Understanding bipolar disorder

I am mourning my husband, Jeff. He’s very much alive. And he hasn’t blown town with a younger woman on his arm. But he is gone.

Jeff was diagnosed with late-onset bipolar disorder a couple years ago. The funny, loving, gentle man I once knew disappeared with the diagnosis. The new man was a stranger to me.

Most people who have bipolar disorder cycle between the depths of depression and the highs of mania. Jeff has primarily experienced the manic form of the condition. When this occurs, it’s often referred to as unipolar mania.

Doctors don’t totally understand what causes bipolar disorder. It’s widely believed that it occurs when chemicals in the brain aren’t working correctly. Stress or trauma may trigger the condition. It also runs in families. Jeff, though, has no known family members with the disorder.

We tend to associate bipolar disorder with younger adults. Most often, it’s first diagnosed in people between the ages of 20 and 40. Late-onset bipolar disorder occurs in people over age 50. Jeff’s symptoms first surfaced after he turned 60, which is even more rare.

It’s hard to pinpoint just when Jeff started displaying symptoms of bipolar disorder. In late 2010, he took early retirement and we moved to a different state — the type of major life changes that may have a role in triggering bipolar disorder.

Throughout 2011, Jeff became increasingly lethargic and began drinking heavily. I grew frustrated with his inability to be social or make even basic decisions, but didn’t recognize that alcohol was the problem. By the summer of 2013, however, we both knew his drinking was out of control. He immediately signed up for an outpatient alcohol treatment program and has not had a drink since.

Initially, sobriety seemed to make a huge difference for the better. Jeff had boundless energy and tons of enthusiasm. He became more social and involved in activities. But he also began to be very self-absorbed. Looking back, the need to be on the go all the time, irrational ideas, and apparent inability to think of anyone but himself may well have been the first signs of mania. The lethargy and drinking also could have been related to bipolar disorder.

In the fall of 2013, Jeff got sick. That September, he had surgery for prostate cancer. The following January, he was struck with what we were to learn was constrictive pericarditis, a serious heart condition. He was critically ill and had several surgeries. He had his last surgery in August of 2014. This surgery removed most of his pericardium and although it greatly relieved his symptoms, he was left with congestive heart failure.

When Jeff was in the thick of this medical chaos in August 2014, he had a period of about a week where, out of the blue, he had strange psychiatric symptoms. He spoke nonsensically, often repeating a phrase over and over again. He created wild scenarios for things he’d do in the future, such as producing a self-massage video that would make him rich.

There was no diagnosis for this episode, though he may well have been experiencing symptoms of psychosis. Psychosis is a mental health condition that occurs in up to 55 percent of people who have bipolar disorder. It was frightening to watch this unfold. Would he come back? The doctors didn’t know.

Although Jeff’s mental health problems were pressing, his physical health was so poor that his heart surgery was scheduled immediately. The surgery was partially successful and relieved his most urgent symptoms. But as Jeff’s physical health improved, his mental well-being was increasingly precarious.

After recuperating from surgery in the summer of 2014, Jeff went into a phase of full-blown mania that continues today. Mania is typically characterized by an elevated mood, hyperactivity, and disorganized behavior.

At first, I enjoyed the manic part of Jeff’s new personality. The introvert I’d known for years was suddenly an extrovert. He was enthusiastic and communicative. He wanted to go places and do things.

But my enjoyment was short-lived. A musician, Jeff began going to music clubs several nights a week. Coming home in the early morning hours, he would be unable to sleep. Many nights, it was common to find all the lights in the house on, candles burning, and the television blaring. The following day, I’d hear how much networking he’d done at the clubs: “I was a smooth-talking schmoozer. Everyone loved me.”

He said he was putting together bands. Despite his braggadocio, Jeff’s speech was revved up and disjointed. He seemed incapable of listening to people or picking up on social cues.

One morning in early 2015, I found a note in the kitchen, telling me he’d gone to Nashville — a 1,000-mile round trip in a car that barely ran, driven by an ill man. I vacillated between anger, frustration, concern, and sometimes, desperation. Nothing I said made any difference. Frankly, it was like dealing with a defiant teenager.

Jeff had always been extremely diligent with money and bill paying. But as he started wheeling and dealing with the band scene, he also began buying musical and stage equipment.

In November of 2015, I learned the house payment hadn’t been made for the last couple of months. That was far from being the only skipped bill. Checks began bouncing, and the insufficient funds fees became astronomical.

Yet the UPS man was at our door almost daily with packages for Jeff. As tension grew between us, Jeff opened a post office box at a local UPS outlet, so I wouldn’t know what he was buying. He spent five hours and hundreds of dollars on one trip to the grocery store alone. Amazon and eBay were his constant companions during his sleepless nights. As often as not, he didn’t remember what he’d ordered.

While Jeff has always been something of a pack rat, I am a neatnik. We juggled this well for many years. But my new husband was a full-blown hoarder, like the ones seen on TV, living in homes filled with mountains of stuff. Purchases and junk began cluttering the house and yard. It eventually reached the rafters in the garage.

He also began “fixing” things around the house. Although this is something he did well before he was ill, it wasn’t anymore. He broke the air conditioner and furnace. Then he attacked the electrical system, knocking out power in one room and the garage. I have no idea why he could no longer do things that had been easy for him in the past. When I offered advice or voiced concerns, he became angry.

When Jeff was working on the electrical system, I found out that he’d put live wires into an extension cord and taped them together with electrical tape. Because the furnace was broken, he bought space heaters — then piled papers up against them. A couple times, I found burners on in the kitchen.

Our home became an obstacle course. Late one afternoon, I walked into a dark hallway, not paying attention to where I was going. Jeff had left a crawlspace access on the floor open. The fall down the hole gave me a nasty gash in my head and a painful, four-part fracture of my humerus, the bone that extends from your elbow to your shoulder.

Our home no longer felt safe. At this point, my children, all living in other states, began to ask me to leave the house. For me, the finances, condition of the home, and concerns about Jeff’s physical health made leaving seem impossible. But staying was no easier.

For me, the heart of my relationship with Jeff had always been the complete trust I had in him. It was also the fact that he always made me feel loved. I was secure in these realities. Bipolar disorder changed this.

Jeff became irritable and angry. It was impossible to reason with him about his difficult behaviors and actions, and I became the bad guy. He was totally self-absorbed and driven. Every conversation quickly became about him. Every day brought more arguments and fighting. Anger and disappointment gave way to hurt and guilt. I began to struggle with anxiety and hopelessness.

On some level, Jeff recognized that he was not well. He agreed to get professional help in the fall of 2015. However, our community had a shortage of psychiatrists and only a couple took Medicare. The waiting list to be seen was two months.

When he finally saw a psychiatrist, in November 2015, Jeff was diagnosed with bipolar disorder and placed on medications. One medication knocked him out, so he refused to take it. Any effort to try different medications in order to find which were most effective for him was hampered by long wait times for appointments. It wasn’t long before Jeff lost interest in getting help and taking medications. As is common in people who have bipolar disorder, the mania was more fun than being medicated. Despite my pleas, he’s still not taking medication and he has yet to see a therapist.

Six months after Jeff walked into the house and announced he’d filed for bankruptcy, we decided to get a legal separation. This would, hopefully, protect my financial record. The separation was final on September 17, 2015, three days before our 20th anniversary. The irony of the date saddens me. Jeff forgot the date.

Early this year, Jeff moved to the West Coast, where his family is. With help from my children, who came in from out of state, I was able to get the mounds of clutter out of the house and the repairs taken care of. I listed the house and it sold quickly.

I now live alone in a southern city, around the corner from my older daughter and her family. My finances are precarious. I’m still reeling from all the chaos and change and sadness from the loss of my husband.

The failure rate for marriages in which one spouse has bipolar disorder is 90 percent. Some people are able to make these marriages work. From speaking with others, it seems that persuading the affected spouse to get psychiatric care and stay on medications is critical.

Jeff and I talk several times a week and text almost daily. I try to keep current with his health issues and encourage him to get the care he needs. I worry that in addition to hours of mania, he now shows the depressive symptoms of bipolar disorder. I’m very concerned about his physical health.

I don’t know what the future holds for Jeff and me. I miss my husband terribly, but I also don’t want to live with the fear and frustration of our last couple of years together. It’s most painful and conflicting when, for a few minutes on the phone, I feel like I’m once again talking with my loving husband, the guy I was married to before he had bipolar disorder.

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