Expert: Libby Bonner - 12/2/2008

Question
My husband and I have been married for almost 8 years. He has always been depressed but refuses to get medical help, because he does not trust the medical profession (which is strange, since I am a nurse). About 2 years ago he started acting very strange with lots of angry outbursts and irrational behavior, for example, parking his vehicle at the end of the driveway to keep anyone from pulling in and pulling his hood up over his head. He refuses to have a television in the house, collects junk, and is obsessed with the Bible.  He is very antisocial and even has panic attacks at times. Does this sound like bipolar or schizophrenia or both?  I moved out about 9 months ago, because his behavior became so disturbing, but I love him and haven't filed for divorce, hoping that he will come to his senses and get some help. When I try to talk to him, he just says that he only sees himself getting worse, although he will not discuss divorce with me. He has turned his heat and air off, taken out his refrigerator and is generally living like a homeless person. He holds down a job, so he can function at least on that level, but he has no friends and limited contact with his family. Do you have any advice for me?

Answer
To your diagnostic considerations, you could add schizoaffective disorder.  Or perhaps one or more of the personality disorders??

I wonder what sort of work he is doing that he is able to maintain.  As long as he IS working, it would probably be of no use to ask the police to check on his [home] welfare.  Additionallly, at this time he doesn't seem a danger to self or others....unless your climate is such that being w/o heat or A/C could be a hazard to him.

I can see no way to get him into treatment at this time.  He may or may not trust the medical profession, but there will always be a reason that he won't get treatment.

However, it is interesting that he sees his future self only getting worse.  THAT is an acknowledgement that things are not good now.....and the only opening I see for future dialogue:  what would worse be like, and how does he see his status currently; can he think of things that would keep him from getting worse?  ---- Though could be that much of the screwball stuff he has already done has been an attempt to ward off "worse."   One really can't imagine his likely worldview and which of his actions are taken to maintain it, improve it, keep it from getting worse.

And no discussions of help will cause him to seek help.  His thinking appears not to be rational, and so you can see, I hope, the futility of further appeals to rationality.  Save you energy.

I don't know that you need to discuss divorce with him:  do you want one?  I can't see him opposing you.  

Things to think about re divorce: is he renting the house where you both lived, or do you own it jointly?  At some point in the future, he may lose his job, lose the house [whether rented or owned], lose insurance....etc.    I'm not suggeting that you should stay w/ him - together or apart.  Just that you could find yourself as his sole support AND may find by that time that he does have a diagnosis and does needs meds.  At the very least, I'd be looking at what my health insurance has to say about MI coverage; some is shockingly small.  And so you may find yourself w/ an extremely dependent, ill husband....w/o the resources to care for him.  I am assuming that somehow, by that time, he will have come into care, likely involuntarily.    [There are more and more Rx programs for the indigent now than ever......but to quailify for them, he [and you] would be far better off divorced:  only the very poor and the very rich can afford the costs that mental illness impose, seriously.

I've not been much help.  Write again if there are more specific things that I can address.

As to coming to his senses: if he were able to do that, he wouldn't need help.