If symptoms are related to an individuals' aggression or inability to fulfill responsibilities, family members may well become angry with the individual. They may experience anger if they see the individual as malingering or manipulative. Anger can also be directed at the "helping" professionals who are unsuccessful in curing the illness "once and for all." Anger may be directed at other family members, friends or God. Typically, these same family members experience feelings of extreme guilt after the individual is diagnosed. They are concerned about having had angry or hateful thought and many wonder whether they somehow cause the illness by being unsupportive or short-tempered. Moreover, much literature and other media of the past few decades have largely supported (erroneously) a common notion that parents are somehow always responsible for producing mental illness in a child. And so, parents and to a lesser degree, other family members may find that feelings of guilt and the wish to compensate for any wrong doings prevent them from effectively setting limits and developing realistic expectations.
If the individuals' illness creates an ongoing burden for the family because of such things as decreased income or continual disruptions in the family routines, it is not uncommon for family members to find themselves in a cyclic pattern of alternating feelings of anger and guilt.
Equally painful is the sense of loss that is associated with the growing awareness that, in severe case of recurrent bipolar disorder, an individual may never be quite the same person the family knew before the illness. There is grieving over lost hopes and dreams. The mourning process is usually marked with periods of renewed grief stimulated, perhaps, by the accomplishment of a peer, a family celebration or some other seemingly minor event. Eventually, as with any other loss, whether the end of a marriage, the death of a loved one, or the loss of ability though illness or accident, what is needed is a careful re-evaluation of goals and an adjustments of expectations.
Related here, may be some feelings of shame associated with unfulfilled expectations and with the stigma of mental illness. It may be interesting for family members to realize that one of the reasons mental illness carries with it such a stigma (less so nowadays), is that mental illness is often associated with decreased productivity. The value of productivity and the motion of "the bigger the better," have long formed a mainstay in North American culture. The family may have to grapple with whether they want to place such emphasis on to values related to the family, spirituality or other focus may help to diminish any unnecessary suffering due to feelings of shame.
Finally, anxiety may be ever present as family members grow to continually anticipate a change in mood, a return of symptoms. Families may find planning events fraught with worries of whether the ill relative will present any problems at the event. There may be fear that unprovoked conflicts will arise at any time, that other family members may suffer. Children may fear that they will inherit the illness, the fear that they may have to manage the care of their ill relative as well as manage their own lives when the primary caregivers can no longer do the job. To cope with such consuming anxiety, some family members learn to distance themselves (both physically and emotionally) from the family while others may put their personal goals on hold in anticipation of the next crisis. In any event, families need support to learn to manage anxiety and to lead as fulfilling lives as possible. Attending bipolar support groups can help relieve the pressure experienced by families caught in their stressful situations.
On Being Bipolar