How would I see love in a picture? I wondered. Okay, so maybe I’m not that photogenic, and the photographer had to coax me to smile and get the pose right, but the pictures look fine to me.

I wasn’t going to argue with Avigail, though. Instead, I consulted with some mentors, who encouraged me to be more verbally affectionate. At one point, in desperation, I called Avigail’s kallah teacher and asked her to please explain to me what I was doing wrong. The kallah teacher spoke to Avigail and gave her some encouragement.

“It seems to me that you have a very caring husband who wants the best for you,” she said. “Maybe you should be taking more walks together.”

We received quite a few suggestions like that, and I embraced each one eagerly, thinking that this new bit of advice was the key to becoming the good husband I sought to be. One experienced mentor suggested that I read the book Men Are from Mars, Women Are from Venus, and in that book I discovered that women crave empathy and don’t appreciate hearing fix-it solutions from their husbands. Wow, I thought. If only I had been told that earlier. Now everything is going to be great.

But the empathy I offered did not make Avigail any happier with me. On bad days, she alternated between angry outbursts, tearful tirades, the cold shoulder, and the silent treatment. Even the most innocuous conversation had a way of turning into an argument, leaving me baffled anew each time as to what I had done wrong.

And then there were the good times, in which Avigail was smiley, chatty, easygoing, and humorous. Nothing was a problem then; if I accidentally left my cup on the table, she would make a joke out of it — as opposed to the times she told me I must really hate her if I could leave my cup on the table.

Sometimes, we could go a month without a single argument, and sometimes, we could have five arguments in one day. I could never predict when my actions would be totally okay with Avigail and when the smallest thing I did would be proof I didn’t care about her.

Throughout these ups and downs, my mother’s words kept echoing in my ears, as I told myself that I have a lot to learn about being a good husband. Never did it occur to me that something else was going on besides my own unpreparedness for marriage.

Avigail’s irritability and volatility became much more pronounced after the birth of our first baby, and other people — both inside and outside the family — began to pick up that something was not right with her.

“Asher, what’s with your wife?” people would often ask me. “She seems so aloof, so out of it.”

Avigail struggled with nursing and caring for the baby, but when I tried to help, she displayed fierce resistance to my involvement. And woe unto me if I dared suggest something that might help the baby eat better or cry less.

“You think I’m not capable of being a mother!” she would shout at me. “You’re always doubting me!”

I learned very quickly to mix out.

At around this time, I found Avigail crying on several occasions about things that had gone wrong between her and her mother. So maybe it’s not just me, I thought to myself.

It was my mother who pushed me to get Avigail to see a therapist and gave me the name of a Mrs. Levitsky, whom she had heard good things about. Knowing that Avigail would not be open to seeking help for herself, I suggested to her that we go for marriage counseling. She was resistant to that idea as well, until I said, “Maybe the marriage counselor will be able to help you sort out your relationship with your mother.”

For some reason, that prospect appealed to Avigail, and she agreed to come with me for counseling. My mother provided me with the name of a top marriage counselor, and we made an appointment to see her.

After first speaking to Avigail individually, the marriage counselor called me in to speak to me alone.

“What’s troubling you in your marriage?” she asked.

“Nothing,” I said, “other than the fact that my wife feels I don’t care about her.”

“Do you care about her?” she asked.

“Of course I do,” I said. With that, I promptly burst into tears.

“I see you really do care about her,” she murmured. “It seems to me your wife has some emotional baggage.”

Hearing this was a huge relief to me. Until that point, I had truly believed that the problems were all my fault: I didn’t know how to be a husband, I wasn’t affectionate enough, I was somehow uncaring and unloving. Now I understood that there was more going on, and it had little to do with me.

The marriage counselor then called Avigail into the room and spoke to us together. “I suggest that Avigail find a good therapist and work through what’s causing her distress,” she said.

When I mentioned Mrs. Levitsky’s name, she agreed that she could be the right person for Avigail.

The process of therapy proved very difficult for Avigail, as it brought up all sorts of painful issues. I did my best to be supportive and encourage her to keep going, which meant that I had to come with her for joint sessions on many occasions to learn how to be there for her in the ways she needed me to. In general, though, Mrs. Levitsky was not very forthcoming to me about what was going on with Avigail.

When I asked her privately what she thought the main issue was, she replied, “Oh, Avigail has some anxiety.”

I did not see any improvement due to the therapy, but I figured that my role was to keep quiet and be consistently supportive, so I duly sent Mrs. Levitsky an expensive shalach manos for Purim and made sure Avigail always had money to pay for her appointments.

About a year after Avigail started therapy, her closest friend — a loud, jolly, bubbly girl — got engaged, to a chassan who was equally loud, jolly, and bubbly. This chassan had a lot of action happening around him, and he and Avigail’s friend made a very excited-looking pair. Seeing the excitement between them during their vort and wedding triggered Avigail in an unprecedented way.

“You see?” Avigail cried to me. “That’s a good husband. Why can’t you be like him?”

At a loss for how to respond, I called Mrs. Levitsky.

“Tell Avigail to come see me immediately,” she responded.

When Avigail came into her office for a special appointment, Mrs. Levitsky was blunt with her. “You can’t expect your husband to be your friend’s husband,” she told her. “Comparing him to your friend’s husband is the worst thing you can do for your marriage.”

She didn’t stop there. “I want you to go see a psychiatrist immediately and get a prescription for medication.”

When I heard this, I called up Mrs. Levitsky myself. “I don’t understand,” I said. “Avigail has been seeing you for a long time already, and I haven’t seen any real progress. If she needs medication, why didn’t that come up earlier?”

“Are you kidding?” Mrs. Levitsky responded. “I’ve been talking to your wife about medication from the first day she stepped into my office! But she was so resistant to the idea that I had to carefully plant seeds during every session so she would eventually agree. Now that we had this blowup with her friend, I finally have an excuse to get her to see a psychiatrist.”

The psychiatrist diagnosed Avigail with generalized anxiety disorder (GAD) and prescribed medication for her. Upon reading the package insert that came along with the pills, Avigail expressed to me how relieved she felt. “This describes exactly what I’ve been experiencing since high school!” she exclaimed. “I never understood it before. Now I realize that I’ve been suffering from a chemical imbalance. My life finally makes sense!”

Things started to make sense to me, too. I had always interpreted Avigail’s anger and sadness to mean that I was doing something wrong; now I understood that her outbursts were the result of a deep-seated inner fear that she wasn’t worthy of being loved. The problem wasn’t that I didn’t love her — it was that she felt unlovable, which was why she interpreted my every action as proof that I was uncaring. If I had been unprepared for marriage, I finally realized, it was because I knew nothing of mental health conditions and automatically blamed myself for whatever issues we were experiencing.

Our relief upon receiving a clinical diagnosis was short-lived, however, since the medication actually made Avigail’s symptoms worse. She became more explosive, expressing her anger far more vocally and frequently than before. If in the past she had cried to me that I didn’t care about her, now she would scream it at the top of her lungs.

We went back to the psychiatrist, who switched Avigail to a different antidepressant. When that didn’t help, he raised the dosage. When that didn’t help, he told us he wanted to try giving Avigail lithium, and he sent her for a blood test before starting it.

I did some research and discovered that lithium is prescribed for bipolar disorder, and that it is a much more serious medication than the antidepressants she had been on until now. This made me nervous, so I raised the issue with Mrs. Levitsky, who was still seeing Avigail regularly. She recommended that we switch to a different psychiatrist, Dr. Mildred Banes.

Until now, the visits to the psychiatrist had been covered by our insurance, but now each visit to Dr. Banes was costing us $400 out of pocket. She concurred with the first psychiatrist’s diagnosis of anxiety and recommended that we keep experimenting with different antidepressants and dosages until we got it right.

During each visit, Dr. Banes would ask Avigail how she was doing and Avigail would say, “Fine.” In general, Avigail presented beautifully in public. With the exception of the months after birth, when she was noticeably depressed, she never displayed volatility to anyone other than me, and perhaps her own parents. Each time we met a new doctor or therapist, she came across as put together, capable, and perceptive, giving off no hint of the way she related to me when we were alone.

When she told Dr. Banes, in my presence, that everything was fine, I thought I was going to faint. Things were not fine at all. Avigail was extremely irritable, complaining about every little thing I did, from the way I opened the tissue box to the way I chewed my food to the way I swept the floor. She could give me the cold shoulder for five days because she was displeased with the greeting I gave her once when I entered the house — and I would have to plead with her for days to tell me what I had done wrong before she would clue me in.

When I expressed my concerns to Dr. Banes, she said, “I don’t know. Based on what your wife is telling me, she’s responding well to treatment.”

Finally, after I insisted that something was wrong, she agreed to raise the dosage. But again, there was no improvement.

Both my parents and my in-laws kept noticing that something was wrong with Avigail, and they nagged me to find out what the problem was. “What should I do?” I asked them. “She’s on medication. The second psychiatrist agreed with the first one.”

My mother did some research and suggested that we see an even more prestigious — and expensive — psychiatrist. This third psychiatrist echoed the diagnosis of the first two, and recommended that we continue seeing Dr. Banes.

“Stop second-guessing your provider,” she chided me. “Just continue with treatment.”

Having heard from three psychiatrists that Avigail was receiving the correct treatment, I felt resigned to the situation, even though I knew things were not the way they should be. Avigail continued taking the medication, with no improvement. Our second son was born three years after the first, and again Avigail had some sort of postpartum reaction, but that only prompted further tweaking of medications and dosages, with little effect.

When our older son, Zevy, was five years old, I noticed that he, too, was suffering from his mother’s extreme irritability, chronic criticism, and angry outbursts. I made a point, therefore, of taking him out of the house as much as possible and spending calm, happy time with him. Despite my efforts, however, his behavior was unruly, defiant, and explosive.

Avigail and I consulted with a parenting coach, who gently encouraged her to be more present and loving with Zevy. But Avigail decided that what Zevy needed was strict discipline and boundaries, and she insisted on punishing him each time he spilled his drink, left a wrapper lying around, or dawdled before bedtime. When I quietly pointed out to her that these were normal behaviors for a five-year-old, and reminded her that the parenting coach had advocated a more positive approach, she flew into a rage and accused me of being unsupportive.

She was also becoming more depressed, and also panicky, despite taking her medications religiously. Plus, she was suffering from debilitating back pain. She went for numerous tests and scans, but no cause was found for the pain.

Her backaches did have one small upside. When she was in one of her sulking moods and would refuse to come to the Shabbos table, if the kids asked me where Mommy was, I could at least look at their sad faces and say, honestly, that she had back problems and couldn’t sit.

Feeling that things could not go on like this, I called Relief Resources and asked for the name of the best psychiatrist out there. I felt foolish seeing a fourth psychiatrist after hearing the same diagnosis and recommendations from the first three, but I was the one who had to live with Avigail, and I knew that her issues were not being treated properly.

Relief gave me the name of a psychiatrist, Dr. Reisner, who was reputed to be the “king” of his field. His office was a two-hour drive away, and he charged $1,000 — out of pocket — per visit.

While we were driving to see him, Avigail turned to me and said, “You know, you should be the one going to see this Dr. Reisner. You have an issue, not me.”

I nodded. “Could be,” I said.

Dr. Reisner listened carefully to both Avigail and me, meeting with each of us separately in order to get a clear picture of what was going on.

“Anxiety is not the problem here,” he said, at the end of that first visit. “The correct diagnosis is cyclothymia, which is characterized by frequent mood swings. It’s a distant cousin of bipolar disorder, but differs in that the symptoms are much more subtle.”

Neither of us had ever heard of cyclothymia, but Dr. Reisner assured us that we were hardly uneducated in this regard, since it is a little-known condition that overlaps with many other mental health conditions, including anxiety, depression, bipolar disorder, and borderline personality disorder.

“Many psychiatrists don’t know how to diagnose it,” he said. “They’ll treat it as anxiety or depression, but the medications for those conditions actually aggravate cyclothymia.”

Bingo!

“It can take years before cyclothymia is accurately diagnosed,” he continued. “And it’s usually a spouse or other close family member who provides the information necessary for the diagnosis to be made. That’s because the disorder affects self-awareness, so people who suffer from it do not have a good handle on their own behavior and tend to downplay their symptoms when talking to therapists or doctors. Instead, they blame their loved ones for whatever feels wrong in their life or relationship. Around people outside the family, they typically seem charming, upbeat, and capable, even if around close family they’re sullen, irritable, and harsh much of the time. There’s no way a mother with this condition will have reasonable expectations of her children and be attuned to their needs.”

Bingo again!

Dr. Reisner prescribed mood stabilizers for Avigail, and she responded beautifully to those medications. Suddenly, the smiley, easygoing, delightful Avigail reappeared — and remained that way consistently. For the first time in our marriage, I did not have to worry that the tiniest thing that went wrong would send her into a tailspin of recriminations. She started to be patient with the kids, spending relaxed time with them and showing them love instead of showering them with criticism. And her backaches disappeared completely.

The transformation was miraculous. Even the wedding pictures that Avigail had previously hated suddenly seemed beautiful to her. Having read up on cyclothymia — in invaluable books such as Soft Bipolar, The Cyclothymia Workbook, and Bipolar, Not So Much — I had learned that people with the disorder tend to misinterpret facial expressions and wrongly ascribe negative or hostile intentions to others. But that was a thing of the past — or so I thought.

The medications Avigail was taking were not compatible with pregnancy, and after about a year of taking the mood stabilizers, she started expressing her intense desire for more children. Dr. Reisner agreed to wean her off the medication temporarily so that she could have another baby, and a year later we had a girl.

I had expected that after the birth Avigail would go right back on the mood stabilizers, but she refused, at first because she couldn’t nurse while on them and later because she didn’t want to be on medication at all. But her behavior during the pregnancy was difficult to handle, and it escalated after the birth. She would yell at me that I was a bad husband and refuse to come along to close family simchahs and events, which was extremely embarrassing for me. At times, I would beg her, with tears in my eyes, to come along with me to a Shabbos meal after we had been invited to eat out. She wouldn’t hear of it, though, and would stay in her room while I went alone with the kids.

Both older kids started displaying symptoms of anxiety at this point, becoming clingy and whiny. Zevy, who was already eight, reverted to throwing tantrums like a two-year-old. Avigail’s strained relationship with the kids, I realized, was mainly a result of her perception that when they misbehaved, they were out to get her. This evoked a head-on response from her, and I knew that only medication could fix that perception. But my pleas that she resume medication made her turn against me in fury as well.

I began to seriously contemplate divorce at this point, but I knew that it would be terrible for the kids to be alone with Avigail, who would probably have custody most of the time. I also felt that the instability of divorce would be worse for them than the volatility of their current situation.

Avigail adamantly refused to see a psychiatrist, but, after much urging on my part, she did agree to go back to Mrs. Levitsky. Again, Mrs. Levitsky spent session after session warming her to the idea of medication, and eventually she agreed to see a psychiatrist at a local clinic.

I made the huge mistake then of not insisting that she go back to Dr. Reisner. He was far away and prohibitively expensive, I reasoned, and we were still in debt from the therapy and psychiatric bills we had accumulated over the years. Besides, we already knew what the correct diagnosis was and had good experience with the medications Dr. Reisner had prescribed. All we had to do, then, was ask the local psychiatrist for a new prescription of the same medications, and we’d be all set.

It turned out that this psychiatrist, Dr. Lauren Kreitowitz, believed in empowering women to be their own advocates. When Avigail came to her and said flatly, “I’m here because my husband wants me to be on medication,” Dr. Kreitowitz’s antennae rose immediately.

“Oh, my,” she said. “You can’t let yourself be controlled like that. You need to be managing your own health and working to regain your individuality. Your husband should have no say whatsoever in your treatment.”

After hearing Avigail’s description of herself as “totally fine” and of me as “unloving and uncaring,” Dr. Kreitowitz assured Avigail that she did not require medication. In subsequent visits, she began coaching her to be more assertive and even consider divorce.

Knowing that Avigail’s core problem was that she couldn’t feel loved, I became increasingly alarmed by the advice the psychiatrist was giving her. Mrs. Levitsky agreed that only medications would make Avigail feel that she was truly loved, but neither of us could sway her to see a different psychiatrist or even consider requesting medication. And the more I challenged Dr. Kreitowitz’s assessment and begged Avigail to go back to Dr. Reisner, the more I played into the narrative of the controlling, neurotic husband.

“You’re the problem!” Avigail would yell. “You think I’m crazy! You have no right to mix into my life!”

“I don’t think you’re crazy at all,” I would say, trying to stay calm. “The fact that you have a chemical imbalance that makes you need medication doesn’t make me look down at you at all. Actually, it makes me respect you more, because I realize how much you have to handle. If I were in your shoes, I probably wouldn’t handle it nearly as well.”

But these words, too, were construed as manipulative.

Hearing again and again how manipulative I was made me start doubting my own sanity: Maybe I was the problem? The books I had read on cyclothymia advised against entering an argument with a cyclothymia sufferer, because that invariably triggers a fierce response and exacerbates the issue, but how could I remain silent when my wife, my children, and I were suffering so severely?

Finally, in desperation, I contacted the marriage counselor we had seen way back after the birth of our first baby, and brought her up to date on the situation.

“What I’m going to tell you now is going to make your wife feel very alienated from you,” she warned me. “But you really have no choice. You need to make it clear to her that either she goes on medication, or you’re leaving.”

I could not bring myself to actually say those words to Avigail, but the marriage counselor’s advice did give me the confidence that I was doing the right thing by pushing my wife to take mood stabilizers.

Now, with the backing of the marriage counselor and Mrs. Levitsky, I began bombarding Dr. Kreitowitz with emails filled with information about cyclothymia, and explaining how this condition often goes misdiagnosed and mistreated, even by competent professionals.

“Research shows that one out of every three people who seek help for depression actually have cyclothymia,” I wrote. “And it’s so hard to recognize that it typically takes ten years to accurately diagnose.”

I also described to her the severe impact on my children. I got nowhere with this approach, however, except to reinforce Dr. Kreitowitz’s perception of me as a domineering, manipulative husband.

But then Hashem made a miracle happen. Dr. Kreitowitz took a sudden leave of absence, and her replacement — a young, newly minted psychiatrist — showed willingness to hear my side of the story and consult with more experienced doctors about cyclothymia.

When he became convinced that Avigail needed mood stabilizers, he told me, “Don’t worry. I’m going to get your wife to take them.”

I don’t know exactly what he told her, but she left her second session with him with a prescription, which she promptly filled.

That was two years ago. Since then I once again have a wife, and my children once again have a mother. And my wife can’t get over what a great husband she has.

In the past, many well-meaning relatives, friends, and therapists offered advice and suggestions for how to solve the children’s “issues,” but this just got Avigail preoccupied with futile and counterproductive solutions, such as seeking to change their schools or medicating them. Today, baruch Hashem, it is abundantly clear that all they needed was a stable mother.

Psychiatric medication, I’ve learned, is a double-edged sword. The wrong medication can cause horrendous results, and it can take many years, and consultations with numerous professionals, before the right medication is found, especially for a little-known condition like cyclothymia. But it’s worth pursuing the correct diagnosis and treatment, even if it means challenging the assessments of countless doctors, because the right medication can be lifesaving.

It saved my life, and the lives of my kids, for sure.

The narrator may be reached through LifeLines or the Mishpacha office.

(Originally featured in Mishpacha, Issue 820)