In the second half of 2010 my blog focused on the challenges of attending college with bipolar disorder. Most significant amongst these is the disparity between the lifestyle requirements of recently diagnosed bipolar students and the behavioral norms of their peers. This is one of the key reasons that mood stabilization can be so difficult to achieve during the first few years post-diagnosis, usually somewhere between ages 16 and 25. When bipolar disorder is identified in the mid-twenties or later, the young adult has some important years of maturation that make an enormous difference in successfully adjusting to the diagnosis. But when the disorder is identified in the mid to late teenage years, then typically, turbulent times lie ahead.

This topic has received much attention over the last several years, and for good reason. Teens and young adults facing the early stages of bipolar illness need all the positive advice and guidance they can get. But there’s another population also struggling with the impact of bipolar disorder. Their numbers are almost twice as large as the population of college-bound bipolar students! And the adjustment issues of this population often receive inadequate attention. I’m referring to the parents of recently diagnosed teens and young adults.

If you’re among this group and your child has completed high school then the approach of fall semester can be a very unsettling time, even more so if your child is about to begin a first year away at school. There aren’t many issues that will cause parents to feel more anxious and helpless than knowing their child has a psychiatric disorder while also knowing that developmentally, the child is at a point where parents can no longer protect and assert control. Needless to say, the complexities and pitfalls of university life are frightening prospects for the parents of college-bound young adults in general, let alone with bipolar disorder.

I don’t mean to imply that all young adults with bipolar disorder are rejecting of parental influence or even rejecting of their psychiatric treatment initiated prior to their departure for school. There are those who recognize that parents and professionals do have good judgment. They listen. They take in what you have to say and give it serious consideration. They’ve developed a strong degree of maturity and self-control at an early age. They’re fortunate and so are you.

More broadly speaking, it’s more common to find late adolescence and young adulthood characterized by striving towards independence, self-definition and a rejection of parental influence. Sometimes the experience can seem like the terrible two’s, only more prolonged and with less control available to parents. You’re encountering the reality that you’re no longer the head coach. Instead you’re relegated to a position on the sidelines where you can observe your child and cheer them on, but it’s your child who’s really in the game.

Additionally, you are likely to find that your son or daughter doesn’t want to know they’re bipolar. They don’t want to be different than others. They don’t want to take medication, they don’t want to need it and they certainly don’t want others to know that they need it. They also don’t want to relinquish the experience of doing what most of their friends are doing, whatever that may be. In fact, the recently diagnosed bipolar college student probably doesn’t want much of anything to do with bipolar disorder.

Compounding these common elements of resistance and denial are factors such as the high stresses of academics and social life, inadequate sleep or highly variable sleep patterns, alcohol and substance use, as well as, difficulties accepting vulnerabilities and appropriately communicating these to others. All the above (and more) can become major impediments which interfere with the maintenance of stable functioning.

So what do you do? How do you extend your influence and guidance into the collegiate world of your university student? The painful truth is that you can only do so much and most of it has already been done. The process of your instilling all the good stuff is definitely on the wane.

You’ve attempted to convey your values and ideals. You’ve provided consistency and nurturance which have contributed to your child’s own sense of self. You’ve tried to be a positive role model. You’ve even helped your child cope with adversity through his or her perception of how you’ve done the same. And even though your fears may tell you otherwise, your child is going to take you with them. What’s less clear is the extent to which the internalized parental voices that reside in your child’s psyche are going to hold up in the face of all the other influences of the university environment.

This places you, the parent of a young adult bipolar college student, in a real bind. You may fully appreciate the adverse consequences of your child’s rejection of bipolar lifestyle requirements. As a consequence of your concerns, you may feel a strong sense of urgency to have your son or daughter “do what’s medically indicated.” On the other hand, you’re faced with the limits of your own influence as well as the possibility that trying harder to impose control may only lead to stronger reactivity when your child pushes away with even greater force.

I wish there were an easy answer to the age-old dilemma of trying to let go and hold on at the same time. But there isn’t when it comes to bipolar disorder. If there were, it would lie somewhere between being magnificently patient and accepting of your helplessness while being a good educator in relation to your bipolar college student.

You can provide relevant, balanced and easily digestible information about bipolar disorder. You can assist in identifying what resources are available for getting help when needed. You can reassure that you’re there to love and accept and even to help pick up the pieces if things do fall apart. Doing all that with grace and subtlety as opposed to overflowing with frustration and fear will require all the wisdom and maturity that you can draw upon. That’s your task as a parent.

You probably know the well-worn phrase about “leading a horse to water…” In the broad scheme of things it’s important to recognize that your child’s life experience will be a powerful teacher. You gradually matured through your own trials and errors. Your life history will illustrate that: Take a few moments and let yourself reflect upon some of the poor choices you made during your adolescence and young adulthood. Those choices were probably instrumental in helping you to gradually figure things out. The same will occur with your child. The frightening aspect of this prediction is that an accumulation of bad choices can have significant adverse consequences when it comes to bipolar disorder.

If your child’s bipolar instability does become acute, psychiatric hospitalization may be necessary. If this occurs, he or she will likely stabilize as a function of receiving appropriate treatment and support. Short of this worst case scenario, your child may find that he or she is too symptomatic to successfully get through a semester. Medical withdrawal and a temporary retreat to the less stressful environment of home aren’t so uncommon for bipolar college students.

I often advise parents of bipolar students to remain open to the possibility that a four-year degree may require five or six. This isn’t what you had planned, but trying to accelerate things can often make the situation worse. Besides, there’s no race to the finish line. In fact, the bipolar university student who successfully obtains a degree without any setbacks is the exception to the norm.

So whether we’re talking about a hospitalization, a medical withdrawal or even the need to drop a few courses, these experiences become powerful lessons as the bipolar student gradually learns how to manage it all. It’s self-evident that most young adults don’t want a stay in the hospital. Most also don’t want to have to leave school and come home with their tail between their legs. Most really do want to find a balanced and successful path towards their degree and what lies beyond.

Bottom line - it’s important for you to work on nurturing your connection with your child. You want them to know that you’re there and available to respond with help once they’re ready to reach out and ask for it. The reality is that with the new-found independence of university life, they may encounter unanticipated difficulties. Your work is to become better at managing your sense of helplessness as you watch from the sidelines.

 Will your child learn sufficient lessons before it’s too late? Will he or she eventually reach out and say – “Mom and Dad, I know I haven’t been very receptive, but I think I need your help now”?

I can assure you, from what I’ve observed during my 23 years in the trenches of university counseling centers, most eventually do … and they become stronger as a function of the struggles they’ve endured.

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Russ Federman, Ph.D., ABPP is in private practice in Charlottesville, VA (www.RussFederman.com). He is co-author of Facing Bipolar: The Young Adult’s Guide to Dealing with Bipolar Disorder (New Harbinger Publications). www.BipolarYoungAdult.com

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Going to College With Bipolar Disorder - Part II

Issues and challenges faced by college bound students with bipolar disorder

Going to College With Bipolar Disorder - Part I

A discussion of issues faced by college-bound students with bipolar disorder