Guardian Angels of Tough Love:
Caring for Loved Ones with Manic Depression

Manic depression can best be likened to a roller coaster in which sufferers plumb the depths of despair and scale the heights of euphoria. More than just an extreme form of sadness, depression is a state of mental and emotional paralysis that depletes the sufferers’ ability to think, feel and live. For them, each day only holds forth the painful prospect of having to go through the motions of life without any meaning or purpose. Then, without their knowing, sufferers experience a gradual lifting of their spirits to normalcy that deludes them with the false promise of recovery, before they are propelled to the manic state.

In mania, sufferers ride on a perpetual high, driven from one reckless impulse to another: engaging in one-night stands; insulting their superiors at the workplace; and going on spending sprees while their accounts are running on empty. They live only in the present, as though they were exempt from the laws governing reality. Their reckless frenzy only comes to a crashing halt as they slip gradually, with increasing fatigue, into another depressive episode, burdened by consequences of unpaid bills, unemployment and ruptured relationships.

Faced with such a baffling condition, sufferers and caregivers often look to the psychiatrist/therapist as the savior who will dispense the magic pill or treatment to make the nightmare go away. It will not take long, when the miracle has not occurred, that they will be compelled to confront the awful reality: the most important player in this fight against the illness is the sufferer, not the psychiatrist or the therapist. However, as the sufferers are engaged in the throes of their battle for their mind and emotions, they are still highly dependent on the unconditional love and firm guidance of their caregivers.

The next most important player is the caregiver. Caregivers often think of themselves as concerned, but helpless, bystanders who lack the knowledge and experience to make a difference to the well-being of their loved ones. In reality, caregivers play multiple roles that are pivotal to their loved ones’ journey of recovery. For instance, caregivers can serve as an intermediary to provide reliable reports of their loved ones’ condition to the psychiatrist and pose questions to elicit helpful information. In addition, they are protectors who ensure that the basic needs (food, clothing and shelter) of their loved ones are met. Essentially, caregivers ensure that the edifice of their loved ones’ life remains intact so that the latter can focus on getting better.

However, the caregiver role that I most want to focus on is the role of the caregiver as the “guardian angel of tough love”. This particular role often poses the greatest challenge to caregivers. As guardian angels of tough love, caregivers take on the awesome responsibility of doing whatever is within their power to motivate and steer their loved ones towards recovery. More specifically, they will do their best to ensure that their loved ones are doing the things that empower them to effectively manage their condition. This means that even when they face resistance from their loved ones, caregivers must steel themselves to act against their loved ones’ will in the spirit of love.

What are the do’s and don’ts of tough love?

Do’s

• Remind and enable their loved ones to pursue a responsible lifestyle such as taking medication (if needed), as well as engaging in daily exercises and de-stressing techniques;
• Motivate them to persist with their treatment programme when they are discouraged;
• Guide them to helpful external resources such as books, the Internet and support groups; and
• Challenge them to face up to their life issues, the root causes of their mental distress.

Don’ts

• Make excuses for them;
• Finance/enable their reckless and impulsive lifestyles;
• Give in to their whims and attempts to escape from life; and
• Shield them from the full consequences of their actions without letting them take some responsibility.

All too often, in doling out tough love, caregivers come up short. Instead of standing up to their loved ones and reinforcing the practices of sanity, they allow themselves to be pulled into the swirling vortex of madness that is consuming their loved ones. While these caregivers think that they are protecting their loved ones, they are only feeding the cycle of madness and perpetuating its vicious nature. When caregivers bail their loved ones out of trouble in their attempt to spare the latter from pain and suffering, they prevent the latter from experiencing the sobering impact of a harsh reality check that can interrupt the momentum of their manic high.

Back in 1996, my struggle with manic depression culminated in an unexpected pregnancy—the product of a brief and fiery relationship with a music video director during my manic phase. Considering that I had just enrolled in the fourth year of my university study and I was living on my own in Los Angeles, my pregnancy could not have come at a more inopportune time. My mother, who had flown in to help me for three months, offered to take baby Sebastien back with her to China where she was residing to raise him on my behalf. Eternally protective of me, she wanted to spare me from the challenges of doing what she and my father had thought was impossible for me to do: juggling a new baby as a single mother with studies and work.

In taking on this challenge, with limited financial support from my parents from afar, I was initiated into the grueling apprenticeship of raising Sebastien who was fussy, colicky and hyperactive from the very start. For the privilege of raising him, I went on medication responsibly. His subsequent diagnosis of autism at a mere 18 months old and the accompanying challenges of tantrums, language and learning delays, coupled with aggression, propelled me on a road less travelled that disciplined my impulsive nature and strengthened my spirit.

Looking back on those dark days, as I was struggling with depression and my dire fear of my inability to care for Sebastien, I could see how tempting my mother’s offer was. It would have been far too easy to shirk my responsibility and walk away; but I am glad I did not. One year later, I managed to complete my year of study, while working part-time and taking care of Sebastien on my own. On a subsequent visit, my father quietly acknowledged my first steps towards redemption: “I did not think you were going to make it. But you did.”

Well, back then, neither did I. Ironically, Sebastien would turn out to be the ideal “caregiver” for me, motivating and challenging me to rise above my limitations and living my life with discipline, commitment and love. After being on medication for nearly ten years, I succeeded in weaning myself off medication five years ago. Today, Sebastien continues to be a powerful motivating force in keeping me on keel in my life.

Although I would not recommend my lifepath as a panacea for anyone, it is instructive in highlighting the reality that caregivers who overprotect their loved ones often do more harm than good in the long run. What both caregivers and their loved ones need to realise is that the steps along the way towards recovery will require tremendous courage, discipline and commitment, as well as a painful coming-to-terms with their illness and their lives. For sufferers of manic depression who have spent most of their lives running away from their problems, the return to life can feel like a monumental, uphill task.

So to all caregivers, I would like to say this: If you want to help your loved ones get better, step in and help them with the firmness that is anchored in love. It is not your role to spare them from the painful reckoning of the devastated state of their lives – this is a necessary first step in their recovery. Nor can you undergo the challenging work of rebuilding their lives with discipline for them. But you can walk alongside them; offer them your shoulder to cry on; and encourage them to take one difficult step before another, thus guiding them with a beacon of hope to the light at the end of the tunnel.

©Choo Kah Ying 2009. No portion of this article may be reproduced without author's permission.