18 months ago my wife had a nervous breakdown at work. She had psychotherapy and is on meds for anxiety/depression, but has never been able to return to work. Since that time, she has been having conversations with herself, sometimes out loud, usually not, that she subsequently believes to have actually occurred. As a result of which, she acts on the false information. She also has become very absent-minded as a result of the conversations, leaving food out to spoil, driving erratically, etc. She is in denial regarding any mental health issues. Currently, she has told me she can no longer live with me as a result of such conversations because of things I was alleged to have done or not done or things I don’t recall since I was not actually part of the conversation.

A: The denial system in people who struggle with the symptoms can be very powerful and frustrating to those closest to them. It seems as if two things would be warranted. First, psychiatric evaluation of the medicine she’s taking to reevaluate its effectiveness might be important. Secondly, couples therapy where some of your concerns can be entered in front of a third party may be very valuable. Without some insight into her condition the long-term prognosis would not be good. I think these two sources of consultation would be important for both of you at this time.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral