“There are a few things you can do that improve mood problems, and a few things you can do that make them worse.”
– Bipolar, Not So Much, Chris Aiken, MD and James Phelps, MD

As doctors Aiken and Phelps explain in their book, mood disorders affect family and friends.  Moods are catching.  And yes, you may find your friend or family member’s mood is contagious.  In my last posting I talked about things their book recommends to enhance communication; such as showing emotional warmth, being emphatic, and making positive comments, etc. (Read my March 14^th 2017 post, “What to increase: four things that help mood disorders” to refresh your memory of the those helpful tips.)

Today I will emphasize the “…few things you can do that make them worse.” The authors explain that the brain is wired to react to negative events more than positive ones, so it is important to decease interactions that I talk about below.

But be patient with yourself!  What matters is getting it right most of the time.

INTERACTIONS TO DECREASE:

One. Beware Critical Comments (These are comments that point out fault and pass judgment. Sometimes they are criticisms aimed at suggesting poor motivations.)

It can be difficult, but watch the use of the word “should” in your mind and words, say Doctor Aikens and Phelps. They continue, “…try not to communicate that things ‘should’ be different. They aren’t.”

Look at your expectations, and ask: Are they realistic? If your loved one is having an episode and you haven’t lowered your expectations for now, you may need to. Critical comments spring from a mismatch between ideals, expectations, and reality.

The authors make a great suggestion, “If you cannot lower your expectations on an issue (you are not alone in that), lower the frequency with which you remind them about it.” Dr Phelps and Atkins recommend you schedule weekly opportunities to talk about your concerns rather than bringing them up unexpectedly throughout the day.  “The brain follows a psychological law called intermittent reinforcement, which means it reacts to random comments as though they are happening all the time.”

Rather, check in with your loved one! You are encouraged to ask about ways you may come across as overly critical. “Bringing this up at the weekly meeting can keep them from feeling like it’s a weekly complaint session with them as the target.”

Two. Avoid Scrutinizing Moods

While you want to monitor for relapses when someone is in recovery, too much focus on this may come across critically.  The authors recommend, “In general, you should respond to your relative’s emotions just as you would to someone who never had a mood disorder. Don’t be too quick to evaluate whether each emotion represents a new episode or medication reaction.” Again, the medical doctors  recommend asking: Ask your loved one how they’d like you to share your observations.

Three. Be Careful of Overinvolvement

Overinvolvement can happen innocently and unintentionally.  You want to take an active role in your relative’s recovery.  While it is a natural and caring reaction,  too much involvement can stress your relative. The authors state ”Mood disorders can cause people to feel guilty, controlled, or like they’ve lost their self. Overinvolvement from relatives can intensify these feelings.” Strive for positive support.  There is a fine line between positive support and overinvolvement.  For example, driving your son to his psychiatric appointment is supportive when he’s too depressed to start the car.  But the same action can be overinvolvement when he’s entering recovery.

Another hazard: it is easy to get hooked on the ups and downs of your loved one’s mood, trying to determine if what you did that made the illness worse or better. You may be taking on too much of the responsibility and burden for the illness on yourself.  Remember: But be patient with yourself!  What matters is getting it right most of the time.

Four. Steer Clear of Hostility

To avoid hostility, the authors write, watch out for beliefs that blame your loved one or that question their motivation. Dr. Aikens and Dr Phelps  cite the following examples:

• “He wouldn’t be like this if he tried harder.”
• “She doesn’t want to get better.”
• “She just wants an excuse for her behavior.”
• “He may have a disorder, but he has more self-control than he lets on. I’ve seen him change around his friends—-he’s like a totally different person with them.”

This last example is particularly important. The experts write that when someone has a mood disorder, their worst face usually comes out at home or with family. “This tendency for symptoms to vary in different settings causes two problems. One, it makes the family think that their relative with mental illness has more self-control than they actually do. Blame and hostility follow. Two, families are prevented from seeing how their relative is improving.”

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Beware Critical Comments. Avoid Scrutinizing Moods. Be Careful of Overinvolvement. Steer Clear of Hostility.  Whew!

In the last two blog posts, we reviewed both interactions to increase and those to decrease. The Interactions we discussed here have been given as guideposts to family and friends.  However, they are guideposts and suggestions only, not a guide to perfect care. Dr Aikens and Dr Phelps remind us that what matters is getting it right much of the time. They clarify, “It’s the frequency and duration of your actions that matter to the brain; just as the skin is affected by how long it’s exposed to the sun.  …Focus on the basic principles above and respond to the rest with grace and acceptance.”