Best Differential Diagnosis Book

ImageRecently, a friend asked me, “Julie, why don’t you write a book about bipolar disorder and relationships?” “I already did that with my first book for couples where one person has bipolar,” I replied. “I don’t mean couples, Julie!” he exclaimed. “I mean friendships. I can’t seem to keep any friends.”

I know what my friend—a man in his late 30s who struggles with bipolar disorder—meant by this statement. Like me, he wanted good relationships, but often found that bipolar got in the way. In the years after I was finally diagnosed with bipolar in1995, I managed to lose almost all my friends because of my neediness, irritation, paranoia, medication side effects, and more. In 2001, I hit rock bottom when I received a letter from my best friend (I’ll call her “Melissa”)that changed my life forever. While it was terribly hard to read, this letter ,in fact, saved my future relationships.

Melissa and I had been friends since high school; I was always the aggressive force in the relationship. As my illness got progressively worse, I became weak while she became strong. She started sticking up for herself; I, on the other hand, began to sink into a hole of depression that seemed inescapable. I called Melissa constantly and complained about my life. When she didn’t respond the way I wanted, I became paranoid and angry, telling her she wasn’t a good friend.

An unwelcome look at ‘relationship killers’

Looking back on it now, I had become prey to the typical bipolar relationship killers—neediness, selfishness, and paranoia. One day, my friend, in a five-page, single-spaced letter, made it clear that she couldn’t take it anymore:

It seems to be a continual problem with us that you think I don’t spend enough time with you. What am I to do? I go long stretches of time without seeing lots of people, and they just don’t seem to have a problem with it. They are busy, too. They have lives. I guess I’m just tired after all these years of feeling like I have to continually defend myself that I don’t give you what you need. I wish you could accept what I give and not seem to continually feel that I’m not giving enough.

I cried and cried when I read Melissa’s letter. How had this happened? I was indignant, angry, and sad—I felt misunderstood and attacked. Didn’t she understand how terrible bipolar is? How could she be so insensitive? I had been the popular one in high school and used to have so many friends. I was mortified as I read on:

Julie, you are such a wonderful person. I could list 50 positive things about you. But I can’t be the primary support person in your life that you seem to continually want me to be. I don’t have anything left. I’m 36 and I don’t want to be the caretaker I was in my teens and 20s. I want to care for me. That doesn’t mean that I’m a bad friend or a bad person.

Overcoming the ‘bipolar trap’

At the time, I overlooked the words, Julie, you are a wonderful person. All I saw was the criticism. Iwas utterly unaware of the “bipolar trap”—allowing my mood swings to determine my behavior and in the process losing all reasoning.

Indeed, because my depression made me needy, I excessively looked to others for help. Selfishly, I couldn’t focus on the lives of my friends—my despair was all-consuming. Finally, my paranoia became so intense—I couldn’t stop myself from sending long, rambling emails about how people didn’t really care for me.

The final blow came toward the end of Melissa’s letter:

I want you to have fun with my friends. One friend liked you a lot, but she was a bit concerned with the slew of illnesses you described. I know you want to be honest about your illness, but you also have to realize that [your fulsome descriptions] can scare people off on a first meeting. Sometimes I want to include you with things I do with friends, [but] they would prefer not to.

As I read this passage, I realized that few people really wanted my company. Honestly, I had no idea that bipolar’s mood swings could do this to a person—I was still blaming others for my unhappiness.

Concluding her letter, Melissa said that while she cared about me, she could no longer be friends. I replied with a long, miserable email about how she didn’t understand how hard life was for me—she was insensitive!

Eventually, most of my friends left me. Because my self-treatment plan was then at a beginning stage, I hadn’t made the connection between bipolar’s mood swings and my own behavior.

After reading Melissa’s letter over and over and weighing my options, I had a moment of clarity that I can vividly recall: I could stay as I was—miserable and friendless—or I could take advantage of this amazing gift my friend had unknowingly handed me. With these reflections, I felt my hurt and my anger slip away. To get better, I would have to change every negative behavior Melissa had described. I had no idea how I was going to do this—the problem appeared insurmountable. Still, I made the important connection that if I could somehow control my bipolar disorder, I would become a better friend. This meant finding a way to manage my symptoms. In this way, I could manage my behavior toward potential friends even when I was experiencing the mood swings. Furthermore, I realized that myself-treatment plan simply wasn’t working at that point. I needed to make a change if I was going to get better.

Turning things around

Confronting my shortcomings was one of the most painful things I’ve ever done. It made me realize that there was nothing wrong with my friends; rather, there was something wrong with me. So I let go of my pride and got to work—I learned to manage the illness and my emotions to the point that I started to become a better friend.

It took me many years to truly change, but I kept going. I stopped talking so much and started listening.

I consciously tried not to monopolize the conversation with my health worries. By using the self-treatment plan that I developed and now discuss in my books, I began to recognize the signs of these relationship killers and to limit their occurrence.

As I began to better manage the illness, I saw the huge connection between the random emotions caused by untreated bipolar disorder and the real me—the good me—beneath all the symptoms. I taught myself to live by the new code I had created and not according to this horrible illness.

Now—seven years after receiving this letter—I’m surrounded by friends whom I care about deeply. They often compliment me on my friendship skills. Sometimes I tell them about this letter, explaining that it’s still a struggle for me to be a good friend. And while I have certainly wrecked a few relationships over the past few years, I know that I have come a long way.

Unfortunately, Melissa and I stopped seeing each other in 2001. She has no idea that she changed my life with her compassionate, kind, and truthful letter. Perhaps I should send her this column and let her know she is one of the main reasons I’m now able to write books that help others become better friends.

Julie A. Fast, along with John Preston, Psy D, is co-author of Get It Done When You’re Depressed, Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner, and Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability.


Tips for being a better friend

Listen more than you talk.
Limit talk about your health problems.
Stop complaining and start changing.
Don’t send email or make phone calls when you’re feeling sick and needy. It will never go well.
Read about the “bipolar conversation” I discuss in all my books.
Always ask yourself, is this the real me or the bipolar me? Then make sure the “real you” is in control when you see your friends.
Give yourself time to change. You can become a superb friend in less than a year!


Comments on: "Relationships And The Bipolar Trap" (1)

  1. I agree with your recommendations for being a better friend. I think many codependent tendencies are a part of mental illness due to mood swings and insecurity.

    Were you from a family that was emotionally, physically, or verbally abusive?

    Do you remember or are you aware if your guardians/parents guilted or shamed you?

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