Expert: Libby Bonner - 9/23/2008

Question
Hi,
I am writing regarding the relationship i have with my wife. She was diagnoses BP about 9 years ago and has been disabled since. She has been compliant on her meds as far as I can tell. She had a daily medication box with seven days and compartments for AM and PM. She stopped using this method about a year ago and now I can not really determine her compliance. In January she has had to change Pdocs because of the doc of 7 years left private practice. New doc is wonderful. Personable and knowledgeable.  

I see no improvement in her. Just different behaviors. She has been known to be in bed asleep for up to 18 hours. She will not journal or document her activities and responses. I believe she may not be telling her doc and therapist 100% truth and I know she is not compliant with other therapeutic modalities suggested such as photo-therapy and exercise.

Our children are concerned for her as she consumes KFC at least once a week, developed Diabetes after weight gain from Zyprexa, and is generally not contribution around the house. The kids feel that they shouldn't have to do everything if their mom sits on the couch and directs them without being responsible for herself. Basically they love her and at the same time resent her behavior.

Her spending habits are not lavish however bring us to the brink every month. Actually this is very difficult as I do overtime at work to stave off the collection companies.

I feel like I am on the roller coaster myself because I was dragged on over the years. I need a break. I can not continue this too much longer. I have been in therapy my self and this is what her docs suggest whenever I accompany her to an appointment. Often they are surprised with some of the detail I provide regarding the home life.

I am wondering what I can do to help her. I feel like I have done all I can and have very little left. Some of my thoughts are to:
1)  Separate
2)  Find a residential treatment facility where she would
   have to be independent
3)  Consider divorce

I've been involved with her illness and treatment since diagnosis in 1999. Some times I wonder if she is being manipulative or just not caring about her outcome. She speaks often about the length of this and the amount of problems she is encountering.

How can I help her? I feel like I am enabling her if I stay with her.

Answer
First impression is that it shouldn't have been this bad, and surely not for the whole time since diagnosis.    --- But clarify first: the docs suggested therapy for you...or they are encouraging divorce...or maybe both.

Of course they are suprised by details you provide....you should go to as many appts as you can.  Pts - medical pts even - just don't remember all the details when in the doc's office.

I have questions.  She is disabled, but has not applied for SS disability?  [SSDI]  Has been turned down? When last time, and how many times?  She has Medicaid??? or how are her meds paid for?

I am wondering whether and how new doc has changed meds and what she takes now.   --- You mentioned former compliance.  Did you see her take the meds in the compartments, or were they just gone regularly and apparently taken?

Everything is wrong w/ this picture.  Has ECT [shock therapy] ever been considered - when she was sleeping 18 hr/day, for instance.

She appears to be very sick, too sick to know it, and too sick to care about it.  And certainly too sick to undertake light therapy or exercise on her own.  And I can't imagine what the therapist is doing to earn his keep....one can be too sick to benefit from therapy.

About options that you mention.  There is no environment where she would  have to be independent, except perhaps the street.  [I think this doing nothing is illness, and not laziness...]   --- You could certainly separate, and she would go where?   ---  I do sympathize more than 100% w/ your situation and being at your wit's end....these are awful situations.

How does she get money to spend?  Can she be gotten off your checking and credit card accounts?  Do so if you can and give her an allowance.

This book will help you right away.  Author is Woolis; title is When somone you love has a mental illness.  Pls BUY it and start using it - you will use it a lot.  It will help you communicate more effectively w/ her....and you will not feel so HELPLESS.  It will also make you more aware of family problems in all mental illnesses and how to solve them.   Also, try to find a NAMI affiliate and attend local meetings....lots of very targeted answers there:  nami.org.   [If you stay w/ this long enough, there are NAMI classes for you, for your wife, to think about taking.]

What about the kids - they need some therapy, I would think....Is there any to be had, maybe now and then family therapy for you and them together???  Try not to form alliances w/ the kids against your wife - easier said than done; try to appear sympathetic to all parties.

Anyway, here's a plan.  [This plan assumes that current doc has all the former doc's records for her - if not, make sure that happens ASAP.]  Also, find out if there is a community mental health center nearby.  Any psychiatrist's office, or hospital psych ward, should know.   The plan: make, or ask your wife to make, a "long" appt for you both at the new doc.  Go and review the whole course of her illness, the course of her treatment. Ask, especially, what each of her meds is intended to do; ask when the current dose was begun; ask if those doses remain appropriate now; ask if there remain any appropriate meds that might be tried.  Ask what one can expect in the future.  Ask that she, the doc, and you set some short term goals for her, or even maybe for you, too. [IF she is on lithium, what is her current lithium level and is it checked quarterly, or how often.]

Raise the issue of compliance, and whether she is complying...and remember that your wife is the one who lives w/ the side effects of these meds...there are meds she may have very good reasons not to want to take, and she should have a say.

Ask the doc to write an order for "any/all services" at the community MHC and then see what programs there are appropriate; if she has Medicare or Medicaid they will be free....I would hope you could get a psych soc worker to come weekly to your home as well.

I would hope that goal-setting, and maybe a meds change, and getting services from the Center, and BUYING and using the Woolis book, and going to NAMI, might bring about some small but significant changes.

BUT.  This doesn't really address that you are at the end of your rope.  Certainly you should divorce or separate if your own life is about to fall apart completely.  Do either of you have family who are close to you, or even geographically close?  Could she stay w/ someone for a month, while you catch your breath?  Or could someone stay in the home for a couple weeks...while you go to a relative?

And we would like to see you working less...that can't help your stress.  If there are collection companies in the picture now, would some free legitimate financial counseling help you consolidate some bills, or get a better handle on things?  [Don't get scammed, tho.]
This might even be the way you get agreement that accounts must be in your name henceforth.....could solve many problems.

Attending NAMI is one of the single best things you could do, though.  That group has seen and done it all, and then some.  Telling your story will help you begin to clarify what should be done.  You really need other support persons in your life.  If there is more than one local NAMI group, go the the one that has speakers AND a support group.

We need to get you some breathing room.

Pls write again, w/ more info, new questions, whatever.