Lily Strachan serves as a chaplain to Robert Menzies College at Macquarie University. She was a fellow with Anglican Deaconess Ministries (ADM) in 2021 and is completing a book on living with bipolar and loving those who do. In this third article, Lily provides insights on how to care for someone with bipolar. Her early articles on understanding bipolar and treatment for bipolar can be found here. In a final article, Lily will share about living as a Christian faith with bipolar.
Caring for someone with bipolar
Caring for someone who lives with bipolar can be challenging. After all, mental illness is awful, complex, and sometimes long-lasting. It’s heart wrenching to see mania or depression tear your loved one apart – especially when it seems that there is no end in sight.
Seeking to love someone who is unwell can be difficult because in mental illness your loved one might not behave like a loved one. Being in survival mode, they may be selfish, or lash out at you in anger, frustration, and pain. Being in a caring role can also stir up your own struggles – anxiety, depression, anger, or heartache. We worry for their safety, and we grieve the person they used to be.
As carers, we want to heal and fix the person we love, but we can only do so much.
As carers, we want to heal and fix the person we love, but we can only do so much. It can seem like they are stuck in a world that is beyond our reach. Feeling helpless is common.
Caring for someone with bipolar is also a privilege because you can make a real difference in their lives. You can offer them comfort and care when they need it the most. You can encourage them to get help, and you can offer simple things like a cup of tea, a walk around the block, or a lift to the doctor.
Because caring is both difficult and a privilege, it is important to remember who you are.
Remembering who you are
If you are their friend, be a friend – do friend stuff. Go for a walk together, play sport, do some knitting, watch a movie, send them funny memes. If you live with your bipolar child, be the parent. You might help them to make a doctor’s appointment, cook them some meals, and be alert to their early warning signals.
If you are a friend or a family member, remember that you are not your loved one’s psychologist, counsellor, or psychiatrist. Don’t try to fulfil these jobs when they are not yours to fill. You can encourage your loved one to see their doctor to get a mental health care plan and a referral to a psychologist and a psychiatrist, but do not try to do the jobs that only those professionals can do.
Most of all, don’t try and do God’s job. You are not qualified. Christians believe that it is ultimately God’s job to heal and provide for someone who is unwell – that he alone can bring good through what is not good. Whilst you can be an incredibly useful carer, you cannot control the situation or provide the perfect care and help that only God can. If you are a Christian, entrust your loved one to God’s powerful, loving care in prayer, and seek professional help.
A helpful question to ask yourself is, ‘How can I partner with Jesus to love them today?’ This reminds us that it is ultimately God’s job to care and provide – and that we serve under his sovereign care.
Caring for yourself
As finite people, we need to care for ourselves. It is imperative that you are not the only person caring for someone who has bipolar. Make sure that you are part of a network of people – including health professionals – who are involved in caring for them. This goes back to the reality that you are only one person, performing one role – either as friend, family member, church minister, or doctor.
Encourage your loved one to write a health care directive, that includes the people they are happy to be informed if they become unwell with a manic, hypomanic, or depressive episode. Part of this forward-thinking could include instructions on how they would like to be treated in the event of an episode – such as not wanting to be given certain medication, and who they are comfortable with visiting them in hospital.
Giving your loved one agency is important and having them write a health care directive helps with this, so that even when they are unwell, their wishes can be respected.
Having your own healthy boundaries is essential, particularly when you are feeling overwhelmed, and particularly if you are a people pleaser who struggles to say no. Don’t accept violent, aggressive, or manipulative behaviour, but instead enforce boundaries by, for example, ending a phone call if they are yelling or being abusive. Communicate boundaries such as how much time you can spend with them, and how quickly you will respond to messages. For example, those who I care for, know that I am not available between 10pm to 7am because regular sleep is important for me to stay well. They have other people they can contact during those times.
Boundaries reinforce what is not acceptable and helps those who are unwell to have healthy ways of relating to others.
Boundaries reinforce what is not acceptable and helps those who are unwell to have healthy ways of relating to others. It’s a good idea to check in with your own psychologist or counsellor to ensure that your mental health is being looked after. All of this will help you to be able to care for your friend or family member in a way that is sustainable.
How can you help someone who is struggling?
Listen and Lament
First, listen. As David Augsburger observes, “Being heard is so close to being loved that most people cannot tell the difference.”[1]
Don’t jump in to compare their situation to yours and don’t presume to know what purpose is behind their pain. Don’t pressure them to show that they are getting better. If you ask how they are, be prepared to hear the real answer. Instead of asking “How are you?”, be more specific by asking “How are you feeling today?” or ask them to rate their mood with a number out of ten.
When you do speak, make sure to validate and empathise with their suffering. We need to sit with people in their grief, and lament what is not good. Rejoicing with someone is a wonderful thing, but we need to mourn with those who mourn, rather than urging them to rejoice when they are in the pit. We can think that our job is to make the struggling person happy, but providing neat, positive answers is rarely helpful.
Don’t skip lament and head straight for phrases like ‘everything happens for a reason’, ‘things are not as bad as they could be’, or even ‘God works all things for the good of those who love him’.
Don’t skip lament and head straight for phrases like ‘everything happens for a reason’, ‘things are not as bad as they could be’, or even ‘God works all things for the good of those who love him’.
Yes, God does work through suffering. But God also hates suffering, grieves it, and he calls us to grieve too. It’s powerful to join someone in their desperate, doubtful, even angry cries for God to bring relief. Such cries don’t undermine faith but are essential parts of it.
I have benefited greatly from friends who lament with me. Georgina is such a friend. She knows my stories and my struggles, and I know hers. She listens without judgment and without trying to tidy the mess. I love her for that. She reminds me that this world is at once broken and beautiful. She does not pretend the mess away but reminds me that I am deeply loved by God and by her. She stays on the phone when I cry or fall silent.
Ali is another friend. As I tentatively explain my struggles, she is warm and sympathetic, not worried or alarmed. She reflects my feelings back to me in a way that shows she hears and understands. She is a non-anxious presence.
Ali shares a little of the difficult things in her life, which I really appreciate. It means that the conversation is not all about me trying to explain my pain. She has felt depths of loss, disappointment, and sorrow too. Her story is different to mine, but we can sit more easily with the sadness together. We laugh and cry at the crazy mess and surprising joys of life.
Along with my excellent psychologist, such friends give me space to grieve what is hard. In the presence of their listening ears, their words, and their tears, my pain is safe to express.
Practical care
You can provide practical care – meals, a walk or a coffee, lifts to appointments or outings. You can encourage them to take the medication/s prescribed to them and to talk with their doctor before stopping a medication. You can help them to exercise by showing up and going for a walk together. If they are talking about making major life decisions, encourage them to put off big changes until their moods are more stable.
If someone is unwell, follow them up, and take the initiative to spend time together.
If someone is unwell, follow them up, and take the initiative to spend time together. They may not have the energy to reach out to you, but they might be responsive to your efforts.
My friend Rachael is brilliant at practical care. Once, when I was returning to work after a period of depression, she called me each morning for weeks to encourage me to get out of bed and get dressed. With her help – both simple and radical – I found it easier to get out of bed and go to work, day by day. When I was struggling with church, leaving midway through the service, she followed me outside – not to pressure me back, but to check how I was going, and to ensure I was safe. One night when I was talking about killing myself, she got in touch with my dad straight away, knowing that he was better placed to help in this situation.
Helping someone who is experiencing mania or hypomania.
How can friends, family or ministers help someone experiencing mania, hypomania, or psychosis?
If someone has accepted their diagnosis of bipolar, it can be helpful to gently point out that it seems that their mood is inching upwards, so that they can check in with their doctor and manage their mood by reducing external stimulation, increasing anti-psychotic medication and so on. However, if someone is unaware or is in denial about their illness, it can be difficult to cut through their exuberance or paranoia to convince them that they need to seek professional help. Either way, it is important to be clear and transparent.
it is important to be clear and transparent.
Clear communication might sound like this,
‘Lily, you don’t sound like yourself. You seem upset and worried. I think it would be a good idea to check in with your doctor to see if everything is ok. I’m happy to help you make an appointment and come with you if you would like.’
I have happily gone with friends to see my doctor when I have been manic. They have helped me to see that all was not well. They assisted me in making an appointment and driving me to the doctor, seeking my permission and explaining what we were doing each step of the way.
A day later, however, when my mania continued to mount and tip over into psychosis, I was too unwell to make decisions about getting help. They tried to speak with me about seeing a doctor or going to hospital. But when I was unable to communicate or act rationally, they made the right decision to call an ambulance to get me to hospital for expert evaluation and intervention.
Suicidal or psychotic
If someone is sharing thoughts of suicide, it is good to ask them about it, and to ask if they have a plan to hurt themselves. Contrary to what some might think, asking does not encourage someone to suicide – it helps as they share these lonely and desperate thoughts with someone who cares. Never try to deal with someone who is suicidal alone. Call Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636 for help. If your loved one doesn’t want to speak, you can ask a counsellor on one of these lines to give you advice on what to do next.
If someone is suicidal or you think they might be manic (highly elevated mood, grandiose delusions, risky behaviour) or psychotic (a break with reality, paranoid delusions, not making sense), do not hesitate to contact emergency services on 000, or take them to the nearest hospital. It is better to have your loved one assessed by a medical expert than be left to get worse on their own.
If you or someone you know is in crisis, please call one of the following national helplines:
Lifeline 13 11 14, Suicide Call Back Service 1300 659 467
Prayer
If you are a Christian, pray for your loved one and pray also for yourself.
Most days of the week I meet with people who are battling mental illness. If I couldn’t entrust them to the one who knows them best, loves them the most, and keeps every promise, I would quickly sink under a weight of responsibility that I cannot bear alone. Ask God to care for them and ask him to care for you with comfort, wisdom, and strength.
When someone is manic or hypomanic, avoid prayers that are overly spiritual. People struggling with elevated mood can be susceptible to religious ideations, thinking themselves to be an angel, a demon, or even a Messiah. They may believe they are part of a grand plan for salvation or world transformation, so avoid praying about God’s purposes, and keep the language grounded and simple.
You could pray something like this,
“God, thanks that you love Lily. Thanks that you are powerful to help her. Thanks for Jesus who guarantees help in all circumstances. Help her to feel better soon. Provide Lily with the medical help that she needs. Amen.”
Truth telling
Once you have listened and lamented, you might have the opportunity to speak the truth in love. People struggling with depression often believe lies such as, ‘I have no value’, ‘My life is not worth living’, or ‘God cannot help’. The lie that underpins all these lies is that God is not good. Gently challenge this with truth from Scripture. Here we read on page after page that God loves us and will always fight for us – that he will go to the ends of the earth, indeed to death on a cross, to ensure our salvation.
Be gentle, humble, and kind – quick to listen, and slow to speak.
Offer the consolations of the gospel, not demands. Don’t urge them to ‘try harder’, ‘trust God more’, or even to read their Bible. When people are struggling, they need God’s comfort, grace, and rest. Reassure them of what Christ has done for them, not what they must do. It is ok if they cannot pray, cannot read, or cannot trust. Pray for them, read to them, and trust when they cannot.
Be gentle, humble, and kind – quick to listen, and slow to speak. Your loved one may not remember the things you say, but they will remember how you said them.
Churches
It’s important that churches be safe, listening spaces, not one where power is exerted over others, but where individuals are seen, heard, and respected.
It’s important that churches be safe, listening spaces, not one where power is exerted over others, but where individuals are seen, heard, and respected.
Some practical things: Don’t force people to sit up the front when they may need to be up the back. Don’t pressure anyone to be in church but let them know you missed them, and that you are thinking of them. Ask if you can help with anything and offer prayer. Train your staff and other church leaders to grow in their knowledge of and sensitivity to mental health issues. If someone with a mental illness only wants certain people to know about their struggles, respect their privacy unless they are in danger.
Churches should be places where people’s hard and negative feelings – as well as joy and hope – are welcomed and honoured. Do you sing any songs of lament, or only joyful songs? Do you speak about mental illness from the front and pray for unwell people in your corporate prayers?
Whether someone is a Christian or not, God calls us to care for them with the same love he has shown to us. As Paul says in Romans 12:9-12
“Love must be sincere. Hate what is evil; cling to what is good. Be devoted to one another in love. Honour one another above yourselves. Never be lacking in zeal, but keep your spiritual fervour, serving the Lord. Be joyful in hope, patient in affliction, faithful in prayer.”
Caring for those who are unwell can be difficult, and we can’t do it alone. Love with the love that God has shown you. Hope and pray when they cannot. And for those days of despair and grief, trust that God is holding onto you too.
Understanding Bipolar Series
[1] Caring Enough to Hear and Be Heard: How to Hear and How to Be Heard in Equal Communication
