I am sorry for your difficult and complicated situation. I am familiar with a very similar case of a woman with schizophrenia. She and her family have experienced the very same problems and it has been a difficult road for everyone involved. I am not sure exactly how the Canadian mental health system works but in the United States, it is extremely hard to get good quality treatment. I am sorry I cannot offer any specific recommendations for dealing with the Canadian system other than to keep trying to get her help.
You mentioned above that your wife has a very hard time recognizing that she is ill and getting help for her problems. You must understand that this may not be her just deciding or choosing not to get help but instead that she lacks the insight to know she is ill. Approximately fifty percent of people with schizophrenia and bipolar disorder do not take their medications because they do not believe they are ill. Approximately one hundred studies have been conducted on this “lack of insight” phenomenon and consistently report forty to fifty percent of individuals with schizophrenia and bipolar disorder suffer with impaired awareness. The lack of awareness is a biologically based deficit known as agnosognosia. This deficit, or loss of ability to recognize one’s illness, is similar to what those with neurological disorders sometimes experience. There are occasions when people who have had a stroke do not believe their legs do not work despite much evidence to the contrary. Similarly, half of all individuals diagnosed with schizophrenia or bipolar disorder do not recognize they are ill. In these cases, they refuse treatment and will even generate alternative reasons to explain away their condition. According to research, people who lack insight into their illness are not simply denying it to give people a hard time; they truly do not know they are ill. Albeit extremely frustrating, their denial is not a deliberate act. Unfortunately, in America, and I am not sure if this is true in Canada, the mental health system leaves the decision to take medication or accept treatment up the patient, half of whom do not and cannot recognize they are ill.
In the case I am familiar with, the husband also wanted to leave. He especially wanted to leave after spending years of having to involuntary commit his wife to hospitals against her will because of her refusal to take medication. He ultimately did not leave and decided to stick it out with his wife. In this case, after 20 years of her episodes, the family, including the children, now adults, finally banded together and took a hard stand with the mom/wife and demanded that she take her medication. After a few trial and error attempts to force her to take her medication, it finally worked. That was over a year ago and the mother/wife takes her medication every day and has not relapsed. This is quite a remarkable feat given she had relapsed and been hospitalized over 30 times over the years, all due to her refusal to take medication because she did not recognize she was ill. The family worked out a system where they take turns giving her medication; each person assigned a specific day.
The doctors considered her a lost cause, so ill that really no one could help her. But after 20 hard years, the family’s efforts paid off and she is finally on her medication and relapse free. She still does not recognize she is ill, nor will she ever most likely, but she takes her medication that prevents relapses and for the family, that is all that matters.
I tell you this story not to compel you to stay with your wife but just to show you that things can change. It took this family a long time to realize how to help the mother. Had the family been informed by the mental health system about what schizophrenia is and how, as a family, to best help her, it may not have taken this long. It was not until the family learned the best way to help their mother with schizophrenia, and that they were able to help her. The family in this case had three children as well and none developed any type of mental illness. If fact, two of them went on to have careers in mental health.
You are in a tough situation. There are no easy answers. In America especially, it’s often the case that the families abandon their ill family member. In the case I spoke about above, had the family divided and had the husband left, its likely that the mother would be living in a state hospital or even more likely, be living in the streets or jail.
Your wife is your children’s mother and will be forever connected to her children. My suggestion is before you truly consider divorce and dividing the family, read all you can and learn about bipolar disorder. Contact groups like National Alliance for the Mentally Ill (NAMI) (www.nami.org). NAMI is an organization dedicated to helping the caregiver(s) of a mentally ill loved one. If you feel your children are/will be affected, take them to counseling. You can talk to them about their mother as well. NAMI has information about how to talk to your children about their mother. My advice is to learn all you can about your wife’s disorder and don’t give up on your wife until you have tried all that you can. Once you have tried all that you can, then perhaps revisit your divorce plans. That decision however, will ultimately be up to you. I wish you the best of luck and please, if you have any more questions, feel free to write again and I will try to help you the best that I can.
This article has been updated from the original version, which was originally published here on March 28, 2006.