What do you do when your wife starts talking to the devil? That was the question faced by history teacher Mark Lukach in 2009, when his spouse, Giulia, had a sudden and unexpected psychotic episode. In Lukach’s affecting memoir, My Lovely Wife in the Psych Ward, he chronicles what happened before and after he took Giulia to an ER in San Francisco for treatment. It’s a moving account of what it’s like to watch a loved one come undone.
Nine years prior to the crisis, they were college sweethearts—lovestruck, with a bright future. After graduating from Georgetown University in Washington, D.C., they married and moved to San Francisco to start their new life together. Lukach couldn’t have been more proud of his wife, an ambitious striver who aced her internships in advertising and the fashion industry.
Soon after landing her dream job in San Francisco, however, Giulia stopped sleeping and eating. Within a month, she became paranoid and suicidal, and started talking to God, then the devil. It was a shock to everyone—her family, her friends and, most of all, her husband. After spending 23 days in the psych ward, Giulia went home with a shaky diagnosis and an ever-changing cocktail of medication. A crippling depression consumed Giulia for nearly a year. When her recovery finally seemed complete, Giulia and Mark had a baby and Giulia went back to work. Sadly, Giulia’s psychotic break wasn’t an isolated incident. She had two relapses over the next five years.
Lukach spoke with Maclean’s about Giulia’s mental-health crisis, what compelled him to write the book, and why he decided to go public. The interview has been edited and condensed.
Q: Why was Giulia’s breakdown such a shock to everyone? Weren’t there any warning signs?
A: No! She’s incredibly ambitious and accomplished. She graduated college with a near-perfect GPA. She had amazing internships during the summer in New York at an advertising agency and in the fashion industry. She’s a really remarkable person with a long track record of success. She always defined herself as a strong, independent woman. She’s also got a little sass, which is fun. When she started a new job in San Francisco, we both anticipated it was going to be great. There was no reason to believe otherwise. Then, soon into her new job, at age 27, she had her first psychotic break.
Q: Isn’t 27 late for schizophrenia to present itself, if it’s schizophrenia?
A: Yes. That’s why coming up with a diagnosis was so difficult. Schizophrenia was their first diagnosis, but they changed it multiple times. It was atypical to have someone in their late 20s with schizophrenia who was so accomplished. Bipolar disorder typically manifests itself earlier, in late adolescence and early 20s. The doctors really struggled. She didn’t fit into any textbook category.
Q: Describe Giulia’s psychotic break.
A: At first, it was appetite loss, sleep loss and work paralysis. Menial tasks became quite difficult. She had a total loss of confidence. She was anxious and indecisive about a lot of things. It escalated. Her psychosis included paranoia and some hallucinations. She believed she was having conversations with God, at first. That’s why I was lulled into being optimistic, because the conversations she had with God were actually reassuring. But then she had conversations with the devil, and they were really alarming. He was saying things to her like, “You’re never going to make it out of it. You’re not worth saving. The evil in the world will disappear if you die.”
Q: How much time passed from the beginning of her symptoms to the first hospital visit?
A: It was six weeks from the start of her new job to the ER visit and the hospital. It was so drastic, so fast, with no pre-existing signs. It was extremely atypical.
Q: Will you take the readers through the ER experience?
A: The nurses and doctors immediately gave Giulia anti-anxiety medication. They had no idea what was wrong with her. I thought the ER would find the cause. Next, they said they had to get her to a psychiatric facility in a partner hospital. We sat around for about six hours, waiting for a bed. It happened fast when they found a bed. They put her on a stretcher and I had to follow the ambulance in our car. They processed her in the psych ward. They were overworked and didn’t have the time to help me understand what was going on. They focused on getting her into their system, not explaining what that looked like to me. The door was closed in my face and I was told to come back during visiting hours. It was terrible. I can’t overstate how miserable it was.
Q: How did your friends and family react?
A: They were alarmed and sad and had no idea how to help. There was a sense of powerlessness. What do you do? There was a lot of hand-wringing. It felt like I was grieving someone who was alive. I was processing that the rest of our life may never be the way it had been.
Q: If Giulia had a broken leg, not a mental-health crisis, would people’s reactions have been different?
A: Very. With issues of mental health, there’s a lot of speculating. If someone’s diagnosed with cancer, you don’t spend a lot of time trying to lay blame where the cancer came from. With Giulia, there was a lot of “why did this happen? What’s the source—is it chemical, a manifestation of something?” It wasn’t ill-intended. It’s just a natural reaction to mental illness. Over time, I had to let go of it. I’m not going to understand what it is. The brain’s too complicated to understand. We think a lot about cures. We don’t like the idea of saying, “This might come back”. That feels like you’re not winning. Winning is beating it. Another part of our situation is accepting that we’re not going to “beat” this thing. We can only live with it and not be so disrupted by it.
Q: Did you ever consider leaving the marriage?
A: During the crisis, no. By the time she got sick, we’d been together for nine years, married for three. They were nine incredible years. I couldn’t see her as anything else but family. The hardest parts weren’t during the crisis, but after, when we were trying to put the crisis in context and move forward. We questioned the strength of the marriage and had a hard time seeing eye to eye. When she was healthy, we said, “Oh God, look how we’re treating each other now. What are we doing?”
Q: How did you deal with the pain and resentment of being forced to do all the parenting yourself when Giulia relapsed, just five months after the birth of your son, Jonas?
A: I learned that self-care is a crucial investment. Happiness was a default for me, because of my very privileged upbringing. I never saw happiness as something you had to work for or earn. When Giulia was sick and I was a solo parent, I had to schedule things to remind me why I liked to be alive—like running or surfing. I started seeing a therapist the week she was in the ER. I eventually learned to carve out time to be physically active. I had to learn how to take care of myself so that when I’m at the forefront of caring for others, I can be at my best.
Q: How do you cope with a spouse who openly talks about committing suicide, as Giulia did so often?
A: At first, my instinct was a natural one—to try to talk her out of it. I’d try to rationally explain away her irrational impulse. It took me a long time to realize it wasn’t helping at all. She wasn’t feeling heard. One night, I was beaten down by exhaustion, and I couldn’t muster the energy to go into my hour monologue about why she should stay alive. So I let her talk. I learned to let her talk it out. It wasn’t dangerous. She felt better and it was a transformative moment for me. It’s important to acknowledge someone’s pain and their reality. She said some painful, horrible things about how much she hated herself and God had abandoned her.
Q: Was she particularly religious before the psychotic break?
A: The best way to describe us would be lapsed Catholics. We were both raised Catholic, but I was a bit more spiritual and religious than she was. We went to church sometimes for the community aspect. Giulia liked that.
Q: How did Giulia’s relapse after Jonas’s birth change fatherhood for you?
A: I’d been looking forward to being a dad since I was a kid—the adventure and fun of it. But with Giulia being sick, everything changed. Jonas’s pediatrician told me that children are super-resilient and as long as they have one stable parent, they can weather another parent who has ups and downs with their health. We had the plan that I was going to be the stay-at-home dad, so I expected a special bond that many dads don’t get, but I didn’t expect to be turning to Jonas for emotional comfort that first year. I also realized how much pressure that was to put on a six-month-old child.
Q: It was heartbreaking to read how Jonas shied away from his mother. Has that changed?
A: They have a great relationship now. But there are times when she’s going to have to take care of herself and we’re going to have to protect him so he doesn’t get scared by what that looks like. Her pattern goes like this: very rapid onset, deep psychosis, which transitions into depression, which is also very deep and prolonged. Then, the fog clears and she re-emerges. It’s clear when she re-emerges, but it’s not clear what causes her to re-emerge. Once she’s out, we go back to our regular routine.
Q: You describe something called a “mad map.” How does it help?
A: We created a plan for how to deal with a relapse. When she’s consumed by psychosis and not acting rationally, she’s not making the best choices around things like her job, our child, our parents, her meds. Maybe she thinks her pills are poisoning her. So, the mad map was transformative for us because it allows Giulia to have autonomy and input. It is her health and her life.
I had a friend who was more of a radical thinker. He pointed me in the direction of writers who look at psychiatry as something different than just brain chemistry. There’s something called The Icarus Project, and they’re the ones I credit with introducing me to the mad map. It’s really just an advanced directive. People have those conversations about life support, so it’s a similar thing, but about mental health.
Q: Why did you decide to write this book?
A: Because Giulia and I needed to heal. Giulia needed to understand what I had gone through on her support team. She was having a hard time wrapping her head around that. So, I really wrote it for her so we could heal together, as a household.
Q: But why go public with such a personal story?
A: Mental illness isn’t something we should be ashamed to talk about. When Giulia was in the ER, I was on my phone Googling the terms the doctors and nurses were using, and looking for books I could read to better understand what she was going through. I was also looking for books to help me understand what I was going through, as the caregiver. What choices was I going to have to face? What could I expect? I found a lot of books about what Giulia would be experiencing—which is great—but there was nothing for the caregivers. I was disappointed. As I went through it, I was scared, overwhelmed and exhausted, but also really lonely. I’d never felt lonely before. I felt like the only person who had ever gone through this because I hadn’t found someone to tell me otherwise. For me, the hope for going public is to try to give other caregivers another perspective and they can feel less alone.
Q: How should the system change?
A: So much should change. We need more inclusive care. Giulia’s diagnosis was hers, but it’s also our family’s. My insurance provider only covered 30 minutes per month for me to see a therapist. I went out-of-pocket to therapy, sometimes twice a week. I needed help processing it. We need a model of mental health care that will cost a lot more money. We need it to be more slow and inclusive of the family—not just about symptom suppression. There are super-compassionate people in the system, but it would be life-transforming and family-saving if we could slow everything down and have longer conversations. For example, a three-hour appointment, not just a 40-minute intake interview.
Q: Is Giulia currently on medication? How’s she doing?
A: She is on lithium, which has worked for the last two and a half years. She’s back at work. She takes the meds every day to be able to be healthy for her family. She does it for us.