My Lovely Wife in the Psych Ward
January 13, 2015 12:42 AM   Subscribe

We met at 18. We wed at 24. At 27 I checked my wife into a psych ward—for the first time. How mental illness reshapes a marriage.

A couple deals with mental illness. Sensitively written from the perspective of a committed partner.
posted by vapidave (53 comments total) 66 users marked this as a favorite
As the article is about mental illness trigger warnings are in order.

Referenced in the article; Ronald David Laing; Mad Pride; Allen Frances.
posted by vapidave at 12:50 AM on January 13, 2015 [3 favorites]

Thanks for the post.
posted by a lungful of dragon at 1:01 AM on January 13, 2015 [1 favorite]

This guy is a hero.
posted by modernnomad at 1:46 AM on January 13, 2015 [4 favorites]

It's no fun signing a partner over for Electric Convulsive Therapy (shock treatment). But if someone is chronically depressed and not eating what are the options? The people who are depressed don't thank you for admitting them to a psychiatric hospital.

I never realised the split of melancholy and psychotic depression. The symptoms of psychotic depression are similar to schizophrenia hallucinations.

>> (That’s part of the critique from Insel, Frances, and others: Psychiatry, as it exists in the DSM, is just a directory of catchall symptom-based labels.)
Yes but the medicalization of mental illness has enabled pychiatrists to define the illness by what medicines seem to work.

It's really annoying when the general public confuse psychotic depression with mild depression or people feeling bad.

I was in a relationship with a psychiatric nurse and that was very strange as will.
posted by Narrative_Historian at 1:57 AM on January 13, 2015 [4 favorites]

Jesus this was hard to read. Hits very close to home.
posted by Mogur at 4:45 AM on January 13, 2015 [5 favorites]

You know, this sounds like an awesome guy, and good job for what he has done for his wife, but the solution to the insufficient treatment of mental health doesn't seem like it should be making laypeople the people who treat.
posted by angrycat at 5:32 AM on January 13, 2015 [8 favorites]

Am I the only one that can't get to the article? When I click on the link it takes me to a roundup of stories from this mag, when I click on this story, it takes me right back to the same page.
posted by marxchivist at 5:35 AM on January 13, 2015

Yeah, it was a hard read--you can see the cliffs coming. I think this makes an interesting companion piece to the FPP I posted recently about the move away from institutionalization and toward community dwelling for people with mental illness, and "The Dignity of Risk". How can loved ones and society as a whole best balance best interests and the free will of people with mental illnesses? I have tons of sympathy for this couple, but I do hope the husband takes a firm stance against throwing more innocent children into this mix with a wife who has twice now undergone serious and lengthy mental health crisis with intensely suicidal features, the second of which appears to be linked with PPD.
posted by drlith at 5:44 AM on January 13, 2015 [15 favorites]

What is another terrifying facet of this is that in Italy there are some of the fewest pro-capita inpatient beds in Europe. In a spectacular example of throwing the baby out with the bathwater, mental health care was gutted when asylums were outlawed in 1978. So this happening to her in the US was the best possible tragic scenario.
posted by lydhre at 5:46 AM on January 13, 2015 [3 favorites]

marxchivist, I'm accessing the original okay, but here's a "printfriendly" version that might work for folks having trouble.
posted by taz at 5:49 AM on January 13, 2015 [2 favorites]

I think it's a poverty of the English language that we use the same word to describe how a 5-year-old feels when his baseball game gets canceled because it's raining and the way someone feels who's about to jump off a bridge because life has become unlivable and untenable. And I think Styron's objection to the word depression is a common objection to the word depression - that because it gets used to describe such a range of experience, it's sometimes difficult for people who are dealing with acute clinical depression to convey how different their circumstance is from the circumstance of someone who's simply sad.
-- Writer Andrew Solomon commenting on William Stryon's "Darkness Visible"
posted by CBrachyrhynchos at 5:56 AM on January 13, 2015 [11 favorites]

Oh hi, my parents. Well, Stevenage and Bedfordshire rather than San Francisco but so many points of similarity. This is probably going to be a yearly thing for them - sleeplessness, euphoria followed by psychosis, trip to the hospital.

I have tons of sympathy for this couple, but I do hope the husband takes a firm stance against throwing more innocent children into this mix with a wife who has twice now undergone serious and lengthy mental health crisis with intensely suicidal features

I don't know. Maybe? It's something they'd have to think about? It's not for us to say? I grew up like this and it's no bucket of roses and I wouldn't do that to any kid intentionally, but it's not like there isn't worse going on.
posted by Artw at 6:30 AM on January 13, 2015 [8 favorites]

I wonder how much the writer is blinded by his adoration of his wife. I wanted to shake this poor besotted young man and ask him if he can really protect his young child 24/7/365 from his wife.

Back in the 1950s my equally beautiful and very young mother had similar problems, and my adoring father did what he could for many years until he couldn't take it any more. Meanwhile my younger sisters and I suffered. I didn't know my mother had a mental illness until I was in my teens. Who knows what normal is when they're a kid? I can forgive my mother for the many ways she mistreated us. I will not forgive my father for not protecting us from her illness.
posted by mareli at 6:55 AM on January 13, 2015 [18 favorites]

Surely a better way of managing that would be to actively make your children aware of a parent's mental health problem, rather than saying you'll make your children suffer so don't have any?
posted by Braeburn at 8:12 AM on January 13, 2015 [1 favorite]

By which I mean, I talk to my friends about children and a lot of them worry that they'll pass their illness on, that there's no real escape from bad mental health. But with support there is. Being depressive doesn't make my life not worth living. Unmanaged, it just makes it feel like that's the case.
posted by Braeburn at 8:16 AM on January 13, 2015 [3 favorites]

I thought of myself as Giulia’s advocate, but often, with her physicians, I didn’t side with her. I wanted her to follow medical advice that she herself did not want to follow.
That's the real killer for me, and how this is different from, and so very much harder to deal with than, purely physical ailments. Somewhere, there's an AskMe answer that compares living with someone with mental illness to living with an addict. I can't find it, but this one is similar--you're in a relationship in which the other person cannot give 50%, who cannot meet you half-way.
posted by MrMoonPie at 8:18 AM on January 13, 2015 [4 favorites]

This could happen to any one of us. It's easier to identify with the husband in this story, but any of us could find ourselves in the role of the wife.

That thought makes me very hesitant to go along with many of the "for your own good" and "for the sake of the children" arguments which otherwise seem so compelling (including "don't have more children -- for the sake of the children." That way lies a terrible history of sterilization of the "unfit," not long ago and not far away, here in the US.)

The "mad maps" seem like a good idea, but so fraught... He says they schedule times to discuss what to do if she gets sick again knowing that they are scheduling fights. But what if the sick person won't even acknowledge that they were/are sick? He describes how fuzzy the edges of mental illness are, how poorly the causes are understood, and how central someone's "illness" can be to their identity. The solution of "make a plan while she's well" doesn't really resolve that tension, since it relies on them both being able to agree that she is "well" at a given moment.

So heartbreaking. I guess maybe the solution is some more objective kind of diagnostic criteria? Would blood tests and brain scans that could clearly separate "normal" from "sick" make this easier, easier to know when to let the patient participate in their treatment and when to overrule them? But even if a clear difference can be seen in some physical indicator, does it follow that "different" equals "sick" equals "has no voice in their own care"?
posted by OnceUponATime at 8:26 AM on January 13, 2015 [1 favorite]

I'm trying, but I cannot understand the rationale of someone who does not want to do everything she can to prevent another episode from happening. There is a place for daily medication, and this is it. I speak as someone also in this position, though so far my episodes have been less severe.

Just as I use caffeine and alcohol sparingly (as Giulia does), just as I make sure to get enough sleep (just as Giulia does), part of dealing with a lifelong illness that would otherwise ruin my life, my productivity, and my relationships with those I love is taking medication every day. They always say that when you are feeling great on the meds is when you decide you don't need them. That's the scary part.

I don't think an adult should necessarily be forced to take medication for their own good. However, Giulia has a small child depending on her and sometimes we swallow otherwise bitter pills in order to maintain our responsibilities. It's not illegal to be irresponsible, nor should it be -- but it's not a particularly sound decision on her part, and I don't think it should be encouraged. I wonder what the psychiatrist who prescribed that "rescue" bottle of pills thinks of all this?
posted by fiercecupcake at 8:42 AM on January 13, 2015 [13 favorites]

Rather than "mad maps" we call these things WRAP plans (Wellness Recovery Action Plans), and there are several peer-based organizations in San Francisco that help people work through them. In the community they are thought of as analogous to Advance Directives, in that they help people anticipate the possibility of adverse events and plan for them. Hope for the best, plan for the worst and all that.

The hope here is that the family and the client will be strengthened by going through the process and that, when a crisis hits, the person going through it may recognize his or her "sane" self reaching out, trying to help or support, rather than control. Kind of like writing a letter of encouragement to your future self.

Sometime wrap plans work, sometimes not. But the journey of recovery from mental illness is long and by no means linear.

As far as the thing of having / not having children, I think the important thing is to try to help the child become clear that mom or dad's problems are *not* the child's fault.
posted by jasper411 at 8:47 AM on January 13, 2015 [8 favorites]

I hope this guy someday finds some time to himself and his own needs.

I can only imagine what kind of caretaker burnout something like this must generate in the non-afflicted partner. And the first thing they taught us at 1st responder training was if, tin he the course of trying to save someone you put yourself in a situation that requires rescue, you cease being an asset and become a liability.

Personally, I dunno how down I am with the idea of "Mad Pride";

Human beings are among the most socially interactive animals on Earth. Absent social interaction with other humans during critical early development years, the brain doesn't develope fully. In reality, Tarzan probably never would have learned to speak English & spend part of his time as Lord Greystoke.

Solitary confinement is considered a severe/borderline tortuous punishment in every culture across the globe because of how it affects the people subjected to it. Even spiritual seekers who choose to live in isolation are generally considered hardcore for choosing something so alien to human nature. And prisoners in solitary become psychotic, delusional, and have all manner of mental health problems because of the isolation from human contact. It changes how their brains function and rewires the neural pathways.

Given that psychosis can be induced and nobody is arguing that the men locked down in the SHU are somehow expressing a truer, more authentic message when they start to break down, why is it different when someone's brain ends up broken and they exhibit similar characteristics out in society?
posted by Pirate-Bartender-Zombie-Monkey at 8:50 AM on January 13, 2015 [2 favorites]

Blood tests and brain scans don't typically show any difference unless the cause of the mental illness is physical (brain cancer, lesions, etc) in nature.

In assessing an acutely psychotic patient in a psychiatric hospital, where the treatment is largely pharmaceutical in nature, I typically have a conversation with the person about how their day went or how they came to be in the hospital and characterize their responses with qualitative descriptors. If they are acutely delusional, bizarre, disorganized -- we note this. If they're seeing or hearing things that other people don't see or hear, we talk about it and make sure they're not hearing commands to hurt themselves. If their judgement or insight improves, we note this.

Some people do eventually display fewer positive symptoms of psychosis, mania, schizophrenia. Some people don't. I've only seen it happen through medication but maybe that's a product of my environment.

I don't think anyone knows why.
posted by sibboleth at 8:51 AM on January 13, 2015 [3 favorites]

"[I]t's not like there isn't worse going on" isn't a good reason to add children here, Artw.
posted by uberchet at 9:01 AM on January 13, 2015 [5 favorites]

Blood tests and brain scans don't typically show any difference unless the cause of the mental illness is physical (brain cancer, lesions, etc) in nature.

Don't you think it likely that its always physical in nature, and we just don't know the physical cause in most cases? (So we have little choice but to treat the symptoms?)

What I'm getting at, though, is that even if we did know the physical cause in every case, I'm still not sure that would make it okay to treat people against their wishes. There are deaf people who are just fine with their lives as deaf people, and don't want cochlear implants. There are people on the autism spectrum who are just fine with their lives as autistic people, and don't want to be "cured."

So, even if we knew the physical cause of his wife's symptoms, I'm not sure if that would solve the author's dilemma. I'm not sure it would totally justify his decisions to treat her as an equal at some times and a dependent who can be medicated against her will at others.

But maybe it would, or partially would?
posted by OnceUponATime at 9:14 AM on January 13, 2015

Great essay, although how does the "mad pride" theory the writers describes coexist with self-harm? According to the writer his wife at various times considered taking her own life.
posted by Nevin at 9:16 AM on January 13, 2015

This is hard for me, but I feel like it is so close to my story that I can’t not comment.

My wife’s diagnosis is bipolar but, like the author’s wife, it has mainly presented itself as mania and psychosis, including two hospitalizations, the first for more than a month, plus a lengthy period of outpatient care, the second for nineteen days. Both hospitalizations happened when we were in our twenties, and in both cases we weren’t prepared. She didn’t have a psychiatrist she was seeing regularly, didn’t have medication and we didn’t have a plan.

We have two kids. Again, like the author’s wife, my wife had a manic episode in the immediate postpartum, but this time we had a plan. We had both met with her psychiatrist, we had a medication plan that took nursing into account, we had help line up if we needed it. We were prepared, we thought.

Of course, we really weren’t. Our plan managed to keep her out of the hospital and at home with the baby, but that was about it. I think this was immensely positive for her mental health and recovery, but it meant that I spent a lot of time with a newborn baby and a wife I did not trust to leave alone by herself for more than a few minutes. I is still by far the hardest thing I’ve had to do in my life. It took a while, but she got better, and six months later she was back to being herself. I vowed that I wouldn’t do that again. One kid was enough.

But three years later, we changed our mind. It was very difficult for me to agree to having a second child. All I could imagine was going through what we had before, but with a three year old to take care of as well. But my wife wanted a second child, and I couldn’t stand the thought that years down the road we would look back and I would be the reason my daughter didn’t have a sister. So I agreed.

This time our plan was much more aggressive in terms of medication, care and support. And while my wife had a depressive episode during the first trimester of her pregnancy, and we dealt with it. And the postpartum turned out to be… fine. She was fine, which was the last thing I expected. That was three years ago.

And I’m glad we did it. I love my daughters very much I’m glad we have both of them. But I wouldn’t have done it if we hadn’t gone through the work of making the plans and getting on the same page and knowing that we were a team.

I know that my wife’s mental illness will always be something that we have to deal with, in one way or another. She will always have to pay attention to her sleep, to her mood, to her thoughts, in a way that most people don’t. Things aren’t perfect, and the road can be bumpy. But we can and do have a great life. We have two wonderful kids. We live in a great town. Despite everything, my wife has managed to forge a successful academic career.

It sounds like the author and his wife are doing the work they need to do. It isn't easy. I wish them the best of luck.
posted by Lazlo Hollyfeld at 9:20 AM on January 13, 2015 [40 favorites]

I'm just blown away by how he did it. How? How did he get up every morning with that fear that the person you love most in the world is . . . not there? How did he stay up all night with her and not completely lose it?

I feel so badly for this couple, and their story terrifies me. I don't know what I would do in either of their positions.
posted by chainsofreedom at 9:25 AM on January 13, 2015 [3 favorites]

I'm glad that the author feels able to talk publicly about the stresses of a family member with serious mental health issues. The problem with talking publicly is that the Internet Never Forgets and one discussion like this could very well be the silent roadblock to a job or a promotion.
posted by plinth at 9:28 AM on January 13, 2015 [3 favorites]

That thought makes me very hesitant to go along with many of the "for your own good" and "for the sake of the children" arguments which otherwise seem so compelling (including "don't have more children -- for the sake of the children."

By the same token, there was (IMHO absolutely justified) criticism leveled against Andrea Yates' husband for both ignoring her doctor's recommendation against having more children after Andrea's history of PPD/psychosis and for failing to protect those children adequately against the mental health crisis during which she murdered them all.

I think saying "I can't agree to make more children with you until your mental health has been stable for an extended period of time either without medication or taking medication that can be safely continued throughout pregnancy and lactation" is the responsible and ultimately loving and supportive thing to do, and not a slippery slope toward sterilization.
posted by drlith at 9:32 AM on January 13, 2015 [16 favorites]

This is very close to home for me too, enough that I don't feel I can comment at length without saying things that aren't my story to tell, but it was good (if hard) to read. Thank you for posting it.
posted by Stacey at 9:32 AM on January 13, 2015 [3 favorites]

The "mad maps" seem like a good idea, but so fraught... what if the sick person won't even acknowledge that they were/are sick?

I have a Facebook friend (real-life acquaintance) who is active in the mental health patient advocacy field and who chooses to be very open about her own mental illness online in an effort to fight stigma. She has posted portions of her WRAP (Wellness Recovery Action Plan) to Facebook, including the part where she wrote out what it looks like and feels like when she is just barely starting on a downward spiral, that she may be faking it very convincingly and yet if she is doing x and y or feeling z, then it is time for her to take the next action. (I assume there is a list of supports she plans to seek, though she hasn't posted specifically about that.)

On one hand, part of me is like, oh god you can't talk about this on Facebook boundaries boundaries. But on the other hand, the longer I'm Facebook friends with her and see how responsibly and consistently she deals with it, the more impressed I am and see her as a role model in dealing with my own (way less scary sounding) diagnosis.
posted by Bentobox Humperdinck at 10:15 AM on January 13, 2015 [7 favorites]

Blood tests and brain scans don't typically show any difference unless the cause of the mental illness is physical (brain cancer, lesions, etc) in nature.

MDD is always physical. Even if it starts with what you might call "situational" or "cognitive" factors, the effects are physical.

For MDD, research has found differences in volume in the hippocampus and ventromedial prefrontal cortex and significant changes in the structure and function of other places in the brain, compared to non-depressed people.
posted by cotton dress sock at 10:15 AM on January 13, 2015 [5 favorites]

I feared Giulia's recovery being taken out of the hands of sane, compassionate people—i.e., her medical team, family, and me—and given over to people like herself, who might be psychotic or suicidal.

Even in my healthiest, least depressed moments, living with the knowledge that the people in my life see themselves this way -- sane, compassionate -- in contrast to me and my mentally ill peers is just... man, I don't even know. It feels fucking awful, is all.

Dude spends the entire rest of the essay talking about how much he adores and admires his wife, but with one sentence, he wipes it all away to call her insane and malevolent (or whatever similar characteristic can be held in opposition to compassionate). Does he think that mentally ill people don't already know that many and maybe even most of the people in our lives believe us to be irretrievably bonkers and thus inherently unable to take responsibility for any sort of self-care? Like, I totally get that it's very important to people who don't suffer from severe mental illness to hold themselves up on a pedestal and talk about how That Could Never Be Me, but damn. I would not want to pin those labels on someone publicly under any circumstances, I don't care how nuts they are. Just because I'm suicidal doesn't mean I can't take care of my shit. It's all a matter of degree.

But if your spouse has a known tendency toward completely losing touch with reality, the kind of deal where she's receiving audible instructions from God on a regular basis, it seems like a really bad idea to even entertain the notion of letting her stop taking her meds so she can get pregnant again; down that path lies literal madness. I hope they'll at least put together a psychiatric advance directive -- not a "mad map" for household discussion, but a legal document that you give to your doctors -- before she starts tapering off.

And maybe I only see things this way because I was born without the biological imperative to make more humans, but I absolutely do not believe that "I want to have more children" is a good enough reason to open yourself and your already-existing kid(s) up to the probability -- not possibility, probability -- of honest-to-goodness psychosis. Watching the person who's supposed to be your adult caretaker get hauled off into the back of an ambulance in handcuffs for "dehydration" a few times a year ain't all it's cracked up to be.

Parents with severe mental illness have a duty to keep taking their meds so they can stay alive and healthy for the sake of the family they already have. It didn't kill my mother when she purposely stopped taking lithium so she could pop out an entire frigging brood, but it sure as hell almost killed me.
posted by divined by radio at 10:39 AM on January 13, 2015 [19 favorites]

The biological imperative is strong, though, and often cannot be ignored.
posted by Nevin at 11:41 AM on January 13, 2015

“Mark, I think this is worse than if Giulia had died,” my mother-in-law said to me one night after leaving Saint Francis Memorial. “The person we visit is not my daughter, and we don’t know if she is coming back.”

Oh, my god, I know this feeling. I live with this feeling every day. What keeps me going is the knowledge that new discoveries have been made recently, and there is (distant) hope.
posted by MexicanYenta at 12:06 PM on January 13, 2015 [2 favorites]

I enjoyed that article. It's a very difficult read and scary. And yet reaffirming to me. Thanks.
posted by dios at 12:07 PM on January 13, 2015 [1 favorite]

Sorry, could have used language better, instead I invoked dualism. Of course all illness has physical and mental components. Some symptoms of 'mental illness' can be attributed to organic causes.

The reality is that very few people with MDD are going to get an MRI of their brain, as it will not, in this paradigm, alter the diagnostic and treatment course of the disease.
posted by sibboleth at 12:24 PM on January 13, 2015 [1 favorite]

I'm trying, but I cannot understand the rationale of someone who does not want to do everything she can to prevent another episode from happening.

Sometimes the side effects of the treatment are really bad, leaving one feeling like a zombie 100% of the time, or causing serious physical illnesses. The cure can seem literally worse than the disease (and sometimes it is).

Sometimes there is a hope there won't be another episode, that it was a fluke caused by a convergence of negative events which can be avoided.

Sometimes there is a rebound effect when things are going well; like people with heart disease or diabetes, it might be easier to sustain difficult activity and dietary changes when the acute symptoms are more immediate, and harder a year or two down the road.

Sometimes there are social issues - feeling like a burden, or feeling like others are trying to control one (an often accurate but lied about reality, which really doesn't help).

Sometimes the symptoms themselves interfere; people with depression often have difficulty getting started on a given task and not being able to accomplish a basic task can then cause a shame spiral which makes it even more difficult to accomplish the task; breaking a shame spiral is incredibly difficult. People with delusions also often have perceptual differences which can include literally not realizing what their behavior is or not being able to track behavioral changes over time; this can lead to a circumstance where it seems like everyone is lying about you and blaming you for things you know you didn't do, at which point being medicated for all of this stuff just seems like more victim blaming.

Sometimes the process itself is demoralizing; psychiatric medications are less like going to the doctor and getting given a prescription, and more like being the subject of a single subject study where minute changes will be made over time and sometimes the effects (or lack thereof) of the medication can be horrific. Only this study is your life.

The stigma, usually internalized, can also be horrible. I spend a lot of time talking about taking medication for heart disease and insulin for diabetes when talking to people about taking medications every day. There is a despair attached to the idea of being "broken" on some level which is far more personal when the symptoms are psychological or expressed socially.

Sometimes the helpful dose is twice, even three times a day, which can get confusing and frustrating fast even for people without cognitive issues.

Stigma is often accompanied by moral claims which can be all too realistic in the face of psychosis. "I must be a bad person" is a devastating thing for people to internalize. Many cultures also hold that shaming or hurting people is a positive and useful thing to do which will cause positive effects; internalizing that can mean individuals punish themselves extensively, weakening themselves and destroying their resources and fortitude in the belief that they are doing something good (you see this cycle a lot in people who self-harm).

And sometimes the meds don't really work; mistaking correlation and causation is incredibly common in psychiatry, especially since the science is currently on the poor side, the placebo effect is not entirely accounted for due to the difficulty of the circumstances, and we don't actually understand what we're doing re: neutrotransmitters. We need a lot more knowledge before it will be anything other than trial and error, and having your life be other peoples' trial and error can be devastating in and of itself, especially if those people are also rushed, stressed, and irritated by a system which is more important that dotted /I/s and crossed /t/s than whether people feel listened to and cared about.

I would disagree that "mad pride" is a form of self-harm except in extreme cases, however. "Mad pride" is an attempt to combat the stigma that says deviating from the norm is a priori a mental illness. Mental illness as a reason to dismiss people ("they're delusional") and ignore what they have to say is common in contemporary society, and the history of using it as a way to literally incarcerate people is very recent (the modern standards for involuntary holds date back to the 60s). Before then, one could handle troublesome family members by paying a sanatorium enough to hold them, and convincing doctors they were insane.

Speaking as someone who works with some pretty disabled people, they all have something important and valid to say - it's just sometimes a lot harder to hear it. I wish more people made the effort to listen to others. I doubt that would solve all problems - psychosis of the schizophrenias type seems to be culturally universal as few mental illnesses are, for example - but it would go a long way to feeding their social need to be valued as individuals who deserve to be heard.
posted by Deoridhe at 1:03 PM on January 13, 2015 [21 favorites]

There are things you shouldn't have to listen to. When my mentally ill family member calls me with a long and profanity-laced rant, I hang up. Setting this boundary has improved my life greatly, and I can't imagine it makes his life any worse. Eventually you have to say no.
posted by elizilla at 1:41 PM on January 13, 2015 [2 favorites]

He gets warned for the first few profanities, and sometimes he manages to pull back from it. I think the only reason he manages to pull back from it when he does, is that he's learned that the limits are hard. I absolutely will turn off my phone. I am not a sacrificial goat to carry away his burden of hate. (With or without a coat.)
posted by elizilla at 1:47 PM on January 13, 2015 [1 favorite]

I wonder how much the writer is blinded by his adoration of his wife. I wanted to shake this poor besotted young man and ask him if he can really protect his young child 24/7/365 from his wife.

From what? "The crazies"? Nowhere in the article did it mention that she was aggressive, violent, or that her psychosis had any affect on her physical behaviors at all. The notion that if you have one psychotic syptom you've got them all, or that you're just some nutcase waiting to burst at the seams and murder everything around you-fuck that.
posted by FirstMateKate at 2:59 PM on January 13, 2015 [8 favorites]

I don't have the biological imperative to reproduce, either, but I am still really uncomfortable with the notion that people living with mental illness, and their families, should be subject to social judgment for doing something that is such a fundamental part of normal human life. Mental illness carries such stigma, and people with mental illnesses have to deal with so much ableism. My mom had untreated and undertreated mental illness, and, sure, it fucked up my childhood, but if it had been appropriately treated, I don't think it would have damaged me any more than having a parent with any chronic physical illness or disability, and probably less than life with parents who are able-bodied and -minded but are selfish assholes or crap at parenting. Whether the disability is mental illness or a physical impairment, disability per se isn't a reason people shouldn't parent.
posted by gingerest at 3:16 PM on January 13, 2015 [7 favorites]

Sorry to have picked at you, sibboleth. I just think it often gets missed that something like depression could have a few causes, and yet end up with the same effects. True, those scans have squat to do with what happens on the ground, and you clearly know what you're talking about, and obviously, deal with on a day to day basis.
posted by cotton dress sock at 3:54 PM on January 13, 2015

I could not get on board with the author's aversion to medical treatment of mental illness. What about Adam Lanza? Jared Loughner? Andrea Yates, as already mentioned?

One might say, well there's no evidence the author's wife is inclined to harm anyone except herself... fine, but we're still talking about a human life.
posted by halonine at 5:07 PM on January 13, 2015 [4 favorites]

Great article, thanks for posting.

Also it is not unusual to be diagnosed MDD + psychosis in your first episode, and the next episode or a few later may be your first manic episode + psychosis. Even in bipolar disorder, manic episodes are less common and depressive episodes usually come first. So the doctors may not have been "wrong" in diagnosing MDD first and then changing to BPAD, since that is a fairly common trajectory.

Also want to give a shout-out for Lithium. Lithium is a lifesaver and has demonstrated anti-suicidal properties above and beyond its mood stabilizing properties. There is even a hypothesis that lack of Lithium as a micronutrient is a risk factor for affective illness, which is intriguing. It's amazing that the 3rd simplest atom in the universe is also an awesome medication.
posted by fraxil at 5:30 PM on January 13, 2015 [1 favorite]

One might say, well there's no evidence the author's wife is inclined to harm anyone except herself... fine, but we're still talking about a human life.

her human life

obviously it's not that simple because I think it's entirely fair to say that she owes it to her child and husband to be "there" as much as possible

but those are pretty much the only people whose business her life is right now and anyway where they end up doesn't really seem to be opposed to medical treatment but for approaching it in the most humane way possible.
posted by atoxyl at 5:39 PM on January 13, 2015 [1 favorite]

@atoxyl True. So long as she is not a threat to anyone else. Hopefully the people around her will take appropriate action if it comes to that.
posted by halonine at 10:22 PM on January 13, 2015

My mother, who was born in the late 1920s, had schizophrenia that apparently started manifesting itself when she was in her late teens. She was 21 when I was born and had two more children after me. The only time I remember her physically harming me was when she forcefully burned me with a cigarette when I was about 14. As far as I know, she never physically harmed my younger sisters. The emotional harm she did to all of us, on the other hand, was enormous and deep. Her viciousness was very sly. I remember trying to talk to my great-grandmother and grandmother about it and they accused me of making it up, their darling would not behave that way, they said. (Years later my grandmother finally got it and apologized to me.)

During much of my mother's life treatment for her illness was not very effective, and even when a certain drug showed promise she could not be counted on to take it.

If anyone close to me was in a position like the writer of this article I would urge them to, at the very least, find full-time household help on top of all the emotional and medical and psychological support the whole family needs.

Ultimately, in my humble but experienced opinion, your children have to come first.
posted by mareli at 5:39 AM on January 14, 2015 [5 favorites]

I am so sorry you had to deal with that mareli (I have...not identical but similar issues with a childhood that was at times emotionally abusive and damaging, though mostly not physical but always with the threat looming, constant fear). Respectfully I would say though that gingerest is onto something--adequate treatment for many forms of mental illness is the real issue, not that having mental illness inherently precludes you from being a decent parent. Also, I am glad the original post touches upon the fact that using "mental illness" as a catchall term for a vast array of things causes problems when we talk about things like how that relates to parenthood. There are forms of disorder I would not feel comfortable dealing with with a dependent present. There are definitely some I would though. And within each type, there is still the individual to take into account (how well they respond to treatment they have access to, what their specific manifestation of said disorder looks like and the history there, their social safety net, and also just plain who they are, etc.), something the strictly medicalized view of mental disorders often isn't able to. I think sweeping declarations about whether "someone with a mental illness" should have kids or not is pretty simplistic and I can see why people would be uneasy with that (not to say you are making them, just, for the purpose of discussion in general).
posted by ifjuly at 6:47 AM on January 14, 2015 [1 favorite]

And as someone's mentioned upthread, we don't know what Giulia is like in detail during these breaks except that she has delusions, often of a religious nature, and can become suicidal. Sometimes psychosis can manifest as potential violence towards others, or viciousness and abuse. Sometimes not. And for some, with enough effort at treatment and planning and a safety net in place for the bad times, it can be tackled and kept in check. For some, not. I've known and know people in all of these camps.

Which is not to say being delusional around a young child is ok. But lumping it all together as "you shouldn't parent ever" because it all fits under the umbrella term "mental illness" bothers me, because it isn't all the same, and how/whether it can be handled well enough to parent safely varies.
posted by ifjuly at 7:02 AM on January 14, 2015

here's another person who found the anti-medicine sentiment threaded throughout the piece disturbing.
posted by angrycat at 8:57 AM on January 14, 2015 [4 favorites]

I'm a bit late replying to Deoridhe's post, but I can't stop thinking about this.

I get it. I really do. I am fortunate now finally to have found meds that work for me (even though, yeah, they have not-great side effects, I've gained weight, and I worry about the long-term ramifications of taking this shit for effectively the rest of my life).

WRT the zombie-fying effects of some meds: it makes me wonder if Giulia is basing this on the short periods of time that she has consistently taken them. The therapeutic dosage I am at now has taken quite awhile to get tolerant to to the point where I can function. If you are going on and off different meds, not only are you not going to achieve this, you are also potentially setting yourself up for drugs that work to not work for you anymore.

In addition, if you give credence to the idea of kindling, it can be dangerous to go without meds until the next episode hits; potentially, you are setting yourself up for worse and worse episodes, and often if you try a medicine that used to work for you, it may not work again.

I get the hope that it was an isolated event, too, but two hospitalizations puts the lie to that.

And I especially get the feeling-broken. It sucks to take daily meds, and I take them both for a mental illness and for a physical chronic illness. It's depressing to fill up my pillbox and it's depressing to take all those pills and it's a pain in the ass to keep on top of ordering refills and going to the doctor. And I am very privileged in the first place to have good doctors and (finally) health insurance and be able to take time off work to deal with this shit. But you know what makes me feel less broken? When I take care of myself and it works.

Treatment and compliance is a two-way street. I'm very, very lucky to have a caring, patient doctor willing to work with me to adjust my meds. I have to meet him halfway by trusting him and being willing to try things till we can get to where I am stable.

It fucking sucks and it's expensive and it's a goddamn pain in the ass, but I am thankful for it, and I do it not just for me but for everyone else around me. And I don't have a small human depending on me.
posted by fiercecupcake at 11:02 AM on January 14, 2015 [3 favorites]

And it has taken me the better part of two decades to come to terms with this. I am also incredibly fortunate that I managed to keep myself safe and not alienate everyone I love in the meantime. I see it as part of the upkeep of my relationship with my partner to do things that I maybe don't want to do, like take daily meds, in order to keep that relationship strong. I really have a lot of sympathy for the husband in this situation.
posted by fiercecupcake at 11:06 AM on January 14, 2015 [4 favorites]

posted by Uther Bentrazor at 8:57 AM on January 15, 2015

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