“There’s no handbook on how to survive your young wife’s psychiatric crisis,” writes Mark Lukach. When he and Giulia wed at 24, Mark was the dreamer; Giulia was the planner. He wanted to surf; she wanted three kids and a booming career by the time she turned 35. Then, at 27, Giulia had her first psychotic break. “Crazy in Love” is the story of their marriage: what happens when one spouse becomes the other’s keeper. Much of their struggle revolves around the idea that mental health treatment decisions should be taken out of the hands of doctors and caretakers and put in the hands of patients. Mark and Giulia learn about “mad maps,” tools for psychiatric patients to outline what they’d like their care to look like in future crises, much like advance directives for the dying. Those maps become a source of strength and hope as the couple and their son face the future.
Mark Lukach's Pacific Standard feature is available to subscribers—in print or digital formats—now, and will be posted online in full on Monday, January 12. Until then, an excerpt:
There's no handbook on how to survive your young wife’s psychiatric crisis. The person you love is no longer there, replaced by a stranger who’s shocking and exotic. Every day I tasted the bittersweet saliva that signals you’re about to puke. To keep myself sane I hurled myself at being an excellent psychotic-person’s spouse. I kept notes on what made things better and what made things worse. I made Giulia take her medicine as prescribed. Sometime this meant watching her swallow, then checking her mouth to confirm that she hadn’t hidden the pills under her tongue. This dynamic led us to become less than equals, which was unsettling. As I did with my students at school, I claimed an authority over Giulia. I told myself that I knew what was better for her than she did. I thought she should bend to my control and act as my well-behaved ward. This didn’t happen, of course. Psychotic people seldom behave. So when I said Take your pills or Go to sleep, she responded badly, often with Shut up or Go away. The conflict between us extended to the doctor’s office. I thought of myself as Giulia’s advocate, but often, with her physicians, I didn’t side with her. I wanted her to follow medical advice that she herself did not want to follow. I’d do anything to assist her doctors with their treatment plan. I was there to help.
Once discharged, Giulia’s psychosis lasted another month. It was then followed by an eight-month-long haze of depression, suicidality, lethargy, and disengagement. I took a few months off of work to be with Giulia during the day and keep her safe, even get her out of bed. Throughout, her doctors kept tweaking her meds, trying to find the best combination. I took it upon myself to make Giulia take her pills as prescribed.
Then, finally, almost abruptly, Giulia was back. Her psychiatrists told us that her long episode was probably a one-and-done thing: major depression with psychotic features—a dressed-up term for a nervous breakdown. We needed to be proactive and careful about Giulia maintaining balanced and stable habits. That meant her staying on the pills, going to bed early, eating well, minimizing alcohol and caffeine, exercising regularly. But once Giulia returned to health we greedily inhaled our normal lives—windy walks on Ocean Beach, actual intimacy, even the luxury of stupid, meaningless fights. Soon enough she was interviewing for jobs, and landed a position even better than the one she had left when she was hospitalized. We never considered the possibility of a relapse. Why would we? Giulia had been sick; now she was better. Preparing for further illness felt like courting defeat.
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