This is a hard problem and it's probably unrealistic or unfair to place it in front of anybody. But I'm pretty desperate and out of ideas. My wife has been acutely mental ill for several years. She was always been vulnerable to anxiety and depression, has struggled with food and body image etc; but this is a whole order beyond anything I'd imagined possible. So far the NHS has not been able to make a dent in it, and a private psychotherapist has made some progress in following threads and exploring her childhood, but if anything that seems to just trigger her.
She repeatedly becomes caught up in bouts of intense self-loathing during which a self-critical inner voice tells her she's the most useless and selfish person ever in the history of the universe [that sort of thing but worse: the word "bitch" comes up a lot] and that she should kill herself. It's not an 'other' voice or an audio hallucination; she recognises it as her own mind or part of herself, but during these periods or 'attacks' she has no control over it at all and it berates, bullies and torments her. It demands she kill herself, and she tries to fight it (we have children, teenagers, who she utterly adores) but the relentlessnees of it wears her down until she wants to kill herself just to escape it and the intense inner conflict it creates within her. There's a physical component to it as well, a kind of vicious circle: moments where the self-critical voice seems to really get to her are accompanied by flushes of adrenalin, which she feels intensely in her stomach.
This self-loathing state doesn't come from nowhere but builds up slowly over weeks or a couple of months (but it's getting shorter). At first she thinks she's just having a bad few days, then weeks, then she starts to hide it from me because she feels ashamed. Soon she enters an 'appeasement' phase where e.g. she will start to secretly buy paracetamol and take 3, 4, 5 at a time, or alterntatively do the same with psychiatric drugs. Eventually she'll confess and tell me she's in trouble again, and then we call for help from the NHS. I am getting better at recognising earlier when she's in a downwards spiral but, well, she's a master of evasion and disguise and she kind of grew up like that, of which more below. The appeasement phase seems to have settled these days on her taking small overdoses, but a couple of years ago she was burning herself with hair-straighteners, several times a day. Doing so made the self-critical voice go quiet for a while, as if it was an angry god to whom she had to make sacrifices. At one point she was covered with burns all over her arms and stomach and a nurse had to come in every day to dress the worst bits. I know that sounds extreme. Every time I think or talk about I can hardly believe it happened. But I couldn't take the straighteners away because she might then turn to something worse, and I couldn't stay awake and watch her 24 hours a day.
She's been on high doses or Prozac, no help. It was switched to another anti-depressant called Venlafaxine which we were told is a pre-ssri anti-depressant, and for a while it seemed to be a wonder-cure but after most of a year seeming on the road to improvement these attacks came back. She reports she doesn't feel depressed like she did in the past, just tormented. The only thing that ends the attacks is high doses of old-school anti-psychotics combined with tranquilisers, which turns her into a zombie. She's spent months at a time under a blanket on the sofa alternately dozing and watching Poirot and Lewis. (I work from home which is something of a blessing). She increasingly hates the anti-psychotics because they take away all her emotions and she feels completely empty. So after 3-4 months we slowly reduce them, she seems much better for a while and then the whole cycle starts again.
I'm writing this with the intention of presenting it to all the mental health professionals involved. NHS mental health services are stretched almost to breaking point, staff turnover is constant and they're all fire-fighting and stressed as hell, so the attention and treatment my wife's had has been haphazard and intermittent. So if I frame the problem as concisely as possible and repeatedly wave it in their faces I might get the right person's attention. But thought I'd hedge my bets and try here.
Here's the history. Going along with mumsnet convention I'll call my wife DW.
DW’s maternal grandfather was a tyrannical physical and sexual abuser and alcoholic. We're not sure exactly what went on but the impression I get is of a particularly disturbing and nasty episode of Twin Peaks. It has left a trail of emotional devastation that's ongoing decades after the perpetrator has died.
DW’s mother, my mother-in-law, was the eldest child and is a very damaged, strange and eccentric woman who has never sought any help for her own mental health. Her own two siblings were under mental health treatment and in and out of hospital and institutions all their lives. DW’s mother has a very unstable sense of self, is cold, controlling, intense, narcissistic, hyper-anxious, has a history of sexual indiscretions and a very creative and self-serving sense of truth and reality. Her focus is almost entirely upon maintaining her public persona and appearance: she presents herself as a wonderful creature full of light and love, sort of a mixture of Mary Poppins and Mother Theresa of Calcutta, but on the inside she's a permanent demented tornado of almost superstitious foreboding and anxiety. She is very beautiful and always was. But she's mad as a box of frogs.
DW was the eldest child, and when her younger sibling arrived two years later her mother appears to have been unable to cope and became ruthlessly strict and punitive with DW: mainly emotional abuse involving long periods of coldness and neglect, but also some physical abuse: smacking and slapping. Most of DW’s primal trauma originates from that period of her life. With her therapist she has unearthed feelings from when she was four years old in which she recalled experiencing her parents as terrifying figures, as if (as she interpreted it) they were the Moors Murderers, and also that at that age she regularly wished she was dead.
DW's father is less nutty but was no help. He is in the thrall of his wife's strange, mesmeric hysteria and is only concerned that she doesn't get upset and then make his life hell for a week. We joke that he's like a nazi collaborator. He was a more loving parent but would blame DW for upsetting her mother and would often get into furious tempers and shout and smack and slap.
Neither of DW’s two siblings escaped unscathed, but as the oldest child DW was most severely damaged. As their first child she was idealised, and her appearance and behaviour were expected to be impeccable, as a reflection of her parents’ perfection. If she fell short of the ideal she was punished mercilessly. Consequences - lectures, punishments, emotional neglect - extended for days or sometimes even weeks.
In such a dysfunctional family DW was the scapegoat. When, inevitably due to the weird and controlling behaviour of the mother, internal tensions arose DW, being the most damaged child, would usually be the first to display fear or distress, and the family would then immediately turn on her and attack her and condemn her as the source of the problem - of being hysterical, selfish, attention seeking etc. In that way - or so it seems to me, I read books - the family tension was directed at a safe target while the real problem remained hidden. (This was still happening when we met in our twenties, and when I began stepping in and standing up for her they were absolutely horrified, and they all hated me for years). Throughout her childhood the validity of DW's own feelings of pain, fear and confusion were continually denied. She was told she was hysterical, self-indulgent, selfish, a liar and ‘making it all up’. Her parents shamelessly lied to her, denying obvious truths and painful events that had happened. They repeatedly warned that if she did not behave as they wanted then the family would be destroyed: her mother would go into hospital and she and her siblings into care.
DW has fought bravely and resourcefully all her adult life against the effects of this painful childhood, compensating for her lack of self-esteem by achieving tremendous things in her career - she was at one point at the top of her profession. She wants to be happy, and there were lots of happy times in the past. And, believe it or not but I can only assert it, we're Romantics and we love each other. To me she's a fragile, talented, beautiful, precious wonder. Yet she's always been running to keep ahead of these traumatic feelings, which remain with her as a frozen lump of unprocessed emotional pain and misery, now clamouring to be heard and refusing to take no for an answer. But she CANNOT process them because she was brought up under overwhelming pressure - trained - to suppress and internalise them and turn them onto herself. I've seen many times over the years how, if something triggers painful memories or she feels anger and resentment towards her parents or any compassion for herself, her instinct is to immediately think "I'm BAD", attack herself, doubt herself, condemn and loathe herself. She knows she does this and that rationally (she's well-educated and an excellent thinker and logic-chopper) it makes no sense, but she cannot stop.
She is therefore caught between a rock and a hard place. The traumatic feelings will not be denied, but connecting with them inevitably creates a kind of psychic ‘immunity’ reaction and generates overpowering feelings of self-hatred and shame. The result is a deadlocked inner conflict, from the pain of which the only viable escape is, as she sees it, suicide.
Psychotherapy once or twice a week seems potentially positive, but it is not enough. The unstable, incendiary nature of the problem - intense trauma wrapped in a protective shell of imposed self-loathing that prevents its expression - means that she does not get the sustained support required to enable her break through the barrier. All it does is take her close enough to trigger the spiral of suicidal thoughts, and then ‘...and I’ll see you next week’.
It seems to me that What DW desperately needs is a safe place where she can be firmly and persistently guided through this deadlock and express and come to terms with these ancient traumatic memories and feelings. It needs to be a place where she cannot resort to self-harm during what will, inevitably, be a very painful process. But it would discharge this terrible tension, which could transform her life. Yet on the other hand some say that residential units can be 'contagious' and spending all your time with a group of people with similar problems can validate and stimulate yours. But this is all by-the-bye because the NHS doesn't seem to have of offer such a thing, and going private is absurdly expensive, far beyond our now shrunken savings. But I feel I must. do. something.
This has all been hellish, and most of all it's not good for the children. But anyway it's late now. Sorry this is so long. I'm wondering, has anyone else encountered or experienced this sort of thing? If so how was it resolved? Am I missing something obvious, or are there any other options I haven't considered? Should I even post this..??
Thanks
PS: Ironically I get on quite well with the mother-in-law. We had a few sharp disagreements early on but now we manage pretty well. If you weren't brought up by her or married to her she has no power over you and you see through her scary hypnotic weirdness like it's a magic trick. Her saving grace is that she's brilliant with babies and little ones, especially if they're ill and they've both been reasonably decent grandparents. I feel sorry for her ultimately, as she's a victim too. Inside she's about seven years old. But nevertheless she is primarily responsible for this mess.