Bipolar 2 From Inside and Out

Posts tagged ‘caregivers’

The Three Kinds of Care

December is National Family Caregivers Month, so it seemed like a good time to talk about caregiving. In my view, there are three kinds of caregiving: giving care, receiving care and self-care.


Caregiving is not an easy task, no matter whether you’re a family member or a professional. With an uncommunicative person such as one with depression, it practically takes telepathy. At times it seems impossible to know what kind of care is needed. A hug? Encouragement? Alone time? Help with chores? A listening ear? My husband, who is my principal caregiver, does all those things for me.

One thing about caregiving that I learned from my parents is that caregivers need recognition, too. My mother took care of my father all through the years of the illness that killed him. He wasn’t mentally ill, but his physical needs were many. Once my mother came to me and asked if she was doing a good job of caring for him. Of course, I reassured her. The thing is, objectively she knew that she was meeting his needs well. She just needed to hear it from someone else. You can talk about not looking for external validation, but sometimes it’s the kind you really need.

Receiving Care

All caregivers need recognition, and the best kind comes from the person for whom they care. That’s not always possible. Many therapists find it inappropriate to get gifts from their clients (mine accepted a small plant graciously). But a simple holiday card can be a nice remembrance. Other recipients of care have something to offer their caregivers as well – simple human connection.

Certainly, those of us receiving care can be irritable or even angry about needing care, but some recognition from us can go a long way toward keeping our caregivers, well, caring. Kindness is reciprocal. I know it’s hard to remember that or to act on it.

I owe my husband – my primary caregiver – more than I can say. Without him, I wouldn’t be able to do what I can do – take care of paying the bills and work enough to keep us mostly current, for example. And I thank him, appreciate him, and do what I can for him. I try not to be greedy with his time and efforts – I know he has other things he’d rather be doing or needs to do for his own care. I know I don’t do nearly as much for him as he deserves.

Self Care

For people who have a mental illness, self-care can be difficult. We know what we should be doing, but it’s often difficult. It feels like self-care is just another chore, on top of all the other things we’re not able to do. If I can’t keep on top of laundry and dishes, how am I supposed to keep on top of showering? If I can’t manage to get out of bed for more than a couple of hours a day, how am I supposed to find time and motivation to exercise?

I know that self-care is important, but I have trouble doing it sometimes. I know I’m capable of it. I’m on my own while my husband is at work, and I managed to keep up self-care while he was out of town earlier this year. But somehow, I never seem to get beyond the very basics of self-care – eating and sleeping regularly. Never mind the manicures, shopping sprees, and bubble baths that some recommend. Those might require getting dressed, going out among people, and spending money. (Bubble baths don’t, of course, unless you count going out to get the bubble bath, which I do count. I sure don’t have any on hand.)

If you’re able to make even modest efforts toward self-care, make sure you give yourself a metaphorical pat on the back. Believe me, you’ve earned it.

The bottom line is this: No matter whether you give or receive care or care for yourself, you need and deserve recognition and appreciation.

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On My Own

Earlier this month, my husband went away for 11 days to visit his 96-year-old mother, leaving me at home to fend for myself. I didn’t object to his going (though that hasn’t always been the case on other occasions). But it left us both concerned about how I was going to manage without him for nearly two weeks.

My husband helps me with most of my self-care needs. I guess I shouldn’t even call it self-care because he does so much of it. He makes sure I eat regularly, shops for food, and usually prepares dinner. He recognizes when I’m overwhelmed and gives me a hug. He helps me get ready if I have to go out. He does most of the physical chores. (I do the ones involving a computer, like correspondence, bill-paying, and scheduling appointments.) He calls me twice a day to make sure I haven’t fallen and been unable to get up. If I don’t answer the phone, he rushes home on his break to help me. I really don’t know what I would do without him.

For 11 days, though, I was going to have to. We hadn’t been apart this long for years.

Since one of my major self-care problems is forgetting to eat or not having the energy to make myself something to eat, he stocked up with all the things I like that were easy to fix and eat: juice, cola, ginger ale, yogurt, cans of soup, whole wheat bread, bologna and salami, assorted kinds of cheese, applesauce, and those little frozen meals for useless people like me. There were muffins and frozen waffles for breakfast, peanut butter and mac-n-cheese and spaghetti for lunch and dinner, and even jello and pudding for dessert. Everything that needed heating was microwaveable.

I often eat in my study, where there is a little tray table, so we devised a strategy for getting to and from the refrigerators. The time when I trip and fall most often is when I’m carrying several items and lose my balance. He came up with the idea that I should carry my food items in a plastic grocery bag to and from my room. We have hundreds of those bags. And it worked. I didn’t fall once. I don’t know why we didn’t think of that before.

He still called me every day, though of course there was nothing he could do for me if I fell. In fact, he called me much more often than twice a day, just to talk. We found the thing we miss most when we’re away from each other is simply shared conversation.

I developed a little routine to see me through the days. In the morning, I would have breakfast and watch a cooking show till I was awake and alert enough to start my day. Then I would do my work in the mid-morning until lunch. After lunch, more writing. After dinner, music or TV, or more work, if I had an especially pressing assignment. Go to bed early. Lather, rinse, repeat. Repetitive, certainly, but it seemed to work.

So, what did I learn from this exercise? Well, first of all, I found out that 11 days on my own is a doable thing – if we anticipate difficulties and prep for them. That I am able to continue my daily rhythms and keep up with my work, eating, and sleeping. That I experienced no recurrence of my bipolar symptoms even though my usual environment had changed. (I had been worried about depression or anxiety setting in.) That the loss of my husband’s presence wasn’t crippling. That we managed to retain our important connection despite the physical distance between us.

That photo with this post isn’t entirely accurate, though. I didn’t meet my own needs completely on my own. My continuing self-care still required my husband’s help. But once the systems were in place, I managed. On my own.

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Caregiving: What We Owe Our Animals

By fantom_rd /

I’ve written before about emotional support animals and what a difference they can make in the life of a person with a mental illness such as bipolar disorder. And that’s still true. Emotional support animals and trained service animals can make a vast difference in helping a neurodivergent person cope with life and their disorder. (A thorough guide to emotional support and service animals can be found here:

It’s unfortunate that misunderstanding and misuse of emotional support and service animals have made it more difficult for persons who really need them to have the comfort and utility of such a companion when they really need it. The fact that pet “vests” labeled Emotional Support Animal are available willy-nilly online is a disgrace. (I saw one site that sold all kinds of vests with assorted patches, ID cards, and collar tags. It had “It is fraudulent to represent your dog as a service animal if it is not” in really small type on only one page.) Real service animals require thorough training and provide specific kinds of support to their humans.

There are many animals that provide comfort, companionship, and emotional support without being official, trained service animals. Cats, for example, are notoriously bad at being able to perform actions such as diverting a person with OCD out of a behavior loop or reminding a person to take medications. Hamsters, rats, and fish, while providing hours of comfort and emotional diversion, are not really qualified as service animals. Monkeys can be officially accepted as service animals, as can pigs and miniature horses. But the ADA (Americans with Disabilities Act) makes no provision for emotional support sloths, lizards, or rabbits. People who take these animals onto airplanes or into restaurants – or people who take untrained dogs there – screw it up for those who truly have need of nonhuman support.

But that’s not what I’m here to talk about today. I want to discuss people with mental illness and what they owe to the animals they live with. Caregiving.

It’s great that animals can act as supportive caregivers to human beings in need, but the animals have needs, too, and it is up to the human being to accommodate them.

Unfortunately, when I had my worst major depressive episode, I was not able to provide proper care for my companion animals. The cats needed regular food and water, a clean litterbox, and appropriate medical care, at a minimum. Fortunately, when I was too ill to provide those, I had a caregiver (my husband) who was. If he had not been available and willing to take over the pet-care duties, they would have been neglected, and suffered for it.

This is not to say that people with mental illnesses should not have pets. Companion animals can be a wonderful solace and comforting presence. My cats’ purring, lap-sitting, and other behaviors have been soothing and peaceful at times when I really needed it. Just their presence could bring me out of myself for a while. Caring for some other being is a powerful adjunct to therapy.

Even persons with severe mental illnesses can benefit from the presence of animals and are able to care for them, sometimes even better than they can care for themselves. Think of the homeless veteran with PTSD who cares for a companion dog, making sure it eats even if he doesn’t, and finding it shelter from the cold. It’s hard to say which is doing more for the other. And people with depression, for example, may find that caring for an animal brings them out of themselves, at least a little, and connects them with a world wider than the inside of their head.

What I am saying is that people who know they may be incapacitated by their mental illnesses probably should make preparations for a time when they are not able to care adequately for their animal companions. I was lucky to have a caregiver who was as emotionally invested in caring for the cats as I was. He took over the caregiving for them as well as for me.

It is, however, only sensible to make plans for your animal companions if you know you may be unable to give them proper care – for example, if you know you are facing hospitalization. Pet-sitting or boarding arrangements can be made in advance and called upon in case of emergency. Even a pet feeding and watering station that provides several days’ worth of sustenance can make owning a pet more practical when your coping skills disintegrate.

I wouldn’t give up my cats for anything. Unless giving them up was the only way to ensure that they received proper care. No animal should suffer just because I do.

My Turn to Care

My husband had a heart attack this fall. He got a total of five stents, avoided open heart surgery, and is now in cardiac rehab. And I am helping take care of him.

Dan has been my caregiver as long as I’ve known him. He has stuck with me through the various ups and downs of bipolar disorder – when I was untreated, when I was struggling with finding the proper medication, when I shouted at him, when I was immobilized – whatever. I couldn’t have got through what I’ve been through without him.

Now I get to pay him back, at least a little, for all he has done for me. I have no training and little experience as a caregiver. But there a few things I can do for him, in addition to loving and supporting him as he has loved and supported me.

I can facilitate his appointments, meds, and procedures. Dan has a tendency to forget when is next appointment is, and with which of his many doctors. I have a perfectly good whiteboard in my study on which I note my own appointments as well as keep track of my work. It’s no trouble at all to add his and remind him.

Getting to his appointments is another area where I can help, especially since his cardiologist has a number of offices in various parts of town and in nearby suburbs where he practices on different days of the week. Since I’ve lived here most of my life, I know the area better than he does and I go with him to navigate. (He’s never gotten used to GPS.) I suggest routes that are easy to retrace and figure out when to leave to get there on time.

Dan has in the past had a habit of forgetting to take his various medications.  When that involved sertraline, I didn’t worry much since I know that once a certain level has built up in the body, missing a dose is not such a big deal. But with his blood thinner, a missed dose could lead to a clogged stent and another heart attack. So I proactively encourage him (as my therapist suggests I call nagging) to take them daily and on time.

I can handle financial stuff. With Dan being off work for so long and hospital and doctor bills adding up, our finances are getting pretty tricky. I can make sure I have steady work and even take on extra sometimes. I can fill out the forms for short-term leave, financial assistance, insurance, and other necessities.

I’ve even been able to set up PayPal and Facebook funding pleas to help us get a little extra cash to pay the utilities and other bills. (GoFundMe may be next once all the medical bills are in.)

I can handle computer stuff. Finding locations of offices and hospitals and the cardiac rehab place, phone numbers of financial aid programs, and names and side effects of medication are easier and quicker for me to do on my Mac than for him to do on his ancient PC. I can find things he needs on ebay for the lowest price. I can find and email various forms and records of expenses to wherever they need to go. This may sound minor, but believe me, it can take up a lot of time and frustration. I think of it under the heading of relieving his stress.

I also know how to network. A Facebook friend of mine teaches Tai Chi at a local Y. Through him I found out that the Y does not charge for his classes. And through Google I found that this month the Y waives membership fees if you donate canned goods to a local food pantry. The Y’s amenities include exercise classes and water aerobics, which I also could use. I also found a local Senior Center that has yoga and free weights (and community theater) as well.

I can understand his depression. Being faced with intimations of one’s mortality, combined with money problems and not being able to work can make anyone depressed. And Dan was already taking meds for depression before this current crisis even started. I am, of course, a third-degree black belt when it comes to depression. I know how he feels, why he’s feeling it, and what will and won’t work in helping him through it. I can be patient, supportive, and there to communicate or simply hug when he needs to, as he has so often done for me.

There’s not much care that my husband needs in the way of actual physical care. He is not so incapacitated that he needs help with feeding, dressing, bathing, or other tasks of daily living (other than changing his bandages when he cut his finger open and required eight stitches).

But I like to think that the support I can give him helps in his recovery by taking some of the stress off him, which his doctor recommends and which he has done for me innumerable times. We’re a team and this time it’s my turn to take some of the weight.

Caregivers Need Care Too

While there are professional caregivers, family members often provide care and support for those with bipolar disorder and other mental illnesses.

My husband of 35 years is my caregiver. He does a spectacular job – making sure I have my meds, taking me to my appointments, running the errands that I have no spoons to do, keeping the house quiet when I need to sleep, making sure I eat at least one nutritious meal a day.

It’s a lot. And there are things I can give him in return. Things he needs.

Appreciation. When my father was dying of cancer, my mother was his primary caregiver. One day she came to me, wanting me to tell her that she was doing a good job. She knew that she was. She just needed to hear it from someone else, someone who could tell her that her excellent care had been noticed and appreciated.

Appreciation – validation – is the thing that caregivers need most, to replenish themselves, to allow them to keep doing the things that are so vital for their charges. And it’s the easiest to give. When you’re in the depths of depression, it may be difficult to remember to say “thank you,” but it means a lot to your caregiver.

Now I’m mostly out of my depression (usually), and I say “thank you” a dozen times a day. And he always responds, “You’re welcome, friend.”

Alone time. Primary caregiving can be a full-time job. I know that one thing I need in the process of healing is alone time. Dan needs it too. He needs time off, even if that’s just time to retreat to his study and watch a movie or go outside and dig in the garden. I can always reach him if I really need him – for example, if I have a panic attack – via cell phone if nothing else. But, as the saying goes, you can’t pour from an empty vessel. That’s part of the reason that he’s able to give me so much of what I need.

Couples time. This doesn’t necessarily mean sex. It means time spent together, doing something other than dealing with mood swings and trauma. It’s a little gift we give each other. Sometimes I sit through a movie I don’t really care for, just to give him the gift of snuggling on the couch. He got me color-and-bake ceramic mugs that are great for creativity and distraction. One rainy afternoon we sat together and each colored one side of the mugs.

Life stuff. Dan does most of the chores and tasks of daily living, but I do what I’m able to. I earn money. I pay bills online and do most of the other computing, except what he does for leisure. I help with cooking to the extent I can – sous-chefing, finding recipes, breading or mixing or inventing dressings and sauces, making grocery lists. He can ask me for help too.

Sharing my spoons. When I do find myself with a few spare spoons – a little extra energy occasionally – I try not to be selfish with it. When I have spoons to spend, I like to shower and dress and go out for lunch. But the other day, I showered and dressed and went for a walk in the woods with Dan, something he’s been longing for. My spoons ran out pretty rapidly, but he appreciated that I made the effort and shared one of his delights. It was another gift that cost no money.

In other words, when you have a caregiver, don’t think it’s all one way. Your caregiver needs care too. Small or large, what you are able to give will be appreciated.


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