Here are a few important things I have learned from my experience. I don’t pretend to have mastered all of these points, but if you have a mate with a mental illness, perhaps you can benefit from my struggle.
- KNOW YOUR ENEMY! The more I learned about William’s illnesses, the more I was able to understand his behavior. This enabled me to better empathize and become a more positive force in his treatment. Obsessive-compulsive disorder is an anxiety disorder characterized by intrusive thoughts followed by rituals aimed at warding off the anxiety-provoking obsessions. This explained the bizarre sexual thoughts and William’s subsequent, drastic actions. His was a less common form of the disease, which was why his therapist had failed to identify it. William’s hospital psychologist also felt he may have bipolar disorder, more commonly known as manic-depression, which explained the mood swings, as well as social phobia, which explained his extreme fear of criticism or evaluation. Our family therapist also identified some dissociative symptoms — the reason William would seem to “check out” during marital conflicts. Although much of the time it felt like my husband was the enemy, the illness is the true enemy. If your spouse has a mental illness, arm yourself with as much information as possible. A full psychological evaluation is critical. Read books, talk to the doctors, and even take a class if you have time. The more you know, the easier it will be to sort out the illness from the one you love.
- GET THE RIGHT KIND OF TREATMENT. I’ve heard that it takes seven years from the time someone is begins to look for help for their OCD until they find it. Although William had been seeing a therapist for six months prior to his hospitalization, the treatment he was getting was completely useless for his type of disorder. Psychodynamic therapy, rooted in Freud’s theories of conflicting inner impulses and childhood issues, is not an effective treatment for OCD. Cognitive-behavior therapy (CBT) on the other hand, which focuses on thought processes and changing specific behaviors, has a proven track-record for many anxiety disorders. CBT is expensive and sometimes hard to find but well worth it. Also the judicious use of proper medication is essential. William was put on 150 mg of the antidepressant Zoloft, which is also effective for OCD. It may be necessary to make sure your spouse has been stabilized with medication before starting off with CBT. Sometimes it is important to make sure the medications are working before any ‘cold turkey’ can be served!
- DO NOT PARTICIPATE IN YOUR SPOUSE’S ILLNESS! I thought I was being supportive by offering continued reassurances and listening to William’s confessions. However, I later learned that this type of participation only worsened his OCD. I have since heard of many cases where spouses have helped the ill member with his or her irrational rituals. Although it is important to not enable or participate in a ritual it is also important to let them finish their ritual or compulsion with out yelling, “Stop it!” Never say, “Can’t you just quit doing that?” Talk to your mate’s clinician about what your role in the treatment should be. Your behavior can effect your spouse’s recovery for better or for worse. However, don’t fall into the trap of thinking you can cure your mate. The illness is his responsibility.
- REMEMBER, YOU ARE THE HEALTHY ONE! Even months later, William would still question his diagnosis, then at other times he would insist that I had OCD too. When your mate is not thinking clearly, he or she may try to convince you that you are the one with the problem. You may question your own judgment at times. Follow your intuition and stick to your guns. Do not allow your partner’s disordered thinking to effect your self-esteem.
- GET FAMILY COUNSELING. Keeping a family together is hard enough even when neither member has a mental illness. Family counseling has helped our marriage tremendously. Make sure you find someone who also has a good understanding of your partner’s disorder. Having a couples therapist who knows how to do CBT when necessary has really come in handy.
- GET SUPPORT! You can’t do it alone, and you can’t expect your impaired mate to meet all of your emotional needs. Maintain as many friendships as possible. Find a support group for yourself — attend a monthly meeting for family members of people with OCD. This is a great source of education and coping strategies.
- FIND OUTSIDE ACTIVITIES. Because so much of my daily life revolved around my husband’s dysfunction, other activities were critical. Find something that you like to do without your spouse. This will give a needed break and provide you with more energy for the next bout.
- HAVE REALISTIC EXPECTATIONS. Once William was out of the hospital and successfully participating in the UCLA NPI day treatment program, I was so impressed by his improvement that I often forgot that he was still mentally ill. About three weeks after has initial diagnosis I began to miscarry my pregnancy. When I asked him to take me to the doctor I was shocked and hurt when he suggested I go alone because he had so much work to do, even though he had taken a leave of absence for the quarter. In retrospect, I can see how his anxiety impaired his ability to respond appropriately. (At the time, however, I was not so understanding!)
- HELP OTHERS. After several months of attending my family support group I found that I actually had something to offer others who were just beginning on the road to recovery. I was surprised at how good it felt to be useful. I later became involved with the OC and Spectrum Disorders Association (formerly the OC Foundation of California). I frequently correspond with others who are in need of advice and support. Helping others has given some meaning to what is unquestionably the worst experience I have ever endured.
- EXPECT SETBACKS. Although there are many excellent treatments, a relapse can happen at any time. After a year of treatment, William’s psychiatrist weaned him off of medication. Many of his symptoms returned, and he was too embarrassed to tell anyone for almost twelve months. When I found out about it, the shock was almost unbearable. Like many mental disorders, there is no cure for OCD. Accepting that there will be setbacks makes them easier to handle when they occur.
- RECOGNIZE PROGRESS. Especially during times of difficulty, I forget how far we’ve both come. Since William’s initial hospitalization he completed a successful course of difficult CBT and earned a master’s degree in physics. I have a better understanding of his illness, our relationship has improved considerably, and yet I feel more independent than ever before.
It’s been two years since William’s initial diagnosis. The first year was difficult and William’s progress seemed painfully slow at times. Medical bills totaled over seven-thousand dollars after insurance, but the results were well worth it. Despite many ups and downs, William’s functioning has greatly improved. He just passed his first oral exam, and is less than a year away from a Ph.D. He dreams of being a professor.
Though I’m grateful that we’ve made progress and found some good treatments, I reflect soberly on the losses and many unknowns. I lost my husband for over a year and still don’t know who he is much of the time. I’ve lost many of my ‘friends,’ our church, my sanity at times, and even our unborn child. I realize that life has no guarantees, that my husband or children might wrestle with the same demon on another day. I hate the struggle, but I know I’ve come out stronger. Though I don’t have any satisfying answers yet, I turn to God for strength. I try to deal with the problems as they arise, one day at time.