Effect of marriage on pre-existing psychoses : Indian Journal of Psychiatry (original) (raw)

Department of Psychiatry, Jawaharlal Nehru Medical College (JNMC), [Datta Meghe Institute of Medical Sciences (Deemed University)] Sawangi (Meghe), Maharashtra, India

1Department of Psychiatry, JSS University, JSS Medical College Hospital, M. G. Road, Mysore, Karnataka, India

2Department of Psychiatry, M. G. I. M. S., Sevagram, Wardha, Maharashtra, India

Address for correspondence: Dr. Prakash B. Behere, Director – Research and Development (R and D), Department of Psychiatry, Jawaharlal Nehru Medical College (JNMC), [Datta Meghe Institute of Medical Sciences (Deemed University)] Sawangi (Meghe), Wardha – 442 004, Maharashtra, India. E-mail: [email protected]

“Marriage consists of the rules and regulation which define the rights, duties and privileges of the husband and wife.”

– Georgea Lundberg

Marriage is a social union or legal contract between a male and a female having intimate interpersonal relationships. It has been the greatest and most important of all social institutions in the human society. People marry for many reasons such as legal, social, libidinal, emotional, economic, spiritual, and religious. These might include arranged marriages, family obligations, legal establishment of a nuclear family unit, legal protection of children, and public declaration of commitment.

The relationship between marriage and mental illness is very complicated and this issue commonly arises in psychotic illnesses. Psychosis is usually diagnosed at late adolescent and early adulthood. Being a disease of the age at which decision of marriage is taken, the question of whether to marry or not and whether marriage will lead to improvement or deterioration in psychoses is equally faced by patients, their family members, and treating psychiatrists. Mental disorders and problems in marriage are closely linked though there is a controversy about the sequence.

PECULIARITIES OF MARRIAGE IN INDIA

In India, marriage is a social institution of extreme importance. It is much more than a variety of close personal affiliation uniting two partners and is based on the following foundations…[1] most often it is not a free personal choice but is an arranged relation between two families; the maturity of the partner is not an essential requirement for marriage, and marriage encompasses a heterosexual relationship. In Indian marriage, the husband is considered the head and principle earner of the family; sexual fidelity and monogamy of both husband and wife are represented as marital ideals. Society exerts great pressure on both sexes to marry; mostly people marry without thinking about their personal choice of getting or not getting married. In the presence of mental illness, if marriage is done under pressure, it may lead to deterioration of mental condition.

SITUATION OF MENTALLY ILL FEMALES

In India, marriages are usually arranged by parents and are influenced by number of factors such as astrological compatibility, caste regulation, geographic proximity, and expectations of dowry. Female psychotic patients have multifold psycho-socio-economic problems than males because in an Indian setting, male dominates and he is the deciding person for selection of partner. Female patient undergoes tremendous stress in getting married, and if she is having pre-existing mental illness, then the situation worsens. Almost all females face many of the following problems in getting married and sustaining married life. Firstly, at the time of proposal, when a girl is shown to the male partner, it is a stress due to the uncertainty of fixing up of marriage. Secondly, the question of dowry hampers and causes stress. Thirdly, after marriage, she has to leave her parents’ house where she has spent 18–20 years of her life. Fourthly, she goes to a new house where she has to cope up with new family members of different temperaments. Fifthly, if she is on drugs for maintenance of improvement from psychoses, she has to face difficulties such as her in-laws may ask for the reason of taking drugs and she may stop taking because of impending risk of questioning and may lead to relapse. Sixthly, she has to undergo first sexual experience which may be traumatic to her. Seventhly comes pregnancy, which itself is a stress (wanted or unwanted). Eighthly, she undergoes the stress of having a male or female baby because male babies are socially much more accepted and preferred over female babies. And finally, child birth. Because of the above-mentioned stressors, female psychotic patients may have more episodes of exacerbation of symptoms or relapse of psychotic illness.[2]

For most women in India, marriage is a one-time event in life, which is glorified and sanctified and is associated with much social approval. If this is endangered or broken by mental illness like psychoses, the lives of these women are shattered beyond repair. Married mentally ill women are more likely to be sent back to their parental homes, abandoned, deserted, or divorced. More females face broken marriages as compared to males who remain single.[3]

MARRIAGE: A STABILIZER OR STRESSOR

Marriage may influence mental health in different ways. In India, it is popular belief that marriage is a cure for different forms of mental disorders ranging from hysteria to psychoses. Marriage may reduce mental health problems through its effects on social support and intimate connection. On the other hand, marriage can theoretically impose some harm on the mental health of a person. Many studies confirmed the finding that there is a higher percentage of marital discord, separation, and divorce among psychiatric patients.[4] Often, mental health professionals have to give advice regarding the marriage of a person suffering from schizophrenia. Not only are they approached for advice in this matter, but also they meet with the consequences of ill-planned marriage which can be detrimental to the continued well-being of certain types of mentally ill like acute psychotics. However, there is no factual evidence to support one or the other view. Often relatives ask, “Should patient get married for cure?” The answers of many of these questions posed by families are unclear because of little research data available in this area.

BURDEN ON SPOUSE AS A CARE GIVER

Mental disorders impact not just on the individuals affected but also on those around them, including immediate family, other relatives, and may be both. For many people, marriage creates an important sense of identity and self-worth.[5] Caring of a person who is mentally ill may affect the mental health of the spouse. Some support their mentally ill partners, but most of them do not want to live with them and ask for separation. This happens more with female mentally ill patients. After separation, women live with their parents. Care givers of these women suffer much more than the patients themselves; feelings of disruption, loss guilt, frustration, grief, disappointment, and a fear about the future of their loved ones make them miserable.

MENTAL ILLNESS AND MARRIAGE – LEGAL VIEW

The contract of marriage needs both physical and mental elements. Conditions prevailing in the course of marital life determine the continuation of the relationship between partners. Desertion, cruelty, adultery, and mental illness may interfere with the marital life, and it may not be possible for the relationship to continue.[6] There are different laws governing marriage in different religions. According to Hindu Marriage Act (1955), grounds for judicial separation are that the respondent has been incurably of unsound mind or has been suffering continuously or intermittently from mental disorder of such a kind and such an extent that the petitioner cannot reasonably be expected to live with the respondent. According to Muslim Marriage Act (1939), a person of unsound mind cannot contract a marriage and such a marriage if contracted is void. However, if the guardian of the person with unsound mind considers such marriage to be in his interest and in the interest of society and is willing to take up all the monetary obligations of the marriage, then such a marriage can be performed. Marriage can be dissolved by divorce by the parties without recourse to court and on certain grounds by recourse to court. A Muslim husband of sound mind may divorce his wife without assigning any cause by pronouncing “TALAQ.” A Muslim woman can seek divorce on the ground that her husband has been insane for a period of 2 years. According to Parsi Marriage law (1936), any married person may seek divorce if the defendant was with unsound mind at the time of marriage and has been habitually so up to the date of the suit: Provided that the divorce shall not be granted on this ground, unless the plaintiff (i) was ignorant of the fact at the time of the marriage, and (ii) has filed the suit within three years from the date of the marriage. These acts have not been revised since years. Recent research data and consensus hold that there may be serious violation of rights of persons with mental illness in some cases where these acts are applied. Indian Psychiatric Society is trying hard to bring changes. Indian Psychiatric Society recently conducted a workshop on guidelines for marriage and mental health issues in women in September 2011 at Chennai under the specialty section, “Women and mental health,” which may prove to be the guiding point for the practicing psychiatrists in India. We are hopeful that some guidelines will come out by early next year.

REFERENCES

1. Sinha VK. Marriages in India: What purpose do they serve? Indian J Soc Psychiatry. 2009;25:67–8

2. Behere PB, Tiwari K. Effect of marriage on pre-existing psychotic illnesses in males Report submitted to Indian Council of Medical Research. 1991

Cited Here

3. Thara R, Srinivasan TN. Outcome of marriage in schizophrenia Soc Psychiatry Psychiatr Epidemiol. 1997;32:416–20

4. Dominian J. Marriage and psychiatric illness Br Med J. 1979;2:854–5

5. Gove WR, Style CB, Hughes M. The effect of marriage on the well-being of adults: A theoretical analysis J Fam Issues. 1990;11:4–35

6. Nambi S. Marriage, mental health and the Indian Legislation. Presidential Address Indian J Psychiatry. 2005;47:3–14

Source of Support: Nil

Conflict of Interest: None declared