Crazy, In Love

Posted by fxckfeelings on September 19, 2013

In the self-help-iverse, “limits” is often a dirty word, because we should all aspire to reach the loftiest heights or depths of intimacy. In reality, limits are crucial when setting both personal and interpersonal goals, but they’re especially vital when you’ve got a partly functional, mentally ill family member to take care of. In that situation, you will probably feel like doing anything to get him/her into treatment, including persuasion, confrontation, and threats of expulsion. In reality, your influence over the course of a mental illness is often, well, limited, treatment or no, and trying too hard to make it better can make it worse and drive you crazy. Instead of getting over-absorbed in efforts to help, get help yourself in figuring out the limits of what’s possible and respecting your other priorities, including safety, security, and the nurturing of others. Refusing to acknowledge limits is a lot easier/more damaging that learning to respect and use them to your advantage.
–Dr. Lastname

I’m married to a wonderful, unique individual, a free spirit who lived in a van for several years avoiding the world. After we married, we had a difficult couple of years, but then my work took off, and I got pregnant. My husband, already a night owl, turned into an irritable, stressed out insomniac who oscillates between manic episodes of ultra productivity, to sleeping for marathon amounts of time, missing appointments, being late for work, generally letting everyone down. He seems so resentful of me—everything I say he takes to the utmost extreme. We have been in talk therapy for three months, which has been pretty useless. The therapist has recommended my husband see a general doctor and a shrink about the insomnia. On a long road trip he started hallucinating and driving off the road. Sometimes he admits there’s a problem, other times he doesn’t. This morning, after another night of no sleeping, he screamed at me, collapsed on the floor and then crawled into the closet and passed out. I have asked him to leave our house until he seeks help, but he also refuses to leave. If I don’t pay the bills, he will be unable to. I reached out to his family and they keep saying it’s a marital tiff. He’s a wonderful man who is deeply troubled right now and in huge denial. I think he has some serious mental health issues which have been brought up by the huge responsibility of being a father which need addressing. How can I best help him?

You know that your husband’s dangerous behavior is out of his hands and in his mind. Unfortunately, there are lots of medical and mental health problems for which no one, including this mental health professional, has the answers, and this may be one of them.

The danger of trying to help him if it’s just not possible is that you’ll exhaust yourself and, worse yet, put yourself and your baby at risk from his symptoms. His illness may not be his fault, but that doesn’t make it your only responsibility, either.

Your first job, then, is to assure yourself that you’ve done everything you can reasonably do to help your husband; neither a therapist, nor his family, nor your own patient efforts to persuade him have seemed to make a difference. It would be nice if you could sneak some lithium into your recipe for his breakfast muffins, but that’s neither legal nor particularly tasty. All that’s left is to review his current condition with a professional and assure yourself that no stone has been left unturned.

Now that you’re ready to ignore any inner or outer voice telling you that you should be more helpful, prepare your own definition of dangerous behavior and a plan for dealing with it. Think of the scariest things your husband has done or might do, then plan what you’ll do, where you’ll go, whom you’ll call/what you can expect them to do, and how you’ll access your resources in such a situation.

Having accepted that you can’t change his illness and behavior, don’t think for a minute that forcing him to leave your home, if you think it’s necessary, makes you responsible for his pain. If you must push him out, promise to welcome him back when he’s well. You’re not trying to punish him and you can’t save him, but you can give him incentives for saving himself. In the meantime, you have the rest of your family’s safety to think of, including your own.

If he says or does something that really frightens you, you may be able to do more to help him; once he says that he wants to do something harmful, or starts to do it, police have the right to take him to a hospital and doctors can keep him there whether or not he agrees. Once treatment starts, he might get his own judgment back and decide to continue it, so remember, worse is sometimes better.

In any case, don’t rate your love and devotion by how much you’re able to help him or ease his pain. Judge yourself by how well you try, while taking care of yourself and baby in the presence of an overwhelming and sometimes dangerous illness. His illness may be out of his hands, but that doesn’t mean you have the power to carry it on your shoulders.

STATEMENT:
“I feel there’s nothing I can do to protect myself and my baby that won’t hurt my husband and make him sicker, but I know I’ve done everything to help him and that his illness, not I, is responsible if he’s not getting better. I’ll make the tough decisions that are now necessary, knowing they’re not meant to hurt him and that illness alone is to blame for anything bad that may happen.”

My son is often depressed and won’t take his medication. He just sleeps all day, calls in sick to work, and acts grumpy when he gets up. I’ve had it with his nasty attitude and do-nothing-for-yourself behavior and I’ve decided to kick him out unless he agrees to take his medication and get better. He says medication doesn’t agree with him and that he wants to work but can’t. He’s twenty years old and no longer a kid, so I think it’s time for tough love. What do you think?

It’s natural to channel frustration over your son’s persistent depression into tough love and a kick in the pants when other, gentler kinds of help haven’t worked. The problem is, however, that tough love often carries its own risks, like easy regret. That’s why, like the person above, you should first assure yourself that you’ve done what you can to help him before risking a move that may cause harm.

You can recommend treatment, of course, but you don’t know what will work and what won’t, so don’t urge him to try a treatment he has reason not to like and don’t grade him on whether he gets better. Instead, urge him to gather information about what he thinks will help him, using the internet and, hopefully, a consultation with a live clinician. Offer to help him sort out possible treatments and self-help activities, like exercise, keeping busy, and doing some kind of work every day, at whatever level he can. Don’t criticize him if he underperforms, just urge him to set his own standards for performance and then ask him whether he met them.

With luck, you can find performance standards that reflect his effort and values, rather than things he can’t help, like the state of his depression and the way it can scramble his brain. If he believes in the value of getting up at a certain hour, you can measure his wake-up time daily. If he thinks exercise is worth a major commitment, measure whether he meets it. Your goal is never to prove him lazy, but to encourage him to manage his illness and hold himself accountable for doing what he believes he should do.

Fortunately, you don’t mention any of the self-destructive behaviors that depression stimulates in many people, such as drug abuse or lying to cover up shameful avoidance. If he couldn’t stop himself from doing something you thought was destructive and dangerous, you might well find it necessary to kick him out of the house. Don’t do it out of anger, however, and make it easy for him to return if he’s ready to try harder and you think he’s safe to have around.

Remember, depressed people are often irritable and irritability is contagious, so don’t set limits because you’re angry and fed up, or you may amp up his negativity. Instead, put together a positive recovery plan (don’t hesitate to get a consultation yourself) and then use incentives to push him along. It may be difficult and require patience and a tolerance of his irritability, but you’ll have the satisfaction of knowing you’re doing a good job of highest-degree-of-difficulty, black-diamond parenting with as must skill (and as little regret) as possible.

STATEMENT:
“When my son acts like a lazy, disrespectful bum, kicking him out feels like the best way to teach him a lesson. I know, however, that depression may well prevent him from surviving on his own, so I’ll use eviction only when necessary while I try to put together some goals, schedules, and rewards that will get him moving towards good self-care and recovery.”