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Dr. Keane
Dr. Keane, Therapist
Category: Mental Health
Satisfied Customers: 1379
Experience:  Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
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I have been working with Dr. and he has been very helpful

Customer Question

I have been working with Dr. Michael and he has been very helpful re: my issues. Well, my husband also has problems that are making mine worse. He is 60 and has metabolic syndrome. and is also bipolar. His diet is poor and he is over weight, running a blood sugar in the 115 range, is irritable. He takes symbyax, self adjusted between 3 and 6 mg per day, says 6mg leaves his with hangover, 3 mg is not quite enough to control outburst, irrational anger, and when it was real bad before the symbyax, I think he's crossed the line into psychotic episodes. Meds were prescribed by primary care doc, process of seeing what would work, what didn't. symbyax helps the best but he still way overreacts to minor things and I am always the focus of his anger; manipulative enought to find a way to make me the bad guy regardless of whether or not I was involved. He refuses to go to therapy, is knee deep in denial. I go to therapy and am not reluctant to seek help when needed, I have a daughter to finish raising and shes a great kid in spite of her dad's behavior. This is probably and impossible situation and my option is to leave but that comes with terrible financial consequences for me and my future and at 56, the prospect of starting over isn't too appealing. Any suggestions on how to better handle him? I'm dealing iwth my own illness made worse by his outbursts but am not quite ready to thro in the towel. thanks
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 6 years ago.
Hello. I believe I can be of help to you with this issue.

Tell me if you would about this behavior and symptoms that make you think he might have dementia? I ask because if he is experiencing the onset of something like Alzheimer's disease, his care will become more challenging for you, unfortunately. Your reference to tremors might suggest Parkinson's disease as well. You could ask your family doctor---any physician he likes and trusts to have his staff call your husband and tell him he is overdue for a routine physical exam and prostate screening. Also, ask the doctor if he could be fairly insistent about an appointment. For example, you could suggest that the doctor persuade him by saying something like, "in order for me to continue prescribing medication to you, I really must see you and update our evaluation of your condition" Also, if your husband has had a prostate screening recently (which I doubt), they could tell him they want to discuss with him a routine colonoscopy given his age. Explain to the doctor that the staff member needs to be persistent and persuasive get him to commit to an appointment. Prior to the appointment, you would remind your physician about covering a few key points:

Medications he is taking, side effects, etc.
Questions about his short term memory and speed of mental problem-solving
Inquiry about his tremors---are these medication related, signs of Parkinson's, etc.
The need for dramatic "stress reduction" in his life through consultation and counseling, perhaps marital therapy.
Other things the physician thinks are important.
Would the physician be willing to make a referral to a psychiatrist or neuropsychologist or neurologist?

You should ask that the staff member tell you husband that you must attend at least part of the consultation session based on the rationale that you will need to understand about any treatment recommendations or medication changes; but the real purpose is for the doctor to ask you questions with your husband present so some of your concerns about how the medication dose may relate to his moods and anger outbursts can be discussed. But, all in all, I think if the physician were to tell you husband that he must complete an updated evaluation of his condition before he is wiling to prescribe more medications, this should get him into the office.

How to deal with your husband's behavior. The basic idea here is to start changing the way your relate to your husband. Try to avoid responding or reacting to 'bad behavior' and begin giving extra attention to 'good behavior'. So if your husband is in a foul mood, avoid talking to him, being near him, and even, give him a cold shoulder. Don't engage him in conversation to help calm him down etc. Then, when he says anything polite, or pleasant to you, compliment or positively reinforce his behavior quite strongly, e.g., "I appreciate you speaking to me in such a nice tone of voice". "It sounds like you are feeling better right now. I'm so happy to see it". "I appreciated your compliment". "It was so nice to see you really listen to [name of your child]; I'm sure they really appreciated having their dad listen to them" Now of course, the question is, does your husband EVER say or do anything that is positive that you could compliment him about, or positively reinforce? The point of doing this is that over time, the person will increasingly tend to continue to say and do more pleasant positive things (which of course, is incompatible with being in a foul mood---can't do both at the same time).

let me pause here and get your feedback....
Customer: replied 6 years ago.
Even tho he's on meds his outbursts are cyclical. He will go to his PCP, he likes her, but he won't go to any other professional,he says he doesn't need it. I can talk to her, I know her well and don't have reservations about having him seen by a specialist. Was going to suggest to her that she start with a neurology consult....local neurologist is former engineer, real person, very nice, would do a good job. His behavior during these episodes is simply irrational. He focuses his anger on me whether i'VE been involved or not. He is in denial about his tremors. It takes him a while to process information and respond and he gets angry at me if the conversation gets too deep, again my perception is that this is denial. And lastly, in the 80's he abused cocaine terribly according to him (I didn't know him then). People that knew him then say he's much different today, did not have these rages before this drug binge, he drank alot during those periods. Now he smokes a minimal amount of pot, drinks beer thruout the day. This of course bothers me, he has yelled at me daily over nothing which makes my anxiety symptoms worse, but I have done what you suggested....I don't react to his irrational behavior and will go to a hotel for the night if needed. Have had to call police a couple of times, don't like to be in car when he's driving because if he gets mad he will drive recklessly, if I'm driving he's yelling at me the entire time telling me how to drive. At times he skips his symbyax and from my perspecitve he becomes psychotic. I am a retired healthcare administrator and nurse, so this is what I observe in him, married now 20 years. In the past he has been violent and I've had to call the police a couple of times, then he settles down for a period of time. I stay only because I think he'd die if I left as he is very dependent but I'm dying for my emancipation as he is very controlling and I am very independent, do what I enjoy and when I enjoy something, he tries to bring up something negative. He dislikes my family and likes the idea that I live across country from them, which has its advantages but he is jealous when I want to travel to see them. I can assure you he is fading slowly, my 16 yr old daughter even notices. takes no responsibility for anything, depends on me to subsidize his furniture business, and has no real friends, just comes home and nags me to death. Believe me I have discussed with doctors and therapists, all have said it sounds like bipolar and possibly some dementia. he has no motivation to do anything. Now that I'm retired, I get accused of being "lazy" even tho I have plenty to keep me busy. Food is a big issue for him, he "must" have a full, unhealthy meal waiting for him when he gets home and explodes if I don't fix one. These are all extreme reactions during which he flys into a rage. I realize that for my own health I may need to live elsewhere but am waiting until my daughter is 18. When he is not going thru one of the episodes, life is pretty normal except for his distraction and lack of motivation to do anything. He doesn't seem to be able to have fun, this is a change over the last 10 years.
Expert:  Dr. Michael replied 6 years ago.
I have a few difficult questions for you that I hope will constructively challenge you a bit---in ways I hope will be helpful, of course. But they are difficult questions.

I have an odd sense that despite his denial about his problems, your husband HAS to realize he would be in dire straits physically, if you left, because he knows he is dependent on you. If this is true, then he likely believes he has to bully, demand and exert control because this is the only way he knows how to command your attention and involvement with him. He may hold the rather bizarre belief that if he doesn't regularly bully and manipulate you, he has no power whatsoever in the relationship. Obviously, if this is true, it represents a pretty pathological and pathetic strategy for maintaining a relationship---but I do have a sense that this is accurate about your husband. Based on this, I would have to recommend that you make definitive plans to get out of this relationship as soon as you feel you can afford the disruption and financial stress. So here is the first question: I realize you feel you cannot leave for financial reasons right now, but help me understand how the financial situation might change to make it possible for you to leave, once your daughter turns 18?

And relatedly, here is question #2: You are going to have to eventually stop subsidizing your husband's failing business. Is it true that you are actually losing money by keeping it open, and objectively, you'd have more monthly income if it closed? Help clarify this for me please because if you are subsidizing it, then you simply MUST at some point, close the doors. How, when will you do this, exactly, etc.?

Now, if you stopped subsidizing your husband's furniture business, and could recoup the outlay for that, you could then save that chunk of money and put it away as a reserve fund for moving out and resettling yourself; or you might think about presently, putting the money toward renting a small quiet efficiency apartment, sleeping room or even a small modular home/mobile home, or renting a motel room by the week, so you can simply leave for a few days or a few weeks, when your husband acts up badly. So question #3, is there a way to make an intermediate transition to eventually leaving the relationship by spending time away from home for personal respite and emotional recovery from stress?

I would offer the speculation that your husband has sustained some brain damage from cocaine abuse and alcohol consumption; it is thought that such abuse can prompt the more rapid development of dementia in people who are predisposed to dementia. I think you realize that your husband is probably on a gradual "death march". You feel you must be there to literally, keep him from self-destructing, but I must ask, why can't you allow him to assume responsibility for himself just a bit more---for better or worse? For you to maintain this belief suggests you truly feel he is incompetent and that because of this, you are actually responsible for taking care of him---much as you would feel you are responsible for a truly helpless and dependent infant. Feel free to correct me, but I must ask question #5---is this belief you hold that he won't survive if you don't feed him and do whatever else you do, every day? Is this accurate and rational?

I asked the above question because I want to toss out a possibility---a 'what if?" proposition---probably quite a scary proposition. What if you informed your husband that on alternate evenings each week, he would have to fix his own dinner when he got home or you'd have leftovers defrosting for him to reheat, because you had evening classes or an alternative activity you've committed to----maybe library research topics that interest you or a class at a community college or adult continuing education course or??? I don't know what it might be but what if you announced that your evenings were going to dramatically change in this way, and you simply let him rant and rave and get angry and try to control you----but to no avail? What would happen if you pushed back in this way?

Thats all for now. I may not be able to respond to your next post for a while because I have to prepare to travel in the a.m., so take your time thinking about these questions and responding. It may take a day or so before I can have free time to log back on to this site. Hope this is o.k. with you.
Customer: replied 6 years ago.

ok, you' ve given me alot to think about. The quick answer to your questions is that I'm scared of what he might do as he's capable of violence and God knows what else. We live on a farm and have a herd of donkeys and 5 dogs and other critters you'd find on a farm. He takes no responsibility for them, so I take care of them. Have sold some, others I am very attached to and it would be a huge loss, which I have had enough of the last few years, losses that ultimately caused my episode of stress cardiomyopathy--I have brothers in Hawaii, but no other family, all have died, so its me and my daughter really. The home that I could move to is in town so it would be a hardship with the animals, and to be honest, I can't stand the thought of selling them although I may have to. I would prefer that he leave, but he won't, I would have to support that for the sake of my health and that of my daughter. When my daughter is 18 she has a house of her own to go to. I would likely go with her so I need time to deal with animals and all the details without telling him. You aren't asking r suggesting anything I haven't been asked before. And lastly, the economy has taken a toll on my finances (as a hospital/healthcare exec prior to retirement due to illness) and the business. I'm trying to turn the business around from what he set up and am starting to see some improvement. My thought was once the business was self sustaining, would hand it over to him and rid myself of it. Unfortunately we bought the building the business is in and have a fairly substantial mortgage, so I can't excape the financial drain every month. I feel that in part he married me because I made very good money at one time, raising my daughter (she was a joy)was hell because he couldn't handle the normal stress of raising a child (so I have and she's great, understands her dad has problems and she doesn't seem to let them bother her). Maybe I should do what you suggest, make an appt for him with our pcp, go with him and discuss tremors, etc. Look forward to hearing back whenever you have time, thank you. and by the way, I have a few bad habits myself, mostly due to self medicating to get away from him in my head. I am aware of this, do not over due things when I'm away from him, in fact don't even think about needing anything excert for what's been prescribed. However, I have a tendency toward substance abuse when I am stressed and he enables me to do these things.

So you can see I'm in a bit of a jam. I long to be single again, but truely enjoy my husband and family when things are good. I think we should be apart, but I'm not sure how to go about taking those steps and fear the financial consequences. I recently inherited a great deal from my stepfather and mother's trust, mostly stock which is intact, but all the cash was used up on paying off bills and making payments on the building. Alone, I can't quite make it as he brings in some money now from the business which has huge potential, its just that we live in a small, geseconomically challenged working class community and even with the economy improving its slow to catch up here. He comes up with some wild ideas, pays no attention to our budget, and I've told him I'm about to pull the plug on the business if he doesn't make some immediate changes (he has complied somewhat). This is his second marriage, his first broke up for the same reasons I've described above, he has minimal contact with his 3 other grown kids and grandkids, that relationship is strained and they resent me and my daughter, which again, he denies....won't go visit them in Texas without me, but they want to see him, not me so why put myself and my daughter, who they also resent, in that position? I'm not afraid to say no, I'm only afraid of what he might do when I do. thanks

Customer: replied 6 years ago.
You are right, my husband is a bully no matter how one defines that. While he can be loving and thoughtful, I am expected to support him no matter what, while he only puts me down. I worked this thru in therapy relative to my stepfather and brothers, but it never crossed my mind that this bully thing applied to my marriage until you brought it up (should have been obvious long time ago). Your honesty sort of hit me hard between the eyes but I know you're right and nothing will change unless I do.  I usually walk away from his outbursts, have handled as you suggested many times, no long term changes.  Am continuing therapy with my therapist, lots of these anxiety symptoms might go away if I get away from the person and things that keep this going.  thank you again for your honest words, I really needed to hear them.  Lynn