If you have a friend with bipolar disorder, you may already know that this health condition can cause extreme fluctuations in mood and energy levels. But there are also a lot of myths and misconceptions about bipolar disorder. Because of that, showing up for your friend with bipolar disorder will likely require some greater understanding of the condition on your part.
Judgment about mental health can be pervasive and harmful, and friends play an important role in providing support and kindness. “A friend doesn’t judge a friend in a way that triggers them to be their worst selves,” Manpreet Singh, M.D., director of the Pediatric Mood Disorders Program at Stanford, tells SELF. “A friend helps a friend be their best self.” Here, mental health experts and a person with bipolar disorder share how you can be an excellent source of support to people with this mental health condition.
1. Don’t equate your friend with their bipolar disorder.
Your friend who has bipolar disorder is not their bipolar disorder. They are so much more than their diagnosis. “It doesn’t define me,” Danyelle H., a 30-year-old based in Pittsburgh who has bipolar II disorder, tells SELF of her condition.
Due to rampant stigma, people with bipolar disorder can already feel like they’re being inspected under a microscope, Kirsten Bolton, L.I.C.S.W., program director for McLean OnTrack, McLean Hospital’s outpatient program for psychotic disorders, tells SELF. They don’t need that from friends, too.
2. Learn more about your friend’s specific diagnosis.
“Learning as much as you can about bipolar disorder can help with knowing what to expect and what people can do to potentially be helpful and supportive,” says Dr. Singh.
There are four main types of bipolar disorder, and they differ based on the mix of symptoms a person experiences. For instance, people with bipolar I can experience a wider range of symptoms involving manic episodes (an extremely elevated mood and energy levels), hypomanic episodes (an abnormally high but less extreme mood and energy levels), depressive episodes (low mood and energy levels), along with mixed mood episodes that bring about manic and depressive symptoms at the same time, according to the National Institutes of Mental Health (NIMH). People with bipolar II only experience those hypomanic and depressive episodes. Knowing the scope of your friend’s condition can help you offer the best support.
“The joke is [that] ignorance is bliss, but when it comes to mental health, ignorance can only be hurtful,” Danyelle says. “I think the more people know, the better.”
You can do your research through organizations like the National Alliance on Mental Illness, the National Institute of Mental Health and the U.S. National Library of Medicine. In addition, here’s some SELF reporting that may help:
3. Ask your friend if there are any ways you can help—like checking in with them if you notice certain symptoms.
Your friend most likely will not want you watching them like a hawk, randomly asking if they’re taking their medication, or doing anything else that can be invasive and hurtful. But learning about the symptoms specific to their condition can help you pick up on any changes that may signify an upcoming mood episode. And, if they’re comfortable with it, you can check in with them when you notice those symptoms.
For example, if someone is experiencing a depressive mood episode, they might become more isolated and stop replying to messages or calls; if they’re dealing with a manic or hypomanic episode, they may become irritable, sleepless, or talk about many different things quickly, says Dr. Singh. Here’s more information about the various symptoms of bipolar disorder.
If your friend starts exhibiting these symptoms in a way that’s abnormal for them, Dr. Singh recommends saying something such as, “You don’t seem like your typical self. Is there anything I can do to help you get the help you need?”
Even if they’re not sure of exactly how you can help—or don’t need or want your help—simply asking can be meaningful. “If you ask me what I need, I may be struggling a lot and I might not be able to tell you,” says Danyelle. “But just the fact that you asked me what I needed then gave me the opportunity to tell you what that is, to meet me where I am, and to be respectful of my needs in that moment? That’s a capstone of my relationships in general.”
It’s a much better strategy than ignoring a friend’s symptoms. “A lot of times people don’t know what to do, so they shut down, and that’s probably the worst thing,” says Danyelle.
4. But remember—you are not their doctor or therapist.
“You don’t have to do a diagnostic interview or psychologically size up a friend—that’s not your role,” says Dr. Singh. “Your role is to express concern, especially if there might be a serious risk of harm, and help them find help as quickly as possible.”
Outside of that, don’t assume that you need to monitor your friend’s moods or behaviors for any changes unless you’ve specifically talked about that. Having a conversation with your friend about what symptoms or triggers they’d specifically like you to take note of—or not—is a great place to start.
For instance, if you know your friend is in a lot of debt and they’ve asked you to help them monitor their spending when they’re experiencing a manic or hypomanic episode, then it would make sense to speak up when they’re suddenly talking about making an unnecessary financial purchase with money they don’t appear to have. But if you haven’t discussed your role in helping them manage their symptoms, you don’t want to just assume that every splurge they make is due to a manic episode.
And remember: Unless your friend is experiencing a mental health emergency with symptoms like suicidal ideation, all you can do is be there for them and encourage them to talk to their doctor if you’re concerned—you can’t force them to get treatment.
5. Prioritize encouragement over advice.
Even if you’ve done your digging on the disorder, throwing out unsolicited opinions or suggestions can make your friend feel pathologized, Bolton says. Also, your advice might not actually be helpful or accurate, no matter how much research you do.
Instead, try statements like, “I’m here for you,” “I care,” or “Even though I don’t fully understand, I can offer my support.”
“We need encouragement,” Danyelle explains. “We need someone who is going to hold hope when we can’t hold it for our ourselves.” Stay away from anything that telegraphs pity. “No one wants to hear, ‘I feel so, so sorry for you,’” says Dr. Singh.
None of this is to say you can’t ever offer your friend advice, but you should ask if they’re open to it in the first place. If they are, it’s all about framing your advice as an option rather than an answer.
“It’s not, ‘This is what you should do,’” says Danyelle. “It’s, ‘You’re not alone. This has worked for some people. Maybe it could work for you.’”
6. Stay away from platitudes.
After all, if someone could calm down or cheer up, they would, right? “People can’t simply ‘snap out of it’ or choose to be happy, no matter how well-intentioned your advice might be,” Dr. Singh says. “It’s hard to know how to react … but platitudes end up antagonizing people more than they actually help.”
7. Remind your friend that their mood episodes aren’t permanent.
Even if they feel neverending in the moment, mood episodes come and go. “Knowing that can be a huge source of optimism for people who are struggling with moods that are undesirable,” says Dr. Singh.
You don’t want to veer into “everything will be fine!” platitude territory, though. Instead, say something more honest and specific, like, “I know this sucks right now. I remember you told me that you usually come out of your depressive episodes in three to four weeks, so you have about [insert however much time is remaining here], right? Every single day that passes gets you closer to that point. Is there anything I can do to help in the meantime?”
You can also take the initiative to suggest activities the two of you can do together that you think may help, even if it’s as simple as going outdoors and getting some exercise or fresh air, says Dr. Singh.
8. When your friend isn’t experiencing a mood episode, ask what’s most helpful to them when they are.
Since everyone is different, it’s a good idea to ask your friend what’s useful and what’s not during their mood episodes, Bolton says. They might have different insight into their condition when they’re not experiencing those shifts, which can translate into better action items for you.
9. To make your friend really feel heard, listen to them actively instead of passively.
Active listening involves making eye contact, affirming what the person is saying with feedback like nodding and occasional verbal responses like “uh-huh,” and asking clarifying questions that show you’re paying close attention, Dr. Singh explains. You can also reflect their experience back to them by saying things like, “So, what I’m hearing from you is that the hardest part of having bipolar disorder is…”
Beyond that, active listening also involves avoiding the urge to immediately jump in and try to help. “The way that the friend ends up finding a path to recovery could be completely different from the ideas you had,” Bolton says. “Or they may be similar, but allowing the space for the friend to truly feel heard is important.”
You may not feel like listening is doing much, but it can. “One of the most important things is being able to sit with someone in that darkness,” says Danyelle. “I don’t expect someone to fix it and I don’t want them to. Just understanding that that’s the space I’m in … and not being afraid to be there with me is incredibly helpful.”
10. Accept that your friend’s symptoms might affect your relationship.
Treatment may help manage a person’s symptoms, but it can’t offer a cure for a person’s mood changes. It’s a chronic condition. “Your friendship may be one of the most stable aspects of their lives,” says Dr. Singh.
Part of that friendship involves understanding how your friend’s symptoms may affect your bond. “A friend who can weather those ups and downs will likely be someone who truly understands the condition well,” Dr. Singh says.
This is another time when it’s important to remind yourself that your friend’s bipolar disorder doesn’t define them. They can cancel on you last-minute without it being a sign that they’re isolating themselves due to depression. They can become easily irritated with you for reasons besides entering a manic episode. Do your best not to immediately chalk everything up to their bipolar disorder, and set and reinforce your friendship boundaries when necessary just as you would with other friends.
11. Suggest they get involved with organizations that can connect them to other people with bipolar disorder.
For instance, The Depression and Bipolar Support Alliance (DBSA) is a peer-run organization that can help people with bipolar disorder get to know others who have the condition, says Bolton. Danyelle is currently cochair of the organization’s Young Adult Council, which recently released DBSA’s Social Wellness handout to help people with mental health conditions (and those who love people with mental health conditions) navigate interpersonal relationships.
“This group has helped me learn more about myself and promote my own recovery, as well as provide support, hope, and encouragement for others that are experiencing the same challenges,” Danyelle says.
12. If your friend seems in danger, be there for them, be transparent about your concerns, and seek emergency medical attention if necessary.
When you’re doing your research about bipolar disorder, make sure to learn the signs that your friend needs urgent mental health attention. That can include talk of suicide or death-related thoughts.
If you feel like your friend is in crisis, use reassuring language such as “I’m here. I care. I want to help. How can I help you?” or “Your life is valuable and worthwhile, even if it doesn’t feel that way right now,” says Dr. Singh.
Ultimately, though, you should recognize that you can’t handle this kind of situation alone. If your friend is suicidal, in extreme emotional distress, or otherwise making you fear for their health, call 911 or contact the National Suicide Prevention Lifeline at 800-273-8255. The lifeline is free and available 24/7. It may also be necessary to contact your friend’s family, Bolton says.
Don’t let fear that your friend will be upset stop you from seeking help. “If you are getting to the point that you feel your friend needs to be safe, previous boundaries that were held in your relationship may need to be violated,” says Bolton. Yes, your friend might be angry, but what matters most in this situation is their safety.