IT IS Ruby's father, though, who is always the last to know when an episode is about to happen. Perhaps, Ruby says, it's her father's way of coping with his wife's illness. "I do not think he can still be in denial after all these years," she says. "He just chooses to delay acknowledging that Mama could be ill again, and again the family will be going through exactly the same difficulties we go through every episode. Over and over again."

Whatever his shortcomings in anticipating an episode, Ruby's father has been a stable parent, someone they have all been able to rely on. He has never said or done anything that would show how devastated he is with what has happened to his wife, but they know it has cut deep. Yet when well-meaning friends had suggested that she be institutionalized, he had refused. "He loves her no end," says Ruby.

It is in his work that her father finds solace, she says. "I cannot believe a man of his age can still work so much, and it's worrisome," she adds. But lately, perhaps because he thinks his children are already old enough, he talks to them about their mother and how she was before she got sick, even of how he thought they would not be able to endure it all during the early years. "But that's all," says Ruby. "He doesn't really talk about it much."

Talking to others who will understand is crucial, though. Balderama say it is vital for families with a member who has bipolar disorder to have the support of fellow caregivers. "It is important to know you are not alone," she says. "That you are actually not that different, and it's all right to have this because a lot of people do."

Balderama says there are institutions such as St. Luke's Medical Center, Makati Medical Center, and Medical City where patients with bipolar and other so-called mood disorders have formed groups. While informal, these support groups have helped not only the patients themselves, but also their caregivers. After all, as Ruby says, "It's a disease that affects everyone around her."

Fortunately, as the patient reaches the golden years, the episodes do get less intense, and Ruby says her mother's behavior has gotten less offensive; the mania tames as time passes, and even the depression not as bad. The episodes come less frequently, too, and for shorter periods of time. Ruby says that in the past, each episode would last three months. Her mother would even go into what experts call "rapid cycling": In one year, she would be manic for three months, depressed for one month, okay for three weeks, and then manic again. She would have three manic episodes in a year. Says Ruby: "You'd really go crazy yourself. We could not even tell how she would be the next morning."

And, of course, her mother was younger and stronger then, and she would go out, making herself and those she encountered more vulnerable to harm.

But now that her mother isn't young anymore, the stress of a manic episode can be too much for her body to endure. "What will happen next, physiologically?" wonders Ruby. "It scares me."

Still, Ruby and the whole family are thankful for every little improvement in their mother's condition, and they work hard to manage her illness wisely. They are all now familiar with the triggers — of which travel, and the stresses from their father's job in politics, are the most frequent culprits (though Ruby concedes that even if her father's work had been different, her mother's illness would have still manifested.) They try to lessen those triggers. Balderama calls it "social manipulation": If you know that something will likely trigger an episode, then deprive the patient of that stimulus.

As soon as Ruby sees a hint of a coming episode, she consults with her mother's doctor and increases the medications. Then she warns her mother that an episode is about to occur. "Mostly, she cooperates," she says. "(But) there are times she is stubborn." Ruby is used to being the bad cop, though, and is firm with the rules.

She likens each episode to a train that neither she nor anyone else can stop. But Ruby has learned to forgive herself for those feelings of hatred that come all too often. "For a long time I was convinced I was evil for feeling that way," she says. "But now I know I can detest her when she is detestable. It goes away."

She knows, however, that the pain, like the illness, will always be there. "There was a time when I had thought that soon the hurting will subside, and I can crawl out of this hell," says Ruby. "I know now that I will not. Maybe it's like having a child — he is your child, for as long as he lives, and through all that will happen in his life. This is my mother. She is my mother and I love her, and her illness — which haunts me even in my dreams — will forever be a source of my pain."