In any marriage, one plus one equals friction. Make one of those “ones” a ticking time-bomb or a lit bottle rocket, and if you haven’t had one yet, you have a problem coming to you. With a spouse who has a Severe Mental Illness diagnosis, an untreated or unrecognized episode can not only leave you in a state of chaos, but can lead to crisis and a multitude of other issues if not addressed and treated.
As someone with an SMI, I’ve been on the giving end of that relationship – in terms of giving my husband a huge shock when I went off my bipolar medications three years into our marriage. I unwittingly and somewhat due to Anosognosia (lack of insight) and also pride, decided to forego taking my medication.
I denied I had the illness and requested my therapist redact my diagnosis. Thus the spiral, or rather escalation, up into manic psychosis blindsided my husband who had never seen me in an episode before.
For a while, he didn’t presume it was my mental illness but rather an emotionally unsettled wife who was (over)reacting to his absence for a month-long trip to Mongolia. Being a military family, my husband was not sure how to handle my mood swings.
Long story short, it would have helped tremendously if we could first identify the problem. I had a clue, and asked him to take me to the psych hospital. After about a month of hysterics and outbursts at home and on vacation for our anniversary, he finally drove me to the psych hospital for treatment.
I would recommend the following to any couple who is experiencing the severity of a mental illness episode. By then it’s when you need the most help and direction. If you can have them agree to treatment, this is the best way they will be able to get well. And the sooner, the better.
Things to keep in mind with Severe Mental Illness: In Severe Mental Illlnesses like bipolar disorder, schizo-affective disorder, and schizophrenia, there is a strong chance that Anosognosia can cloud your loved one’s judgment.
In these cases, it’s best to involve the help of a mental health professional like a licensed therapist and psychiatrist (doctor who prescribes psych medications) from the onset.
If they aren’t seeing a professional yet, it would behoove them and you to access one as soon as possible. If their symptoms are self-medicated and treated with little or no medication, it is always best to consult with a professional to help them and you identify their illness and recognize its facets.
The practical, simplest (not easiest, but simplest) keys to having a successful marriage with someone with Severe Mental Illness are what I recommend that work in my marriage:
- Encourage your spouse with SMI to take their medications as prescribed. If they are at a point where they cannot manage this responsibility, you may very well need to step in a serve as a caregiver to help them help themselves with this task at this time. Simple, but as I said, not easy. They may resist. If so, try brainstorming ways with their mental health providers that you can work together to make sure this routine is established.
- Encourage them by pointing out the positives. This may seem like watered down positivity, but it’s not. When we’re in an episode, we need direction and guidance, and consistent building up. The negative depressed thinking can easily sway us, and we need you to help us see the brighter side of life, appreciate the little things, and notice when that silver lining is peeking out over the clouds.
- Take time and take care of yourself. This is again, simple, but not easy. The emotional tolls caring for a loved one with an SMI are exceedingly difficult to handle. That makes it harder to take care of yourself, but you must. Have a good support network of other close family and friends, and your own therapist if possible. Talk regularly with those support people to ensure your sanity and your loved one’s safety. Don’t forget your physical needs too – eat well and exercise as best you can.
- In remission, draw up a GAMEPLAN. It is imperative that while they are in the good times and can reason and think clearly that you have a “game plan” to prepare for the worst. To find a template and receive a free copy of one I use that you can print out and fill in, go to bipolarbrave.com/resources. Have it handy in a folder or binder, just in case.
- Get on the same page. As best as possible, communicate with your spouse that you want to be able to have access to their health and medical records. HIPAA is a tricky thing and the nature of it can be detrimental in the case of mental illness. If you don’t have a POA (Power of Attorney), or Conservator, discuss this possible aspect of your relationship. It’s a serious thing, but so are Severe Mental Illnesses. I personally do not have one, but have been able to be of the mind in episodes to keep the communication and PHI (Personal Health Information) open and accessible to my family.
- Take a break from caring and just be. In an episode this can be challenging. In a state of recovery and maintenance, you must be able to enjoy and relax with each other. Resist the temptation to control and just rest in the fact that God is. And if you’re not there yet, find resources to help you. You need to lighten up and let loose every now and then. Laughter is the best medicine by far, and if you’re at a pause or break in between episodes, savor the time and show you appreciate the person you married.
- Be each other’s safe place. Honor each other’s wishes for keeping things that are personal, private. You should want to have their trust, and so try to keep things between the two of you that aren’t unhealthy. If you’re dealing with a SMI spouse in paranoia, that will be a different story. But overall, as long as they are safe and not in danger or a threat to themselves or others, you can let them confide in you. You may have to get help if they are planning to do something dangerous or have already acted out physically. In that case, the safest thing to do is get help.
- Pray together. If they are in hyper-religious state (mania or psychosis) this may be a trigger and irritate them or encourage more hyper-religious behaviors, but if they are not and are more grounded, offer to pray with them. Praying separately can be good too.
Aside from these 8 suggestions, you can see there are probably numerous other ideas for helping your marriage with your spouse with SMI, but these are a start and basic suggestions. For more info on helping you or your loved one in a marriage with SMI, visit my resources page on bipolarbrave.com/resources.
Katie Dale is the author of But Deliver Me from Crazy: A Memoir and the mind behind the blog BipolarBrave.com. She is wife to an Air Force officer and a mom to Jaxon and cat Anna. They live in rural Missouri and wherever the US Air Force takes them. She enjoys long walks, runs and naps to help keep her bipolar in remission.