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by Julie A. Fast and John D. Preston
New Harbinger, 2004
Review by Kevin M. Purday on Jun 14th 2005

Loving Someone With Bipolar Disorder

This book has a very precise aim and is targeted at a very precise audience although not quite as narrow as the subtitle would suggest. Its averred aim is to enable someone married to or living with a person suffering from bipolar disorder to help her/him reduce the impact of the illness on their relationship. The primary audience is therefore the partners of sufferers. During the course of the book, however, it is also made clear that the wider family and indeed friends could benefit from this book.

There could be no better author of this book than Julie Fast. Not only does she herself suffer from bipolar disorder but so too does her partner (not the book's second author). In addition, she is the person behind the website www.bipolarhappens.com John Preston is a clinical psychologist who specializes in, among other things, depression. They seem to have shared the writing and re-writing so successfully that the book reads seamlessly.

Bipolar disorder is more normally these days referred to as a spectrum disorder. Like so many other conditions it comes in a range from severe to mild(ish) with several variations along the way. The most extreme form is Bipolar Disorder I which shows itself in alternating deep depressions and full-blown manic periods. Each of these usually lasts for weeks or even months with intermittent neutral mood states although some sufferers do swing instantly from one extreme mood to the other. In the U.S.A. it is reckoned that about 1% of the population suffers from this extreme form. Less severe in some ways but affecting about 4 to 5% of the population is Bipolar Disorder II. Sufferers from this form spend a far higher proportion of the time in deep depression and the manic periods are less extreme than in Bipolar Disorder I so they are normally called episodes of hypomania. The least severe form is Cyclothymia in which the sufferer has swings of mood from depression to hypomania but these are not so extreme as to qualify for Bipolar Disorder II and the sufferer's lifestyle is less drastically affected although relatives and friends will regard her/him as extremely moody. Unfortunately, most people with Cyclothymia will see the condition eventually deteriorate into Bipolar I or II. Many people suffering from one of these forms of Bipolar Disorder resort to substance abuse, usually but not always alcohol, to alleviate some of the worst symptoms. This seems to be a major factor in converting Bipolar Disorder II in particular into Rapid Cycling Bipolar Disorder. This is a form in which the transformation from one extreme to the other becomes more rapid and when the sufferer has many more than four episodes in a year it is known as ultra-rapid cycling.

The book makes it clear that the bipolar disorders in the spectrum are all primarily physical illnesses with a high genetic factor although stress seems to be a major factor in actually triggering the condition. The authors take great pains to point out that, since it is at root a physical illness, mood-stabilizing medications are essential. The book is not meant to be a self-help manual to replace medication. Instead, the book is meant to be a guide to help with all the emotional ups and downs and as a source of information as to when, for example, immediate medical help must be sought.

At the heart of the book lies the problem that sufferers from one of the bipolar disorders do not usually know when they are swinging into depressive or manic mode. Even worse, the naïve partner often does not realize. The authors are keenly aware of the terrible things that a sufferer can do while in the depths of depression or on the peaks of mania. Unless treated, a complete inability to work is not uncommon in the former and may lead to suicide attempts. Unless treated and controlled, sufferers in the latter state may become sexually highly promiscuous, go on massive spending sprees, indulge in binges of one sort or another, need very little sleep and think that they can solve the world's problems. What the authors have set out to do is to produce a highly practical book of guidance for partners (and family and friends). They carefully go through the symptoms which show the beginnings of either depression or (hypo)mania -- delusions, hallucinations, paranoia, anger and irritability, anxiety, feelings of over stimulation and of being overwhelmed, lack of concentration, thoughts about suicide, self-harm and hypochondria. The authors suggest keeping a journal to log all of these. This can then lead to tracking exactly when these symptoms emerged. This in turn can lead to discovering the triggers, both secondary and primary, which have to be neutralized as quickly as possible if full-blown depression or mania is to be avoided. Stress at work, a bereavement, natural catastrophes and man-made disasters are obvious candidates for primary or root triggers of depression. Caffeine, alcohol or other drugs and junk food can all serve as root triggers of mania.

The journal should ideally be a shared venture between the sufferer and her/his partner. If this is successfully undertaken, then triggers can be immediately identified and precautionary measures taken instantly before they begin to wreak havoc. The authors call this their 'Holistic Treatment Plan' and very sensible it is too. Basically what they are saying is "let us take control of this bipolar disorder and let us not allow it to destroy our lives." As soon as the sufferer says that s/he cannot cope with work or wants to go out gambling all night, the partner know immediately that something is starting to go wrong, gets out the journal, identifies previous occasions when something similar happened and refers to the things that worked to calm the situation and immediately engages with her/his partner. Given good will on both sides, the authors assure us that this procedure can and does work. Julia Fast and her partner are living proof of its success for them. The authors make it plain time and time again that all of this has to be carried out in conjunction with the sufferer's doctor, psychiatrist, therapist, etc.

The authors are also extremely sanguine about those occasions when the sufferer refuses to co-operate. Ultimately, without co-operation the whole procedure is doomed and the partner is given very sound advice, firstly, about protecting any children from the relationship, secondly, about separating the finances of sufferer and partner, and, thirdly, about the possibility of having to leave the sufferer and end the relationship.

This is a book firmly rooted in experience and reality. For anyone with a partner suffering from bipolar disorder, it is an absolute 'must buy.' For psychiatrists, clinical psychologists and psychotherapists it is a book that they simply have to have on their shelves -- preferably more than one copy so that they can lend it out. There are a few typos which need to be ironed out prior to a second edition. However, they are not going to worry the thousands of people for whom this book will certainly be a godsend.


© 2005 Kevin M. Purday


Kevin M. Purday is Head of the Cambridge International High School in Jordan and recently completed the Philosophy & Ethics of Mental Health course in the Philosophy Dept. at the University of Warwick.