Bolanle is a 32-year-old lawyer whose husband, Akin, was first diagnosed as having 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 up 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 find 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 depression episode.
He subsequently recovered and was doing fine until his final year when he suddenly became full of energy and started 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. The cumulative impact of the two episodes in his penultimate and final year of schooling was that his academic grades dropped from first class and he eventually graduated with a 2.1.
Several close friends of Bolanle and some of her family members counseled 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; he had 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)? Or had an accident and became paralysed? 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-ups, avoiding stressful situations, and a loving and supportive relationship, he could escape having further episodes. Or they could catch warning signs early and report to his doctors for possible dose or medication adjustment, or therapy support. So, she decided to stay with him. Besides she was not keen on dating all over again and hoping she would 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 an oil company that 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 at her. Unfortunately, her worst fears soon came to pass as he suffered a full relapse two weeks later. She was called to the office where he had to be restrained by security men and taken to the staff clinic, as he had started shouting and screaming at the general manager during a board meeting. She did not even want to imagine the implications for his job moving forward. She was only concerned about his getting well. The doctor reassured her that he would be fine, but more problems arose because he stopped taking his medications.
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 are labeled in various ways: ‘not trusting’, ‘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 when things go south and the person suffers a breakdown, they are the ones that will end up sacrificing their time, jobs and everything else to run around and provide full-time care until the victims recover and find their feet again.
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 blood pressure (BP) or blood sugar is well controlled at that moment. Otherwise, they will soon run into trouble when complications arise.
It is against this background that persons with chronic mental disorders should appreciate that if they fail to take their medications and go for regular check-ups simply because they feel fine, they will be inviting another relapse.
Conclusion
It is our hope that everyone with a chronic medical condition such as mental health challenges will abide by the medical advice of their doctors, take their medications regularly and heed the warning alarm bells from their loved ones, even if they don’t feel there is any problem. It never hurts to be too careful.
This is specially dedicated to all the hardworking, self-sacrificing caregivers and families of persons living with a chronic mental condition. You all deserve special plaudits for the painstaking labor of love, on an ongoing basis
