“”With shining eyes & hearts filled with promise, we spoke those words “for better or worse” Yet even as we took those vows, we stood as two neophytes, unaware of the great darkness looming around us, soon to be unleashed – challenging all we believed and affecting all we held sacred.””
rebekah duffus
Mental Illness and Marriage . Is it worth the efforts & extremes in emotion? Can such a union be rewarding and functional? Is there a hope for long-lasting happiness in such relationships ? Many questions surround the partnering. of two people – even when there is no known debility in either party. Thus we enter a realm in which the topic is current yet the dialogue is clouded by lack of insight and ignorance. As with any intelligent dialogue, one must define the principle terms. Thus we begin by solidifying our concept of the standard of “relationship” and continue then to determine a common ground regarding the definition of that ‘undiscovered country’ that is mental illness.
As this discourse seeks to understand marriages in which one party has a mental illness diagnosis, let’s begin with the relationship. How do we define marriage? It would be difficult to find a human being unfamiliar with marriage for it is a fundamental social construct and serves as a social union or legal contract between two adults. It has been said that marriage is one of the most important of all known social institutions. The longevity of the institution of marriage historically is a reflection of its multifaceted role in human society. Certainly marriage and personal commitment is – in one form or another – the most enduring of human bonds. Humans seek to form recognized bonds for many reasons: these reasons cover everything from legal, social, reproductive and emotional to economic, spiritual, and religious. Within the boundaries of a committed relationship much can be accomplished. Partners can build a nuclear strength which can support a whole world of possibilities in joint endeavor. There is a physical safety known when one is accompanied. Pooling of resources benefits both parties. Across the board, two adults bound in common cause are more successful than each alone. Longevity studies support that married adults live longer lives than those who are unmarried. Reading through the literature, the numbers vary depending on who is spinning the statistics. These claims are not restricted to male/female relationships; adults with a partner are Not Alone. This is basis for all the claims. People with a partner have a sounding board, a companion, a hand to hold… someone to ask how they’re feeling, and to remind them to drink their orange juice. THIS is the non-statistical truth and it is not simply anecdotal.
A marriage holds no promise that both partners will maintain their well being. The standard vows of marriage which include the words “in sickness and in health” were first published in English in the prayer book of 1549, based on earlier Latin texts of the medieval period. Such terms have been at the heart of the social ‘partnering’ institution for over 500 years. Obviously it was known that the status of a partner was not guaranteed. Thus the contract carried a ‘disclaimer’ & bound those within the contract to remain united whether health was maintained or illness descended.
What is “illness” then? What do we define as a sickness when it is not caused by an obvious wound or process known to us ?
From the earliest records, we learn that “deviant” behavior, unexplained afflictions, indeed even still births, menstrual maladies, rashes and phobias have been considered supernatural and a reflection of the battle between good and evil. When confronted with the unexplainable humans have historically (and even into the present day) deferred to the explanation that “”evil is afoot””.
In the Bible’s Old Testament and the Jewish Torah, evil spirits and divine punishment were considered causes of disorders of all types. Reward and Punishment have always been dual themes in the stories of mankind and we see such used throughout history in an explanatory role. From the earliest recordings those who behaved erratically were considered to be ‘oppressed’ or ‘possessed” by evil, or more distinctly by demons. Demonic forces are considered to be the ambassadors of the penultimate figure of Evil, Satan. These people, behaving in a manner inconsistent with the norm were ostracized, banished from the community lest they bring some evil into the midst of the ‘faithful.’. Consider the man who lived among the tombs . (Mark 5:1-20 KJV) He had been exiled by his peers for his behavior; he was stronger than any of the other men and practiced self harm. He is the first to state that he contained within himself a legion, or many different personalities. He was seen as “”sick”” in so far as the text proclaims he was “”healed”” Yet the knowledge of and understanding of Dissociative Identity Disorder & self harm as a symptom lay some two thousand years ahead. Here we see the perfect example of the attitudes & mores of the evolving Common Era. All was seen as a “‘fight for mans’ soul.”” .
A brief overview of historical psychology will give us a context for the concept of ‘ mental illness’ . The earliest known records of mental illness coincide with the earliest documented knowledge of psychology as it affects human behavior and its relation to perceived “illness.” Awareness, the “knowing “ and treating being two different things, the development of an insight into the truth of such illness, the causes and possible treatments is an ongoing process. Even now. practitioners are adding empirical data to an ever evolving panoply of knowledge. The conversation is righteous, the advance is steady, the summit is yet unseen.
In the 5th and 4th centuries BCE Hippocrates, in his Aphorisms, characterized all “fears and despondencies (if they last a long time) as being symptomatic of melancholia. Thus the concept of “depression” described as a distinct disease with particular mental and physical symptoms enters into the medical conversation. There is no mention of therapeutic actions or activities.
Dating back to 1900 BCE in ancient Egypt, the first descriptions of hysteria were found recorded on the Kahun Papyri.[3] In this culture, the womb was thought capable of affecting much of the rest of the body. [4] Moving forward in time, the consensus did not change, only the treatment. The term “hysteria” was thus applied to women who displayed excessive emotion- these women were met with the standard therapies of the 19th century- institutionalization and radical hysterectomy. A sad thing to see so little progress made in 4000 years .
Lunatic is an antiquated term with which nearly all are familiar, The term refers to a person who is seen as mentally ill, dangerous, foolish,[1][2] or crazy, thus exhibiting ‘lunacy’. The word derives from lunaticus meaning “of the moon” or “moonstruck”.[3][4][5]. The folk tales of men who were transformed by the full moon, becoming “werewolves” bear a striking resemblance of an archaic and fearful populace with no concept of psychological disorders . What one does not understand must be feared . Surely a supernatural agency was at work.
The history of the concept of “psychosis” can be traced from the time it was coined in 1845 . Originally, psychosis included the category of mental handicap, as well as certain other serious mental disorders but within a year of such appearing in the medical literature the term and concept of psychosis had become synonymous with the two terms “psychopathy” and “psychoneurosis.”. The term thus became synonymous with the concept of mental illness.
French psychiatrist Jean-Pierre Falret published an article in 1851 describing what he called “la folie circulaire,” which translates to circular insanity. The article details people switching through severe depression and manic excitement, and is considered to be the first documented diagnosis of bipolar disorder
The first, formal description of schizophrenia as a mental illness was made in 1887 by Dr. Emile Kraepelin. He used the term “dementia praecox” to describe the symptoms now known as schizophrenia. Dementia praecox means “early dementia” and as schizophrenia typically presents in early adulthood, it is easy to see how early psychiatry practitioners saw the onset of symptoms as a devolution rather than a evolution or beginning.
Borderline Personality Disorder first appeared in DSM-III ( Diagnostic and Statistical Manual of mental disorders) as a bona fide psychiatric diagnosis in 1980.
Obviously the understanding & treatment of mental illness has but a small wealth of knowledge compared to the institution of marriage.
It is a long held belief that a marriage/committed relationship has the capacity and tendency to stabilize a mentally ill patient who is cooperative with ongoing therapeutic intervention. Marriage has long been considered a stabilizing force in general, providing structure to help eliminate an endless scope of unsettled behavior. Structure then is the common denominator and for the mentally ill patient seeking stability, structure is key. Patients who maintain a relationship are more likely to continue with their medication, maintain social structure and overall rate higher quality of life than those without partners
Can those with mental illness diagnosis find healthy love ? Codependency often develops from dysfunction in a loving relationship. This applies to all relationships, regardless of extenuating diagnoses. Often in any maladaptive unions see the evolution of symbiotic relationship where one member is dysfunctional and one attempts to balance this with the full care and organization of the family unit.. It is not uncommon for a mentally “healthy “ companion to make many plans away from and in the home to impose structure and control, to avoid conflict. to maintain an environment which will not exacerbate a partner’s symptoms and to distract one’s self in general. Isolation is an oft seen response : Self preservation is vital and not always a conscious stance. Union is what is being attempted consciously while the subconscious seeks to disengage.
Studies have shown that people who suffer from mental illness have a higher rate of divorce. One study that was conducted in 2011 actually put that divorce rate increase at between 20 to 80 percent. The multi-national study was conducted by the National Center for Biotechnology Information, While divorce is detachment in the extreme this separation of selves is very common; one need not file legal documents to ‘divorce’ affection and attention from a spouse who is perhaps very much loved but with whom a peaceful coexistence seems impossible.
Living with a mentally ill spouse disrupts all levels of function. Yet to leave a spouse/companion who is suffering with a mental illness is a complex & disruptive step to take. Leaving a mentally ill partner to survive on their own, without spousal emotional and physical support is seen in society as weak. Self Preservation is not always appreciated . He/she who leaves can be harshly judged by others and indeed by themselves, adding to the sense of failure. Therein lies the disparity, the “”Catch-22”.
Stigma is attached to the couple in which one person is managing and one is faltering physically or mentally. Yet stigma is also attached to a healthy spouse who separates from one suffering from illness: Both dialogues need to be shut down. Stigma keeps everyone ‘sick’. The best outcome relies on psychosocial support and therapeutic relationship between two committed individuals with one common goal. Also all should see the necessity of open conversation with peer groups regarding the misconceptions of a psychiatric diagnosis. In this manner family, friends and spouses/companions become a part of the patient’s overall wellness. Hiding one’s diagnosis leads to further dysfunction. Nothing undermines self worth quite like the feeling of shame. The words must be spoken. The terms must not be avoided or whispered of as if scandalous. A spouse would not hesitate to say “my wife broke her leg.” The day must come when it raises no eyebrows to say “my wife is bipolar.” This simple example is representative of how far are society has yet to evolve in the ·destigmatization of illness of the mind.
Writing this, I am a woman diagnosed with Bipolar Disorder 1, and Borderline Personality. My journey has been one of such trial and significance that I am prompted here to write of the struggle, triumphs and defeats from an intellectual and academic standpoint rather than an emotional point of view. My hope is to add to the conversation valuable experience to further destigmatization and be an example of survival. I have been married to the same man for 35 years enjoying a committed bond in a decidedly tumultuous life. What then have I found personally as the mentally ill spouse in a long term relationship ? My husband and I have been together since 1983. We married in 1986. Our union was formed when we were in our 20s myself exhibiting full mania beneath the guise of ‘party girl’ . Pregnancy and subsequent childbirth brought a long period of stability, during which time our children were born and we experienced a normalcy and prosperity which unfortunately devolved into a period of self destructive mania, major physical illness followed by a heavily medicated fugue persisting approximately 15 years.
What happened to the marriage during this time? My husband stepped in and became both mother and father to our children. He managed all the finances and kept our mutually held properties in order. He has supported my recovery. This is a best case scenario and one for which I am eternally grateful. His love and commitment is a life preserver tossed to one flailing in a cold dispassionate sea. Surely I am one of the most blessed women on the planet. Often I feel I do not deserve his commitment as I have been something of a disaster for at least a third (if not half) of our married life. Yet he will say “You have always been like this. I fell in love with You, I love you. You are not your diagnosis.” During the worst times he would sleep in another bedroom and we rarely spent time together. While this was seen and felt keenly as abandonment, it was the only way he could maintain control of the home and be a valid support to the children.
For me a physician has played a key role in my journey but finding a physician who would be a ‘health partner’ was one of my life’s greatest challenges. Self-advocacy is paramount; when my hope was waning, a partner who supported the endeavor made it possible to continue rather than simply lie down and concede that mental illness had won.
It is true that the overt manifestations of mental illness may be difficult to recognize: patients often minimize symptoms and hide disturbances out of a fear of stigmatization and shame . Being willing to work through the tedious protracted process of determining the best medications can be daunting and discouraging. Many patients have doubts regarding their diagnosis and often feel conflicted. Family and social support can be lacking . A thousand different causes, concerns and emotions litter the path to stability. Not in the least, it can be the rapid pace of clinics which give patients 15 minutes in which to address their needs; physicians have been, in my experience unwilling to veer off the path of physiology into the tangle of psychiatric disorders. Managing a patient on mood-stabilizers can be tedious. If a simpler course can ”take the edge off” it is most certainly sought. Often a patient must exhibit significant psychopathy, risking their own well-being and that of others before someone seriously considers the diagnosis of mental illness. Years of stability are lost when a patient’s mental illness go untreated. It was my experience that I had to beg to be referred to a psychiatrist. My family doctor who had become my doctor during my stable period thought my behavior and indications were exaggerated. . Even when I was in his office, battling mania, tearful in my instability and spiraling lack of control, he said “Oh, you’re not bipolar. I’ve never seen any indication of that.” I was ‘maintained’ on alprazolam, a benzodiazepine for ”anxiety” and Paxil for ”depression’. For years, I swung beneath the two extremes of mania and depression, completely disheartened by my own behavior and presenting a puzzle of frustration to my family. I had no advocate save myself – a self of which I had poor concept, a self I doubted, loathed and mistrusted.
Often a family doctor will refer a patient to a ‘psychologist’ operating under the flawed assumption that the patient is in need of some talk therapy to sort things out. While in no way are the skills of a psychologist as a LSW (licensed social worker) disdained, or scorned, those with psychiatric disorders are often kept from a truly therapeutic avenue by presumptive and short sighted referrals to providers whose expertise is ill suited. My family doctor referred me to one such ‘therapist.’. This social worker was well known in the community. Our first session, he asked if I planned on losing any weight and used a light bar (a kind of new fangled pocket watch) for me to follow with my eyes in order to become calm. His therapy involved suggestions as to how I could change in order to make my family happier . Repeatedly he suggested I would feel better if I would wear more colorful clothes. Eventually our sessions devolved into talk (his talk) in which he spent the 40 minutes sharing frustrations of marriage,, asking medically oriented questions (I am a Registered Nurse) and telling ‘war stories” regarding some of his more interesting cases. When my mania began to be more acutely manifest this psychologist said “I’m not taking care of this kind of crazy.”. Subsequently he released me from his care saying “I lose money ever time you walk through the door . Your insurance does not cover my full fee.”
A desire for ‘real help’ necessitated my leaving the care of my family physician, finding a new doctor and then pleading for a referral. Multiple requests were met with skepticism and inaction. Once my husband stepped in and stood by my side I found my new doctors were much more attentive. Corroboration proved extremely vital in my ‘being heard’, It is a sad footnote that my voice on its own was not enough to evoke action. A psychiatrist took my treatment to a level of ”being believed”. No more patting my hand and handing me a prescription for a mild antidepressant. Finding the right medication, indeed staying committed and compliant through the maze of pharmaceuticals has taken 13 months and counting. Support form my spouse kept me vigilant; my thinking patterns are changing thus my behavior is changing. “”Can you tell a difference?”” This is a conversation my husband and I have frequently. Having such an honest sounding board has helped me trust my perceptions. Huge changes begin as small nudges. Self doubt once plagued my thought patterns. An honest companion has reinforced my behavior by validating my perception that indeed changes for the better were happening. My marriage has become once again a joint effort. I trust this partnership as it has remained consistent through time. I cannot stress how vital a role both my partner and my medication play in this effort toward stability. It is vital for me to continue with both in order to stay on track. It has been said that “we are the source of all our dismay” and while I do not feel responsible for my psychiatric diagnosis, I do feel it is my responsibility to maintain my awareness and stick to a therapeutic care plan.
Finding this care plan has taken years; many succumb to the discouragement, the disheartening sense of hope fading. Days turn to weeks turn to months – mental illness, a lack of proper, available therapies, a lack of support and understanding and a sense of profound shame can lead to one’s submission. Giving up hope in the face of such a complex challenge is sadly a common theme. The presence of a partner can change absolutely everything. Hope is reflected in their eyes. Love can quiet many storms. No, a partner cannot heal the illness but a partner can provide that spark of self-care and self esteem which, though rudimentary and flawed, give me the confidence to say “as long as there is breath in me, indeed there is hope.” Through my bond with my partner and the evidence of true love in the form of caring and advocacy, I daily rise with a desire to continue the journey toward stability. Living with a psychiatric diagnosis is not easy, but it IS possible when the diagnosis is balanced by a care plan. and a willing supportive companion. How did I become so fortunate and so unfortunate at the same time ? Living with a dual psychiatric diagnosis is difficult and complex. To be married to a partner who has never let me go is what makes such a life worth living.