responsibility for themselves.

• Find a support group - family members recommend peer-to-peer support groups as invaluable for providing advice, suggestions, coping strategies, and much-needed empathy for the struggles you go through. These are the people that understand, and have been there too. Try starting with your local chapter of NAMI (a U.S. national organization for the mentally ill and family members).Look up a NAMI chapter near you.
• Caring for the Caregiver - an article explaining why it's crucial that you take care of yourself first.
• A Caregiver's Guide to Living With Mental Illness - how you can help your loved one, and how you can help yourself.
• The Caregiver's Bill of Rights - you have the right to want and expect things for yourself too.
• Recognize signs of burnout - and get help for yourself.
• Insurmountable Stress - not actually insurmountable. Learn what you can do to help yourself.
• The Principles of Living a Balanced Life - to help a caregiver keep things in perspective.