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‘I made a promise when we got married. I promised that I wouldn’t commit suicide,” says Laura Sanscartier. The 35-year-old vocalist lives in Dracut with her husband, Paul. She has bipolar disorder.

One in four Americans — approximately 61.5 million people — experience mental illness in a given year, according to the National Alliance on Mental Illness . The organization estimates that 211,000 suffer in Massachusetts.

There are secondary victims: a patient’s caregiver, often a spouse.

“I lost my husband and best friend . . . I am utterly heartbroken,” Susan Schneider, wife of the late Robin Williams, said in a statement after the actor took his own life in August during a bout of severe depression. The circumstances underscore the ordinary extraordinariness of living with a mentally ill partner. Schneider was reportedly out running errands when the comedian hanged himself.

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Paul and Laura married seven years ago. Laura was diagnosed with anxiety at 15, attempted suicide in her late teens, and her bipolar symptoms emerged in adulthood. She and Paul, who acts in his spare time, met at the theater.

“Before meeting him, I went through a period where I didn’t need to sleep. My speech was fast, I had creative bursts, I said ‘yes’ to a lot of stuff but couldn’t follow through,” Sanscartier says. She eventually became suicidal. She called her new boyfriend, Paul, en route to the hospital.

Early months of dating are awkward enough without throwing a mental illness disclosure into the mix. Dr. Ken Duckworth, the Boston-based medical director of NAMI, recalls a lecture he gave to 60 young-adult patients.

“I asked them a simple question: ‘At what point do you share information about your illness when dating?’ It became a two-hour conversation. Most waited to see how serious it was becoming and evaluated the tolerance for differences: How do they talk about people with disabilities? How open-minded and gentle are they?”

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Paul was both. “I kept bawling, ‘I’m so sorry. I’m just so sorry,’ ” Sanscartier recalls. “He said, ‘What in the world do you have to be sorry for? You’re battling an illness.’ ”

Paul now works full time at a Wilmington electroplating company; Laura collects disability and works at Dracut’s library. When she’s well enough, she sings onstage. For creative release, she blogs about her experiences at www.coffeeandlithium
.blogspot.com. They have no children but keep busy with theater, cooking, and friends. Many stay with Laura when Paul’s at work.

“He can’t stay home with me all the time,” she says. “Luckily, we have understanding family and friends. If I’m feeling like crap, they’ll come over. It’s a fly-by-the-seat-of-your-pants illness. If we need to cancel our plans, they understand.”

This can be as straightforward as postponing dinner dates or as devastating as hospitalization.

Sanscartier was recently released from inpatient treatment at Concord’s Emerson Hospital. Now she attends outpatient psychiatric therapy at McLean Hospital in Belmont.

For the Sanscartiers, a hospitalization choice is just one more marital conversation. “I’ll have uncomfortable feelings that get worse; then we’ll have a discussion. Paul will say to me, ‘You can’t hold it together right now.’ If I’m seriously considering suicide, I cry uncle. I want to keep my promise. That keeps me going,” Sanscartier says.

It can be a big burden for even the most loving spouse.

Sabrina Holley-Williams, 38, and her wife, Christine, live in Fitchburg. They met in college and have been married for 10 years. Christine dealt with depression when younger and her problems escalated in 2003, when she miscarried the couple’s daughter. A year later, she attempted suicide by overdose; Sabrina called the paramedics. Even now, Sabrina is remarkably rational recalling the incident.

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“I’m skilled at coping. I’m even-keeled to a fault,” she says. “Christine would have very low lows, but they would be short term. You just kind of coast through until the next incident,” she says.

Christine was relatively stable until the 10th anniversary of the miscarriage. In the past year, she’s been hospitalized six times. She attempted suicide again in June, in her therapist’s waiting room, by an overdose of prescription medication and Tylenol. Sabrina received a vague text from Christine while at work, tracked down Christine’s psychiatrist, and located her at the hospital, where she had suffered liver damage because of pill intake. Christine received short-term disability before returning to work.

“Sometimes the hospitalizations are a relief,” Holley-Williams says. “Christine is safe, and I have a break. You spend so much time caring for your spouse that it can become a coping tool. It’s a balancing act. I want to be proactive and responsible, but I also don’t want to push any buttons or upset her on top of everything else.”

Social worker Hilary Bye runs the Family Transitions support group at McLean. She often sees spouses suppress their needs to support a sick partner.

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“One of the biggest things is not to make them feel like the ‘patient’ in the relationship. They’re still the person you married; they’re an active contributor. Right now they’re just having a harder time,” Bye says.

But for marriages tinged with mental illness, it’s tempting to handle a partner delicately no matter what. Milk left on the counter? Keep quiet. Seething over chores? Do them yourself.

Bye cautions against this.

“This illness isn’t their identity. It’s a part of them, but it doesn’t define them. Although you’ll have to titrate at times, treat them the same. They still need expectations,” she says. “It’s tempting to go into ‘caregiver mode,’ but no person can do it all for one person — for six months or 60 years,” she says.

Spouses need an outlet, and talking helps. As mental illness remains stigmatized, though, honesty can feel like infidelity. “In the beginning, I felt like it was Christine’s life, her story to tell, her pain. It felt like a betrayal to talk to friends,” says Holley-Williams. “I didn’t think about it like I was also dealing with it.” Recently, the couple shared their ordeal on Facebook.

“People are afraid to ‘out’ their spouse. If this is a problem, just talk about it from your own point of view,” says Duckworth.

Support groups are a good starting point. Dennis is a facilitator with the Depression Bipolar Support Alliance of Boston. His former wife suffers from mental illness.

“I ran a spousal support group for six years,” he says. “It was difficult for me to talk about my partner’s illness because it wasn’t my own. I felt like I was violating her confidentiality,” which is why he asked that his last name not be used.

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“Everyone in our group was seeing a therapist themselves, and many were on medication. The only difference is that partners can always leave,” he says. Of the eight people in the group, four eventually divorced.

Mental illness often masks a marriage’s underlying issues. Andrew, now in his 30s, was married to a bipolar woman during his 20s. He’s suffered from depression but felt that his more manageable problems paled in comparison to hers. “I didn’t have to leave work just because I couldn’t get through the day,” he says.

Gradually he transformed from husband to helpmate. “I was walking on eggshells, and as with so many suffers, self-medication became part of the problem. It got to the point where friends wouldn’t want to go out with us because we wouldn’t know what could happen. There was always a chance of a public breakdown,” he says.

Her illness became the marriage’s foundation. “It wasn’t even an option to walk away. When someone tells you they would die without you, it makes it really difficult to leave,” he says. “In a weird way, it prolonged the relationship. We had ultimate incompatibility issues, but this masked it.”

Ultimately, his ex-wife left the relationship. He later remarried.

“A big part of it was we were almost looking at the condition as something to ‘fix,’ as if there wouldn’t be any underlying problems in the marriage after that,” Andrew says.

For couples dealing with mental illness, the work — and the support — continues.

“I’m constantly afraid that Paul might say: ‘This is my breaking point,’ ” says Sanscartier. “But he’s stayed with me. We hate the disease, not each other. Our marriage vows said, ‘For better or worse, sickness and health.’ And we meant them.”


Kara Baskin can be reached at kcbaskin@gmail.com