Sanity for Dummies. I'm the dummy.
March 30, 2010 10:37 AM   Subscribe

I'm concerned about my fiancée's mental health. I don't know much about this stuff. Help! Novel-length details within.

My fiancée seems to have ADD and some sort of anxiety disorder. I say "seems" because she doesn't have a firm grasp on the situation herself, and she refuses to show me any medical documents or let me go with her and talk to her doctor. She hasn't been to the doctor herself, in a long time.

She's not being secretive, she just hates doctors. Actually I'd say it goes beyond dislike. It's a genuine irrational phobia. When she was very young she underwent a bout of tests to diagnose her and she's terrified of going through that again. In her words, her parents made her try every possible type of therapy when she was growing up, from counseling to meditation to Ritalin and Adderall. She tells me that none of them work, though she was just a kid when she tried them and I don't know how long each trial lasted. Now she's on Zoloft and Concerta and she considers herself done with trying new things.

Usually (the vast majority of the time) she is clear-headed and everything's awesome. But sometimes things get bad. Currently she lives with her parents and they're the gatekeepers of her meds, refilling her prescriptions when needed. But she forgets to tell them when she's running low, and then skips taking some of them to make her supply last longer. Or she'll be running out the door in a hurry and just forget to take them that morning. Even when she does take them, sometimes (and this is happening more frequently, I think) the effects will wear off early in the evening and she'll be just like she never took the meds at all. I'm concerned that her body's adapting to the medicine and the pills are becoming less effective. But she's already had to increase her doses several times and is now taking the maximum allowable amount of this stuff. There's nowhere else to go but back into the experimentation mode that she's so afraid of. And I don't blame her. When the meds aren't in control she becomes unpredictable.

I don't understand this stuff much apart from what she's told me, but here's what I've observed when she's off her medication:

She has mood swings. She'll go from happy to angry in a flash, and over the most inconsequential things.

She has hypochondriac tendencies, which I think are just an offshoot of her anxiety. She becomes paralyzed by fear of the worst-case scenario in ordinary mundane situations, and convinces herself that something is going to kill her, or me. No amount of reason can quell it (though I've found saying "don't you think it might just be your anxiety talking?" helps).

Sometimes she goes into some sort of mental feedback loop, where she is "thinking too fast" and can't communicate her thoughts to me. She usually wants me to do something to help but I don't know what it is, and she can't tell me. And she gets extremely frustrated with me for not getting it, and herself for not being able to focus.

In rare situations the feedback loop bubbles over into a full-blown panic attack. She loses her balance and gets down on the ground, gasping for air, her arms and legs and head spasming uncontrollably. I'm utterly clueless about what to do when this happens, but she's made it clear that she needs to touch me when it happens. If she can't feel me she feels alone and really freaks out. I feel bad about this next part, but I also have to restrain her because she tries to claw at her face and eyes. Occasionally she speaks but it doesn't sound like her, it's more of a growl. She demands that I let her scratch herself and, referring to her eyes, says "I want them OUT." It's scary, it's like something out of a horror movie. If we were living in another time I'd probably be sure she was possessed. Last time this happened, it took about an hour to pass.

I try talking with her about what happened, later, when it's passed. She remembers the whole thing and remarks about how she felt like she was aware of what she was doing at the time. Maybe it's hindsight or the clarity of the moment, but she says "I think I could have stopped. I think, on some level, I just wanted the attention." I don't know if it's true or not that she had any real control of the situation. She has also alluded to thoughts of hurting me, including biting me vampire-style or breaking my arm, during these panic attacks. I know she would never even consider harming me when she's thinking clearly.

She's not like this all the time, it's really pretty rare, but I'm worried about it becoming more frequent in the future. I want to be the best husband I can, well-informed about her condition and caring for her appropriately. I'm scared that she's not taking responsibility over it herself, relying on her parents to deal with paperwork and medical records and pill dispensation. These tasks will fall on me when we're married, but she might not let me take them. In many respects she's an independent young woman, but in this area she still seems rather unwilling to grow up. She resents her parents for the role they take in managing her health. She seems to be evading the whole issue, like if she doesn't think about it, it'll go away. When I ask her about it, she usually gets defensive and says "I don't want to talk about it." She gets angry when I ask to take her to a doctor. She's very insecure about her mental health and is afraid she might be crazy and have to be locked away, or she might have to deal with a disruptive change in prescriptions or routine. I'm also trying to respect her desire to keep my nose out of her personal struggle, but I don't know where to draw the line. As her future spouse I feel my nose belongs in there and I'm frustrated that she won't let me in.

As for me, I'm really concerned about her addiction to these drugs. I'm not convinced they aren't a big part of the problem, and I view this path as a dead-end street. There is nowhere to go but to keep increasing the doses until she can't anymore (pretty sure she's already there now) or switch to stronger drugs with worse side effects, and take them every day for the rest of her life. Plus, this complication: she and I are abstinent until we get married. She's starting the Pill soon in preparation and I have no idea how that's going to interact with the drugs in her system (or sexual activity itself). She's also turning 21 soon and will begin drinking alcohol for the first time. Again, I have no idea what to prepare for. And when we try for kids in a few years, that's an even bigger can of worms. In brief, I'm absolutely terrified.

If it's not obvious, I personally have no disabilities or disorders and I take no medication. This is all completely new to me and out of my experience.

tl;dr - How much control should I have over the care of my soon-to-be wife who refuses to take proper care of her own mental health? What is "proper care?" How do we get off the dead-end path toward a life of escalating drug dependency, or should we? What should I know about starting birth control, becoming sexually active, and drinking alcohol, with regard to Zoloft and Concerta? How can I protect my fiancée and myself from her dangerous/unpredictable side without degrading her or treating her like a child or an animal? How do we raise kids someday, in that kind of situation? I don't even know what else to ask. Advice from similar marriages is greatly appreciated.

I'm sorry for going on so long. These are the ventings of a scared man. But I need to wrap up with this important point: I love my fiancée and she loves me. Most days are uneventful and terrific. What I described here is not at all the norm for us. We're getting married and are thrilled about it! We're very open with each other, and this is really the last hurdle of trust in our relationship. She's just extremely guarded about her mental health, with me and with everyone. I feel she is slowly beginning to open up to me though. I'm prepared to accept the bad with the good in this marriage and weather this out no matter what happens. Thanks in advance.
posted by anonymous to Health & Fitness (45 answers total) 15 users marked this as a favorite
How much control should I have over the care of my soon-to-be wife who refuses to take proper care of her own mental health?

Directly? None. You get to voice your concerns with her, talk about it with her, encourage her to take control for herself, offer whatever help she needs, but you get absolutely zero control over her mental health.

You can't change her. She can change herself, and she may decide she wants to, but you can't change her. You need to figure out if you find the current situation acceptable in the long term, because there's a very good chance that's what it will be (or worse). If you can't live with how things are now, then you may want to reevaluate your relationship as a whole.
posted by brainmouse at 10:48 AM on March 30, 2010 [2 favorites]

There's a lot to talk about here, but I'm going to start with the drugs:

Even when she does take them, sometimes (and this is happening more frequently, I think) the effects will wear off early in the evening and she'll be just like she never took the meds at all.

That's not how Zoloft or other SSRIs work. The reason they take six weeks to take effect is that a certain level must be built up in the system. Similarly it takes a while for the effects to wear off.

On the other hand if she's not taking them regularly they may not be working at all. The level has to be built up and maintained.

I'm concerned that her body's adapting to the medicine and the pills are becoming less effective.

Specific drugs do "poop out" after a while, but given the vast variety of them a switch is relatively easy to make (I speak from experience here).

As for me, I'm really concerned about her addiction to these drugs.

Neither Zoloft nor Concerta are addictive. If you mean that she requires them (which it sounds like she does) that's a whole different ballgame. If it helps, you may want to think of them as something more akin to insulin -- nobody thinks of a diabetic as being addicted to insulin.

There is nowhere to go but to keep increasing the doses until she can't anymore (pretty sure she's already there now) or switch to stronger drugs with worse side effects,

This is incorrect as noted above. Switching to other drugs in the same or different classes is sufficient.

and take them every day for the rest of her life.

This may be very likely. And that's life with an improperly wired brain. Just be glad you live in a time when treatments exist.

She's also turning 21 soon and will begin drinking alcohol for the first time.

This is a bad idea. She needs to recognize that alcohol is going to interact poorly with the drugs she's on. If she's truly afraid of having to change her routine, then she shouldn't be changing it herself by adding alcohol to the mix.
posted by Tell Me No Lies at 10:57 AM on March 30, 2010 [10 favorites]

How do we get off the dead-end path toward a life of escalating drug dependency

People who are mentally ill do not get to wake up one morning, say, huh, today's Tuesday, I will suddenly be fine and no longer need my medication. It doesn't work that way.

And for many of us, myself included, we continue to *have* lives due to "drug dependency." Please stop with the drugs=bad framework. It's not helpful for your fiancee, or for anyone else.
posted by crankylex at 10:59 AM on March 30, 2010 [30 favorites]

Why, oh why, are you rushing into marriage so young? Of course I'm assuming you are close to your fiancee in age. Your fiancee sounds like she might benefit from living on her own for a while. You ask "how much control" you should have "over her care"? So she's going from her parents controlling her care to you controlling her care? When is this poor girl going to have a chance to have control over her own life? Is she a member of some culture and/or religious group in which parents turn over control of young women to husbands? What country do you live in? Who prescribes these meds if she won't go to doctors? Does she see a therapist? The whole situation sounds rather strange.

My advice, as the mother of three grown sons, is to postpone the marriage!
posted by mareli at 11:00 AM on March 30, 2010 [36 favorites]

She's starting the Pill soon in preparation and I have no idea how that's going to interact with the drugs in her system

If possible, I think she should hold off on taking oral contraceptives until she is more stable and/or gets her current medications adjusted.
posted by puffin at 11:02 AM on March 30, 2010

Ann Landers said it best: People are on their best behavior before marriage.

What brainmouse said. Are you both satisfied with the way you (plural) are handling things now? If her parents handle her meds now, does that mean that she truly can't handle them herself? Are you comfortable handling them, then? Can you deal with the status quo, knowing that there's a real chance that things won't get better? Can you live with her occasional scary panic attacks? Can you live with the fact that your children may witness them, and possibly inherit their own form of the illness? Lots of questions to ask yourself; her guardedness about and refusal to deal with her illness are huge red flags; people have to admit they need help before getting it. Do whatever works for you, but if you're making long-term plans based on the idea that she'll get better, I can tell you from personal experience that those plans might be a waste of time and effort.
posted by Melismata at 11:13 AM on March 30, 2010 [2 favorites]

I'd like you to try to restart and think of your fiancee's problems as akin to any other, long-term, debilitating, chronic illness. If you were to marry someone who had diabetes, or a digestive system disorder, for example, certain lifestyle adjustments would need to be made. These might include proper medication, dietary and exercise needs, appropriate social/interpersonal structures, and so forth. In the same way as having diabetes or a heart condition does not indicate a personal failing for which a loved on should be infantilized, neither do mental conditions. I bring this background in first, because it sounds to me that you have made some unstated assumptions that your fiancee could just STOP. Could just wake up one day, use a bit of self-control, and be better. This is not true, and if she had had challenges her entire life to date, you should expect she will continue to have them. You need to take some time, and reality check on this issue. If, as you say, you are only 'beginning' to open up on these issues, given your very young ages, it may be premature to marry.

The above should not be read as an accusation that you are a jerk, because I promise you it doesn't contain any barbs of that nature. You may be able through patience and perseverance to encourage your fiancee to return to treatment with a mental health specialist. Such an individual has many tools available to them other than medication and grueling diagnostic procedures. The simple opportunity to sit and talk together with a counselor or therapist may help you both get much needed guidance, and put both of your feet on firmer ground. I really bet that a good counselor could help you understand how best to help your fiancee (because I can tell you honestly care for her and want to help and support her as best you can), what kind of quality of life and emotional improvements she might be able to achieve, and create a care plan. Your fiancee has the right to expect that as an adult, she can drive the train - can make decisions about medication, about the kinds of tests she wishes to have, and so forth. Knowing this may help her to be less fearful. Knowing she has a partner who will refrain from judgments (such as medication-as-addiction, which are the antithesis of helpful) and support goals to improve, may be helpful.

With regard to drinking alcohol, I am certain it is contraindicated (meaning not allowed) on Zoloft. I don't know about Concerta. Thus, your fiancee will be best served medically and emotionally by choosing not to drink alcohol. With regard to sexual activity, if the two of you decide that it is important to avoid pregnancy while you work to make progress together on these issues, I don't think any rational person could fault that. Some birth control has emotional side effects, so the combination of the therapist or counselor I talked about above with a good gynecologist (many understand the emotional side effects of hormones) may be helpful. There are some methods that don't use hormones at all, but those should be discussed with a doctor. I can't recommend enough the idea that you find a trusted talk therapist, who prescribes no drugs but serves as a guide and sounding board on these issues, to help you start to tackle them.
posted by bunnycup at 11:13 AM on March 30, 2010 [2 favorites]

You don't know what you're getting yourself into.
posted by (Arsenio) Hall and (Warren) Oates at 11:14 AM on March 30, 2010 [23 favorites]

she tries to claw at her face and eyes. Occasionally she speaks but it doesn't sound like her, it's more of a growl. She demands that I let her scratch herself and, referring to her eyes, says "I want them OUT."

This is very, very disturbing.

You are wonderful, but you need to recognize that this is serious stuff.

As brainmouse said, you need to discuss your concerns with her. If she chooses to get help, you can decide if you can stick with this.

If she chooses to not help herself, I'm sorry, but you're asking for a lot of pain.
posted by dzaz at 11:16 AM on March 30, 2010 [1 favorite]

You and your fiancee are not going to get anywhere-- with having kids, with sex, with drinking-- unless she's competently cared for by an excellent therapist and a psychiatrist. The therapist will help her analyze her behaviors and the psychiatrist will monitor and prescribe medication to enable her to keep going on a level playing field.

Without that, you guys will likely keep going on this way, with the clawing and the thoughts of harming others and so on, until something hits a breaking point. If your fiancee is committed to marriage, children, and adult responsibilities, she needs to commit to an adult, rational approach to her condition.

(That, by the way, also includes accepting that having to take psychiatric medication may well be a big part of her treatment, and that having to take medication for the control of a psychiatric disorder is not the same as, say, smoking crack or shooting up heroin. Treating these situations as identical stigmatizes the person seeking treatment.)
posted by fairytale of los angeles at 11:17 AM on March 30, 2010 [4 favorites]

There's more here than I can address, but this part is easy:

She's also turning 21 soon and will begin drinking alcohol for the first time.

That doesn't follow. Just because something is legal doesn't mean you have to do it or that you should. As it is said "‘All things are lawful’, but not all things are beneficial. ‘All things are lawful’, but not all things build up."

Similarly, while I think I may disagree with mareli who seems to be of the opinion that it doesn't make sense to get married at your fiancee's age. I disagree in principle, but for you and her, just because people can get married so young doesn't neccesarily mean it's a good idea to get married at that age. It sounds like your fiancee has serious uncontrolled mental health issues. She should probably be stable for a good period of time before she gets married. In my Church, someone with such serious mental health problems (periods of illucidity that seem to go beyond, the normal description of panic attacks) might not even be considered capable of getting married, because of inability to give the proper consent that constitutes a marriage.

Certainly you should be talking with a therapist or pastor as a couple before getting married.
posted by Jahaza at 11:23 AM on March 30, 2010 [2 favorites]

(And, well, treating heroin and crack addicts like they're morally depraved stigmatizes them too and hinders treatment, as smarter MeFites than I could tell you, but that's not the point of your question.)
posted by fairytale of los angeles at 11:23 AM on March 30, 2010

How does she have these medications if she hasn't gone to the doctor? If her parents are getting these drugs and giving them to her, this is A VERY BAD IDEA. If she's taking the wrong medications, and not taking them properly, she would obviously not be experiencing the benefits of those medications. Psychoactive medications need consistent monitoring by a health professional. Neither you nor her parents know enough about these medications to be able to monitor her effectively. This could be doing a million more times harm than good.

She NEEDS to see a psychiatrist. NEEDS.
posted by so_gracefully at 11:25 AM on March 30, 2010 [1 favorite]

Are the two of you in premarital counseling? If so, this is something that you should be discussing in that context. Your fiancee will likely have (some form of) her mental health issues for the duration of your marriage. Both of you will need to find healthy, supportive ways to deal with that. This isn't a matter of "How much control should one partner or the other have?"--it's exponentially bigger than that. If you are not in premarital counseling, you should be. Marrying young is not necessarily a bad thing, but it is a recipe for disaster to marry without having a clear-eyed, sober, and honest understanding of your respective expectations, assumptions, and goals for maintaining a healthy, sustainable life together.

More concretely, I suspect that, for the two of you to have a happy, stable life together, she will need to take a more active role in her mental health care. She feels she was forced into various treatment situations as a child, and now allows her parents to shoulder much of the burden of her care. It sounds like she needs to find a way to move from the position of a child, enduring treatments chosen by her parents, to that of an adult, making responsible decisions under professional care. You can't force that, but you also don't have to acquiesce to living her current plan of not taking responsibility for her mental health.
posted by Meg_Murry at 11:31 AM on March 30, 2010 [3 favorites]

When I was a little younger than you, I married a man who had some mental problems that were not as severe as those you describe. I loved him, and he loved me, but he proved to be a very bad husband because of the problems he had. I thought that I could either "fix" him or that we could work through them, by dint of my determination and energy if nothing else. I did help him--he got a professional degree that he would certainly have been unable to complete on his own and that has furnished him with a career in the decades since. However, the marriage took all the mental and most of the physical energy I had for seven years and, when he ultimately left, largely because he grew to resent my competence, I was wiped out. It took me years to recover from my hurt and anger and I spent far more time than was healthy reacting against what I felt was his betrayal.

All this is by way of saying that a) you cannot fix your fiancee--she must manage her life herself and b) even if you exert heroic efforts to help her, the result may not be what you want.

Love is hard to find, but this sounds like a situation where love may be doomed to be sacrificed to mental illness. I urge you to wait to marry her. She needs to spend at least two years living by herself and managing her own problems. You can still love her and help her, but don't marry her yet and don't assume the responsibility for caring for her. Remember that your life is important, too. It is important that she gets the care and attention she needs, but she needs for the sake of her own proper development as a personality to furnish as much self-care as possible. Further, your sacrificing too much of your life to her needs during the critical years of your twenties will not result in a net gain of health or happiness for the both of you. Sometimes the hardest thing is letting a weak person learn to fend for herself. Good luck.
posted by Jenna Brown at 11:34 AM on March 30, 2010 [12 favorites]

How much control should I have over the care of my soon-to-be wife who refuses to take proper care of her own mental health?

This is a very tough question.

First of all, living with someone who refuses to take responsibility for any given part of their life is going to be tough. I think you recognize that, but you also need to recognize that love does not conquer all. You can love someone very deeply and still not be able to make a life with them.

But you seem determined, so:

Having been married to a person with an untreated anxiety disorder I can tell you that the biggest problem you are going to have is maintaining boundaries. You already have a good start on being patronizing and that needs to stop: you cannot have a successful marriage without respecting her choices.

In this case her choice is to either ignore or deal with the problem obliquely. You need to respect that and let her experience the natural consequences of it. She will have panic attacks. She will spend a lot of time living in dread. Hopefully at some point she will get tired of it and decide to deal with it head on, but only she can do that and she only will when the time is right for her.

In the meantime all you can do is be there when she asks for help. It was a very unsatisfying situation for me -- I wanted to fix her problem, after all -- but in the long run it's about all you can do without completely disrespecting her.

There may come a time when it is necessary to disrespect her: if she starts consistently talking about self-harm -- you are going to need to get her help against her will. She may indeed end up committed in that case.

Basically you are going to have to balance your concern that she refuses to take care of herself against your respect for her as an adult human being. Adults can refuse to take care of themselves. As I said, it's going to be tough.

In my own case I lasted about four years before my frustration with her lack of responsibility in treating her condition (and my annoyance with its ongoing effects on our mutual life) morphed completely from spousal concern into contempt. At that point it wasn't fair to either of us to continue.

I should say that my situation was complicated by the fact that I am Bipolar II, a condition which I have been extremely aggressive in treating. I definitely felt both resentful and morally superior at times -- perhaps you'll have better luck coming at it from a neutral place.

In any case, that's my experience. I wish you luck and I hope for a happier outcome than I was able to manage.
posted by Tell Me No Lies at 11:36 AM on March 30, 2010

I should say that my situation was complicated by the fact that I am Bipolar II, a condition which I have been extremely aggressive in treating. I definitely felt both resentful and morally superior at times

Just to clarify, I didn't feel resentful and morally superior because I'm Bipolar II. I felt resentful and morally superior because I was treating my condition and she was not.
posted by Tell Me No Lies at 11:43 AM on March 30, 2010 [1 favorite]

I am not a shrink. I don't play one on the internet.

However...your girlfriend needs a real doctor on her side. Psychiatrists are trained to deal with mental health issues and are familiar with the various brands of drugs used to treat some disorders.

That said; symptoms like growling and clawing at her eyes do not sound like panic attacks to me...although I suppose everyone's reactions are different. It sounds much more like schizophrenia...or rather, it sounds much closer to things that my schizophrenic best friend used to do.

You, even as a husband, do not have the right to control how she medicates or doesn't medicate her illness. She does however, have an illness. If she chooses not to seek help, or not get diagnosed, or not do anything to alleviate what she's outwardly manifesting, then you will have no power to make her do any of those things and your only choice will be to manage the outbursts the best that you can, and possibly be put in the position of having to call for emergency and institutional help, if she continues to get worse. Or dealing with the fallout of what happens if you're not around to babysit her all the time.

I would sit down with her and her parents and try to have an open discussion about her medical needs. If she refuses to do that, or they refuse to do that...then you might want to consider stepping back and thinking about whether you want to be doing what you're doing for the next X years.
posted by dejah420 at 11:46 AM on March 30, 2010 [1 favorite]

But she forgets to tell them when she's running low, and then skips taking some of them to make her supply last longer.

That needs to stop. It isn't rocket science to figure out how long a number of pills last at a fixed rate of consumption and write a refill date on the calendar.

I want to be the best husband I can, well-informed about her condition and caring for her appropriately.

Impossible without her receiving ongoing care from mental health professionals.

As for me, I'm really concerned about her addiction to these drugs. I'm not convinced they aren't a big part of the problem, and I view this path as a dead-end street.

You should avoid speculating about things you clearly know nothing about. A necessary psychiatric medication not an "addiction" and your speculations about her medications contributing to her situation have no basis. You sound like you have a prejudice about medication for mental health and you had best divest yourself of it because your wife to be is probably going to be on medication for the rest of her life. She needs the consistent intervention of doctors to figure out how this is best managed.

The bottom line is that her medications are not being managed and her mental illness is not being treated and is out of control. To the extent that I had any influence in an individual's life I would not let this situation persist for someone I loved.
posted by nanojath at 11:46 AM on March 30, 2010 [1 favorite]

I'm prepared to accept the bad with the good in this marriage and weather this out no matter what happens.

Everybody thinks that when they're getting married. Divorce rates show that in practice, it's an unrealistic belief.

You might think that you're prepared to stay with her even if her mental issues get much worse. You also might think you're prepared to stay with her even if you have a deeply unsatisfying sex life (no sex before marriage means that you don't know if you're sexually compatible, and her medications do have known side effects with regards to sex). You're making a huge assumption about the way you'll feel five years from now.

I felt much the same way you did when I was getting married - I assumed that I'd always be willing to put up with my fiancée's mental issues, and I assumed that I'd always be satisfied with our good-enough sex life. That lasted about a year.

I can't express this sincerely enough: you shouldn't get married until you're certain that neither of those issues will be a problem.
posted by ripley_ at 11:54 AM on March 30, 2010 [1 favorite]

This young woman owes it to herself, and to you, to properly acknowledge her medical situation. Otherwise bad, bad things will happen. I say this from both personal and secondhand experience.

The purpose of being on a regimen of psychiatric drugs, like those she is on, is to help treat her mental state. Any changes in dosage, side effects, or changes in results should mean a trip to the doctor. No negotiation. Ignoring the fact she is having issues is akin to a diabetic saying "well, this insulin is working well, but I can't feel two of my toes, but it's not a big deal."

I think the best thing to do here is recognize that things are not normal. If you accept that her acting irrationally, erratically taking these medications, and refusing to go to the doctor is the norm, then the situation will escalate. Believe me. If she is able to get a birth control prescription, there's a chance that her mood, outlook, or physiology may change and add another change to this mix. If you're lucky, it'll be positive. If you're not, then things may get even further from a reasonable norm, but you'll adjust to it as well.

This is her life, and it is your life. If you are not comfortable with part of it, you must address it. You owe it to her, and you owe it to yourself.

I do not have a "similar marriage" situation I'm referencing here, but I do have an engagement I broke off and a family with anxiety issues. After having addressed a handful of issues, life is much, much better.
posted by mikeh at 11:55 AM on March 30, 2010

One more thing relating to premarital counseling: it can be a really good way to start an honest conversation about ongoing individual problems within the relationship, things that will not be resolved any time soon, such as one partner's mental illness or one partner's high-stress professional field. It's an opportunity to say, "I have A, B, and C issues that cause me stress and pain, and you have X, Y, and Z issues that cause you stress and pain; I am annoyed by your condition X and you misunderstand my condition C; knowing that we are each dealing with our respective issues and baggage, and will be doing so potentially for years to come, how do we make a life and a marriage together?" So, specific to your situation, it's a chance to say, "Jane has mental health issues that she will be dealing with long-term; John does not understand Jane's mental illness; given those conditions, how can Jane and John create a life together now and for the future?"
posted by Meg_Murry at 12:02 PM on March 30, 2010

On a somewhat unrelated but extremely important note: A person who forgets to take pills (or is very erratic about it) is a lousy candidate for the Pill.

Things may get much more complicated than you are anticipating, much more quickly than you are anticipating.
posted by Tell Me No Lies at 12:05 PM on March 30, 2010 [24 favorites]

Lots of good advice above, especially from so_gracefully, Tell Me No Lies, and mareli.

Being a good spouse to someone with severe, long-term mental illness requires a lot of patience, stability, maturity, understanding and deep emotional reserves. That's even if the person with the illness is sticking with the appropriate treatment they need to manage their condition. If the ill person refuses proper treatment, you're likely to be over your head in very short order. From everything you've said, you are assuredly not qualified to "have control" over your wife's care.

I'll also echo the concerns of others who have asked how your fiance's parents are getting medications for her if she isn't seeing a doctor on a regular basis.
posted by tdismukes at 12:11 PM on March 30, 2010 [2 favorites]

I'm happy to say I'm not in a similar marriage. While this almost sounds like something my husband could have written a few years ago (catastrophasizing, full-blown panic attacks including screaming and self-injuring--even in public, on one deeply embarrassing occasion), I was in a much better place by the time we did get married. You can't fix this, not directly: although my husband he knew he had very little control over it, he kept trying to fix things. Ultimately, I had to be the one who did all the work involved in finding a good psychiatrist, working through my issues, and finding the right meds--and staying on them. It took about a year and a half to find the right combination & dosage, and it was well worth the time, effort, and side effects.

It's not, as you put it, a "dead-end path toward a life of escalating drug dependency." They're not addictive--you don't require higher and higher doses. Antidepressant poop-out and withdrawal can be a pain, but given the alternative of crazy panic attacks, I'd rather endure a month or two of readjusting to new meds.

What should I know about starting birth control, becoming sexually active, and drinking alcohol, with regard to Zoloft and Concerta?

Being emotionally stable should probably be her first step. She should NOT be drinking on those meds, at least not until she's stable. If she goes on the Pill, she'll need to take it at the same time every day, within a short window, for it to be effective. Hormonal birth control is also very good at making you emotional and she'll likely have to try a few before finding one without side effects (or acceptable ones), so if she's bad at taking pills and hates doctors and messing with prescriptions, I don't know how she'll deal with that.

I'm in a similar boat with regard to the birth control, alcohol, and antidepressant combination. I'm also bad at taking pills at the same time daily, so I'm on Nuvaring. I don't drink much, or often. I'm on antidepressants indefinitely, and my current mix is working pretty well, so I don't expect that to change unless they stop working. I check in with my psychiatrist twice a year, but when things weren't going so well, I was going at least twice a month.

I wish you the best of luck. This situation can improve, but you need to SEE A DOCTOR. And I agree with everyone who's advising you to put off the wedding.
posted by kiripin at 12:38 PM on March 30, 2010 [3 favorites]

I want to be the best husband I can, well-informed about her condition and caring for her appropriately. To be very truthful with you I really do not know how you can be well informed about her condition, she seems to not trust you enough to actually tell you what she has been diagnosed with. You need to know what she has been diagnosed with in order to say that you can be there for her. It is easy to say that you can handle whatever comes up and be there for her when she needs you, VERY hard to do it if you do not have a clue of what you are dealing with. I say this not to be mean or dissuade you from marrying here, but as someone that has been married to a wife for ten years that has bi-polar.
First thing you need to know is what is wrong with her. Next pick up a book and explore what happens when people have her condition. Then find some forums on the web and read the horror stories that people write. If that does not scare you off look deep into yourself and ask yourself if YOU have what it takes to take this on. Many people do not have the inner strength to love someone that has a mental condition that affects the way they look at life, the self harm that they feel, the mood swings that are abrupt and lead you to wonder "wtf was that".
You, if you are going to do this, have to be the stable ground in her life and that takes work. I went through a lot of things with my wife so far and poeple wonder how I did it. This (whatever she has) will not magically go away someday, its always there in the background waiting to come back out. You do not beat it, you help them control it. The thing about all this is is you are really just a bystander here, SHE has to control whatever it is that she has, with a doctors help and you supporting her. She takes the responsibility and you help her on your end. You cannot make people take thier pills, they need to do it. You need to have a frank talk with her and tell her that you need her to take control, get help, then you and her can move forward after that. After you have all the facts.
And please do not have children until this is controlled. Your in for a tough fight if she will not take responsibility to keep herself reasonably centered and adding kids into the mix will make for trouble. My wife and I are still together, but please, please think long and hard before you jump withought knowing where the bottom is. It has been my experiance that the bottom can be a very dark place for both of you.
posted by ionized at 1:03 PM on March 30, 2010

I am a mental health clinician, and what you describe does not sound at all to me like a panic attack but like a far more pathological, very-likely psychotic episode. At 21, she's right at the age where serious psychopathology emerges. I wouldn't dare diagnose over metafilter, but I would definitely say your main prerogative right now is to get her to a psychiatrist at any cost.
posted by namesarehard at 1:24 PM on March 30, 2010 [10 favorites]

She remembers the whole thing and remarks about how she felt like she was aware of what she was doing at the time. Maybe it's hindsight or the clarity of the moment, but she says "I think I could have stopped. I think, on some level, I just wanted the attention."

There is a lot of very good advice in this thread. I just wanted to briefly add that you should not necessarily believe your fiance when she says she could have stopped in the midst of an attack. In my experience, after people have scary experiences in which they were endangered by their brain's improper functioning, their natural tendency is to minimize what happened. For example, I once had to rescue a diabetic friend from drowning in the ocean when his blood sugar got so low that he literally couldn't keep his head above water to breathe without help. It was obvious to me at the time and to everyone else who has subsequently heard the story that he would have died if I hadn't towed him back to the shore; we were alone quite a ways out as he's a strong swimmer when his brain is functional. However, despite having been conscious and to some extent "aware" (albeit in a very impaired state), he himself has never admitted that he was in serious danger. When other people expressed their concern over something like that happening again, he would say "I would have been OK, I would have made it out on my own." That isn't true, but it's reassuring for him to think it. Imagining that he had control over the situation, that it wasn't really so serious, made him feel safer and more empowered. The very fact that such a thing really could happen again makes it especially important for him to down-play the threat, so as not to have to live in fear of a recurring danger. I have seen the same thing happen to people who had episodes of severe mental illness - afterward they would minimize the extent to which they were out of control and how much damage they could have done, as a form of retroactive psychological self-protection. Yes, in such incidents the people are often aware of what's happening (at least to some extent) and able to remember it later - but that doesn't change the fact that at the time, they were genuinely unable to help themselves, no matter how much they might wish to believe the contrary.

It's possible your fiance really could stop - but in the absence of concrete evidence to that effect, it's also very possible that she couldn't. And sometimes no one might be there to restrain her. This is one more reason why it seems very important for her to be evaluated by a kind, respectful psychiatrist who can help her find a more effective treatment plan.
posted by unsub at 1:54 PM on March 30, 2010 [4 favorites]

Screw the rest of my advice, I have edited it down to this:

She is taking Schedule II medication but will not see a doctor. There is no way for this sentence to be true unless there is illegal activity involved. There is either a lie or a crime here, and for you right now, you should consider those equally serious.

There is a very real chance that you are being lied to. She's either not on drugs or she's actually under the care a doctor. If she's not on drugs, she's probably lying about other aspects of her situation. If she is and she's lying about seeing a doctor...why?

(There's a third option, I guess, that something horrible is going on at home. If that's true, you should help her get out and get help. Marriage is not the help I'm referring to, start with social services.)

She does have a legal right to privacy concerning any treatment she is receiving. And she has a personal right to it, of course. But in the real world, you don't start a marriage this way. You should have already had one or more very serious meetings with her and her parents to discuss all of this, if for no other reason that her parents should want to make sure that she transitions to living with you without dying from a dumb medication interaction. Why is that not important to them? Why is it not important to you?

I'm not sure there's any point in telling you not to marry someone who can't take care of herself, so consider this: you can't take care of her. You literally do not have enough basic information to do so, and she's not letting you have it. Use the big brain on top of your neck and think critically here and decide what your boundaries are and exercise them, for god's sake.
posted by Lyn Never at 2:07 PM on March 30, 2010 [14 favorites]

I agree with WeekendJen. Don't get married.

Her: She is NOT an adult, and therefore not capable of entering into a marriage; until she takes control of her own mental health and starts managing her own life, she is not ready for other adult responsibilities like marriage. Having family support is awesome, but having parents manage your care is childhood.

You: You are incredibly ignorant about mental health issues, and apparently despite the fact that hers are extremely serious, you've chosen NOT to educate yourself about the medications she's taking (not addictive) or about mental health issues in general (not a moral failing; may require lifetime medication).

Your relationship: As someone with experience in mental health and marriage, this should not be the LAST hurdle in your relationship; this should have been discussed a LOOOOONG time ago AND YOU SHOULD HAVE BEEN AWARE OF HER MENTAL ILLNESS BEFORE BECOMING ENGAGED. The fact that you know nothing about it -- nothing -- and that she's kept it from you says that your relationship isn't ready for marriage. Her mental illness is a major thing that will affect your entire lives, possibly more than any other single aspect of your relationships (particularly if she refuses to treat it), and you are totally in the dark about it. That should send up red flags. Like, a lot of them.

The future: You want to put her on the pill, which will probably mess with her emotional state, even though her mental illness isn't well controlled and she refuses to see a doctor. Women with mental illness, even minor cases of depression, are typically pretty careful about starting on hormonal birth control because of the interaction between hormones and emotions. Why aren't you willing to undertake responsibility for contraception? Not your job? (And secondly, sex can be another enormous emotional thing, and given the fact that you're virgins waiting until marriage I'm going to guess that you've both invested it with a lot of meaning. JUST HAVING SEX is going to throw her for a loop emotionally and affect her mental health, even without including hormonal birth control.) You want to have children with her. Many mental illnesses are hereditary, but having a child is always rolling the dice. To me, there's a much more concerning question: would you leave her alone with an infant? Someone who has to be restrained to keep her from harming herself? Would you trust her with care of children, when she refuses to medically care for herself? If you have children, protecting those children has to become your number one priority, in front of coddling her. Can you handle that? Do you have the financial wherewithal to pay for daycare even if your wife's at home? Finally, even just getting married will probably throw her mental health off-balance -- it happens even to people with minor depression whose depression is generally well-controlled, because of the shifting support systems in your life.

If you really care about her, you need to educate yourself -- a lot. And then you need to see that she's getting the care and treatment she needs BEFORE you subject her to the massive life changes of marriage, sex, and hormonal birth control. And unless and until she gets her mental health in order*, you shouldn't even be thinking about children.

*I'm not saying people with mental illness shouldn't have kids, but they SHOULD be as well-controlled as they possibly can be, and have a plan for what to do in case there are problems, because when you're a parent, a lot of YOUR needs come second. You don't even get to have the flu in miserable peace ... you certainly don't get to have a nervous breakdown without dramatically affecting the lives of little forming humans.
posted by Eyebrows McGee at 2:08 PM on March 30, 2010 [13 favorites]

You're getting a lot of good advice here.

How is your relationship with her parents? If its good, I'd be tempted to ask them if they could tell you exactly what she was diagnosed with. If she hasn't been to the doctor "in many, many years" its possible that she simply was too young/immature at the time of diagnosis to process her diagnosis and/or she doesn't know because her parents never actually told her the official diagnosis. If they're evasive, that would be a huge red flag for me that perhaps she was improperly diagnosed and/or they're somehow treating her outside of a formal doctor's order.

Has she had these panic attacks her whole life? Have her parents/teacher seen them? How do they respond?

Whatever you do, I beg you, do not have a child with this woman - planned or unplanned - until her illness is under control. Post-partum depression could make things much, much worse, plus how would you feel if your two or three year old child had to see/comfort her during one of panic attacks. Wear a condom, get her on Norplant or some other "always working" birth control medication, do both - whatever it takes.
posted by anastasiav at 2:26 PM on March 30, 2010

You shouldn't marry someone who has threatened serious physical harm to you unless she is doing everything in her power to make sure it never happens again. By refusing to seek the medical care that she'd need to manage these episodes (which do sound much more like psychotic episodes than panic attacks), your fiancee isn't just trivializing her own health, she's showing that she has very little concern for your safety.
posted by arianell at 2:50 PM on March 30, 2010 [1 favorite]

this is really the last hurdle of trust in our relationship.

This is huge. Marriage, IMO, is all about trust. If you don't trust each other 100%, then your relationship isn't based in reality, it's based on what you each let the other see.

Also, by not taking responsibility for her own care, she is not behaving like a responsible adult*, yet she expects you to sign up for a lifetime of dealing with it all, while still refusing to let you know exactly what it is you'll be dealing with. And does she still expect her parents to be handling her medication after you are married?

*Granted, this may be one of her symptoms. I'm not condemning her for this, just pointing it out.

Summary: you two do not know each other well enough, nor trust each other enough, to get married, IMO. Are you really willing to make a lifetime commitment to someone who isn't willing to tell you all about the crippling medical condition you'll have to be dealing with for the rest of your life?

What should I know about starting birth control, becoming sexually active, and drinking alcohol, with regard to Zoloft and Concerta? How can I protect my fiancée and myself from her dangerous/unpredictable side without degrading her or treating her like a child or an animal? How do we raise kids someday, in that kind of situation?

These are all questions you should be asking her doctor.
posted by MexicanYenta at 2:53 PM on March 30, 2010

I'm going to speak to whole other issue here: your fiancee's hating doctors, having an "irrational phobia" of them. This is a big problem purely on its own, apart from the mental health issues she faces.

One of my aunts had a huge phobia of doctors. She simply did not go to doctors -- at all. Finally, only when she could no longer hide the fact that she had Stage IV breast cancer tumors visibly popping out against the skin of her breasts, then she saw a doctor. She died within a few months of her diagnosis, at the age of 49, leaving behind her two young children and my uncle as a single father to them. Oh, and yes, her mother had had breast cancer and her sister had had a brain tumor, so she knew she was at risk. But none of that mattered compared to her own fears. It was an utterly preventable and frankly selfish thing to have happened. My cousins are haunted by her death.

This is the kind of woman you want to be the mother of your children? She needs to grow up, be responsible, face her fears and work on them. She needs to be responsible for herself before she can responsible for children.
posted by Asparagirl at 2:56 PM on March 30, 2010 [3 favorites]

I was in a very similar situation as you are today. My marriage lasted around 9 years.

I remember having all this fears about: "How can we break-up when we're so close to
getting married?" I was also entertaining all this rosy thoughts about " I can weather all
of this.... she will change.... our love will overcome..."

The damage caused now to me, to her, to our kids, to our lives, has been devastating. Compare that to the relatively small damage of breaking up.

As the majority of the other comments here, there are RED flags everywhere. I urge you to reconsider the whole relationship.
posted by theKik at 3:01 PM on March 30, 2010 [2 favorites]

Mod note: few comments removed - if all you want ot say to the OP is "you are wrong" please don't bother, keep advice constructive and helpful
posted by jessamyn (staff) at 3:03 PM on March 30, 2010

It might be very painful and a bit embarrassing to you, but could you ask her to sit with you at your computer and read your post and all the replies to it together? Stress that it is an anonymous forum, and you feel terribly lost and helpless. Making her part of your dilemma might encourage her to share information with you and come up with a plan to help herself and you.
posted by meepmeow at 3:48 PM on March 30, 2010

I am not going to comment much on the medication aspect, because I agree that increasing dosage and always relying on drugs seems like trouble, but I've also learned to try not to tell people that because, as someone without any mental issues, I "just don't understand what it's like, and I don't know what I am talking about," etc, etc.

But reading your post, there are a few things that stand out to me. She is so young. You said yourself that you don't know what she is like when she drinks. You don't know how often she will drink. You don't know what she would be like living on her own and taking care of herself. You don't know what it would be like living with her, how much she would let you take care of her. I feel that in order to get married a person should at least have time to be by themselves for a while and really get to know themselves. She has not had a chance to do that, and since she is so young she will still be growing into a different person over the next few years. Since you are marrying her, you need to know what it would be like to live with her, to be with her while she is still growing up and changing. Living together before marriage is not an option for all couples, but please think about all the things I mentioned. All these things you yourself said are a concern, and you deserve to know how she would handle all these things before getting more involved with this girl. Think about it - if you and her can't figure out a way to deal with all this now, to get her to take her meds now, how is this going to work when the birth control pill totally messes with her moods, or later when she potentially has post-partum depression and isn't taking care of herself or your kids? These are worst-case scenarios, but she needs to take responsibility for her mental health. Talk to her about all this and don't let her just freak out, avoid the conversation, and blame it all on her ADD. You need to know before you get married that this is something you will both be able to deal with, that she will be a responsible adult when she is moved out of her parents house, that she will go to the doctor if it is needed, and she will take care of herself.
posted by KateHasQuestions at 5:20 PM on March 30, 2010 [1 favorite]

Do not marry her until she takes responsibility for her condition.
posted by St. Alia of the Bunnies at 5:33 PM on March 30, 2010 [1 favorite]

If you have only experienced a few of your fiancee's "anxiety attacks" imagine what it will be like when you actually live together and you are around her every day. What will you do if she seriously injures herself, you or another person? What would happen if she starts to have these episodes every day? What if she has an episode in public or when you are not at home?

I suspect that your fiancee either knows or suspects that there is something seriously wrong with her mental health and is embarrassed and/or in denial. The things you describe do not sound like ADHD or anxiety.

Insist on pre-marital counseling from a qualified therapist prior to getting married. Taking responsibility for her own mental health issues, getting the med situation figured out and being completely transparent to you about the situation need to be things that happen before you commit to sharing a life together.
posted by pluckysparrow at 6:05 PM on March 30, 2010

In addition to other advice offered here, there is one very concrete step you could take together: finding a responsible, respectful primary care physician. Someone you two find together, who has no relation to her parents or her past treatment. Yes, she has to take responsibility for her own health, but you can work with her to find a PCP as Step One.

Yes, your fiancée should see a psychiatrist immediately, but it may be impossible to actually accomplish that immediately. At least she can find a way to PRACTICE interacting as an adult with a non-threatening doctor who is not focused exclusively on her mental health. These are skills that can be learned, not something we are all born knowing how to do or do well.

The doc needs to know about her fear of medical professionals, so s/he can help make the situation less scary and understand why your fiancée may be a "difficult" patient. Your fiancée needs to know that as an adult she can refuse any request the doctor makes. The purpose is to get her to practice self-care and being responsible for her own health. This, in turn, can create a new way for her to think about medicine and a new way for you to act as a caring person who supports her in learning new skills (not a parent, not an enabler, not a controller).
posted by kypling at 6:47 PM on March 30, 2010

I'm no longer a mental health professional seeing clients (and of course would never diagnose online anyway), and IANAD, but from my past experience, I agree strongly with namesarehard -- your description of your fiancee's behaviors and her age make it sound like she could be struggling with something much more serious than panic attacks and/or ADHD. Even if those were correct diagnoses when she was younger, other things might be happening now that do sometimes arise around her age. Not meant to alarm but just to say that things do change, and if she really hasn't seen a doctor for so long, your post raises several concerns that suggest a strong need for consultation with someone who works with these issues.

Several people have given good advice in this thread urging that she needs professional help to find out what's going on and to determine the best way she can help herself and get treatment. I sincerely hope you and her family are able to help her take those steps. However, as others have noted, ultimately it is her choice, her decision, her adult responsibility (unless things get so bad that she reaches the point of involuntary commitment, but that's another story). Please do not marry until you both/all know much more about her condition(s) and she is receiving whatever competent, likely ongoing treatment is needed. Good luck to you.
posted by stillwater at 7:18 PM on March 30, 2010

By no means a professional, but my two cents: when you have a relative with a physical or mental disability, you need to manage your expectations. If this persists or gets worse, you have to be all right with maybe not having kids, maybe not being able to go on trips that stress her out, so on. Not saying that this means you can't/ shouldn't get married, but you have to mentally prepared, and know ahead of time that your wants and expectations might have to be a distant second to her medical needs.

Second: you are one half of this relationship. The other half is another person who, like other posters noted, has to act like an adult too. Being an adult means that when you're in your right mind, you communicate on important things like medical issues that you have which could result in another person (someone you care about!) getting hurt. From what you're saying, it doesn't sound like this is happening. I don't know you, I don't know your fiance, but it seems like there has to be some meeting halfway here. You really don't sound like you know what the hell is going on, and you're signing up to be the one who takes care of her when she's not well. It seems like you're setting yourself up for failure.
posted by _cave at 7:35 PM on March 30, 2010

Also: Have you told her how you feel? That this frightens you, and you don't know how to handle it (though you love her)?
posted by _cave at 7:37 PM on March 30, 2010

Speaking from personal experience: If your fiancee has any issues with mental health or depression — which it sounds like she does — she should NOT go on the Pill without doing some serious research first. Dr. Jayashri Kulkarni is one of a regrettably small number of people studying this kind of thing. The article Is the pill playing havoc with your mental health? touches on her research and is a good place to start.

Being on the Pill made me suicidally depressed, and all I'm dealing with is plain ordinary depression. It sounds like your fiancee has a more complex set of issues going on, and I personally would advise her to stay far, FAR away from hormonal contraception.
posted by Lexica at 4:51 PM on March 31, 2010

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