Rappler’s Life and Style section runs an advice column by couple Jeremy Baer and clinical psychologist Dr. Margarita Holmes.

Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in three continents, he has been training with Dr. Holmes for the last 10 years as co-lecturer and, occasionally, as co-therapist, especially with clients whose financial concerns intrude into their daily lives.

Together, they have written two books: Love Triangles: Understanding the Macho-Mistress Mentality and Imported Love: Filipino-Foreign Liaisons.

---

Dear Dr. Holmes and Mr. Baer:

Before I married my husband Sophocles, I warned him na baliw ako (that I’m nuts), but he married me anyway. He told me (I still have it etched on my soul): “Babes, don’t worry, I love you in your totality, baliw and all. Together we shall drive your demons away.”

None of my other boyfriends answered like this when I warned them I was crazy. They asked me what I meant about being baliw, asked me if it was “sa lahi namin” (part of my genetic pool, ran in my family).

But Sophocles was positive all the way. But now that we are married, I do not feel his loving me in this way at all!

I am bipolar 2, and occasionally, my manic highs are not so pleasant. I can sometimes rage. BUT I am not so nuts that these rages have no basis.

For example, my latest rage went this way:

His friend tried to cheat him, so I got angry at his friend, telling him never to come to our house anymore.

Then, this same friend tried to cheat him again, with yet another business venture. So again I got angry. But not only at his friend this time, but also at him.

And I could feel myself getting angrier and angrier, unable to stop. Finally, when there were no  other objects I could find to throw, and I’d said all I wanted to say, I quieted down.

He came to me and said he didn’t know if he could take all this fighting, screaming, throwing, and scratching. I told him: “I know I overreact sometimes, which is why I was so happy when you didn’t mind when I said I was crazy.”

But now he seems unable to deal with my craziness. Where were all his promises to fight my demons with me? I feel let down. And sometimes I am so angry I even pack my bags and leave him, though I end up coming back.

But I have done that many times already. I am afraid if I do it again, he will not beg me to come back like he used to.

Do you think there is any hope for us?

Patti

————————-

Dear Patti,

Thank you for your letter.

Your letter interestingly focuses solely on your rages and Sophocles’s reaction to them – as though your rages are an absolute and only his reactions are a variable. But rages and other bad behavior are not simply to be taken as givens, as though they are as immutable as your height or the size of your nose. They can be addressed, controlled, even sometimes eliminated.

While you happily declare you are bipolar 2, you make no mention of therapy, medication, or indeed any effort on your part to control your condition. This is not to say that control is easy or total, merely that it is an option worth trying, not only for the sake of your own mental health but also for that of Sophocles and others within your orbit. If you are truly concerned about the survival of your marriage, treatment is surely something to consider very seriously.

Bipolar disorder (BiPD) is not the easiest illness to treat. It can often take several years to identify the best pharmaceutical solution (and dosage) for a patient because it is not a case of one size fits all. Psychotherapy, support groups, and lifestyle changes are often part of the process as well.

For those unable or unwilling to go the pharmaceutical route, there is always the homeopathic option. Some people have great faith in this but the emphasis has to be on faith in the absence of any clinical trials proving the efficacy of the treatment.

Dr. Holmes will expound further on treatment.

As for Sophocles’s initial promise to deal with your craziness, promises are easy to make, particularly during courtship. The reality is something else. He may have been unaware of the extent of your craziness and even if he had been, constant exposure to this sort of behavior can erode even the best intentioned promise. Mania (and depression) can be extremely taxing to live with, particularly, as seems to be your case, if the sufferer is unmedicated, either by choice or circumstance, and any hope of recovery is therefore an unlikely outcome, at least in the foreseeable future.

One further comment on your belief that your rages have basis. One of the features of BPD is that sufferers are convinced of the righteousness of their behavior. The cause of their rage may or may not in fact exist but the strength of their response, their rage, is often totally disproportionate and this makes life very difficult for those caught in the vortex.

By going for treatment and demonstrating your resolve to get better, you will both be acting in your own best interests anyway and hopefully also strengthen his resolve to stay the course.

Best of luck,
JAFBaer

Dear Patti:

Thank you very much for your letter. I do not know enough about your particular bipolar disorder (BiPD) to give you a specific program to follow so that you will be in better control of your symptoms.  Neither am I legally able to prescribe medication for you.

I mention medication because research in BiPD strongly suggests, if not confirms, that it has a strong biogenetic basis. Thus, it will be very hard – some would say nearly impossible – to manage something literally brain- and/or physiologically-related with something that is not also brain- and/or physiologically related.  

In my 30+ years of clinical practice, I know only one person who has been able to manage his BiPD without medication. This is, in fact, so rare that his psychiatrist plans to write a book about his case. It was a difficult process for him to be able to manage his bipolar disorder without medication and he had to make many sacrifices, including giving up his acting career in New York and teaching drama in a high school in Nebraska.  

I don’t know how many people would be sanguine and humble enough to make that sacrifice.  

Perhaps, if more people were able to make the right lifestyle choices in every aspect in their lives that they knew affected their moods, more would be able to manage BiPD without medication, but right here and right now, medication seems a necessity in managing your BiPD. This does not mean medication is the only thing you need to manage your disorder; just that it is a good first step.

Other possible steps will include what Mr. Baer suggests: psychotherapy and lifestyle choices. Cognitive Behavior Therapy has been touted as one of the best short-term therapies for clinical depression, which is half of what BiPD is all about.  

There are many lifestyle choices that could improve how you manage your BiPD — eating healthily, exercising sufficiently, meditating, reducing your stress levels. THE most important intervention, however, is getting sufficient sleep, both in quality and quantity. 

There is so, so much more I wish I could share with you, Patti, but we will need more information from you. At the moment, all I can share are “tips” that research has determined to be most helpful to the general population which I hope you will have also found helpful. 

All the best,
MG Holmes

– Rappler.com

Please send any comments, questions, or requests for advice to twopronged@rappler.com.