I am excited about this episode today. We all dread mental health issues but today you’ll find out that there is a lot of hope for marriages where one spouse has significant mental health problems.

Mental health is a huge problem that affects millions of people around the world. Disorders including depression, anxiety, bipolar and others impact many more people than you may think and can cause real pain and distress.

Living with a long term mental illness is hard, and so is being married to someone with such a disorder. So today we want to look at the reality of how mental health impacts marriages, and what you can do to support your spouse if you are in this situation.

How Mental Illness Impacts Marriage

We need to be realistic about the impact of mental illness on marriage. Mental illness in one spouse often has a negative impact on wellbeing and marital satisfaction for both the mentally ill spouse and the other[i]. This is normally stronger for the mentally ill spouse but both spouses to feel the effects.

What we’d like to share with you is that for both the ill spouse and the healthy spouse, there are specific mediating factors which can account for much of the marital distress, and therefore be used to help keep marital satisfaction high even when dealing with severe mental issues like mood disorders, anxiety disorders and substance abuse disorders.

Attributions

Mental health disorders (especially mood disorders like depression or bipolar) affect how you interpret your spouse’s actions and what you attribute them to[ii]. This attribution effect is important to be aware of.

Mental health disorders cause people to attribute their spouse’s actions more negatively. They can also cause people to attribute negative behaviors to being stable parts of their spouse’s personality rather than being isolated one-off incidents. This tendency to attribute things negatively leads to lower marital satisfaction over time. Levels of depression themselves do not lead to lower marital satisfaction: all the changes are due to this attribution issue[iii].

Remember our recent episode on attribution and misinterpretations in marriage? We talked about how the way you interpret your spouse’s actions can either set you on an upward or a downward spiral. Mental illness can, if you aren’t careful, make you more likely to see everything as negative, which then alters the way you act and feel. So we really have to watch the attribution piece and thoughtfully counteract that.

Negative Thoughts and Views

People with mental illness will hold more negative views about themselves, and about their marriage. Mental illness can affect perception so that the mentally ill spouse pays more attention to negative events and disregards the good things that happen. Mental illness can also cause people to have more negative expectations about the future[iv]. All these negative beliefs and expectations can influence the way people act and cause them to withdraw and hide away.

Interpersonal Difficulties

Anxiety, depression and personality disorders can all lead to impaired social skills,[v] such as expressing more negative views, difficulty expressing emotion, reduced problem solving ability, a high need for reassurance and difficulty accepting and believing the reassurances offered.

The cycle of repeatedly asking for reassurance or seeking comfort and the refusal or inability to accept comfort can eventually lead to rejection.

These issues can create interpersonal problems within a marriage over time as the non-ill spouse has to constantly reassure and comfort their mentally ill partner without getting as much support in return. Also without getting appreciation for the effort required to support the ill spouse.

To help with this, training in communication and social skills can lead to improvements in symptoms of mental illness, and improve marital functioning at the same time[vi]. Once again the point here is that it isn’t the mental illness itself that’s causing the marital problems, it’s a specific issue that’s caused by the illness but has a very practical solution. So there’s hope there.

Supporting Your Spouse Through Mental Illness

Once again we’ve created a bonus guide for our much appreciated supporters who are interested in going deeper with this subject. This is a great 3 page guide full of ideas to help you make the most of this situation and really bring out the positives despite the challenges. If you’re looking for some insight into how mental illness works and how you can support your spouse through it, you need this guide. You can get this by becoming a patron of The Marriage Podcast for Smart People.

Supporting the Mentally Ill Spouse

So how can you support your spouse through mental illness? If your spouse has some kind of long term mental illness you may feel powerless to help them, but it turns out that you as the spouse are perfectly positioned to help them through it. Here are a few ideas.

Positive behaviors. A study in 1998[vii] identified five key positive behaviors which can be used to support a mentally ill spouse:

  1. Enjoyable time spent together
  2. Positive listening
  3. Tangible/practical assistance
  4. Self esteem support
  5. Intimacy and confiding

These behaviors help the mentally ill spouse feel supported and can reduce symptoms over time. So these simple things which should be a part of any healthy marriage can actually reduce the burden of mental illness. We go into more detail on each of those five in our bonus guide so definitely check that out.

Accept the issue. While there are definitely things you can do to help your spouse, expecting the mental health issue to just vanish is going to make things much worse. Expecting or putting pressure on your mentally ill spouse to change creates a higher risk of marital distress[viii]. It can be difficult to understand what your spouse is going through since there are no outward signs of illness, but it’s important to understand that mental health issues are just as real and serious as physical ones.

Change is possible but it has to be a very gradual process and challenges and setbacks are likely, so expecting or needing your spouse to recover is likely to turn mental illness into a bigger marital problem.

Conflict and problem solving. A study in 2002[ix] surveyed 22 couples where the wife suffered from an anxiety disorder such as agoraphobia. They found that husbands in these marriages were often more critical of their wives and less likely to use positive problem solving skills. These couples also showed higher rates of negative nonverbal behavior and longer “negative exchanges” (arguments). This then led to higher marital discord. So working on good conflict resolution and communication skills can certainly make the mental illness less of an issue.

Similarly, a study by Coyne et al[x] found that arguments with your spouse are a risk factor for the onset of depressive disorder, and having a spouse you don’t feel you can turn to or confide in also leaves people vulnerable to depression.

So you want to work hard at maintaining a posture of approachability and helpfulness.

Compassion and reassurance. As we saw above, mentally ill people often need regular reassurance that they are still valued and cared for, but struggle to accept reassurance and comfort when it is offered.

This is because people with anxiety or depression suffer from both negative emotions (sadness, worry, hopelessness) and negative thoughts and beliefs about themselves (thinking they are worthless or that other people don’t like them). So they need reassurance to comfort the emotional side of the illness, but the thoughts and beliefs they hold make it hard for them to believe that they are really loved and supported[xi].

Spouses should therefore continue to offer reassurance and comfort whenever needed and try not to get frustrated when the person continually asks for support. Continually affirming that your ill spouse is loved and valued can slowly change their perception of themselves and help change their negative beliefs over time.

However, spouses need to be careful to show support and validation to their spouse, but not to their ill spouse’s negative views and beliefs about themselves. Normally showing that you understand and agree with your spouse’s views and perceptions is a good thing, but when your spouse holds very negative views of themselves due to mental illness, showing agreement with these views can reinforce them and end up being harmful[xii]. You want to try and lift your spouse out of their negative thoughts and beliefs, not wallow in them alongside them.

Supporting Yourself While Your Spouse is Mentally Ill

The other side to this is making sure that you are ok while your spouse is mentally ill. A happy spouse will go a long way to reducing the impact of mental illness, and just because you are the “healthy” one that doesn’t mean you don’t have needs that should be met.

So let’s look at some issues that you need to think about.

Attributions. Mental illness can cause people to say or do things they would never do otherwise. For example, illness may make people more easily angered, more prone to self destructive behavior or less willing to engage with their spouse.

Spouses should attribute these things to the illness, not to their spouse. Thinking that negative behaviors are deliberately performed by your mentally ill spouse and intended to cause harm creates higher distress within the marriage[xiii]. So learning to separate your spouse from the things the illness causes them to do or say can protect you from distress. A simple question you can ask yourself is, “Is this the illness speaking or my spouse speaking?”

Stigma. Mental health is often poorly understood or stigmatized by society, which can lead to the other spouse feeling isolated or unable to share about the difficulty of supporting their mentally ill spouse[xiv]. Friends and family may, for example, be unable to understand and accept mental illness and instead refer to it in other terms such as thinking the mentally ill spouse is just stressed, or that they just have a weak or anxious character.

The non-ill spouse may also come across the attitude that they are in some way responsible for their spouse’s condition. Being aware of these issues and choosing to selectively confide in a few trusted friends can help you get the support you need without feeling isolated or stigmatized.

Identity. Supporting a mentally ill spouse can “absorb” your sense of self and identity as you spend all your time and energy supporting your spouse or dealing with doctors and mental health services[xv].

To cope with this, spouses should aim to develop a more balanced relationship in which they can care for their mentally ill spouse while also pursuing their own interests and friendships. In this way caring for their spouse becomes part of their identity, but not the full extent of it.

Part of this requires the healthy spouse to understand that they cannot be solely responsible for curing or controlling their spouse’s mental health[xvi]. You can certainly help them, but taking sole responsibility for the health of your spouse creates a situation of codependency, which isn’t good for anyone.

Couple Therapy. Obviously if your spouse is mentally ill then therapy, medication or counseling are great treatment options to ask your doctor about. But joint therapy has also been shown to be particularly helpful for couples where one spouse is suffering from mental illness[xvii].

Joint marital counseling or therapy reduces symptoms for the mentally ill spouse and reduces the strain for the non-ill spouse. Reductions in mental illness are often fully caused by improvements in marital functioning caused by the joint therapy. So couple therapy improves marital functioning and marital satisfaction, which in turn lowers symptoms of mental illness[xviii].

That is REALLY cool as well! Of course, marriage therapy is our specialty and if we can help you with that please reach out to us through our website.


References:

[i] Mark A Whisman, Lisa Uebelacker, and Lauren Weinstock, Psychopathology and Marital Satisfaction: The Importance of Evaluating Both Partners., 2004, lxxii <https://doi.org/10.1037/0022-006X.72.5.830>.

[ii] Frank D. Fincham and Thomas N. Bradbury, ‘Marital Satisfaction, Depression, and Attributions: A Longitudinal Analysis.’, Journal of Personality and Social Psychology, 64.3 (1993), 442.

[iii] Fincham and Bradbury.

[iv] Steven RH Beach, Frank D. Fincham, and Jennifer Katz, ‘Marital Therapy in the Treatment of Depression: Toward a Third Generation of Therapy and Research’, Clinical Psychology Review, 18.6 (1998), 635–61.

[v] C. Segrin, ‘Social Skills Deficits Associated with Depression’, Clinical Psychology Review, 20.3 (2000), 379–403.

[vi] Segrin.

[vii] Beach, Fincham, and Katz.

[viii] Sue Bauserman, Ileana Arias, and W Edward Craighead, ‘Marital Attributions in Spouses of Depressed Patients’, Journal of Psychopathology and Behavioral Assessment, 17 (1995), 231–49 <https://doi.org/10.1007/BF02229300>.

[ix] Dianne L Chambless and others, ‘Marital Interaction of Agoraphobic Women: A Controlled, Behavioral Observation Study’, Journal of Abnormal Psychology, 111 (2002), 502–12 <https://doi.org/10.1037/0021-843X.111.3.502>.

[x] James C. Coyne, Richard Thompson, and Steven C. Palmer, ‘Marital Quality, Coping with Conflict, Marital Complaints, and Affection in Couples with a Depressed Wife.’, Journal of Family Psychology, 16.1 (2002), 26.

[xi] Segrin.

[xii] Beach, Fincham, and Katz.

[xiii] Bauserman, Arias, and Edward Craighead.

[xiv] Jeppe Oute Hansen and Niels Buus, ‘Living with a Depressed Person in Denmark: A Qualitative Study’, International Journal of Social Psychiatry, 59.4 (2013), 401–6.

[xv] Hansen and Buus.

[xvi] Hansen and Buus.

[xvii] Beach, Fincham, and Katz.

[xviii] Beach, Fincham, and Katz.