How's Your Marriage, Doctor?

Bernice English, MD, andHamilton Walsh, MD, cameto see me within the past year.Dr. English is a rheumatologistand Dr. Walsh, a cardiologist. Theyare both 60 years old and have beenmarried for 31 years, having met duringtheir residencies. They have three adultchildren, all doing well.

Lapse in Judgment

Mopping Up

After the Affair

"Our saga is called ," Dr. English began.She started to cry. Dr. Walsh sat stone-facedsome distance from her on mycouch. I passed her a box of tissues asthey sat in silence. I looked at them andsaid, "Do you want to talk about it?"More silence ensued. Finally, Dr. Walshspoke, but not before some sort of nonverbalpermission from his wife."Bernice had a brief fling with her golfinstructor recently. It's over now, butI'm really worried about her, Dr. Myers.I'm afraid she might harm herself." Ilooked at Dr. English, who averted mygaze and said, "I don't deserve to live.This is so painful. I've brought shameon my family, my reputation, and myprofession. I hate myself, and I wantHamilton to divorce me."

As the interview continued, Ilearned some key information. Dr.English's relationship with the otherman seemed in part due to a lapse ofjudgment. This behavior was certainlyout of character for her. She had a historyof mental illness, having suffereduntreated postpartum depression afterher second and third children.

"What did we know in those days?"she explained. "I just thought that I wasinadequate and weak. My mother toldme that I was too much of a careerwoman and not enough of a nurturer.My guilt was off the wall. Hamilton waswonderful, and so was our nanny; Icouldn't have survived without them. Itwas only later, when I was feeling normalagain, that I told Hamilton how suicidalI had been—it went on for weeks." Shedenied any recurrence of depression untilnow, which she attributed to the affair.

Inherited Depression

But something else came out in thatfirst visit. Dr. English's father, uncle, andcousin had suffered from bipolar illness."And I think you've got a touch of ityourself, dear," said Dr. Walsh. "Eversince your menopause, you go up anddown in your spirits, not wildly, but subtlyfor weeks at a time. You've been a bithigh for the past 4 months; you're upearlier than usual, playing your music abit loudly, wearing more makeup, andtaking on more responsibilities at thehospital. Although our garden is stunningthis year, your planting has been abit excessive. And you're obsessed withgolf. Even before you were involved withDerek I was worried about you. I'venever seen you flirt so much in all theyears we've been married."

I met with Dr. English individuallyfor the remainder of the visit and againthe next day. My working diagnosis wasbipolar illness, type II. She was verydepressed, but not actively suicidal. I puther on medical leave; she was impairedand not well enough to be working.

She responded nicely to both a moodstabilizer and an antidepressant and hasremained stable. My visits with the twoof them have been largely supportive andeducational. They have a strong maritalinfrastructure and love each other deeply.I have also met with their children, whowere worried about their mother and arerelieved to see her so well now.

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.

Michael F. Myers,