an estimated 17 million Americans suffering from a depressive illness (Sheffield, 1998), it is safe to say that mental illness is one of the most painful and persistent
trials that a family will face (Morrison, 2005). The American Medical
Association considers it the most incapacitating of chronic conditions in
relation to social functioning (Sheffield, 2003). More than one in ten people
will suffer a serious depression at some point in their life; however, nearly
two-thirds do not get the help they need (Morrison, 2003; Sheffield, 1998).
an illness impacts the home, specifically a marriage where one spouse is
suffering from depression. Both partners benefit from understanding depression.
this illness impacts so many lives, it is apparent form the number of
individuals who actually seek help that few victims and family members are
equipped with the information they need to understand mental illness. This is
unfortunate because depression is the number one psychiatric disability of our
time and takes place within relationships, often having harmful effects on them
(Papp, 2003; Kung, 2000; Jeglic, 2005).
feels sad from time to time. However, it is important to distinguish between
major depression and life's transient sadness (Morrison, 2003). The term mental
illness does not refer to the normal wear and tear of life that comes as a
result of social and emotional concerns (Morrison, 2005). Rather, mental
illness is described as abnormality in an individual's mood or a brain disorder
causing mild to severe disturbances in an individual's understanding, thinking,
and behaviors (McKenry, 2005; Morrison, 2005). Depression consists of negative
behaviors such as lower motivation, and increased self-focus and irritability, which
leads to strains in the depressive's relationships (Papp, 2003). In his book, Valley
of Sorrow: A Layman's Guide to Understanding Mental Illness, Alexander
Morrison described the affects of mental illness in the following manner,
It will have become apparent that emotional,
spiritual, and physical toll from mental disease is horrendous. It exceeds the
ability of words to describe. The tsunami of suffering extends outward from the
victim to engulf family members, friends, Church associates, and fellow
workers. All involved struggle to try to make sense out of what is going on. Dreams
are discarded, hopes dashed. Panic, sorrow, and a sense of hopelessness can
pervade every waking moment. (p. 115)
disturbances are severe and last long enough they can affect the victim's
ability to function normally as an individual or productive member of society (Morrison,
2005). Serious depression takes on a life of its own, all encompassing and
unlimited (Morrison, 2003). Even serious depression may disappear of its own
accord but usually some sort of treatment will be necessary, and it is
recurrent and may occur again (Morrison, 2003).
other infirmities such as cancer or heart disease, mental illness appears in
multiple forms with different characteristics requiring different treatments
(Morrison, 2003; Sheffield, 1998). Although certain characteristics will turn
up consistently, it is impossible to predict with complete accuracy how any
given depression will manifest itself; for example, some people are
consistently depressed for years at a time while others will experience cycles
of depression and remission (Sheffield, 1998).
is an "internalizing" disorder, meaning it involves major disturbances in moods
and emotions (McKenry, 2005). An understanding and an ability to interpret
symptoms will give clues to a correct diagnosis of depression (Sheffield, 1998).
mentioned above, type and severity of symptoms will vary and will look
different for each individual. Those who suffer from a mild and untreated
depression may be able to function well enough to fool those around them, but
it is when depression goes beyond a mild form that it can wreak havoc in the
individual's life (Sheffield, 2003).
and the Family
have found that depression tends to run in families (Sheffield, 1998). And
while it is known that depression has a genetic connection, researchers have
yet to discover exactly how (Morrison, 2003).
with predispositions for mental illness face many challenges. For example there
are reports of victims who have records of past hospitalizations facing reduced
career opportunities, receiving limited insurance coverage, and even being
denied coverage from insurance companies (Morrison, 2005). In addition many
families will face social stigmas about depression. Victims may encounter fears
of being shunned, whispered, or laughed about (Morrison, 2005). Also those
suffering from depression may believe that spouses, friends, children, and even
employers may abandon them (Morrison, 2005).
social costs of depression are not limited to the depressed individual but
include family members (Benazon, 2000). In sum, a large part of the burden for
victims and their family members will be "the prejudice, ignorance, misunderstanding
and social stigma which characterize the attitudes of many in society towards
the mentally ill" (Morrison, 2005, p. 289).
Facts About Depression and Marriage
and marital problems have reached epidemic proportions in today's society
(Gordon, 2005). For example, depression affects 10%-25% of the population and one-half
to two-thirds of all marriages are likely to be affected by a separation or
divorce or both (Gordon, 2005). This does not, however, mean that divorce and
separation always lead to depression. But it should be kept in mind that when
individuals do seek help from a mental health facility, marital problems and
depression are among the most prevalent problems for which treatment is sought
(Heene, 2005). Some researchers suggest that 50 percent of all distressed
couples have at least one member who is clinically depressed (Gordon, 2005). Furthermore
research done on depression and the marital relationship indicates that one of
the most consistent predictors of difficulties in relationships is negative
affect (depression, etc.) in one partner (Papp, 2003). And indeed couples in
which one spouse is depressed report more uncomfortable feelings and negative
well-being when compared to nondespressed couples (Jeglic, 2005).
has found that the stress of taking care of someone who is mentally ill can
trigger depression (Sheffield, 2003). This is crucial information when tied
with other findings. For example more than 50 percent of depressed individuals
report marital problems and depression has been found to precede marital
problems which in turn results in an increase of the one-year likelihood of
divorce by a startling 70 percent (Johnson, 2000; Benazon, 2000). This is a lot
of information and another way to understand this information is to realize
that marital problems and depression form a detrimental cycle. Depression leads
to marital problems and marital problems in turn lead to depression.
problems and depression take on a cyclical relationship as shown by additional
evidence suggesting that marital problems influence the onset, maintenance, and
treatment of depressive episodes (Kung, 2000; Johnson, 2000). For example
difficulties in marriage such as arguments are most frequently reported as the
events prior to the onset of depression (Kung, 2000). On the other hand
research also indicates that depression may induce poor interpersonal relations
which cause additional stress resulting in increased levels of depression
(Gordon, 2005). In sum, research has found the relationship between depression
and marital conflict to be reciprocal (Papp, 2003).
it is certainly not depression alone that breaks up relationships a growing
number of experts believe that depression is often the cause rather than the result
of a divorce (Sheffield, 2003). For example two ways in which the functioning
of a marriage were affected by depression were first the way the couples
communicated when fighting and second how the individuals in the couple
mentally represented their relationship and its functioning (Heene, 2005).
Spouse as Caregiver
be a spouse and also the caregiver of a depressed person can have a strong
impact on the individual (Wittmund, 2002). In fact patients' partners have been
found to be at high risk of developing depression themselves, and report an
increase in depressive symptoms (Wittmund, 2002, Jeglic, 2005). Research also
shows that living with a depressed spouse places a considerable psychological
burden for the caregiving spouse (Benazon, 2000). It is no surprise that
spouses as caregivers are the most at risk because they have the most invested
in the relationship (Jeglic, 2005).
order to understand how depression reeks such havoc on the spouse of depressed
individual it is important to have a picture of a loving and healthy
relationship to compare. Individuals who come together to form a couple bring
with them individual beliefs about love, marriage, intimacy, gender roles, etc
(Papp, 2003). Once a couple is formed there are attributes that act to help a relationship
or marriage function in a healthy way. For example there are conscious efforts
to develop emotional closeness and show love (Duncan, 2000). Individuals in
strong relationships take time to communicate and really listen to each other's
hopes, dreams, feelings and concerns (Duncan, 2000). Strong marriages will
include individuals who solve problems together, do family work together, and
are based on equality in the marriage relationship (Duncan, 2000).
Family: a Proclamation to the World declares that a "Husband and wife have a
solemn responsibility to love and care for each other..." (¶ 6). Marriage
contributes significantly to an individual's self-esteem (Kung, 2000). It is no
wonder that when such an influential role is threatened or when an individual
perceives they have failed in marriage, a sense of failure may permeate all
aspects of life (Kung, 2000).
of depressed individuals are like anyone else entering a relationship. They
come with expectations, dreams and hopes. As a result when they examine their
lives after becoming a caretaker they see multiple limitations and losses
particularly concerning the partnership (Wittmund, 2002). It is no surprise
that living with a depressed spouse acts as a source of strain and emotional
distress for spouses (Benazon, 2000). Caretaker spouses not only experience
limitations in their personal relationships but problems may affect their
career, social acceptance and limit their leisure activities and life style
(Wittmund, 2002). Spouses of depressed individuals who were interviewed
reported restrictions in their social and leisure activities, a fall in the
family income, and a strain in the marital relationship (Benazon, 2000).
only do spouses of depressed individuals deal with life's daily hassles they
also have to deal with the symptoms of their partner's depression and inability
to help or participate in the relationship. Often the caretaker spouse is left
with an increased work load and a decreased support system (Wittmund, 2002). For
example in a relationship where one spouse is depressed, the caretaker spouse
often have more responsibility for maintaining family functioning and the
well-being of any children (Benazon, 2000). This lack of spousal support is one
reason caretaker spouses may have an increased risk of depression (Kung, 2000).
Spouses may be unable to ask friends or neighbors for help with day-to-day
tasks due to shame or fear and this can lead to a general avoidance of social
situations in an attempt to avoid uncomfortable questions (Wittmund, 2002).
(1998) gives words to the emotions caretaker spouses experience in her book How
You Can Survive When They're Dressed when she says, "[caretaker spouses]
wonder why no one understands that another's depression directs and colors our
lives, our thoughts, our feelings, just as surely as it does those of the
depressive" (p. 1). For a caretaker spouse living with a depressive who views
the world through despair is disheartening and leads to many of the same
feelings, such as worthlessness, that the depressive feels themselves (Sheffield, 1998).
problems for the caretaker spouse begin out of the public view and within the
private marital relationship where the caretaker spouse is an eye-witness as
their friend and lover transforms into someone they don't recognize (Sheffield,
1998). The despair only increases when the caretaker spouse realizes that no
matter how much love or sympathy they show they are not able to help their
spouse and as a result they begin to lose themselves as well (Sheffield, 1998).
caretaker spouse often finds that their life with a depressed partner is very
different from how they had imagined it would be (Wittmund, 2002). Often they
will have negative attitudes toward their depressed spouse (Benazon, 2000). Sometimes
caretakers may even see their depressed partner as a burden (Jeglic, 2005). Many
caretakers will talk about their depressed partner as though they were another
child to be taken care of rather than a spouse (Wittmund, 2002). Ironically
these feelings can lead to the same feelings that the depressive experiences
such as self-doubt, demoralization, anger, and a desire to escape the source of
distress (Sheffield, 1998).
a result both members in the partnership where one member is depressed view
their partner as more "negative, hostile, mistrusting, and detached and less
agreeable, [and] nurturing" (Kung, 2000). With such feelings it is no wonder
that hurtful acts such as name calling, ridiculing, or intentional negative
social comparisons occur that are damaging to the relationship (Roby et al,
2000). This lack of mutual respect and courtesy between spouses can lead to
psychological abuse between the partners (Roby et al, 2000). Such abuse between
partners is especially painful because it occurs between two individuals who
have promised to each other and the law to nurture and cherish each other (Roby
et al, 2000).
such circumstances what can be done for the depressed, the caretaker spouse and
To Live with Depression
advice is written as though the process of diagnosis and treatment of
depression is easy or occurs in a perfect world (Sheffield, 1998). However,
those in the role of caretaker spouse they know that it is much harder then it
seems. Sheffield (2003) describes the position of a caretaker spouse well when
she says, "Loving someone who is depressed brews confusion frustration,
resentment, and pain" (p. xxii). But it is important to remember that family
members are vital to helping those with mental illness (Morrison, 2005).
connection between depression and marital distress is influenced principally
through the way individuals explain the negative behavior of their partner
(Gordon, 2005). Individual's personal explanations of negative martial events
greatly impacts marital satisfaction and their emotional state (Gordon, 2005).
to attribute blame to someone is pointless and results in unnecessary suffering
for the depressed and the caretaker spouse. Searching for a source to blame
wastes energy that would be better spent in learning more about the illness and
possible treatments (Morrison, 2005). Those who suffer from depression don't
choose to and are not simply lacking willpower, "they cannot, through any
exercise of will, get out of the predicament they are in" (Morrison, 2005).
understanding that depression is not intentional caretaker spouses may be able
to change they way they think of their spouses. For example caretaker spouses
my see their spouses as a victim rather than a saboteur of the marriage (Sheffield, 1998).
better use of time and energy would be to search for understanding and
increased capabilities for compassion and patience (Morrison, 2005). Developing
patience through increased understanding is one of the best tools a caretaker
spouse can acquire. Patience will be especially beneficial when dealing with
the continuous ups and downs of depression and even the constant care needed
for patients who may be in danger of suicide (Morrison, 2005).
spouses can provide encouragement and realistically remind the depressed of
God's love, and the love of family members (Morrison, 2005). It will be
important not to lose patience and to avoid saying things such as "just snap
out of it" or "get a little backbone" (Morrison, 2005). The importance of
avoiding such phrases is exemplified through this quote from Helping and
Healing Our Families:
Anyone who has ever witnessed the almost
unbearable pain and uncontrollable weeping of a severe panic attack, or the
indescribable sadness of severely depressed person who cries all day and
retreats in hopeless apathy, would never think for a moment that mental illness
is just a matter of willpower (Morrison, 2005 p. 292).
that depression and not the spouse is the villain is a huge step in the battle.
However while patience, compassion, and love provide support and are crucial
for learning to live with depression within a marriage they are not a cure for
the illness therefore it is important to seek knowledge of the illness and of
treatment options (Sheffield, 1998).
depression as an illness and the biological process can help caretaker spouses
to take an active role in treatment (Morrison, 2005). Caretaker spouses who
have little understanding of depression may try to control the ill person and
their behavior as if the depressed spouse were a child (Sheffield, 1998). Having
knowledge of the illness and where it comes from will help and enable caretaker
spouses to better cope and communicate with health care professionals (Sheffield, 1998). This includes understanding the length of time medication can take to
become active and learning behavioral techniques that are crucial to the healing
process (Morrison, 2005). Sheffield (2003) put the importance of knowledge into
perspective when she said,
Knowledge is power; choices should be
informed by an appreciation of the advantages and limitations of any treatment.
Asking the right questions of the professionals reduces uncertainty and stress,
and will help both partners assess progress, or lack of it, more accurately.
the depressed to get treatment is not always easy and may require more than
gentle assertiveness (Sheffield, 1998). Caretaker spouses may even experience
strong resistance to the idea of seeking help (Sheffield, 1998). Sheffield (1998) points out that the better informed a caretaker spouse is the better they
will be able to help the depressive overcome resistance and seek appropriate
it is important to seek help and treatment promptly (Morrison, 2005). Quicker
and better results can be expected from cases that received professional help
early before the illness became deep-seated and therefore less easily treated (Morrison,
are many forms of treatment and it can be daunting to try and understand what
the doctors are talking about (Sheffield, 1998). The type of treatment that is
prescribed will be determined by the form of depression that the victim suffers
from (Morrison, 2003). For the caretaker spouse, knowing what is medically the
matter with their spouse is essential to their wellbeing and can provide a
foundation for the future (Sheffield, 1998). It is invaluable to the caretaker
spouse to learn about depression and how to deal with it (Morrison, 2005). This
is especially true since depressed individuals may not be good questioners or
listeners, may distort information based on their moods, and are often not the
best judges of their progress (Sheffield, 2003).
victims of depression will find their suffering greatly reduced with proper
treatment (Morrison, 2005). An absence of necessary treatment increases the
potential for depressed individuals to harm themselves and others (Morrison,
care providers often use a three-pronged treatment approach that includes the
social, biological and psychological aspects of depression (Morrison, 2003). Many
sufferers, in fact just under half, seek help from primary care physicians
rather then specialist such as psychiatrists and psychologists (Sheffield, 2003).
and other remedies are not subject to the Food and Drug Administration
requirements for safety and efficacy trials (Sheffield, 2003). While these
remedies may have been tested or researched the studies have been poorly
designed and have been tested against placebos and not against antidepressants
(Sheffield, 2003). Nonprescription remedies can be risky and have not been
found to be the best remedy (Sheffield, 2003).
antidepressants, if used well, have been found to provide help to 60 to 70
percent of all those suffering from depression (Sheffield, 2003). One study
found antidepressants to be helpful in alleviating most severe symptoms of depression
and enabling sufferers to face life's problems although they did not alleviate
the problems (Papp, 2003). Medication can reverse bizarre behavior and assist
in healing the brain and improving effectiveness of psychotherapy (Morrison,
2005). The influence of an optimal dose of medication can occasionally be felt
within ten days, however for most sufferers a more gradual change, possibly
taking up to twelve weeks, is more normal (Sheffield, 2003).
spouses should be aware that patients may start skipping pills and even
discontinue them because they may not be able to discriminate between their pre
and post-medicated self (Sheffield, 2003). In the minds of the depressed,
behavior changes as a result of medication may not be noticed and this can lead
to discouragement and the eventual stopping of medication (Sheffield, 2003).
about medication(s) a depressed partner is taking is only the beginning (Sheffield, 2003). A caretaker spouse should maintain good communication with the care
provider as they can provide good input as a close observer of the depressed (Sheffield, 2003).
all the responsibilities and weight that caretaker spouses face it is important
that they take time out for themselves. As a caretaker spouse individuals spend
much time supporting not only the depressed but children and outside roles such
as employee as well. Caretaker spouses will also bear the brunt of depressed
moods of their spouse which can lead to personal demoralization (Sheffield, 2003).
a result it is important that caretaker spouses maintain a life of their own. Not
only is this beneficial for the caretaker spouse but it will allow them to be
of most help to their depressed spouse. It is important that caretaker spouses
find time each day, even if it's only a few minutes, to recharge themselves (Morrison,
2005). Some suggestions for recharging include: reading a good book, talking to
a trusted friend, or calling a family member (Morrison, 2005). The method is
not as important as realizing that nurturing the self is vital to the health of
the relationship (Morrison, 2005).
Depression is an illness that can greatly
impact a marriage if it goes untreated. Not only does the depressed individual
live with the symptoms of the illness but the caretaker spouse also is subject
to similar symptoms and increased responsibility with less support.
information on mental illness is available for the general public online at:
accompany her books Anne Sheffield has created a website that includes a free
discussion board that may be helpful for some individuals. Follow the link to
the main page and then click on message board:
Written by Jaelynn R. Jenkins,
Research Assistant, edited by Alan Springer, Ph.D., Marriage and Family Therapist,
and Stephen F. Duncan, Professor, School of Family Life, Brigham Young University.
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