It's a mess again. I'm done again.
- Thread starter Daniel E.
- Start date
I drove to town to get away from him and now I am driving back home to him. I feel like I am screwed no matter what I do.
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David Baxter PhD
Late Founder
Is that because you feel you have nowhere else to go?
No. Now I think my best compromise is to get a job in Phoenix -- two hours away -- in a couple months once his back is better. And then I will be out of the house for 12 hours a day (8 for work and 4 for driving). And then I will have more of a life on my own already if I do decide to leave.
But realistically, I still have my clothes in my SUV in case I decide to leave again today. I am very on edge because I don't see the hope for this relationship.
But realistically, I still have my clothes in my SUV in case I decide to leave again today. I am very on edge because I don't see the hope for this relationship.
David Baxter PhD
Late Founder
It’s no way to live, that’s for sure.
gooblax
MVP
Sorry to hear that his behaviour keeps triggering you @Daniel.
He sees his psychiatrist at the VA today. So I will be going with him since he has very little insight into the "collateral damage," which is mostly him yelling at me. My main complaint will be that -- from what I see -- they just push pills at him and seem to do nothing cognitively or behaviourly to increase his insight. At which point hopefully she will recommend therapy for him.
I just asked my husband if the VA ever told him about a treatment plan or went over coping methods. "Never" is his answer.
David Baxter PhD
Late Founder
Wow.
That's quite sad if true.
That's quite sad if true.
So far, so good with the VA. My husband's relatively new psychiatrist called on Monday after we cancelled his appointment on Friday because of car trouble. She changed his antipsychotic for a different one since he is having more mania than depression. So he will be starting Zyprexa and has come off Latuda. (And if he gets unwanted side effects from Zyprexa, her next plan concerns Geodon.)
When this coronavirus thing is over, she will be seeing the both of us in person. I like her already since she expressed a lot of concern about his yelling. (She even recommended I try cashew milk since it may taste better than other non-dairy milks.)
When this coronavirus thing is over, she will be seeing the both of us in person. I like her already since she expressed a lot of concern about his yelling. (She even recommended I try cashew milk since it may taste better than other non-dairy milks.)
Happy update:
1) Zyprexa is working well for him. (It is like he is back on the lithium as far as I can tell, which he had to stop taking due to being older with kidney issues in his bloodwork.)
2) He has started painting as a new hobby and has signed up to take digital photography courses online.
1) Zyprexa is working well for him. (It is like he is back on the lithium as far as I can tell, which he had to stop taking due to being older with kidney issues in his bloodwork.)
2) He has started painting as a new hobby and has signed up to take digital photography courses online.
Today was a bad day. So much to deal with -- his chronic pain, his other bipolar family members, his bipolar disorder as usual, and my OCD/anxiety and depression. I have been triggered all day long it seems and have been going for walks but they haven't helped much because I come home to him. And I feel stuck because I live too far from Phoenix to do anything but work from home in the future.
He can tolerate a lot more drama/friction/arguing than I can. I scheduled an appointment to see my therapist, but I told my husband our future doesn't look good since I can't take much more of this. He thinks I should just buck up and am over-reacting as usual.
If there was some miracle chill pill that would increase my tolerance level, I could deal with things better. But I feel like I am living in a group home of two mentally-disordered individuals who trigger each other, and this was happening since our marriage began -- way before the quarantine. When I was working full time, we did not get along any better, either.
We get along and then we don't -- and then we cycle again.
He can tolerate a lot more drama/friction/arguing than I can. I scheduled an appointment to see my therapist, but I told my husband our future doesn't look good since I can't take much more of this. He thinks I should just buck up and am over-reacting as usual.
If there was some miracle chill pill that would increase my tolerance level, I could deal with things better. But I feel like I am living in a group home of two mentally-disordered individuals who trigger each other, and this was happening since our marriage began -- way before the quarantine. When I was working full time, we did not get along any better, either.
We get along and then we don't -- and then we cycle again.
David Baxter PhD
Late Founder
Eventually, it comes down to a personal decision about how much tension, strife, conflict, stress, and abuse you want to tolerate, and perhaps more importantly whether you are living a life you want to live indefinitely.
It's never an easy decision to make.
But ultimately you have to trust yourself to make the decision that is best for you and to leave everyone and everything else out of the equation.
It's never an easy decision to make.
But ultimately you have to trust yourself to make the decision that is best for you and to leave everyone and everything else out of the equation.
Partner Coping Strategies
Lowing expectations:
• “It’s hard not to have too many expectations from the person that is closest to you, but you better not have expectations, because when there are expectations you get disappointed quickly.”
• “Sometimes I forget that he is ill and that I might have high expectations—expectations that he will pay attention to everything and make all the efforts, but this is not always possible.”
Focusing on the positive:
• “In moments of crisis you sit with yourself, and you say: “Why did I get into this [relationship]?” But then if you think about what is good, on the positive things, you get new strength. Because we can look on the positive and optimistic things.”
• “You need to find a source of energy to feed you. Because we don’t have a supportive environment, and there isn’t something that will motivate us. So you sit with yourself, and you build positive thoughts.”
Hope:
• “This illness is with her all the time. It’s an illness that is one of the most difficult ones to have. I hope that the scientists and the professors will develop a new medicine that will postpone the illness for a long period, for several years really.”
• “I don’t believe there will be another episode. Not with him on the pills.”
Love:
• “If you love your wife then you won’t leave her no matter what is going on with her, if you love her you won’t leave her. I’m with her until the end … I don’t care anymore if the symptoms will come back.”
• “With all the hardships I realized that I’m really connected to her. With all the lack of logic and the difficulty. You have to be connected spiritually or emotionally, because otherwise it’s very difficult for this marriage to last.”
Patience:
• “You need to be patient. Patience, a smile, these are the tools for coping.”
• “You need a lot of patience, this is the most important thing. It’s hard. You just need to take under consideration that the person is ill and you have be patient. Patience and to accept it.”
Nonreactivity:
• “In temperamental moments, you need to understand that it will pass. You need to restrain yourself and think this is a storm right now, and it will pass.”
• “I need to remind myself once in a while that I don’t have anything to be upset about, because it will pass. When I had moments of crisis, I would say to myself: It will be over, and it will come back to normal, it’s just a little bit more.”
Taking it day by day:
• “I live from day to day.”
• “[When she’s in a manic episode,] it’s basically just getting through the week, week and a half, or whatever it takes till she calms down and recovers and I just get through it the best I can.”
Avoidance:
• “When coping with her illness, I take no time for myself, I had no time to stop and think. It’s is the way I choose to help her.”
• “I don’t deal with the difficulty. I am very busy, on the everyday I forget about it. If I sit alone, it’s
always in my head. At home we don’t talk about the illness at all. I never received any guidance, but I
don’t want any, because there’s no need, I don’t want to get into it again. We are well, he’s taking his
pills, there’s a routine. You don’t need to bring up that issue again.”
Source: Granek et al., "Hold on Tight: Coping Strategies of Persons With Bipolar Disorder and Their Partners" (2018)
Lowing expectations:
• “It’s hard not to have too many expectations from the person that is closest to you, but you better not have expectations, because when there are expectations you get disappointed quickly.”
• “Sometimes I forget that he is ill and that I might have high expectations—expectations that he will pay attention to everything and make all the efforts, but this is not always possible.”
Focusing on the positive:
• “In moments of crisis you sit with yourself, and you say: “Why did I get into this [relationship]?” But then if you think about what is good, on the positive things, you get new strength. Because we can look on the positive and optimistic things.”
• “You need to find a source of energy to feed you. Because we don’t have a supportive environment, and there isn’t something that will motivate us. So you sit with yourself, and you build positive thoughts.”
Hope:
• “This illness is with her all the time. It’s an illness that is one of the most difficult ones to have. I hope that the scientists and the professors will develop a new medicine that will postpone the illness for a long period, for several years really.”
• “I don’t believe there will be another episode. Not with him on the pills.”
Love:
• “If you love your wife then you won’t leave her no matter what is going on with her, if you love her you won’t leave her. I’m with her until the end … I don’t care anymore if the symptoms will come back.”
• “With all the hardships I realized that I’m really connected to her. With all the lack of logic and the difficulty. You have to be connected spiritually or emotionally, because otherwise it’s very difficult for this marriage to last.”
Patience:
• “You need to be patient. Patience, a smile, these are the tools for coping.”
• “You need a lot of patience, this is the most important thing. It’s hard. You just need to take under consideration that the person is ill and you have be patient. Patience and to accept it.”
Nonreactivity:
• “In temperamental moments, you need to understand that it will pass. You need to restrain yourself and think this is a storm right now, and it will pass.”
• “I need to remind myself once in a while that I don’t have anything to be upset about, because it will pass. When I had moments of crisis, I would say to myself: It will be over, and it will come back to normal, it’s just a little bit more.”
Taking it day by day:
• “I live from day to day.”
• “[When she’s in a manic episode,] it’s basically just getting through the week, week and a half, or whatever it takes till she calms down and recovers and I just get through it the best I can.”
Avoidance:
• “When coping with her illness, I take no time for myself, I had no time to stop and think. It’s is the way I choose to help her.”
• “I don’t deal with the difficulty. I am very busy, on the everyday I forget about it. If I sit alone, it’s
always in my head. At home we don’t talk about the illness at all. I never received any guidance, but I
don’t want any, because there’s no need, I don’t want to get into it again. We are well, he’s taking his
pills, there’s a routine. You don’t need to bring up that issue again.”
Source: Granek et al., "Hold on Tight: Coping Strategies of Persons With Bipolar Disorder and Their Partners" (2018)
Decreased empathy response to other people's pain in bipolar disorder: evidence from an event-related potential study
Bipolar disorder (BD) patients often demonstrate poor socialization that may stem from a lower capacity for empathy. We examined the associated neurophysiological abnormalities by comparing event-related potentials (ERP) between 30 BD patients in different states and 23 healthy controls (HCs, matched for age, sex, and education) during a pain empathy task...
Compared to healthy controls (HCs), BD patients have fewer social interactions. Patients with BD also showed impairments in emotion identification regardless of current disease severity, a deficit also present in first-degree relatives, indicating a potential endophenotype for BD. In addition, BD patients with varied disease severity demonstrated deficits in mentalizing. These observations illustrate that BD patients are unable to comprehend and ascribe mental states of others, which could underlie deficits in empathy...
Our study provides preliminary but compelling evidence for a pain empathy deficit in BD patients at the neurophysiological level using ERP recordings during a well validated empathy paradigm. The results showed that late (conscious) and potentially also early (automatic) neural processing stages of pain empathy were impaired and that ACC activity while judging pain in others was reduced in BD patients. In addition, self-reported empathy scores were lower in BD patients than HCs [healthy controls]. Taken together, the present results demonstrate impaired empathy at the neurophysiological level in patients with BD. YMRS scores were negatively correlated with difference waves, providing the first indication that altered pain empathy in BD may be state-dependent. This deficit in empathy may explain the poor interpersonal interactions observed in many BD patients and suggests that BD patients may benefit from psychotherapy targeting empathy.
Bipolar disorder (BD) patients often demonstrate poor socialization that may stem from a lower capacity for empathy. We examined the associated neurophysiological abnormalities by comparing event-related potentials (ERP) between 30 BD patients in different states and 23 healthy controls (HCs, matched for age, sex, and education) during a pain empathy task...
Compared to healthy controls (HCs), BD patients have fewer social interactions. Patients with BD also showed impairments in emotion identification regardless of current disease severity, a deficit also present in first-degree relatives, indicating a potential endophenotype for BD. In addition, BD patients with varied disease severity demonstrated deficits in mentalizing. These observations illustrate that BD patients are unable to comprehend and ascribe mental states of others, which could underlie deficits in empathy...
Our study provides preliminary but compelling evidence for a pain empathy deficit in BD patients at the neurophysiological level using ERP recordings during a well validated empathy paradigm. The results showed that late (conscious) and potentially also early (automatic) neural processing stages of pain empathy were impaired and that ACC activity while judging pain in others was reduced in BD patients. In addition, self-reported empathy scores were lower in BD patients than HCs [healthy controls]. Taken together, the present results demonstrate impaired empathy at the neurophysiological level in patients with BD. YMRS scores were negatively correlated with difference waves, providing the first indication that altered pain empathy in BD may be state-dependent. This deficit in empathy may explain the poor interpersonal interactions observed in many BD patients and suggests that BD patients may benefit from psychotherapy targeting empathy.
The Mentalizing Approach to Psychopathology: State of the Art and Future Directions
May 2020
Summary Points:
1. Mentalizing (or reflective functioning) refers to the highly developed, evolutionarily prewired human capacity to understand the self and others in terms of intentional mental states, such as feelings, desires, wishes, attitudes, and goals.
2. Mentalizing impairments are transdiagnostic and transtheoretical vulnerability factors for psychopathology; temporary or chronic impairments in mentalizing are implicated in a wide range of psychological problems and disorders.
3. Recent formulations have shifted from an emphasis on the role of dyadic attachment in the development of mentalizing in earlier formulations to a broader, socio-communicative approach that emphasizes the role of family, peers, and broader sociocultural factors in the development of mentalizing and the capacity for epistemic trust, the evolutionarily prewired capacity to trust others as sources of social information.
4. A growing body of research supports the (cost-)effectiveness of mentalization-based treatment (MBT)—that is, treatments that focus on the recovery of the capacity for mentalizing and epistemic trust.
5. Although the evidence base for MBT is growing, there is a need for large-scale trials to further investigate the (cost-)effectiveness of MBT, its purported mechanisms of change, and its potential to be implemented in routine clinical care.
6. Similarly, there is a need for more research on the assessment of the various dimensions of mentalizing, which will also enable research concerning the neurobiological bases of mentalizing and associated psychological processes.
May 2020
Summary Points:
1. Mentalizing (or reflective functioning) refers to the highly developed, evolutionarily prewired human capacity to understand the self and others in terms of intentional mental states, such as feelings, desires, wishes, attitudes, and goals.
2. Mentalizing impairments are transdiagnostic and transtheoretical vulnerability factors for psychopathology; temporary or chronic impairments in mentalizing are implicated in a wide range of psychological problems and disorders.
3. Recent formulations have shifted from an emphasis on the role of dyadic attachment in the development of mentalizing in earlier formulations to a broader, socio-communicative approach that emphasizes the role of family, peers, and broader sociocultural factors in the development of mentalizing and the capacity for epistemic trust, the evolutionarily prewired capacity to trust others as sources of social information.
4. A growing body of research supports the (cost-)effectiveness of mentalization-based treatment (MBT)—that is, treatments that focus on the recovery of the capacity for mentalizing and epistemic trust.
5. Although the evidence base for MBT is growing, there is a need for large-scale trials to further investigate the (cost-)effectiveness of MBT, its purported mechanisms of change, and its potential to be implemented in routine clinical care.
6. Similarly, there is a need for more research on the assessment of the various dimensions of mentalizing, which will also enable research concerning the neurobiological bases of mentalizing and associated psychological processes.
"In development and in psychotherapy, mentalizing begets mentalizing, as exemplified by a mentalizing stance that fosters inquisitiveness and curiosity about mental states in oneself and others." ~ Jon G. Allen, Mentalizing in Clinical Practice
What is Mentalizing Why Do It with Jon G. Allen, PhD - YouTube
What is Mentalizing Why Do It with Jon G. Allen, PhD - YouTube
If my husband decides to ride an ATV (all-terrain vehicle) despite my reservations, am I ethically/morally entitled to divorce him if he becomes severely injured and needs round-the-clock care the rest of his life? Doesn't sound like I love him at all that way, but he has a history of having made unilateral decisions with no concern for the effect on me, and it is wearing me out again mentally. He has agreed (for now) not to ride an ATV because of my reservations, including the fact that a volunteer firefighter died in our small town last year from riding one.
It seems telling myself that I can bail out of this marriage at any time is the only way I can cope lately since there is always a new risk he takes on every year or so that I think is just asking for trouble. It seems like a tightrope between me seeming over-controlling and him seeming like someone who favors short term benefits over long term consequences.
The other thing this month is he wants to trim trees again, with him on a 8-foot ladder holding a chainsaw. The last time he did that was six years ago, when he fell and needed rotator cuff surgery. I told him it was a stupid idea back then before he did it. Now he thinks he is invulnerable again since he thinks he will be more careful.
Just having to think about this stuff seems like another reason to bail, though things eventually work themselves out. But it is like a surprise party every so often. Before he always agreed that ATVs were too dangerous. Now he is tempted again because the brother-in-law has one.
I just wish it was more black and white, since there are spouses without bipolar who do even riskier things like race motorcyles. Everything seems so subjective sometimes, with both of us seeming irrational to the other. We just seem too different some of the time.
It seems telling myself that I can bail out of this marriage at any time is the only way I can cope lately since there is always a new risk he takes on every year or so that I think is just asking for trouble. It seems like a tightrope between me seeming over-controlling and him seeming like someone who favors short term benefits over long term consequences.
The other thing this month is he wants to trim trees again, with him on a 8-foot ladder holding a chainsaw. The last time he did that was six years ago, when he fell and needed rotator cuff surgery. I told him it was a stupid idea back then before he did it. Now he thinks he is invulnerable again since he thinks he will be more careful.
Just having to think about this stuff seems like another reason to bail, though things eventually work themselves out. But it is like a surprise party every so often. Before he always agreed that ATVs were too dangerous. Now he is tempted again because the brother-in-law has one.
I just wish it was more black and white, since there are spouses without bipolar who do even riskier things like race motorcyles. Everything seems so subjective sometimes, with both of us seeming irrational to the other. We just seem too different some of the time.
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David Baxter PhD
Late Founder
I don't know what to say, Daniel.
Your husband's behavior is classic bipolar - the anger outbursts (aka bipolar rage), the impulsive behaviors, the risk taking behaviors, the lack of insight (anosognosia)...
The right medication certainly helps a lot of people with bipolar disorder but not all and it can take a lot of trial and error to find the right medication for an individual. And even then, compliance can be an issue since the individual often doesn't believes s/he needs or that the medication makes any difference.
That often makes living with bipolar disorder more difficult for family members than the individual himself.
If you stay, it's something you will probably have to struggle with as long as he lives, unfortunately.
Your husband's behavior is classic bipolar - the anger outbursts (aka bipolar rage), the impulsive behaviors, the risk taking behaviors, the lack of insight (anosognosia)...
The right medication certainly helps a lot of people with bipolar disorder but not all and it can take a lot of trial and error to find the right medication for an individual. And even then, compliance can be an issue since the individual often doesn't believes s/he needs or that the medication makes any difference.
That often makes living with bipolar disorder more difficult for family members than the individual himself.
If you stay, it's something you will probably have to struggle with as long as he lives, unfortunately.
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