Psychotic illness in Marital disorders

The third group of mental disorders which may render people unfit for the responsibilities and obligations of marriage and parenthood includes what are called the psychotic illnesses, or in more popular terms the insanities. The occurrence of a psychotic illness does not necessarily bring about a hopeless marital situation, any more than a severe physical illness will do. Treatment of many people with such illnesses is much more successful in these days, and many of them are very responsive to the devoted care of an understanding partner and relatives.

The psychotic may generally be distinguished from the neurotic, although there is no sharp line of demarcation, by the fact that he lacks insight into reality as well as into his own inner attitudes, while the neurotic, with defective insight into himself, generally has reasonable insight into the realities of life. Because of his lack of insight into reality the psychotic shows more irrational attitudes, and is much less “accessible” to counseling and psychotherapy than the neurotic.
The commonest types of psychotic illness are the “affective disorders” which mainly but not entirely involve feelings, and the various forms of schizophrenia, in which feeling, thinking and behavior are generally all involved in the disorder.

The affective psychoses are more common in the second half of life, and are of two general types, which in some cases alternate with one another in the same person. First are the depressive illnesses often termed “melancholia,” characterized by progressive inconsolable sadness and by deadness of feeling and utter pessimism. There may be strong delusions of guilt and failure, and about bodily functions. The other type includes the elated-feeling people, with bouts of tireless energy and enthusiasm and increasing restlessness, in which everyone is expected to share.

The melancholic people may bring some strains on marriage, but with reasonable understanding, which avoids attempts to argue them out of their depressions and delusions, they are generally manageable except for certain agitated types that need some restraint. There is often some danger of suicide, and such people are usually hospitalized and given special treatment, which is reasonably successful in many cases.

People suffering from mania may need urgent restraint in some cases, and particularly some protective measures against overenthusiastic spending of money, which may rapidly reduce a family to financial straits. They are usually responsive to treatment in hospital, and may remain well for some time until a further attack of mania or a gradual drift into a period of melancholia.

Schizophrenia in its various forms is commonest in the first half of life, although one form, the paranoid or delusional, often occurs in older people, either as a gradual development from the earlier form or as an apparently fresh illness. The most common early indications of schizophrenia are indifference, incongruity of emotions, such as giggling in the face of tragedy, irresponsibility and lack of initiative, dreaminess, and emotional withdrawal. There may be bizarre associations of ideas, delusions and hallucinations, and in one form fixed symbolic posturing. In early stages a young person may become involved in an impulsive marriage, and with the strains and responsibilities of marriage, and particularly those of pregnancy and childbirth, may suffer a serious breakdown in health and sanity.

Tags: Counseling