Kristina Randle, Ph.D., LCSW

I have been married for 12 years to a 43year old woman, who has been diagnosed with bipolar. She was diagnosed in 2003 .Most of the symptoms were present throughout our married life together. She refuses to take her medication or receive any medical treatment, since her diagnoses. The last three years have been the greatest trouble for me. To be honest with you looking back on our relationship I would say the last 10 years have been a challenge. We have three children, two boys and one girl, ages 12, 10 and 5 and it has been hardest on them. In January 2006 I made the decision to leave the relationship. It was the hardest thing I’ve ever done.

My children mean the world to me, but being in the house meant constant fighting. My children never had a moment’s peace. It was like living with a ticking time bomb of emotions, I never knew what I was coming home to an angel or devil. I felt I had given 110% to this relationship but can’t give any more. How do you describe living with someone with bipolar? You’re always walking on egg shells, always trying to please her to keep the peace, never discussing her spending habits, never talking about her verbal abuse to me or the children, never talking about why she had to quit her job as a nurse, how she couldn’t hold down a job. I look back and think what I could have done differently, I don’t know.

I tried to get her help. She has been hospitalized three times, the last time in Jan. 2006. She was treated by two psychiatrists. One wanted to commit her and the other felt she was fit to go home and take care of the children, with the stipulation that she would take her medication. This was hard to swallow, because a social worker and our family doctor felt that she needed the treatment. She had already proven that she was not capable of doing that. I was devastated when they sent her home. I was hoping she would finally realize that she would get the help she deserved.

This has always been her downfall, not admitting that she needs help. She never could. She always had an excuse, always blaming someone else for her illness. Why can’t she see what the rest of the world does, what she is doing to herself and our children? I need to explain to you why I felt the last three years have been as big a struggle for me. My wife?s bipolar disorder has also developed into paranoia. She is constantly claiming that people are stalking her, threatening her, everyone’s out to get her, spreading lies about her that she was stealing medication, abusing the children, being a pedophile, committing arson, the list goes on and on. What is worse is she’s actually writing down her thoughts and sending out letters to people in the community. Also professionals, like teachers, hospitals and police.

Our neighbors, the children’s teachers, my own family, to my mother and sister claiming they have done horrible things. It has just been a nightmare. We live in a small community, so you can imagine what this has done to my family. Some days after I came home from work, she would have letters written on my behalf to sign, that said that I had heard or actually witnessed some of these rumors. The hardest part is how she treats the children and what its doing to them in the community. She always pushes them to do better, nothing is ever good enough for her she is always in their face when they’re involved in something, and making sure it’s up to her standards. She is always trying to keep me and my family away from the children. She is constantly telling them how horrible daddy, the grandparents and Aunties are. My children once asked me, daddy why does mummy not like our aunties and grandparents, they didn’t do anything daddy. What can I say to them? I have to always downplay situations like this.

My parent?s home has been like a second home to my children, is always been like a safe place for them. They always looked after the children when we needed them too. The children have told me on numerous occasions, daddy why does mummy just sit in her room, listen to music and type on the computer. The children are left alone most of the time to play video games. When they ask mummy if they can do anything with her, most of time she yells at them. The kids also tell me that she forgets where she put stuff; also a lot of the food in the fridge is a spoiled.

Parents of my children’s friends do not let their kids play with mine because a lot of them have witnessed my wife in one of her paranoia states. She asked one the parents if she was bugged and also told her how bad I was and that she felt that I had tampered with answering machine, which she send out to get looked at by the manufacture. So how do you deal with someone in this situation? I have started divorce proceedings and I’m ending the relationship, because I feel I have no other choice. What about my children?

My lawyer tells me I probably won’t get full custody but I should get 50-50 custody. How can I protect my children? How do you talk to someone who will not listen, who won’t get help? I feel alone in this situation. Doctors can’t help me, her family can’t help me, I have talked to everyone I can think of and no one can give me any help. Can you? Please answer, if you can, as soon as possible.

I am sorry for your difficult and complicated situation. I am familiar with a very similar case of a woman with schizophrenia. She and her family have experienced the very same problems and it has been a difficult road for everyone involved. I am not sure exactly how the Canadian mental health system works but in the United States, it is extremely hard to get good quality treatment. I am sorry I cannot offer any specific recommendations for dealing with the Canadian system other than to keep trying to get her help.

You mentioned above that your wife has a very hard time recognizing that she is ill and getting help for her problems. You must understand that this may not be her just deciding or choosing not to get help but instead that she lacks the insight to know she is ill. Approximately fifty percent of people with schizophrenia and bipolar disorder do not take their medications because they do not believe they are ill. Approximately one hundred studies have been conducted on this “lack of insight” phenomenon and consistently report forty to fifty percent of individuals with schizophrenia and bipolar disorder suffer with impaired awareness. The lack of awareness is a biologically based deficit known as agnosognosia. This deficit, or loss of ability to recognize one’s illness, is similar to what those with neurological disorders sometimes experience. There are occasions when people who have had a stroke do not believe their legs do not work despite much evidence to the contrary. Similarly, half of all individuals diagnosed with schizophrenia or bipolar disorder do not recognize they are ill. In these cases, they refuse treatment and will even generate alternative reasons to explain away their condition. According to research, people who lack insight into their illness are not simply denying it to give people a hard time; they truly do not know they are ill. Albeit extremely frustrating, their denial is not a deliberate act. Unfortunately, in America, and I am not sure if this is true in Canada, the mental health system leaves the decision to take medication or accept treatment up the patient, half of whom do not and cannot recognize they are ill.

In the case I am familiar with, the husband also wanted to leave. He especially wanted to leave after spending years of having to involuntary commit his wife to hospitals against her will because of her refusal to take medication. He ultimately did not leave and decided to stick it out with his wife. In this case, after 20 years of her episodes, the family, including the children, now adults, finally banded together and took a hard stand with the mom/wife and demanded that she take her medication. After a few trial and error attempts to force her to take her medication, it finally worked. That was over a year ago and the mother/wife takes her medication every day and has not relapsed. This is quite a remarkable feat given she had relapsed and been hospitalized over 30 times over the years, all due to her refusal to take medication because she did not recognize she was ill. The family worked out a system where they take turns giving her medication; each person assigned a specific day.

The doctors considered her a lost cause, so ill that really no one could help her. But after 20 hard years, the family’s efforts paid off and she is finally on her medication and relapse free. She still does not recognize she is ill, nor will she ever most likely, but she takes her medication that prevents relapses and for the family, that is all that matters.

I tell you this story not to compel you to stay with your wife but just to show you that things can change. It took this family a long time to realize how to help the mother. Had the family been informed by the mental health system about what schizophrenia is and how, as a family, to best help her, it may not have taken this long. It was not until the family learned the best way to help their mother with schizophrenia, and that they were able to help her. The family in this case had three children as well and none developed any type of mental illness. If fact, two of them went on to have careers in mental health.

You are in a tough situation. There are no easy answers. In America especially, it’s often the case that the families abandon their ill family member. In the case I spoke about above, had the family divided and had the husband left, its likely that the mother would be living in a state hospital or even more likely, be living in the streets or jail.

Your wife is your children’s mother and will be forever connected to her children. My suggestion is before you truly consider divorce and dividing the family, read all you can and learn about bipolar disorder. Contact groups like National Alliance for the Mentally Ill (NAMI) (www.nami.org). NAMI is an organization dedicated to helping the caregiver(s) of a mentally ill loved one. If you feel your children are/will be affected, take them to counseling. You can talk to them about their mother as well. NAMI has information about how to talk to your children about their mother. My advice is to learn all you can about your wife’s disorder and don’t give up on your wife until you have tried all that you can. Once you have tried all that you can, then perhaps revisit your divorce plans. That decision however, will ultimately be up to you. I wish you the best of luck and please, if you have any more questions, feel free to write again and I will try to help you the best that I can.