Beyond the First Dance
Behavioral Health and its Effect on Marriage
Listening to the daily news about the opioid crisis and alcohol-related incidents, one can begin to imagine the stress on marriage and families. Yet, when it comes to these issues, many individuals hesitate to discuss such topics for fear of being negatively judged. “Behavioral Health” includes both mental health and substance-use issues. While these are separate conditions, they often co-exist. Currently, there are many people who erroneously believe these issues are caused by a moral weakness, a character flaw or the result of poor parenting. Research has proven otherwise.
Mental health issues, like depression, anxiety, post-traumatic stress disorder and bipolar disorder, as well as substance misuse, and even gambling addiction, have a biological basis. While environment can play a role in their emergence, these conditions are part of a family’s medical history. This does not mean such problems will always occur in a family member, but rather that an individual is at higher risk for experiencing a similar disorder. Sadly, when it comes to recognizing and dealing with these conditions, there remains an unwarranted stigma.
There is nothing that will affect a marriage or family more profoundly than un-addressed substance misuse and/or mental illness. In my career as a nurse practitioner, my work as a Certified Prevention Specialist and as a co-facilitator of a family support group, I have seen marriages destroyed and families shattered when these conditions are not addressed. When we take these subjects out of the box of secrecy and speak about them with the same concern and respect we assign to other illnesses, we take a huge step toward erasing the stigma.
Ideally, such conditions should be addressed early on when a couple is seriously dating. If one’s parent experienced serious depression or if a sibling suffers with alcoholism, these conditions should be discussed just as openly as diabetes or cancer. If either partner is personally affected by these issues, the couple needs to talk about how it has been managed and how it will be addressed if it arises in their marriage. To avoid discussion about such issues is to court disaster.
Behavioral health illnesses are often insidious, making it more difficult to recognize them in the early stages. Because of the stigma, treatment is often delayed, allowing for problems to escalate. Relationships can suffer irreparable harm when treatment is postponed. Communicating openly about their concerns around issues of mood changes, drinking, gambling or substance use allows a couple a greater chance to save their marriage. This is often easier said than done.
In my years as a nurse practitioner, I often witnessed denial when an issue was raised by one spouse. A husband may have been concerned about his wife’s depressed personality, yet she did not want to seek help. A wife would worry openly about her husband’s nightly drinking and he would contend that he deserves a few drinks, saying it is not a big deal. In the attempt to get through to a partner in these situations, emotions can erupt that do not help matters.
This is a time for the healthier spouse to seek support and professional counseling. Friends or co-workers may seem like an appropriate sounding board, but lacking objectivity and expertise, they are likely ill-equipped to address such situations. Meeting with a therapist can help a spouse or other family member to deal with the stress and master the skills necessary to motivate for change. Attending groups like Al-Anon and peer support groups can also provide insight and helpful resources.
For the past 14 years, Patrick and I have co-facilitated a support group for family members of loved ones suffering with substance misuse. We witness firsthand the impact behavioral health issues have on a family, as marriages are being fractured and siblings suffer in silence. Substance use disorder is a family disease and it needs to be addressed as a family. To do this requires that parents pull together when their child is affected. When it is a spouse, it is critical that the partner seek individual counseling to keep his or her own head above water and ensure the family remains stable.
Behavioral health is finally recognized as part of overall health care. These complex brain disorders need to be addressed like other medical issues and, indeed, are now covered by insurance with the same coverage as other chronic, relapsing illnesses. In 2008, the Federal Parity Law was passed, requiring that both mental health and substance use disorders be treated with the same coverage afforded all other chronic, relapsing illnesses. To do otherwise is discriminatory and illegal. As patients and consumers, we have the right to expect that such issues will be addressed with the protocol that includes screening, diagnosis, appropriate treatment, medication when needed, and follow up to ensure the best outcome.
Knowing that the impact on relationships, and specifically marriage, can be profound, we should all be seeking the necessary care for ourselves and our families.
Taking care of oneself is critical to staying healthy. Even though your partner or child may seem the source of the problem, the only person you can change is yourself. Knowledge is power. Learning about the condition that your loved one is experiencing can help you best respond. Seek out a support group and individual counseling, and take time every day to do something you enjoy. Such decisions will help you deal with the stress and can have an incredibly positive effect on your marriage and family.
Until next time, be present to one another and God, and always listen with love.
Susan McKeown is currently a Family Support Coordinator with Children’s Behavioral Health Collaborative. Susan’s first book, Beyond the First Dance, was published in 2015.