When Ted Turner started TNN, the media was overwhelmingly negative about the chances that he could compete effectively with the established networks. Newsweek magazine proclaimed "it can't be done!".

We know today that not only was it done, but also it did not take long for CNN to overtake the established networks at providing live worldwide coverage of news events. Ted Turner paid scant attention to the nay sayers. He knew it could be done and he made it happen. According to Newsweek magazine and the Wall Street Journal, Turner was diagnosed with manic-depressive illness years ago. Manic-depressive illness, or bipolar disorder as it is now called, is characterized by excessive fluctuations in mood. People who are in the midst of a manic episode, or its less severe variation, hypomania, can be very successful. They are energetic, euphoric and enthusiastic about projects. They can be visionaries who see opportunities where others see obstacles. They are high on self-efficacy; they have a strong belief in the value of their mission and oodles of confidence in their ability to make it happen.Many do make their vision happen.

Unfortunately, others do not. The fallout from a manic episode can be devastating. Relationships can rupture, sometimes beyond repair. Careers can come to a crashing halt. Approximately 1 percent of the population, or 2.5 million Americans, experience some form of the disorder. It is estimated that each person with bipolar disorder will influence the lives of at least four other people. That's 10 million Americans who have had first- hand contact with a person diagnosed with bipolar disorder.

Mild mood fluctuations within a narrow range are a normal part of everyday experience for most people. Occasional highs and peak experiences are also normal. However, individuals with bipolar disorder experience shifts in mood and behavior of sufficient severity to cause impairment in all areas of life functioning. While in the midst of a manic episode, individuals with bipolar disorder may alienate others and end up losing the supportive resources they will need in recovery. The disorder results in much suffering and has tremendous social impact.

If you are a family member, or a friend, or a co-worker, the experience can be painful for you also. Professionals can offer people who are close to someone who has been diagnosed with bipolar disorder the following words of advice.

Learn everything you can about bipolar disorder. Know that bipolar illness is considered a biologically based disorder that has profound social and psychological impact. There are some estimates that only about 50 percent of individuals with bipolar disorder receive treatment or seek treatment. A psychiatrist is most likely to be the medical professional who will treat the biological imbalance. A therapist will help with the social and psychological factors that shape, perpetuate and maintain the disorder.

Be aware of the telltale signs of the disorder:

• Excessive mood fluctuations ranging from manic highs to severe depressive episodes; about 10 percent to 15 percent result in suicide
• An increase in goal-directed activities such as business wheeling and dealing and compulsive spending that can result in bankruptcy
• Impulsive behaviors that can be self-destructive
• The person may lose touch with reality and believe they have supernormal powers or be in touch with others with supernormal powers

A person in the midst of a manic episode can show very poor judgment. Lapses in judgment and reality testing can lead to devastating consequences. John T. was trying to keep a failing business going while in the midst of a manic episode. He borrowed thousands of dollars on the assumption and promise that he was soon to inherit an equal sum. Instead, he inherited a few hundred dollars. When he failed to pay one creditor, all his debts were called due by his other creditors, all of whom knew each other. John was forced to file for bankruptcy. His former business partners sued him. The district attorney filed several felony charges related to kiting checks Ñ writing bad checks and transferring money from one bank account to another in the hopes that you can keep the money moving around enough so you never get caught without enough money in any one account. At his trial, John insisted on acting as his own attorney, with devastating results. His courtroom manner was restless and intense. He tended to overwhelm others with his behavior, his speech and occasional outbursts of temper. His knowledge was nil of the legal basis for his case. In the end, the judge got frustrated and complained that he was spending too much time watching out for John's legal rights, rather than presiding over the case. The jury found him guilty. No one realized John was in the midst of the acute phase of a manic episode. Shortly after, he made extensive suicidal preparations by writing and sending good-bye notes. He was found in time with a gun by his side. For a riveting account of the inner experience of bipolar disorder by a psychologist with the disorder read An Unquiet Mind by Dr. Kay Jamison.

Be aware that chronicity and relapse characterize the course of the disorder. Most relapses occur when the person discontinues his or her medication. Persons with bipolar disorder enjoy the euphoria and energy of the manic phase of the disorder. Do not be angry with them about this. It is understandable that they should crave a return to this state of mind. In its most extreme form, individuals can experience a subjective feeling of union with the universe. Who wouldn't want to feel this way? The more prosaic moods of everyday life can seem dull and flat by comparison. The fact that relapse is a predictable part of the disorder is not cause for loss of heart. The counseling field has very good technologies to help prevent relapse.

Be aware of your own genetic loading. We know that there is a very strong familial transmission of affective disorders. Twin and adoption studies strongly suggest the transmission is genetic. It is well worth becoming familiar with your family tree and what individuals on your family tree may have had a history of mood disorder or any other mental disorder. Familiarity with other family members with the disorder can help ease the loneliness and anomie experienced by the individual with the disorder.

Know the difference between being supportive and enabling. The most supportive thing you can do is to refrain from taking care of any messes that may be created while the person is in the midst of a manic episode. Let the person experience the natural consequences of his or her behavior. Experiencing the consequences may be the one circumstance that wakes them up to the nature and severity of their difficulties. Be willing to find help for the person, but do not take care of the problems that have been created by his or her behavior.

Be kind to yourself. Family members may think their job is to be positive and reassuring at a time when they may be feeling negative and pessimistic. If you are feeling overwhelmed, tired or irritable, you are getting burned-out. In that case, the first step is to recognize it and be kind to yourself. There is no problem with your needing space from time to time. In fact, when aggressive feelings set in, it's time to give up, at least for the time being. When you are feeling irritable, you need to recognize you have gone as far as you can. Acknowledge that you have been helpful and that letting go, although bittersweet, is the best thing at this moment. You could even seek out help for yourself. Talking with others about how you are doing is also helpful.

Be willing to work with your own mind. Ask yourself in what way does having this person in your life create an opportunity for you? It could become a learning experience on how to work with your own mind. We could get in touch with how much suffering we create for ourselves by our attachment to making life and people be the way we want them to be instead of the way they are. We could practice on a daily basis letting go of our own preconceptions and attachments. We could experience the equanimity that comes from accepting things as they are. We could relax with our own experience and avoid trying to force other people to meet our expectations.

Meditation practice is one way to learn to tame your mind. The image is of a person riding an ox while playing the flute. You are riding your own mind rather than letting your mind run amuck with you. Taking the time to sit down and just notice how your thoughts come and go can give great insight into the experience of the person with bipolar disorder. The person with bipolar disorder feels that his or her mind is going at 78 revolutions per minute, while everyone else's is going at the boringly slow rate of 33 revolutions per minute. Taking the time to sit down and meditate a few minutes each day you will find yourself having a very similar experience. You will be amazed at how much our thoughts drive us into a frenzy of one sort or another. It is when we are in these amuck states that we create messes for ourselves and for others. The person with bipolar disorder is providing you with the opportunity to open up or shut down. Being a family member, you have little choice but to embrace what is happening.

Familiarize yourself with the process of treatment. Bipolar disorder is a very treatable condition. Treatment typically consists of three stages. First is management of the acute phase of the disorder. Hospitalization may be necessary. It is highly likely that the attending physician will recommend a course of medication. Once the acute phase of the disorder has been brought under control, the individual can begin to focus on developing the cognitive and behavioral coping strategies needed to prevent a recurrence of the disorder. By learning to identify dysfunctional thought processes and the behaviors that result from faulty thinking, you can be instrumental in preventing a relapse. Here is where the hard work in treatment will occur. Individuals with bipolar disorder need to have the courage to examine their own belief system and identify those components that have led to disastrous behavioral responses in their life. Individuals with bipolar disorder can be very ambivalent about evaluating faulty beliefs, such as "I can make it on my own, without treatment." The friendliness and support of family members can be most helpful now. Treatment will also focus on making the lifestyle changes necessary to prevent a recurrence of the acute phase of the disorder. Healthy eating, sleeping and exercise habits are essential ingredients of any treatment plan.

During the final maintenance phase, development of relapse prevention strategies becomes important. These include identification of red flags that signal a recurrence of the disorder. Some warning signals may be cognitive, such as "I can manage without medication." Other signals may include emotional states, which suggest mood may again be fluctuating above or below normal. Adjustment in medication levels may be necessary. A positive relationship with the medical professional treating the disorder is critical. If the relationship is good, the patient is more likely to make the follow-up appointments that allow the physician to evaluate the effectiveness of the medication.

Familiarize yourself with the treatment options available. Know what resources are available to help individuals with bipolar disorder and what resources are available to help family members. The Internet is a mine of information on mental illness and bipolar disorder. Here are a few of the available Web sites:

National Alliance for the Mentally Ill www.nami.org/ 1.800.950-6264

National Institute of Mental Health www.nimh.nih

The National Mental Health Association www.nmha.org/ New Guidelines for the Treatment of Bipolar Disorder www.cma.ca/cmaj/vol-157/issue-5/0503a.htm

Straight Talk about Bipolar Disorder, a videotape www.intellimg.com/avp/mania/

Accept that ambivalence about seeking help, taking medication and making lifestyle changes is normal. Individuals with bipolar disorder are no different than anyone else in their attitude about change. Think about any of the lifestyle changes you know you should be making in order to be healthier such as losing weight, exercising on a regular schedule and eating low fat foods. Then identify your own thoughts about the changes that you know you should be making. You will see that part of you wants to be slimmer, more active and healthier, but another part of you feels grouchy because you know that the pain of change outweighs the benefits of change. "I'd like to lose 10 pounds but I don't want to go through the pain of reducing my food intake" or, "I'd like to be more physically active, but I'm too tired or too busy to exercise." This is exactly the way individuals with bipolar disorder feel: "I'd like to have more stable moods, but I don't like the side effects of the medication." "I'd like to have less stress in my life, but not at the expense of giving up the euphoria of the manic phase of the disorder."

Be willing to hear both sides of the ambivalence about change. Of course, you want the person with bipolar disorder to take their medication, be in treatment and have a healthy lifestyle. However, try to refrain from being a cheerleader for change. There is a tendency for family members and friends to promote and advocate for the changes that are necessary in recovery. Don't worry so much about that. Instead, be willing to hear their negative feelings and thoughts about taking medication, being in treatment and having a healthy lifestyle. Listen and hear the negative side of what these changes mean from the other person's point of view. Don't try to change your loved one's thoughts or feelings even if they do increase your own anxiety. Instead, try to listen to your loved one's views about the consequences of change with an attitude of unconditional acceptance: "I can see that from your point of view, being on medication isn't all positive." "If possible, you would prefer not to have to pay so much attention to maintaining healthy habits." Helping the person to feel heard and understood about the pain of change is actually one of the most supportive things you can do for someone with bipolar disorder. The effect of being supportive without trying to change that person can be quite paradoxical. Feeling supported and heard about the negative side of change has been shown to actually increase a person's motivation to persevere in their journey of recovery.

Practice low expressed-emotion (EE). Studies have shown that speaking to a mentally ill person with low levels of expressed emotion (EE) may be the single, most useful way of responding. Low EE does not mean you must suppress your feelings. You can say whatever you are feeling for yourself, as long as you express it in low EE terms. Interactions characterized by high EE have been shown to correlate with an increased incidence of hospitalization. Practice being low EE. You will see that the low EE skill will help you in every area of your life. It has the effect of motivating other people to want to help you. If you are a high EE person, find someone in your life that is naturally low EE, and use that person as your model. Archie Bunker is high EE. The Dalai Lama is a person with low EE. Reframe the shame. Many individuals with bipolar disorder and many family members still feel the social stigma attached to having a brain disorder. Advocates for the mentally ill are working hard to change the public's view that the mind and body are separate entities. The mind and body are not separate entities. They do not work on different principles. They work together synergistically. Over the past 10 years, we have witnessed tremendous advances in our knowledge about how the brain works. Having a disorder of the brain is analogous to having any kind of medical disorder. We don't look down on individuals with diabetes who may need to take insulin. In much the same way, medications are available that are amazingly effective at helping regulate neurochemical dysfunction. Researchers are producing new lines of medication capable of better targeting of specific neurochemicals with fewer side effects. There is much work yet to be done, but there is every reason to be optimistic for the near future.

Chodron, Pema (1997). When Things Fall Apart: Heart Advice for Difficult Times. Boston: Shambhala Publications, Inc.

Jamison, Kay Redfield (1995). An Unquiet Mind. New York: Vintage Books.

Wegela, Karen Kissel (1996). How to be a Help Instead of a Nuisance: Practical Approaches to Giving Support, Service and Encouragement to Others. Boston: Shambhala Publications, Inc.

Michele Packard, PhD is Executive Director of Sage Institute, a licensed outpatient drug and alcohol facility that specializes in the training of mental health professionals. Dr. Packard is a licensed psychologist with over 20 years experience in the substance abuse field. She travels nationally as a trainer of mental health and substance abuse professionals.

Robert Styer, MA is Clinical Director of Sage Institute. He is a licensed marriage and family therapist who has specialized in treatment of children and adolescents for the past 15 years.

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