By Roger Pehlke

“Coming Unglued: The Bipolar Home in Times of Trouble” will be addressed by the keynote speaker, Mason Spain Turner, M.D., at NAMI-Yolo’s signature Pat Williams Mental Health Dinner.

The event takes place Thursday, Feb. 16. Doors at the Veterans’ Memorial Center, 203 E. 14th St., open at 6:30 p.m.

Tickets are $40 general, $10 for students and $3 for mental health consumers. Early ticket purchase is advised, because the event is expected to sell out. For more information, call (530) 756-8181.

Turner is chief of the department of psychiatry at Kaiser Permanente Medical Center in San Francisco and the assistant director for regional mental health and chemical dependency services for Kaiser Permanente, Northern California.

He earned a bachelor’s degree is psychology from Dartmouth College and his medical degree from the University of Texas. Turner completed his residency in psychiatry at Harvard University Medical School through Massachusetts General Hospital and McLean Hospital in Boston.

As a clinician, he concentrates his practice in general psychiatry, addiction medicine and the treatment of personality disorders. Recent work has turned to the effects of an individual’s mental illness on the family system.

Turner received the 2011 Healthcare Hero’s Award sponsored by the San Francisco Business Times, given for extraordinary service in patient care in the Bay Area.

NAMI-Yolo caught up with him last week to ask him about his upcoming talk.

Who’s coming “unglued?” And what do you mean by that?

The person with bipolar disorder, certainly, but also the family system can come unglued. Often, we forget that the identified patient is part of a connected system that also needs just as much attention in treatment as the patient.

In a so-called “normal” family, there is a certain dependence on predictability, of things being as you expect them to be — a restful environment with familiar patterns when you come home from work, for example.

But when a family member has bipolar disorder, things get unpredictable in a hurry. It fragments the family system. In some cases, the home may turn into a poisonous environment, rather than a restful retreat.

Let me illustrate. I have a young, adult female client who has bipolar disorder. Her father is a police officer and a single parent. Her treatment providers are far from their house in the opposite direction of his workplace, so the father has to drive huge distances to ensure his daughter gets timely and effective treatment.

When the daughter relapses, the number of trips increases. Added stress on top of an already stressful job makes it hard for Dad to hold things together. That’s what I mean by “coming unglued.”

You hear the term “bipolar” a lot these days. Is bipolar disorder affecting more people or is there just greater awareness?

Bipolar 1, the more severe form of manic/depressive disorder, has neither increased nor decreased in diagnostic rates. However, bipolar 2 disorder, which is characterized more by depression with mild mania, is being identified more frequently these days.

Too, as stigma lessens in our society, people are talking more openly and more frequently about bipolar. That’s a good thing — less stigma.

So, part of the problem with diagnosis is that people do get tagged with a name, then have to live with the stigma. Don’t diagnoses change? People do get better.

Definitely. People get better, yes. We struggle with this issue in psychiatry because diagnoses we give are often of a chronic condition and stay with patients for life. I coach patients when I give them this diagnosis about how to reveal your bipolar disorder, and to whom.

While important to normalize your experience and realize you are not alone, connecting with others, you also have to be careful with your information. Among people you feel are likely to stigmatize, don’t share as freely.

In talking with families of your clients, what do they tell you are the most stressful things they endure?

Mostly, it’s the unpredictability. Our bodies really don’t like unpredictability. That’s stressful. Secondly, there’s a sense of “being stuck” with a lack of options or significantly conflicting choices: My son can’t live on his own. He can’t live at home. A cash-strapped mental health system means limited housing options. He can’t be homeless. My decision is what? Choosing the least evil.

This leads to my third point — guilt. Parental decisions have consequences. There is always second-guessing. Is it the right decision for this person I love? Making a least-of-all-evils decision never feels good, and it leaves parents feeling guilty.

A fourth major stressor is making exceptional accommodations to lifestyle, like our police officer friend driving in the most challenging traffic gridlocks in the country around the Bay Area to get his daughter to the right treatment. Families make accommodations at every turn.

Another example: It’s exhausting at a dinner party to monitor exactly what you share with other families when the conversation turns to “what are your kids doing?” Helping your son or daughter navigate through everyday life, through their medical and support needs, takes enormous patience and many, many accommodations.

Are there specific strategies for stress management that will help in the “bipolar home”?

Start with setting realistic expectations. You never undervalue what your loved one can accomplish. Many accomplished people have bipolar disorder — professors, politicians, doctors, journalists, artists of all kinds. But anyone with bipolar disorder, and their family, should view things realistically and understand what constraints there may be.

Next, build up a network of support. Organizations like NAMI are excellent for this. The Family-to-Family and Peer-to-Peer support groups help a lot of families cope.

Thirdly, education. Be aware of the “course” of the illness, how it plays out over time, what medications address what symptoms. Draw a timeline and understand seasonal change or patterns of relapse and recovery. Gain empathy of what the mania is like that your son or daughter is experiencing.

Finally, problem-solving strategies that you use in everyday life may not work or may need to be tailored. For example, depending where your loved one is in their illness “course,” you use different ways to communicate and address different levels of recovery.

Is there such a thing as a perfect mix of medication, therapy, exercise, nutrition, etc., for a person grappling with bipolar disorder?

Whether it’s bipolar 1 or bipolar 2, a baseline requirement is medication. It’s not an option. Which medications and what dosage will differ person to person and from time to time, but science today gives us some effective medicine. Use it.

With regards to psychotherapy, don’t forget the strong need to focus on concrete skills for dealing with both depression and mania, and the techniques may be different. Where feasible, I’m a believer in family-focused therapy, engaging the parents or other support systems in an integrated fashion.

Some clients have no family around. Other times families resist this involvement. But well-planned family support can make a big difference.

Next is education. I give my clients a lot of homework. Educate yourself and be able to track the “course” of your condition. Know yourself so you can make decisions for yourself that are most helpful to your life.

Finally, flat out avoid substances. There is a huge risk of chemical dependency among people with bipolar disorder.

How are external factors, like a reeling economy, impacting families facing severe mental health issues?

These are turbulent times. We all only have so much capacity to deal with all the stressors coming at us. We have to be realistic with what we can handle. When there are additional stressors —house foreclosure, job loss or cutback, denial of medical support benefits, more family members living under one roof — the ability to deal effectively with a family member with bipolar disorder becomes more of a challenge.

There needs to be in the family a conscious effort to make a plan. It may be as simple as dividing up jobs between the mother and father — you deal with finances, I’ll deal with medical support for our son. Or it may be a tough choice to periodically distance yourself from your loved one. Families get into trouble when they accumulate stress to the point of becoming dysfunctional. I can’t deal with this. Period.

Sounds like a balancing act for parents. Be prepared for the unpredictable. Know when to engage, when not to. Take care of yourself so you can be there to help your bipolar son or daughter.

Exactly. A person’s ongoing bipolar disorder can take a toll on the family. It is important that family members don’t personalize their loved one’s symptoms or tie the illness to their relationships. Find ways to help the person with bipolar disorder build a better life but which simultaneously allow you to take care of yourself.

It is, yes, a balancing act between when to actively support the person with bipolar disorder and when to back off to allow them personal growth and self-responsibility. And, armed with education on the course of the illness in your loved one, prepare for the unpredictable.

People with bipolar disorder can recover. They can lead productive, loving, lucrative lives. Their families can maintain the home, keep things together, and lead happy lives themselves. These things can happen. Human beings are resilient.

But, in the bipolar home, it takes uber-vigilance and a plan to keep from coming unglued, particularly these days.

— Roger Pehlke is president of NAMI-Yolo.

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