Living with dual diagnosis husband who married me for a visa

I am living with my husband in Australia. He has come from west africa. It is impossibly painful and has eroded my very self. He has substance abuse issues and drug induced psychosis, culture shock and suffers from isolation. he is also a very brilliant musician and dancer, excelling in several instruments and at dancing, and wants and deserves to be famous. however, though i work really very hard to get him work and organise classes and promote him, he undermines himself continually by being impossible to work with and unreliable. he married me for a visa, i know, but we had been together in africa for over a year and had built an intimate and intense relationship in that time. i realised there that he was incredibly desperate, maybe the most desperate person i had ever met. i thought getting him out of africa would help and he would settle down, cos he was behaving really badly there. i am a lot older than him, but didn't know by how much until we arrived and he told me his real age. i know that it was stupid to think coming here would make a big difference, but we were very close and i thought he was crazy from being stuck in the poverty and hardship he was suffering there. he is uneducated and has spent his time since a young age in the streets and ghettos of his country's capital. i really thought the opportunity would be enough to turn his life around.
of course nothing changed much and as time went on i found out more about him and he confided in me more about what goes on in his head, i also realised how terribly addicted to alcohol and marijuana he is, and that started at age about 12 or 13. he does, surprisingly confide in me a lot, though at other times is secretive and lies a lot. but he is not very good at it! he always tells me the truth in the end. so i learnt about the voices in his head, the horrible things he sees, experienced his wrong wrong thinking and paranoias. he is a muslim, but traditional beliefs are very superstitious, and i dont think that helps at all. he is beset by spirits, witches, jujus and the tv talking to him. some is cultural, some is psychosis. i have been dealing with the abusive and difficult nature of this relationship for years now, the time in africa and coming to three years here. i cant take much more of it and my mental health, which wasnt the best, though not this bad, is getting worse and worse. i get confused, rundown, vague, exhausted, depressed, angry, suicidal, hopeless, and have run out of steam, and i am very stoic and tough!
people "accuse" me of being "a rescuer" and i get guilty about that, but have just realised that is pop psychology of a modern, self-interested and selfish world. i realise, if you see someone in trouble, do you walk past? if someone is drowning do you ignore them or wade in and try to pull them out? so i feel better about myself since realising that but the problem is, he keeps going back, i've pulled him out and he is still throwing himself back in to dangerous and self-destructive depths. he spent months this year not drinking, what a relief, cut the smoking right down then almost altogether. but any stress and hes right back to it. he's started on the drinking again and is throwing away everything, treating me with total disrespect etc, smoking again, getting more symptomatic and endangering his "public" standing as a teacher of music and dance and musician. he ends up in the city sleeping with the drunks in the street, comes back after a while and says he's sorry, he's vague and ill. now he's back here, he said he wanted to go to a psychiatrist he recognised he has a problem and wants help. big thing, and i was relieved, spent a few days trying to find a private dr. though we cant afford it as we dont work much, hes too unstable and only get a bit of welfare. but the public system was terrible for him and put him off, i dont want that to happen again. services are thin on the ground, we have to go to the city to find a dr. with any cultural sensitivity, i made the appointments, but he wouldnt go at last minute and turned back to the pub. i am at my wit's end, i feel i cant throw him out because he is ill, out of control, completely friendless except for me and "friends" he drinks and smokes with, who know nothing about him and are in the same denial, or when they work out he's a bit strange dump him or fight him. he is in a foreign land, beset by demons, isolated and suffering from culture shock and ptsd. i know all his secrets, his past, i know his family and friends in africa, i know his home and haunts there, and his art. but i am so so tired and i dont know what to do, he won't help himself and the help i am now giving is just trying to do some damage control. he started back on abilify because we had the old meds, but without a psychiatrist to monitor i dont know if he should put his dose up yet or not, and it is all being screwed up by drinking and smoking. he also has liver damage. i love him and i care about him but i am obviously not helping him. or maybe i am? where will it end? i wish he could go back to africa, i think he would be better off there now, at least he wold be in his own culture which has a lot going for it, but the expectation from family and friends for him to return from the golden west with heaps of money and gifts for everyone is too much for him.
i just really need to talk to others who might understand how complicated and difficult this is, for me at least, living with someone sick like that is so so hard. and i do think he is sick, though i am aware he is sensitive, creative and can read people, and is very close to god and spirits. i am ready to disappear, living everyday with irrationality and paranoia, with snippets of love and peace in between, not enough now to keep me from losing myself and my hope altogether. there are no carer support groups here or anything, cant even find a web one.
thanks for reading my story.
M

Sounds like a terrifyingly difficult situation to be in... First of all, I have to commend you for trying to help a person out, it comes rarely and too far inbetween these days. But, I am also sorry that it seems to have damaged both of you further. It's as if, you are holding on to someone hanging over the edge of a cliff but find yourself slipping with them unable to find anything for yourself to catch on to.
On the face of it, it seems that the most rational decision would indeed be to go back to Africa. He is scared to face them, to show his family and friends that he has 'failed'. To not take him back is to grant him the ability to keep running away from that demon of failure. Perhaps taking him back could in some way make him face his own inability to understand that only he can make positive changes in his life. Seems that he relies a little too much on others to make those changes for him. Once and for all, he would have to come to the very physical realisation that if he doesn't do something constructive with his life, it won't happen on it's own.

The second option - and the most painful - would be to show him life if you weren't there (for a few weeks/months). How would he cope if you didn't run around sourcing all these doctors, medication, psychiatrists, treatments and obviously the normal living expenses as well? I fully understand that he suffers from many mentally debilitating conditions as well as addictions. But sometimes to get a change to happen, one needs a really, really big kick up the ar*e to get the ball rolling. ... But that decision has to be yours to judge whether it is safe enough to proceed - since you know his condition better than I do. It may very well be that he would die without you - after nearly 4 years he may be unable to fully rely on his own resourcefulness.

I'm sorry I can't be more help than this, I really wish you the best. Keep strong. There are choices in life, just, sometimes it's hard to see through the fog. x