Managing expectations of function in spouse with Bipolar Disorder

Hello all. I've been a loved one to a spouse with bipolar disorder for a number of years. My spouse is mediated with lithium therapy and most of the time med compliant. I've been involved minimally in discussing treatment with his doc, but have tried over and over to discuss what we should be seeing as a result of medication. There seems no static answer to this question. How much should my spouse be functioning in order to say that he is being treated properly? What should he be able to do? What will he not be able to do?

He was a very high functioning person until he hit 40 and suddenly was like a different person. Things just really spun way up and he hung himself a few weeks later. He seemed before this to be somewhat eccentric in a very creative and non-destructive way. He was able to care for himself. But since we have done the rounds in the ER every 3 months to a year. The last few years, since we found lithium, things have been more stable. He does not need the ER, he does not attempt suicide. But he is unable to handle the stress of working away from home, he cannot seem to manage things like caring for himself in washing his clothes, remembering to bath regularly.

As a result of him not being able to work away from home ( I mainly think it's dealing with the personalities of those he would work with) we run a business together from home. He is only able to focus on a single task within this work and does so in an overkill way, working himself too much and overdoing the task in a large way; many times working 16 hours a day around the clock, 7 days a week. I have tried to encourage him to ease up, there is no perfection to achieve, relax a little. The result of him focusing so intently on a single task is detriment to the rest of his life. He spends no time with our child and cannot manage basic care for her, like changing a diaper, picking her up when she needs him, making sure her car seat is secured even though it's clear he loves her and enjoys her when he does take a moment. His personal hygiene falls apart. Any and all other responsibilities in his life are either left behind or I have to manage them.

There is so much more. Some examples: He avoids anything he dislikes completely in what I feel is an overreactive way, but maybe it's not.

(ex: He will come into a room where things are set a certain way, say we're eating dinner, and sit down. Then he will immediately start moving things around to suit himself. Like moving my drink because it's inconvenient for his elbow, but moving it across the room where I can't reach it.

Or say I'm settled down nursing baby on my side and I have something I'm watching on the laptop, he will enter the room and rearrange the laptop up high where I can no longer see it but it's convenient to him to see. If I mention that I can no longer see it he gets angry and says he feels unwelcome and leaves. )

A year ago I asked him to stop shifting things in this manner and he began sleeping on his office floor, on a hardwood floor. He does not seem to mind sleeping there though he says he would like to come back to bed and I have invited him to do so he continues to sleep on the floor in another room.

I worry about his frustration level with inanimate objects.

(ex: He constantly breaks things. Ex: For months I have had the Q-tips in a jar on the bathroom shelf. He knocked it off, breaking the jar, getting a Q-tip out a few days ago and all he said was "It shouldn't have been perched there precariously". No I'm sorry. He put the Q-tips into the sink and left them, he did not replace the container and blamed the Q-tips for him breaking them. He becomes angry with the inanimate object. He does this or something like it probably 2 times a day. )

Is this a managed person? Is this the best we can hope for? Is this what the meds can do?

I love my spouse. I want the best for him. But I can't seem to get any answers from his doc about what we should expect or what we should be seeing. Does anyone know?

That's not managed, IMO.

I'm stable on a combination of drugs. I'm still limited. I can only do a little work and it's with tons of accomodations. I have dietary limitations. I have to keep a regular schedule. Avoid stressful-everything (both good and bad stress).

For example, my fiance and I will not have a normal wedding. I can't handle the stress of it. I went off the deep end for 4 months after he proposed and I think it was another 4 months before my Dr. got me back to stable. That hurts to not have the dreamy wedding, but it's what I must do to stay stable and healthy.

Does he drink coffee or caffienated soda?

My SO also has a very large habit of taking anything that could be construed as even slightly critical or questioning of him very much to heart. He also has extreme avoidant tactics. Such as me asking him not to move things around to only suit himself and to instead move them to where they suit everyone resulting in him sleeping on a hardwood floor for the next year and refusing to discuss it. Any issue that may need correcting in an adult household that needs some work is strongly avoided by him and there is a refusal to either discuss or correct the behavior. This causes many problems.

Is this a bipolar symptom or a personality trait?

Caffiene is huge. HUGE. H-U-G-E. !

Last time I had more caffiene than in a soda I ended up in the psych ward. Point taken?