Tales from the Couch

Seeing the patient from psychiatry’s perspective

Getting Better Can Be Risky

How therapy can upend a relationship.

A 55 year old man came to my office, asking me to help his wife. I thought it odd his wife didn’t accompany him to the consultation. It soon made sense why he’d come alone.

Mrs. L had always been socially fearful. Some might call it being shy or retiring, but it was much more. They had few friends, spent nearly every evening home, and settled into a predictable and uneventful life. Despite these limitations, the couple developed a comfortable psychological equilibrium.

When Mrs. L turned 52, her shyness escalated. She became completely avoidant of people; stopped answering the telephone; refused to go to a movie or local store; and the couple ceased dining out. In fact, Mrs. L’s avoidance became so extreme, she spent all her time in the bedroom. The thought of being anywhere else, even in other rooms of her house, aroused panic-level anxiety. Her condition had escalated to severe, incapacitating agoraphobia.

Each day, Mr. L went to work while Mrs. L remained in the bedroom. He did the grocery shopping; picked up dry cleaning; and attended to chores requiring any contact with people. The couple lived separate and apart from humanity.

Mr. L didn’t protest. In fact, he acknowledged the situation gave him ample time for his abiding passion: reading American history. Mr. L didn’t understand why his wife wanted to see a psychiatrist. I found this shocking, since the couple’s life appeared to be so compromised. He’d adapted to his wife’s condition, and was content with their lives. I wondered if he feared a changed Mrs. L would upend their relationship.

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Some days later, despite terrible anxiety during the trip to my Manhattan office, Mrs. L began treatment. She was tired of her bedroom-bound existence. Though she reveled in dependency on her husband, there was some part of her wanting to change. And change she did: a month later, with medication and psychotherapy, she began wanting to dine out, go to a movie, and engage in normal interactions with people. It was clear her phobia was being extinguished. She also confided Mr. L seemed “not so happy” with these changes. Tensions were developing between them. I began wondering who really was the sicker partner.

After a few weeks of the new and improved Mrs. L, her husband called to say she would no longer be coming for treatment. Knowing Mrs. L would deteriorate without medication and therapy, I asked to speak with her directly. Mr. L told me, “She doesn’t want to talk with you.”

I’ll never know whether or not that was true, but what I do know is change can be a threat to any relationship. To preserve what they had, Mrs. L would be heading back to the bedroom.

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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