An under-recognized issue in the mental health system
Pierre Imlay, MEd, RMFT (Article published on http://www.heretohelp.bc.ca/visions/couples-vol10/mental-illness-in-couple-relationships)
The impact of mental illness on a couple’s relationship has often been an overlooked dynamic in both the public media and academic journals. Traditionally, people have examined and written about how an individual’s mental illness affects their parents, or conversely, how a parent’s mental illness affects the child.
This oversight is in part due to the traditional practice of mental health professionals focusing on symptoms within the individual, and overlooking the patterns of how individuals relate to each other in a couple relationship.
However, it has been known for a long time by those working in the field with couples that individuals who have a mental illness can have a negative impact on their spouse’s mental health, and vice versa. At times, both partners in a relationship can be struggling with symptoms that have developed as a result of the original illness in one of the partners. In fact, research on psychiatric illness in the couples relationship has found a positive correlation between one partner having a mental illness and the other partner also suffering from a mental illness.
Relationship stress goes both ways
In my career as a therapist, I’ve worked with couples in various settings. I’ve witnessed first-hand the curative effects that a healthy relationship can have on an individual struggling with mental illness. Healthy relationships serve as a buffer to help the individual ward off both physical and mental health conditions.
On the other hand, it’s well recognized that relationship stress with a partner can negatively affect the person who is struggling with a mental illness and make the condition worse. The stress in the relationship can impact their physical functioning as well.
I’ve often seen the negative effects of relationship stress on people who struggle with depression, anxiety and related disorders. An individual will have been struggling with one of these conditions for quite some time. The partner may initially spend a lot of time taking care of that person and working hard to maintain the relationship. This pattern can go on for years. But it often happens that the caregiving partner grows tired of this role, because they’ve been ignoring their own needs. The result is that the partner may end up slowly retreating from the role of caregiver, or may react in angry outbursts. This can make the other person’s original symptoms worse.
Meanwhile, partners who are providing care to their spouse with a mental illness have been found to exhibit signs of burnout identical to that found in nursing staff at psychiatric hospitals.3The person providing care may spend much of their time focusing on the suffering of their partner. They may follow prescribed treatment programs that focus on healing the partner but ignore their needs. Their mental health often deteriorates, and they may experience changes in their daily functioning, including poor sleep and appetite. They may also develop thoughts of shame and hopelessness as they begin to feel less effective in helping their partner and don’t see their partner’s recovery moving forward.
When couple relationships are under stress, partners begin to physically and emotionally distance themselves from each other. They tend to avoid each other, and when they do come together, it’s often strained, resulting in restrained or surface-level conversations. The basic quality of working together as a unit to tackle common problems is torn apart as both partners feel an increased level of frustration and despair.
If one or both of the partners is struggling with a mental illness, these negative emotional reactions are often intensified. At a behavioural level, individuals tend to isolate themselves, may turn to alcohol and drugs to numb difficult emotions, and sometimes turn to having extramarital encounters. When the marital stress is at its peak, there’s a greater likelihood of substance misuse, movement toward divorce and male aggression.4
Get help to get (back) on track!
It’s important for couples to get help in order to get their relationship back on track before the situation reaches crisis proportions. Sadly, many couples who go to couples therapy have been experiencing these dysfunctional patterns of relating to each other for a long time. I’ve met many couples who enter treatment at this later stage, and by this point in time, at least one person is feeling less hopeful than the other person and is looking for a plan to exit the relationship.
There are times when continuing on in the committed relationship is detrimental to the health of both people involved, not to mention to the children, if children are involved. Finding a way to separate that, though painful, won’t be destructive can be another option for the couple to pursue.
At one time, I was a mediator in the family court system. One of my central tasks was to help separating couples develop separation and parenting plans. These plans are meant to establish a post-relationship framework for how the two people will relate to each other in terms of separating resources and co-parenting children.
In couples with mental illness, the same planning process applies. However, it can be more challenging, because the emotions that get triggered tend to be more intense, and the individual’s coping strategies are more limited. Often, these clients are overwhelmed by the legal procedures involved in the separation process, and benefit from the support of therapists, legal advocates and other healthy family members.
The mental health field is becoming more aware that marriage often brings a mixed bag of stressors and rewards to all those who embark on the journey. For people with mental illness, these stressors are even greater. Yet, even with the presence of mental illness, committed relationships can benefit from interventions that help the couple get back on track and help to improve, or at least stabilize, mental health symptoms. Couples therapy can help partners improve their communication and problem-solving skills, and refocus on strengths to enhance their resiliency.
Some marriage and family therapists have argued that premarital education can be an effective way of preparing people for marriage by teaching them basic skills they’ll have to use in their marriage. Premarital education programs include modules on finances, healthy communication, dealing with conflict and planning for parenthood. Some organized religions require that spouses take a premarital course if they want to get married in their church.
Most marital researchers and therapists argue that having a clear idea of what you want for yourself and in your relationship is important for the health of both the committed relationship and the individuals. This applies, regardless of the degree of mental illness, or whether mental illness is even present.
A healthy view of the couple relationship includes having reasonable expectations of the rewards that marriage brings, and recognizing that it still requires personal effort by both parties to make it work.
About the author
Pierre is a trained Marriage and Family Therapist and on the board of the BC Association for Marriage and Family Therapy. He has worked as a family justice counsellor, providing counselling and mediation to couples going through the separation process. In employee assistance plan (EAP) settings, he has also counselled couples experiencing a wide range of issues such as anxiety, depression, addiction and child-related concerns. Currently, Pierre works at Langley Mental Health providing short-term couples therapy, intake and group therapy