Friendships require cultivation and cooperation to thrive. But when one friend also has to cope with a mood disorder, things can be even more complicated.

“Friends show their love in times of trouble, not in happiness,” ancient Greek poet Euripides once said. What was true in ancient times still holds true today. Our most valuable, most important friends are those who are there for us when we need them the most.

Friendship can provide the salve in the wound, the laughter in the disappointment, and the inspiration to become your best self. When Bill Withers’ crooned, “I just might have a problem that you’ll understand. We all need somebody to lean on,” in his heart-string-tugging tune “Lean on Me,” he highlights the reciprocal nature of friendship. Friends are there for each other.

Unlike family, friends find one another. And with no shared cultural script for how a friendship should progress, friends have to figure it out for themselves. Sometimes it’s not easy. Just ask Kevin from New York.

Acceptance

“Making and maintaining friendships has always been my biggest challenge. At present, I have only two people I consider close friends. I can and do speak with them about everything,” says Kevin.

While a friendship can be just as rewarding as any other, it can also be complicated when bipolar disorder enters the equation. In years past, before diagnosis, Kevin’s unpredictable moods could prove unnerving for some. “There are not as many people around me who are scared to death,” Kevin says semi-jokingly of his life now. “What I didn’t understand is how [bipolar] affected the people around me.”

In the 18 years since Kevin was diagnosed with bipolar disorder I his social life has changed considerably. He says he and his two closest friends, Holly and Nathan, a married couple, look forward to sharing “lazy Sundays” together, along with his dog Eevie.

Regularly socializing and sharing relax time affords Kevin the comfort to reach out to them when he is not feeling so relaxed. He says, “They are the only people I will bring stuff up to. If I hit a depression, or if someone or something is bothering me, I will even call them. I don’t wait until I run into them.”

“It takes about two seconds before we laugh about whatever is going on,” he adds.

Holly and Nathan not only accept Kevin, they treasure his friendship. As Holly puts it, “Kevin’s bipolar does not define him. He is an amazing human being—kind, intelligent, funny, gentle, trustworthy, honest, and weird enough to be fun and interesting.”

When you are dealing with bipolar disorder, “You are searching for acceptance more than anything else,” says Courtney L. Davey, MA, MFT, who works as a marriage and family therapist in Philadelphia as well as admissions counselor in a psychiatric hospital. Friendships lost because of bipolar symptoms can make you feel as if you are not accepted, she adds.

Finding friends

“I encourage my clients constantly to create a web of support, and to keep working on it,” says Davey.

Through many years of practicing her spiritual discipline, Marianne had developed a strong network in her New Jersey community, including several close friendships. However, it took her entering into a dark place to risk taking some of these relationships to a new level.

Five years ago, waves of self-hatred led to suicidal thoughts, and Marianne, who has bipolar II, was terrified of hospitalization. Who would take care of her cat? Her distress compelled her to reveal her fears to her long-time friends.

Sharing her pain with those closest to her paid off. They opened up to her as well, which helped her take the focus off of herself. They also encouraged her to get out of her comfort zone.

Now, Marianne lets her friends know when she needs help with transportation or anything else. “They realize how hard it is for me to get through the day. Although I do volunteer almost every day, sometimes I have to breathe and center myself just to buy a pack of gum.”

She reflects on past friendships, “I wasted a lot of time getting people to like me who were emotionally unavailable. Imagine 20 people are clapping for you, and the one that leaves the room is the one you want as your friend.”

When it comes to finding comfort in friendship, Dennis of Ohio also arrived at a turning point. A year after being diagnosed with bipolar II, Dennis was diagnosed with high-functioning autism, which complicated his ability to socialize and made him realize that he didn’t read body language naturally.

He had to learn to remind himself to “switch his brain into socialization,” to make himself aware of people’s mannerisms and expressions so that he could more effectively communicate with others.

Dennis’s challenges with bipolar eventually inspired him to reach out in virtual friendship, as a peer. A professional writer, he created his own blog, which aims to offer helpful information to those newly diagnosed or struggling with bipolar and their loved ones.

He points out that communicating through social media can sometimes be an option to creating friendships and getting support. “Talking about something doesn’t always have to be verbal.”

Dennis’s friend Jennifer R., an RN who lives in Indiana, admires Dennis’ “tireless” devotion to his friendship blog and says, “I think he has become most helpful to those that love someone with bipolar disorder.” And it works both ways, she adds, “Oftentimes, Dennis is my “reality check” and keeps me grounded when I start to lose my way. I feel fortunate to be his friend.”

Jennifer emphasizes that friends need to accept bipolar as a brain-based illness. She says, “He can’t just “snap out of it.”

As a therapist, Davey agrees, “Having some understanding of bipolar’s nuances is important for friends, or its symptoms and necessary lifestyle accommodations can seem baffling. Or even worse.”

Friendship dynamics

“Social support is very, very important for someone with bipolar. It helps you manage stress as you maneuver your way through the ups and downs of the illness,” says Eleora Han, PhD, Clinical Psychologist and author in Virginia.

Friends can help in providing that source of strength, although navigating the relationship may involve some trial and error.

Han says you want your friend to understand that bipolar is biological and that you are working hard to manage it. She adds, “You want someone who doesn’t judge you or think it’s an issue with morals or character.” If your friend mistakenly believes that your challenges with moods and thinking patterns are due to a character flaw, this can cause you to doubt yourself, experience shame, and question your treatment plan.

The uninformed friend can prove counterproductive to someone with bipolar, as Han has observed. She says, “An unhealthy relationship might worsen bipolar symptoms, whereas a healthy relationship may provide invaluable encouragement and stability.”

Sometimes a friend who is a negative influence can drain you of the energy you need to practice self-care, detour you from achieving your goals, or even trigger an episode. Part of that self-care is being able to step back and assess whether the friendship is beneficial for you and being willing to let go of it if it’s not.

Dennis steers clear of negative individuals. He admits, “It’s a balancing act in some cases, and sometimes you have to make a clean break.”

As to the other side of the friendship equation, not everyone is able to handle the intensity that often accompanies bipolar—intensity that eases, but can somewhat remain, albeit morphed into heightened enthusiasm, even when stability has been achieved.

“Not every friend is going to be good with handling bipolar,” notes Dennis. “They might have a thin skin or be dealing with their own traumas. People need to be a friend, give as well as receive, and invest the time and effort.”

And sometimes episodes spell the end of a friendship. “Not every person signs up for the trials and tribulations that come with it; some relationships are not able to withstand that,” explains Davey.

Gift of friendship

Close friendships can serve as that magic ingredient in one’s treatment plan. Friends can make you laugh as well as hug you when you cry. And when someone takes the time to learn about bipolar and is willing to voice their concern over behavior shifts, it can be vitally important.

Some friends can act as your sixth sense to help you notice the subtle signs that can be nipped in the bud to help you avert an episode. “Finding those pre-symptoms, having those people come to you in a place of caring rather than a place of judgment,” can be invaluable, Davey points out.

Of course, it’s important to first establish some guidelines for how and when your friend should communicate a word of warning for changes in mood or behavior.

Dennis’s friend Justin, a social worker from Tennessee, says, “Knowing that someone accepts you, acknowledges there is a problem, and assists you in seeking life-changing help, may be the difference between changing for the better or finally ending it.”

Trusted friends can be of support by providing a “reality-test,” and help you review details of whatever situation is upsetting in order to assess whether your hopes or fears about it are realistic or exaggerated.

A close friend can also help you become your own best friend, which can be challenging, adds Davey. “If we don’t have a positive relationship with our self, we are never in a position to have a positive relationship with others.”

By Sasha Kildare