Newly diagnosed bipolar spouse, minor kids — what should I know?
May 7, 2020 10:14 AM   Subscribe

My spouse has a new bipolar diagnosis as of a few weeks ago, as a result of a very serious manic episode (including psychosis and involuntary holds). They’re currently in residential therapy, likely to leave at the end of the month, though they currently deny their diagnosis. We have minor children who have been through more than they should have had to. As someone with no meaningful knowledge (though I’m learning as fast as I can), does anyone have experience here they can share?
posted by DoubtingThomas to Human Relations (15 answers total) 1 user marked this as a favorite
Do your kids have a pediatrician (or the same ongoing pediatric practice, at least) who can make a phone appointment with you? There's two things you need to prioritize there: a referral for therapy for them that's appropriate to their ages, and a discussion with the doctor about quarantine, as I cannot imagine it is a good idea for someone coming straight out of a residential program to not isolate for 14 days before you and the kids are exposed to them, and that a real tough challenge in these circumstances. Possibly there are local resources that could assist with some of that, and your kids' doctors are likely to know about them.
posted by Lyn Never at 10:30 AM on May 7, 2020 [7 favorites]

I don't know of anyone who has been released from a (quality) residential treatment center without a treatment plan for at-home. If your spouse is in denial of the diagnosis, does that mean he or she will also be noncompliant with a treatment plan? Or are they willing to participate in their treatment plan despite their denial of diagnosis? If it's the former, I think you are going to have to decline the home release and ask your spouse to stay elsewhere. If it's the latter, I think you're fine to re-combine households (after a 14-day quarantine) assuming you're able to get your kids into therapy to help process what's happened.

You are not a monster for insisting that the treatment plan be followed in order for your spouse to live with you and the kids, and if it is not followed, to insist that the spouse leave.
posted by juniperesque at 10:48 AM on May 7, 2020 [25 favorites]

If you don't already have one, get a therapist for yourself, and get one for your children, too.

Think of this as a "put on your own oxygen mask before assisting others" thing. You're going through something extremely challenging, and a therapist will help you cope, process, and plan.

If you don't know how to find a therapist, give us some information about your location, and all of us at AskMe may be able to help you find resources that can be helpful.
posted by meese at 10:53 AM on May 7, 2020 [6 favorites]

I'm so sorry that you're going through this. Lyn Never is spot on, get your kids someone to talk to about this. In addition, start right now with taking care of your own mental health. Find a good therapist asap if you don't have one already, develop or tap into a support system, develop or maintain healthy hobbies and coping skills. You need someone to talk to about this situation who isn't your spouse. Having someone in your life with serious mental illness is often difficult and draining, and you can take better care of them if you are healthy yourself.

I work in residential mental health treatment and I see a lot of spouses and parents burn themselves out trying to do too much. Be loving and supportive to your spouse, but don't take responsibility for their health and recovery. Especially as you mention that your spouse doesn't currently accept their diagnosis, be prepared for things to be hard until they do. They will ultimately be the ones who have to do the hard work - you can't do it for them. Talking with a therapist can help you figure out where to support and where to step back, and how to balance your own health and your children's along with your spouse's. I don't mean to be dire - I have seen people make amazing recoveries and live full and healthy lives, but they all had to come to a place where they understood that they were ill and took responsibility for their own treatment to get there, and that can take time. As Juniperesque said, you may need to make some hard decisions about whether they are ready to live with you again. Keep reading and learning about their diagnosis, and also look up 'living with someone with [diagnosis]'. Look for support groups for family members (a therapist can also help you find these). Keep talking to your spouse's providers, know what their treatment plan involves, find out what medications they're on and research them - and know if they haven't taken meds before, it may take a few tries to find the best ones for them. I wish you all the best and hope that things get better from here!
posted by MartialParts at 10:55 AM on May 7, 2020 [4 favorites]

In more normal times, an involuntary hold after a serious episode would come with some sort of post-release care plan like an intensive outpatient or partial hospitalization program. If no one's talking about those things with you yet, it's absolutely okay to ask for your spouse's social worker to call you to talk through what that might look like.

A partner in denial with no plan for ongoing post-release treatment would be a lot for anyone to deal with at any time, let alone with kids and during a pandemic. I strongly recommend placing a high priority on getting your own support systems beefed up as much as possible. It may be hard to sniff out a "partners or family of people with serious mental health issues" support group but if they exist near you and are holding some kind of remote meetings at the moment, they can be deeply helpful in the situation you're in. If not, there are online versions but I have to say that personally I've found them less helpful; but if they're what you can access, then it's worth a try. It may feel selfish to spend your energy on your own support right now, but I promise you it's not. It's not only care that you deserve, but it will allow you to be a better support for your spouse and your children. Likewise, if there are friends or family that you can talk to, maybe do that. If you can get some FMLA paperwork in place at work to let you handle your partner's care and/or your own therapy during this time, do it. (Or if you have a great and supportive boss who will be flexible without the paperwork, great, but if not, take the family leave you are allowed to, if you need to.)

I would put a high priority on requiring your partner to keep taking any meds until/unless they establish a relationship with a care provider who can work with them on alternatives, and to insist that they attend therapy. They don't have to accept the diagnosis right now but if they will accept that *something* is haywire and they need to be in treatment in order to come back and live with you, that's probably enough to be getting on with. But if they won't take meds and won't be in treatment, you have a hard decision to make and no one who has been in your shoes would blame you if you decided they could not come home to live with you and your kids until that changes. If you were my friend, that's what I would advise. There has to be some baseline commitment to treatment and to rebuilding family bonds and trust, for you to get through what will be a rough time ahead of you. Your partner will have to take responsibility for their own health and stability and you will have to let them even when every bone in your body is screaming for you to step in, come to the rescue, organize things, count the pills, set up the appointments, monitor the progress, fix it. You can't fix it. You can support your spouse in the work they have to do, but it is their work

For whatever it's worth: it's been many years since my partner's hospitalization. Things are so, so much better now. The experience was terrible and left us both with trauma that we will probably both always be working through to one extent or another, but I don't regret that he came home and I'm grateful for the good years we've had since. We both had to really recommit to working through hard things, though, individually and as a couple, and I don't think it would have worked if we weren't both able to do that. There's only so much you can do alone. You are allowed to take care of yourself and your children.

I can't speak to the diagnosis-denial stuff; that's not within my realm of expertise. But other than that, you're welcome to MeMail me anytime. This is hard, painful stuff and it's hard to find other people who've been through it, but finding those people can be a lifeline.
posted by Stacey at 11:11 AM on May 7, 2020 [15 favorites]

I am bipolar, and a parent.

I didn't accept my diagnosis at first, or for years, until I finally realized that yes, I would need to take medication every day for the rest of my life and things began to get better for me. During those unmedicated years, I flew off the handle in ways large and small and harmed my children in lasting ways. They are both adults now, but both have issues with drinking and relationships that seem a natural consequence of their sometimes-chaotic childhoods. One child fully agrees that her issues are my fault, the other hasn't connected those dots (or more likely, chooses to spare my feelings, even to himself) but I know, and I know I cannot take anything back no matter how much I wish I could.

Psychiatry is in its infancy, still, in a lot of ways. There is no blood test for mental illness, and diagnosis and treatment require a lot of trial and error and perseverance on the part of the doctor and patient. Plus, if you are American, insurance costs and copays and approvals. But there is hope -- I am bipolar, I take my prescribed medication every day, I have been stable for many years, and I am not an emotionless zombie, I am still me. But I am a me that lives with the heartbreak of seeing my past actions play out today in my children's issues, something I could have been spared, that they could have been spared, if I were not so scared, and proud, and unaware of the effects of my actions on the ones I love.

Feel free to MeMail me if you want to chat, or your spouse wants to chat. If there is anything I can say that would save you and your children from future harm and your spouse from the kind of guilt I have to live with, I want to try.
posted by pH Indicating Socks at 12:09 PM on May 7, 2020 [35 favorites]

The MeFi Wiki ThereIsHelp page includes links to a variety of resources, including a section about Help with Finding a Therapist that also includes AskMe threads. I think it also makes sense to start interviewing attorneys now (MeFi Wiki) to find someone with this kind of family law experience that you are comfortable having as a resource to help protect the best interests of your children. The idea is to hope for the best, but prepare for the uncertainty, and be ready in advance for a need to act quickly to help minimize disruption for your children.
posted by katra at 12:11 PM on May 7, 2020 [1 favorite]

Nthing all the recommendations above. Creating a support network for yourself and your children, and holding boundaries with your spouse is key.

To speak to the diagnosis denial: lack of insight and judgement around their own behaviors and actions is unfortunately a symptom of mania/psychosis, and depending on the severity of the episode, it may take them weeks to months on a consistent medication regimen to regain this. Your spouse may also experience guilt or shame about the behaviors they engaged in while altered, which can certainly play a part in this. As stated above, you might definitely find yourself "doing the work", which is understandable - you have young children! And it's a pandemic! - AND you should not be working harder than your spouse.

Prior to their discharge from residential, I would recommend (if not already scheduled), that you participate in a family meeting with their treatment team to discuss what you are and are not willing to allow, should your partner return home. Ideally, a step-down to a Partial Hospitalization Program or Intensive Outpatient Program would be recommended, although I know that realistically that has become even more difficult to navigate during covid.

Two more things that I think are often overlooked or not talked about:
- not all, but many folks who experience a serious manic/psychotic episode experience a severe depressive episode once the psychosis resolves. By maintaining a consistent relationship with an outpatient therapist and psychiatrist after discharge, these clinicians will be able to continue to assess your spouse for risk of suicide or other life-threatening behaviors, and make medication changes accordingly.
- ask for assistance from the treatment team to provide your spouse the support they need (that's assuming if needed), to quit the use of any mood-altering substances, alcohol, cannabis, etc. There may be a time in their life when your spouse can use in moderation safely, but now is absolutely not the time to fuck with that.

I highly recommend the NAMI Family to Family program for support from folks going through similar experiences. The ones in my area have gone fully virtual, but are working hard to continue to offer support throughout the pandemic.

It's great that you are reaching out for help already. Remember to be kind to yourself - as much as you can be prepared, you and/or your spouse will inevitably take steps backwards or "not do it right" at times, and that's ok and normal too.
posted by gollie at 12:17 PM on May 7, 2020 [5 favorites]

My mother had bipolar disorder. She was not in denial, took her meds and went to therapy, and was still a terrible parent and a difficult person. I'm not telling you this to be the bearer of doom and gloom, because that may not be your experience, but I just want to acknowledge that you, your spouse, your support system can all do everything "right" here and it will still be a challenge for quite some time (and may not fully resolve in the happiest and healthiest of ways).

I really wish you and your family the best.
posted by sm1tten at 1:49 PM on May 7, 2020 [3 favorites]

My mother was also bipolar. Please feel free to MeMail me if you'd like to learn more about what that was like.

Please, please get therapy for yourself and for your children.
posted by Sublimity at 2:35 PM on May 7, 2020 [1 favorite]

Thanks to all so far.

I, thankfully, already have a therapist, and one of the first things I did after the initial hospitalization was find therapists for the kids. That’s in place now, and seems to be helpful. They’re clearly acting out in various ways — misplaced anger, lots of physicality — but I’m trying to be a broken record to help them recognize the severity of what they’ve been through. “It’s okay to be angry, it’s not surprising that you miss them and you’re not sure if you want them back, remember they love you” type-of-thing.

I’ve also joined one NAMI family-to-family virtual group. It was helpful to talk with people who could relate, but it’s only once a month, which is why I reached out here.

I haven’t had any hard conversations with my spouse yet — I’ve been desperately trying to be accommodating and make sure they stay in residential. They’re not stable, but at some point those conversations need to happen. It’s clear they don’t remember what led to the eventual hospitalization.

I’m a mess — I know I’m a mess; I’m scared that I may have to make hard choices, and worried that I’m jumping the gun by thinking of all the things that could go wrong.

If nothing else, though, I’m not obsessing over the coronavirus. Small favors.
posted by DoubtingThomas at 3:24 PM on May 7, 2020 [7 favorites]

I'd like to note that there is a difference between 'accepting one's diagnosis' and deciding that one is better off taking psych meds. I accepted a diagnosis of bi-polar disorder fine when it was first given to me during a hospitalization but over the years my belief that that characterization had any value was lost along with my faith in psychiatry as a profession. As a field they have very little actual knowledge of the problems they are supposed to treat; I would say they are still very much in the dark ages. But they do have psych meds that can prevent mania and psychosis, although at some very real cost to mental and spiritual well-being. It may be an easier sell for your spouse to disconnect the need to take medications -- to prevent hospitalizations, say -- from the need to accept whatever dogma and stereotypical attributions the psychiatrists are laying on them. It's quite possible that the latter are false, and your spouse shouldn't have to swallow them kit and caboodle as part of the process of finding effective treatment.

I expanded on the theme of psychiatric medications and treatment in a comment on a recent thread. (And I've commented regularly on psychiatric-themed threads on mefi over the years. You can find them through my profile if you are interested.) Basically, good psychiatric treatment is one that is driven by the patient's concern for their own well being, and good psychiatrists are ones that have a lot of humility. I'd ask you to please bring a healthy scepticism to the pronouncements of the profession and of mental health groups like NAMI.

Good luck.
posted by bertran at 3:52 PM on May 7, 2020 [1 favorite]

When I was 9 my father ended up hospitalised for what was later diagnosed as bipolar. (At that point the diagnosis was major depression, but the manic episodes that followed over the next few years made things clearer).

It was... problematic, but mainly because of the way my mother handled it. (She did the best she could, I think, she just didn't have good coping tools herself). The worst thing was lack of information. So I think communicating with your kids in an age appropriate way about the diagnosis, about the treatment, about the prognosis, and about your own feelings about it is really important. (It was only in my twenties that I found out about the bipolar diagnosis, even, although I should have guessed, based on what I had to live with for my whole teenage years). It sounds like you are probably doing communication pretty well, though.

The other thing is, assuming he doesn't end up completely stable on the meds, and continues to have at least occasional episodes over the years, it's really important to let your kids know when his behaviour is influenced by his illness. I grew up thinking that (a) some pretty terrible behaviours were normal parenting and (b) that my dad was kind of an asshole, and I think that if my mother could have called those behaviours out at the time or later to me privately as due to the illness, I would have been more understanding.
posted by lollusc at 5:56 PM on May 7, 2020 [1 favorite]

So, I’ve been through similar situations with my spouse. The timing is a little different as she was diagnosed younger and hasn’t been hospitalized since we before we had kids, but dealing with bipolar has been a constant throughout most of our 20+ year relationship. I’m not a medical professional of any kind, so all I have is our experiences, so take all of this with the appropriate caveats.

First off, this is monumentally hard stuff, especially given the larger circumstances, so being a mess is to be expected. It sucks, and it’s hard, but you can get through it. It sounds like you have your priorities straight, and you are doing the best you can for your spouse and your family.

The question of “accepting the diagnosis,” really comes in two pieces I think. The first is being aware that something was wrong enough that they needed help. The second part is accepting that they have bipolar disorder and need to be on medication, probably for the rest of their lives. This second a much harder thing, and as other have said it can take a long time to internalize. I would argue that as long as they agree that the meds are necessary and continue to take them, that’s enough, in the short run at least.

Which isn’t to say the meds are a panacea. This stuff isn’t an exact science and it’s very likely it will take a while to find the right medication or combination of meds that works for your spouse. Some of them have pretty nasty side effects which may make them doubt if taking them is worth it. A good psychiatrist who is willing to listen and adjust things is a big part of getting this right.

I think you’re right to avoid hard conversations for now. If your spouse is still in a residential program, they almost certainly aren’t in the headspace to deal with big picture stuff. That can wait, and it may have to wait for a while, as you need to be the one driving the bus and making all of the decisions until they are ready.

After each major episode my wife had, and after each time she was hospitalized, I worried that something fundamental had broken, that the paranoia and psychosis would never leave, that she would never go back to being the same person I knew. But she always did. And she always went back to being able to take charge of her life.

The biggest mistake we made, and the one I would caution the most against, is getting too comfortable. This may sound laughable now, in the middle of the shit, but when things get back to normal, and god willing they will, it is surprisingly easy to just go back to your lives the way they were are pretended it never happened. To stop taking the meds because, “well I feel fine now.” To stop going to the therapist. To not refill the prescription when it runs out.

I feel like one of my jobs is to be the institutional memory for us as a couple since, like your spouse, my wife doesn’t remember a lot about her manic episodes. So remember. Be vigilant. And above all, plan for the next time, because it is overwhelmingly likely that there will be one. Remember and watch for the warning signs. Make a medication plan for when things start going wrong. Reach out to friends and family so they can be ready to support you when you need them. Have a channel open to your spouse’s psychiatrist so you can reach out when necessary.

Don’t give up hope, and feel free to reach out to me via MeMail if you have any questions, or if you just need some to talk to.
posted by Lazlo Hollyfeld at 8:14 PM on May 7, 2020 [6 favorites]

Am a relative of someone who has a bipolar diagnosis. I write it in that way because there are so many things that we do not yet understand about mental illness. A friend of mine who works in medical education once told me, "Don't worry about the diagnosis, focus on managing the symptoms" simply because next year supposed malady X might become Y. (Keep in mind, I am someone who suffers from ADHD, depression, and anxiety; I am not anti-therapy, anti-medication, nor anti-shrink. It took years to get the right ones but I finally know what being not-depressed feels like and it has been a revelation.)

In my experience, it can be really easy to confuse the symptoms of an illness with the person you love. Going to Al-Anon meetings, which is for the friends and family of alcoholics, has been helpful for dealing with my relative who has mental illness because it reminds me that they did not choose to be ill any more than I chose to be ill. Of course, I still need to set appropriate boundaries and take care of myself. But that needs to be done in a loving and accepting way (ideally). Another relative was ranting about our mutual relative recently, and was all, "Why don't they stop doing X?" etc. and I reminded him that no one chooses to be diabetic and no one choose to be bipolar (or, in my case, crippled by anxiety and depression without the appropriate meds).

Sometimes I am able to remind myself that what I am hearing from my bipolar relative is the disease speaking. Sometimes I simply need to go to the bathroom or take a short walk to avoid saying something I regret. There are techniques available that can make it easier (this refers to someone with borderline personality disorder but again, pay attention to the symptoms rather than the diagnosis). A bunch of people in Al-Anon have found the program helpful for dealing with those with mental illness as well as alcoholics (but that is not an official line).

The things that have been most helpful for me have been to realize that 1. My relative is not being bipolar at me and their behavior is not personal even if they are busy telling me in that moment that I suck. It feels personal, very personal. But try your best to train your brain to take a step back and realize that is the illness and not the person you love. 2. My relative is ill, not mean. 3. Even so, unacceptable behavior is still unacceptable so if they are acting out in ways that are dangerous (to themselves or others) or are doing things that I find personally painful or upsetting, my job is to respond appropriately to ensure they (or others) stay safe and/or that I leave if they cannot respect my boundaries.

This stuff gets easier over time but it is never exactly easy. For what it is worth, my relative is a funny, super smart, loving, kind, and truly wonderful individual. I try to remember that on those occasions (which are much less frequent these days) when they lose their shit. I also make an effort to plan lots of fun and loving things to do with this person to bank lots of good experiences as a buffer for when things get bad again.

I know you are in a hard and scary place. It is also hard and scary for your spouse. You may feel resentful at times; I certainly did. But I got over it, in part by setting boundaries and doing other forms of self-case. Your marriage is not necessarily doomed and the story may yet end well enough. Thanks for the question, OP and best of luck.
posted by Bella Donna at 11:08 AM on May 8, 2020 [1 favorite]

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