I am a 44-year-old widowed parent to an 11-year-old daughter. I was diagnosed with bipolar disorder type II, with rapid cycling over 20 years ago when I was at university. I have a very difficult, treatment-resistant, form of the illness and suffer multiple episodes across the year. I require regular changes to my complex medication regime. I worked for 15 years as a specialist speech and language therapist having to gradually reduce my hours due to the illness until I gave up work to care for husband who had cancer, after which my illness became too erratic to return to work.

Four years on I have started writing around mental health issues and I’ve just finished a book on bipolar disorder and bereavement which I hope to publish next year. I have been motivated to write this article having seen first-hand the complex effect bipolar disorder can have on a child whose parent has the condition.

The needs of children with bipolar parents

The effects of bipolar disorder on children who have a parent with the condition isn't something which is extensively covered, with most articles understandably about managing the condition or supporting someone with the condition. But many people with bipolar have children and it is easy for their needs to go unnoticed, especially given as they are often silent about them and do not express that they have any. Every family has different experiences with children with different personalities but many of the core issues are the same, even if they manifest differently in the child. I am going to share my personal experience and some of the things I have learned with the help of a therapist in the hope that they might be useful to someone else.

Six weeks after my daughter was born I had a depressive episode and went into a mother and baby unit for a few weeks to change my medication. My husband came every day and the nurses facilitated, as much as possible, normal interaction between our baby as possible.

When she was 18 months, bigger and more aware, I was in a mixed state and needed a residential treatment for 3 months. I was overwrought with worry about attachment but also very unwell. But my husband brought her to see me every day and I was reassured by professionals that as long as the she had one strong attachment there shouldn’t be a problem. Obviously, this has implications for those with young children who are single/lone parents. The professionals were right though, and we picked up the pieces and carried on as normal and had no problems in our relationship at all. There were no further admissions in the years that followed and during times when I was very ill at home my husband stepped in and she appeared to find this security enough to compensate for the fact that I was ill and out of action.

The problems appeared after my husband died. Piglet (that is her code name as she likes the character from Winnie the Pooh), has found it much harder to cope with my illness since I have become a lone parent. She had lost her support system, her dad who would take over as the pillar of strength and security when mummy was ill. Now she is effectively home alone with it as so many children are.

It started about 18 months ago – I was rapid cycling quite fast. She appeared to be coping as she has on all previous episodes, but as I came out of the episode the problems started. She had a fall and fractured her leg. Following this there were two ‘questionable’ hand fractures –  the consultant said it was unlikely they were fractured at all. They had looked like it on the emergency room X-ray, but in the orthopaedic follow-up 10 days later there was nothing. He said the amount of pain she was reporting was excessive, too high compared to what the X-ray showed and asked if anything was going on at home, as he felt it was psychosomatic. Sometime after this she started vomiting her food and becoming more labile in mood. She also didn’t want to leave me, becoming distressed if she had to – declining sleepovers with friends which she previously loved.

I found Piglet an excellent counsellor, thinking it was delayed grief, but as we went through the process the counsellor reported that she felt a more present issue than grief. She thought Piglet was struggling to deal with my bipolar episodes. She has never been very good at talking about her feelings and obviously as she didn’t want to upset me, her emotions were coming out physically and in behaviour. Interestingly she waited until I had recovered so she knew I could take her anger. She attended counselling for a year and we did some really useful sessions all together looking at the illness, talking about it, learning about it and acknowledging it, as well as finding useful strategies for her. It really made me think too. I get so absorbed when I’m in an episode and no matter how much I love my daughter, sometimes even meeting her basic needs is hard, let alone considering her emotional needs. If she doesn’t show signs it’s easy to think she’s ok.

Everything went back to normal until I had a very severe episode this Autumn. I was virtually catatonic for the entire first month Piglet was returning each day from her first month at secondary school. At a time when she really needed her mum and routine, she had none of that. I continued to be ill for a further month. Piglet appeared to be fine, coping with her new challenging travel arrangements, being in a bigger school with many more children, new children, new teachers, more homework. As soon as I was somewhat recovered from the episode it started, the vomiting, her being moody, exhausted, not wanting to get up in the morning. It took me a while to realise what had happened. This was the transition from me recovering to being well and all my mother’s instincts kicking back in. I just looked at her one day and couldn’t believe how fragile she looked. It was post-episode stress again as I named it. She denied it. I pushed a little and said “Look, of course it’s been stressful, you’ve had all this on and you’re coming home to a mum with bipolar disorder who is not well and not giving you all the support you need”. I put everything I had into re-establishing a routine, dinner at 5.30pm, bed at 8.30pm, asked the school to give her a break from weekday homework and just giving her my full 100% attention. I offered a return to counselling which she declined. But she really responded to those normal things that I just can’t put in place when I’m ill. She fends for herself a lot when I’m ill, as I think a lot of children with parents who have bipolar do. We just manage, we somehow get by. But these are little beings with big needs and it has to come out somewhere, somehow.

I feel lucky that we have come to the point where we can talk about it. Children with parents who have bipolar tend to want to protect the parent. Initially they may feel they did something wrong. Even once they are past that stage they don’t want to make it worse. They want to protect you. They notice the parent’s fragility and that is why they hold in their own feelings until the parent is strong again and then it just comes out. My daughter has spent a lot of time denying that my illness has any effect on her whatsoever or that I am difficult to be around in any way. I don’t think she wanted to upset me. I am still having to reassert “It’s normal to find it stressful to live with someone with bipolar disorder”. “Coming home every day from school and finding me exactly where you left me cannot be nice”. We are slowly starting to laugh about things and this time she gladly accepted my post-episode nurturing and did not deny my assertions that she was suffering from stress and exhaustion. I think she even used the phrase “I’m feeling better now” by which of course she inadvertently acknowledged that something was wrong.

I’ve just had a significant manic episode and she appears not to have found that difficult at all. I always think that’s easier for her, but I am mindful that it is still a big change and may be unsettling. It is something I want to explore.

I’m not sure how much I can change ‘in episode’. But I do want to look at her support systems and have them more robustly established. We did a little bit of work on this therapy and used some during the depressive episode but it was still a little ad-hoc. I’d like to think I can try and find the energy to keep her evening routine a bit better during episodes. But that is easy to say now and harder to do when I can’t get out of bed. Some of the things below are things we have done that have been useful that might be food for thought. You will need to adjust for age.

Strategies for supporting children who have a parent with bipolar disorder:

1. Brainstorm: “What does depression look like?” “What does mania look like?” Try and get the child to find words that go with each polarity. What is mummy/ daddy like when they are well? Get the child to find three positive words to describe mummy/ daddy?
2. Self-care: Take a piece of paper each and spend time writing down and drawing images to show the things that make you feel good, things you like to do etc.
3. Support: Who can you call? Agree together three people the child can call on if they are worried about your behaviour or want to chat to someone when you are ill. Get them to store these numbers in their phone if they have one. Ideally the child will choose and you will agree but if you are really not happy you could say “Can you think of anyone else?” Emphasise to the child that it is really OK if they need to call these people when you are ill, either because they are worried about your behaviour or simply because they want someone to talk to.
4. Openness: It is also a good idea to tell the child that bipolar disorder is an illness like any other illness. It is not a secret and they can talk to whoever they want to talk to about it, as wherever they can find some support is a good thing. Some children might even need to know that you can’t die from it, they can be secretly harbouring this as a worry but be afraid to ask. Ultimately, we all have to find our own way of parenting the best of our ability whilst suffering this disabling condition.
5. Communication: The key thing in my opinion is communication. Communication takes the fear away. Communication breaks some of the power of the illness down and gives you and your child the feeling you are back in charge. And finally, of course communication is the key to any good relationship. Despite everything we go through, I am proud to say I have the most amazing relationship with Piglet. I’m far from perfect when I’m ill but I make up for it when I’m well, we have the best of times, she has the best of experiences. We adore each other and I don’t think she’d want anyone else. She has said she thinks I’m brave and she is proud of me the way I battle this illness. I just want to ensure that her needs continue to be met and the impact on her is reduced. This will be vital in maintaining her mental health and reducing her risk factors for inheritan

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