Care-giving burden for persons with mental health problems

BOLANLE is a 32-year-old lawyer whose husband, Akin, was first diagnosed of having a bipolar disorder when they were still undergraduates. They had been dating for the past three years and he had become her rock and pillar. They were simply inseparable. It had started with his becoming reclusive, not picking her calls and locking himself in his room and missing classes. She thought long and hard about whether she had done something to upset him but could not identify anything. She went to confront him after two weeks and she met him crying alone. He couldn’t explain what was happening, but he just felt overwhelmingly tired and sad for no reason. She insisted they go to the university clinic, where he was diagnosed as having a depressive episode.

He subsequently recovered and was doing fine until his final year, when he suddenly became full of energy and was behaving inappropriately and claiming to be very important and rich. She knew something was amiss again and with the support of his friends, they took him to the clinic where his diagnosis was changed to bipolar disorder. Apparently, some individuals suffer alternating episodes of depression and manic episodes, thus fluctuating between the two extremes of mood disorders. Such individuals were described as having bipolar disorder. Thus, Akin was informed in his final year, that his diagnosis was bipolar disorder.

Several close friends of Bolanle and some of her family members counselled her to jilt him and move on, as he is likely to continue having further episodes in the future. Will she be ready to be serving as a caregiver on a continuous basis into an uncertain future? She pondered the situation, but he has always been very good to her and she had no complaints. Should she now abandon him at the first sign of turbulence? What if she became depressed after childbirth (postpartum depression)? Would she be happy for him to divorce her because things had changed?

Indeed, the doctor had explained that with careful management, use of his medications, regular check-up, avoiding stressful situations and a loving and supportive relationship, he can escape having further episodes. Or catch warning signs early and report to his doctors for possible dose or medications adjustment, or therapy support. So, she decided to stay with him. Besides she was not keen to start gambling all over again, with dating and hoping she will find someone she would get along with again. We will make it work together, she resolved. I will do my utmost best to support and be there for him.

They got married immediately after his youth service, as he had served with a oil company which recruited him immediately due to his brilliance and dedication to duty. The first five years of marriage went by in a blur. They were blessed with two boys, and he was doing very well at work. Then she noticed that he had started skipping his medications. When she probed, he would insist he was fine and there was no problem. Then he started sleeping poorly and was becoming irritable, full of energy and quarrelsome. She pleaded with him to take his medications, but he always reacted angrily to her insinuating that he was mad when there was nothing wrong with him. Thus, she had to let him be, while praying that he does not suffer a relapse.

On one occasion, she called his doctor to please speak with him, which the doctor did. But he stormed home that evening and was furious. How dare she do that? Was she trying to humiliate him and make him lose face? He thundered. Unfortunately, her worst fears soon came to pass as he suffered a full relapse two weeks later and she was called to the office where he had to be restrained with security men and taken to the staff clinic, as he had started shouting and screaming at the General Manager during a board meeting.

 

Discussion

The biggest challenge for caregivers of persons with mental disorders is that once they are fine and doing well, they may be in denial and refuse to take their medications or attend their follow-up clinics. If the caregivers try to apply pressure, they may become the enemy, and be labelled in various ways: ‘not trusting me’, ‘implying that I am sick or mad’ and so on. Thus, such caregivers may bear the brunt of their anger, especially when it is clear to the caregivers (parents, siblings or spouses) that something is going wrong.

Yet we know that individuals with chronic medical conditions, such as hypertension, diabetes and some mental disorders need to be on medications for the rest of their lives to remain healthy and to control their symptoms. It would not make sense for someone with hypertension or diabetes to refuse to take medications because their BP or blood sugar is well controlled at that moment. Otherwise, they will soon run into trouble when complications arise.

 

Conclusion

This is especially dedicated to all the hardworking, self-sacrificing caregivers and family of persons living with a chronic mental condition. You all deserve special plaudits for the painstaking labour of love, on an ongoing basis.

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