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Aug 27

A Bipolar Couple

coupleThis morning one of the clients we have worked with for several years came in with his wife. It was a surprise that she joined the weekly session. They had just returned from a vacation in Mexico. And neither of them had had any fun on the trip.

When he left for Mexico, he was very mildly hypomanic and, I suspect, stayed that way during the vacation.

His wife has a slight tendency towards depression and anxiety. They both did their very best to be polite and understanding with each other, but the experience was a pretty good example of why it is that significant others are often the ones who are the most upset about hypomania.

In my office, Bob was was noticeably more assertive than he usually is and more talkative as well. However, he remained his usual charming and thoughtful self. He did mention that he had decided to reduce one of his medications on a trial basis a few days ago without talking to me, which is unusual for him. He also noted that on one occasion, he took the very sedating night time dose of medication in the morning by accident with the result that his wife had to handle most of the details of flying from one location to another.

Essentially, the issue was that Bob was being assertive in a way that works fine in a business environment, but was very different from the way he usually is in his relationship with his wife. She was reacting to it with anxiety about the possibility that this might represent the new normal for him (which, by the way, was something that he said he would like to have happen, for he was enjoying this assertiveness).

What I took from it was the observation this change in his behavior was that he was willing to take risks that he would ordinarily never take and which had potentially, a negative effect. For instance, reducing his medications when he was hypomanic and his wife was already upset with him was a very unusual decision for him and seemed at odds with what he has y told me in the past.  He has consistently reported  that his marriage is the most important thing in the world to him.

Meanwhile, his wife was worrying that this was the beginning of a trend (which I can understand, but was also pretty unlikely since he has, unfortunately, had episodes of hypomania and depression and in-between, normal periods, since I have known him and thus it would be very unlikely that he would stay in this hypomanic state indefinitely).

I did find myself sitting there and thinking about the dilemma of being married when one’s mood changes one’s personality so dramatically from time to time, both from the standpoint of the person affected as well as from the standpoint of the partner.

Fortunately,  they have been working with a couples therapist, and I think this will be another opportunity for them to eventually figure out new creative ways of living and adjusting to changes in their marriage.

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