How's Your Marriage, Doctor?

I recently gave a lecture with the sametitle as this column. Afterwards, ayoung physician approached me andsaid one word, "Terrible." I thought hewas commenting on my presentation, butin fact he was answering the question,"How's your marriage, doctor?" Heasked if he could make an appointment.

Crumbling Marriage

Dr. Sloan is a 36-year-old radiationoncologist. His wife was a nursingsupervisor at a major teaching hospital.I say "was" because Mrs. Sloan has notbeen able to work for over 3 years, andis currently on long-term disability andextended leave from work. She hasdeveloped severe bipolar illness, hasbeen hospitalized 4 times, and hasmade two very serious suicide attempts.Despite aggressive somatictreatments (many different antidepressants,alone and in combination, moodstabilizers, and a couple of courses ofelectroconvulsive therapy) and variedpsychotherapy approaches, she has hadonly brief periods of symptom relief.Understandably, this has been painfuland demoralizing for her, exhaustingand confusing for Dr. Sloan, and toughon their marriage.

"I feel guilty all of the time—everyminute of every day—unless I'm distractedby my work," Dr. Sloan said. "Iused to feel guilty that I was well andMarion was sick, like it's just not fair,she doesn't deserve this. It wasn't in thecards when we were dating and firstmarried. Then I began to feel guilty forbeing so angry at her for not gettingbetter, not trying hard enough, beingsuch a couch potato, not exercising,and gorging herself on food."

Like so many others with this diagnosis,Mrs. Sloan has gained a tremendousamount of weight because of thesymptoms of the illness and the medicationsused to treat it. "And now I feelguilty for no longer feeling. I'm numb,detached, cold, and rejecting. What Idon't feel guilty about, and this is veryweird, is how much I fantasize aboutother women, great sex, doing neatthings together, and starting a wholenew life." I felt sad for him and ofcourse sad for his wife too. He wantedto know if I had anything to offer theirmarriage. I said, "Let's try."

Dejected Wife

I met with Mrs. Sloan alone and listenedto her story. She was very awareof how her sickness had impacted themarriage. "It's awful, it's very hard tocommunicate when my mind is so clutteredand my memory so terrible," sheexplained. "I feel like I've lost part ofmy intelligence. It's so hard to keep upwith world events—even to read atrashy novel. And I've gained tons ofweight; my body image is disgusting. Ihave no libido and I know how thatbugs my husband—we used to have asparkling sex life, and I miss that somuch." She began to cry at this point."I know he's pulled away, and I don'tblame him. He's a good man and hedeserves better. And he's doing doubleduty at home because I'm so disorganizedand listless—he does most of thecooking, the shopping, the laundry, thebills, you name it."

Our marital work is just beginning.They are both talking about somethingthat they have in common and mourningwhat they once had as a couple andhoped, or hope, to have in the future.Thus far, I'm struck by the fortitude andintegrity of these two fine individuals.There is still enormous love in their marriageand a strong infrastructure. It is aprivilege to be part of their journey.

Michael F. Myers, a clinical

professor in the Department of

Psychiatry at the University of

British Columbia in Vancouver,

Canada, is the author of Doctors'

Marriages: A Look at the Problems

and Their Solutions (Plenum Pub Corp;

1994) and How's Your Marriage?: A Book for

Men and Women (American Psychiatric Press;

1998). He is the past president of the Canadian

Psychiatric Association and welcomes questions

or comments at myers@telus.net.