What to Do with an Emotionally2
or Physically Disabled Spouse

Letter #1

Dear Dr. Harley,

We've been together for 20 years, happily married for 17, and have two teenage sons. Since I returned from a 3 day business trip 5 weeks ago (my first in 4 years) my wife has accused me of 1. having an affair, 2. trying to hide assets, 3. threatening her, 4. wanting to hurt the children, 5. tapping her phone, 6. bugging the house, 7. not loving her. 8. planning on leaving her for a younger woman, etc. I haven't done any of these things.

I love my wife with all of my heart. She has now locked me out of the house and gotten a restraining order preventing me from contacting her or my kids. She has always been slightly paranoid, and now she has gone off the deep end (At least with respect to me. She is still fairly rational and normal with everything else). She will not talk to me at all, she throws away my letters and she accuses the counselor we were seeing of lying to her and now she won't go to a counselor either.

What should I do?

B.R.

Dear Mr. B.R.,

Your wife is probably suffering from a paranoid disorder. It is usually a problem that gets worse over time, since in many cases its underlying cause is damage to the brain which, itself, deteriorates over time. Most people who are known to have a degenerative neurological disorder are somewhat paranoid.

Some people are paranoid at an early age, which could reflect an early brain injury. One of my clients that I saw for the first time at the age of 16 had a serious head injury when she was 6. She is now 38 and on rare occasion manifests some paranoid symptoms, but is married with three children and has steadily improved throughout her lifetime. It's a rare but encouraging example.

Some of my clients with serious paranoid disorders have eventually divorced their spouses, with everyone who cares for them, including their loving spouses, trying to stop them. I have gone to extraordinary lengths to try to prove that their paranoid fears are unfounded, but rarely does "proof" have any effect.

Sometimes medication can control paranoid thinking, particularly when the person is experiencing schizophrenic or manic symptoms along with being paranoid. But you describe a pure state of paranoid thinking in your letter, and medication has not been very successful in treating it. Psychotherapy is also somewhat unsuccessful, although there are instances of full recovery.

As you discovered, after taking your 3 day business trip, people that suffer from paranoid thinking don't like their spouses to leave them alone. I believe that your wife may eventually let you back into her world again. If she does, don't ever leave her again overnight. The more time you spend with her, the less chance she has to imagine what you could be doing behind her back. Also, stress clearly increases paranoid thinking, and when you're with her she will be less anxious.

For a while, you may suffer stress from all her accusations, and it may even make you very angry. But I would not argue with her. Simply reassure her that you love her, and promise you will never leave her overnight again. That may settle her down. Also, call her regularly throughout the day. The more of your time you give her, especially when she has your undivided attention, the fewer symptoms you are likely to observe.

People with a paranoid disorder imagine all sorts of plots designed to do them in. Some are dangerous to live with because they are convinced their spouses are planning to kill them. I have counseled paranoid clients that have tried to kill their spouses in what they think is "self defense." Whenever I have a client who threatens to kill their spouse, I advise a separation until there is evidence of remission.

In your case, there does not seem to be any danger, so I would encourage you to make every effort to reunite with her. I think she will probably respond to you efforts within a few weeks, or at the most, a few months.

Make several efforts each day to talk to her, and when you can, tell her that you love her. Tell her the truth, never go along with one of her fantasies just to try to get along with her. If she demands that you confess doing something she imagined, gently tell her that you would never do anything to hurt her. Give her regular reassurance that you care about her and don't let yourself become so frustrated that you end up saying something that would hurt her feelings.

Next Letter

What to Do with a Depressed Spouse


Introduction: This week's subject is related to an earlier subject entitled, "Emotional and Physical Disabilities" (June 3rd). You may want to read it along with this week's column. Since the letter this week is longer than usual, and my answer is also long, my column includes only one letter.

Dear Dr. Harley,

I have been married to my husband for two and a half years, and we've been together for four years. Throughout almost our entire relationship, my husband has been either mildly or severely depressed. His job creates so much stress for him that it affects his entire life, but I fear it's not his job that makes him miserable. He has a lot of emotional baggage from his past that he denies affects him, including his adoption at birth and the murder of his sister ten years ago, neither of which he has dealt with, and to sum it all up, he feels he has no value as a person.

On the other hand, I have learned, by spending most of last year in therapy, to reclaim my self-worth and value my needs as I once did before I met him. He has grown quite resentful as I have come to these realizations, because when I married my husband, I was in denial about the significant problems that already existed between us. I thought that my love could fix all of his past hurt and make him truly happy at the same time. (It was his challenge to me when we married that since everyone in his life has always left him, I would too someday, and I was determined to break that pattern for him.) Well, my "love" has fixed nothing, obviously, and all I have gotten for my efforts is resentment that I have changed. My change is that I now value my own needs as much or maybe more than I do his, and I only want him to reciprocate for all the attention and love I've given him.

We tried marriage counseling together last year, and he resented our therapist for constantly "blaming him" for our problems. I never interpreted that she did that, but it was what he chose to see, so nothing was accomplished in the effort. We stopped going when we moved away, and never resumed in our new city.

I seem to have a need to stay with this selfish, disturbed man. I do want to make him happy and myself happy, but when I try and explain my needs and what I want, he is defensive and doesn't listen. He demands, "What do you want from me?" and calls me names (moron, stupid, idiot). He is a control freak, and I have just about reached the end of my rope. As I'm sure you realize, he has to learn to love himself before he can be an equal partner to me, and I am going to try one last time to get us into therapy. I don't have much hope, and I just want to know if you perceive that I am doing something wrong. He says that I only pick fights and complain constantly; that my problem is that I just don't understand men. He generalizes that all women are annoying and that men really want to be with other men, with few exceptions. He values his male friends and treats them like gold, but I don't receive the same priority, I feel. He says that I am wrong, but I say actions speak louder than words.

What have I not done? I am tired of being expected to put him first, and he is resentful of how I now ask for my needs to be met rather than automatically meeting his, and have mine eventually fall into place like before. I feel that he has years of self-analysis ahead of him before he can be at the same level of self-love and self-knowledge that I am, and that I am married to a man that feels more like a child to me than a husband. He wants me to "mommy" him frequently, and that has killed my physical reactions to him, about which he is also resentful on the rare occasion that he has a sex drive. So, what do I do? I really have so much doubt that I fear any effort on my part or his part will net no great returns. How do I overcome this doubt, or should I just cut my losses and chalk it up to trying to change someone from the start? Please help, I could really use the guidance.

A.J.
Dear A.J.,

From your description, you married a man who has "used up" the love of many women. I'm sure that others in his past have come to many of the same conclusions as you have. Your husband probably has a serious depressive disorder, and he's probably been that way, off and on, most of his life. It's certainly no fun living with someone who's depressed, and I would imagine that if he doesn't overcome his depression soon, your name will be added to the list of women who've left him. However, there are proven ways to help him out of his depression that may save your marriage.

Apparently, you lived with him before you were married, and you probably had a better relationship then. You may have met him when he was in a more energetic part of his cycle, and since you married him, his cycle has turned to a less energetic form of depression. He may have periods of temporary recovery that last days or even weeks, but the recoveries are less frequent and don't last as long as they used to. His depression doesn't keep him from his job, but it makes his work miserable. When he comes home from work, he may try to relieve his suffering with alcohol.

If I'm right about this man, his problem may be almost entirely biochemical. The juices that flow through his brain make him depressed. Lots of people are that way, and without medication that stops depression, there's not much they can do about it.

Granted, he's probably done plenty to make himself even more depressed. The way he has treated the women in his life has caused them to leave him. That's pretty depressing. He's probably done all sorts of things in a state of depression that has made his life pure hell for himself and anyone around him. After someone's been depressed a while, it's hard to know what causes the depression, biochemistry or the behavior of the depressed person, because his behavior also makes him depressed.

I won't lay all of his problems (or even the majority of his problems) at the feet of his depression, however. He probably has a lot to learn about caring for a woman, but his depression has given him a handicap that makes him socially disabled, at least when it comes to marriage. Regardless of how hard he tries to please you, his depression makes him a miserable man to be with. He simply cannot meet your emotional needs while he's depressed.

Depression is the most common of all emotional disorders. Everyone knows what it's like to be depressed from time to time, but that's not what depression, the emotional disorder, is all about. It is not the sorrow we feel at the time of an important loss, but rather, it is an irrational feeling of hopelessness when there is evidence for hope. The emotional disorder, depression, leaves a person blinded to his opportunities, unaware of his potential. The longer he is depressed, the more opportunities he misses until his life becomes a self-fulfilling prophesy -- he always thought he was worthless, and finally he proves it because he stops doing anything that's productive.

Whenever a spouse I counsel for marital problems suffers from severe depression, my first item of business is to treat the depression, not the marital problems. The treatment, however, is much simpler than most people think. Anti-depressant medication is the ticket. It greatly relieves, if not eliminates entirely, a depressive state so that the spouse I counsel can succeed in meeting the other spouse's emotional needs. As his depression is lifted, he seizes opportunities both in his marriage and at his job, that makes him more successful. In the end, his self-esteem is restored because he finds himself successful in achieving his life's ambitions. I do not believe that counseling to improve self-esteem, apart from showing people how to be successful, ever really improves self-esteem.

The approach that I use to save marriages looks at the present and future for solutions. I encourage you not to worry about your husband's past, his self-esteem or whether or not he loves himself. After he is treated medically for depression, focus your attention on the way you treat each other in the here and now.

Your biggest hurdle will be to follow my Policy of Joint Agreement (Never do anything without an enthusiastic agreement between you and your spouse). His depression has made it impossible for him to follow that policy, and by failing to follow it, you have both been developing habits that make you increasingly incompatible. You are coming to a point in your relationship where you will be so incompatible that you will not be able to live together anymore, and you will end the relationship. When his depression lifts, he will be in an emotional position to learn new habits, habits that will restore compatibility to your relationship. By following the Policy of Joint Agreement you will eliminate all the things you're doing that grate on each other, and you will substitute behavior and activities that make both of you comfortable.

If either of you feels you cannot follow that Policy, it means that you are willing to gain at the other's expense, and that will eventually ruin your relationship. When you follow the Policy of Joint Agreement you create compatibility by taking each other's feelings into account, especially when you don't feel like it. When you feel the most self-centered, that's when you need it the most. If you cared about each other all the time, you would follow the policy instinctively, but in every relationship, there are times that we care far more about ourselves than we care about our spouses. So by following this rule day in and day out, you keep your relationship healthy when your instincts would tend to ruin it.

You and every other couple can have a terrific relationship regardless of your past. Granted, your spouse's depression must be treated, and, in my judgment, anti-depressant medication should do the trick. But his past has left him with all sorts of unpleasant habits which must change before you can have a happy marriage. If you follow the Policy of Joint Agreement as soon as his depression lifts, you will have that relationship.

If anyone reading this column is suffering from the disabling condition, depression, help is already available to you. Medical science has found an incredible cure that should leave you free to solve your marital problems intelligently and completely. Don't ignore it, take care of it now.

One of the first things I do when couples see me for counseling is to evaluate them for drug and alcohol addiction. If I feel that either is addicted at the time, I refer the addicted spouse to a treatment program. The Love Buster, drug or alcohol addiction, will prevent them from resolving their marital conflicts because it controls them. It must be eliminated before marital therapy has any hope of being successful.

My job as a marriage counselor begins after successful treatment and sobriety. If the addicted spouse refuses treatment, then I direct the unaddicted spouse to Alanon or some other support group for spouses of alcoholics. Sometimes, I encourage an intervention.

That's what I learned to do after discovering that an alcoholic is so much in love with alcohol, that while in the state of addiction, there is no way for them to consider their spouse's feelings whenever they make decisions, a necessary condition for a great marriage. Alcohol always comes first, even when it is at the spouse's expense.

But even after sobriety is achieved, it's an uphill battle for the couple. The spouses of alcoholics are usually so relieved when treatment is successful that they often think their marital troubles are over. It's true, addiction makes it impossible to resolve marital conflicts. But sobriety itself doesn't solve them -- it simply makes them solvable. Once addiction is overcome, a couple is faced with the legions of other Love Busters that were ignored in the shadow of addiction or were created by addiction.

Some people wonder if they are really alcoholics. They may not go to bars, and they may not even get drunk very often. What is an alcoholic? My definition of an alcoholic is someone who cannot follow the Policy of Joint Agreement because of their craving for alcohol. If your drinking in any form bothers your spouse, and you cannot or will not give it up for his or her sake, I consider you an alcoholic because alcohol is more important to you than the feelings of your spouse.