How's Your Marriage, Doctor?

Physician's Money Digest, September 2006, Volume 13, Issue 9

Dr. Ambrose is a child psychiatristwho is a specialist in eatingdisorders. Six years ago,she and her husband consulted me forseparation therapy when they weredivorcing. She called recently, "I'd liketo schedule a visit for James (her exhusband)and me. Our daughter Blainehas been diagnosed with bulimia, andwe'd like your help. She's seeing a goodpsychiatrist, but I think that James andI need a road map."

In that first visit, I learned that eachof them had remarried. They had jointcustody of Blaine, now age 14, and shewas spending alternating 2 weeks ineach of their homes. It was James' wife, Sheila, who first noted thechanged behavior in Blaine, such aseating less at meal time, increasingamounts of time in the bathroom, runningwater to mask sound, emptysnack wrappers and bags in her wastebasket,and several bookmarkedInternet sites about weight loss. Sheilatold her husband, who then asked Dr.Ambrose if she had noticed anything.

"I'm having a kaleidoscope of emotions," said Dr. Ambrose. "I can'tbelieve it. How could I miss this? I'mangry at myself, I'm angry at Blaine,and I'm angry at you, James. Yourmarriage is none of my business, but Iknow that Blaine resents Sheila. Youand Sheila are obsessed with fitnessand proper nutrition. Blaine is purgingand making herself vomit so she can fitinto such an anal household."

James' response was no surprise andladen with sarcasm, "Thank you forthe consultation, Fran. I used to adorethe way you'd analyze me, free ofcharge. Your profound insights weregreat for my self-esteem. Hmmm, Iwonder why I divorced you."

I stopped this interaction and askedDr. Ambrose to talk about her anger atherself. She started sobbing, and after afew moments, she began, "I'm sorry,James, I still attack when I feel most vulnerableand afraid. I've tried so hard tobe a fit mother to Blaine. I blamedmyself for the divorce. I'm angry that Ifailed as a wife. I've spared her thedetails of my research and clinical workin eating disorders so our home could benormal. And I've never told her whatboth you and Dr. Myers know, aboutmy own anorexia nervosa when I was inmedical school. So I beat myself up forthat too—that my genes are a curse."

I have had another visit with the twoof them and one visit with each of themand their spouses. The sessions havehelped, and Dr. Ambrose has begun individualtherapy with a psychologist.

Michael F. Myers, a clinical professor in theDepartment of Psychiatry at the University ofBritish Columbia in Vancouver, Canada, is theauthor of Doctors' Marriages: A Look at theProblems and Their Solutions (Plenum PubCorp; 1994) and How's Your Marriage?: A Book for Men andWomen (American Psychiatric Press; 1998). He is the pastpresident of the Canadian Psychiatric Association and welcomesquestions or comments at myers@telus.net.