Blame it on illness -- still?

Q: My wife was diagnosed as having BPD early January 2001. Since then she has been in an institution. When home on leave she seems to want to hurt me - not physicaly but by saying she wants to pick up where she left off - going out to clubs and so on . . . is this normal? My wife was unfaithful on several occasions over Christmas and appears to feel no remorse, guilt etc. she seems happy to blame it on the illness and expect me to accept this!

Dear Kevin --
Here's how I look at that.  It seems reasonable to "blame" behaviors while manic on bipolar disorder.  So looking backwards, maybe that's an acceptable explanation of stuff that happened when she was ill, including sexual acting out, which is pretty common in manic episodes.

But now, either she's not manic anymore, in which case she's fully responsible for her choices; or she's still symptomatic, in which case she needs to participate fully in treatment to bring those symptoms under control.  So, in either case, she's responsible now for these behaviors and can no longer "blame it on the illness".  Though it might be fair to ask you to accept what happened in the past, you shouldn't have to accept this now.  

Mind you, that's just my view.  I do really believe people are not able to make choices in the way they usually would when they are having a manic, or depressive episode.  Some people can't even make choices about treatment when they become ill, in the way they would if not ill.  However, it then becomes their responsibility when well to take responsibility for how they might act (by their history) when ill: block themselves from excessive spending by not carrying credit cards, for example; or in this case, recruit friends (not you) to help prevent her from sexual acting out, if that's really a "manic" symptom. 

Dr. Phelps

Published February, 2001