I'm concerned about my wife's mental health

Tuesday | May 14, 2024

Love Letters Marriage

I’m concerned about my wife’s mental health

Dear Meredith,

I have been married for 15 years. We have two kids, a house, an entire life. Our marriage has been mostly happy throughout the years.

My wife has some mental health issues that are getting severe. When I met her, I was aware that she had CPTSD and was on medication for anxiety and depression. She does, and always has done, a lot of work in therapy and groups and such. She has always been able to manage her condition.

Her condition is getting much worse, though. She now has physical ailments (digestion problems, odd pains and rashes, erratic physical functioning like numbness) and delusions. The delusions are bad and getting worse. Some of them are delusions of grandeur. Sometimes they are delusions about conspiracies against her.

The delusions make it hard to relate to her or even know what is going on with her. I cannot tell her that she is wrong, so I basically go along with the delusions. Some of them involve me. She will think I am evil at times or that I have been captured and am being used to attack her. She will go through stretches where she doesn’t feel safe around me and gets really jumpy when I do things for her. She will scream at me and tell me she never wanted to be with me. Not all involve me, though. Sometimes she sees me as a helper. In her clearer moments she will settle and open to me and allow me to be close. This is always followed by a blowout over something I did not see coming and her retreating even farther away. Our latest one, for example, was because I did not acknowledge that she cleaned the house within five minutes of first seeing her upon coming home.

Her therapy team cannot diagnose her. They don’t think she is bipolar. They don’t think she is schizophrenic. They are not sure what is happening and go along with things. I do know that she cannot find a good therapist and has settled for what she can find over nothing at all.

Obviously this is a huge strain on the entire family. We can’t make plans because we have no idea what state she will be in at any given time. I never know how to approach her or what will set off a fight or an episode. Sometimes just being careful around her will set off a fight because to her, I am not being real.

I don’t want to leave her. I do believe in “in sickness and in health” and know she is really sick right now. I would not walk way if she were getting cancer treatment or if she had dementia or Alzheimer’s. I do have a therapist who helps me, but things are mounting. To sum up my long, depressing letter, I am asking what can I do. Do I go through the difficult process of extracting the kids and leaving? Do I “take care of myself as best as I can” and keep showing up each day? Ultimately we do love each other and I know that. There are moments mixed into this where she is very sweet and caring.

– Sorry for the Long Letter

This letter is so far above my “this column is for community engagement and entertainment” pay grade that I called McLean Hospital shortly after reading.

I wound up speaking with Kirsten W. Bolton, program director of Appleton, a residential treatment program for people with psychotic disorders. (For those who don’t know, McLean is a psychiatric hospital close to Boston.)

Before I get into what Bolton told me, please know that her thoughts are general ones. She can’t diagnose a person or give specifics about a case after hearing about a letter sent to an advice column.

She did have some thoughts. 1. She said that in a case like this, get a second opinion. If you need help with that (finding and affording it), we can talk more via email, but she said “there are clinicians out there who don’t really get great training when it comes to treating and identifying psychosis. … [It’s] really important to get someone really savvy – [who] knows their stuff.” It doesn’t sound like the current team is it.

2. She said to take very good notes about everything that happens at home. Log all thoughts and changes. You’ll be doing this for you, your kids, the medical professionals who want to help, and your wife. It’s easier to get the right assistance if you can give specifics.

3. You can call your wife’s care team and give them information. Bolton explained that there’s nothing wrong with letting them know when she says something concerning, upsetting, or threatening … because they need to be in the loop.

If you feel like you’re in an emergency situation, treat it that way, she said. Be surrounded. Bolton mentioned 911, but she also said 988 is designed to help people in crisis. This relates to her point about taking notes, by the way, because when help arrives, you’ll want records. Bolton talked about bringing a loved one to an ER “with this documentation in hand – a well drawn out kind of history to say ‘this is what’s going on. I really think my wife needs needs help.’”

I asked how to talk to a spouse about this when they might not trust the people around them. She gave an example of how to frame the conversation, centering loved ones. “I need our kids to be safe. And I would hope that you would agree that our children need to be safe, and that we need to have a healthy, happy household. And that isn’t happening right now, right? I’m worried that whatever is happening is getting in the way. How can we partner together to seek help to make this situation better?

I also asked what a person could read for help. Bolton recommended a book: “I Am Not Sick I Don’t Need Help!: How to Help Someone Accept Treatment” by Xavier Amador. Bolton said there’s a method in the book designed to help loved ones communicate about all of this.

I want to add – with no expertise – that caregiving is complicated. If you’re overwhelmed by the state of things and worried about safety, make a plan for next steps. Let others in your life know you need support. Talk to your therapist about what this could look like.

As for staying vs. leaving, it sounds like getting the right help has to happen first. That’ll make it easier, I think, to make decisions you can feel OK about.

– Meredith

Readers? I know this is above all of our pay grades, but have you figured out ways to talk to loved ones about how they’re doing? How have you navigated the health system to find support you need?

Send your own question about relationships (dating, divorce, breakups, singleness, health) to the anonymous form or email
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Featured Comment

“Does your wife have a GP? Has she had an MRI, blood work etc.? Don’t rule out that there could be something physical or neurological going on, including early onset Alzheimer’s. I don’t think counseling is the answer here.

My mom had similar symptoms but she was already 68 when she showed signs of dementia. Do you leave your wife alone with the kids? How is she with them? We had to involuntarily commit our mom when she had an obvious break. Believe me, it was the very last resort and nothing we had wanted to do. Hopefully you are some distance away from that.”

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