How's Your Marriage, Doctor?

Dr. Taylor, a retired pathologist, andMrs. Taylor, a retired librarian, cameto see me with their complaint: "Weneed some help. We argue all the time.Things were okay with us until 2 yearsago, when our troubled daughter beganto affect our marriage."

STRUGGLING WITH ADDICTION

Their 35-year-old daughter Carla wasa great worry to them. They described along history of instability since she was ateenager—manifested in taking drugs,running away from home, having 3 therapeuticabortions, and attempting suicideseveral times through wrist slashingsand medication overdoses thatresulted in a half dozen hospitalizations.

Nothing seemed to help. She hadbeen married and divorced twice andbecame a lesbian for a while. She wasnow living with her boyfriend, Jim. BothCarla and Jim were in recovery from drugabuse and living on social assistance.

So how did this affect their marriage?Dr. and Mrs. Taylor were deeply dividedon what to do with Carla. Dr. Taylor feltsorry for her; Mrs. Taylor was fed up.Carla was not allowed in their homebecause she couldn't be trusted. Notonly had she stolen and sold some oftheir home's valuables to buy cocainewhen she was using drugs, but she andher friends had broken into Dr. and Mrs.Taylor's ski cabin and taken items.

Mrs. Taylor learned that her husbandwas having furtive meetings withCarla—usually a meal or coffee together—and he would give her cash for food,cigarettes, rent, etc. But Carla began todemand more and more money fromher dad, who seemed powerless to setlimits. He felt so guilty and frightenedthat he confessed to his wife. She wasactually quite sympathetic and understanding.He stopped meeting withCarla after this, but within weeks, Dr.Taylor was back to his charitable self.

That's when their fighting over thesituation heightened and they decidedto come for some assistance. I explainedthat Carla might have at least 2 diagnoses—substance dependence (whichwas obvious) and a personality disorder.I gave them some reading materials(which they devoured) and then we discussedhow entrenched and treatment-resistantcertain behaviors can be, particularlyself-centeredness, emotionalinstability, impulsivity, inner emptiness,and antisocial actions.

PUTTING PIECES TOGETHER

Treatment was on 2 different tracks.First, I referred them to an addictionmedicine counselor, where they learnedan enormous amount about the diseaseof addiction and its relation to addictedindividuals' families. They went to aseries of lectures and began to attendAlanon (they tried Narcanon but didn'tfeel comfortable there).

Second, I had a series of marital therapysessions with them. What seemed tohelp was the opportunity to cometogether and talk about (and gaininsight into) so many bottled up themesand emotions: the sense of failure theyfelt as Carla's parents; the anger and sadnessthey felt about their other 2 children"cutting themselves off fromCarla"; the terror of receiving a call fromthe police that would say Carla wasfound dead on skid row from an overdoseor homicide; Dr. Taylor's guilt thatas a physician-father he couldn't domore to help his daughter, to save herfrom self-destruction; Mrs. Taylor'sremorse and self-blame that she hadfailed as a mother to her only daughter;and anger that Carla's problems hadeclipsed their retirement years together.

After a few months, they both felt alot better, their boundaries were muchclearer with Carla, and the couple beganto relax and have some fun together.

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;

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.