The Bipolar Disorder Survival Guide: What You and Your Family Need to Know

333 Pages·2002·14.14 MB·English

by  David J. Miklowitz

•

Recognizing Early Warning

Signs of Mania or Depression

• Understanding Your Everyday

Ups and Downs - and When

It's Your Symptoms Talking

• Working with Your Doctor

to Find the Right Medication

and Therapy

• Preventing Mood Swings from

Ruling Your Life, and Staying

on Track at Home and Work
S
THE T H E BIPOLAR B I P O L A R DISORDER D I S O R D E R SURVIVAL GUIDE
G U I D E
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THE
T H E

BIPOLAR DISORDER
BIPOLAR DISORDER

SURVIVAL GUIDE

SURVIVAL GUIDE

What
W h a t You Y o u and a n d Your Y o u r
Family
F a m i l y Need N e e d to t o Know K n o w

P h D
DAVID D A V I D J. J. MIKLOWITZ, M I K L O W I T Z , PHD

�

PRESS
THE T H E GUILFORD GUILFORD PRESS

New York
New
York I/ London London
© Press
© 2002 2002 The The Guilford Guilford Press
A
A Division Division of of Guilford Guilford Publications, Publications, Inc, Inc.
72 Spring York, NY
Spring Street, Street, New N e w York, N Y 10012 10012
www.guilford.com
www.guiLford.com

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rightsreserved reserved

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evaluated by qualified professional.
health concerns concerns should should be be evaluated by a a qualified profeSSional.

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Cataloging-in-Publication Data
Library of of Congress Congress Cataloging-in-Publication
Data

Jay, 1957Miklowitz:, Miklowitz, Oavid David Jay, J957disorder survival guide: what you and your family
The bipolar bipolar disorder survival guide: what you and your famiLy need need to to know
k n o w /I
Miklowitz.
David J. J. Miklowitz.
cm.
p. cm.
Includes bibliographical bibLiographical references references and and index. index.
ISBN-13: 978-1-57230-525-0 (pbk.)
ISBN-lO: ISBN-10: \-57230-525-8
1-57230-525-8 ISBN-13: 978-1-57230-525-0 (pbk.)
(cloth)
1-57230-712-9 I$BN-13: ISBN-13: 978-1-57230-712-4 978-1-57230-712-4 (doth)
15BN-1O: ISBN-10: 1-57230-712-9
illness—Popular works. I. Title.
1. Manic-depressive Manic-depressive illness-Popular works. I. Title.

RC516 .M554
RCS16 .M554 20012001
616.89'5—dc21
616.89'5-dc21

2001040937
Contents
C o n t e n t s

Preface

vii

PART I The Diagnosis Bipolar Disorder
PART I The Diagnosis and and (ourse Courseofof Bipolar Disorder

Book?
1 Why W h y Do D o II Need Need This This Book? 3
You,
2 What What Bipolar Bipolar Disorder Disorder Looks Looks Lihe-to Like—to You,
Everyone Else
to the the Doctors, Doctors, and and to to Everyone Else 13
Court:
3 Into Into the the Doctor's Doctor's Court: 30

Process
What to to Expect Expect from from the the Diagnostic Diagnostic Process

Me?:
4 Is Is It It an an Illness Illness or or Is Is It ItMe?:
Diagnosis
Tips on on Coping Coping with with the the Diagnosis

54
54

PART
PARTIIIICauses (ausesand and Treatments Treatments

From?:
5 Where Where Does Does Bipolar Bipolar Disorder Disorder Come Come From?:

73

and Stress
Genetics, Genetics, Biology, Biology, and Stress

Me?
6 What What Can Can Medication Medication and and Psychotherapy Psychotherapy Do Do Jar for Me?

Medication
7 Coming Coming to to Tenns Terms with with Your Your Medication

,

98

129
vi
vi CContents ontents

PAR I I Self-Management
P A R T T IIII Self-Management

Disorder?:
8 How H o w Can Can II Manage Manage My M y Disorder?:
Practical
Practical Ways W a y s to to Maintain Maintain WeI/ness Wellness

9 What
9 W h a t Can C a n II Do D o If IfIITlI/nk Think I'm Manic?
I'm Getting Getting Manic?

151

183
183

10 What Think I'm
W h a t Can C a n II Do D o If If II Think I'm Getting Getting Depressed? Depressed? 214
214
Feelings
11 Dealing Dealing with with Suicidal Suicidal Thoughts Thoughts and and Feelings 238
238
12
12 Coping Coping Effectively Effectively in in the the Family Family and and Work W o r k Settings Settings 254
254

Resources for for People People with with Bipolar Bipolar Disorder Disorder 290
290
References 297
297
Index 311
About the
the Author Author 322
322
Preface
P r e f a c e

I

I first first became became interested interested in in bipolar bipolar disorder disorder in in 1982 1982 when, when, as as a a
predoctoral psychology
psychology intern intern at at the the University University of of California, California, los Los Angeles Angeles
bipolar support group with a fellow
(UCLA) ( U C L A ) Medical Medical Center,
Center, II supervised supervised a a bipolar support group with a fellow
intern.
intern. The The assignment assignment was was a a challenge, challenge, but but IIwas wasimmediately immediatelystruck struckby byhow h o w

from 19 5 0 —
the members members of of the the group-men g r o u p — m e n and and women w o m e n ranging ranging in in age age from 19 to to 50illness. They had
had discovered, discovered, quile quite independently, independently, how h o w to to deal deal with with their their illness. They had
learned to recurto ask ask for for medical medical and and social social support support when w h e n the the early early signs signs of of recursupport,
rences first first appeared, appeared,to torely relyon on their theirSignificant significantothers othersfor foremotional emotional support,
them
and lO to separate separate themselves themselves from from the the disorder disorder and and fight fight its its stigma. stigma.All Allof ofthem

taking medicaunderstood that that leading leading fulfilling fulfilling lives lives required required more more than than just just taking medication.
tion.
disorder,
The experience experience inspired inspired me m e to to choose choose a a PhD P h D dissertation dissertation on on this this disorder,
young
specifically about about family family relationships relationships among a m o n g late late adolescents adolescents and and young
have
since, I1 have
adults who w h o were were recently recently out out of of the the hospital. hospital. In In the the 15 15 years years since,
disorcared for, for, or orsupervised supervisedthe thecare careof, of,several severalhundred hundredpeople
peoplewith withbipolar bipolarfisorclinical pracder and and their their families families in in the the context context of of my m y research research studies studies and and clinical pracperson
tice. tice. People People have have come c o m e to to my m y office office in in a a variety variety of of clinical clinical slates, states, each each person
and unique
his or or her her own o w n unique unique expression expression of of the the disorder disorder and unique beliefs beliefs
with his
about how h o w it it should should be be treated, treated,the thefactors factorsin inhis hisor orher her genetic, genetic,biological, biological,oror
have
background that that caused caused it, it,and andwhat whatititmeant meantfor forthe thefuture. future.Many M a n yhave
family background
intensity
a love-hate love-hate relationship relationship with with the the illness: illness: they theyhave havecherished cherished the theintensity
had a
low
emotional experiences experiences that that mania mania provides provides but but have have detested detested the the low
of the the emotional
disorder's unpredictability, practical, and
periods, periods, the the disorder's unpredictability, and and the the emotional, emotional, practical, and fifi­
their lives.
damage done done lO to their lives.
nancial damage

vii
VII
viii
viii

reface
PPrelme

My long-term collaboration (1979-1997) with the Goldstein,
(1979-1997) with thelate late Michael Michael Goldstein,
My long-term collaboration
eduPhD,
P h D , of of UCLA U C L A resulted resulted in in the the development development of of family-focused family-focused therapy, therapy, an an edu­

family
cational intervention intervention that that assists assists people people with with the the disorder disorder and and their their family
an illness experimenillness episode. episode. My M y experimenmembers in in coping coping during during the the periods periods after after an
m y U C L A colleagues,
tal studies studies at at the the University University of of Colorado, Colorado, and and those those of of my UCLA colleagues,
that people w h o receive have
showed that people who receive family-focused family-focused therapy therapy and and medication medication have

lower rates receive indirates of of relapse relapse and and less less severe severe symptoms symptoms than than people people who w h o receive indiobserved
vidual supportive supportive care care and and medication. medication. Their Their improvements improvements can can be be observed
for up studies, funded
up to to two two years years after after they they begin begin family family treatment. treatment. These These studies, funded by by
the National for Research
National Institute Institute of of Mental Mental Health Health and and the the National National Alliance Alliance for Research
people. The
on Schizophrenia
Schizophrenia and and Depression, Depression, have have included included more more than than 150 150 people. The

participants have retirees; from
have ranged ranged in in age age from from teenagers teenagers to to retirees; from people peopleexperiexperitheir first w h o have been ill ill for for
enCing encing their first manic manic or or depressive depressive episode episode to to those those who have been
of their the disorder only occasional
most of their lives; lives; from from people people for for whom w h o m the disorder poses poses only occasional
life problems
problems to to those those who w h o are are chronically of hospitals; people
chronically in in and and out out of hospitals; and and people
in a contexts.
a wide wide variety variety of of living living situations situations and and family family contexts.
II wrote wrote this this book book to to respond respond to to aa need need voiced voiced by by Virtually virtually everyone everyone with with
whom
w h o m II have have worked, worked,along alongwith with their theirfamily family members. members. People Peoplewith with the thedisordisorwish for understanding from Their
der wish for more more understanding from relatives, relatives, friends, friends,and andcoworkers. coworkers.Their
family members, relative
members, in in turn, turn, want want to toknow k n o w how h o w best bestto tohelp help their theirbipolar bipolar relative
without becoming Both ask
becoming angry, angry, controlling, controlling, or or overprotective. overprotective. Both ask the the core core
people with disorder
question this
this book book attempts attempts to to answer: answer: How H o w can can people with the the disorder
better m mediachieve beuer mood o o d stability stability and and lead lead more more fulfilling fulfilling lives, lives, while whiletaking takingmedithe realities imposes?
cation and and dealing dealing with with the realities the the illness illness imposes?
belief that with the those
It It is is my m y strong strong belief that people people w who h o do do best best with the disorder disorder are are those
w h o have and h minihave learned learned to to recognize recognize triggers triggers for for their their mood m o o d cycles cycles and how o w to to miniwho
of these recthe impact impact of these triggers. triggers. They They are arepeople peoplewho w h o stay stayclose closeto totheir theirrecmize the
phyommended o m m e n d e d medication medication regimens regimens and and have have good good relationships relationships with with their their phyhave regular have
sicians. sicians. They They have regular therapiSts therapists or or go go to to support support groups. groups. They They have
they can latlearned as as much m u c h as as they can about about the the illness, illness,go goto toconferences conferenceswhere where the thelatthe
est findings findings about about the the disorder disorder are are presented, presented, talk talk with with orhers others who w h o have have the
They
illness, and and read read books books and and anicles articles concerning concerning the the latest latest treatments. treatments. They
have learned their perlearned to to accept accept the the disorder disorder but but do do not not unnecessarily unnecessarily limit limit their perit.
sonal goals goals because because of of it.
members'
that bipolar bipolar support support group group years years ago,
ago, II was was impressed impressed by by the themembers'
At that
ability and other as themselves. One
and willingness willingness to to take take care care of of each each other as well well as as themselves. O n e
group member inpatient unit tell
m e m b e r regularly regularly made m a d e trips trips to to the the local local hospital hospital inpatient unit to to tell
and
patients with with the the disorder disorder about about the the advantages advantages of of obtaining obtaining medical medical and
the U m e m -
psychOSOcial
psychosocial treatment treatment at at the UCLA C L A Affective Affective Disorders Disorders Clinic. Clinic. When W h e n aamemto
ber of of the the group group started started to to cycle cycle into into an an episode, episode, others others were were quickly quickly able able to
Pre/oce
Preface ix
IX

recognize the
the early early warning warning signs signs and and offer offer assistance. assistance. Members Members were were somesomeblunt with said.
times blunt with each each other other but but would would say say things things that that needed needed to to be be said.
I'd that
I'd like like to to think think of of this this book book as as performing performing the the same same function function as as that
support group.
group. It It is is my m y sincere sincere hope hope that that after after reading reading it, it,you you will willfeel feelless less
alone in available,
in your your struggles, struggles, realize realize that that there there are are effective effective treatments treatments available,
and have
have at at your your fingertips fingertips strategies strategies to to prevent prevent mood mood swings swings from from ruling ruhng
your life.
life. I Ihope hopethis thisbook bookwill willtell tellyou youthe thethings thingsthat thatneed need to tobe besaid saidand and
that you'll your benefit,
you'll use use them them to to your benefit, even even if if you you don't don't always always want want to to hear hear
them. conthem. Most Most of of all, all, II hope hope you you and and your your family family members members will will become become convinced that
that you you can can lead lead aa full full life life and and achieve achievemany many of ofyour your personal personalgoals goals
the disorder.
despite having having the disorder.

A Word
Word of of Thanks Thanks

Many deserve heartfelt appreciation for supporting me in writ
Many people people deserve mymy heartfelt appreciation for supporting me in writing
feel especially grateful collaborators, Ellen Frank, PhD,
book.IIfeel especially grateful toto my m ycollaborators, Ellen Frank, PhD, andand
this thisbook.
of Medicine, for
David Kupfer, Kupfer, MD, M D , of of the the University University of of Pittsburgh Pittsburgh School School of Medicine, for
their clinical their encouragement
clinical wisdom wisdom and and their encouragement of of my research. The
m y research. The illness illness
relapse prevention, ef-
management tools tools outlined outlined in in this this book-education, book—education, relapse prevention, efand
fective communication communication and and problem problem solVing, solving, relying relyingon on social socialsupports, supports,and
of familysocial rhythm rhythm stabilization-in stabilization—in many many ways ways reflect reflect a a synthesiS synthesis of familysocial
approach to helpfocused therapy therapy principles principles and and their their interpersonal interpersonal therapy therapy approach to helpbipolar disorder.
ing people people cope cope more more effectively effectively with with bipolar disorder.
throughout
Many teachers teachers and and close close colleagues colleagues have have been been inspirational inspirational throughout
strongly influenced problems:
my m y career career and and have have strongly influenced how how II think think about about clinical clinical problems:
Falloon, , Keith Nuechterlein, PhD, Raymond
Michael Goldstein, Goldstein, PhD, PhD,Ian IanFalloon, MD, M D Keith Nuechterlein, PhD, Raymond
Craighead, PhD, Gary Sachs,
Knight, Knight,PhD, PhD,Connie ConnieHammen, Hammen,PhD, PhD,W. W .Edward EdwardCraighead, PhD, Gary Sachs,
Wynne, M D , Robert
MD, M D , Michael Michael Thase, Thase, MD, M D , Steve Steve Carter, Carter, PhD, PhD, Lyman Lyman Wynne, MD, Robert
Kay Jamison, PhD. graduate stuLiberman, Liberman, MD, M D , Michael MichaelGitlin, Gitlin,MD, M D ,and andKay jamison, PhD. My M ygraduate stufirst
dents and and postdoctoral postdoctoral fellows fellows at at the theUniverSity Universityof ofColorado Colorado are areoften oftenthe thefirst
for working with individuals families, and their
to suggest suggestclinical clinicalstrategies strategiesfor working with individuals oror families, and their
They have
research has has often often influenced influenced the the direction direction of of my m y own. own. They have included included
PhD, Jeff
Elizabeth George, George, PhD, PhD, Teri Teri Simoneau, Simoneau, PhD, PhD, Dawn Dawn Taylor, Taylor, PhD, Jeff
Sachs-Ericsson, PhD,
Richards, MA, M A , Tina Tina Goldstein, Goldstein, MA, M A , Natalie Natalie Sachs-Ericsson. PhD, Jennifer jennifer
Richards,
with
Kalbag,PhD. PhD.Colleagues Colleagueswith
Wendel, MA, M A , Kristin Kristin Powell, Powell, PhD, PhD,and andApama AparnaKalbag,
Wendel,
heart, including
whom w h o m II collaborated collaborated at at UCLA U C L A hold hold a a special special place place in in my m y hean, including
PhD, Mintz,
PhD,Angus Angus Strachan, Strachan,PhD, PhD,Martha MarthaTompson, Tompson,PhD, jim JimMinlZ,
Margaret Rea, Rea, PhD,
Hwang.
A m y Weisman, Weisman, PhD, PhD, and and Sun Sun Hwang.
PhD, Amy
and col1I would would like like to to extend extend special special appreciation appreciation to to several several friends friends and col