Depression is no longer the swear word it once was, but there are still thousands of people suffering from depression - and many do not receive any treatment. The same applies to other mental disorders, such as bipolar disorder.
Thousands of sufferers struggle every day with the devastating symptoms of the disorder. The people that suffer the most however, but about whom little is ever said - and even less done - are the sufferers' partners.
They endure a daily struggle just to keep their heads above water, and often need as much help as the sufferer himself.
Depression - the basis
Claire Newton, a psychologist, explained that there is a difference between feeling depressed under expected circumstances - such as after the death of a loved one - and biogenic depression.
The latter is caused by a chemical imbalance in the brain, and can be long term as well as recurring. It is a chronic illness, and not something which a person can get over on their own.
She says there are still many people who do not recognise depression as a disease. As a result, many sufferers don't receive any treatment. Some sufferers use alcohol or other drugs, and even consider suicide.
"It makes life for themselves and those around them very miserable."
According to research by the South African Medical Research Council (MRC), South Africa - in comparison with 14 other countries - has the second highest incidence of drug abuse, the sixth highest incidence of anxiety disorders, and the seventh highest incidence of mental disorders. Only 15.4% of people with disorders receive treatment.
With this statistic in mind, one can conclude that there are alarming numbers of secondary victims (partners).
A woman's struggle
[Please note that while most of the article is about depression, this case study is about a woman whose husband suffers from Bipolar Disorder.]
Nina Mensing * is a secondary victim. She told us that she and her husband met at school and that they started dating when she was 16 and he was 17.
"He had his first manic episode when he was 15 years old. I heard about it and also heard that he had been diagnosed with Bipolar 1 disorder (more manic than depressed). We have been married 13 years now.
"A mental illness has an enormous impact on individuals who are diagnosed with it, but few people realise how big the impact is on that person's family. There are numerous books, support groups and medical journals for the sufferers, but the disease manifests itself at home and there is no diagnosis and no pills for us," said Nina.
She said the months prior to a manic episode were so traumatic that she sometimes could not wait for her husband to become psychotic, so that he could be admitted [into the care of an institution]. "When I said 'in sickness and in health', I thought it involved giving him a painkiller every now and then, and supporting him after an incident. I never thought I would have to look at my husband's wild eyes staring at me from behind bars while he was sitting in an institution."
Nina tells how it affected their relationship: "A mental illness does strange things to a relationship – it tears you apart with such force that, after an episode, it takes years to trust each other again. The constant emotional and verbal abuse during a manic episode is very bad.
"I tried as a wife and mother to keep the household running and to bring home a salary to pay the accounts. I prepared meals, attended the children's school activities and did what I could, but during his episodes, I could not do anything right. Then I was his biggest enemy and it was my fault that he was suffering. The reproach was unceasing. I had to fight against doubting myself. I learned to hear but not listen, but the harassment (not physical) cut to the bone.
"After such an episode, I suffered from depression myself. I am currently on medication, and receive psychological treatment. No one can escape becoming down.
"Between episodes, he was a normal, loving and humorous man and father. During an episode however, although everyone told me it was the bipolar that was talking, I struggled to carry on loving him, knowing that it could happen again.
"As my children grew older, they also began suffering severely as a result of their father's illness. My oldest has been begging me to send his father away.
"Their father had episodes that sometimes made their lives incredibly difficult. At these times, they tried - as far as possible - to avoid him. During a depressive episode, he was very irritable and insisted that he be left to spend the day sleeping in peace. At such times, he did not eat with us, and if he did the atmosphere was loaded.
"I blamed him for it, because he chose not to take his medication and take responsibility for his condition. It is a disorder that can be treated, but he said he would fight it himself."
After 19 years of ups and downs, expensive psychiatric visits, stress and uncertainty, Nina told her husband he had to choose between divorce or taking medication.
After two years on medication, the change in his character is nothing short of a miracle.
"The wonderful man I loved has come out of hiding, and it was worth the wait. Things are not always easy, but there is hope," says Nina.
(Nina has written a book about her experience. A Manic Marriage is to be published this month.)
What about the supporters?
Dave Turo-Shields is an author, university faculty member, success coach and psychotherapist. He said that if one party is depressed, the chances are nine times greater that the marriage will end in divorce.
He said in a normal relationship, there is a normal flow of give and take. In a case where one party is depressed - for example the man - the woman usually takes over all the tasks that would normally fall on him. Depending on how long the situation persists, it may just become too much for her.
It can also lead to the partner blaming the depressed person, and feeling less sympathy towards them. Many women have said that it would have been easier to separate, because living with a person suffering from depression is like being a single parent with a special needs child - as well as having to bear all the other responsibilities.
Dave confirmed that supporters often develop depression themselves.
"If a person constantly lives in a heavy, depressive atmosphere, they learn depression. As a parent, you set an example to your children about how to act, and if it is depression that they are exposed to, they can also develop depression. "
Dave said it was very important to remember that it is the depression (or other mental disorder) that is the enemy, and not your partner. It is not always easy, but it is necessary to maintain this perspective.
If the depression lasts a long time, it should be treated, but the relationship should also be given urgent attention.
He suggested that the supporter empower herself by obtaining as much information as possible about her partner's condition.
Leslie Zeigler, a clinical social worker/therapist in New York, said it is very important for a supporter to realise her "love" alone is not enough to take the pain away from her partner. She emphasised that it is important to be patient and supportive, but that it should never be at the expense of the supporter's own needs.
She gives the following tips so that the supporter can care for herself and her health:
- Try to maintain your own daily routine.
- Give yourself some "me" time and also a few treats. If your partner does not feel like going to a movie, be accepting and loving, but go alone or invite a friend.
- If your partner is not in therapy, encourage him to go for treatment.
- If your partner wants to cancel a holiday, for example, try to still go - even if you have to go alone.
- Find something to do outside your normal routine, such as art classes.
- Understand that your emotions can range from love, compassion and understanding to feelings of helplessness, hopelessness, impatience, irritation, loneliness and anger.
- Acknowledge how you feel, but do not judge yourself.
- Allow your partner to recover in his own time - with treatment, of course.
Cassey Amoore, is the counselling manager and liaison for the South African Depression and Anxiety Group (Sadag). He recommends the following:
- Help the person to find out what his mental illness is, and get help. Go with him.
- Find out whether there are support groups in your area – it helps to share your fears and emotions with others in the same situation.
- Learn everything you can about the disorder - the more you know, the better you can help your partner.
- Give your partner love and support - it is very important for his recovery. Try to see and remember the good in him.
- Allow the person to be part of your life – introduce new experiences, as well doing things he used to like.
- Do not force the person to feel better. The feelings he is experiencing are real. He is not just being weak or lazy.
- Involve the person in major family decisions. Do not shut him out because you think it is too stressful for him. Treat him as normally as possible. Most importantly, listen to him.
- Support your partner. Remind him that assistance is available and that he really can and will feel better.
- Do not treat the person as a child. Help where you can, but don't do everything for him. It is important that he does things for himself.
- Take it seriously when your partner talks about suicide and get help immediately.
If you suspect your partner is suffering from a mental disorder, speak to your doctor first, so that he can determine whether or not here is a physical cause that will explain your partner's behaviour.
If there does appear to be a mental illness, your doctor can refer you to the right organisation or specialist.
Although you should support your partner, it is equally important that you do not neglect yourself. Your own mental health - and the well-being of your family - is just as important.
- For more information on Nina or support for bipolar disorder, visit her website: www.bipolarsupporters.ning.com
- Call Sadag at 011 262 6396 0800 567 567 or send an SMS to 31 393 or visit www.sadag.co.za
- Call Claire Newton on 031 261 7466 or visit www.clairenewton.co.za