Impact of Mood Disorders on Victim, Family, and Friends

A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

E. Impact of Depression and Bipolar Disorder on Others

Mood disorders affect not only the lives of the victims themselves, but also the entire social setting in which he/she moves: marriage, family, friends, job, society at large. The root cause of all these impacts is the degraded ability the victim has to "perform" in these different areas of his/her life. Thus a seriously depressed person will become morose, incommunicative, withdrawn, and unable to participate actively in what is going on. He/she will often become a "wet blanket", sapping out whatever joy there might be in any occasion, and most will agree that they don't enjoy having this person around. It, therefore, can become a rather heavy burden upon family and friends to have to compensate, on the one hand, for the loss of the "social'' contribution that would customarily be expected from the victim in the normal family setting, while at the same time making an extra input of care, encouragement, supervision, and listening to him/her. A manic person is the opposite: he/she will be obtrusive, aggressive, argumentative, convinced of his/her infallibility, vain, arrogant, and quick to give orders to others. Such people can be a real pain to be around. In the family setting a manic person is often rocking the boat: causing arguments, being peremptory, making irresponsible expenditures and commitments, and unilaterally breaking agreements.

It is impossible even to estimate the amount of emotional pain, stress, and loss family members experience in trying to deal with, ultimately to help, a mentally ill person in the household. In many cases their lives are seriously disrupted, becoming a kind of living hell. Perhaps nothing is more awful than to see, day in and day out, someone you love severely degraded by an illness you don't fully understand, to do everything you can think of to help, and have none of it work. And in addition to have to deal with the stigma associated with such illness, not only by society at large, but also in your own mind, however far back you may have pushed it. And thanks to the outrageously inadequate framework provided in our society for mentally ill persons and their families, you won't get much institutional help, short of hospitalization, which ought to be only the last resort.

As the illness becomes more serious, degraded performance shades into incapacity. Thus the depressive will linger in bed, begin to be routinely late for work, be unable to make decisions or handle the workload on the job, and eventually will be perceived as an unsatisfactory employee. Likewise the manic will make quick but bad decisions based on little or no knowledge or data, will take serious risks with business assets, become insubordinate or otherwise disrupt the normal chain of command, and will be perceived as unreliable, though energetic, and therefore an unacceptable risk.

The loss of a permanent, well-paying job is one of the worst things that can happen to someone with mental illness. First, it means direct loss of income, perhaps the main source of income in the family. Second, it may mean loss of medical insurance, which may be badly needed in the weeks and months ahead. Third, it means an unsatisfactory performance rating in one's personnel file, which may come back to haunt the victim again and again as he/she tries to find further employment. Fourth, it is a serious blow to the self-esteem of a depressive, whereas a manic may not even consider the loss worth notice. Most people do not have sufficient savings to face a prolonged period without income, and available funds are usually quickly exhausted. All too quickly the rent or mortgage becomes overdue, and eviction follows. These difficulties are all magnified and accelerated if the victim is the principal wage-earner for a family. In such cases the role and value of the victim as an effective spouse or parent erodes quickly, and a separation or divorce often ensues. To make matters worse, there is almost no effective public assistance available to a seriously mentally ill person and his/her family. To obtain, for instance, Social Security disability status can take months or even a year (I don't know why so long), and the benefit, once it starts, is minimal -- adequate if the ill person is the "guest" of another family member, but totally inadequate for even bare survival of an individual. This downward spiral is the reason so many mentally ill people end up as street people in our big cities, unable to help themselves in any way that will lead to improvement or remission of the illness.

It is impossible to even guess the tremendous amount of hardship, stress, pain, and despair that our current system produces for people having the misfortune to become mentally ill. One of the most important things that can be done within the existing system is to learn how to recognize mood disorders in an early stage, before the grim scenario given above has a chance to unfold. Once recognized, the illness urgently needs prompt, effective treatment. I stress again that "mere" mood disorders can be life-threatening. If necessary, the victim should be hospitalized, and thus placed in an environment where daily needs can be met, safety can be assured, and optimal treatment given. The expense for such treatment in a private hospital can be very large, and can rapidly exhaust one's insurance. The quality of treatment in free public hospitals may be seriously substandard. These are issues of public policy; we address them briefly below.

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