Are you considerate of your spouse
Living with a mentally ill spouse
1. How does the relationship with a psychotic partner differ from a “normal” relationship?
The difference lies on the one hand in the increased sensitivity of the sick partner and on the other hand in the additional burden on the partner or relatives.
Higher sensitivity of the psychotic partner: It can safely be said that people with psychosis are more vulnerable and thin-skinned than healthy people. There is a clear difference in sensitivity between the partners.
We would like to cite the story of the princess and the pea as an example. A prince is looking for a princess to marry. He finds a suitable lady, but is unsure whether it is really a princess. So he decides to test it: He hides a pea under 100 mattresses and lets the princess sleep on it. The next morning the princess complains that she could hardly sleep because she pressed something terribly. From this almost unbelievable sensitivity, the prince realizes that he really is a princess and marries her.
What is interpreted positively in the fairy tale seems difficult in everyday life, because partnership is not only beautiful, but also offers plenty of opportunity for conflict. These conflicts can in turn be stressors that trigger psychosis. How living together with a highly sensitive partner can work is now shown in detail.
Additional burden on relatives: Anyone who lives with a partner with psychosis is about as stressed as a medical student before his first state examination - with the big difference that the student's additional burden disappears after a few weeks, while the additional burden on the relatives or partner persists for months, years or even decades remains (1). However, there are ways that a family member can take to deal properly with this additional burden.
2. Problem areas within the relationship
Areas that can lead to tension are the same for healthy and mentally ill couples: money, sexuality, interests, bringing up children, parents-in-law, loyalty, order.
It is first necessary to be aware of several points:
- There is a difference in sensitivity between the healthy and sick partner, which, if ignored, leads to the fact that one partner is often deeply hurt by the other due to his higher sensitivity or that the “thick-skinned” partner gets the feeling that he is constantly behind the other have to. The two partners should at least know this connection, as this alone can avoid many problems or tolerate them a little more relaxed.
- Medication and psychotherapy can compensate for extreme vulnerability so that the healthy partner no longer has to be disproportionately considerate. They can empower a sick partner to endure normal friction within a relationship.
- A break can occur in the long run if the healthy partner refuses to be considerate, takes a rigid stance or does not take into account the fact that the sick partner may be less capable of conflict.
Agreements in the domestic and family area between the person concerned and their relatives, carers and life partner are one of the most important “supporting pillars” of a successful relationship. The adherence to or breaking of agreements by those affected decides, for example, decisively on whether partnerships last or diverge.
Agreements require the ability to agree. This statement may seem trivial, but the far more common case is that a person concerned makes assurances, but at the time when it comes to redeeming, he no longer stands by his word.
In order to prevent the latter case from occurring in the first place, it is very important to clarify in whom the person concerned has such confidence that he would listen to him even under the influence of a psychosis - even if this person told him that she believed the victim was sick and would advise them to see a doctor. The person of trust can be the partner or another person. The relationship of trust is necessary because agreements, if they are to be kept, presuppose this relationship of trust. With whom the relationship of trust is great enough, the person concerned should definitely determine in a healthy phase.
Example: One day a woman retired to her room on the upper floor of the house. She refused to eat because she feared she was poisoned. She hermetically sealed her room, believing that poison gas was being let into it. The family was completely overwhelmed with this situation and no longer knew what to do. Finally, the woman was admitted to the clinic against her will by the medical officer.
Agreements that are made in a healthy phase can give the healthy partner or relatives more confidence in the crisis. The woman in the example agreed with her family that they should fetch the pastor if she went “crazy” again. She has great confidence in the pastor and would believe him if he carefully taught her that she was sick. If the person concerned determines which person has their trust, this usually means that this person can still reach the person concerned in the crisis.
Perhaps the most important topic for agreements with the sick person is that the person concerned shows his partner, family or other relatives a way to reach him if he denies his illness.
In this context, the important question arises as to why the person concerned denies his illness and whether he really does not notice anything of an impending new psychosis attack. It is wrong, as an outsider, to believe that the person affected does not notice an approaching psychosis flare-up. He notices it very well by registering that something has changed compared to his previous perception - comparable to a deterioration in visual performance, until one day the newspaper reader has to admit that he simply can no longer recognize the letters and the change the eyes now have to compensate with glasses. The reason why those affected usually deny their illness is most often the lack of trust in their environment.
The denial of the disease can be counteracted by the fact that the person affected - as soon as he notices a change in his behavior - at least makes use of the person in whom he has particularly great trust. The person affected should “tip” him in a healthy phase, openly communicate his observation of new symptoms and assure him that he will then consult his doctor. The person concerned will only proceed in this way if he has developed an awareness of the problem - for example by discussing the situation with his partner, relatives or friends in a healthy phase, as it is when he has become psychotic but has no insight into the disease. If this has already been the case, partners or relatives can work with him to consider how to react to such a situation in the future.
4. Dealing with psychotropic drugs
A large group of those affected suffer severely from the symptoms of psychosis and would like medical help. The willingness to take medication is strengthened when the person concerned expresses the desire to do so - triggered by severe psychological stress.
The feeling of being unable to withstand the psychosis is initially the only subjectively obvious reason why the person should take medication. Later on, relationships are broken during the psychosis or things have been done for which the person concerned is ashamed in hindsight.
Example: In psychosis, a woman insulted her neighbors, who until then had always been helpful and maintained a friendly relationship with the sick woman. When she "came to" at the clinic, she said that she wanted to be prevented from doing such things. She is also ready to take medication for this.
There is a risk that the patient will begin to change the prescribed dosage or discontinue the medication entirely. This often triggers a relapse, which in turn proves the doctor right that it would not work without medication. It is therefore an important requirement of the attending physician that he carefully checks the feedback on the tolerability of a drug and also on the subjective rejection of drugs. It must be clear to the doctor that the patient cannot see whether he or she is suffering more from the side effects of the medication than from the disease itself.
In the search for the most individually tolerated drug, the patient may have to try a new drug many times until he has found the right one. The doctor and patient should be patient for this, because only if the dosage is well adjusted will the latter perceive the drug as a help. The fact is that one and the same drug in the same dosage can cause completely different reactions in different patients. Therefore, advice from other sufferers about certain medications and experiences is often helpful, but not necessarily transferable.
The effort of having to search for a long time until the person affected finds the right drug and the right dosage is definitely worth it. In the long term, the medication not only affects acute psychotic symptoms, but also balances out the strong vulnerability - which can be very debilitating in everyday life.
The partner can support the sick person in the following ways:
- He asks those affected how the medication works and whether the side effects are tolerable.
- If the side effects are unbearable, he accompanies his sick partner to the doctor.
- He encourages his sick partner to report all observations about the side effects to the doctor, since only then does the doctor get the chance to change the drug or adjust the dosage better.
5. Therapeutic accompaniment
If a psychosis has occurred in a partnership, it makes sense to check the relationship for conflicts, for example in couples therapy. The therapist will then, for example, also ask the healthy partner what he would have to do to ensure that his sick partner gets psychosis again. This interesting question will trigger a thought process in the healthy partner in which he also questions his own behavior.
A psychosis can cause deep mutual injuries, which then lead to a breach of trust, a decline in love and ultimately to separation. The psychotic partner can do or say things that deeply hurt or anger his healthy partner, such as when he squandered family wealth in a mania.
At the same time, however, the healthy partner has the feeling that he shouldn't be angry because his partner is sick. He feels hurt, but doesn't know what to do with the feeling because the sick person cannot be held accountable.
Likewise, the healthy partner can also injure his sick partner in the psychosis by possibly having him admitted to a clinic against his will or by handling psychotic content inappropriately.
In no case should it happen that the feeling of hurt is suppressed and covered over. The fact is that the partnership has broken and that is what both partners have to deal with.
These points can be the subject of couples therapy in which the partners try to process what happened in the psychosis. But individual psychotherapy is also important because the person affected can experience it as a great help in everyday life: He has the opportunity to discuss difficulties and conflicts and to review his coping strategies.
Psychosis affects all areas of partnership, including sexuality. The need for sexuality can be immeasurably increased through the psychosis, but it can also be completely lost. The perceptions are distorted or overlaid with delusional ideas. For example, if a woman sees her husband as a devil, with horns and a horse's foot, she will find it very frightening when the devil wants to sleep with her. Some people who have experienced psychosis report that they have had an orgasm just from erotic thoughts. Others experience their heightened sexual sensitivity as the sexual manipulation of forces outside of themselves. They sometimes report that torturous experiments and manipulations were carried out on them.
How should the healthy partner deal with this situation? It is important that he first takes back his own needs towards his sick partner. In the case of psychosis, the initiative for sexual activity should always come from the sick partner. Under no circumstances may the healthy partner sexually harass the sick person or exploit a certain weakness of the sick partner for his needs. A sick woman in particular can find it difficult to say “no”. If her lack of contradiction is then exploited, the sexuality she experiences is by no means something voluntary, even if she apparently joins in without resistance. Basically, it's more of a rape.
7. Children and family planning
For many couples the question arises as they live together whether they want to have children or not. Then the question of whether the disease can be inherited by the couple is important. Even psychotically ill people want to be taken seriously with questions about family planning and not be fobbed off with answers such as “Be glad you don't have any children”.
If the couple asks themselves the following key questions, this can help:
- Can the partner with psychosis deal with his illness in such a way that he has it largely under control, or does it attack him like a fate? If the disease hovers over the person affected like the sword of Damocles and he does not have it under control, the situation is already very stressful and it would be advisable not to have children. First of all, the person affected should try to take self-help measures - such as dealing with early warning signs - to get their illness under control so that they can deal with it. Knowing the connections about early warning signs is extremely important, as correct behavior can prevent a new outbreak of psychosis under certain conditions. More details on this are described in the authors' book (see below).
- Who is fully there for the children if the parent with psychosis is absent? The healthy partner is required here. Can he care for the children alone if the sick partner is absent? Children should not suddenly be brought into a new, unfamiliar environment or be cared for by completely strangers due to the crisis of their caring parent.
- Children are not always just a joy, they are also a great burden, especially for parents with psychosis. Who supports the parent with psychosis when the children are sick, when there are sleepless nights, when there are other difficulties?
It is precisely for this last reason that a woman with psychosis should not have children if she does not have a partner. The situation of a single mother - especially when the children are small - is very stressful. A single mother with psychosis should urgently have someone, perhaps her own parents, available to take the pressure off her.
Basically, there is no simple answer to family planning for mentally ill people. Parents should also be aware of the risk of having a mentally ill child, and then consider with a clear head whether or not they want to take it. The decision to go through life without children can also be a responsible decision. Under no circumstances, however, should a mentally ill child be viewed as an “unworthy life” to be avoided at all costs.
8. Speaking after the crisis
When a psychotic crisis is over and the person comes home from the clinic, the partners and families try to get back to everyday life. The time of psychosis caused a lot of chaos, extreme emotions and injuries.
One often experiences that those involved forget everything and want to start over. This is understandable, but speaking is very important after the crisis: After the psychosis, the partners should take time to remember what has been all together. They should share with each other how they experienced the events from their different perspectives and what difficulties they had with each other.This gives both partners the chance to correct their behavior for any further crises.
The following important questions should be clarified in joint discussions between the partners after the crisis:
- What are the requirements for hospital admission?
- Does the affected person definitely not want to go to the closed ward?
- In which situations in the clinic (e.g. restraint, drug side effects) should the healthy partner intervene?
- How often and for how long and by whom does the person concerned want to be visited in the clinic?
- Should the healthy partner have contact with the attending physician?
- How should the healthy partner react to psychotic content?
- Which behavior of the healthy partner helps the person affected?
- What behavior should the healthy partner avoid?
- Who will take care of the kids, pets and flowers?
- How should the partner prevent harmful behavior of the person concerned (e.g. behavior that is harmful to oneself or others, disturbance of the peace, aggressiveness)?
These agreements give both partners security. They are one of the most important “supporting pillars” for the partnership. The healthy partner will no longer feel so powerless and helpless in the face of a psychosis, but with these agreements he has action strategies ready, which he knows are also in the interests of his partner. In this way, the sick partner also knows that in the event of a psychosis, things will happen the way they want them to.
Often it also turns out that the healthy partner has many questions about the understanding of psychosis and that it is of great help to him if his affected partner talks to him about this in a healthy phase.
9. Positive behaviors of the partner and relatives
The following behaviors by the partner and relatives have proven particularly effective:
- Do not criticize the patient, because criticism can dramatically worsen the symptoms and (in extreme cases) cause unpredictable actions. Example: A father told his daughter with psychosis that she was too fat. The daughter then committed suicide. Even if the effects are not always as extreme as in this example, criticizing the patient is one of the most common mistakes made by partners, relatives and relatives, as it is difficult for them to understand the person affected. You should always keep in mind that the person affected is more burdened by criticism than it initially looks.
- Do not “tug” the sick person (this is often difficult for parents to do when their children are sick).
- Have supportive medication taken.
- Let the patient live out his impulses to a large extent. Example: A victim wanted to make tea at two o'clock in the morning, which was rejected by relatives because of the unusual time. The woman later reported that she was bitterly cold due to the effects of the medication and that she wanted to warm up with the tea. Therefore, relatives should tolerate such “unusual” behavior.
- If the patient's behavior is disturbing, convey this to him as an “I-message”. Example: “I feel disturbed when you turn up the stereo system so loud” - not against it: “Turn the music down immediately!”
- Maintain social contacts (visit a doctor, accompany the patient as much as possible, and invite friends).
The following behaviors have proven to be effective when the partner handles the additional workload correctly:
- Maintain your own hobbies even during the illness phase. These are an important source of strength for a healthy partner.
It is important, for example, to inform the person concerned about the time of their return from sport and to ask them whether they can hold out on their own for so long. The time must then also be adhered to precisely, because the absence of the partner means stress for the person concerned. This stress can be withstood by the person concerned over a previously agreed time frame, but if the time frame is exceeded it quickly becomes unbearable for the person concerned. If the partner is late only once, the relationship of trust is destroyed.
- Pay attention to the alarm signs of overload in yourself: The thoughts are often, sometimes too often with the sick partner - this can lead to very dangerous situations, e.g. in traffic. It is necessary to anticipate this beforehand and to adjust your own behavior accordingly.
- Deal with your own fear (possibly with the help of a group of relatives that exists in every major city).
Further tips are described in the authors' book.
(1) Oral information on the occasion of a lecture by Dr. med. Michael Franz on March 9th, 2002 in Hofgeismar.
- Beitler, H. u. H., Psychosis and Partnership, Bonn, Psychiatrie-Verlag, 2000
- Dachverband psychosozialer Hilfsvereinigungen e.V., Thomas-Mann-Straße 49a, 53111 Bonn, If your mother or father needs psychiatric treatment, brochure for children between 8 and 12 years
- Dachverband psychosozialer Hilfsvereinigungen e.V., Thomas-Mann-Straße 49a, 53111 Bonn, If your mother or father has psychological problems, brochure for young people between 12 and 18 years of age
- Dachverband psychosozialer Hilfsvereinigungen e.V., Thomas-Mann-Straße 49a, 53111 Bonn, If a mother or a father has psychological problems ... how are the children? Brochure for concerned parents
- Knuf, A., Gartelmann, A., Before the voices come back, Bonn, Psychiatrie-Verlag, 1997
- Mattejat, F., Lisofsky, B., Not from bad parents, Bonn, Psychiatrie-Verlag, 1998
Helene Beitler, born in 1959, studied philosophy, social work, free graphics and painting. She is a member of the Federal Association of Experienced Psychiatrists and has experienced a total of five psychotic episodes since 1987. Married to Hubert Beitler since 1981. They have two sons, the older of whom is also experienced in psychosis.
Hubert Beitler, born 1954, active as Dipl.-Ing. in the car development of a well-known automotive company. Together with his wife he is the author of the book "Psychose und Partnerschaft", Psychiatrie-Verlag, Bonn 2000. Together they run an offensive
Public relations work in the form of lectures and seminars.
Created on May 16, 2003, last changed on March 15, 2010
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