How's Your Marriage, Doctor?

Its

message:

This is a story with a sad outcome. If you or your spouseshould suffer from postpartum depression,get support for your marriagebefore it's too late.

Drs. Andrews and Brooks called in themidst of a huge crisis. Dr. Andrewsaddressed her concern: "I'm here to salvagemy marriage. Jim told me last nightthat he's in love with someone else andwants to leave." Dr. Brooks gave his chiefcomplaint: "I'm here for help to separate.We have 2 beautiful kids and I don'twant to make a mess of this. Joan is right,I'm in love with another woman."

BACKGROUND GLIMPSES

Drs. Andrews and Brooks were classmatesin medical school and got marriedat the beginning of their residencies.They are both psychiatrists. Married lifewas running along pleasantly until theirfirst child, Maureen, was born. Withindays, Dr. Andrews crashed into a severedepression. She was anorexic, couldn'tsleep, became very lethargic, and disorganized.Breast-feeding became increasinglyfrustrating, as did other demandsof infant care. When she developed horriblethoughts of harming the baby, herfamily physician started her on an antidepressant.A psychiatrist assessed herand added an antipsychotic.

Fortunately, she began to feel betterwithin a week, and with the help of hermother and husband, things wentsmoothly. Or so she thought. When shebecame pregnant again 2 years later,she continued her antidepressantthrough the pregnancy (the neuroleptichad long since been discontinued).But despite maintenance treatment,she developed a severe postpartumdepression again and was hospitalizedfor 3 weeks. Dr. Brooks took a temporaryleave from his work and took overat home for about 3 months. He nevercomplained, and his fortitude and sensitivityto Dr. Andrews' illness helpedenormously to alleviate her guilt.

When Bradley, their son, was age 6months, Dr. Brooks met a woman atwork who was newly separated. Bothwere lonely and vulnerable. Theirfriendship increased in intensity andthen became sexual. Over the nextyear, Dr. Brooks' feelings for her deepened.He continued to function at workand at home. There were no overt signsof a marriage in trouble.

FAIT ACCOMPLI

MUSINGS

Dr. Andrews assumed that thingswere fine. Consequently, when her husbandtold her that he was in love withthis other person and was leaving, shewas in shock: "I've been kicked in thestomach. This is a bad dream; it can't betrue. He doesn't know what he's doing.We've been through so much. Of coursewe've drifted a bit, but wouldn't mostcouples with this history? I believe in us.I know that we can fix this. We're astrong family; everyone says that."

Unfortunately, Dr. Andrews' wordsfell on deaf ears. Dr. Brooks was alreadyemotionally separated, detached, andnumb, but feeling very guilty. He hadno interest in marital therapy. Likemost spouses in situations like this, Dr.Andrews was furious that she had notbeen given any chance to fight for hermarriage, that this was presented toher as a done deal.

Dr. Andrews became increasingly depressedand suicidal. She did not haveto be hospitalized because various familymembers came to live with her andwatch over her. I treated her with medicationsand individual therapy. I treatedDr. Brooks with individual therapytoo. Over the next 18 months, the 2 ofthem worked out a reasonably comfortableco-parenting relationship andnegotiated joint custody with theirindividual attorneys and mediation.

I wonder if these 2 would have madeit if Dr. Brooks had received some supportby his wife's psychiatrist after herfirst postpartum depression, and beyond,or if someone had recommendedmarital therapy for the couple?

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.