Psychologically Speaking

My wife is mentally ill. She is 38. She refuses medical treatment. She complains of body pains and head ache always.

Dear Dr. Batya, My wife is mentally ill. She is 38 years old. She refuses medical treatment. She complains of body pains and head ache always. She sleeps always. I lost hope. Please suggest something to save her. - Concerned Husband Dear Concerned Husband, Your brief letter raises two very important issues. How does one who refuses medical treatment get help, and how does someone live with an individual who is mentally ill? Your wife is very young and her vague physical complaints can be a sign of many things. Headaches, body aches and excessive sleep could all be symptoms of a mild to severe depression. Depending on the nature, intensity and degree of impairment to everyday functioning, these symptoms could also be reflective of a more serious medical problem. Without a visit to her physician, one can't really say just what is going on. You comment that your wife is mentally ill. My first question might be who made this diagnosis, on what basis was it made and when was it made? Symptoms sometimes evolve over time and physical and mental illness sometimes go hand-in-hand. As a result, one might see vague physical complaints as part of a broader constellation within depression or anxiety, or one may see sleep and headaches as part of an underlying medical or neurological condition. You have suggested that she is in need of "being saved," so it sounds as if whatever is going on with your wife is certainly serious or has been a problem for quite some time already. Would you be able to possibly persuade her "just once" to go and see someone? I often find that when patients are reluctant to make that initial appointment, once they do indeed come in for a single session, they usually have faced the worst and are more than willing to return. People choose not to seek help for many reasons. Often they are afraid of what they will hear and prefer not to know the truth. The fear of the unknown can be both traumatic and incapacitating, as a person usually imagines a far more serious situation than the one they are in. Perhaps they believe they have something seriously wrong and the psychologist or physician will either confirm that their worst fears were valid - or worse, they will be laughed at, their fears will be seen as groundless, and the doctor will make light of them. There are no stupid questions or concerns, and you as a patient or patient advocate have a right to ensure that your questions get answered in a way that you can understand. If you are not comfortable with the person or the answers you receive, consider speaking with someone else. Because your wife refuses treatment at this point, you can contact her doctor and ask questions as a concerned spouse. The doctor, for reasons of confidentiality, may not be able to give you specific information - but he may be able to give you some general guidance which can indeed be helpful, or you may be able to attain information based on knowing more of the facts. While there is little one can do for your wife because she refuses treatment or is not currently in a position to help herself, there is much one can suggest for you. Sadly, I hear in the tone of your question that you, too, are feeling desperate and are losing hope. Living with someone who is unwell, whether due to physical or mental illness, can be extremely stressful. The small things in life that one takes for granted somehow seem to take over and issues that may seem inconsequential to many, take up a tremendous amount of time and energy. As a result, you, too, may feel depressed. You may be tired, worn down and may need a change of pace or scenery. You will need to make more of a life on your own. This may not be at all easy if in the past you often did many things as a couple. Guilt often plays a role here and I would strongly recommend that you seek supportive psychological counseling if you are having difficulties. A therapist can help you with coping skills, give practical advice and, above all, be a listening ear for you as you attempt in some way to move on. The writer is a licensed clinical psychologist in Ra'anana. This column offers general psychological advice and is not intended to replace treatment by a mental health professional.