Expert: Libby Bonner - 8/13/2008

Question
QUESTION: Hi,
My daughter is 28 and was diagnosed with bipolar about a half a year ago.  She is reasonably medicated as far as I know.  She lives in Manhattan with her boyfriend and I live south of Boston. Both she and her boyfriend are smart, level-headed people and I love and trust them both.

Around May, my daughter just seemed to need to distance herself from me. I am divorced and she is an only child, so I try hard to not put pressure on her in general. She is sensitive to that.

When she was first diagnosed we were on the phone a lot, and I went to see her in NY to help her figure out what to do.  She was fairly scared and she came home here for a few weeks to get regulated with her meds.  (This was what she and her boyfriend thought was the best solution at the time.)

She has withdrawn from graduate school, but plans to go back this fall.  I know she has anxiety at times, and I know her confidence wavers.  But she does have friends, gets out, and has a social life.  

Our relationship is very changed.  She does not want me to visit her, she is uncomfortable with me.  Our conversations are awkward. This is a very big change that started right after she was up here to visit me on Mother's Day (which seemed to be a happy, normal day).  The next time I talked to her, she just was not the same.  

We do talk online at times - usually she initiates it.  I am really missing my connection with her, but I don't want to force her to react to my concerns.  She knows me very well and is an astute observer when it comes to feelings, etc.  

She is in therapy three times a week, and this is because of her diagnosis.  Of course I am very concerned, but it seems like I have to keep my distance.  

I want so much to just hug her or have things back the way they were.  We have always been close,  with - of course - the usual ups and downs of mother - daughter complications. I dare not write to her about this issue, my fear is that she will withdraw more and it will seem like a confrontation to her. She knows how I feel, I'm sure of it.  But, am I doing the wrong thing by just keeping my distance and pretending that this is ok with me?  It seems that that is what I must do, but it feels so awful and is such a loss.  

Thanks for listening.

ANSWER: Sorry to have kept you waiting; I can usually do same-day responses.

I have had your experience, w/ my daughter, except that I received a letter announcing that we would henceforth have no contact.  And we didn't, for nearly a year.  She was fairly sick at the time, and not receiving the best care....the early years of her illness really predated today's psychiatric approaches and excellent meds.  I don't mean to suggest at all that you are headed in that direction, only that I know how bereft you are feeling.

I hope you can maintain some regular communication w/ her boyfriend that will be comfortable for him and be acceptable to your daughter.  There are so many things that might be going on, and so many unknowns re the future, that some contact w/ a third person will be awfully desirable.

I think your current stance is probably the right one, hard as it is.  And I hope that time will bring her closer to you again.

Do hang onto the good news, that she initiates emails w/ you.

I do have some concerns about how well she may be right now.  You mention her having gotten regulated on her meds and then having returned to NY, but that would be unusual luck to get it right so quickly and not have some ongoing meds tinkering.  Do you think she sees a psychiatrist regularly?  She certainly should be, forever, since meds tinkering is a lifetime thing:  stability can and does slip, and the sooner meds are reviewed and perhaps changed, the better.

I also wish I/you knew more about the 3x/wk "therapy." Meds are the mainstay of bipolar treatment and so I am wondering what the purpose of the therapy is and what the credentials of the therapist are.  If she is having problems adjusting to the realities of the diagnosis, that might be a valid reason for short-term therapy.  Or therapy might be in order if anxiety is a big component - though one would still like to know that there were goals and an end-point in mind.

The immediate actions that might benefit you most right now would be to start attending a good NAMI family support group.  You can find  affiliates at nami.org and then contact those closest to see if they have support groups.  You might need to attend a couple different ones to get the right fit.

It might be appropriate for her boyfriend to find a group, or to take the NAMI Family to Family class.

Your daughter likely would benefit greatly though contact w/ other patients ["consumers," in NAMIspeak.]  The newly-diagnosed are dealing w/ a terrible welter of emotions about their diagnosis, their futures, and about who they now are.  Until they make some contacts, they feel terribly isolated and have no way to get any useful feedback about their thoughts and their prospects....  It's possible that a NAMI affiliate near her offers informal meetings for consumers or perhaps offers the NAMI class Peer-to-Peer.  Community Mental Health Centers also usually run informal groups for consumers.  It's likely that she could attend those w/o any formal connection w/ the Center; otherwise, her doctor could write an order for those Center activities that would benefit her.

NAMI Connections is a new program for consumers, but that program currently runs only an hour and a half/week in most locations.

Her University may even have a NAMI consumer chapter - check the website.

I dwell on all this because you are likely to see more of her again once this whole thing normalizes for her and gets integrated into her view of Self.  Try to remember that she now has a chronic illness at a young age - hard to handle...and an illness that may make subtle changes to her personality...and that likel will affect her moods.

Maybe make a one-time declaration, if you haven't yet, that you do miss her and that she will always be close to your heart....whatever sounds like you.  Don't change much that you would normally do - send birthday cards and such....but you might want to feel out what her wishes are re celebrations and holidays...both are usually stressful for consumers.  Hang onto the low-key stance that you are doing now, vent to your closest friend/s, and be extra low-key if/when you next meet her, esp if at your home.  Do make your love and constancy clear, but hold the streamers and champagne.  Don't even necessarily have firm expectations about the length of a next visit, regardless of the length agreed to beforehand.  Flexibility is all.

I am so very sorry for your heart-ache. It is one of those too-numerous ocassions in life when one must bear the unbearable.  I do hope things turn around very very soon.

---------- FOLLOW-UP ----------

QUESTION: Hi, I am very grateful for your help and kind words.  The therapist my daughter sees is a psychiatrist, and her other doc is a psycho - pharmacist.  Of course I do not know their credentials - they are both associated with Columbia U. - where my daughter is a student.

I will look into the Nami Connections, although for her I find she really wants to follow her own path.  Her boyfriend communicated with me in the beginning when she was frightenly sick, but since then he has pretty much been at her side, and quiet with me on that subject. I did e-mail hi and ask him to tell me if she was in danger.  

When my daughter was in HS, she had a few dissociative episodes (that I know of) that lasted at least several hours and were scary for all of us.  She was checked out at a hosp for the first one, and after all the tests, they recommended a good psychiatrist for her.  She went once, and then was extremely resistant. Her dad and I were getting ready to divorce at the time, and she was an only child, so I imagine there were pretty heavy feelings there.  But, I don't know how or if that relates to her present condition.  I'm sure she has discussed this with her doctor.

At other times after that, she expressed the desire to have psychological help - but never seemed to complete that thought.  Once, in college, she thought out loud (online) about my somehow helping her to see a therapist at home here. But again, she pulled away from the idea on her own.  So, I know there have been some kind of issues going on for a long time, but just had no way to really help her.  Although we are close, she has always pulled away if I get too very close.  Her aunt on her father's side has had bipolar for many years, and I guess that helped them come to this diagnosis more confidently.  

You know, I think I have just been so worried about her, but I guess what you are saying is that there is only so much I can do.  

You are right about on-going wellness - she has had some panic attacks these last few months.  She has told me about at least some of them, and I know she has told her doctor.  

Thanks for listening so closely and for caring enough to be empathetic.  That helps.  I guess I do not have another question and you do not need to write back - I just wanted to fill out the details for you.  I will think hard about what you have suggested.  

Kind regards,

Barb

Answer
Just a few words.

There isn't much you can do BUT you can just drop those ocassional tiny reminders that you are there.

I realized while writing, about NAMI Connections, etc., that you can't give her this info now - "her own path" - but had hoped a hint to the boyfriend might be possible.  

There must be health insurance here somewhere for a psychiatrist 3x/wk.  Hope he/she is helping - maybe it's a NY thing, the frequency; hangover from the days of psychoanalysis.  Elsewhere, psychiatrists' roles are as experts in diagnosis and therapeutics.
But perhaps her doc has training in cognitive behavioral therapy [its former name; can't recall the current one.]  That would be an excellent use of 3x/wk.

Otherwise, wish she were spending more time w/ consumers and less w/ the doc!

The psycho/pharmacist sounds like good news.

It does seem that there may be many issues here, with a still unknown outcome.  These things do evolve - new understandings re diagnosis, w/ resulting changes in meds - and they take time.

Pls do try a NAMI group.  You may find a counterpart there - a person apart from her child.  That would have been helpful to me.

Hang in, and be hopeful.