She doubts commitment to bipolar husband

Dear Dr. Camardi:

I am the wife of a manic-depressive patient whose father you take care of in a nursing home. I spoke to you one time about my father-in-law and you seemed to understand him very well. So maybe you could tell me what to do with his son.

I love Jack very much. I take that back. I love Jack very much when he’s “up,” not so much when he’s “down.”

He’s a good guy when he’s up and a lot of fun, and it’s not that he treats me bad when he’s down, it’s just that he just ignores me and everything around him completely.

It’s kinda scary when he gets that way, and he really hates taking his meds because of the way they make him feel and he just likes being “up.” But I don’t know what to do … should I just hang in there and hope it works out or should I just leave and start all over with somebody else?

I feel like I’m just wasting time hanging around him sometimes.

— Richmond

Manic-depression syndrome, also known as bipolar depression, is a complex disease characterized as having wide shifts in the patient’s energy level and mood.

It has been estimated that about 6 million people in this country have this disease. Males are affected as equally as females, and most cases develop from early adolescence through the late teenage years..

In spite of certain stereotypes I have seen , bipolar patients can do well with a dedicated team approach to their care. However, the disease can be labor-intensive for all concerned.

Let’s first recognize that you both have lives to live. It is not all about one or the other — it’s about both of you. And then the question becomes: How best are we to go about living those lives so that they will be fruitful and fulfilling while facing the challenges you outline?

Let me state the obvious — I have not cornered the market on wisdom enough to tell you what to do. I can share with you what I have seen and learned in over three decades of caring for others with this type of condition.

To be fair, what I have seen on a day-to-day level often boils down to a struggle for emotional and sometimes physical survival for both parties. You both are suffering because of this condition.

Over time, it sometimes will make you wonder if it’s all worth it. The result is that some may regret the effort. Others have felt gratified that they “hung in there” as a spouse’s love and support can be the linchpin of recovery and a happy life together. But it takes a deep commitment.

He has to commit to doing the best he can in finding the proper combination of therapeutic approaches to improve his condition and to working with his care team on a regular basis. You have to recognize that there will be many speed bumps along the road and being there for him when he’s “down” is not a walk in the park .

Both of you have to accept a new normal in your unique relationship and share in the process of treatment . This level of commitment is not selective — it’s all or none — but it can be done.

Recognize that you may have gone or will go through emotions ranging from sympathy to frustration to anger . Yet you should tell him how his condition is affecting you in a calm and non-confrontational approach.

I have found it very helpful that during periods of well-being, focus on the positive aspects of what binds you together and do not dwell on the negative events of when he was “unwell.”

Highlight the good times and stay in the moment of the joy you felt together to affirm your relationship. To this end, to learn other coping skills and techniques, I would strongly encourage you to find your own therapist, as you need to be educated about the condition and to realize that it is a disease that needs to be managed like any other disease.

I think it is key that you continue to enjoy your interests and circle of friends and not give up everything. Failure to do this will only add to the burden of negativity. Finally, joining a support group can be very beneficial to allow you to understand that you are not alone.

At the end of the day, I must say that I respect you immensely for openly exploring the path you’re on and appreciate the soul-searching and work you have already put into your relationship. Take it day by day.

Know that I have seen more of these relationships work over than time than fail. I think he knows you are there and what you do and loves you for it in his own way.

And you may find a way to love him that you never thought existed that can open a whole new vista of self understanding. Whatever keeps you together, don’t let it die. Everybody needs somebody else, and you may just need each other more than you know.

Good luck. Keep me posted.

Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.

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