Expert: Libby Bonner - 5/11/2007

Question
QUESTION: My husband is bi polar. He currently is treated with Lithium, Lamictal, Effexor, and Seroquel (which he recently quit taking on his own). He takes his medication regularly and sees his psychiatrist every 4-6 weeks. However, he is still having episodes. He drinks (not at home cuz I won't allow it) at his sister's periodically (when I am upset with him) and it makes the episodes worse. During episodes, he alientates me from his family, tells me he hates me, wants a divorce, etc. He is becoming more spiteful. Is this normal bipolar behavior and does it get better? Is there anything I can do for myself?
ANSWER: I'm sorry that your husband is still so sick.  I'm afraid it IS "normal" bipolar behavior IF 1]the doctor and patient can't imaginatively find the right meds and the rights doses, or if 2] the pt is just very, very hard to get stabilized w/ meds.  I would guess your husband is the latter, based on the meds he takes.   [Sounds like his doc is trying everything.]

Would like to know in a future email, if you wish, at what age he was diagnosed, your ages, ages when married, whether there are children and their ages.

I do need to know if he sees a private psychiatrist or one based at a community mental health center.  Would like to know last date he was hospitalized, if that applies.

There are several things you can do, and I am so glad you wrote to ask.   Yours is a very difficult situation.

First, let the psychiatrist know that he stopped the Seroquel.  You don't need to tell your husband that you have done this.  And, you can do it whether or not you currently are allowed to talk w/ the psychiatrist [and vice versa.]  Just call or write the office to report it.  In situations where the family is frozen out of info and of access to the doc, they still have the right to report things. This WILL come to the doc's attention and I imagine he will not tell your husband about your report.   You are giving the doc useful info -- he could be totally puzzled about why, if H is taking Seroquel [and the other meds], he is not doing better.  ....You should also mention that he is becoming more spiteful.  Give a couple examples and try to give an approximate date when things got worse.  -- Also give date Seroquel was stopped.

Next, check wwwl.nami.org   I do hope there is a NAMI affiliate near you and that they have, in addition to speakers, a support group for families.  This is SO helpful that you should make every effort to connect to a group, even if it involves travel or other inconveniences.  I'm going to a NAMI support group tonight.  I will always go, whether things are going well, or not, here at home.  It feels good to be w/ others who understand COMPLETELY what you are talking about.  And they have years of collective experience to share.

[Ask NAMI about its Family to Family classes.]

I'm concerned to hear that he is able to "alienate you from his family.  It suggests that they:  don't understand/believe that he is ill; maybe don't understand any aspect of mental illness or bipolar illness; suggests that he behaves somewhat bettter w/ them than you [this can happen]; or that his bipolar self, when quite ill, is just an exaggeration of the rather obstreperous son they dealt w/ when he was younger [so they just see it as him being his old self, only more so]....and probably sick then, too, but unrecognized by them.    

So one of the best things that could happen would be getting them to understand that he is ill and to understand the key behaviors that show beyond doubt that he is ill.   Were they pleasant enough to you before he was ill?  Liked you fine at the time you married?  ---  However -- if he has successfully cast you in a terrible light, it will be doubly hard to get them to buy into the notion that he is ill.  --  What is their understanding of whether he is ill, or their thoughts about why he sees a doc, takes meds, probably doesn't work????

THIS will help no matter what else is going on.  The book is by Woolis and the title is When someone you love has a mental illness.  Please please buy it immediately, read it, re-read it, USE it.  It will offer strategies for communicating more sucessfully, de-fusing tense situations [or avoiding them], setting limits.  You will feel more sure of yourself and you will have new tools to use when dealing w/ him.  This book makes people hopeful again.

Here would be the absolutely ideal situation, if it could gradually be brought about, over time.  I would break it down into little things/goals and chip away at them.  Here's the ideal.  You, his parents, your parents, your friends, family - whoever counts - all understand that he is very ill, that the illness is real, and that he will have to stick w/ meds forever.  All of you also need to realize that he may never get as well as some others w/ the same diagnosis, if he is "hard to treat."  Ideally, he would sign a release of information allowing you and the doc to talk to one another about aspects of his illness and treatment.  Even more ideally, and esp important when the ill person lives at home and not alone, you AND he would go together to his psychiatrist appts.  

This is another thing you can do - easier than ideals perhaps.  If his only care now is Rxs, important as they are, then it would be good if he could be connected to a community mental health center and some of its services, which might include a weekly visit from a psych social worker, which would take a great load off you.  His doc could write an order for a/any/all services.   --- You might want to call a community MHC to see what services they have - classes [sort of training classes - dealing w/ illness, dealing w/ others, etc.] and then tell the doc specifically what things you feel might benefit him.

Think about all this, and new questions, and then write again.  Being alone w/ a spouse as sick as yours, w/ no family or other emotional support [or w/ a family against you], and w/ only a doc that you probably aren't allowed to talk to, and w/ Rxs as the only support for him AND you.....  that's just about as tough as it gets.

First goals.  Get Woolis.  Find ONE person willing to understand mental illness w/ whom you can talk freely.  Get away, if you possibly can, for a day or two, when you need to.....doesn't have to be travel or a trip, just whatever "getting away" would be possible for you and helpful to you.  --- How do your parents fit in here, by the way.

I wish you some less stressful days ahead and I wish for your husband and his doc better success in finding, if possible, the Rxs that will improve things for everyone.

---------- FOLLOW-UP ----------

QUESTION: Follow up answers:

He was diagnosed at 29.
We are both 31.
We met in July of 2006 and married in September of 2006, we were both 30, and this is a second marriage for both.
I have 3 children, 14, 12, and 4. He has a son 6.
He sees a private psychiatrist. I also attend his appointments. The appointments usually average 5 minutes.
Last date hospitalized was 10  years ago after a break up with a girlfriend. From age 16-28, he used drugs and alcohol heavily until his diagnosis.  

Answer
Glad my answer was helpful.  I should have added a more detailed ideal to the list:  that his parents will at some point be making use of their copy of Woolis, attending NAMI, and will have taken the NAMI Family to Family classes.

I am concerned about your children's exposure to this, as I'm sure you are.  Perhaps Woolis offers some help?

About going w/ him to the doc.  Family often wonder how to talk 'about' the patient while in an appt.  IF you can do this w/o a lot of rage later on,  I would suggest using any opportunity when the doc has asked a Q but not gotten a full or complete answer.  In which case , use your dumbest, most innocent voice and say, "Well, but there was that time at your Mother's...."  or whatever works.   If he omits something because the doc has not asked, there is " Did you mean to tell Dr X about _______ ?'