Dr. Sally Willard explained to meover the phone, "I think my husband'sdepressed, but he doesn'tthink so, and maybe he's right. All I knowis that we're miserable—I mean, I'm miserable,and I think he's just fed up withme because I'm on his case so much."Isuggested we three meet and try to sort itout. Following is a simplified and condensedversion of that first visit.
In response to my salutation, "Howcan I help?"Dr. Willard started talkingand didn't stop until I interrupted her. Shewas on a roll about her husband Robert,a paramedic. Negative and critical, butconcerned, she started with clinical language—she was a family physician."Rob's dysthymic, can you see how flathis effect is? He's monosyllabic, anhedonic,anorexic, and has no libido,"sheexplained, "and he may have covert suicidalideation."She talked as if she waspresenting a case at hospital rounds.
I was relieved, and I imagine Rob wastoo, when she switched to lay language;albeit, it was still painful to listen to."He's in his own little world. He ignoresme and the kids and has become ayounger version of his father, who coppedout of life,"Dr. Willard said. "And helooks at me with scorn. I don't think hewants to be here anymore."
I cut in and asked Rob to speak.Guarded and articulate, he began, "I'munhappy, but not depressed—psychiatricallydepressed as Sally thinks. Our marriageis a mess. You're observing in amicrocosmic way how we communicate.She starts and goes on, and I shut down."
In subsequent visits, I learned thatSally was a hard-driving woman whoovercame tremendous odds to become aphysician. She dropped out of high schoolafter her mother's third marriage brokeup and ran away. She lived on the streetsfor a while, getting into drugs and prostitutionbefore entering a youth outreachprogram. Eventually, she went back toschool and worked as a veterinarian'sassistant for a few years.
In her mid-twenties, she took somecollege courses, gained entrance to a university,and applied to medical school.She did well academically, but crashedemotionally into a suicidal depressionwhen her live-in relationship with anotherwoman broke up. After antidepressantsand psychotherapy, Sally returnedto dating men. She met Rob at the hospitalwhen she was a final year medical student."He was the first man who treatedme with respect,"she said. "It took me along time to trust him."
Rob's background was different. Hisparents were smalltown immigrant farmers—according to Rob, "plain, hardworking,salt-of-the-earth types."Theyoungest of four, he was the only kid inhis family to flee rural life. He had alwaysbeen interested in the health field, anddecided to train as a paramedic after abrief stint in the Army Reserve.
Marital treatment with Sally andRob was brief. Sally eventually understoodhow she was projecting her ownfears of illness (eg, depression) and drivefor achievement onto her husband. Withthis insight, she was able to relax and seethat Rob was basically okay—differentthan her, but steady and committed toher and the family.
Rob grasped how his laconic styleconfused and frightened Sally and realizedthat he needed to be more communicative.He recognized that Sally's rantswere about anxiety and a need to reconnect,not hostile attacks against him.
professor in the Department of
Psychiatry at the University of
British Columbia in Vancouver,
Canada, is the author of
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 firstname.lastname@example.org.
Michael F. Myers,