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Harvard Medical School
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General Medical Questions
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Question : My wife is emotionally unstable. I (and many others) believe she could have bipolar disorder. She’s defensive, and hard to confront. It’s starting to affect my health. Any advice to help us?
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The Trusted Source
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Howard LeWine, M.D.

Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.

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November 01, 2011
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A:

To a certain point, we all have trouble seeing our own problems clearly. But when a family member suffers from a disruptive and potentially dangerous illness, it can very painful.

Let’s assume that your wife does have a problem that needs treatment. Can you — can anyone — intervene? In the United States, courts have struggled with that question for at least 150 years. We value helping people who can not help themselves. But we also value autonomy and privacy. So when does the community (including a spouse) have the right to intrude or force treatment?

As a society, we have recently tilted in the direction of personal freedoms. I think these protections are important. Many of us would be scared to live in a society where it was too easy to be put away or given unwanted treatment.

So your wife does have a strong right to refuse treatment. And that includes being hospitalized. But you still have options. To start, find out what the laws are in your state on civil commitment and guardianship. Search your state government website. Or contact a lawyer.

Here’s what these terms mean:

Civil commitment laws rule when and how a person can be hospitalized and treated against their will. A person can usually only be commited iif their illness creates danger. That is, she must be at high risk for causing violence to others or to herself. It’s frustrating. But hospitalization cannot be ordered if your wife only needs treatment.

Guardianship is a legal tool for proving that a person is not competent to make decisions. A guardian makes decisions on behalf of an incompetent person. The courts are cautious here too. Taking away a person’s power to decide is another big intrusion on personal freedom. So the courts will only appoint a guardian if you can clearly prove that your wife doesn’t understand the nature of her illness and treatments.

Talk to a lawyer specializing in family law or mental health law. He or she should be able to advise you about what is practical in your community. If you are successful in getting treatment for your wife by using one of these legal means, hospital treatment may help her turn the corner.

If you don’t want to jump the legal hurdles, another option is to look out for your own interests. Don’t feel that you must arrange your life completely around your wife’s illness or symptoms.

Consider this analogy: Before an airplane takes off, the flight crew tells you what to do if the oxygen masks drops: put your mask on before helping the person next to you. It’s the same in your home. Protect your own sense of well-being. If you don’t, it will be impossible for you to help your wife. If you have children at home, you may need to move to protect them.

You can speak with a mental health doctor yourself. Find someone who can help you figure out your view of the problems at home and what needs to happen for the sake of the family. And be able to communicate this with your wife. Along with the support of your family and friends, you can also outline your personal limits. That is the least you need to keep up your household.

If your wife is deeply unwilling or unable to see a serious problem, you might have to make one of these hard choices to see any progress at home.

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