Dealing with the unsupportive partner . . .

I have had a rash of patients (a gaggle of patients . . . ?) who have had great difficulties with their significant others . . . ok . . . ok . . . all the patients are female and they are referring to their generally bull headed and unsympathetic husbands. I will admit that my slice of time with these women is brief and infrequent (med checks in a managed care market), but the pathology that is described by the patients is clearly biologically psychiatric and the women are suffering. I will give two brief summaries . . .

Ariel is a young lady in her twenties who has a pattern of anxiety symptoms that is very obsessive with some compulsive behavior. She has been treated for Panic Disorder and Depression in the past but went off her meds because she felt well and “didn’t want to need the medicine”. She did well for about 5 months and then had the gradual reoccurance of the primary symptoms (OCD variant) that has created significant panic symptoms and mild depression. This very nice lady was seen by me as a quasi-emergency. The underlying OCD pattern was not picked up by her previous doc, but seems to be at the root of her issues. She is suffering . . . I mean . . . S..U..F..F..E..R..I..N..G . . . with her symptoms. She was in tears in my office describing the anquish she felt about her husband’s inability to understand what she was going through. He was going to be MAD that she came home on medicine. Yet, that medicine has helped greatly in the past and caused no side effects for her (not even sexual side effects . . . the usual reason husbands don’t like medicine).

Another example . . .

Belle has been seen by me for years. She CLEARLY meets criteria for Bipolar Disorder. From my first meeting with her she as been able to see the symptoms, discuss the symptoms, accept her diagnosis . . . but refuses to go on any mood stabilizer. Her severe depressive symptoms led to a trial of Zoloft which has been helpful for both the depression and the PMDD symptoms that she has experienced. Every time she comes in, we discuss mood stabilizers . . . and she refuses. But today was different. Things have gotten worse. She is jumpy . . . she is not sleeping . . . she is impulsive . . . and her level of irrititability is so much worse that she can no longer control herself. She is mean . . . I mean . . . REAL mean (her description). And she is finally able to talk about the options. Most of the options she refuses (standard items such as Depakote, Lithium). She is willing to consider Abilify or Trileptal . . . but her husband will be . . . MAD . . . because . . . SHE SHOULDN’T NEED SOMETHING LIKE THAT!!!

Here is where the “rant and rave” begins . . .

What the heck are these men thinking. These are nice women who are trying desperately to do the right thing . . . to take care of themselves and to treat their husbands and families well. They are trying to manage what are clearly biologically mediated processes and not just being . . . “weak” or “not strong enough” (which is how their husbands are making them feel). Because of this, they must deal not only with their internal pathology, but also their own sense of biological failure, a sense of letting their spouse down, and a growing feeling of inadequacy as a person/spouse/etc.

As a doctor, a psychiatrist, a man, a husband . . . I find this intolerable. I have encouraged both women mentioned above to invite their husbands to the next meeting with me. I encourage all of you out there (man or woman) who have a spouse or significant other who is not sympathetic or cooperative, to get your psychiatrist to invite them in to the session to teach them about what is really going on . . . that mental issues are not about personal inadequacy, but about biology . . . about how you are put together . . . your chemistry. If you are married, you married someone with a specific chemistry. And if that person has a problem, you promised to help them out. You are not allowed to be a miserable tyrant. If you don’t understand, don’t just complain and be negative. Follow through on your vows . . . for better or worse . . . get in there and help out . . . be active . . . be positive . . . be a man.

–Dan Hartman, MD

5 comments to Dealing with the unsupportive partner . . .

  • I’m completely not in this situation. But could part of it be that the men involved here are actually finding it difficult to distinguish between the disorder and the person? Bipolar disorder has its perks. Hypomanics are often fun people to be around (as long as you don’t have any problems you want them to care about). Accepting that the charisma, confidence and spontaneity of the person you love are actually pathological symptoms, that these things aren’t really them at all sounds like it could be difficult.

    And OCD kind of translates to high-maintenance. Obsessive is the flip-side of passionate. Is it possible that the guy who’s with her enjoys looking after her when she’s anxious, that these things are part of the reason he was attracted to her in the first place?

    It would make sense that these men would prefer to find their partner’s inability to deal with the negative sides of their disorders a threat to their relationships. It’s probably easier to think of your partner as weak and not strong enough. After all, that way things can stay the same and you won’t have to accept that you don’t know them anywhere near as well as you thought you did and the thing (or at least a significant part of it) you fell in love with is really a disease.

    Or they could just be ignorant jerks.

  • Chimp-

    Good to hear from you!

    All good points. From my patient’s perspective (only one side of the story, I will admit), they sound like ignorant jerks. BUT, having been an ignorant jerk a few times in my day . . . it is always more complicated than that. The danger from the shrink’s perspective is that the women in question are reluctant to get treatment or remain in appropriate treatment. Education and communication are key here. That is why I invited them in. Hopefully, the men in question will be able to provide a bit more support for their ‘significant other’ if they understand. They don’t have to like the idea of them being on medicine . . . my patients do not like being on the medicine . . . but they cannot get in the way of treatment and thereby promote a pattern of suffering.

    –DH MD

  • Sarah

    My boyfriend of 2 1/2 years chose to leave our relationship recently. After all this time and knowing I am on medication for bipolar and seeing it works amazingly well, he actually cited his reason as ‘apprehensive about the whole mental problem’.
    I give you ‘ignorant jerks’ as your reason for their unsupportive, demanding behaviour. They can’t be babied by their women and they certainly can’t bother babying us!

  • Sarah–
    Maybe it was his inability to deal with the “mental health thing”, but, from what you write, mental health issues were not big component of your life. You took your meds, . . you did well. Why all of a sudden did it make it impossible for him to be a life partner???

    Maybe it had nothing to do with your health issues. Maybe he just got to a point in the relationship where he realized that it wasn’t the “life-relationship” he was looking for. Many men (women, too) use extraneous features of their partner to make an easy out for themselves. It can tragically leave someone feeling inadequate when, really, it wasn’t about them . . . it was about the other person just not wanting to be in that relationship and not knowing how to get out. After all, not everyone is for everyone. Don’t take his “reason” too seriously. If he was being superficial in blaming your health issues as a reason to get out, he is not deep enough for you. If he really COULDN’T deal with your mental health issues . . . double good for you that the relationship ended now. You deserve someone who will be understanding and supportive. It is what being a life partner is all about.

    –DH MD

  • hay

    i have recently been diagnosed with bipolar. my fiance has turned really mean, puts me down and has today told me that he ll cheat and possibly leave me and my 2 kids if my sex drive goes.when i get put on medication. hes been really insulting and not supportive at all. its him that upsets me and constantly accuses me of cheating. i am loyal and i m meant to be planning a wedding for next may. i have a dress and everything organised but cant help but hate him. i dont want him near me now, hes a selfish piece of shit but i somehow feel responsible.