How one marriage survived multiple episodes of psychosis and suicidal depression

Mark Lukach met his wife Giulia in the Fall of 2000 when they were both eighteen at Georgetown University in Washington, DC. By the first winter break, they were already talking about how many kids they wanted to have together. They married and moved west to live the California dream.

Giulia’s first psychotic episode came unexpectedly. It was their third year in California. Giulia had just started a new job. She was uncharacteristically anxious. She began obsessing over simple emails. She lost her appetite. She had difficulty falling asleep. And then the delusions started.

Giulia came to believe that she was the source of all the bad in the world. She became suicidal. Terrified, Mark drove her to the hospital, even though she resisted.

“At the hospital, they were throwing around terms that I didn’t understand like psychosis,” Mark told an audience of 1200 people gathered to hear his keynote speech at Breakfast of Champions, an event hosted by Canadian Mental Health Association Middlesex and St Joseph’s Health Care Foundation in London, Ontario. “I had no idea what was happening to her, and I had no idea what was happening to us.”

Mark went on to write about his experiences with Giulia in the bestselling book, My Lovely Wife in the Psych Ward. Giulia has now been hospitalized a total of three times with psychosis and suicidal depression.

The first hospitalization

During that first hospitalization in 2009, Giulia was offered anti-psychotic medication. She refused. “I had to confront what love actually looked like,” Mark said. “The harshness of what love can be, not just the fun and joy. But that sometimes when you love someone, you have to choose between one horrific choice and another.”

Giulia was held against her will, which meant that if she refused medication, hospital staff could forcibly inject her. “That’s what I thought she needed,” Mark said. “And I never actually sat in the room and watched as hospital orderlies held her down and put medication into her hip. But that’s a trauma…” his voice cracked in disbelief as he looked back on it “…that I wanted for her. Because I was so scared of what no care would look like.”

There was no one there to help him navigate these choices. “I felt like I was operating on instinct.”

After discharge

Giulia was discharged after twenty-three days. She was heavily-medicated and intermittently psychotic. One of the few things that she wanted to talk about with Mark was suicide. “It was like the dessert she was looking forward to at the end of the day.”

Mark took a three-month leave from work to be with her. “It’s the loneliest I’ve ever felt in my life,” he said. “It’s the most scared I’ve ever felt in my life. I felt like I was grieving for someone who was with me every day.”

He pretended that none of it bothered him because that’s what he believed he needed to do. He was the cheerleader for Giulia, but inside, he was completely falling apart.

Because Giulia was still suicidal, Mark had to hide her medications in different locations around the house to prevent her from overdosing. This involved elaborate deceptions. And when it came time for her to take her meds, he made her open her mouth to prove to him that she had swallowed them.

“She used to call me the medicine Nazi in her support groups,” he said. “And I understand why. But it still hurt me…”

After the initial crisis

And then, after nine months of utter heartbreak, her doctors finally found the right combination of medications. Within a matter of three days, her depression was gone. Her suicidal thoughts were gone. Her lethargy from the medications was gone.

It was disorienting.

“All of a sudden, this woman that I thought I had lost was back. And now we didn’t know how to be together… All those bottled-up feelings? Now I was letting them out.”

He wanted her to know how hard it had been for him. Meanwhile, she couldn’t understand why he couldn’t just be happy now that she was better after going through the worst year of her life. Mark recalled that it was during this period – after the initial crisis had passed – when their marriage was under the most strain.

Letters to Giulia

Whenever they tried to talk things through, they ended up fighting. After a while, Mark discovered that the best way he could explain himself to Giulia was to collect his thoughts and write letters to her which she could read when she was ready. Each letter set the table for a conversation. These letters were later compiled in the book, My Lovely Wife in the Psych Ward.

Mark believes that the book and the New York Times essay that preceded it received such an overwhelmingly positive response because they were “tapping into this unbelievably universal experience of caring for someone, not knowing how to help them, unintentionally maybe hurting them, and then needing to process that.”

The second hospitalization

Mark and Giulia moved on with life. They had a baby boy together. They wanted to believe that her psychotic episode was a one-time deal, but in 2012, five months after their boy was born and shortly after Giulia returned to work from maternity leave, she had her second psychotic episode.

Heading to the emergency department this time, Mark felt confident. “I’ve been here,” he told himself. He thought once the doctors got Giulia’s meds sorted out, she’d come home, and everything would be okay. Then Giulia’s doctor pulled him aside. She told him: “You have no idea what you’re doing. Yes, you’ve been here before. But now you have a baby.” She was right. Caregiving for a psychotic wife with a five-month old at home was when Mark felt the most desperate. “I probably didn’t have the capacity to be there for these two people who needed such different things from me.”

Taking a step back

It was after this second episode when Mark took a step back and began to recognize how his efforts to enforce Giulia’s treatment regimen – advocating that she get an injection against her will, always checking that she took her pills – made her feel. He realized he needed to hear what she was actually saying.

Mark’s advice for family caregivers looking after someone with a mental illness is this: “I think the single greatest gift that you can give someone is to listen to them, not necessarily jump to action.”

Giulia’s third hospitalization in 2014, when their son was two-and-a-half, was the least traumatic. Mark knew what care Giulia wanted. That’s because they’d talked about it after her second hospitalization. He was able to act on her behalf, not based on what he assumed she wanted.

For example, after her second hospitalization, they discussed what to do with their son if she was ever hospitalized again. Should Mark bring him to the hospital to visit? She said, “Absolutely not. I don’t want him to see me in a psychotic state. I think a psych ward is too scary for a child. So, no. Please do not bring him.”

He was glad he knew that because when she was hospitalized for the third time, she called him fifteen times a day and asked him to bring their son. Instead of having to simply forbid it – and put further strain on their marriage – Mark was able to remind Giulia that they’d discussed this before and she didn’t want their son coming to the hospital.

Key takeaways

Based on his experiences, here are three things Mark thinks are important for family caregivers to focus on:

Actively listen to the person you're looking after
Plan for future relapses as a way to create a harmonious recovery plan
As a family caregiver, prioritize self-care and avoid isolation