All stimulants can cause mania
Tips on how to deal with manics
Three rules for dealing with bipolar patients in the acute phase of illness (with special attention to mania)
For several years I have been active in the Bipolar Self-Help Forum of the DGBS as a person affected by writing and a member of two other bipolar subjects, my brother and my father. Relatives who, during a phase of their relative or, often even more dramatically, their partner, find desperately that all the rules of living together and all of their behavioral strategies of daily life can become invalid at once are often looking for answers in the forum Books, brochures, doctors or even social workers could not give them.
How should I deal properly with my affected partner / relative if he is currently in an acute phase of illness?
This topic concerns almost all relatives who do not want to severely break off their relationship with the person concerned, sooner or later, and represents a great challenge that is often more poorly than rightly mastered for years or even decades.
In a current crisis in particular, relatives often lack clear guidelines on how to behave, while descriptive information about the disease itself is relatively easy to come by. Often there is something like the desire for a manual, an “instruction manual” for the mentally ill, not just for information about the nature of the disease. The one does not automatically result from the other.
Usually there is great uncertainty and the fear of doing something wrong when the family member has to deal with an acute phase for the first time. Co-dependent communication structures can develop quite quickly and later sometimes persist for decades.
The topic therefore also affects the mental health of all those involved.
Over the years I have written the following text to relatives who are looking for help, more or less unchanged, it is, so to speak, the quintessence of what I can write about functioning communication in phases of illness after 45 years as a relative and 25 years as an affected person. Generally speaking, they are very good rules of communication, but they offer great advantages for both parties, especially when talking to an acutely mentally ill person, and can therefore improve the relationship between the two ...
Even if the text deals primarily with the communication with manics, which is again a particular challenge, these rules also apply to all other phases of the disease, whether depression, schizoaffective phases or mixed states.
In extreme situations, “completely normal” communication with manics is no longer possible at all. But even in mania, when the zenith is exceeded, the manic person notices that he is socially isolated through his behavior, he can sometimes no longer communicate intelligibly and is lonely in his state, a general "real" willingness to talk (not monologues ), or longing for the "normal" conversations.
Sometimes, even in a manic, a desire for normalcy can be heard in a helpless way. He does not specifically choose his mania and if it works, it can also subjectively become a curse, especially if dysphoric conditions occur. It is incredibly frustrating for the manic to find that no one can keep up with his pace, that people get scared of him whom he actually loves, and above all, that they keep failing to understand themselves.
He often feels very alone and misunderstood. He can never really convey to healthy people what he really feels, but he often has an irrepressible desire for it, because he has feelings of freedom, greatness, all-encompassing truth, importance, which are triggered directly by his brain chemistry and are not comparable to anything "Normal" people feel.
Even with drugs, it is not really possible to get at what a manic can actually experience in his nervous system. There are manics who deal with cocaine, a highly euphoric stimulant, calm down because mania is able to generate far greater euphoria and excitement in them, and they only feel an effect when paradoxical effects already set in again in the overdose area.
It is important to know that it is impossible to empathize with what a manic or psychotic is feeling, but with a little empathy you can at least grasp partial aspects, such as the urgency or sometimes the helplessness when it comes to communicating with others.
A common problem when talking to a manic is that he thinks and speaks very quickly, that he loses the thread and continues with something apparently completely different, that his thoughts roll over and he can constantly change direction in the conversation.
He doesn't choose that.
This is part of the intoxicating effect that mania has. There is little point in constantly pointing out or reprimanding him for it, for a manic his own thoughts usually seem completely logical and correct in themselves.
Countless times I have sat helpless at the end of a conversation in the mania when the other person interrupted the conversation because it had nothing to do with the original topic. It is often not in the manic's power to follow clear red threads. That's part of the disease. A manic is often extremely distracting, self-centered, or even erratic, and while the behavior can be extreme, it often happens without his even realizing it.
There was a party, when at the end of a conversation / sentence I suddenly found myself completely alone in the room. Allegedly, I had been told several times, without success, that the party was over and everyone had left. Two hours beforehand ... One often experiences the same in mania.
The following 3 basic rules are intended for discussions with manics, but generally offer many advantages for communicating with relatives and partners.
1. Be kind.
That is absolutely essential. Friendly in the sense of "like a friend". How would a friend behave?
- A friend always shows his willingness to help.
- A friend speaks to me with genuine interest, and does so on an equal footing.
- A friend listens carefully and asks if he doesn't understand something.
- A friend is not dependent on me, he is always benevolent by my side and honestly gives me his opinion.
- A good friend tells you the truth, even if it's uncomfortable. He would never lie to me just so as not to upset me.
This rule must also be strictly adhered to in the second meaning of "friendly". Before you become unfriendly yourself, you must end the conversation, but with a brief explanation and the announcement, if you are less excited, that you will be available again for a conversation. If you lose your temper, get angry, or rude, the meaningful conversation is over anyway.
That's not bad. That can happen, especially when talking to someone in an acute mania. But then it's time to withdraw from the conversation until the excitement is gone. This can also simply be a very short spatial separation, e.g. you briefly go to another room to calm down (announced).
A mentally healthy relative has no chance against the violence that a manic can develop in anger, against his sometimes irrepressible will and his excessive self-confidence. It is simply not an honest fight, the manic is often very much at an advantage due to his brain chemistry, the lack of critical ability and the pathologically increased self-confidence in excitement and arguments. Therefore, in any case, break off the conversation immediately in the event of a dispute, the dispute is in no case to be won. The escalation is the end of the conversation. If you can no longer be friendly, the conversation has to be interrupted or ended.
2. Be honest.
So all I can do is warn against censoring yourself too much just to "not upset" the manic. When he's in an aggressive mood, there's nothing that can't upset him.
If he realizes that the other person is lying to him because he is afraid of him and his reaction, it can make the situation much worse. In the vast majority of cases, a manic does not want to cause fear in others, at least not if he really wants to have a conversation. But he really wants to be taken seriously. (The only exception: he's very happy and joking ...)
The fearful, co-dependent way of always paying attention to how I react and then adapting my own communication accordingly, which my mother had internalized with my father over the decades, often so excited that I after a family Sunday afternoon visit Was seriously drained and ill for at least one to three days. Even when I was already in drug therapy. In fact, my partner noticed this much more clearly than me, I was already too used to this type of conversation.
Such codependent communications are often attempts at tampering with the aim of calming down the manic. And that is anything but healthy, neither for the relatives nor for the person affected. First of all, it absolutely does not work as desired and secondly - is there anyone who likes manipulation that happens unconsciously?
It has nothing to do with friendliness or honesty, it is a level on which the following constantly penetrates: "I am afraid of you." And that means in reverse "YOU are scary "- but without saying it.
A manic can tell if you just "speak up" so as not to provoke him. And that can be unbearable. A good friend would never do such a thing. So you should absolutely be honest.
A manic has disturbances in perception and thinking, it is difficult for him to see reality. The relative is able to do this, however, and must absolutely remain in reality. Simply affirming a manic's worldview means aggravating his illness. You could just as easily call the rule "stay authentic" or "stay recognizable as a person".
3. Be consistent.
Anyone who wants to talk to a manic in a healthy way has to be consistent.
A manic himself is only capable of consistency in very few cases, since his thoughts are constantly in motion and new possibilities are constantly opening up for him, so that he can rarely stick to a topic consistently.
So consistency is the responsibility of the loved one. That means what you say should be meant seriously.
If conflicts are addressed in the conversation, the family member must consistently express his or her opinion. Even if that means that it comes to an escalation and then the conversation has to be broken off (see the first rule).
If you make your own limits clear to a manic, you automatically give him something he can rely on, because he himself can simply no longer see the limits of his actions and judge them correctly. If the other person then says: “Stop, this way and no further”, that is a clear message that you can understand. Also as a manic. However, the consequences of crossing the border must be clearly announced in advance.
Example: The relative says in an emerging dispute in which the manic announces that he wants to riot out of anger: "If you break something here with me and rage, I will call the police."
Or, for example, on the phone: "If you threaten me with suicide now, I'll be afraid for you and I'll be forced to call for help."
Or: "If you keep insulting me like you are right now, I'll break off the conversation."
That means, you have to communicate your limits clearly as soon as they are exceeded, you have to communicate what else is the consequence, and you have to be consistent in any case if it comes to further limit violations. The manic must be able to rely on being honest and serious about him. Sometimes this also involves serious consequences.
This is the practical application of so-called demarcation that relatives are given as advice over and over again.
Last but not least, "staying consistent" also means that you have to adhere to these three basic rules in any case. If you notice that you can no longer adhere to one of these rules, you have to end the conversation.
Apart from the fact that there are very simple rules that should actually apply to all friendly conversations, they can generally improve the conversations and the relationship between the relative and the person concerned very much - especially in the long term. They prevent codependency and create clarity for everyone involved.
Honest, friendly, consequent, that is easy to remember and sounds very simple at first.
But it is not! It takes a lot of practice and, especially as a family member, you have to check yourself over and over again. It is often very difficult to adhere to these simple rules.
But there is actually no alternative if you want to get along with a person affected in the long term who repeatedly goes through phases, whether out of lack of insight or because therapy and medication can only insufficiently help him or both. Everything else unfortunately ends up unhealthy - both for the person affected and for the relatives.
The name of the author is known to the DGBS.
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