COUPLE RELATIONSHIPS

THERE ARE many reasons of a social nature for the deterioration of marriage – causes such as the loss of traditional family values, the advent of women’s entry into the labor force and the loss of faith in God, among others. Our focus however, in this article, will be on some of the psychological and interpersonal dimensions.

THE CASE OF MADAME DESJARDINS

My first contact with real toxicity in relationships was during my year of residency training in psychiatry at a private hospital that catered to the rich and famous. The couple were the Desjardins.

Madame Desjardins was a woman in her early 40s with a pleasant personality and a relatively opulent lifestyle. Her husband was a prominent businessman with a long string of financial successes. He was very hard-working and very demanding at home. No one at the hospital recalled seeing him, since he was always working.

There was something unusual about the case of Madame Desjardins. She had been admitted to the hospital with a diagnosis of psychotic depression. This was before the days of DSM manual diagnoses. However, there was no family history, either of depression or psychosis, as far as we could tell. She had never been depressed before getting married and at the hospital there was nothing crazy or even depressed about her behavior. In fact, she stood out in her normality and people often mistook her for a staff member rather than a patient.

In taking the case history, most of the symptomatology centered on her performance as a housewife. At times she would be extremely efficient and at other times she would break down into a paralysis of the will – an anergic impasse. During the weeks prior to admission she was making more and more errors at home. She would regularly overcook the family meal. Her husband would show up at g or 10 o’clock at night, after a long day at the office, to a burnt roast chicken or a totally dried-out lasagna. She often forgot the laundry or the children’s lunches. The week before admission, she had left a broom in the stairwell that her husband usually raced down every morning in his rush to get to work. He had a nasty tumble, fractured a vertebrae, and decided it was time for his wife to be hospitalized.

After a few pleasant individual therapy sessions centered around her current symptomatolgy and her past history which – aside from some minor learning problems at school – was quite unremarkable. I decided that the problem must be elsewhere and invited her husband to come in. He was, of course, difficult to reach and even more difficult to schedule. As well, he was insisting we see the children, since they would serve as witnesses to his wife’s misbehavior.

So we scheduled a family therapy session. I had just begun my studies of family therapy and thought that this would be a great place to practice what I was learning. Each family session followed the same format more or less. Mrs. Desjardins was almost totally silent Even when addressed her responses were brief and unhelpful. The children would sit dutifully in their places and not dare to interrupt Mr. Desjardins would rail on about his wife’s depression, her mistakes, her sabotaging his career.

He would punctuate his verbal assaults on his wife with questions to me about her diagnosis, the cause of her illness and what treatments we were going to undertake. He would express his disappointment with the failure of the outpatient treatment of his wife who had continued to deteriorate. Then he would insist that she needed electric shock treatment which had helped one of his colleagues’ mothers to recover from a melancholic depression.

He never asked his wife’s opinion or that of his children either. He never expressed sympathy for her psychic pain. He never brought her flowers or chocolates or any of the usual presents people bring for patients in the hospital.

Somewhere around the third or fourth session, after a particularly intense tirade about how his wife should be behaving, I looked at him squarely in the eyes and said, somewhat naively, “Mr. Desjardins, have you ever considered the possibility that you are too harsh and authoritarian in your family?”

He looked back at me, equally intent on registering his own opinion, and said in a loud voice, slamming his fist on the table for extra emphasis, with a sound that reverberated through the entire department:

“Dr Rreps, I am an extremely gentle man…!”

At that point I knew we were not going to get very far in family therapy and my supervisor agreed. We decided instead to help Mrs. Desjardins regain her strength and learn some forms of appropriate self-assertion and psychological defense on her own.

FAMILYTHERAPY

Family therapy and couple therapy are probably the most difficult enterprises in all of psychiatry. There are currently over a dozen different schools of approach to family therapy. They include names such as the Bowen Family Systems Approach, Menuchin’s Structural Family Therapy, the Milan Systems Approach, Psychoanalytic Family Therapy, Problem-solving Family Therapy, Psycho-educational Family Therapy and many others. They draw on each of the various schools of individual psychotherapy and add “systems” approaches designed specifically for collective realities. Each of the approaches has specific applications and has been found useful in particular contexts. For example, psycho-educational approaches have been shown useful in families where a person has been diagnosed with schizophrenia.

When I first started psychiatry, the approach in vogue was one based on communications theory (Bateson, Weakland et al.) which held that schizophrenia was produced by pathological communication in the family, which included placing the patient in “double-bind” situations from which he or she was unable to escape. This ended up creating a culture in which parents were blamed for children’s psychoses, adding the element of guilt to the already substantial burden of being the parent of a psychotic child. With the advent of neuropsychiatry and genetic research this theory is no longer mainstream and parents can put aside their inappropriate guilt and learn to cope with what constitutes a severe, biologically-based psychiatric illness.

Couple therapy developed from family therapy but often turns out to be even more challenging. The pitfalls of projections, introjections, displacements and miscommunication seem to be particularly acute in this one-to-one context whose only real parallel is the mother-child relationship. The original pattern, once established in the mother-child bond, tends to repeat itself in the couple context and in every other relationship for that matter.

THE CASE OF DAN

I was reminded of these pitfalls several years ago as I crossed the campus of my Alma MaterMcGiIl University. There I ran into an elementary school classmate named Dan who I had not seen in close to thirty years. He had since become a very successful lawyer, working vigorously for the rights of indigenous peoples in Canada and had clearly become prosperous and self-assured.

“How’s it going, Dan? It’s been a long time” I offered.

“Terrible” he answered, clearly relieved to be able to speak about something that he may have been keeping hidden from his current friends.

“What’s up?” I said trying to make light of it.

“It’s my marriage …”

“I didn’t know you were married … Tell me about it” I said, sounding perhaps a bit too much the professional psychiatrist.

“I don’t get it!” he stammered, clearly frustrated. “I did everything right We dated for two years, we lived together for three years and only after that did we get married”. He paused, took a deep breath and continued, “It lasted three months! And then we separated”.

“She changed completely once we were married. Before, we got along fine, the occasional spat nothing serious. After the marriage we couldn’t agree on anything, not even what to buy at the grocery store”

I smiled.

“What are you smiling about? It’s not funny!”

“You’re right It’s tragic, but I’ve seen this all too many times. I will try to explain it to you in brief but if you really want to get a handle on it you’d probably have to consult someone”

The fact is that he had probably changed as well after the marriage, but didn’t realize it I then explained to him what I have observed working with couples. There are three or four crucial points in the life of a couple: when they get married, when they move in together, if they buy a house together and when they have children.

At any of these points an internal psychological change can occur. The person then becomes more identified than previously with the same-sex parent Usually the man becomes more identified with his father and the woman with her mother but the identification may cross gender lines. In this way the previously cute and seductive female can become aggressive and domineering like her mother or the soft-spoken gentle male suddenly becomes autocratic like his Dad (or his Mom). At that point the entire interaction dynamic changes and the conjugal atmosphere can alter, sometimes radically. In order to understand this better I think it would be helpful briefly to explore Object Relations Theory.

OBJECT RELATIONS THEORY

Object Relations Theory is an outgrowth of psychoanalytic theory. It is most commonly associated with the name of Melanie Klein, one of Freud’s major successors and a creative adversary of Freud’s own daughter, Anna Freud, who preferred her own school of Ego Psychology. Other well-known proponents of Object Relations Theory were Fairbairn and Winnicott who are considered “Kleinian revisionists” Nowadays the best known theorists in this school are Heinz Rohut who developed his own school of Self-Psychology and Otto Kernberg, famous for his work on the Borderline Personality.

The important discovery of the school of Object Relations Theory is that we are inwardly not just one unified personality but actually a constellation of entities. Somewhat parallel to the Islamic and Sufi concept of the self as composed of nafs (ego), qalb (heart), ruh (soul) and sirr (secret), the psychological concept is composed of Self and Object: the I-Thou relationship. Thus we have within ourselves a stable notion of who / am and who the other is.

Accordingly to the Object Relations Theory these two entities are formed through the processes of Identification and Introjection. Through “identification” we internalize the consciousness of another person (usually one of our parents) which then becomes part of the “self”. Through introjection we internalize the other person who then becomes part of the “other” or what the psychoanalysts call the “object”. Thus we have self-object relationships within our psyche.

This may sound at first quite abstract, but when confronted with it in relationship, it becomes very real. How many husbands after years of marriage have said to their wives, “You’re just like your mother!” And how many wives have had to say to their husbands “You’re being just like your Dad now”. Conversely, how many husbands have said to their wives after a long period together “you’re treating me as if I were just like your Dad but actually I’m very different”. And how many wives have had to say to their husbands “You’re treating me as if I were like your Mom but I’m not at all like her. Pm not controlling and demanding like she is but that is the way you perceive me”

This is all about identification and introjection and projection. Why projection? Because we play out the internal object relations externallyover and over again. This is what establishes the “negative relationship pattern”.

THE ABUSED WOMAN

A striking example of this occurred in my practice a few years back. As psychiatrists we often work with other mental health professionals in a collaborative or consultative capacity. One of the professionals that I work with from time to time is a psychologist who is very involved with women’s rights and protecting abused women from further abuse. She is a regular volunteer at a women’s shelter and wanted to refer me one of her patients for medication. This woman, Yvonne, in her early thirties, had a long history of being with violent partners and being assaulted.

The psychologist had tried to refer this client to me on a couple of previous occasions but each time she had found excuses not to come. This was her third attempt In addition, the psychologist was really worried about the client’s suicidal tendencies since she was going on vacation which made her worry even more about her patient’s vulnerability. I had given Yvonne an appointment previously that she had missed and this was our second attempt The psychologist was well aware of how difficult it was to get an appointment with a psychiatrist and was relived to hear that I had accepted to see her client a second time.

A week later, I had to call her back to explain that the patient had missed her appointment a second time – without even calling to apologise. This feminist psychologist was now more than frustrated – she was furious. “I could kill her” she blurted out Then she caught herself and we both burst out laughing. She had fallen into the trap! This lady, Yvonne, had once again enraged someone – in this case her female helper. In fact it was not only a problem with men but permeated all of her relationships. She knew how to induce anger in anyone!

If we return to Object-Relations Theory then we can begin to understand what is going on here. The patient just described had an inner self-object world that consisted of the self as victim and the object as aggressor. Once this was well- established inwardly (let’s say for now with the help of a consistently aggressive, violent father) it is only a matter of time before this scenario gets played out in the outer world. This can then be enacted with almost anyone a spouse, an employer, a friend and even the “helping” professional.

For a long time, I asked myself how this occurred, as the theory only tells us that this will happen but not how. The answer eventually came to me in the form of two equations or formulae.

The first was f(x)=c. This is a basic algebraic formula, often hidden somewhere in our high school math textbooks. The reason it is hidden is because it does not give rise to any mathematical problems. The “x” is the variable – in some situations called the independent variable. But in this equation the result “c” is a constant No matter what the “x” is – what situation, what context what interpersonal relationship the result is a constant We could call this “the principle of psychological homeostasis”. What does it mean?

In the case of Yvonne, the abused woman, the “c” is abuse, violation or ill-treatment No matter what situation “x” she enters, eventually she ends up feeling violated or abused. In other cases, the “c” may be rejection or betrayal or disappointment or being lied to. The variations are endless. Each one of us has a “c”, some of us have several. They correspond to the continuity of the person – or at least the continuity of their relationships. We can observe this in our daily interactions. Some people seem to get on easily with everyone and others are always in conflict. Some people seem to be able to succeed in everything they undertake. Others have a penchant for failure and disappointment.

Then I asked myself how we get to the “c” the interpersonal constant The answer came in the form of an acronym – PSI. PSI stands for perception, selection, and induction.

Induction, the last of the three letters PSI is the most sinister and potentially the most potent We saw a good example of this with Yvonne the abused female. She was able to “induce” the female therapist to violence – even if only in her thinking.

There is a well known English platitude that “it takes two to tango”. But an effective inducer can tango all alone.

End of Part One. Next Issue:

SAVING RELATIONSHIPS: THE QUR’ANIC IDEAL