Mental Health – Husband has bipolar disorder: I have been serving for 12 years, I feel tired all the time, I am getting depressed, what should I do?

Question- My husband has bipolar disorder. We have been married for 12 years. For a long time we did not know that he had this condition. Sometimes he would be very happy, very energetic and sometimes suddenly he would be very depressed. Initially it seemed like a normal mood swing. But then the period of depression started lasting so long that he did not go to office for weeks. Remained lying in the room closed. Four years ago we learned that he had bipolar disorder. He is undergoing treatment. Also taking regular medicines. But after 12 years of caregiving, I am completely exhausted. Now I need help. It seems that my mental health is deteriorating. What shall I do? Expert – Dr. Dron Sharma, Consultant Psychiatrist, Ireland, UK. Member of the UK, Irish and Gibraltar Medical Councils. First of all, thank you for asking the question. I can understand how much courage it takes to even ask this question in our culture and social conditioning. Your question is absolutely valid and I will try to answer it as best I can. What is caregiver stress? The person caring for a person suffering from some kind of physical or mental illness himself also goes through deep stress. He has the full responsibility of taking care of the sick. Many times the caregiver does not get the support and help needed to do this work. In such a situation, the mental and physical health of the caregiver is also negatively affected. In the language of psychology, it is called caregiver stress. Where did the concept of caregiver come from? The concept of caregiver stress first emerged when it was observed that people caring for a person with a chronic illness were becoming sick themselves, even though they were not the “patient.” In the 1970–80s, researchers working on dementia, stroke, cancer, and serious mental illness found that the physical and mental health of caregivers was also deteriorating. These people started becoming victims of emotional burnout and anxiety. Irritability increased in him. Not only this, the proportion of metabolic disorders like diabetes also started increasing among them. It was from here that I understood that caring for someone is not just giving one’s time. Caregiving takes mental energy. For this it is important to be emotionally tolerant. The caregiver has to remain alert all the time and this constant pressure leads to care stress. Under what conditions does caregiver stress occur? However, caregiver stress can happen to a person taking care of a patient with any chronic illness, such as paralysis, cancer, Parkinson’s disease, chronic pain, etc. But this stress is seen more deeply in those caring for people suffering from mental illness. The reasons for this are clear: 1. Uncertain nature of the disease. In the case of mental illness, there is no fixed timeline of illness, treatment and recovery. The patient may feel better at any time and his condition may worsen at any time. In such a situation, the caregiver always has to be in alert mode. Uncertainty always keeps him alert. 2. Change in behavior: In conditions like depression, bipolar disorder and schizophrenia, a person’s behavior can change at any time. He needs care all the time. This is an emotionally draining experience for the caregiver. 3. Invisible illness: One problem with mental illness is that it is not visible from outside. Therefore, the caregiver does not even get validation for his hard work and dedication. Neither from family, nor from society. 4. Constant emotional monitoring: The burden of keeping an eye on the patient’s medication, sleep, mood, social withdrawal, everything falls on the caregiver. 5. Reversal of roles: In case of prolonged illness of a family member, the wife/husband, son/daughter gradually become the “care manager”. In such a situation, the natural balance of the relationship gets disturbed. 6. Indian Social Expectations Caregivers in India are expected not to complain, take care of everything, and suppress their fatigue. This makes the stress deeper. Difference between caregiver stress and depression Caregiver stress and depression are not the same thing. Many times both are considered one and the same. The hard work and pressure of caregiving leads to chronic fatigue, which leads to feelings of sadness and irritability. Many times people confuse this with depression. Therefore it is important to understand the difference between the two. Point to note: The most important thing to note here is that if caregiver stress is ignored for a long time, it can turn into clinical depression. Potential Risks of Caregiver Stress If caregiving stress becomes excessive and gets out of control, it can lead to many health risks. See the details in the graphic below – Caregiver stress poses a risk to the patient. If the caregiver is a victim of chronic stress, it can also pose a risk to the patient. The risks may include: ● Decreasing quality of care ● Emotional neglect (even if unknowingly) ● Inability to administer medications on time ● Increased conflict between patient and caregiver ● Irritability of caregiver leading to worsening of patient’s condition ● Increased risk of relapse, crisis, or medical emergency Are you struggling with care stress? Here I am giving you a self assessment test. There are total 8 questions in the graphics below. You have to read these questions carefully and rate it on a scale of 0 to 3. For example, if your answer to the first question is ‘no’ then give 0 marks and if your answer is ‘almost daily’ then give 3 marks. Finally analyze your total score. Its interpretation according to the numbers is also given in the graphic. For example, if your score is between 0 to 6, it means that stress can be managed. But if your score is more than 14 then you are at risk of burnout. You need to pay attention to your mental health. Understanding and Managing Caregiver Stress Through CBT CBT (Cognitive Behavior Therapy) recognizes that our stress is created not just by circumstances, but also by our thoughts. A common thought in caregiver stress is – ● “I have to stay strong no matter what.” ● “If I lose control, everything will go wrong.” ● “My fatigue is secondary.” Reframing this thinking with CBT Old thinking: “I’m tired, so I’m weak.” New thinking: “I’m tired because I’ve been caring for so long. It’s a human reaction.” Write this thing down daily and repeat it in your mind again and again. By doing this the thinking changes. The mind starts adopting alternative thoughts. What a wife can do are some practical steps: 1. Set role boundaries. Remember – 2. Differentiate between crisis and routine. Remember – 3. Self time is non-negotiable. Remember – 4. One person with whom you can share your heart. 5. Have the courage to seek professional support. The caregiver may also need therapy or counseling. So don’t hesitate to seek help. This is not a weakness of the caregiver, but a need. When is immediate help necessary? In these situations, immediate help or professional help is very critical. If any of the situations in the graphic below arise, don’t hesitate to seek help. Final Thoughts Caregiver stress is not a minor or marginal issue. This is a serious situation. But if it is identified and addressed on time, it can be easily managed. Remember: …………… Read this news also Mental Health – Kept partying, didn’t pick up friend’s call: He committed suicide that night, am I responsible for my friend’s death? It is not okay to blame or hold yourself responsible for a friend’s death. Your guilt is not at all proof that you are responsible for your friend’s death. Read further…