You know what to do; call 9-1-1. You keep your spouse reassured until medical professionals arrive. The only decision is whether to ride in the ambulance or drive separately; 2) You’re at home with your spouse who starts to frown and mentions things are not right. Concerned, you ask questions… but the answers do not make sense. His condition intensifies and he suddenly bolts out the front door. What do you do? Call 9-1-1? What should you say when you are not even sure what’s wrong? Do you go after him… do you wait until he returns? If so, how long? You’re not sure what to do.  

For many of us, when we vowed “for better or worse” and “in sickness and in health,” we were not thinking about mental illness. We thought of disease, not disorder. Yet, mental illness can have a devastating effect on marriage. A 2011 multinational study of marriage and divorce found that mental disorders increased the rate of divorce from 20-80%. “In separate survival models, all 18 mental disorders are significantly associated with divorce after adjustment for sex, age, country, years since marriage, months dating prior to marriage, and educational attainment” (p. 481).

The mental disorders in this study represented a spectrum of anxiety disorders (such as panic disorder, generalized anxiety disorder, and post-traumatic stress disorder), mood disorders (such as major depression, dysthymia, and bipolar disorder), impulse disorders (such as oppositional defiant disorder, conduct disorder, and intermittent explosive disorder), and alcohol/drug abuse and dependence. “Notably, about half of the societal impact of mental disorders on divorce is attributed to two disorders: major depression and alcohol abuse” (p. 484).

Reading the Signs

Mental illness encompasses a vast array of behaviors depending upon the individual and/or co-occurring disorders… so what is a spouse to look for? Spouses may not be trained in mental illness, but they have learned what appears to be “normal” for their loved ones. I have found there are three keys to help a spouse identify the signs of mental illness and know when to get help:

  1. Severity. How severe are the behaviors? Do they significantly and negatively impact relationships, work, and preferred activities? Are the behaviors getting better or worse? The more progressive, severe, and disruptive the behaviors, the more indicative they are of a mental illness.
  2. Frequency. How often do these behaviors occur? Are they repeated after remorse and regret? Are they repeated after protestations they won’t happen again? When negative consequences are insufficient to produce a change in behavior, the higher the potential for a mental illness.
  3. Duration. How long have the behaviors been occurring? A week, a month, a year, multiple years? The more entrenched the behaviors, the greater the probability of a mental illness.

Hierarchy of Care

When one spouse suffers from a mental illness, the other spouse often becomes a caregiver, with significant emotional, relational, physical and spiritual demands. A 2009 study by the National Alliance for Caregiving in collaboration with AARP, titled, “Caregiving in the U.S. 2009,” found negative caregiver consequences involving physical health, emotional health, financial resources, and employment, with an added impact to those caring for someone with mental illness issues.2 “Caregivers whose recipients have emotional or mental health problems are more likely than others to report a decline in their own health as a result of caregiving” (p. 48).

When the caregiving demands are due to mental illness, a spouse may be reluctant to ask others for help. In my practice, as we talk with families of those seeking treatment, we find a percentage of these caregivers overwhelmed and at their own breaking points. When their personal reserves are so depleted, their ability to contribute to the recovery of their loved ones becomes critically compromised. Some admit relief, not only in treatment for their loved one, but also in respite for themselves, resulting in guilt and shame.  

In cases where a caregiving spouse denies the very real need for self-care, I have used an oxygen mask analogy. Self-care is the oxygen mask they put on first, so they can better help their loved one second. The caregiver must be alert to when he or she is “running out of air” and know where to find the oxygen mask—be it with family, friends, a faith community, or community resources.

When the “Worst” Happens

There may come a time when the caregiving spouse must reach out for support due to safety concerns, either for self or the loved one. States have different guidelines for responding to psychiatric emergencies, so the caregiving spouse needs to be familiar with what to do in the “worst-case.”

In the state of Washington, a person who is a danger to self or others can be brought to a medical facility, such as a hospital emergency room, for evaluation by a designated mental health professional. If the person refuses to go to such a facility voluntarily, a police officer can take the person into emergency custody for evaluation.3 Should that person be considered to be in immediate danger, the hold time is 72 hours, which may or may not mirror other states.

Solomon in Ecclesiastes says that “two are better than one,”4 and this is certainly true in marriage. If one spouse falls due to mental illness, the other is there to support, but not without cost—and, hopefully, not without reward.

Gregory L. Jantz, Ph.D., is the founder of The Center for Counseling and Health Resources, Inc., a leading healthcare facility in Edmonds, Washington (aplaceofhope.com). He is a licensed mental health counselor, a chemical dependency professional, and a certified eating disorder specialist through IAEDP, as well as a popular speaker and author of multiple books. Visit him at drgregoryjantz.com.

Endnotes

1 Breslau, J., Miller, E., Jin, R., Sampson, N.A., et al. (2011). A multinational study of mental disorders, marriage, and divorce. Acta Psychiatrica Scandinavica, 124:474-486. doi:10.1111/j.1600-0447.2011.01712.

2 http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf.

3 http://apps.leg.wa.gov/RCW/default.aspx?cite=71.05.153.

4 Ecclesiastes 4:9-12, NIV.