Staying Calm During a Psychiatric Crisis

People often reflect each others’ moods, which is why it’s important to stay calm during a loved one’s psychiatric crisis.

My husband’s psychiatric crisis happened in two parts. There was the initial breakdown and one-week hospitalization, after which he came home for about two weeks. During those two weeks, he started seeing a psychiatrist who—for whatever reason—didn’t believe he’d been psychotic. She told him that he was on the wrong medications, and that she was going to take him off Risperdal and put him onto an antidepressant called Pristiq. A couple of days into this transition, his psychosis took root again.

But the doctor didn’t believe me when I told her what was going on. As John got more and more manic and psychotic, I got more and more panicked. He was calling his co-workers and frightening them with talk of his delusions. I was terrified that he was going to get himself fired, that he was going to ruin his life.

Desperate, I convinced him to call the psychiatrist. At first, she told him that he should go back on the meds the hospital had prescribed, but when he expressed some reservations with this course of action, she told him that she “wasn’t that concerned” about his behavior and explained that he had the right to continue with the Pristiq.

I was horrified, and I let John know it.

Which was a mistake. A big, big mistake.

*****

“You have two options,” I said. “Take the Risperdal, or go back to the hospital with me tonight.”

“I choose the antidepressant.”

“No! That’s not one of the choices.”

“Dr. Black said she wasn’t concerned.”

I wanted to stay calm, but I lost it. I yelled, “Dr. Black has seen you for maybe a total of sixty minutes your entire life, John! I’ve been here with you every day for the last three weeks—”

“Three weeks, Heather?! Three weeks?! Try five years!”

“—and you’re not getting better, you’re getting worse!”

“I need to have a way to vent my frustration!”

“This isn’t normal, John! You need help!”

“The hospital meds don’t help with anxiety! We need to give the antidepressant time to work!”

I was bawling by this point. “Please, John! Please take the medication! I can’t stand here and watch you get worse and worse and worse!”

“So now it comes out, does it? What we’re really talking about: Divorce!”

I had never before in my life been truly dumbfounded, but in that moment, I was stunned speechless. Tears pooled; everything went hazy. Even my lips shook.

“For better or for worse, Heather! In sickness and in health! I meant it when I said it!”

“You need to take the medication!”

His voice suddenly went from being emotional to uninflected: “I’m safe. Those around me are safe. I can breathe but I can’t breathe the water.”

The sense of the floor falling out beneath me. “Please take the Risperdal,” I whispered.

“I’m safe, I’m in control of my own actions. I don’t need an antipsychotic anymore.”

I turned away from him. I wept.

*****

John went into our bedroom and I called my parents. They talked me down off the ledge.

“If he won’t take the medication, he won’t take the medication,” my dad said soberly. “Just remember that he’s your husband and he’s sick; try to stay calm and help him as best you can.”

I hung up. I began to formulate a plan. John was scheduled to attend his outpatient program the next day; I would accompany him to the hospital and try to get the health professionals there on my side.

With a plan in place, I felt better. I stopped crying. I calmed down.

Problem was, John couldn’t calm down. Our fight had done nothing but put him more on edge, and his mind was firing a mile a minute.

That night, he barred me from our bedroom. He took a mirror off the wall and laid it down as an obstacle to prevent me from coming in. He thrashed and talked to himself and broke our laptop computer. He was convinced that our apartment was bugged, that there were security guards outside the door. He didn’t fall asleep until 2:00 or 3:00 am.

Allowing myself to get emotional had only escalated the crisis. The more I had insisted he was unwell, the more defensive he’d become. I’d achieved exactly the opposite of what I’d set out to do.

*****

In a blog post titled “How Do I Convince My Friend to Get Help for Bipolar Disorder,” Natasha Tracy writes, “People are scared to talk about mental illness and everything tends to get emotional before the first word is uttered, but if you’re trying to make Joe come to a realization, you can’t afford that. If you’re emotional, Joe is going to get emotional. That will not help.” I couldn’t agree more.

In the end, what helped John was me calmly and clearly stating what I needed him to do in order to feel safe around him. As Tracy writes, a person “has to see a problem before he sees any value in a solution.” John didn’t have a problem with his strange behavior until I told him that it was making me feel unsafe. In fact, from his perspective, he didn’t believe he was acting strangely (or paranoid or delusional) at all. But knowing that I was not comfortable created a problem for him that he needed to solve.

Fortunately for us, he solved it by checking himself back into the hospital. I don’t think he would have done it, though, if I’d gotten emotional and panicked again.

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4 Responses to Staying Calm During a Psychiatric Crisis

  1. Beth Ansley says:

    I have a 22 year old daughter who has and has not been diagnosed as bi-polar. We are very confused and she is not getting better after at least 5 years of different diagnoses. She is very intelligent and is on a great tract for her future, however about every 2-3 weeks she has a breakdown (crying and total depression) and feels over-whelmed and alone, and feels like nobody cares about her. Other wise she rides very high and is very productive and caring strives to do her best at work, which she has been extremely successful at. One doctor will tell her she is just depressive and prescribe prozac and another will diagnose bi-polar and give her medication that totally wipes her out. HELP!

    • I know it’s been a year since this was posted, but hopefully this might help…

      My husband has bipolar disorder 2 and has been managing it successfully for several years now. There are two important keys to keep in mind to getting that way and I have to give him all the credit for his hard work and research:

      1. Get the right doctor. If the doctor she has is only throwing one medication on top of another without switching them out and not listening to you, you need to find a new doctor who specializes in bipolar disorder.

      2. The most commonly prescribed anti-depressants usually aren’t enough and will often make the situation WORSE because the patient starts to then “rapid cycle”. On one hand this might at least help a bipolar specialist to diagnose it faster, but it’s like riding a roller-coaster without a lap-bar.

      Good luck, and God bless you for being there for her.

      Amy

  2. Hi Beth,

    I’m sorry your daughter is having such a hard time. It can be very confusing when different doctors are telling you different things. I’d recommend finding one doctor you trust and giving him/her time to figure out what’s wrong. Make sure that you can talk to the doctor and provide your perspective on what’s going on with your daughter — a lot of people with bipolar feel good when they’re manic/hypomanic, so they only talk about their depressive symptoms, which can lead to misdiagnosis. So it’s vital that you’re allowed to tell the doctor what you’ve observed of your daughter’s behavior.

    If the first medication doesn’t work, allow the doctor to make adjustments. There are many medications to treat bipolar, so if the first one knocks your daughter out, there are others that the doctor can try. Sometimes it can be a long and frustrating process, but if you have a health care professional you trust who really listens to you, you should eventually be able to find effective treatment.

    Hang in there!

    Heather

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