The short answer, of course, is: love someone who is mentally ill as you would love anyone else—unconditionally, with all your heart—but don't expect that love to be reciprocated, and don't expect everything to just "get better" one day, because it probably won't.

Mental illness can come in all shapes and sizes; trying to maintain a relationship with someone who suffers from mild depression is a walk in the park compared to trying to work things out with an individual with schizophrenia or bipolar disorder. So there is no silver bullet, no panacea...each relationship has its own parameters and its own rules—the most important being that those parameters and rules are subject to change at almost any time.

Back in grad school, I dated a young woman who, as it turns out, suffered from bipolar disorder. I won't get into the gory details of the relationship, but suffice it to say that bipolar disorder can manifest itself in a billion different terrible ways, the most frequent of which being a pendulum that swings back and forth between "I love you, I can't imagine my life without you" and "I hate you, I can't stand you, get the hell away from me."

I don't want to generalize about people who have this particular disorder (because it does indeed manifest itself in different ways depending on severity), but it's not uncommon for bipolar individuals to have trouble with impulse control, to have trouble maintaining stable relationships, to fear commitment, and to intentionally sabotage relationships even when they're (miraculously) going quite well.

Loving an individual with a mental illness is tricky; it takes patience and a degree of self confidence lacking in most of us (including, apparently, your humble author). It's difficult not to get angry when your boyfriend or girlfriend tells you, "I love you," one minute and "I never should have left my last boyfriend/girlfriend" the next. It's difficult not to be crushed when you realize that you really care for someone and, meanwhile, they're doing fairly awful things behind your back.

The situation actually seems to be worsened if you understand the underpinnings of the disorder involved. I stayed in the relationship mentioned above way too long, despite all the lies and deceitfulness, despite the fact that I only felt she genuinely cared for me about half of the time. I stayed in the relationship because the excuse—you know I'm sick, honey...I didn't mean what I said—rang true with me. I spent a good deal of time in my undergrad years taking courses in psychology and the philosophy of psychopathology and I agree with the materialist point of view: we are very much the sum of our genetic code and our environment, and we have very little (if any) free will.

So who am I to judge? How can I really condemn a person for acting in a way that is very much a part of her nature, a part of her illness? Should she really be held accountable for things she can't control?

So when she apologized, it seemed genuine. And hell, I have no doubt that it was genuine. But what took me so long to realize was that apologies didn't matter, best intentions didn't matter, and, in this case, love didn't matter, either. Because every apology was followed by more thoughtless actions...because despite best intentions, we are who we are, and some mentally ill individuals (even when medicated) simply lack the capacity to see their own actions with any type of perspective or introspection. They don't mean to hurt people, but they do—and, often, they will continue to do so, because that's the nature of the disease.

Looking back on that relationship, I often ask myself: Why did I put myself through so much hell, just so she could hurt me, apologize, and then proceed to hurt me again and again, over and over? It seems like a stupid question. What, was I a glutton for punishment or something? Why did I hang around when I knew that any love she felt for me was fleeting at best—why did I hang around when I knew that she was never going to "get well?"

Ah, but therein lies the rub. Implicit in any relationship with any mentally ill person is often the belief that "one day s/he will get better, and everything will be okay." It's a stupid thing to believe, but we believe it nonetheless because it's human nature to believe perseverance pays off...that if you try hard enough, things will work out. This may indeed sometimes be the case, but with individuals who are mentally ill, it often just leads to heartache.

Put simply, the mentally ill often play by a different set of rules. We try to interact with them, to work things out with them, to maintain our relationships with them; but in the end, we're often inadequately prepared.

Sadly, my understanding of this subject runs deeper than memories of some failed relationship from years past. Mental illness has taken a toll on my own family, and loving a family member who is sick in this way can often seem like an impossible task.

I've written about my sister before. Life with a family member who suffers from mental illness (in this case, Borderline Personality Disorder) is stressful as hell, to say the least. With some Borderlines, you can trigger an episode just by saying something seemingly innocuous; life becomes an exercise in walking on eggshells. You can't treat the person you love the way you used to for fear of hurting that person's feelings, driving them away, or otherwise wrecking the relationship.

My sister and I used to be best friends. Now I view my relationship with her differently, in a way that is difficult to explain. I still love my little sis, and I'm sure I always will—but loving her has taken a back seat to making sure I'm prepared for whatever might happen next. I've lived through her drug abuse, her attempts at suicide, and her subsequent involuntary commitment to a mental institution.

When I think of my sister, instead of thinking, "Gee, I sure love her," I find myself thinking, "Good god...what's next?"

The answer to that question came recently: she's moving to Dallas. After spending a few weeks with an ex-boyfriend of hers, she's decided to pick up her life and move in with him. No matter that this ex-boyfriend is diagnosed manic-depressive (and off his meds). No matter that this ex-boyfriend has been known to cut himself and abuse all kinds of drugs. No matter that their relationship already failed years ago. None of these things matter to the mind of a Borderline, who are notorious for having difficulty with impulse control.

She's moving hundreds (hell, maybe even thousands) of miles away, to a place where she knows no one (except the ex-boyfriend), to a place where she has no support structure to catch her if and when this latest scheme fails. The last time I wrote about my sister, I suggested that her killing herself was inevitable, that I was simply glad she hadn't done it yet. It would seem, however, that this eventuality is becoming more and more of a reality every day.

It won't be long now, I find myself thinking.

I'm usually not a fan of fatalism, but when you've exhausted all of your options (save calling her up and screaming at her and getting myself cut out of her life again), you suddenly realize that certain things are just going to happen in this world, and sometimes there's not a goddamned thing we can do about it.

A few weeks ago, karma debt and I had a very nice conversation via /msg regarding the similarities between my sister's situation and what happened with Hermetic. (I felt terrible, because at the time, I had no idea who Hermetic was, being a relative newbie to E2 and all.) karma debt was extremely supportive, giving me all kinds of advice and well-wishes, but one thing she said still echoes in my mind: No matter how prepared you think you are for it, when they actually do it, you're never ready. You're never prepared.

She's right, of course. I keep telling myself that I know my sister is probably going to succeed in offing herself one of these days; I know it's not my fault, and I say I'm not going to blame myself if and when it happens. But the truth is, I will. The truth is, no matter how much I've done to try to avoid this eventuality (and that's quite a bit), it'll never be enough...I'm always going to end up thinking that I could have done more, I should have done more, I should have been there for her in some greater capacity, I should have stopped her, somehow.

And yet here I am, present day, and nothing has even happened yet. Why am I not doing something now? Have I really exhausted all my options, or have I just exhausted myself? Have I given up on her prematurely? Is there some way I can (literally or figuratively) shake the bejesus out of her and get her to realize what she's doing to her family, to herself?

Enough explication. Enough backstory. Enough concern for things that haven't even happened yet. As the title suggests, this is supposed to be a how-to.

I wish I could just jot down "twelve easy steps for loving someone who is mentally ill," but it would all be tripe bullshit—and besides, as the anecdotes above suggest, I haven't quite yet mastered the skill myself. But I do have a few thoughts to share on the subject, thoughts that basically boil down to the following:

Don't withhold your love from someone just because s/he is mentally ill. First, there are varying degrees of mental illness, and certainly the kind of stuff I've been discussing in this writeup doesn't apply across the board to everyone who is sick. But even with the ones who aren't "mild" or "moderate," some of the most incredible people in this world are bipolar or borderline. Meet them, get to know them, and love them (if applicable). Not every relationship with a mentally ill person is doomed to fail.

But...

Don't let your concern for someone else's mental illness be an excuse for ignoring your own mental health. In other words, if your friends or loved ones are sick, give them some leeway. Give them your understanding. Give them your love. But don't let them use their disease as an excuse to treat you horribly. Don't let them use "I'm sick" as an excuse to hurt you and your family. In short, treat it as you would any other relationship: Understanding goes a long way, but if a person (sick or not) is continuously hurting you, for your own sake, you must distance yourself from that person.

That last part may seem like a difficult pill to swallow, but sadly enough, those feelings will develop by themselves over time. Don't get me wrong, I still very much love my sister—but at some point in my life (not so very long ago), I had to make a conscious choice to stop worrying so much about what she's going to do to herself next. I had to make a conscious choice to accept the fact that I am not my sister's keeper. She must live her life and I must live mine—and whatever happens...well, I'll just have to deal with that when it comes to pass.

Because throughout this entire saga, I've learned one very important lesson: There's only thing worse than watching a friend or loved one destroy themselves, and that's allowing yourself to drown in their wake.

It sucks to watch someone you love spiral down the drain, and it's natural to offer them your hand to try to pull them out. But if they continuously try to pull you in with them, if they're more interested in bringing you down than allowing you to bring them up...at some point, you must stop offering them your hand.

I respect the author's (No Springs') important message, and especially the two points of advice given, which are well-stated. I'd like to offer some of my own perspective as a bipolar individual.

How can I really condemn a person for acting in a way that is very much a part of her nature, a part of her illness?

I'm not sure about this wording. I think it is worth pointing out that, at least in the case of mood disorders such as bipolar, it is valuable to consider someone's illness as quite separate from their nature, at odds with it even.

... [D]espite best intentions, we are who we are, and some mentally ill individuals (even when medicated) simply lack the capacity to see their own actions with any type of perspective or introspection. ... [T]hat's the nature of the disease.

I would not wish someone to infer that the effects of a mood disorder on such capacities are fundamental and not treatable with medication. Such effects are a dramatic result of an imbalance in brain chemicals that can often be treated. For example, when I have been manic, my thinking has been irrational, inappropriate, irresponsible -- but this is not part of my "nature" at all. Medication these days is very good, and I would like to believe that any bipolar person can be helped and lead a normal life as I do, free from such unnatural tendencies.

To love someone, in the real and unconditional sense, is something often confused with the idea of staying by someone's side and accepting all their behaviors, especially those behaviors that directly impact you as a person. To love someone who is mentally ill requires a different set of standards. You need to work to establish mutual respect, something a mentally ill person is often incapable of understanding and accepting.

A mentally ill person will also often have trouble understanding the need for personal boundaries and personal space, especially with someone they are in a relationship with. Based on my personal experience, I recommend making it possible to take long breaks from physical interaction. For someone with mental illness, the knowledge that you can leave at will but will always come back can be a powerful thing.

I've lived with and been in intimate relationships with two mentally ill women. The first was never really diagnosed, but she was suffering from the impact of a very powerful case of post-traumatic stress disorder. It was the result of a childhood where she was physically and sexually abused by her father, who ended up killing three of her siblings as a result of his abuse. She had an intense attachment disorder that caused her to treat casual relationships and friendships as being much more intimate, lasting and intense than they really were. She tended to imagine things happening to her that really weren't, imagining I was being abusive towards her at times, something that balanced out with her belief that we were destined to be together and had a "perfect relationship" that would never end.

Debra could not understand my need for personal space and boundaries. She tried to involve herself in every aspect of my life, treating my attempts to spend time alone as me having something to hide, usually an imagined affair. At times she would launch into a night of attacks against my person, trying to rip me apart using words she felt would wound me deeply, storming off in her car afterwards vowing never to return. In the morning I would wake up to a breakfast of bacon and eggs and Debra with a pleasant smile saying, "Did you sleep well, my love?"

Based on experience, both first hand and witnessed, it is impossible to have a relationship with a mentally ill person. A relationship requires some degree of stability and in most cases, with a mentally ill person, stability is impossible to achieve. To love them and care about them is one thing, and I work with the mentally ill because I love and care about them, but to love them in the way usually outlined by a romantic/physical/sexual relationship is not possible for any enduring length of time. You love the person, yes, but what your needs drive you towards is the hope that they will find the right path to treat, maintain and possibly cure their mental illness. This is a pipe dream. It is a self-defeating path. Once you are in this intimate relationship with a mentally ill person you become an enabler. It is unavoidable, no matter what lengths you go to try to convince yourself it isn't.

It is simple, really. Even in the case of a mentally ill person who knows they need treatment and ongoing therapy, being in an intimate relationship with someone gives them the sense that they can function normally. We consider being in this type of relationship to be the strongest sense of normality in our lives. Getting and keeping a job doesn't compare. Owning a home or paying the rent on time doesn't compare. Having another person love and accept you to the point where they are investing themselves wholeheartedly in a relationship with you is much, much stronger. And if this person has a job, a place to live and a car to get around in... suddenly it doesn't feel as if their mental illness means that much any longer.

Debra threw herself into intimate relationships and attached herself to men as if she was using a staple gun to do so. I wasn't the only one, and she is still doing it today. She did this because it allowed her to avoid the fact that she needed very serious treatment and therapy. She had incredibly unstable mood swings, imagined and believed in things that weren't really happening and for which there was no evidence whatsoever, and would stab herself with a knife to get attention when she felt people were ignoring her. Being in a relationship with a man allowed her to convince herself that she did not need help, that she was fully functional and normal.

To the extreme, The Former Muse, followed a very similar path, although she was always convinced every friendship and relationship she was involved in would fail. She was diagnosed with bipolar disorder, but over the last few months I knew her, the psychiatrist who met her when she was spending a few weeks in a psych hospital wanted to take her off her meds because he was convinced she was either borderline personality disorder or something quite different. The something quite different involved her absorbing the symptoms, habits, actions and diagnoses of the people she had worked with in her career in the field of psychology and adopting them as her own. It wasn't that she was faking her illnesses, but that she was genuinely absorbing them, as you could not fake her actions or her way of life. However, most of her symptoms and activities began only after she encountered them in others. She had always been deeply troubled in a way she could not define, and in essence she sought to define it by using tested models. Those that fit, such as bipolar disorder and cutting, she adopted. She only adopted suicidal behavior after I came to live with her. It wasn't part of her repertoire prior to my coming to live with her.

And the truth was, as it was with Debra, that it was not possible to love her and be with her in an intimate relationship. She sought to destroy the relationship and then praise it. She sought every means at her disposal to drive me away and then every means at her disposal to convince me to stay. I could either stay as an enabler or abandon her and validate her belief that all people would leave her, which was why I put her in the position of having to leave me.

You can love someone who is mentally ill. I maintain strong friendships with individuals who are mentally ill and I love them. I work with people who are mentally ill and emotionally unbalanced and I love them. You just cannot love them in the way that involves a lasting, intimate relationship because once they become convinced you are there to stay and you love them as they are, they will, in essence, stop trying to heal themselves because they have become validated by your love. The love cannot be unconditional. There must be a condition. They must continue to do everything they can to get "better" and to work hard to become the person they are. You must remind them constantly that you love them, not their mental illness and that you accept it only as a handicap to be overcome.

When things were good between us, The Former Muse would stop taking her meds. When things were bad between us she would start taking them again. When things were good between us, Debra would imagine things that weren't happening to sabotage our relationship and then attack me. When things were bad between us, she would work overtime to convince me she could function like a normal person and would go out of her way to make me happy.

You can't love a mentally ill person unconditionally. There must be a condition and the condition is the mental illness.

Schizophrenia. The word itself is cruel beyond definition, yet necessary? No better example of how love can be cruel.

There's a me that can see how you see things...but no, I cast you into the abyss where you're wrong; no, your demons are not real, I cannot allow them to be, for your good, and for the good of mankind, and I allow myself the privilege of not suffering them as I see the torment on your face.

I could believe every word you speak and feel their claws upon you, but I appear as one face among many, one tormentor that appears in your fragmented world of chaos: The lord of your world which says: Your world is not real, I love you.

Your world is not accurate; I come up with a million reasons which scream across the abyss: Chemical imbalance; the chemical imbalance screeches into the abyss and dissolves what is real for you into hallucinations, not realities. Is it love, or unimaginable cruelty? I trap you in the machinations of chemistry; perishable chemistry; you're made of chemistry. I congeal you into a perishable body, for whom the suffering will end one day, bringing a version of you toward me which is fallible and is never fucked forever, like all the versions of you I don't want to see. I can not see such a thing. To me, your fears never manifest, and I cast into the abyss of nothingness every "you" in which they do.

Love was never so cruel. Can it be said to be love at all, if such things are done knowingly? Or is it mercy?

Note: The use of the male personal pronoun "he" is purely for convenience.

For almost a decade, I was in a relationship with someone who suffers from anxiety and depression caused by a condition that isn't often mentioned: Delusional Disorder -- in this case, the persecutory variety. Thanks to the original post, I also learned for the first time that the Delusional Disorder is just one manifestation of the larger Borderline Personality Disorder. While I was well-aware of the former, I was not aware of the latter, but in any case, I too neglected my own mental health in a long series of failed attempts to stabilize our situation so that I could finally convince him to seek long-term therapy.

I just want to interject here that if you suspect your loved one has Delusional Disorder, learn how to approach the situation. For starters, there is a good article on WebMD authored by the Cleveland Clinic. The key is that you must coax the sufferer into getting help for the associated anxiety and/or depression rather than just to "cure the delusions." Any hint of that will create resentment and resistance, while a symptomatic approach addresses the pain which is real to your loved one. Obviously, if the individual affected by delusions could separate what is real from what is delusional in his thinking, he wouldn't have the delusions. So trust me on this -- tell him that there is help for the anxiety and then go into treatment together so that you can both discuss the underlying reason(s) why he is feeling anxious. And don't be shocked when your therapist doesn't dismiss the delusions either. That's how the professional has to play it because it's the only way to get the patient to stick around long enough to make progress.

In case you're wondering, my former partner has never made any progress against his delusional worldview, and in fact still harbours the idea that a highly organized, technically advanced, powerful group of people with contacts all over the globe are intent on gunning him down, poisoning his dogs, destroying his interpersonal relationships, and causing his complete breakdown. Members of the conspiracy include total strangers, neighbors, acquaintances, (formerly) close friends who got tired of the cold shoulder, and probably now, even me. Delusional Disorder doesn't come with an ammo box full of effective medications, and the prognosis for complete cure is poor, but sufferers can learn to question their own conclusions and can at least know relief from the associated anxiety and depression through effective antidepressants.

Needless to say, he wasn't like this when we met, although there were warning signs such as alcohol abuse and financial irresponsibility. When he got sober early on (and stayed sober for all of our remaining time together) I thought our problems were solved. Well, a big one was solved for sure, but others were just beginning to manifest themselves. Delusional Disorder's median onset is at age forty, and sure enough, that was about the time when the underlying feelings begain to insidiously and progressively take over his life -- and mine.

Obviously, no two situations are the same (hell, no one situation is the same!) but in our case, my partner refused to admit that he was mentally ill at all. After a few weeks of months of depressive hell, he'd obtain a quick script for Wellbutrin SR, then brighten up considerably and would at least recognize the pernicious effects of depression. On the medication, he was able to gain insight and exhibit emotional memory. He was able to see how effectively the feelings of hopelessness and anxiety could be counteracted via self-medication via the Wellbutrin SR. But every time, he would decide that he no longer needed the medication for one reason or another (the latest being the complaint that it slightly raised his blood pressure). His newfound insight would lead him to confidently believe that he would just "know" when he needed to go back into the medicine chest, but of course, depression doesn't conveniently denote its next onset on the calendar, and within a short time he'd be in the quicksand again with the outcome always in doubt and me on the receiving end of sullen stares, angry intonations to "back off" and interaction so limited that I had at times a more satisfying relationship withe plumbing fixtures. So my point here is that unlike the situation in the original post, my partner wouldn't use his depression as an excuse for bad behavior until after he was feeling much better.

Even with the medication, though, the underlying problems -- the Delusional Disorder and Borderline Personality Disorder -- went unaddressed. There's a huge difference between serious therapy and a quick visit to the clinic for a fresh Rx of Wellbutrin SR. One is a visit to the gas station -- sometimes after the car has run out of gas -- and the other is a complete engine rebuild, to whatever extent that such an overhaul might be successful.

Nosprings' original post beautifully summarizes precisely the emotions I have felt throughout this roller-coaster ride. When I left, I gently told my partner that this was a separation and not a breakup, because I will not surrender all hope. However, I now no longer harbour any illusions. I recognize now that my heart was not ready to give up until now, and that I enabled his behaviour by allowing him to become a virtual recluse behind closed blinds, by paying all of our bills, and by keeping his secret from his family because HE felt like to tell them would be some sort of betrayal.

When I left, because he had become 100% financially dependent on me, I supplied enough money for him to get back to his mother's home, with additional funds to follow for about three months. She has a place ready for him and can offer a small inheritance recently received from his grandfather's estate. I made sure that she knows that he is deeply troubled and in need of immediate intervention. I didn't cut off his cellphone service right away, and I gave him our shared laptop because I had a spare, to ensure that he could communicate online. I'm detaching with love, but I am detaching.

I know that others will read this, and ask why I stayed in this relationship for so long? Anyone who has been in my shoes will understand, though -- you stay in it because the good times can be really good. My partner often lavished me with attention and spoke positively about my future and occasionally, about his own. He is artistically brilliant -- an extraordinary horticulturist and landscape designer whose talent seems to have been bestowed by Athena herself. Also, the bonds of love are actually, in a bizarre way, made more powerful by the understanding that if you bolt, this person won't just feel bad for a few days or weeks, but may actually end up in the street, dead, or both. In such a situation, one literally tears oneself in two even contemplating the idea of getting out. It's just unthinkable until such time that you can face yourself in the mirror and know that you've done all you can do. And yet, sometimes still, even now, I wonder. That's how powerful this bond has been.

I resisted leaving because I knew that accepting reality would result in a devastating tidal wave of raw, painful, wailing emotion accompanied by an avalanche of grief, heartache, sorrow, guilt and pain. I won't lie to you -- I got all that -- but I also tapped into my support network and gave myself full permission to grieve not just for him, but for the loss of our shared hopes and dreams. I am still grieving now, but every tidal wave subsides and every avalanche eventually comes to a stop.

The last thing I told my partner is that I could no longer try to save him. I told him that I was drowning and begged him to GET HELP, that it didn't have to be this way, that he deserved to find love and happiness and that he was still now and would always be my friend. I supplied specific information on free resources in our area for counseling and psychiatric therapy. I also shared one last hope -- that in the future, if in fact he becomes an indpendent person and if we both wanted it -- we could potentially explore recreating our future together. But really, that was just my way of offering both of us a shred of promise that all was not lost. It's not a false hope, but an honest hope, and there is a difference. I wished him, more than anything, peace.

The pain has been immeasurable, but at least now one of us will survive. I still have dreams, I still have hopes, but like Nosprings, I too recognize that the mold is indeed largely cast by environment, upbringing and personal experience. I've done my best, and I won't be afraid to express love and support, but I've given all the money and time I can spare. I had to save myself and allow him to meet his destiny on this earth. When our souls dance together across this universe, perhaps his gratitude will fill the extraordinary pain I feel with eternal joy and peace. That's my ultimate hope, and I shall never surrender it.

If you're in a situation akin to mine, or know someone who is, get professional help and join a support group for caregivers. Break the code of silence and let your loved one's family and friends know that you need help as well. Take care of your soul, learn to listen to your intuition, and never be afraid to be honest with your loved one or yourself. You're only human, though, and only you can decide when you'll have to save your own life, but for your own sanity do so in a way that lets you keep your head held high. You'll never regret that, and you'll always cherish the good times and never look back in anger.

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