Wife has serious delusions after mania and refuses medication

[Little]

My wife came out of a manic phase about a week ago. This was only the second manic phase she has had in our marriage of over twenty years. The previous one was over 15 years ago and for the last 15 years, we've led a relatively normal life, with her free from medication.

This time, she was involuntarily hospitalized, which traumatized her and made her incredibly angry. She blames me indirectly for this. Her previous manic phase came after 7 years of psychiatric treatment for depression. She suffered from strong side-effects during this time and from the medication they gave her for mania and this made her become strongly against western medication of all kinds. She doesn't even take Panadol.

So, this time around, she reluctantly took medication while in hospital but has not taken any since leaving. There is zero chance of me convincing her to do so or convince  her that she is ill. In her mind, she is channelling and is on line.

She now does not have mania, but retains very strong delusions that there is an evil organisation out to get her. She believes they are monitoring her flat and around half the city are employed to watch her and trick her, including cleaners and members of the public.

She has zero tendency to self-harm, but she is impossible to live with (we now live apart but see each other daily). Also, it's becoming a problem when she confronts someone sitting next to us in a restaurant in the belief they are a spy sent to watch her. Having said that, she normally leaves when she feels threatened and she isn't a physical threat to anyone. She did leave her flat at 4am this morning to walk the streets because she believed the flat was haunted. She also keeps on throwing her phone away because she thinks she is being tracked.

Forced hospitalization is not an option because that would push her towards self-harm and giving up the will to live. This is one thing she has voiced very clearly. I see our only option at this stage as being me monitoring her while she "rides it out." In her previous manic phase, the delusions eventually disappeared without medication over time, but that was.very tough going

I crash read, 'I am not sick. I don't need help" over the past week, which details how to use LEAP. I've tried this, but am well away from being able to coax her to take medication as a "partner."

Any ideas would be appreciated.

[Croix]

Dear Little~

I'm sorry to hear from your account that your wife's state seems to becoming worse, and she is making far reaching decisions for no valid reason. Together with flying of the  handle I'm wondering if going along with her ideas will be practical in the long term.

I guess you have to consider decisions you make now about treatment could be a source of regret in the years down the track. Do you think the current arrangement will be practical later on or might getting treatment now head off future troubles, even if it means involuntary hospitalization?

Apart trying to work out the best path for your wife I'm glad you are taking sensible decisions and employing an accountant and a lawyer which now your old situation has radically changed is called for.

One think I wanted to mention was my expereice with that family member was that even after treatment and becoming rational the old thoughts before the treatment started were still believed as true, so if for example the delusion someone was plotting against them for a foreign power still seemed real.

The longer this state of mind continues the more false memories may be made (I hope that makes sense)

Croix

[therising]

Hi Little

Things definitely sound like they're getting more out of control, both her and your control. How you appear to her, based on possible involuntary hospitalisation, will depend on her state of mind. While she may initially see you as the 'villian' for having her hospitalised, you may in fact be later seen as her 'saviour' (with thanks to you for saving her from continuing down a deeply concerning and possibly dangerous path). Based on her past experience with hospital based treatment, I can understand your apprehension when it comes to her not suffering through that. Perhaps it's a matter of 1)how treatment's managed and 2)what comes afterwards. For example

• Maybe the question is 'Did all this innocently begin as a form of 'spiritual exploration' or expansion which has led to full psychosis?'. Along with beginning the practice of 'manifestation', could she have been innocently practicing meditating on something like making a more spiritual connection to 'the powers that be'? Could something suddenly have come to mind that sounded like a 'voice' and things full on took off from there? The reason for mentioning this relates to the treatment. For her, in the past, maybe she was making a deeply soulful sense of progress when things went horribly wrong. With the treatment, they may have addressed the psychosis while not helping her return to a far more grounded sense of spirituality (the thing that gave her a sense of connection to life). So, she was left with nothing after the treatment other than a diagnosis of 'psychotic'. The ultimate question becomes 'Could involuntary hospitalisation help her return to reality so that she can safely find a more soulful connection to life?'. At the end of the day, she can't find what she was looking for while she's in this current state of mind. Could hospitalisation be one of the steps in helping her return to what she was initially looking for?

An interesting topic is 'When spiritual emergency leads to psychosis'. I know, another outside the square thing but it actually is a documented thing, believe it or not. Btw, a thoroughly fascinating documentary is 'Crazywise', by Phil Borges. Maybe something worth watching in helping you make a decision.

As I may have mentioned, when it comes to hearing 'voices' we might call them 'the voice of reason', 'the voice of intuition', 'the voice of greater consciousness' or something else. But we call them something, we give them a name. We give them a reference. Without a reference, they are nothing more than a voice in our head that's coming from somewhere, which can be scary and completely disorienting if we've never heard it before. While one may invite and be grateful for the voice of reason, which might sound like 'Do not buy that outfit, you can't afford it. Not while the gas bill's waiting to be paid', another person may fear hearing or be led to delusions by what they have absolutely no reference for.

[Little]

Apologies for my late reply and thank you to The Rising, to Croix and to another contributor who I think also commented. All your comments are incredibly thoughtful and from the heart. 

Dear Croix: Yes, continuation of the status quo was not sustainable as you will read below.

Dear The Rising: Yes, she is the opposite of grounded, no matter how "online" she feels. Her ideas change constantly and she is incredibly impulsive. I actually believe in the power of intuition, but I feel that I her case, she is using this concept as a way of feeling she is in control and she is misinterpreting any idea that crosses her mind as intuition. She may have also created a world with good and evil in order to distract herself from an immense, underlying trauma that she is unable to face. The spiritual ideas we both had been exposed to have some merit, but she has taken them out of context because she needed something strong to focus on as a diversion to her trauma. I could be wrong on this of course.

An update to our situation: A bit over a week ago, after she moved to a second hotel, she suddenly took a flight to Bali (apologies if I already mentioned this). I was able to establish this from the cost of the flight, from earlier conversations with her and after several hours, from her internet bank records. I started looking into going there, etc... Then, the following morning, I had a call from police in Adelaide saying she had flown there, after spending only a few hours in Bali and they had taken her to an emergency mental health centre in Adelaide. She wasn't under any order prior to this, but I understand she had asked for help at the airport concierge. Something must have happened to involve the police and they recognised she needed medical help.

However, she then left the emergency centre without letting anyone know and a mental health order (ITO) was put on her in South Australia. Eventually, she returned to the airport and booked a flight to Perth in the evening. The police ended up taking her in at the airport. 

I flew to Adelaide to see her. Unfortunately, she spent three days in Emergency Dept because the psych wards were full. Then, she was transferred to a mental health centre in the suburbs which is pretty nice indeed. She has been here 6 nights now and the medication has really calmed her down. She still is delusional and still wants to leave soon, but the mania has really subsided. She can go out to smoke and I can take her out for to 4 hrs at a time each day. 

I'm currently flying back and forth every 1-3 days between Melbourne (our home) and Adelaide. The next challenge will be working out living arrangements and how to motivate her to stay on medication after she leaves hospital.

[Croix]

Dear Little~

Your wife can certainly take wild unpredictable actions as a result of her illness, and I"m glad she is temporarily on a ward. I guess the main problems are firstly they have not been able to diminish her delusional state and that she wants to  leave.

Going on expereince with the family member I mentioned who was in a similar ward, it was not the discharge that was an issue, it was stabilization first and then a  6 month compulsory medication order administered by thier GP.  At the end of that time all was well and there has been no reocurrence

I guess talking to her psychiatrist in charge to see what options are available might be best.

What about yourself, how are you managing, and do you have support?

Croix

[therising]

Hi Little

I'm glad things have been taken out of your hands to a degree and there have been other people managing/leading her to the treatment she needs. I feel for you so much regarding the stress you must be experiencing. I'm hoping you are getting the support you need right now and I'm hoping your wife comes to fully realise how blessed she is to have you in her life. You're an amazing person who's been facing so much stress and dread especially. With you knowing where she is, I hope the stress and dread have somewhat lessened for you. 

With an extreme altered state of consciousness (whether that happens through drinking, drugs, psychosis etc), it can be so hard to convince a 'sober' person of how they behaved while they were in that state. They can believe we're making a lot of it up or exaggerating. Sometimes it pays to keep documentation of some type, for their reference, so they can see the serious need to manage staying fully conscious. Perhaps part of that documentation could involve records of the hotel stays, the spending, interaction with authorities, the flight to Bali etc etc. Another part might involve her journaling, having a reference when it comes to where her mind's at (in her words). With the path of medication, might be a bit of a trial and error thing. While she won't want to stay on medication that has depressing side effects, she could end up being happy or content to remain fully conscious while being on something that keeps her grounded yet still living a fulfilling life.

I'm wondering whether there's anyone at the mental health centre (where your wife is) who could recommend resources for guidance counseling for you. They may be able to offer guidance when it comes to how to live separately and how to help your wife manage living separately. Whether the goal for living separately is short term or long term, it may be a matter of getting a feel for that as you go along. When your wife is fully conscious, stating 'I need a trial separation, to see how committed you are to managing your mental health and medication' could be a start. You definitely need a break of some sort, without a doubt. Carer fatigue and burnout are real for someone who cares so much.

[Little]

Thanks guys and apologies for not replying sooner. I believe it has been about a week since my previous update.

Firstly, thank you for asking about me. I don't have any immediate family left in the world, apart from my estranged sister overseas, but I have many friends and friends of my wife asking about me and showing care. You guys are also a godsend. I also am doing an online therapy course, which includes four phone conversations with my therapist and I am discussing with and will be meeting next week a counsellor that has been assigned to me by the Vic health system. A similar counselor for carers from SA also contacted me yesterday. So, I don't feel alone and am very grateful.

Prior to the recent hospitalization, I committed to playing in a new band. This entails weekly practices in Melbourne and gigs 1-2 times a month or more. My wife understands and accepts that I am doing this and has not objected at all. There is a bit of pressure on me now in that my wife is allowed out for four hours a day (in addition to short smoking breaks), but only if I accompany her. So, I am spending at least 4 days a week in Adelaide and the remainder in Melbourne for band work, meetingoi the lawyer, packing up our possessions in the townhouse that we are selling, etc...  I actually am enjoying the increased freedom, but I do need to make more time for sleep.

Thank you for:

"Going on expereince with the family member I mentioned who was in a similar ward, it was not the discharge that was an issue, it was stabilization first and then a  6 month compulsory medication order administered by thier GP.  At the end of that time all was well and there has been no reocurrence."

=> This is really useful to know. I wasn't even aware of compulsory medication orders. Of course, I hope that this time around, me wife will be motivated to take her medication on her own impetus. I think it's possible, because she is progressing somewhat (see below). I also asked that a psychologist/counsellor see her with the long-term aim of working on her motivation to follow the medication plan herself and am grateful that she saw my wife twice last week. Also, her docs are listening to her. They are attempting to reduce her dosage of a synthetic drug and to gradually use a natural drug only that has less side effects and less drowsiness. 

(Continued below)

[Little]

Continued:-

My wife has definitely improved over the past week. She is pretty close to her "normal" self in public. We even went out today with a fellow patient of hers, who is absolutely lovely. My wife no longer cares about the direction we're sitting at the table, about rearranging the items on the table to be numerically acceptable to her, etc... and she no longer is hostile to people in public. She is still delusional: She believes a big "boss man" is pulling the strings of the reality she is experiencing and she believes the Australian Intelligence services are trying to recruit the two of us as spies, etc... She talks constantly about this to me when we are alone. 

Last night, she became extremely angry when she found out she wasn't being discharged yet and her doctor told her she as would remain in hospital for a "while." My wife called me and insisted that I make complaints to the ombudsman, etc...  She believed she was being misdiagnosed and that it was her mercurial personality that they were trying to treat instead of a sickness. I waited a few hours then sent her a message that I drafted with the help of Chat GPT (which has been remarkably helpful). I told her that I wasn't comfortable doing it this time (previously I had made complaints on what I agreed were valid points).

She later indirectly asked me what was stopping them from discharging her. I saw this as a bit of an opening and sent several points to her. Chat GPT helped me to soften the language a little bit. I did not state myself that she was unwell, but focused on her safety, becoming overwhelmed and getting pulled into "something" (a belief system) that feels all-consuming i.e I avoided addressing the belief system itself and focused on the effects on everyday life. I hope the final wording was not too wishy washy, but there's a fine line to walk.

Anyway, I'm not sure if she has read this fully yet, but at least she hasn't reacted angrily. There is definite progress.

A further recent idea of hers is that she wants to remain in Adelaide after being discharged. I know she is yearning for a fresh start after Melbourne. I get that and I agree that Adelaide has much to offer. It's quieter, more peaceful and more laid back. The only downside is that I am not moving here as I enjoy living in Melbourne (that's a boundary of mine) and so in the long-term, I'm unable to be in the carer role for her, regardless of our marital status. That could complicate her discharge. It was giving me some anxiety, but I'm just going to let it run its course for now and trust that things will somehow work out

[Croix]

Dear Little~

I'm afraid this is a long drawn out affair and it sounds like hospital is a good idea at the moment. People who do not believe they are ill may think being in hospital is inappropriate and a miss-diagnosis, trying to appeal to external authorities like the  ombudsman would seem logical from their point of view. In my own family they kept wanting fresh psychiatrists for that reason and also threatened legal action..

My own expereince is that meeting that demand to be out of hospital head on can be counterproductive and you may end up being seen as one of the enemy. So it is a wise move to concentrate on effects as you have done.

Her desire to remain in Adelaide may not last, any more than her overseas trip, it can of course be fueled by her current illogical beliefs. So don't worry about that as yet. It sounds like being in Melbourne is essential for you for valid reasons, so I'd suggest wait and see what happens.

I'm very pleased to hear you are getting support. The whole thing must be very taxing (and expensive) for you.

In SA there are Community Treatment Orders for compulsory medication, and a similar thing in Victoria called Treatment Orders. They are issued for treatment and/or safety and are only issued by nominated persons. As far as I know they do not carry over from SA to Victoria, each state having its own independent provisions (it would bear checking, I'm  no expert).

Croix

[therising]

Hi Little

Congrats on the new band, something that offers you a sense of joy, excitement and self expression. Of course, not entirely liberating as you have so much going on in the back of your mind. I hope it really starts to take off, giving you a solid sense of direction and greater sense of self.

I'm glad to hear you're getting so much support from a lot of different people. I think sometimes we can be thinking 'I've been through this before or something similar' when the truth can be that what we're facing is a first time challenge that may have some resemblance of a past event or past events. What makes it a first time challenge of its kind can involve it being perhaps a little more intense, a little more drawn out, we've got other things or challenges going on in our life that we didn't have before, we can be a little more exhausted, perhaps a little wiser, a little more stressed, having to make new decisions and the list goes on and on. So important to be patient with ourself, kind to ourself and really proud of ourself while managing so many elements we've never faced before. While you're wife is not fully conscious of how unbelievably challenging this time in your life is, she's also not fully aware of how truly blessed she is to have you managing to support her getting back on track. 

I hope everything continues progressing in a way that offers you a developing sense of relief and ease and I hope those around you are able to help you develop an exciting vision that takes you to where you need and want to be in your life. Sometimes it can be so hard to see the way forward. 

[Little]

Thanks Croix. Her doc informally advised me yesterday that she may be leaving in around five days. As of today, her mind is set on Adelaide and I don't think this will.change next week. This is simply because she does not want to return to Melbourne, as she associates it with too many traumatic memories and she has found Adelaide to be acceptable so far. I guess there are a few reasons I don't intend to move from Melbourne. They are:-

1. As you say, her ideas may change at some time and therefore it doesn't make sense for me to plan moving around them. I guess I could plan a short-term move, but then there are also the following factors:-

2. She is sure we are divorcing, as am I (she introduces me to everyone as "my ex."). There is still some tension when we meet and intermittently can start arguing. 

3. Even when I am present with her, she doesn't listen to 90% of the suggestions I make anyway, which is understand given her condition. The only real benefits of my presence are that I can do practical things for her (such as taking her out shopping when I visit her in care), she doesn't feel totally alone and I may learn sooner rather than later of something going wrong than if I wasn't present. Having said that, I wasn't able to stop her wandering the streets in the early hours of the morning, flying to Bali, etc... which were the most dangerous situations so far. The only way to do that would be to stay with her 24hrs like a bodyguard, which is impractical due to our dynamics.

So, I will need to let the docs here and in Melbourne know that she doesn't intend to return to Melbourne and that I won't be present as a full-time or even part-time "carer." I will also tell them that I don't have confidence that she will keep on taking her medication. I have no problem doing this, this time around because I know it's her best chance of avoiding encountering more dangerous situations and going back to hospital. So, a Community Treatment Order is probably a good idea.