For the past year, Amy has attended a support group at Jewish Family Services for family members of people with a mental illness. Amy’s goal has been to improve her relationship with her mother, who has a dual diagnosis of bipolar disorder and borderline personality disorder (BPD).
Amy has struggled for many years to cope with a relationship that often felt like she was on an emotional roller coaster ride. During group discussions, Amy’s anguish was often palpable.
Amy has received support, help and validation from group members — both Jewish and not — on how to cope with her situation.
For Amy, Jewish holidays are often challenging because of the anticipation, expectation and pressure she feels as she tries to have a more meaningful relationship with her mother. Other Jewish group members talk about similar issues and challenges.
Most of the time, Amy’s mother is very high-achieving in her professional and personal life. However, there are times when, because of stress, her anger takes over and she becomes emotionally and verbally difficult.
The frustration for Amy is that she expects better behavior from her mother because she is so “high functioning” and capable in many areas of her life.
From the support group, Amy learned that the hallmark of both bipolar disorder and BPD is instability in mood and relationships. People with BPD and bipolar disorder have remarkably reactive moods and quickly become intensely sad, anxious or irritable in response to events involving close relationships.
A helpful resource to some group participants is “The Bipolar Disorder Survival Guide,” written by David Miklowitz, a professor of psychology and psychiatry at the University of Colorado at Boulder.
The author states that when family members describe the emotional volatility of their bipolar sibling, child or parent, they emphasize the intimidation they feel in the face of sudden outbursts that they don’t feel they provoked.
For Amy, internalizing and personalizing her mother’s anger created a huge fissure in their relationship.
With the support and guidance of the group, Amy had to first work through her own grief and loss at not being able to have the mother- daughter relationship she always wanted, and finally to accept her mother’s limitations. Amy knows her mother’s triggers and is mindful of what she shares and tells her mother.
Bipolar disorder is caused by an imbalance in the brain’s neurochemistry involving the ways the cells communicate with each other. Nobody chooses to become bipolar.
Both genetic and biological vulnerabilities can be set off by various kinds of stressors, conflicts or life changes, whether positive or negative. Risk factors include:
• Stressful life changes, such as the loss of a job, gaining or losing a new relationship such as marriage, divorce or death.
• Family distress or other interpersonal conflicts — high levels of criticism from a parent, spouse or partner; provocative or hostile interchanges with a family member or coworker.
• Sleep deprivation — changes in time zones, overworking and changes in sleep-wake habits.
• Inconsistency with medication – suddenly stopping or regularly missing one or more dosages
• Alcohol and drug abuse will exacerbate either manic or depressive states.
Amy’s mother’s recent willingness to participate in family therapy and take some steps to work on her communication skills has also greatly helped improve their relationship.
In the “Bipolar Disorder Survival Guide,” Miklowitz emphasizes the importance of effective communication in family and marital relationships.
In his study of family-focused therapy, one of the most consistent changes, over time, among patients whose bipolar disorder improved was an enhanced ability to communicate with their spouse, children or parents.
He emphasizes, for example, the importance of active listening, which requires that you avoid any implication of blaming the other. Instead you offer non-verbal acknowledgements and paraphrase what you’ve heard, and ask questions designed to get the speaker to clarify his or her point of view.
During these Jewish holidays, both Amy and her mother continued their work to improve their relationship. It may not be the ideal relationship, but it certainly is a relationship they can both live with.
Note: names and details have been changed to protect the identity of the client. Melanie Wasserman, MSW, LCSW, is a psychotherapist at Jewish Family Services.
Loading ...