I recently shared with Marty what happened when a very dear friend with bipolar disorder came to visit. She was in a manic episode that I found intensely stressful and upsetting. After three days, I made a difficult decision and asked her to leave. I had to do this, but I am fearful that our friendship will not bounce back from this experience. I am not being judgmental. In fact, I 100% identify with what happened as I have been manic like this in front of my friends many times. They don’t like it either. My problem is the energy around the mania. I want to be stable and being around someone who is choosing behaviors that fuel the mania fire is not healthy for me.
With his experience as a long-term support for his best friend Fran Houston who lives with bipolar disorder, and the insights they have shared in their book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder, I asked Marty and Fran for guidance based off of the teachings in their book. Marty’s reply, in the form of an open letter, has been extremely helpful. I am sharing it in the hope it may be of value to others.
Dear Julie.
In the six years we’ve been friends, I have accompanied Fran through episodes of mania, depression, debilitating pain and fatigue. We discuss the key qualities of a successful caring friendship in our book.
Fran has bipolar disorder, chronic fatigue syndrome, and fibromyalgia. We live three thousand miles apart, and at the time of writing have only met once face-to-face. We nevertheless have a close, mutually supportive friendship. How have we done this? Is there a secret? No. There really is nothing special about us! We are friends, and like friends the world over we handle what comes up as best we can. But while there is no great secret to share, there are qualities which are crucial to our success as friends. We trust each other, we are open and honest, and we love to connect.
You and Melissa share these qualities. You were honest with each other through an intensely traumatic experience. You kept the channels of communication open when things got rough. Crucially, you took steps for your self-care. Where you need guidance is in what happens next. I asked Fran about how she manages her friendships.
A Note from Fran: I’m bipolar 2 and my illness has driven friends away due to lack of understanding. For me resonance is imperative. If I am resonating with friends then it works. If I am not then I need to be vigilant about how I manage that friendship. Healthy boundaries, honesty, compassion, and forgiveness are vital. It’s important for me to check in to see how I feel and to be present in the moment. I meditate a lot. It helps me be in touch with myself and handle things better than I would otherwise.
When Fran and I are stuck we turn to Nonviolent Communication (NVC). Also called Compassionate Communication, NVC is a technique developed by American psychologist Marshall Rosenberg to foster compassion and resolve conflicts peaceably. You can take classes in NVC and there is a wealth of material online, but you can use the approach without going too deeply into it.
Feelings and needs are at the heart of NVC. Fran and I begin by acknowledging our feelings, relating them to whatever needs are not being met for us. If other people are involved, we consider (or guess) what their feelings and unmet needs might be. From there, we think about what strategies could bring us closer to meeting our needs. This might involve making a request, of ourselves or the other person, in order to move things forward.
What I pick up most strongly from you Julie is that you felt overwhelmed, shocked, and stressed. Right now, you feel apprehensive and vulnerable about what to do next. My guess is that the following needs are not being met for you. The first is the need for closeness. This event has got in the way of your friendship and you don’t know how to bridge the gap. In your words, “How can a friend who has witnessed and been greatly affected by a person’s manic behaviour find a way back into the relationship?” Authenticity is very important to you. You need a way forward which resonates with your core values, including personal responsibility and honesty. You work hard to maintain a degree of safety and stability in your life, and are unwilling to put yourself at jeopardy. You also care about your friend’s wellbeing and that of your friendship. All this seems under threat. As you put it, “This is a situation where I truly don’t know what to do. I have to protect myself. I want to respect her. I am not being mean, but I cannot go through that ever again and since it’s [due to] bipolar, I know it’s very possible it will happen again.”
I don’t know your friend well, but I would say she feels self-conscious and guilty about what happened; specifically that she didn’t identify what was going on for her and take steps to manage that effectively or communicate it to you in advance. On the positive side, she is appreciative of your honesty, and optimistic about finding a way forward. My needs guesses for your friend are the needs for awareness and clarity regarding her symptoms, also consideration and companionship in her relationships.
Let’s see how you might fulfil your key needs (closeness, authenticity, safety, and security) whilst also respecting your friend’s needs. The good news is there is a lot of common ground. You both understand that a change of situation and environment can be a massive challenge when you live with bipolar disorder. You also know the impact bipolar behaviour—especially manic behaviour—can have on others. Most importantly, you both recognise the vital role vigilance plays in stability and wellbeing. Fran and I talk a lot about this in our book, including the role of friends.
No matter how effective Fran’s medications are, and no matter how diligently she works at her therapies and self-care, wellness can never be taken for granted. If life is a journey, illness is part of the landscape through which Fran travels. It is easy for her to inadvertently find herself in regions of mania, depression, insomnia, pain, or fatigue. Staying well requires Fran—and those who care for her—to be constantly vigilant. It is part of my role as her friend to watch for behaviours and situations which suggest she is becoming unwell.
You have your Health Cards System, Julie, which you have developed to help manage your symptoms. I don’t know if your friend uses your system or another tool such as the Wellness Recovery Action Plan (WRAP) developed by Mary Ellen Copeland. Fran has a number of strategies, central to which are her personal care manual and wellness plan. The latter is designed for friends, family, and others she trusts to help her stay as well as possible.
Fran’s wellness plan describes warning behaviours, and asks for help in identifying them should they occur. (“Let me know if you feel I am exhibiting any of these behaviours. I might not want to hear what you are saying, so remind me of this document and that I asked you to help me take care of myself.”) It also lists strategies Fran knows help keep her well. (“This is what I need to do to look after myself. Please remind me if it seems like I am not doing them.”) If people become concerned there is a list of contacts, including her doctor, psychiatrist, care coordinator, and a mental health crisis helpline. We update the plan from time to time and modify it for specific events such as trips abroad. It was invaluable a few years ago when Fran travelled in Europe, far from her usual support team and routines.
Such tools tend to focus on personal wellness, but the approach can be extended to support the stability of our key relationships. Julie, you might consider developing a wellness plan for when you have visitors to stay. It could include such things as how long you anticipate the visit lasting, what activities and strategies you need to stay healthy, and anything you need your visitor to be aware of such as behaviours you find especially difficult or triggering. For longer stays, it might include an agreement that you and your guest will check in with each other, say after the second day, in case either of you are having difficulties. The idea would be to share the plan ahead of time. It would have enabled you and your friend to share how you were feeling in the days leading up to her visit, so you could decide whether to go ahead or reschedule.
I hope this has been useful. I’m interested to know what you and your friend think of my suggestions. Best wishes to you both!
Marty
