Relationships, Caregivers, and Mental Illness
Relationship in a mental illness situation is a difficult subject to broach, yet is one of the more common concerns visitors to my site write to me about. I have read about frustrations when a loved one with mental illness would not seek help (or admit it), when relationship has become strained due to the behaviors of the partner with a mental illness, or even more devastating consequences thereof (adultery, financial devastation, violence).
There is the issue of “how do I know which is You and which is the Illness?” This is tough to determine unless both partners proactively educate themselves and each other about symptoms of a mental illness and the many physical forms (behaviors) the symptoms manifest.
“Support” Means Mutual Support. Often when we think about support, we automatically think about the person managing a mental disorder. A relationship is a dynamic state involving at least two persons; both need support in a situation where emotional pain is prevalent. Support for a person managing a mental disorder is crucial in encouraging him or her to seek help and to stay on medication. For the “caregiver” (or personal associate), support becomes especially important during the phasic manifestations of the highs (bipolar disorder) and the lows (depression or bipolar disorder).
Caregivers and personal associates can become confused, frustrated, angry, and scared when they are confronted with bizarre behaviors that can erupt during an episode. Sometimes, symptoms can be more insidious and begin with subtle changes in mood that is accompanied with hurtful remarks and concerning behaviors. It can be difficult to catch these early symptoms. We can decide that the other person is just being a jerk (and sometimes that is the case), and fail to monitor more drastic changes that are telling of a depressive or manic episode.
Seeking support is a way of validating our feelings. We want to feel how we feel about a situation without being judged. Separating oneself from the disorder is critical in maintaining a healthy perspective during trying times. This recognition of “who the person is” versus “what the disorder looks like speaking through the person” is a step toward open communication in a relationship. Gaining this recognition involves actively educating yourself in what symptoms of mental illness “looks like” during episodes, and choosing the best coping method when the situation arises.
Prior agreement between partners can work well in many cases. For example, you may want to have a signal that you both to “signal” the onset of a symptom when the waters are calm. You then have an agreement about what you both can do when early warning signs appear. When a person is in midst of a mood storm, he or she may not be able to perceive behaviors that are out of the ordinary. Prior agreement helps to remind the patient that something is happening and needs to be monitored to prevent worsening the situation.
Establishing boundaries is healthy. For example, when a patient experiences depression symptoms, her partner may try to “cheer her up”. This sometimes will not work, and the partner may end up feeling helpless and frustrated. The partner’s feelings of frustration and helplessness will then make the patient feel even worse, and she may additionally blame herself for the situation.
You don’t want to turn your back or cut communication with a person who has become depressed; instead, free the burden from yourself to always have to “fix” a depressed person, even when you have the best intentions. Let the person “be”, and let him or her know that you’ll be there if he or she needs to talk. When you set boundaries and accept that you do not have to assume responsibility to cheer up a depressed person, and that it is not your fault if you cannot cheer up someone who is depressed, you will be less drained emotionally.
There is nothing wrong or unusual in feeling angry, hurt, helpless, frustrated, grief, drained, sad, or scared - but you can make choices with how you want to deal with those feelings.
To Caregivers: There may come a time when your loved one is in complete denial, and is behaving in destructive ways. From my own personal experience with severe depression, I can vouch for having moments of mental clarity where I knew that I had behaved in self-destructive ways, and where this behavior lead to “collateral damage” (hurting others). Although I don’t take responsibility for my depression, I am still accountable for doing something about it, especially when I realize that my behavior can be hurtful both to myself and to other people.
I then have choices. I can refuse to accept that anything is abnormal (denial). I can acknowledge that something isn’t quite right and do nothing about it (disregard for responsibility). I can acknowledge that something is wrong and seek help so destruction doesn’t happen again. Only one of these choices take me to a better quality of life for myself and my loved ones.
During early adulthood, when my depression symptoms were most rampant, I sensed that something was wrong, but I denied that it was anything but my being obstinate or unreasonable. Nothing prevented me from “double-checking” the symptoms of depression, but nothing mattered to me enough to double-check. This lead to unhealthy relationship dynamics, many of which still make me cringe when I recall those interactions. When I got married, I was misdiagnosed with bipolar disorder, and my husband purchased a book about bipolar disorder to learn more. Shortly thereafter, I made a decision that I wasn’t going to repeat the same mistakes that I had made in the past, and I was going to take control and be accountable in managing the depression.
Mental illness may sometimes lead to extramarital affairs and adulterous behaviors that destroy the trust in a marriage and destabilize the home environment. Sometimes the patient’s denial can deteriorate the trust in a marriage by committing adultery or by financial choices that set up the family for ruin (spending sprees, for example). The spouse’s anger and confusion is confounded by the knowledge of mental illness, and whether to forgive his or her partner because the partner is mentally ill and “know not what s/he does”.
Mental illness can never be an excuse or even a valid reason to endure violence or continual physical/emotional abuse. A case can be made for bearing the pain inflicted during the wake of mental illness, but not when the patient continues to refuse treatment or chooses denial about the illness. Even emotional pain, however invisible, can leave deep scars and are as destructive as physical pain. I am especially concerned when there are children involved, and the spouse is struggling with the toll of a mentally ill partner. When children are involved, forgiveness must be dealt with a judicious hand, and with the condition of the patient getting treatment and taking responsibility for his or her mental health.