Please help me help my wife!
January 10, 2010 11:48 AM   Subscribe

What can I do to help my wife (or encourage her to help herself) with her ... dysthymia? anxiety? depression? bipolarism? lack of gumption? laziness? when I am not in close proximity to her and she does not want to go to therapy?

(I apologize for the length of this - as an anonymous post I know it will be hard to follow up so I'm giving as much detail as I can. Please bear with me!)

My wife has, for most of a year fairly constantly, and for perhaps a year before that off and on, lost her desire to ... do just about anything but sleep. She does still have good days from time to time, but they are greatly outnumbered by bad days, where she sleeps till noon, or later, then gets up and watches some tv or putters at something before heading back to bed, sleeping as many as 18 hours a day. She says she is not depressed, per se, and she has been depressed in the past and gone to therapy. She just can't seem to find the will to move on the things she wants/needs to get done. She has a part time career, teaching kids 2 days a week; she can manage to get out of bed on those days and do what she needs to do. She has a class that she goes to once a week that she seems to love, and though she grumbles every week about having to get up at 7 in order to get there on time, she rarely misses it. There have been times over the last 2 years when we have worked on large projects together (eg.: mounting an international exhibition), and when she has this kind of pressure thrown upon her, so to speak, she seems to handle it well, and manages to get through it, often with verve, skill and aplomb. But when she has "free time" she can't seem to make use of it. She wants to continue her artistic exploration; she wants to practice piano; she wants to bake; she wants to keep the house clean... but she doesn't, and she beats herself up for it, which leads her to feel crappy, which makes it that much harder to get out of bed the next day.

I am living and working (and have been for almost 2 years) about a 4 hour bus ride from home, staying in an apartment here, and returning home 1-3 times a month for periods of 2-5 days at a time. My wife (of almost 4 years) is at home. We both know the situation is not ideal, but the work is a great learning opportunity for me that can't be found elsewhere. When I have suggested that I quit here and move back, she says she couldn't live with herself if I gave up my dreams for her. My time here is set to finish in just 3 months, when I'll return home, and try to find work there. When I am home, I try to be as encouraging as I know how. I help her clean the house, or do it myself. I often cook meals when I'm home. I try to spend "quality time" with her. I buy her sweets and flowers. I try to talk her through her worries/problems. When I'm not at home we Skype 3-5 times a week (sometimes for hours) and email (numerous times) daily.

She has been to see a number of doctors. Only when things get really bad will she finally relent to my requests that she go. The doctors she has seen have told her (1st doctor) "you're fine. you just need to establish a regular sleeping pattern - here are some sleeping pills and anti-anxiety pills; (2nd doctor) "you're depressed and you'll be that way forever unless you take these anti-depressants"; (3rd doctor) "sounds like depression to me, here's some pills". I think we haven't found the right doctor, but she doesn't want to see any more. She has an aversion to any kind of medication and either doesn't take the medication she's subscribed, or doesn't take them long enough to give them a chance to show results. She doesn't want to go to therapy - she says she doesn't think it'll help. I think she's scared of something but won't tell me so she just says it won't help. Therapy in these parts [we live in her home country, foreign to me] is scarce, and/or expensive (we are living not too far above the poverty line). I can't say 100% that it doesn't exist here, but I know of no sliding scale options - she says they don't exist here.

She seems to need constant assurance from me that I love her. She asks me over and over "do you love me?" I answer that of course I do, and that she needn't ask because the answer will always be the same (and sometimes when I'm frustrated I say she needn't ask because the answer is the same as when she asked 5 minutes ago!). Any indication of anger or frustration from me tends to be taken as a sign that I've given up on her or don't love her anymore, no matter how much I explain that is not the case.

One final point is that I am perhaps "not fully functional" myself. I have in the past been unofficially diagnosed with dysthymia, and been in and out of therapy. I've been in pretty good shape the last 2 or 3 years, though I have bad days or months here and there. I get up and work 10 hours a day 5 or 6 days a week, and can function fine there, but many of the same issues that plague her also plague me too (inability to move on projects in a timely manner is a big one), though not to nearly so severe a degree.

When we were dating, and when we were first married, she was bright, cheerful, and vivacious (though certainly introverted and shy), with brief periods of self-doubt and neediness. Now I only get *brief glimpses* of that high-spirited, glowing woman that I fell in love with. What can I do? Any and all advice will be greatly appreciated.
posted by anonymous to Human Relations (21 answers total) 15 users marked this as a favorite
I would recommend both an endocrinologist and a therapist. My thoughts are that she is depressed over this situation and that it has snuck up on her so that she isn't really seeing that she has a problem, but she could also have a metabolic or thyroid problem that is making her sleep so much. And there could certainly be some overlap here as well--it is much harder to treat depression in patients with sluggish thyroid, but treating the thyroid issues sometimes helps to clear up the depression.

So, first, get her to a specialist to rule out metabolic problems (endocrinologist). And then consider a therapist for anti-anxiety/depression meds. I think there is some anxiety there as well because of the constant, "Do you love me?" insecurity you mentioned.

After that, she really needs other interests to give her a reason to get up out of bed. Once she is up and moving, she will do more, but on the days she doesn't work or have a class, she simply isn't motivated to get up and moving in the first place.

Good luck. I know this schedule is very hard on both of you right now.
posted by misha at 12:00 PM on January 10, 2010 [1 favorite]

Has she had a complete physical? I'm going to pull out my perennial suggestion of a full thyroid panel: TSH, T4, and T3 (you might have to press the M.D. for that last one).
posted by jgirl at 12:04 PM on January 10, 2010 [1 favorite]

You don't have to feel depressed to be depressed, and sleeping that much IS depression.

As stated above she needs a full workup, and she needs to be open to trying meds at least temporarily. If she is worried about certain side effects, Wellbutrin is certainly a good one to start with (Memail me for details. Been there, done that.)

And then continuing talk therapy of some sort once she's sorted out with meds. There are skills one can use to keep oneself out of this sort of ditch.
posted by St. Alia of the Bunnies at 12:22 PM on January 10, 2010

For a minute, I thought you were my partner! I have been dealing with constant fatigue for about 18 months. I also have had other chronic pain for about 15 years.

The weird thing with my fatigue is that it has kind of looked like depression on the outside, and I have had depression-like thoughts ("If this is what my life is going to be like forever, it's hardly worth living!") but I've been depressed before and this felt more like a gloomy response to the physical tiredness and fatigue.

The trouble with stuff like this is that it can be caused by so many different things, so you have to find a doctor who will work with you and stick with it through many dead ends. I've had the thyroid tests, all kinds of other stuff. I was anemic; we fixed it and the fatigue didn't improve. I had a vitamin D deficiency; we fixed it and the fatigue didn't improve. Finally (I think through an AskMe question) I found out that fatigue like mine could be a side effect of Celexa, and now after a long and hard weaning process, I am off the Celexa and starting to feel better.

My point is not that the cause of her problem is the same as mine (obviously it's not) but that when you are dealing with something that can be a symptom of many different things, being willing to go through that ruling-out process is key. I'm sorry she doesn't have a good doctor right now, but she should try to find one if she can bring herself to. I know how hard it is and how discouraging the fatigue is.

I also have anxiety, and agree that she should also consider therapy. She says options don't exist where you live; one thing you could do is try to look into whether that's true.

Now, you didn't ask what could she do. You asked what you could do. It sounds like you are doing a great job of being supportive, reassuring, and loving, and picking up the slack when you can--my partner has done this, too, and it's been huge for me. But she is not going to improve if she won't take the steps needed, and maybe that's where therapy or a decent doctor could help.
posted by not that girl at 12:26 PM on January 10, 2010 [2 favorites]

If two out of three doctors say she's depressed but she won't take the meds, there are not a lot of options left. I mean, you could futz around with accupuncture, vitamins and tai chi or whatever but I tend to think chemical problems have chemical solutions. I would, therefore, discuss her resistance to the meds with her and see if you can reach some kind of agreement regarding that after you get home. Perhaps she'd be willing to take them for three months and see how she feels at the end of that.
posted by DarlingBri at 2:05 PM on January 10, 2010

IANAMD, but I am an old woman with many experiences under my belt, and somewhat of a romantic, as well.
She is young. You are her beloved and are gone so much. Because of her love for you, she would not deny your learning experience, but she deeply misses you. All women also battle with insecurities, as is displayed by her continual asking if you love her.
Something came to mind that would not cost anything to try...
You said you have approximately three months left where you need to be out of town. You could take one sheet of paper for each day you have left and write a love note, something she could do to prepare for your return, and how many days it will be until your return. This will cause her mind to think with positive anticipation rather than the overwhelming dread of your absence.
An example would be:
90 days left: clean out the closet in preparation for all of my clothes to be beside yours for the rest of our lives. (or you know best what that something should be.)
If you are thinking of me then know that I am thinking of you my beloved (or whatever love name you call her.)
It sounds like you are loving and I anticipate and hope that things will change when you are together every day. Blessings on your marriage and family.
posted by srbrunson at 2:34 PM on January 10, 2010 [13 favorites]

In addition to above suggestions on doctors, which seem imperative, I would say she should exercise every day.

My yoga studio has a monthly workshop on yoga for anxiety and depression.
posted by hazyspring at 3:33 PM on January 10, 2010

Maybe she's lonely because you're gone most of the time? That seemed to jump out at me as something that could cause depression to flare up.
posted by ishotjr at 3:51 PM on January 10, 2010 [1 favorite]

In addition to what others said about getting rechecked by a physician:

Assuming this is entirely due to depression, if she doesn't want to take meds, there are other ways of addressing the problem. The advantage of therapy is that a therapist can be a great coach, and be valuable in offering a different perspective. If therapy is out of the question, as well, she's going to have to do self-directed treatment. That's rough. If it's hard for her to so much as wake up and meet the day, the energy she has available to pull herself up out of this is pretty low. It's going to have to be something she really, really wants. Wanting is difficult to do when you're in the depths of depression.

There are ways of helping yourself to want to make a change, and to continue wanting it. I found the book "Changing For Good" to be especially useful here and throughout the process.

As for addressing the depression without meds or therapy, there's a lot of information online. Google "depression without medication" or search this site. I'm a self-helper with the benefit of having had therapy and taken meds to get myself out of the worst of it, and I've had pretty good success at this point with beating the depression. I'll list a few of my own tactics here:

* Exercise is a big one for me. I find it more effective than taking medication. Doing it daily every morning as soon as I'm awake helps both with keeping it a mindless habit, and making it most effective.
* Getting outside can be another big help, especially when there's sun involved.
* Goalless days and months are a killer. It sounds like she has a bunch of things that she'd like to do, but none of them are engaging her. If she's rising to the challenge of obligations, she might want to add to them. If she can find something non-stressful, with a good dollop of autonomy, to fill her days, it may help her emerge to the world. Something that gently builds a skill could be a great boost.
* Is she pretty isolated? It could help to engage in projects or even just get-togethers with other people. It could help to keep in touch with friends and family.
* Environment has a big impact on mood. T.V., music, and books all contribute to how you feel and how much energy you have. Watching comedy or inspirational shows and movies, or listening to upbeat music, have an immediate effect. (Here are a couple of useful lists.) Having a clean house really helps.
* Counter-thinking/perspective-shifting, à la CBT. CBT is recommended a lot here because it's effective and user-friendly. It's good to have a therapist to guide you through it, but if you can't, there are books and workbooks you can use on your own. The Feeling Good Handbook has a lot of fans. "Guide to Rational Living" is a useful book, as well.
* With any of these things, baby steps are important.

Other MetaFilter posts and comments you may find helpful: "Help Me Be My Own Best Friend", "How to recuperate my life (about getting back into the groove of things after a long illness, but it applies to recovering from depression, as well)," "Learning to be optimistic."

The difficult part of this is that you cannot make her do or want to do any of this.

I wish you both luck.
posted by moira at 4:21 PM on January 10, 2010 [4 favorites]

is it possible she would try a therapist again and not just a medical doctor/psychiatrist?

the best help i have ever had, and continue to get, is from a licensed social worked i kind of randomly found when i was looking for a psychologist. i see her about twice a month, but more if we're working through something or i'm having some kind of stress.

it's really awesome to have someone that will not be judgemental and will also not just try to make me feel better. sometimes if i am dealing with something hard emotionally, i need an objective ear, not just someone to sympathize with.

i know that i am paying her for this. it has helped immensely. she did not want to just "diagnose" me. her philosophy, and that of good counselors, is more about figuring out what makes you tick/cry/sleep all day, and what you can do to change that.

maybe your wife needs someone like that who she can talk to. it's definitely not the same as talking to a friend or other confidante... i don't have to worry about my counselor's emotions or what she thinks of me or if she'll say anything to other people.

maybe you being gone is the problem and she just doesn't want to bring it up to you because she knows there's nothing either of you can do right now.

i wish you the best in getting these next 3 months until you can be at home all the time.
posted by sio42 at 4:24 PM on January 10, 2010

(FWIW, as a data point, srbrunson's suggestion may work for some, but it would violently backfire with me. Without the requests for preparation, on the other hand, I would see it as wonderful, sweet and affirming, and feel a deep sense of support and connection.)
posted by moira at 4:33 PM on January 10, 2010

When you say she's been to doctors, do you mean she has been to regular medical doctors or just that she's been to psychiatrists? When she says she doesn't want to see any more doctors, does she mean psychiatrists?

If she says that she's not depressed, maybe it would be best to rule out every possible medical cause for it, before deciding that it must be depression and going back through all the ways to help her out of depression and/or getting her to take more psych medication.

From what you've written only, it doesn't sound like she's been comprehensively tested for everything medical it could possibly be, at all. Like not that girl says, there are a lot of things that could be behind how she feels.
posted by Ashley801 at 5:54 PM on January 10, 2010

Follow-up from the OP
I offer my thanks to all who managed to get through my interminable post and still have energy remaining to leave a response.

I too feel that my not being with her all the time is part of the problem, and that is why I included that info in the original post. Many of your replies suggest medication and/or therapy. Ultimately, I agree. But, as I pointed out, she is dead set against both at this point. So, while I am currently going through the links in moira's reply about depression without medication, etc., my next question is: "how do I convince her that she needs to go to a doctor and try medication, and is it appropriate for me to force that upon her?"

The suggestions that she add more activity or exercise are welcome and I agree, but how does that work when she doesn't want to get out of bed? We've discussed the idea of her getting another part-time job, and come up with specific possibilities. We've gone to the local swimming pool to get the info about hours and costs, and bought her a swimsuit. We've talked about adding more courses to her schedule, and about making more "playdates" with her friends... she agrees that these things would help her feel better, but ultimately she doesn't follow through and begin any of these. I don't feel I can FORCE her...

I'm pretty sure she's had her thyroid checked and cleared, but I will confirm this. I believe that Moira's observation about srbrunson's idea is spot-on. I know my wife would recoil from the pressure of me wanting her to clean out closets or whatnot, but I will sit down today and put some notes together to send her.

Again, I appreciate everyone's thoughts and I look forward to any further input anyone might have to offer.
posted by jessamyn at 6:36 PM on January 10, 2010

Again, assuming this is depression: as ideal and needful as it is for your wife to see a therapist and possibly get on meds, no. There is no way to force her to do any of these things, and trying to do so will only lose ground and damage your relationship.

I know it hurts to stand by and feel so powerless to help.

The book "Changing For Good" addresses that to an extent. It goes into what she may be ready for and when, and the best tools she can use at that point to help move herself along, and how and how much you can help. For your side of it, it has some don'ts in relation to something she's resisting: Don't push her into action. (Change does not equal action; it begins with contemplation and preparation, and premature action is pretty much guaranteed relapse with all of its associated negative emotions and baggage.) Don't nag by making repeated, insistent comments. Don't give up/become apathetic. Don't enable (by avoiding discussion/confrontation, softening consequences, making excuses, or indirectly/rarely recommending behavior changes).

What the book does suggest is to help her where she accepts it, and to continue to offer love and support. Ask her how you can help her. Listen and offer feedback, but know that she may not benefit from or react well to glib advice and quick solutions. Do your best to have empathy - really try to see and understand things from her perspective. If she's willing, get educated about this together.
posted by moira at 7:51 PM on January 10, 2010

She sounds like my friend who is narcoleptic. She's completely motivated and alert as long as stuff is going on or she has to be somewhere but once it gets quiet, dark or there's nothing very pressing to do? she sleeps. And boy can she sleep. Anywhere, anytime, for as long as possible.

She's been on medication for years which works great. She finally got to see a movie all the way through.
posted by fshgrl at 8:44 PM on January 10, 2010

My wife has, for most of a year fairly constantly, and for perhaps a year before that off and on, lost her desire to ... do just about anything but sleep. She does still have good days from time to time, but they are greatly outnumbered by bad days, where she sleeps till noon, or later, then gets up and watches some tv or putters at something before heading back to bed, sleeping as many as 18 hours a day .... I am living and working (and have been for almost 2 years) about a 4 hour bus ride from home, staying in an apartment here, and returning home 1-3 times a month for periods of 2-5 days at a time.... t the work is a great learning opportunity for me that can't be found elsewhere. When I have suggested that I quit here and move back, she says she couldn't live with herself if I gave up my dreams for her.

I don't understand all the responses congratulating you on being supportive. You sound like you're doing the bare minimum. What your wife is going through is a full-fledged emergency and you are persisting in pursuing a "great learning experience"? Sorry, that's nuts.

Quit your "great learning experience," move home, and attend to this emergency. That's the only good answer to your question.

Oh, and when she says she couldn't live with herself if you give up your dreams for her? Tell her that being with her is your only dream that mattters.
posted by jayder at 9:23 PM on January 10, 2010

OP, you have my sympathy. This sounds like a serious bummer of a situation, and you deserve kudos for being such a devoted, supportive, caring spouse (with not much reward these past few years). I'm responding because I'm a slightly more functional version of your wife, and I worry about placing my partner in the role of eternal cheerleader/caretaker/therapist who constantly has to pull me out of bed, compensate for my bouts of low energy, and talk me down from negativity and high anxiety. So I have some perspective on this sort of asymmetrical neediness.

I agree that the 18-hr sleep cycles and the extraordinary lack of initiative indicate either depression or some other major mental health issue. If your wife won't keep trying to find a doctor or psychiatrist who works for her, there's not much you can do on this front-- as you say, you can't force her to go, and any more bad or ineffective experiences will just increase her skepticism about doctors and medication. And contrary to what pharm companies would have you believe, no magic pill can turn a person who is constitutionally sad or anxious into the confident and stable antithesis of this.

I do wonder to what extent your wife's depression is situational. When you first met her, was she involved in a significantly different enterprise that was a better fit for her (for example: school)? If so, what made it good for her-- concrete tasks, 5-day-a-week involvement, certain social experiences? From what you've described, your wife seems to thrive with structured time. You say she seems to come alive when there's an immediate project and an imminent deadline, and that she enjoys her classes, the ones she's teaching and the one she's taking. Would she benefit from full-time work (if it's possible in your area)? The things she lacks motivation to do and thus beats herself up about-- practicing the piano, baking, housecleaning, art-- are either open-ended self-edification projects or daily tasks that can be neglected without costs. Since these things aren't pressing, your wife can't work up the energy to do them, and then the vicious circle of self-blame begins. Some people seem to work better with constant accountability to other people (I'm one of them), so I wonder if making things 'pressing' is a way to stave off the hopelessness/helplessness that is allowed to set in when there are few challenges and few demands.

She is young. You are her beloved and are gone so much...All women also battle with insecurities, as is displayed by her continual asking if you love her....You could take one sheet of paper for each day you have left and write a love note,

I emphatically disagree with this. It's true that your wife might be intermittently lonely in addition to her other problems, but from what you've said, I don't think your wife's primary problem is that she's pining for you all the time-- you call and skype regularly, you go home a couple times a month, and this separation has an end date. Nor do I think that her insecurity is simply an enlarged version of "all women's" relationship insecurity (ugh). I think her self-doubt in her relationship with you is an extension of what sounds like a deeper, constitutional tendency to doubt and dislike herself. Love notes are harmless, but I don't think they're going to do a thing in this case. Nevertheless, it'll be interesting to see how and if she changes when you return home for good in 3 months. I hope it cheers her up.

I don't know if any of this helps, but good luck, OP, and my best wishes to you and your wife.
posted by ms.codex at 9:35 PM on January 10, 2010

Quit your "great learning experience," move home, and attend to this emergency.

I disagree. I think your wife would just lapse into deeper depression if you were around taking care of her 24/7, I think she means if when she says she doesn't want you to sacrifice your career for her, and I don't think this would be fair to you. This is not a one-time "full-fledged emergency," it's an intensification of tendencies that are latent in her and are never truly going to go away. I think activity and daily purpose are the key to her recovery.
posted by ms.codex at 9:46 PM on January 10, 2010

Help yourself, you can't do much other than that.

I had a friend in a similar situation. After trying valiantly for years to effect any change in a partner who had all the denial excuses you mention (don't wanna, don't think it will help, etc.) decided to see a counselor for herself addressing the "how do I cope with a partner who claims that I am the solution to his issues?" question.

The ultimate answer in this situation was she couldn't cope because her partner was an unsatisfiable pit of neediness. I am of the belief that someone who imagines that another person can be their sole salvation is grossly mistaken and can only drain that person to both of their detriments.
posted by fydfyd at 4:05 AM on January 11, 2010 [1 favorite]

Is there any way she could go with you to work sometimes, and stay with you a night or two before returning home? It sounds like she has obligations at home a maximum of three days a week, and y'all can afford for her not to work full time. So if you can afford that luxury, why not try a few trips out to where you live/work and see if that helps. Maybe you can think of some reasons why this would be good for *you* - you two could be together more, which presumably you'd like, you can take her out on the town a bit or she can help you prep dinner at your home-away-from-home. I guess this is another version of ms.codex's suggestion to help fill her time and give her something to do - but also while keeping her close to you because really, I do think missing you is part (even if only a small part) of what's going on. I also think physical touch is really good for people, and you can provide that for each other in person, not via skype. Maybe she can even take part-time work in the city you're in - even just stocking a bookstore or something really basic could be low stress but a reason to get up and go, and it could help pay for her bus tickets. Then once you're back in the area y'all could think about full time work for her or more structured time generally.
posted by lorrer at 6:48 AM on January 11, 2010 [1 favorite]

I'm a person who has major depression with anxiety as well as ADHD. I'm a full time student and the last 3 weeks with school out over the holidays had me sleeping crazy long hours with naps that last 2-3 hours every day. I have a 7 year old child at home, but for some reason being at home and without the structure of school helped me backslide into anxiety (I did the clingy thing to my husband all last week when my son was in school but my classes hadn't started yet), some depressive thinking and lethargy. Your wife sounds a bit like me, in that when she's alone and doesn't have some structure to her days she begins to think too much and that's a vicious cycle to break out of.

I would suggest that you help her find other distractions during the day, if she can take more classes or teach more classes that would be ideal. She should have a reason to get up and out the door and to be around people. If she doesn't have some sort of structure and routine to her days and weeks, it's very easy to just do nothing. Having a purpose to leave and time tables to keep really seems simple, and it is to most people, but to someone who can tend to "live inside their head" it's very important to give some outside structure for distraction.

Feel free to memail me if you want to talk further.
posted by hollygoheavy at 9:38 AM on January 11, 2010 [1 favorite]

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