Archives for June, 2011
Most people, including many mental health professionals, shy away from discussing suicidal thoughts with someone who is clearly struggling with life challenges. After all, having someone you love and care about decide to end their own life is devastating. But the reality is that if someone is considering suicide, your talking about it is not going to exacerbate the issue; if anything, the person may be relieved that someone else recognizes their agony. According to Lisa Firestone, Ph.D., a clinical psychologist who studies suicidology, most people who decide to commit suicide have a critical inner voice that berates them relentlessly, making suicide seem like the only viable solution to end the pain. This voice drives people to behave in ways that they might not if they were feeling well. So, while you cannot read the mind of your ill partner, you can observe behavioral warning signs that your partner may be planning to commit suicide. The American Association for Suicidology developed a mnemonic--IS PATH WARM?--to help people recognize the warning signs of suicide. It should be noted that these are not a checklist to determine whether a person will commit suicide--if your partner is exhibiting any of these signs, seek immediate help by calling 911, taking them to the nearest emergency room, or calling The National Suicide Prevention Lifeline: 1-800-273-TALK (8255).
Going out to eat, socializing with friends, participating in after-hours work functions, and maybe attending events at your kid's school are usually all part of being in a healthy relationship. But for some people, instead of the above situations being fun, pleasant events, they invoke terror. Social phobia, also called social anxiety disorder, strikes fear in the hearts of millions of Americans every day. Although women with social phobia statistically outnumber men, it is actually the men who seek treatment for this problem more often. Many people choose not to seek help until the social anxiety causes a major crisis in their lives, which is unfortunate, since social anxiety can be relatively easy to treat with medication and cognitive behavioral therapy. Your partner may have struggled with social anxiety for most of their life, or this may be a new issue that is related to something that has happened recently, such as experiencing a traumatic event or having a significant change in appearance (weight gain or loss, physical changes due to chemotherapy, an obvious injury, scarring, or disfigurement). Either way, it can cause tension in your relationship if you as the healthier partner want to participate in an event that your partner finds uncomfortable.
On Wednesday, Susan Pease Gadoua, LCSW, and an expert on divorce, shared her insights about common questions people who are considering divorcing their mentally ill partner have. Today, she provides advice about preparing to break the news and tips on making a challenging situation a little bit easier on everyone involved. If you missed Part 1, check it out here.
Today I am pleased to bring you an interview with Susan Pease Gadoua, founder and executive director of the Transition Institute of Marin, based in San Rafael, California. Susan is the author of two books: Contemplating Divorce: A Step-by-Step Guide to Deciding Whether to Stay or Go, and Stronger Day by Day: Reflections for Healing and Rebuilding After Divorce. Susan also writes the blog Contemplating Divorce on Psychology Today, and is a contributing writer for The Modern Woman's Divorce Guide, Divorce360.com, and The Huffington Post. Given that the topic of divorce is so sensitive, and that the implications of divorcing a partner who has a mental illness makes the decision and process that much more challenging, I asked Susan to share her thoughts about what partners need to consider if contemplating divorcing an ill partner. Today features Part 1 of the interview; look for Part 2 on Friday.
Your partner didn’t go to work again today, and is still in bed at 5:30 pm, when you get home. Or he forgot to pay the bills. Or she spent way more money than you had in the bank, and now you’ve got a huge credit card bill that can’t be paid. Scenarios like this can happen in relationships that don’t involve mental illness. However, when a partner has a mental illness, these types of scenarios can happen more often, and have a greater impact on the relationship. The first time something like this happens, you may say to yourself that it’s okay—you’ll figure it out. Maybe you say that the second and third times as well. Soon after, though, even the most patient person is probably going to get irritated, angry, or feel some type of unpleasant emotion. Why does this behavior by your partner bother you so much, when you know they have a mental illness? Let’s take a trip down memory lane.
This story may resonate with those who question whether they have a partner with a drinking problem: If you put a frog into a pan of boiling water, it will jump out immediately. But if you put the frog into a pan of water that is the frog's body temperature, and then slowly turn up the heat, the frog will stay in the water--even to the point of boiling alive. Why? Because the frog does not notice the gradual change in temperature. Alcoholism works the same way: as the disease progresses, the "heat" is constantly turned up, but often in such small increments, you don't notice right away. It may start out with excusing unacceptable behavior: Oh, he didn't mean that, he just had too much to drink last night. A few years later, the behaviors have become more and more intolerable, but are now the "norm." Eventually, you end up with chaos in your own home that not that long ago would have been unthinkable. If you looked out the window and saw the same kind of things happening at the neighbor's house, you would probably call 9-1-1!
Pregnancy is an exciting time for couples, and there are many things to think about, plan for, and do to get ready for the new arrival. But for a woman with mental illness, pregnancy also means extra special attention needs to be paid to her illness, as well as to the needs of the fetus. As a supportive partner, you play a major role in this. According to the Stanford School of Medicine, "A common myth states that hormones released during pregnancy protect women from psychiatric disorders and foster a period of emotional well-being. Recent studies, however, have shown that up to 20% of women suffer from mood or anxiety disorders during the gestation and postpartum periods. Whether the symptoms develop at the onset of pregnancy or are a continuation of a previous history, women face a difficult decision about how to manage their illness during pregnancy." How do you ensure that the entire family gets through the pregnancy with everyone doing well at the end?
When your partner has a mental illness, it's likely that they have been prescribed medication to help manage their symptoms. While of course it's up to the patient to take the medication as prescribed, often that is easier said than done. Busy doctors often don't have the time to thoroughly explain what the medication is and does, possible side effects, and when to call for help. Ambivalence about taking meds can play a role as well, especially if relief isn't immediate. In addition, the person taking the meds may not realize that they are being adversely affected, but you--as the attentive partner--may notice something is not right. Conversely, your partner may get frustrated (or feel much better!) and want to stop the meds, but you may have been witness to positive changes because of the meds, so it's important to point that out as well.
For a while now--maybe a few weeks, months, or even years--your partner has been doing well. They take their medications, attend therapy, are employed, and your relationship is going well. The harrowing days when the clouds their illness overshadowed everything in life have long parted and the sun is shining on you and your partner again. The future forecast is for sunny and mild temperatures. Relapse can hit a relationship like a thunderstorm that appears out of nowhere on a summer day, or it can creep in like a cloud cover that precludes a change in weather. Depending on the illness your partner has, they can go from "fine" one day to needing immediate intervention the next (as in the case of alcoholism) or there may be little signs along the way that the illness is seeping back in, which is more typical of illnesses like depression and the bipolar disorders. When someone has a history of mental illness, it is never safe to be complacent. While it is nice to think that during remission, the illness is gone forever and will never cloud your life and relationship again, the reality is that mental illnesses often need lifelong maintenance in order to remain in remission. For some people, that means medications and therapy for the rest of their lives. For others, medication and therapy may not be needed forever, but good self-care--including diet, exercise, and sleep--are essential to preventing relapse. As the partner of someone with mental illness, you are often in the position to be the first person to notice the clouds of relapse on the horizon.
When you have a partner with a mental illness, it's natural to want to do anything you can to ease the stress in your relationship. The problems start to creep in when your helping is actually hurting, and it's because you've crossed the line from "caring" to "codependent." In an earlier post, I talked about the "F-word in mental illness," which is fear. Codependent relationships are built upon fear, and are not healthy for anyone involved. Does this scenario (or some version of it) sound familiar? A female partner may spend most of her attention and time assisting her partner in recovering from drug addiction. She feels a sense of purpose and may appear to be wonderfully self-sacrificing. However, she may also be avoiding her own unhappiness and personal issues -- like her fear of abandonment. Her partner may believe that he can't deal with his addiction without her. He vacillates between feeling grateful for her help and resentful for what he feels is her nagging and smothering behavior. Many co-dependent partners report feeling "let down," "taken advantage of," or "trapped" by their needy partner when they are really "trapped" by their own overwhelming neediness. The addicted partner is also using his complaints about the relationship to avoid dealing with his own neediness and addiction. (Source: Codependent Relationships)