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My wife too had a major breakdown almost 18 years after our marriage. We also have two boys, who were even younger than your children at that time. There were times when I thought we couldn’t make it as a family but we survived.

Here is my story and suggestions for you:

1. You need to get involved in your wife’s treatment. Do not depend on doctors to make unilateral decisions. The vast majority of psychiatrists simply push pills. They meet the patient for 15 minutes and make a snap decision about what adjustments to make to medicines. Furthermore, they rarely engage in “talk therapy”, even though their own standards strongly suggest that medicines should be coupled with “talk therapy”. The biggest problem in serious mental illness is “compliance”. This is where “talk therapy” can make a big difference.

2. Initially, I thought that the illness came out of the blue. However, looking deeper it became apparent that we were oblivious to something that was all around us! For one thing my wife’s sisters were also affected. They all lacked friends and had severe trust issues. It turned out that they had grown up in an environment of extreme misogyny. They had been victims of incest and child abuse that went on for many years, suffered domestic violence and neglect. To top it all, the family was politically prominent, deeply religious, and it had been drilled into the children that they were a perfect family. Talk therapy helped in one important way – the counselor never allowed her to minimize or to rationalize what happened to her. The resulting honesty made her open to changes that took many years and that continue to this day. I think that it also helped in compliance. By the way, talk therapy is useless when the patient is already psychotic. So medicines are essential for restoring a degree of sanity and only then does talk therapy become useful.

3. Please note that Haldol is one of the older antipsychotic medicines. I am surprised that your doctor even prescribed Haldol. It is an older medicine and, I think, more prone to Tardive Dyskinesia. There are a number of newer drugs called ‘atypical antipsychotics’. The most popular is Olanzapine (US trade name – Zyprexa). There are a number of others also – Geodon, Seroquel, Clozapine etc. For us, Zyprexa was a miracle drug. In fact it worked so well that my wife would then want to stop taking it once she was functional. So, she would go to the doctor, dress nicely, act normal, and hide any negative thoughts that still lingered. The doctor would be convinced (remember he is deciding based on a 15 minutes of observation) and he would take her off the medicine. And then slowly the paranoia would rise and the cycle would repeat. A big cultural problem is that most psychiatrists (and the general population) believe that these medicines are bad. So, they are ready to oblige as soon as the patient asks to discontinue them. Ask yourself: Does the fear of future neurological harm (for which there is no evidence) outweigh the loss of the joy of life that she is experiencing now and the harm that is being inflicted on your children at such a critical time of their growth?

4. You cannot force your spouse to take medicines. However, you can make it clear to them that if they stop taking their medicines you will leave them. Even though it is not their fault that they are suffering from this illness, they are still responsible for complying with treatment. Be prepared to follow through if necessary. Every time my wife suffered a breakdown and her paranoia returned, I was terrified that one day her paranoia would be directed at me and then she would stop listening to me. I was the last line of defense (her family washed their hands and denied everything) and I knew that once she stopped trusting me, she was doomed and our marriage was doomed. I was lucky that that day never came and it made me more determined to see that her medicines weren’t discontinued. The conflicts about taking medicine are some of my most painful memories.

5. Your children are going to be affected - whether you leave your wife or stay with her. It is a no win situation. I choose to stay and to work to minimize the damage. I succeeded to some extent. Financially, I was lucky to achieve success early. Money was a life saver for us because I was able to leave my job and stay home for several years. By the way, even that affected my boys because we were very conscious that our children should not grow up in an environment of affluence. Some of my wife’s nieces and nephews had terrible childhoods because their sick mothers were violent and paranoid. So, the decision to stay or leave is an individual one. It is possible that leaving her may well be a way to save you and your children from greater damage.

6. I am going to suggest something that some will find controversial: Do not hide the illness from family or friends or even from society. By taking it underground we make it easier to deny and harder to treat. Being open about it will also ease the pain of others who might walk on this road someday. If you think that this will isolate your from society, chances are that as a family you are already isolated from social interaction because of her illness. On the other hand, going public might help you find support from others who have faced similar problems. Now let me also add that I did not fully follow my own advice and only now have I begun opening up. It is also easier for me now, because my children have grown up, there is greater awareness of these issues and there is unlikely to be an impact as the prominence of her family has also faded over time.

7. We have a pretty good life now. Our children have left home. My wife still takes her medicine. It is the smallest recommended dose but we intend to keep it going for the foreseeable future. She is active and full of life. I am also busy working and enjoy learning all the new things that I had not been able to dabble in when I was mired in family issues. Our story isn’t over and I don’t know what life holds for us, but I do intend to enjoy the good place we are in now.
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