Expert: Libby Bonner - 1/8/2009

Question
Hello,Libby. This question is about my 58yr.old husband who's behavior,especially of late,has puzzled me for years. Since he is a recovering alcoholic (long time since last slip),I had always attributed his behavior to withdrawal which I learned can last up to 3 years with someone in recovery and I'm sure it has played a part in his behavior. And about 4 yrs. ago he almost died from gallstone pancreatitis which I don't believe his pancreas fully recovered from and has since caused him quite a bit of discomfort and sometimes pain. An alternative medical doctor friend has been treating him regularly for this and it has made a differnce when he sees him. The problem is that he has mood swings that leave me and our young adult children baffled.Thinking about his latest swing had me, for some reason,looking up bi-polar which led to hypomania and it desribed him almost to a tee! Our doctor friend said he'd look into it but how would I even approach my husband about this? He can get angry quick lately,tell me I'm the one with a problem, etc. and may very well stay away(he presently sleeps at my brother's house although he spends the rest of his time here at home.I just don't know how you help a person look into their mental,emotional state when they don't even think it exists and claim I am the one who has a problem and need to cool off.

Answer
You have a classic dilemma: they don't know they're sick and they think you are the problem.  

Just for starters, though, I have some questions.  Why and when did he abandon conventional medicine for his pancreatic pain....unless your friend does acupuncture?  I would have wanted ANSWERS from conventional docs, and imaging, and explanations, and I would urge you to reconsider that route.

When did the mood swings start? relative to any other events, like the pancreatic stuff, or stopping drinking, or -- ?

Alternative medicine never adequately treated any bipolar/hypomanic disorders, to my knowledge.  There is an array of proven meds that will.  I am also uncomfortable that the alt doc is a family friend....he should be bowing out of this.  And is he equally your and your husband's friend?  I am very concerned that he may soon be your husband's friend only, but your husband's buddy, his enabler, the person who keeps him from appropriate care.  And - depending on what the friend comes to believe, he may join your husband in seeing you as the enemy.    Since you are there, and I am not, you know how likely or unlikely it may be....but it would be a heck of an additional barrier to treatment if "doc" hunkers down and agrees w/ husband.

Back to the pancreatic pain.  It makes a big difference "when he sees him."  Is he somewhat irregular in getting treatment?  Any reason, like he's not sure that it "really" works?  That might be your opening to getting him to your family doc, or back to the surgeon or someone, for more evaluation.   ---  My hope here is that the psych symptoms may be apparent enough for someone to notice and start asking questions.

This book will help you to normalize things some, even though he remains untreated, and later on as well.  Author is Woolis; title is When someone you love has a mental illness.  It is directed to the daily interactions within families, and should help you modify what you say and how you say it in ways less likely to anger him.  You yourself do need to understand, and believe, that he is genuinely ill, and that this illness has caused changes in his thoughts, moods, and behavior.  He is, in a word, irrational to a large extent, and this is beyond his control.

Therefor, don't try to engage him in rational discussion about anything.  Even if it didn't anger him, he cannot understand, nor be receptive to, rational thought right now.  Your goal is to keep ILLNESS in the front of your mind, regardless of how wrong or bizarre his talk is.  Let it roll off....Woolis will give you fine examples.

The book should help you feel less powerless, and less stressed.

What you cannot do is talk to him about any aspect of his illness, nor try repeatedly to convince him that he is ill.

How is his behavior at his brother's house?  Has the brother caught on yet?  

The only other support I can suggest, besides Woolis, is NAMI.  Find an affiliate at nami.org.  I hope you can find one that has a family support group....lots of practical info there, and lots of understanding.  They will be enormously helpful to you as this thing works its way to a good conclusion.

The only really good news is that sometimes the hypomanic phase burns out, and things return to normal.   The bad, of course, is that he could become manic...and that's when you might want to be sure that the brother or some man will come hog-tie him and take him to an emergency room.  

Right now might be a good time to choose a hospital, and to choose a psychiatrist.....to have on hand.

You might also try this ploy, if you and he share a family doc or internist:  make an appt for yourself for any small reason, and at the appt ask the doc is there is a plausible way that they could perhaps need to see him?  If you can get him into the hands of any doc, it's likely that they will know what they are seeing and will do something about it.

BUT you cannot make an adult seek care, AND adults can refuse care even in the hospital.

A tough time.  The thing you have the most control over right now is YOU and your own behavior...use Woolis to make home life as calm as possible.  Be sure also that your kids understand all this...none of them should be trying to pursuade Dad that he's sick.

Here is another help, for you and your family:  look up bipolar in helpguide.org.  Suggestions for family are exellent.