How's Your Marriage, Doctor?

Journal of theAmerican Medical Association

A recent article in the (JAMA; 2003) reminds us thatdepression is common in physicians andthat it often goes unrecognized anduntreated. Not only do mood disorderscause the sufferer incredible pain, but theycan also have pernicious effects on maritalharmony and stability. To get a better ideaof how a mood disorder can affect a marriage,let's consider the case of Dr. Applebyand Dr. Wilton.

Dr. Appleby's Condition

Dr. Appleby, a family physician, liveswith bipolar illness. His first manic episodewas about 5 years ago. He recovered quicklywith a brief hospital stay, a neuroleptic,and a mood stabilizer. After an occurrenceof depression 2 years later, he was successfullytreated with antidepressants.

It has taken Dr. Appleby time to accepthis illness. He has not been compliant withhis medications or my admonitions abouthis use of alcohol. As a result, last year, I puthim on medical leave and referred him to atreatment center for chemical dependency.He is much better now.

Dr. Wilton's Experience

All of this has been tough on his wife,Dr. Wilton, an internist. Before her husbandwas in recovery, she expressed thefollowing thoughts during a maritaltherapy session:

"I love him, but he has no idea most ofthe time how his illness affects our daughterand me. When he's well, it's heaven. It'sthe opposite when he's not well. Hebecomes touchy, picks fights with me,attacks my character, and swears nonstop.

"Sex is a nightmare. One time he'ssweet and thoughtful and the next timeit feels like rape. He's a different personat home because he seems to be fine atwork with his patients, staff, and colleagues.If I dare ask him if he's taking hismedication, he launches a diatribe ofvenom at me. I can't go on like this."

I had a few sessions with Dr. Wiltonalone while her husband was away receivingtreatment. My hunch was correct; shewas clinically depressed. This was actuallya recurrence. Dr. Wilton had experienceddepression in college and during her residency.Restarting the antidepressant thatshe took before has worked to eradicateall of her neurovegetative symptoms.However, she remains sad and anxiousabout her marriage.

Family Affair

It seems that couples' treatment ishelping. I wear 2 hats. I'm an individualpsychiatrist to each spouse (reviewingtheir symptoms and functioning, monitoringtheir medications and side effects,ordering appropriate lab studies, etc)and their marital therapist.

Many of the couple's recent visits havebeen about loss: loss of certainty, loss ofhealth, loss of career trajectory, loss ofincome, loss of trust, and loss of intimacy.Mood disorders and loss have a circularrelationship; loss can be a cause, but also aresult. Early diagnosis and aggressive,broad-based treatment are key.

JAMA

As the article points out, acceptanceis also key: "Barriers to physicians inseeking help are often punitive, includingdiscrimination in medical licensing, hospitalprivileges, and professional advancement.Professional attitudes and institutionalpolicies need to be changed toencourage physicians with mental healthproblems to seek help."

Michael F. Myers, a clinicalprofessor in the Department ofPsychiatry at the University ofBritish Columbia in Vancouver,Canada, is the author of Doctors'Marriages: A Look at theProblems and Their Solutions (Plenum PubCorp; 1994) and How's Your Marriage?: A Bookfor Men and Women (American PsychiatricPress; 1998). He is the past president of theCanadian Psychiatric Association and welcomesquestions or comments at myers@telus.net.