She came up the stairs and was as beautiful as I had ever seen her. Giulia had shocked me with her beauty from the first moment I saw her – her graceful poise, her classy style, but most of all her casual way with it all, a beauty that was flawless and effortless. She almost never wore make-up, but she had put some on for today, along with her most chic sweater and pants. Her cheeks had the light blush of red from her scooter ride home across the city.

"How did it go?" I asked her enthusiastically, wrapping my arms around her before she could even get in the doorway.

"It was … good," she said, avoiding eye contact.

"Good?" I repeated.

"It was just the first day, Mark," Giulia said. "It's just, I guess, everyone is so smart and cool there. I hope I can keep up."

I had known Giulia for nine years, and she had always exuded confidence. I could always count on her thriving at work. I'd seen her do so across four internships and two jobs. She left each one to glowing recommendations and even brighter opportunities. This insecurity was new.

Giulia went to work, each morning taking a little bit longer to get herself ready, as if the right outfit or hairstyle would help her rediscover her confidence. I still had a month left of summer vacation, so I stayed at home and mostly futzed around our spacious, two-bedroom house in San Francisco's Outer Sunset.

Giulia and I talked and texted throughout the day as she struggled to find a sense of place at the new company. She needed me constantly for reassurance. She called one day while I was eating lunch and reading a book. I could immediately hear the uncertainty in her voice. "Hey, honey, would you do me a favour? I just sent you an email I've been working on for a little while. It's to my boss, and I want it to sound, you know, just right. Can you read it and make sure it's okay?"

"Yeah, of course, no problem. What's it about? It is something sensitive?"

"Just read the email, and let me know," she said impatiently. "Call me when you're done."

I logged on to my email.

Dear Jill

I wanted to follow up from our meeting about forecasting for the next quarter. As I'm still new to this company and position, I'm struggling a bit to keep up with the assignment. I hope this isn't a problem, and that we can find more time to talk about it.

Thanks

Giulia

"It's fine, Giulia," I said when I called her back. "It's polite and totally fine. It doesn't sound like a big deal."

"You don't think it's too much? Like, I'm not capable of doing my job? I don't want her to think I can't handle this." She was impatient and cold, as though she were interrogating me.

"No, not at all, it's totally fine, Giulia. You should go ahead and send it."

She sighed. "Are you sure? I worked on this for the last hour."

"It's a great email, Giulia."

"Okay." And then she hung up.

Giulia's calls became more frequent and more frantic. She forwarded me several email drafts a day, most only a sentence or two. They took her hours to write. Her anxiety about what to say in an email monopolised her day. She was assigned projects, and didn't know where to start and laboured all day over how to write an email of a few sentences long to ask a question about the assignment.

"Come on, Giulia," I begged her over dinner, as she sat sullenly, picking at her food, not saying much. "What's going on?" I had been asking her this every day for a week, each time sounding more exasperated, and each time, Giulia shut down. I couldn't stand the defeat of the silence, so I compulsively kept talking about letting bad thoughts go, being in the moment, staying positive, not giving up, all the weary platitudes. 

I cleaned the kitchen as she watched in silence. Only a few weeks earlier we had blasted music for our dishwashing dance parties, one of our favourite chores together. Now she was a silent, isolated spectator. Even our favourite songs couldn't bring her back to me.

We got ready for bed. I followed her into the bathroom and slowly rubbed her neck as she brushed her teeth and took out her contacts. When she finished, we got under the covers together and I cradled her body, my fingers caressing her earlobes, one of her favourite ways to be cuddled. I felt her breathing slow down and the muscles in her body relax. But she couldn't fall asleep.

Three weeks into her job, I jolted awake in the middle of the night to hear Giulia shouting in Italian in a different room. I rushed out of bed to see what was going on. Giulia was in the kitchen, Skyping with her mom in Italy who, at nine hours ahead, was in her mid-morning routine. "What's going on in here?" I mumbled, squinting at the fully lit kitchen. It was 2am.

Giulia craned her neck to face me. "I can't sleep. I'm just talking to my mom."

"Come on, Giulia, let's get to sleep," I said, waving vaguely at the camera.

Giulia's mom backed me up: Giulia needed sleep. In our bedroom, I pulled her close under the covers. I asked yet again what was wrong, trying to coax out the words that might help give shape to what was happening. I forced myself to be gentle, to mask any hint of frustration, but she still had nothing to say. She was becoming too lost in the anxiety to step back to examine it.

I instinctively began to rub her neck and earlobes again, while whispering that she was doing a great job, and tried to get her to focus on her breathing. The truth is, I didn't know what else to do. Her anxiety had been brewing for a few weeks now. Each day felt like a steady escalation of tensions, and I was losing my patience and energy. Her barrage of forwarded emails and desperate phone calls over trivial work matters was dominating my life. At home, she wasn't interested in dinner. At night, she was restless and agitated, and I didn't understand why she couldn't just relax and sleep. We downloaded guided meditations, lit scented candles, played the sound of waves. None of it worked.

[At the time of Giulia's first breakdown, author Mark Lukash had known her for nine years. 'She had always exuded confidence. I could always count on her thriving at work,' he writes.]

At the time of Giulia's breakdown, author Mark Lukash had known her for nine years. 'She had always exuded confidence. I could always count on her thriving at work,' he writes. Photo: Courtesy of Mark Lukach

Giulia began to call in sick to work. She even agreed to see a psychiatrist but was offended by the initial diagnosis of depression. Depression didn't happen to someone like her. This was just a minor setback. The psychiatrist prescribed sleeping pills and antidepressants. Giulia had no intention of taking them. Regardless, she had the scripts filled at the local pharmacy and brought them home. When she set them on the table, she joked that I should make sure to hide the pills in the morning, because since she was so depressed, what if she took them all? We laughed uneasily.

That night we sleepwalked through the same failed ritual, more hours of trying to calm Giulia to sleep, to no avail. In the morning, I woke up late and rushed out the door to get to school on time. I completely forgot about the medicines, which remained where we had left them the night before on the dining-room table.

I came home from work and Giulia was Skyping with her mom, who seemed to be glaring at me through the computer. I had no idea what was going on until Giulia said to me, "You left the pills out."

"I did?" I asked innocently. "Oh yeah, that's right, you did ask. I'm sorry I forgot."

"Well, don't forget any more," Giulia's mom said to me. "Hide them like she asked you to."

It wasn't until later, after dinner, as we were getting ready for bed, that I learned it was a very big deal that I had left the pills out. Giulia told me that when she woke up that morning, she saw the pills and sat down at the dining room table to study the orange jars. She shook them out into her palm to test their weight. And she thought about taking all of them.

"But I wanted to call my mom first," she told me as I listened in horrified silence. "So I Skyped her and told her that I was thinking of taking all the pills, and she begged me not to. So we kept talking – until you got home."

Giulia's mom had stayed on Skype for six hours, stuck on the other side of a computer screen on the other side of the world, refusing to let Giulia hang up until I came home. This changed everything. I asked Giulia to stay in our bedroom with the door closed, and I took the pills and went around the house for a few minutes, opening and closing drawers in each room to make as much sound as I could to make it hard for her to know where I hid them, the worst game of hide-and- seek I had ever played.

Giulia's dad, Romeo, dropped everything and flew out to California. I breathed a sigh of relief. There had been almost a month of Giulia's faltering stability, and now I could go off to work and know that she was safe with family. She had unofficially put herself on sick leave and went to bed with little to no expectation of going to work the next day, so father and daughter spent their days together walking the beach, riding bikes, talking about work, and life, and balance, and happiness. And nothing helped.

Even away from work, Giulia's anxiety grew. She went from restless sleep to no sleep at all. She stopped eating. The colour drained from her skin. It was like watching her vanish right before my eyes.

One morning, when I woke up, Giulia sat calmly at the foot of our bed. "I talked to God last night, Mark," she told me.

I couldn't hide the scepticism in my voice. "Really?" I said.

"I did, and he talked back," she said. "His voice was so loud and clear. I thought it was going to wake you up. He said that everything is going to be all right. We are going to figure this out."

"Well, that's good to hear," I said for her benefit, but nothing about this felt good. Giulia had never talked like this before.

The next morning, when I woke up, Giulia was pacing around the bedroom, mouthing thoughts to herself. "Good morning, honey. How did you sleep?" I asked.

"I talked to the Devil last night, Mark," she said, speaking very loudly and quickly. "He said everything is not going to be okay. He said that there is no way out of this. I can't be saved. I'm not worth saving." She was very matter-of-fact about this, as if reading the weather forecast, but with a rushed intensity.

I jumped out of bed and pulled her close to my chest. "Giulia, you're totally worth it," I whispered back to her. "There is no Devil talking to you. It's just you and me."

"But you were asleep! You didn't hear what I heard!" She was growing desperate for me to believe her, but I couldn't pretend any more that hearing God and the Devil was no big deal.

"I didn't hear what you heard because the Devil isn't real, Giulia. He's not tormenting you. This is all in your mind."

With that, Giulia exploded. "You don't believe me? That the Devil is here to get me? Fine, whatever, get out of my face. This is all going to be over soon anyway."

I left our room and crossed the hallway to the guest room, where Romeo slept. "I think we need to take her to the hospital," I told him. He agreed.

We went into the living room. "Giulia, we need to get you some help," I said. "We are worried and don't know what to do. We want to take you to the hospital."

"No! Don't waste your time. The Devil said I'm not worth it."

"Please, Giulia," Romeo said. "We want to get you help to feel better."

Giulia backed away from us. "Leave me alone!" she shouted as we slowly approached her, cornering her in the front entrance.

Finally Romeo and I grimaced at each other, knowing what we had to do. He grabbed her around the legs, and I scooped her under her armpits, and we carried her down the hallway. She shrieked and reached out wildly for anything to hold her back and latched on to the hallway bathroom doorknob. I pried her fingers individually while she tried to squirm her body free. Romeo and I worked in silence, overpowered by the fierce sound of Giulia's resistance. I caught a glimpse of Romeo's face and saw that he was sobbing, and only when I saw his face did I realise how much I was crying, too.

After six hours at the ER, we were shooed away with nothing but a prescription for a different sleeping pill, a better antidepressant and a Contract for Safety ("If you're ever feeling like you might hurt yourself, you have to tell Mark about it," the social worker told Giulia). I was hoping for more guidance from professionals whose help we needed. Or at least a different type of medication, one that would deal with these new obsessions with God and the Devil. Maybe this was the only help they could provide, but I felt abandoned all the same.

Giulia's mother Mariarita arrived the next night. She pretended to be happy with us all together, but her worry was palpable. I alone couldn't help Giulia. Romeo hadn't stopped things from escalating, either. It was now a full-court press, all three of us in the house to love Giulia back to health.

When Giulia and I married, I nicknamed Mariarita "Suoc", short for suocera, Italian for mother-in-law. She loved the name and wore it proudly in front of her friends. Suoc was now here, in full mama-bear mode, and wanted to sleep with Giulia, so mother and daughter settled in the guest room. Romeo slept in our bed. 

I took the couch. I collapsed in the living room, but took a little while to drift off. With Giulia's parents there to help, I should have felt relief, but instead I felt like I had been exiled to the couch. Their little girl was in crisis and needed support and protection and her surfer dude husband wasn't equipped to do the job. I felt defensive and petulant.

Eventually, I drifted into the first solid night's sleep I'd had in six weeks. Then, at 7am the next morning, Romeo jolted me awake. "We need to go back to the hospital," he said.

I jumped up, pulled on pants and found Giulia pacing around the guest room, her mom upright on the bed, eyes wide open and full of tears, shaking her head in disbelief. Her terror was obvious.

"Mark, the Devil was here last night. But don't worry. I protected my mom. I protected you. I protected all of you guys. I stayed awake and the Devil is still here, but can't get you because I am here." Giulia was babbling. "I need to get out of here. It's over, and worthless to fix things."

This time Giulia didn't fight getting into the car or resist going into the ER. We drove back to the same hospital and went through the same admission process with many of the same people from two days before. A nurse hooked Giulia right back up on an IV drip of Ativan to calm her down.

After 30 minutes, she began to settle in the hospital bed. Suoc sat at the foot of the mattress, Romeo took the chair and I sat on the floor, my back against the wall. We were all lost, silent, sunk in our own worlds.

None of us could do anything. Over the past six weeks, we had steadily ramped up our attention and focus on Giulia, Skyping and praying and meditating and holding her in our arms, but we hadn't helped her. It was almost as if her slide into psychosis was inevitable and that no matter what we did, she still had no appetite, couldn't sleep, heard voices in the night and remained fixated on heaven and hell. "Mark, I am the Devil," she whispered through the fog of Ativan.

After hours of waiting, four people appeared in the hospital room, and my world erupted. Everything seemed to happen at the same time. It all felt out of reach, and the best I could do was hurry to keep up. Four people loaded Giulia onto a stretcher to wheel her into an ambulance that would transport her to a hospital with a psych ward on the other side of the city where there was an available bed. Suoc went in the ambulance with Giulia and I sprinted three blocks to the parking garage to get the car, Romeo chasing behind me. The ambulance was already out of sight by the time we pulled away from the ER, so we sped across the city to the hospital on our own.

Reaching the psych ward, we stepped off the elevator into a new world. The entirety of the walls were glass windows, and almost all the blinds were pulled. The waiting room was about eight feet by ten feet, the floor a bland, greenish tile, with a few beaten-up vinyl chairs sagging along the perimeter. Mariarita was collapsed in one of the chairs, hair dishevelled, hands clasping each other for something to hold on to. She had just landed the night before. She had cried so much already that now her body shook, but no sounds or tears came out. The waiting room was an enclosed fortress in the middle of the ward. Chaos swirled around it. The only bridge between the fortress and the chaos was a single glass door. No one greeted us in the waiting room. No warm, comforting smile, no pat on the hand. Instead just those glass windows with blinds pulled and a few signs printed on white paper, hastily taped up.

Visitors are advised that they are not permitted to bring ANY of the following objects when they visit a patient: weapons, sharp objects, drugs, alcohol, cigarettes, cameras, anything with drawstrings (sweatshirts, shoes).

Visiting hours are from 7–8:30pm. Saturday and Sunday there are also visiting hours from 12–1pm.

Directly across from the doorway was the nurses' station, a stout counter at least six metres long. I craned my neck to the left to the end of the nurses' station and I saw Giulia. She was sitting in a chair across from a nurse with a clipboard. Giulia was in the hospital robe that they had given her in the ER, her glasses on, her shoulders held upright in a perfect balance, as if she were balancing a textbook on her head. I tapped on the glass again, louder. I wanted to reassure Giulia that she was okay, that the people were there to help her. She looked up, saw me, and looked away, returning her focus to the nurse at her side.

I sat back down. "What's going on, Suoc? What happened?" I asked my mother-in-law.

"Nothing," she replied with her thick accent. "They brought her up here while you parked the car and now we're here. What can I say?"

"What did the nurses say?"

"They didn't say anything to me. They took Giulia inside and closed the door and that is it. Nothing." 

I felt so much of everything and had so much to say, but I didn't know where to start, and no one was listening to me anyway. She doesn't belong here. You take care of her or I'm going to sue you for everything this hospital is worth. Give her the best room. She doesn't like heavy carbs with her meals. If any of the patients even tries to touch her, I will fucking kill them.

My heart raced, my fingers twitched, my stomach hurt. My saliva tasted bitter, as if I were going to vomit.

I walked back to the glass door to look at Giulia's new world. A pale, gaunt man with thinning gray hair and a jean jacket hovered near her. He looked to be in his late 40s, and his movements were painfully slow. We made eye contact for a flash of a second, and I was terrified of what he might do to my wife, the two of them locked away from me on the other side of a glass door.

There was a big guy in his 20s, well over six feet tall and probably more than 110 kilograms, with frumpy brown hair matted as though he had been lying in bed for days. He shuffled in and out of view, his pants sagging underneath his hospital gown, revealing the top of his bare ass. He saw Giulia, and saw me at the door, and flashed me a confident smirk. He scared me most of all.

What the fuck had we done? Where had we taken Giulia? This place was full of crazy people who would rip apart someone like my sweet, beautiful wife who, let me remind you, wasn't crazy at all. She just hadn't slept. She was stressed out. She just needed to sleep.

Finally, one of the nurses stood up from her seat behind the station and walked over to the glass door. She surveyed all the patients to make sure they were at least six feet away. She inserted one key into the doorknob and then a second key into a lock on the wall. With two keys in place, the door buzzed, and she pulled it open and stepped briskly into the waiting room.

I jumped up to meet her. Suoc and Romeo stayed on the chairs behind me.

"What do you want?" the nurse asked coldly.

"Uh, what do you mean?" I said. "We just dropped off my wife, Giulia. She's there talking to a nurse, and uh, we, uh, have some …"

"I know you dropped her off. So what do you want?" 

"Well," I said, taking a deep breath. "What is going to happen? This has never happened to us before."

The nurse rolled her eyes, irritated. "Your wife is clearly psychotic and delusional. She has been brought here on a 5150 and so …"

"A 5150? What does that mean?" I said. "And what's psychotic?" I thought of psychopath and psycho killer. Did they think she was going to hurt somebody?

"A 5150 means she's been involuntarily checked in here, and so she needs to stay at least 72 hours, as required by law. The visiting hours are posted."

"I know, but it's so short, only 7 to 8.30pm. Can't I visit her during the rest of the day?"

"No. You've obviously had a long day. I suggest you go home and come back tomorrow to visit her."

"But can we go and see her room?"

"No, we need to process her and get set up, and that is best done alone, away from the family."

I didn't like being called "the family". I started panicking. "Wait, please. Please. You don't understand …" I was croaking. "Please. Can I at least say goodbye to her?"

If she had to stay there, I at least wanted to go to Giulia and hold her hands and look her in the eyes and kiss her forehead and tell her to be strong and that there is so much love in the world that will lift her up out of this darkness. "Please," I begged. "Please. I didn't say goodbye to her."

"It's up to her," the nurse said, finally cracking. "I'll go ask if she wants to talk to you. But she has rights. Otherwise, we'll see you tomorrow."

The nurse crossed back into the other world and I stood at the door, my hands and face pressed against the glass. Giulia watched me. She sat so still and upright, trying to hide her fragility. The nurse approached her and asked her something as she gestured back to the door where I was peering in.

Giulia shook her head: no. 

Edited extract from My Lovely Wife: A Memoir of Madness and Hope, by Mark Lukach (Bluebird, $33), in shops on Tuesday.

Lifeline: 13 11 14.