Wednesday 20 February 2019

How to Gently and Kindly Talk with a Friend About Difficult Bipolar Symptoms

By Julie A. Fast

As friends of people with bipolar and schizoaffective disorder we want to be understanding and kind regarding the struggles people with serious mental illness face. But — and it is a very big BUT — there is a line to be drawn in terms of what you as a friend can handle, especially if the person’s symptoms are active.

I see this from both sides. I have bipolar disorder and a psychotic disorder myself. I know what the symptoms can do to our minds, and ultimately how they can affect our friendships. I have lost or left many relationships with people who have untreated mental health symptoms. On one occasion a friend with schizoaffective disorder decided that I had stolen one of her ideas. She texted me at 11:30 p.m. on a Saturday night and said:

I am very upset with you! I just saw your latest blog post and you’re using my ideas in this post and this is not cool. I need you to take it down and print a retraction!

Another time, a friend with bipolar one decided that he wanted to live the manic life and went off all meds, saying:

I am finally free to live the life I have always wanted!

Let’s look at these situations in more detail.

Scenario One: Paranoia

It was Saturday night. I was asleep and suddenly my phone (that I keep switched on in order to use a sleep app) started buzzing with texts. They were from a good friend, so I assumed she was in a crisis and I sat up so that I could be there for her.


I read text after text accusing me of stealing her ideas. I naturally had the thought Oh no! What have I done?! But when I read them again I realized that there was nothing specific in them. I had not done anything that she could point to that made any sense. I recognized that my friend was experiencing psychotic paranoia and that I was suddenly, after a long term friendship, the TARGET.

It felt terrible. It was a little scary, to be honest.

I was a good friend to her and reading these accusatory words felt like a punch in the stomach. I of course know that she has bipolar and a psychotic disorder. I know that, as I do myself, she gets paranoid. But I have a policy in my own life that I don’t take my symptoms out on the people in my life and I ask the same of my friends. I won’t be the target of a late night paranoia attack, just as I will not let my paranoia make a similar late night attack on someone else.

Believe me, I did this in the past and ruined many relationships, but I have taught myself to manage my paranoia. I thought my friend had done the same. We talked through her worries the next day, but six months later it happened again. This time she accused me of not spending enough time with her and not helping her with her new book project. Of course, as with all paranoia, it FELT real, but she was not being realistic. She was ill with psychosis.

After much sadness and worry I decided that I could not be in this relationship and simply stopped contacting her. I was the “bad guy” who left, but I am ok with that. I didn’t feel protected from her mental health symptoms. I need to be protected if someone is my friend.

I did try to talk with her about how her paranoia affected me but she was in a strong delusion and I could tell that talking was not going to work. I am not here to change anyone. She has a team around her to take care of her. She is fine and I am fine. Our relationship simply ran its course. This often happens and it is a normal part of life. Did I get upset? Of course! She was my friend! But I have boundaries in place to keep myself well enough to be who I want to be in the world and I had to let this relationship go.

Scenario Two: Mania

After a thirteen year friendship, a dear friend of mine who has always worked hard to stay stable suddenly decided to stop all medications in order to live a “manic life.” I felt deep worry about this and let him know my feelings. My policy in life is to let people be who they are. Then I can decide if I want to be with that person. I don’t change people. I knew his plan would be a disaster, but he is allowed to make his own decisions.

I love this person and am still deeply conflicted about what happened. But as with my friend who has paranoid psychosis, a person with bipolar has to be working on their stability to be in my life. Otherwise, I will get sick as well.

In this case, my dear and kind friend, who I will call Marcus, decided that mania was more fun than responsibility. As a result he went off all meds, left his partner and kids and decided to relive his youth. He moved out of his house and got his own place. Before long our phone calls were about the people he was meeting in bars and how he finally felt free for the first time in his life. He told me he was using weed. That really set my alarm bells ringing. Cannabis and bipolar do not mix: the tetrahydrocannabinol (THC) in the cannabis can make us manic and psychotic. I was deeply worried and let him know from the beginning. I gave an opinion and stated my needs.

He came to visit for a weekend and I could tell he was manic from the minute he arrived. His eyes were wild and he was dressed flamboyantly. He openly talked about the handsome men he met at the coffee shop and sat in positions that were sexually suggestive. He was being very outgoing and nice to everyone around him but he was NOT focused on our relationship. He was not bothering anyone, but I could tell he was not himself. It was like the lid had been taken off a jar of bees.

This continued all morning. At lunch he was talking and talking about his new life and playing pool and trying weed, and suddenly I realized that I felt incredibly uncomfortable. He knows my position on cannabis as it made me very psychotic and manic, and in our state it is not well regulated. Marcus would never touch the stuff when stable. When he said this so nonchalantly, I woke up to the situation. I asked him if he was still off his meds.

Oh yes Julie! I went off months ago. They were making me so fat and I was so tired all of the time. Making kids’ lunches and doing homework with them. I had enough! I feel like a real person for the first time in my life!

This continued for a few hours. Finally, I realized that this was not healthy for me. I was getting agitated and worried. Due to my policy of not telling people what to do, but always telling people what I need so that they can decide what works for them, I said the following, right there at my kitchen table:

Marcus, you know how much I care about you. We have been friends for many years and you have been there for me when life was really tough. A large part of our relationship has been working together to manage our bipolar. You help me test the ideas in my books. You were there when I needed to explain my system to the world. I am forever grateful. I am not here to change people and I am not here to tell people what to do. But, you know that my life is based on being stable.

When you say, “I feel that I have been in jail for all of these years. The marriage and the kids were a rope around my neck and now I am free! I don’t need the meds and I need you to understand that this is my choice and I am finally feeling great for the first time in my life!” it is mania talking.

You do not talk this way when you’re stable. I’m not comfortable being around mania. It is truly a trigger for me and I ought to know about triggers as I wrote a book about it and you have always helped me market this book! I love you and you know you are important to me, but I can’t be around this. I ask that you cut your trip short and go home now. This is the best for both of us.

He was very understanding. This was an episode of euphoric mania and people tend to be open to anything during this kind of episode, but I could tell he had no idea that his mood swing was creating one in me. In the past I would have waited it out and become more ill. Not now. Now, I focus on what I need and I let people know this in a calm and kind way. I have to take care of my bipolar disorder first or I literally will not sleep, and then the mania starts in my brain. Oh, this was hard. I loved Marcus, his kindness and friendship, but the decisions he was making were not safe for anyone. We sent a few emails back and forth and eventually I said the following:

Marcus, you visited my house while manic. You didn’t tell me until I was sitting in front of you that you had been off your meds for a few months. I know this is not my business and you don’t have to call me and tell me what you’re doing. This is your life. But I can tell you that this mania is incredibly frustrating, and if I’m really honest it is scary for me.

To see you like this reminds me of my manic days and I feel in a bit of a panic to think of what your kids are going through right now. I am not going to tell you what to do, but I am so sorry, I can’t be around you when the mania is given free reign. It is too stimulating for me and it is very distressing. You know my feelings on the topic.

He was very understanding, but from friends I hear Marcus is still off his meds to this day.

My goal is to help you as a friend of someone with bipolar disorder or schizoaffective disorder figure out what YOU need in the relationship. I could have called his doctor or his ex. I could have gotten involved but that was not my role, and never had been my role throughout our long relationship. Someone who is very manic and using cannabis is not someone I can have in my life. This is not a judgement. It is not about him at all. It is about me. I need stable people around me. I can love my friends with bipolar and psychotic disorders, but I can also be very clear that relationships work best when both people are working on stability.

Your thoughts as a friend?


About the Author

Julie A. Fast is the author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, Get it Done When You’re Depressed and The Health Cards Treatment System for Bipolar Disorder. Julie is a board member of The International Bipolar Foundation, a columnist and blogger for BP Magazine, and won the Mental Health America journalism award for the best mental health column in the US. Julie was the recipient of the Eli Lily Reintegration award for her work in bipolar disorder advocacy. She is a bipolar disorder expert for the Dr.Oz and Oprah created site ShareCare.

Julie is CEU certified and regularly trains health care professionals including psychiatric residents, social workers, therapists and general practitioners on bipolar disorder management skills. She was the original consultant for Claire Danes for the show Homeland and is on the mental health expert registry for People Magazine. She works as a coach for parents and partners of people with bipolar disorder. Julie is currently writing a book for children called Hortensia and the Magical Brain: Poems for Kids with Bipolar, Anxiety, Psychosis and Depression. She struggles a lot due to bipolar disorder. Friendships keep her going. You can find more about her work at and



  1. What did he do? What did he do to you? How was he not stable,,, for example?

  2. Hello,

    Thank you for asking. It was a situation where this person whom I love and care about greatly was acting sexually towards others when we were out in public. He told me he was using drugs and sleeping with strangers. He was not seeing his children. It reminded me of MY past when I had similar behavior around mania and I felt myself getting ill. He was unable to have a conversation that wasn’t about himself and he was making decisions I truly found destructive. But, he is his own person and I truly don’t change others. So I explained what I needed and he made it very clear that he liked being manic and was going to continue to be manic. So we ended our relationship without acrimony. If he every needed me, I would be here. I am a person who gets manic in minutes. I can’t be around the behavior or it will affect me. This doesn’t mean that I am here to change anyone. It means that I am taking care of my own bipolar disorder.


  3. Why do you keep referring bipolar disorder and psychosis as two separate entities? People who have bipolar 1 disorder usually have psychosis. That is part of their mania.