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Depression and Marriage

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Webmd recently ran a valuable article about the impact that a depressed spouse can have on their non depressed partner and the marriage. The article can be found by pressing this URL:

http://www.webmd.com/depression/features/divorcing-depression  

It is an important article because there is a tendency to examine dozens of reasons for why marriages fail without examining the mental health of married partners who are in trouble. My years of experience in a private psychotherapy practice with individuals and couples convinced me of the fact that depression and personality disorders combine to play havoc on marital relations.

Fictional Case Study:

(The characters and events are completely fictional but do describe the types of dynamics that go on when depression enters a marriage. Any resemblance to yourself is completely random and accidental but does show how common the problem is).

The case:

"The couple had been married for ten years. They met in college and instantly fell deeply in love. They had two children and each had a successful career. Money was never a problem and the children were normal and healthy. However, soon after they were married Bob became extremely irritable. For no apparent reason, he would get angry, yell, complain and start a fight. Alice felt constantly criticized and on guard against Bob’s next outburst. There seemed to be no rhyme or reason to these episodes of anger and hostility.

As the years went by Bob’s behavior continued in the same pattern. Most of the time he seemed happy and well adjusted and then, for no reason, would come the anger. During the last year, Alice noticed that Bob was becoming increasingly withdrawn. He stopped playing soft ball with his friends, no longer wanted to go out to dinner, showed no interest in their children and even stopped being sexually involved with her. Alice wondered if Bob had found another woman.

Everything reached a crisis level one afternoon when Bob came home from work early and was drunk. He reported that he lost his job because of his frequent absence and lateness. She was shocked because he had never mentioned it was a problem. They ended up having the angriest argument between them in the two years of their marriage. She warned him that if they did not go for help, she would take the children and leave him. After he sobered up he relented and agreed to marriage counseling.

The marriage counselor, an experienced senior clinical social worker, diagnosed Bob with Major Depression, something that ran in his family. While marriage therapy continued, Bob was referred for both anti depressant medication and cognitive behavioral therapy with a clinical psychologist. The couple learned how to cope with one another. Alice learned how she was an unwitting catalyst for Bob’s anger and Bob learned how to express his emotions in more realistic and grounded ways. Today, their marriage is a success."

Discussion:

1. One of the things I noticed about the Webmd article on marriage and depression was that they described the non depressed spouse as the one who becomes angry and resentful due to the withdrawal of the depressed partner. While this is often true, it is equally important to point out the important fact that depression often brings with it a lot of irritability and anger. Depressed people, far from being silent, are fully capable of exploding into rage, followed by withdrawal. This is one of the factors that drive the non depressed spouse into separation and divorce.

2. Withdrawal does occur with depression and one of the worst ways it expresses itself is in a lack of interest in sexual relations. It is human nature to think that if one’s husband or wife is not interested in sex that there is something wrong, not with the disinterested spouse, but with the interested partner who starts to question their own attractiveness. The lack of sexual interest and activity commonly provokes lots of rage in a marriage.

3. It is quite frequently the case that neither spouse in this type of marriage is actually aware that depression is at work. It seems to be much easier for partners to become defensive, blame one another for no longer caring or loving the other or for being "lazy and useless."

4. The tendency towards blame can take place when and if the depressed spouse overeats and gains lots of weight. Overeating or not eating are symptoms of depression. Of course, over eating with massive weight gain and a tendency to sleep a lot of a way of escaping from the world, can have a devastating effect on the marriage in the ways described in the previous paragraph. "Oh, why don’t you snap out of it," or "if you loved me you would lose weight," are the types of things frequently heard when there is depression that goes unacknowledged or unexplained.

5. A complicating factor can be the situation in which depression is discovered and acknowledged but misunderstood by the non depressed spouse. It is in this scenario that one can hear things like, "depression is nonsense, just snap out of it," or, "baloney, you always were lazy," or, you are not the man or woman I married and you are just making excuses." That type of marital situation does not bode well for the future of that marriage.

6. Due to the fact that depression can be so enervating that the resulting feelings of weakness and lack of motivation lead to job loss and financial problems. The economic impact of depression on a marriage is often disastrous.

7. As alluded to in the fictional case study, drinking can accompany depression. This is true for a couple of reasons, such as the fact that alcohol increases serotonin levels in the brain leading to feeling of energy, optimism and even joy. However, these feelings are often short lived and as the alcohol wears off these joyful feelings can be replaced with increased depression and irritability. In other words, the tendency to self medicate with alcohol only adds to individual and marital problems.

Conclusion:

It has been my observation and experience that a marriage in which one spouse is depressed calls for marriage therapy as well as individual therapy and, perhaps, medication. It is rarely, in fact, never true, that one person causes all the problems in a marriage. Even when one spouse is depressed and causing a lot of anxiety and conflict, the "healthy spouse" contributes to the problems in ways that are often hidden and not apparent. The value of marriage therapy is to help both members of the dyad learn how they engage one another in unhealthy ways and learn more constructive patterns of interaction with one another.

Your experiences and comments are encouraged.

Allan N. Schwartz, PhD

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