Caregiving without Controlling
He’s here today. My husband…is home today and tomorrow and the next day. He works Sunday and then again maybe next Tuesday, but he’s going to be seeing a lot more of home, and the tempting couch, for the next month as the factory has hit its annual slow spell. I’m a little scared.
As I see it, there are four major factors that go into my husband’s mood stability:
- Faithfully taking his meds, and getting into the doctor quickly when he needs a medication or dosage change
- Making healthy sleep habits a priority, not too little and not too much, and being sure to use his CPAP machine for his sleep apnea
- Me taking care of my own mental health and not burdening him with my frustration, anxiety, and stress
- Structure, big time.
As Paul Jones of BipolarBoy.com puts it, everybody has their own flavor of bipolar. No two people with bipolar have the same symptom patterns to the same triggers that resolve with the same meds or lifestyle changes. My husband’s Rapid-Cycling Bipolar Disorder and Attention Deficit Disorder interact in such a way that he cannot function without almost constant activity during the day, and of course, it would be better if the activity was something that didn’t need all of the strength of his stimulant medication to hold his attention.
Without a great deal of structure, he will lay down on the couch and, within a couple hours, cycle into a catatonic depression. It happens so quickly that he is only able to pull himself out of it on his own if he’s able to catch what’s going on within the first hour. Otherwise, we’re looking at a depression that can stretch anywhere from a couple days to a couple months. He tends to lack insight at the first signs of a mood swing, whether going up or down, and even though I’ve been a student of his particular flavor of bipolar for many years now, I don’t always see the early signs myself (I’m a busy mom!), until its too late. So, yes, structure is very, very important – a key proactive approach to keeping him stable.
Which is why the neurons in my brain have started firing at hyper-speed, coming up with activities that will sustain my husband’s interest and keep him stable the next several weeks. There’s also the danger of him flying up into a mania, although less so because of the time of the year; mania’s usually a spring and summer kind of a thing.
I’ve found, through the years, that my job in my husband’s management of his illness really is the management part. I can’t make him take his meds, but I can make sure he goes to the doctor when he needs to, I can do the research on the meds, I can refill his prescriptions on time, I can check that his pill case is packed, and I can make sure his med/mood chart is completed. Same goes with everything: getting to bed on time, wearing his CPAP mask, setting the alarm to get up in the morning and then actually getting up, eating regularly, getting exercise, keeping work schedules on track, monitoring finances, etc. – I don’t do it for him, but I make sure to get everything in place so that he can do it. And I try to not be overly “motherly” about it, either. He doesn’t want a mother, but he also realizes he can’t do it on his own. So, instead of telling him to take his pills, I check the pill case and if the pills are still there, I’ll call him and ask how his day is going, if he feels good despite forgetting his meds this morning? The goal is not to control every aspect of his life but to empower him to take charge.
Same goes with getting structure in his days off from work. He works in a factory where he has specific tasks, needing to be done by a certain deadline, and while there is accountability, he doesn’t have someone hovering over him all day long. To make sure things get done – since with three kids, I cannot do it all! – I mark certain tasks on the calendar to be done on a weekly basis, such as laundry or changing the cat litter or going grocery shopping.
I keep not only a monthly calendar but also transfer each day’s activities and to-do lists to a large dry-erase board. Each person in the family, except for the baby, gets a to-do list; one or two items are denoted that they need to be done today, but the other items can be done as the person feels like it. So everyone can do things at their own pace, but there is the expectation that before someone goes off doing something fun, like fishing or watching football, that the priority items are done before the fun stuff begins. The objective is to provide the structure without the pressure, so the chores are getting done and my husband’s requirement for activity is met, but as stress-free as possible, for everyone involved.
I spent many years resentful of this role that I’ve fallen into. And it showed: Not only was I mean and nasty, but my husband’s moods were all over the place. At some point, with the help from our family therapist, I realized that it was better if I embraced this caregiving role that I was spending so much of my energy and sanity trying to push away. My happiness, my kids’ happiness, and my husband’s stability depended on it.
No matter how well I do this job, as an empowering caregiver, I cannot always help my husband head off his mood swings. Let’s say he’s been off work for three days and his to-do list is done and he’s spent time doing every hobby he can think of, so the only thing that’s left to do is housework he doesn’t like, and it’s a cloudy, cold day. No matter how much encouragement I give him, I will likely not be able to do or suggest anything that will help him stay stable.
At that point, all I can do is hope that this depression will be short-lived and that we’ll see “normal Dad” in a couple days, rather than another six months down the road.
Brhel, R. (2011). Caregiving without Controlling. Psych Central. Retrieved on May 31, 2016, from http://blogs.psychcentral.com/moody-marriage/2011/11/caregiving-without-controlling/