She is new to the practice. I ask about her life and home situation. She is a high school teacher. She and her husband have no children: soon after their marriage he developed a severe depression and he has never really been stable long enough for them to consider having children.
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Rinske van de Goor is a general practitioner. Every other week she writes an exchange column with Danka Stuijver.
He has bipolar disorder and drinks, she says. She talks about how he struggles. That his father often had psychoses and that he had a tough childhood because of it. How he nevertheless studied and how handsome, tough and at the same time sensitive she found him.
Things went very well for several years, they got married, but a year later he became depressed. He had nightmares and drank to sleep. He got into trouble at work. His life thundered down a black icy slope in free fall.
Not only did he lose his job and with it his income, friendships also faded and a few years and a number of relapses later they notice how family also quietly gives up on him, and with it her. Their circle has narrowed.
It’s hard for her. Not just to see him so shattered and depressed. It is also very difficult at times. Because he not only shares his sadness and fear with her, but also his frustration and anger sometimes fall to her. It makes her lonely. She is regularly sad, for him, but also for herself. She has learned to keep her grief to herself and rarely shares it with colleagues or other people. She usually doesn’t have to count on much understanding.
She often gets reactions like: you’re way too good for him, he doesn’t deserve a partner like you. Or: if he were my husband, I would have left long ago. As if living with him isn’t worth living. As if he is not worth it, because with his illness and addiction it is not always easy.
Psychiatric illnesses simply have a low status. And in the hierarchy of respectable serious disorders, addiction is at the very bottom.
She sees how different it is when your partner has cancer with a friend of hers.
He lives a few blocks away. She also has a seriously ill husband – only her husband has metastatic cancer. She doesn’t get any criticism, just a lot of support. From the moment they broke the bad news, the sweet encouraging cards poured in. There are always flowers in the house. The neighborhood is heart-warming: people bring trays of food, the children are always welcome everywhere to play or eat with them.
People are constantly asking how things are going, with her husband, and also with her and the children. Nobody says: why don’t you leave him? Or: Brave to hear that you are still staying – I had left long ago.
While they are both partners of someone who is very ill. And many things are the same. Whether it’s a physical or mental illness, partners of seriously ill people all hope that treatments or admissions will improve. They are afraid to see their partner deteriorate and lose their partner. Both are sometimes more informal carers than partners.
Of course, a psychiatrically ill partner is different. An addicted partner all the way. The relationship is more complicated, because the disease directly affects the relationship. Setting clear boundaries is often important and addictive behaviors should not be rewarded.
A psychiatrically ill partner makes almost everything more complex. There are often concerns about work, money and the effect on any children. Some seriously psychiatric patients may display denial, unpredictable or aggressive behavior, including towards their partner. Partners of psychiatric patients regularly have feelings of failure or inadequacy. Could even more love and even more care possibly have protected the other against the depression, or the addiction? Is it your fault if the other is depressed? Don’t you make the other happy?
Fortunately, within psychiatry there is more and more attention for the partners of the patients. And for any children. Now in society. Who knows, maybe my new patient and her husband will also receive flowers. Or a card, with on it: ‘Good luck, keep courage, all the love.’