Q:  Concerns re: Wife's Risk of Another Episode

I am a neurologist. My wife is 42 and is not diagnosed BP, but has had several episodes of increased energy and excessive spending in the past. This summer she became intensely involved in the care of a friend, injured in an accident. She had increased energy, sleeping only 2-3 hours a night. She spent about $10,000 in 7 weeks, mostly on new clothes. She used 4600 cell phone minutes in one month. She stopped coming home at night. She was irritated when confronted about her activities. I think she had a manic episode. The episode seems over, but unfortunately it has damaged our marriage beyond repair. She has refused to even consider evaluation. Although we are divorcing, I am concerned about her risk of either a depressive episode or another manic event. Am I justified in my concerns? Any recommendations?

Dear S' --
Your concerns sound very justified. You could complete a mood disorders questionnaire (answering the questions as though you were her; I have family members do this from time to time) and hand that on to anyone whom you think might be in a position to help her in the future -- a family doc', a friend, her lawyer, her family, something like that. As long as you pass along this information as "I'm not sure, I'm just worried, draw your own conclusions", I would presume you could not be faulted for trying to create trouble for her using a stigmatized diagnosis -- you'd just be handing on your concerns to someone you hoped might be in a position to help if it were necessary (you might have to refer whoever you're working with in this respect to information on non-obvious bipolar disorder, e.g. my material on BP II, so they know that bipolar disorder is not always the more easily diagnosed full mania). I hope your actions are interpreted as those of a caring friend, and not as inappropriate meddling (I'd have to leave it to you to determine that risk). Good luck.

Dr. Phelps

Published October, 2003