a full psych evaluation and the spouses role

[Anonymous]

Yes DH is not thinking clearly, which is exactly why I personally feel that a doc needs a concise history (preferably one page, two at most) from someone who is not DH.

Since I am telling the truth about my observations, and they go strictly to reporting things said and done, and not interpretations or diagnoses, I cant see how that would harm anything. Eventually they would find the reasons for why I am seeing what I am seeing Right? That is the one thing that I just cant see happening. I mean, them finding the problem, unless they have this other thing to compare notes to.

[Anonymous]

The fact of the matter is that mentally ill people don't self report symptoms well. Its well known and any psych worth seeing knows it too. My husband goes in and tells her all is great when in reality he has been in hypomanic state for weeks, verbally abusive and irritable and hasn't slept well for weeks and hasn't taken the meds she prescribed. Its well known that folks do not comply with medicine. I insisted with Dr I be able to share what I see for me its part of being willing to support stay in teh marriage. If you have a bipolar spouse you will understand.

She seemed surprised when I first called but after talking with my son's psychiatrist, most good docs will welcome family participation with patients agreement.

Get a new doc.

[Anonymous]

Anonymous wrote:Yes DH is not thinking clearly, which is exactly why I personally feel that a doc needs a concise history (preferably one page, two at most) from someone who is not DH.

Since I am telling the truth about my observations, and they go strictly to reporting things said and done, and not interpretations or diagnoses, I cant see how that would harm anything. Eventually they would find the reasons for why I am seeing what I am seeing Right? That is the one thing that I just cant see happening. I mean, them finding the problem, unless they have this other thing to compare notes to.

Here's the problem I see. You write a 2 page letter to a Dr. saying what you observe in DH. Therapist has never met you and never really talked to you. Perhaps because you aren't at that point yet, perhaps because your husband says he doesn't want you at a session and is lying to you about that. Who knows. Anyways, you write the 2 page letter, therapist reads it and says ok. He talks to your DH who denies everything in the letter and is coming across as fine. Then what happens? Does the therapist disregard the fact that your husband appears fine, is talking coherently, and doesn't appear to be in any danger and instead believe the letter he received from someone he's never met, and for all he knows, may have some mental health issues? That's the problem. I'd recommend finding a new therapist and starting from scratch. And YOU set up and appt for the two of you together. Get an established first visit where the issues are laid out on the table. Because no therapist is going to take the word of someone who he has never met over how their patient appears. And that's the problem I think you are running into. I also have a suspicion your husband is not being 100% honest with you

[Anonymous]

DH does not deny that he has gotten in my face and raised his fist. He _has_ told the doctors this, according to him. But they seem to chalk it up to a side effect of the depression and ADD or what have you.

They are kind of acting like its not that big of a deal.

The very good psychi=ologist we used to see together also acted like she sees this all the time.

I have not felt threatened physically in a way beyond just the hurt and outrage at having such a physical gesture made at me by someone who supposedly loves me.

However, I think its kind of a problem that he always blames me for "pusing him" to that point, complete with accusing me of WANTING to do that. That is his assertaion int he moment. Later he seems to realize that is not right. But it does not "stick".

So, unless they know that he says certain things to me both in and out of that moment, they are missing a critical piece of a puzzle.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sorry OP, but unless your husband gives permission or you agree to see a counselor together, you are not allowed to get any information from a Dr. and technically you aren't even supposed to make an appt for him (although a lot of offices will allow you to). It has nothing to do with the therapists. They may have suggested it to your husband, but if he says no, they have to honor what he says. He is the patient.

I think what you need to do is agree to see a therapist together (and you will both be considered patients). Not a marriage therapist though. Just a regular therapist.

PP here. Same with reporting a reaction. Unless your husband was in the hospital and unable to call or email himself, they have to go through him, not you. It's just the law and I'd recommend you read up on it before getting into a huff about it. You can also get a therapist for yourself and then invite your husband to join you at an appt.

This is not true. OP has said that her husband gave permission for 2 way communication with the treatment providers. HIPAA (i.e. health privacy laws) do not necessarily prevent all communication with the family member, and certainly permit more than the narrow communications you describe. Good providers know how to navigate HIPAA to respect the patient and help the patient by involving family members to the maximum extent possible.

Also, your advice about seeing a family therapist is really not helpful, IME. Really the only kind of therapist that is useful, IME, is a clinical psychologist who specializes in therapy with patients with the mental illness OP's husband has. Seeing a "regular" therapist often results in seeing a therapist who is not highly trained in mental illness and does not see a high volume of mentally ill patients and who is not knowledgeable about the importance of/impact of medications on other problems. Often these "regular" therapist mis-characterize problems that are the result of mental illness as something else -- "personality" problems, "denial", irresponsibility, lack of interest in the relationship, etc.

OP, you definitely should be participating in treatment, especially if your DH has given his permission. If the treating providers are not willing to involve you or hear from you even after DH has given permission, then that is a MAJOR red flag that you should be using a different doctor who is more open to family involvement and more skilled at how to accomplish that. All the medical evidence (and there is a lot) shows that family involvement in treatment improves outcomes. There are basically at least 3 major reasons why: 1) family members are often the people closest to the patient who know him/her the best and therefore can identify the earliest signs that something is not right (relapse, initial diagnosis info, med reactions), 2) family members often need psycho-education about the mental illness, treatment and expectations so that they can be supportive, and 3) family members are often the responsible caregivers outside the doctor or hospital facility so they need to know what follow up is necessary.

Here are some links about the importance of family participation in mental health treatment:

http://www.omh.ny.gov/omhweb/planning/hub/consumer/family_flyer.html (this is NY state, but it is a nice summary of WHY family involvement is important and some comments on HIPAA and specifically states that HIPAA does not prevent doctors from receiving info from family members.)

http://www.psychiatry.org/mental-health/more-topics/warning-signs-of-mental-illness -- from the American Psychiatric Association, which recognizes the importance of family involvement.

http://www.apa.org/monitor/2009/10/mental-illness.aspx - from the American Psychological Association

IME, it's basically impossible to "talk" or explain to these family-participation resistant docs why they should change their ways and be more receptive to your participation. IME, it's just easier to find a new doc who is cooperative. Talk with your DH about this. "Interview" at least 3 pdocs who you have researched. You can take part in the beginning and the end of these "interview" visits and leave the middle for your DH to talk alone to the doc. Explain that you and DH want you involved in treatment and want to understand if the doc is open to that and if so, how it can be managed, what kinds of involvement you should have (or not), etc. A doc who can't talk broadly with you about these issues simply isn't experienced enough to manage the illness, IMO.

During the process of finding a new Pdoc, you will come across docs who suggest that you shouldn't be making your husband's appointments, that you are "co-dependent", that you have a control problem, that your participation suggests that your husband isn't open to treatment, etc. Cross these people off your list. They don't get it.

In the meanwhile, I have found that a written note by fax to the office describing the adverse reaction, restating that permission for communication by the husband was given and requesting a call back to you and/or to him, is the way to go. Docs are sensitive to malpractice, and written documentation that shows that an adverse reaction was reported puts the doc in the position of having to respond to someone (but not necessarily you) because it would basically be malpractice to fail to respond.

One thing you should be aware of, OP, it is not uncommon for patients to suffer adverse reactions on psychiatric meds, but these adverse reactions can diminish over time. Of course, that is not a reason to not report or discuss the reaction with the provider, but it is not unusual for a provider to say that some reactions will diminish as the body adjusts to the med and to stay on the med. And, sometimes one has to weigh bad side effects vs. any improvement, and improvement often doesn't begin to show for several weeks. Of course, only the doc can tell what's serious, what might diminish, etc.

If you're feeling frustrated about your ability to participate, can you talk to DH about it? I think for awhile I participated for about 10 minutes every 3rd session or so, with phonecalls/voicemails to the doc on occasion. This was because I talked to my DH and he was OK with it and I just showed up to the appointment with him (basically that or the marriage was over).

Good luck. It is a long process. A doc and meds are no magic bullet, but overall things can get better.

[Anonymous]

OP, get a new psychiatrist. ASAP. Ours takes insurance, welcomes me as a partner any time I want to go along to my husband's appointments, and listens and considers my observations as a valuable tool to help my husband. He's cautious with meds, and knows it's a matter of carefully adjusting dosages and med combinations, and that reactions are highly individual.

Bad reactions, especially rage/hypomania from antidepressants, make for a dangerous situation, and a decent doctor, when informed, should have you change the dosage immediately, not wait until another appointment.

[Anonymous]

If DH needs a psych, I dont think they are going to let me be in on that first session.

Why am I being advised to do exactly that which I am not being encouraged to do by the actual doctors?

Also, please read the post From NAtioal Alliance for the Mentally Ill. I cut and pasted the recommendations straight from their website.

Are they wrong too? I have done NOTHING outside of their recommendations. In fact, it desribes what I have done. I have attempted to be an advocate. I ahve attemtped to get it out into the open what is going on. I have talked with my dauvghter about what is happening.

Now DH says he wants to find a doc on his own. But he is bed asleep. And he has NEVER made ANY of his own doctor appointments. Should i let the 150 just run out and see what happens? I think not. In five days he will be out of wellbutrin 150 and he cant cut the 300mg pills in half as they are XL.

[Anonymous]

You know, OP, if I were you, I'd leave or tell DH he has to get this problem under control or leave. I can't see this improving even if you suddenly find a 'good' doctor.

I'm not sure you can fix what you have described:
"However, I think its kind of a problem that he always blames me for "pusing him" to that point, complete with accusing me of WANTING to do that. That is his assertaion int he moment. Later he seems to realize that is not right. But it does not "stick". "

I think you've got to back away and admit to yourself that you can't solve this person's problems.

[Anonymous]

Anonymous wrote:You know, OP, if I were you, I'd leave or tell DH he has to get this problem under control or leave. I can't see this improving even if you suddenly find a 'good' doctor.

I'm not sure you can fix what you have described:
"However, I think its kind of a problem that he always blames me for "pusing him" to that point, complete with accusing me of WANTING to do that. That is his assertaion int he moment. Later he seems to realize that is not right. But it does not "stick". "

I think you've got to back away and admit to yourself that you can't solve this person's problems.

I'm starting to agree with this poster. I'd give your husband today to make an appt with someone new (but he'll likely still have to follow up with his old doctor if his prescription is running out in 5 days). If he doesn't, say you are going to stay somewhere else for awhile. Be it a family member, a friend, a hotel, whatever. It doesn't seem like, even if you got him an appt, he'd follow through with it. And if I were you, I wouldn't wait around to see what happens when his meds run out.

[Anonymous]

OP, where are you located? I went with DH to see a psychiatrist and he welcomed both of us in, at least for the first session (I did not feel it was necessary after that). This was mostly for ADHD, but also attendant issues with anger and self-perception. The psychiatrist felt it was important that I be there (if DH okay with it) as a loving, concerned partner who has a different perspective on the issues. He's very expensive and not on insurance, but one good thing is that as long as the meds are working okay, he will write a new rx or even tweak it slightly without necessarily making a regular appointment. name is Paul Prunier, chevy chase.

good luck. It sounds as if you are working very hard to try to manage your dh's illness, which can put tremendous stress on you.

[Anonymous]

OP here. I am in Montgomery County.

An unfortunate development: Just today, DH picked a fight with me by bringing up a conflict from a few days ago which began with him making, in front of our daughter, a completely unexpected and inappropriate joke about "not doing mushrooms anymore". This was his "joke" in response to my daughter asking "Daddy, do you listen to Mommy?". Which she asked because she came across the power strip that we had carried up from the basement the day before, which DH had wrapped in a signature way that can potentially damage it, and I lightheartedly had told her, I tell him to not wrap my gear this way, but he cant help himself- this is how he learned to do it". In other words, it was a completely benign concept she was referencing.

I immediately said "Oh shit" in my mind, as in: he is going to be paranoid about that. I tried to deflect with lighthearted questions about what she means, and he seemed to be doing the same. It was first thing in the am and I had not even had my coffee yet. Then DH, blurted out "I dont do Mushrooms anymore." I turned around and just looked at him while cooking the morning eggs, and just looked at him in stunned disbelief while my daughter asked "Do Mushrooms?" and he said "I dont rock-climb anymore" with a little grin on his face while I just stared at him in disbelief not even knowing what to say.

Then I just said "I cant believe your making these jokes"- or something like that WHich started him yelling at me in front of DD while I tried to get away from him. We both in fact went downstairs into the basement with our breakfast. He followed us downstairs and insisted he should be talking about this with me when all I was asking for was a 15 minute break.

This was with him on the double dose wellbutrin. In the analysis that ensued after he finally simmered down, he said he was joking and "I guess we dont see eye to eye". I should add the DH smokes weed, despite my wishing he did not, and while I am ok with it and he claims he told the docs about it (one said he should probably reduce or it might interfere with the medication). But he leaves his stash out sometimes in plain view by mistake and he had been making that mistake alot lately. He apolohozes each time but fails to see that if he keeps doing this, the other person is going to get upset and rightfully so.

So this same person making a drug joke does not see how maybe that really is not the joke to be making for a whole bunch of reasons.

He brought this up today in a belligerent manner, taht the problem wasME that "I clearly thought I could trust you to cover (the joke) for me. Clearly I cant trust you." And that was, Im afraid, the last straw. I told him we are heading for separation. That I cant take this anymore. This treatment of me as always being the problem is something I cannot take anymore.

To which he said "OK". Then "I dont know what I did to deserve you coming to that conclusion".

10 plus years of harsh emotional verbal abuse and other problems. Blaming me for when in fact his meds are being stacked wrong and he is losing ground. Starting fights with me in front of our DD. And he cant see why I have come to this conclusion.

NO, I cannot fix this. Its very sad. The man I married is apparenty completely GONE.

I told him taht as long as I am around him, he wont see what I am talking about. That he should go on the first leg of an out of town contract for 30 days (begins January) and he cna see how he feels without me around. Maybe he will find everything is better for him, maybe he wont. BUt I wont live like THIS any longer.

I have no place to go. We will have to live together while we "separate", which means we take care of our child, we spend time apart. I told him that there will absolutely be NO conversation about ANYthing in front of our child EVER except logistics. He of course quipped "Is that rule just for ME? or is that a rule for us both"? I said I am absolutely resolute that there will absolutely NO discussion of personal matters of any kind in front of DD.

IF he breaks that rule, I will go stay with my dad. LAST thing I want to do, but I will have no other choice.

Im going to stop posting now as its probably pointless. I will reach out to NAMI's forums and see what I can find. If I find something good I will post the link here. So manye people in my position. Tragic.

[Anonymous]

OP, While I totally understand your point of view and your take on things, I suspect the reason they are shutting you out has to due w/confidentiality issues.

[Anonymous]

I don't have any advice but I've encountered similar frustration when dealing with doctors on behalf of my mom who has Alzheimer's. the doctors concerns are about violating privacy regulations. Having her POA and Healthcare proxy helps but not completely. Do you have POA and Healthcare proxy from ur husband? Would he be willing to do that? That could help.

[Anonymous]

OP, I have been in your situation. I would consult with a good lawyer about how to document. You need to disengage and get out, but this guy sounds like he may go for custody. The person you married is not real, that was the facade to reel you in. There is no going back, this is who he is. Be careful.

[Anonymous]

Anonymous wrote:OP, I have been in your situation. I would consult with a good lawyer about how to document. You need to disengage and get out, but this guy sounds like he may go for custody. The person you married is not real, that was the facade to reel you in. There is no going back, this is who he is. Be careful.

OP here.

Not sure that he is actually a narcissist, though. I have known him since he was 16 and I was 13. He has been part of my life for a long time. I think he may have hidden quite a bit about himself before we married, but the real problem now is that I am coming to terms with the fact that lies have been part of the culture of the marriage from the start.

I have not been able to eat properly in several days. I feel sick to my stomach at what I yet will find out. I am truly terrified that you may be right, that in fact he never completely was who he even wanted to be for me. He said some terrible things to me today without seeing that they were terrible things.

I am truly heart and soul sick at the moment.