A care plan for living with bipolar depression – how you can help

A few years ago, a dear friend asked me to please write down for her exactly how she could help me when I’m depressed. I had to write it when I was well, of course, couldn’t think this clearly when ill. I’m publishing these suggestions here not because I expect the whole world to help me, but because these notes may be helpful to other people, with of course, your own needs and amendments. I really think that anyone who experiences mental or other chronic illness should try to create a similar document for those who care for you.

It’s very difficult for me to accept help in these circumstances for a couple of reasons:

Firstly, my self-esteem is so low that I feel utterly unworthy of assistance.

Secondly, other people’s company is at times almost physically painful. Please see my written descriptions of what I’m feeling, to get some idea.

So if I seem resistant to accepting help, bear in mind that these are the reasons. Ask me how much contact I can bear at any particular time. You’ll have to have the courage to be a bit pushy. Rest assured that while it may cause me discomfort, it will never actually harm me. Arriving unannounced is not necessarily a bad idea.

To gauge what I’m capable of at any given moment, you can ask me what my mood is like on a scale of 1–10, where 1 is sheer hell and 10, ecstasy (many years since I hit 10). If 1–2, extended human contact is likely to be painful and most activities very very difficult. Get to 3–4, and things are uncomfortable, but probably bearable.

  • Please check that I have been able to make appointments with my doctor/s.
  • Please check that I’m able to get to them.
  • Please check that I have enough medication. Perhaps help me fill pill boxes so I don’t lose track of them. Check that medication includes sleeping pills, if I need it.
  • If I am having problems sleeping (this is not always the case) please call me or sms me at 10 in the evening, and get me to take a sleeping pill while you’re on the phone; this will help force me to regularise my sleep which I should ideally be starting no later than 11pm.
  • Please check/help me communicate with any people to whom I have work commitments to advise them that I am presently unable to meet those commitments. It may be worth encouraging me to make those calls then and there. You need to ask me exactly what jobs I have on the go, what the status of each project is, and whether it’s under control or not. If not, you need to please help me contact clients or collaborators to let them know that I am unable to work on this job at this time, and a plan needs to be made.
  • Help with getting food or eating is useful, doing the dishes or laundry also very helpful.
  • Providing relatively easy-to-read books, they offer some refuge from the workings of my own mind.
  • Please encourage me to bath or shower.
  • Please check that I have some sort of understanding of/control over my finances. I’m not in the least bit precious about other people knowing the ins and outs of such matters, so feel free to enquire. It may be necessary for me to cancel certain services or debit orders, for example; ask if I have done so. Help me make the calls.
  • Taking me for short excursions without any pressure to talk: short walks; sometimes movies take me out of myself a bit, but if my mood level is lower than 3, this may be beyond me.
  • If my mood is at 1–2 persistently, it may be that I should be getting ECT.

Things that don’t help at all

  • Jaunty self-help literature about the beauty and power of positive thinking, etc. It has its place. But it’s not a remedy for serious mental illness, any more than it will magic away a broken leg.
  • Messages saying, ‘Hope you’re feeling better!’

How I’m feeling

I’ve updated this account, now; these are similar notes I wrote a few years back. It shows that the texture of each depression can be subtly different. For example, during one major depression I was obsessed with my own mortality, constantly calculating the likely time till my own death.

  • Imagine knowing with utter certainty that the world is about to end, and what that feels like. I may be living with that feeling.
  • Imagine that someone incredibly close to you has died. I may be living with that feeling.
  • Imagine feeling that you are utterly, utterly worthless, racked with guilt about your inability to meet your commitments, and that there is no hope for you leading a normal life at all. I may be feeling this way. My self-esteem evaporates, almost completely. I feel utterly worthless, and guilty for even existing.
  • I may be having compulsive or obsessive thoughts; this last depression, for example, I could not cease calculating the proportions of my life lived and yet to come.
  • I may be suicidal. I may be feeling spineless and weak for not having the courage to kill myself.
  • I lose the ability to do things. The smallest things seem close to impossible. Trying to concentrate is like to trying to press together identical poles of magnets.
  • My physical health declines. I become prone to lots of niggling complaints, unhappy skin, etc.
  • Because human beings smell weakness, and often respond unpleasantly, I may be having regular experiences of being treated with contempt or disregard on those occasions when I do venture out.
  • My sleep goes crazy; I may be up all night and asleep half the day.
  • I may not be bathing for days at a time; and feeling correspondingly horrible about myself.
  • I may be feeling like a pariah, quite outside of society.
  • Bear in mind that most people cannot quite imagine feeling many of these things, or feeling them without external cause; are hence prone to dismiss them; that dismissal compounds one’s loneliness. Even I, when well, find it difficult to comprehend or imagine the depths of my own potential misery.

About David

I am an environmental writer, journalist and speaker living in Cape Town, South Africa.
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