How's Your Marriage, Doctor?

Whether we split up or stay together,we need some help," Dr.Tang said over the phone. In my firstvisit, I learned that he was age 42,divorced, a father of a 9-year-old son,and an associate professor of surgery. Hispartner, Dr. Hay, a 30-year-old chief residentin nephrology, stated, "I'm tired ofbeing bossed around—both at work andat home." That really set the tone of thesession. Dr. Tang did most of the talking.Dr. Hay sat largely silent, but spoke volumeswith his body language andexpressive facial gestures.

JARRING DIFFERENCES

This was the first same-sex relationshipfor each of them. They had beencoupled for 4 years, having met at amedical conference. Dr. Tang had beenout of his marriage for about 2 years atthat time. He and his wife divorced as aresult of his being gay. Dr. Hay was verynewly "out," and this was a significantdynamic in their troubled relationship.He liked to party, to hang out with singlegay men his age, and to take ecstasy"occasionally." Dr. Tang reacted to allof this in a very controlled manner,with pedantic lectures and diatribes onfidelity, ascetic self-denial, and Internetliterature searches on the medical dangersof ecstasy.

But their relationship had additionalchallenges. In an individual visit with Dr.Hay, I learned that he had a significanthistory of untreated and recurrentdepression, including a suicide gesture incollege. He was actually quite worriedabout his potential for self-harm.

THERAPEUTIC HEALING

I diagnosed him with a dysthymic disorderand he improved significantly withan antidepressant. Specifically, he sleptbetter, worried less, was less irritable,felt greater self-worth, and became a littlemore assertive. Unfortunately, hedeveloped some sexual side effects withthe medication, which posed more anxietyfor Dr. Tang. Viagra helped.

Another complication was the interracialand interfaith issue. Though it wasno problem for the couple, it was fortheir families. I found it interesting andrefreshing that both Dr. Tang's and Dr.Hay's families were accepting of theirhomosexuality. But it seems that eachfamily had hoped that their son wouldcommit to a man of his own race and religion.I was able to make some suggestionson how to talk to their families in acalmer and less defensive and bombasticway. It was heartwarming to learn howwell Dr. Hay got along with Dr. Tang's sonand vice versa, and what a significantpresence the boy was in their family.

They both made great strides withtherapy. There was a thorny "father-son"element that needed to end. Ispent a lot of time helping Dr. Tang torecognize his feelings—including insecurityabout their age difference, fears ofbeing abandoned, anger, and loneliness—and to speak about these emotionswith Dr. Hay. His manner becameless intellectual, softer, and moreauthentic. Dr. Hay gained a lot of insightinto his passive-aggressive ways and hetoo began to speak more openly andclearly to Dr. Tang when he was upsetand felt like "rebelling." As thingsimproved at home, Dr. Hay tired of theclub scene and the 2 found many waysto have fun together, alone and withtheir friends.

Michael F. Myers, a clinical

professor in the Department

of Psychiatry at

the University of British

Columbia in Vancouver,

Canada, is the author of

Doctor

s' Marriages: A Look

at the Problems and Their Solutions (Plenum;

212-620-8000) and How's Your Marriage?:

A Book for Men and Women (American

Psychiatric Press; 800-368-5777). The immediate

past president of the Canadian

Psychiatric Association, he welcomes questions

or comments at myers@telus.net.