Domestic Violence and Mental Illness

Patient Expert

October is Domestic Violence Awareness month. Lene Andersen, who posts about Rheumatoid Arthritis on HealthCentral, asked me to contribute a piece, along with other bloggers here at HealthCentral.

My pleasure, Lene.

First let's establish that those who are being treated for mental illness are no more violent than the general population. The major catch, of course, is that NOT being treated substantially raises the risk of violence. Bipolar is characterized by lack of impulse control, which is not a good thing when we need to keep our anger in check.

As part of researching my book, "Living Well with Depression and Bipolar Disorder" (HarperCollins, 2006), I parsed every reader comment on my site, It was no surprise that the loved ones to a person observed a lot of anger going on with their partners. To them, anger was clearly THE major feature of bipolar. Yes, they were perplexed by a lot of the other stuff, as well - but, oh, the anger, the anger.

The real surprise was that not one single bipolar patient referred to his or her angry outbursts, even in passing. Yes, there were numerous examples of angry and agitated thinking, but one would never know from these accounts that those with bipolar ever exploded on those unfortunate enough to occupy their blast zones. Trust me, the loved ones have a far different story to tell.

Another complication is alcohol and drugs, which have been linked to all forms of violence and abuse. Unfortunately, self-medication looms large in bipolar. Six in ten of those with bipolar have experienced a substance use disorder some time during their life, more than five times the rate of the general population.

Some of our own meds may enter the equation, as well. Antidepressants carry a considerable destabilizing risk in those with bipolar. Likewise, quitting meds cold turkey may result in rebound symptoms and other bad effects.

Okay, now that I have made you and I out to be walking time bombs, let's get to domestic violence. The violence part of domestic violence refers to any type of emotional abuse and controlling behavior, not just physical violence. Indeed, the emotional scars tend to be far more hurtful and long-lasting.

"What do you do if you are not bipolar but dealing with an angry, unemployed, suicidal bipolar that lives with you and is threatening you now?" asks "Jill."

"Jane" relates:

We were recently on a trip, and he took off from a restaurant mad.I was searching for him for one hour. I finally found him, and tried to get him to get back into the car, so we could go back to the hotel, and he ignored me and continued to walk away. I got out of the car and went to get him and calm him down, and he went ballistic, hitting me and twisting my arm, and swearing at me. ...

Emotional safety is the number one concern for both partners in any relationship. Mental illness obviously poses serious challenges to this. In researching this post, I went over a lot of my old pieces spread over BipolarConnect, mcmanweb, and Knowledge is Necessity.

"To live with a person with a mental illness is to live in an abusive relationship," I say in one piece. "When YOU act up or act out," I advised one woman, "HE is the one who suffers."

I won't mince words here. Even if we are loving and compassionate and caring people, even if we are not engaging in any type of abusive behavior, our illness has the cumulative effect of wearing our partners down to the breaking point. They feel spent, violated. And - irony of ironies - many wind up as depressed as we are.

Take my word for it, I've lived life on both sides of the equation, as a patient and as a loved one. There are no easy answers. This is Domestic Violence Awareness month. I simply urge all of us to be aware.

Other HealthCentral articles on Domestic Violence