Mental Health/drugs Problem With Thai Wife

[LaoPo]

Just heard from my wife's family in Issan that she made another 'escape bid' today! Since she is miles from anywhere and had no money, they caught up with her fairly quickly. Apparently she 'forgot' to take her medicine this morning. I spoke with her this morning and she sounded just fine, and told me that she had taken the medicine....(so she lied..)

If she has these manaic moments after missing her medicine for just one day, does that not suggest that her dosage is too low? She has sounded quite happy for the past week or so, so this event was a surprise.

Also, what is she trying to run away from? She knows that I have resolved all the money problems that she previously caused, so she should not have anything to worry about.

Since they are miles from the nearest hospital, they have given her a massage which has calmed her down and they will take her to Udon Thani hospital tomorrow.

My intention is to relocate to Issan and live together. But it sounds like I need to build a fortress to stop her running away

Simon

Sorry to hear that Simon!

I leave the comments to people who know better than myself, but it's obviously much more serious than you anticipated.

Professional help is urgently required and I'm not sure if Udon Thani hospital (with respect) are able to help her with more/different medication...it's not that simple I'm afraid.

Your intention to live together in Issan is a wonderful idea but she has to be cured first; your life will end in h_ll if you think you are able to cure her (with medication) just being there....

LaoPo

[simon43]

Agree with you LaoPo - this needs careful diagnosis and treatment in hospital.

Not really anything more that I can say!

Simon

[John K]

Hi Simon,

well with your wife taking off like that one of the first questions I would ask her is are running from something or running to something. I would imagine if it was from, perhaps her family is approaching the condition the wrong way. If it is to something chance are it is back to the people who got her problem going. By you telling her the money problems are fixed simply told her there is money available. Perhaps you should change the story and make her think she cause a more major problem and there is really no money. It is a form of suggestion that will make her want to run away less. Understand everything you say to her at this point is a form of suggestion. In her state she is very suggestible to many suggestions, but resistant to the ones that are directly related to her therapy that go against her present goal driven by addiction. Choose your words with care.

At this point what is happening beyond her field of view is irrelevant and she should only be focused on herself getting better. Keeping her isolated from the outside happenings I feel will be helpful at this stage.

I would be sure to let everyone in the village know not to give her money and to stop her if she runs.

It also may be wise just to open a bank account in your name only where she can’t get at it. When she is better you can put it back, but in limited quantities.

Please keep us posted.

[solo siam]

John K,

I'm not sure that you should be trying to delve so deep into someone's Psyche that you have never met, sounds like a sure fire way to make a problem worse - You may have worked in this field before, but if you have you would be the first person I have met who is giving such advise without ever meeting or knowing a person. You may think people can be summed up in 10-20 posts on a website, but I disagree and think some of your advice is taking it too far considering you don't even know these people.

The advise that Simon should make his wife think she caused a MAJOR problem is especially worrying, and seems childish rather than any helpful 'professional' response.

Simon, please don't take advice from a website full of strangers you don't know, do what the doctors tell you even if it doesn't tally with what we woudl do in the west, you cant treat Thai's mental issues in an identical way to how you would a farangs.

[simon43]

One aspect of all this that I need to be wary of is that her family are now saying that her actions are the result of bad spirits and black magic. They insist that they change the location of our hotel spirit house. Well, that's fine by me since it has no affect on me at all. But I sense that the family would now rather be going down the route of trying to exorcise these bad spirits from my wife, rather that sticking with the medical treatment. That does not bode well at all for her at all.

I think I will visit the Khon Kaen clinic on my way up to Issan. This would at least, provide a secure/safe environment for her.

Simon

[simon43]

Grrrr - I have just been told that the medicines proscribed by her doctor in Phuket are finished. That means that she has been exceeding the proscribed dosage. Apparently, when her head hurts, she has been taking this additional medicine, (so she has been doubling her proscribed dosage each day...)

This is one reason why I do not want her family to care for her. They simply do not understand the need to monitor her and to control the access to her medicines and to ensure that when she takes it, she does indeed swallow it !

Simon

[jumnien]

As far as addiction goes, an addict's motto is "if one is good, three is better!" I worked for 2 years in a alcohol and drug treatment center in California and dispensed medication. We never let the addict/alcoholic or family members dispense drugs.

I think a stop off at the Khon Kaen center would be a good start and keep that therapist/counselor in BKK in mind. Best of luck on your journey! Thanks for keeping us all posted. It's good for your situation and you are undoubtedly helping others as they deal with similar circumstances.

[leisurely]

Simon, your patience is an example to all of us. One question, does your wife have a firm diagnosis? I have personal experience of bipolar disorder (a close friend in UK has it) and as far as I can remember, it takes more than missing a couple of doses of her lithium before she becomes manic. Did the doctor diagnose this independantly or did you suggest that it may be. The only reason I ask is that I had my eldest at the hosptial a couple of days ago with a headache. The doctor asked me what I thought it was! I suggested maybe she was getting a new tooth or it was ear related. He decided without looking that it was dental and sent me off to the dental dept. We went to a different hospital and it was indeed an ear infection, but he just took me at my word whch is a bit dangerous.

Good luck with it all.

Leisurely

[John K]

Ben@h3,

The ‘to or from’ is a simple question to help diagnose the root cause. The people that will eventually be working with her will need to know the answer to this. I has nothing to do with helping her as in therapy, but only to better understand the problem. Seeing as she is still more or less in the diagnosis stage they are valid questions. The fact that she took off running is a response to some form of thinking. The rest is just common sense advise that I am sure Simon has received from may other sources. Also please read post #105

I understand your concern about getting advise from this forum and it is valid, however in the effort to help, cuing in Simon on what to look for and what questions a professional would ask can only serve to help her. I have a gut feeling on what it is but I will reserve my opinion.

[OlRedEyes]

All the in depth psychological analysis and advice going on here on the basis of scant info on a forum scares me, honestly. This by people who want to sound professional?

You seem to be covering most bases quite well, including being aware that your own wellbeing is also important. Just one obvious possibility to keep in mind as well is that she may just be pressured and feel trapped in a situation she simply doesn't want to be in, with or without other psychological/medical problems.

A possibility I'd consider is she may simply not want to be with you, but under severe pressure from family to stay. This could be aggravated by having children, that she may or may not want, increasing the feeling of being trapped. I assume you understand the Thai approach to children supporting their family. They may not be camping out around the hotel as you say simply for her own good. Postnatal depression etc. may or may not play a role as well.

Good luck mate. I feel for you.

Edited March 5, 2007 by OlRedEyes

[qualtrough]

One aspect of all this that I need to be wary of is that her family are now saying that her actions are the result of bad spirits and black magic. They insist that they change the location of our hotel spirit house. Well, that's fine by me since it has no affect on me at all. But I sense that the family would now rather be going down the route of trying to exorcise these bad spirits from my wife, rather that sticking with the medical treatment. That does not bode well at all for her at all.

I think I will visit the Khon Kaen clinic on my way up to Issan. This would at least, provide a secure/safe environment for her.

Simon

Simon, If your wife believes in that as well it might not hurt to give it a whirl. Not saying you should stop the other treatment, but the Mumbo Jumbo could help if it is something she too believes in.

I must say you are a far more dedicated partner than I have been or ever will be. I have binned them for far less.

[sbk]

I must say you are a far more dedicated partner than I have been or ever will be. I have binned them for far less.

You mean, like used tissue paper or something

Simon, may I suggest going both routes, the spirit house will help her as well.

[Boo]

Simon not much to add but at least she is away from the phuket bad influences (wont say anythign about the family but beleive you know they aren't always the best solution) if you can afford it, why not employ a private nurse? Someone who answers only to you & who is told to ignore the family where her medication & treatment is concerned?

Explain to the family that the nurse will control all medicines & she is to be deferred to about what dosage, etc & then the family can be on hand to watch your wife in the night time?

The nurse could have all meds under lock & key?

[qualtrough]

You mean, like used tissue paper or something

Dumped, ditched, abandoned, binned, whatever, all euphemisms for breaking off a relationship. There must be fifty ways to leave your lover...

[leisurely]

Excellent advise Boo. I think you should consider this Simon.

[Sheryl]

Simon,

I'm glad to hear she is getting a brain scan. With headaches on top of personality change, a thorough neurological work-up is indicated. I am not sure, though, how much expertise is available at the provincial hospital. You might do well to bring her to Bangkok to consult an experienced neurologist.

Likewise, it sounds like she had been discharged and was at home on meds, which makes me question the quality of the pyschiatric care she was receiving. It takes some time to get the right medication and dosage established and blood levels constant, and that plus some counselling of both patient and family needs to happen before sending a person home on meds.

As to whether missing one dose could cause a relapse, usually no, but 1) I don't know which drugs she is on (some have shorter half lives than others) and 2) from the sounds of things there is really no way of knowing how much she took and when.

By the way, if she is on lithium, the therapeutic range is quite narrow and needs to be monitored closely through blood test. It is easy both to have too much on board, which will cause toxicity, and to have too little, in which case symptoms are not well controlled. There are newer, better drugs but as they cost considerably more, government hospitals may still use lithium. It is also necessary to drink large amounts of water if on lithium, and headache is a common side effect.

If I were you, I'd get a thorough neurological work-up from an experienced highly trained neurologist and, if it is negative, then take her to the pysch department at Samitivej for thorough testing and evaluation to make sure she has been correctly diagnosed. This can all be done as an outpatient so should not cost too much (you would not want her to be an inpatient at Samitivej as it is quite expensive).

With mental illness as with other illnesses, having a correct diagnosis is essential. The medications suitable for one type of disorder will not only not work, but can greatly aggravate, other disorders.

If you can get to the point where neurological disease has been ruled out and a firm pyschiatric diagnosis made, then the challenge is to get her stabilized on appropriate medication. She CANNOT be left to take the meds on her own any time soon....as in, not until she has been stable for at least 6 months and has developed some understanding of her disease...if ever. It is quite common for patients once feeling well to decide they don't need their meds any more, with disasterous results. And her behavior to date indicates a very poor understanding of pharmacology (i.e. increasing the dose of her psych meds because seh had a headache...)

The idea of having a live-in nurse to oversee her meds, once she has been stabilized on the right ones, is good but it could probably be just a nurse's aid, which is cheaper.

If you know what drugs she was on and can either post it or PM me I can advise a little more.

Good luck

[Sheryl]

P.S. I was wondering when the family would bring up the spirit possession angle, most Thai families would have done so even sooner. By all means let them move spirit houses and take her fro blessings by a monk etc, will calm then and may also help her, just be careful they don't go in for more elaborate exorcism rituals that can be physically harmful.

[simon43]

Today I'm flying up to Issan and will visit the addiction clinic in Khon Kaen. If this looks a suitable place for proper diagnosis AND treatment, then I'll check my wife in there later this week.

Simon

[LaoPo]

Today I'm flying up to Issan and will visit the addiction clinic in Khon Kaen. If this looks a suitable place for proper diagnosis AND treatment, then I'll check my wife in there later this week.

Simon

Wish you well Simon and your wife!

You're a great human being.

LaoPo

[John K]

Simon, please get as much information as you can on the place, it may be appropriate for the pinned resource list at the top of this section. Is the staff 100% Thai, and so on. Number of beds and if possible a link.

[FunkyGuru]

My Two satang worth again.

Simon, all the best wishes from me for your wifes speedy recovery. More I researched and worked on the condition/symptoms you mentioned, more I was intrigued.

Wish I had the ability to put all that I learn in black and white. Still here is one link that will give you enough clarity in understanding the bipolar condition. It is a good start to understand the condition.

I agree with Sheryl, exorcism, let her parents and family have a go at it. But careful not to go into the extreme, physically challenging routines. One thing for sure it will do is bring peace to them. I might as well help your wife too. Call it faith healing or whatever, even with scientific/rational mind of mine, I still say, such rituals at times are necessary for those who strongly believe in it. It helps by supplementing the more scientific effort and but should not be used as substitute.

All the best once again from me. I still say, it will over very soon.

the Link: Information on Bipolar condition

[simon43]

Hi - sorry for not rteplying for so long. There seems to be a lack of internet cafes in Issan....

An update:

I returned to my wife's village about 1 week ago after she had 'run away' again in the days previously. The family had then taken her to a doctor in Udon who basically sedated her! (and charged 3,000 baht in the process). She was on heavy sedation, unable to walk or talk and had lost 10% of her body weight.

I decided that sedation was not the best solution

Firstly, I visited (alone) the clinic at Khon Kaen. I had a very good talk with the staff there and it was clear that this clinic was not suitable for my wife, (according to the staff). The clinic treated alcohol addicts and yaba addicts, but would be unable to treat those with any other dependancies.

From knowledge of my wife, it seems that she is more addicted to 'pills' and sleeping pills, rather than yaba or alcohol. The Khon Kaen clinic suggested, (and this was my plan B anyway), that the best treatment for her would be treatment provided by me, her husband. That is, monitoring her moods, controlling her medicines and providing a stable, relaxing environment where she could rebuild her strength - both physical and mental.

I took her off the sedations and put her back on the medicine proscribed by her psychiatrist in Phuket, plus mtulti-vitamins. Within a few days, she could walk and talk, and was much happier in herself.

We visited Nong Khai together and found a very nice (and cheap!) shophouse right by the Mekong river, with a beautiful roof garden. We will stay together here and I will try to get her weight back up. This will take some time

It seems to me that, although her previous actions were 'bizarre', a period of rest and loving care is the most practical course of action. In any case, I have been strongly advised to relax as well!!

Our Phuket hotel is going fine, with her sister in charge.

I think recovery will be a long process. But at least I have got here in an environment where she is much happier and eager to recover.

Simon

[Sheryl]

Glad to hear it, Simon. Your plan sounds sensible and as long as you can personally supervise her taking of her meds, she will likely improve a lot.

There is always this catch-22 with pyschotropic medications, namely that the very people who need them and will benefit from them are, by definition, not stable enough to be relied upon to take them as prescribed...

Good luck

[John K]

That’s good Simon. I would consider a plan C at this point in the event plan B falls short. Stay up on the news in Bangkok on the Dr Prakitpao Thomthitchong's admission as a mentally-ill patient. For the moment this big news and it may provide you with some ideas or possible options for the future should they be necessary.

[LaoPo]

Good to hear from you and wish you and your wife well, Simon!

LaoPo

[Gary A]

Simon,

I'm not really clear on her diagnosis and I think her doctor may not be either. What you describe is not mere depression.

Was she using drugs again? Or just running around wildly?

I am thinking she may be bipolar (manic-depressive) and that these episodes may be manic phases, for which she needs a mood stabilizer not (or in addition to) antidepressent.

Keep searching for the right doctor and hospital, and ask specifically about her diagnosis ad whether she might be bipolar.

Good luck

Four or five years ago my brother's daughter was diagnosed as bipolar. She has never been married but does have a son who my brother and his wife are raising. It's a too long story to tell here but the things she has done sound VERY similiar to Simon's wife. She seems normal and is fine as long as she takes her prescribed medication but sometimes she decides she doesn't need it and goes off on another adventure. She was a teacher at the local Catholic high school but they finally fired her. On one of her adventures she flew to Las Vegas and lost all her savings as well as maxxed out her credit cards. My brother and his wife are at their wits end and have no idea what to do. Best of luck to Simon.

Edited March 14, 2007 by Gary A

[MiG16]

Simon

all the best to you and your wife. I hope it works out.....but also remember that if it doesnt...you have done the best and have tried all possibilities that could be covered.

still wish you both the best

MiG

[Tywais]

One post removed for inappropriate comments - anymore and vacations will be earned.

[NotYetArahan]

My Thai wife became psychotic last year. Voices told her what to do and what not to do. After she came out of it (long story) she told me that she was able to withstand the voices (partly, most of the time) when negative about me because of my consistent kind and loving behaviour.

I know that a next time (hopefully it will not happen) it would be beneficial to stay calm at all times and take care in a loving way. To keep the trust of my wife in difficult periods can be the only thing keeping her from suicide or other terrible things.

I don't know how it translates to your situation

good luck

[ThaiPauly]

One post removed for inappropriate comments - anymore and vacations will be earned.

It beggars beleif Tywais that people can make un-appropriate comments in a thread such as this.

If I were a mod they would not be getting vacations...they simply would not be here any more.

Simon...having been through a similar situation to you with my ex-wife I can empathise...She ran away once when She was under the influence of alcohol -from the UK...she turned up 4 days later in AUSTRALIA !

My story did not have a happy ending...I very much hope yours does.

But please bear in mind you are doing your absolute best for her...thats ALL you can do,

Good Luck Simon

TP