AWARD PAPER: DR. N.N. DE ORATION
Year : 2019 | Volume
: 35 | Issue : 1 | Page : 10--12
Effect of marriage on pre-existing psychoses
Prakash B Behere
Vice Chancellor and Prof. of Psychiatry, D. Y. Patil Education Society (Deemed University), Kolhapur, Maharashtra, India
Dr. Prakash B Behere
Vice Chancellor and Prof. of Psychiatry, D. Y. Patil Education Society (Deemed University), Kasaba Bawada, Kolhapur, Maharashtra
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 although there is a controversy about the sequence. In India, marriages are usually arranged by parents and are influenced by a number of factors such as astrological compatibility, caste regulation, geographic proximity, and expectations of dowry. We have worked for two decades in this area. The work summarizes as “Effect of marriage on clinical outcome of persons with bipolar affective disorder: A case–control study.” Married persons had experienced more episodes of illness and for longer duration. Males are more prone for illness than females in both groups (married and never married). Marriage did not influence the severity of illness in persons with bipolar affective disorder. The effects of marriage on women with schizophrenia are as follows: This study concluded that most of the patients and relatives were of the opinion that marriage can cure mental illness. Child birth was found to be a protective factor for decreasing separation in cases. Severity of mental illness was slightly higher in cases than comparison group. It was observed that with increasing severity of illness marital adjustment deteriorates with antagonistic interaction among members.
|How to cite this article:|
Behere PB. Effect of marriage on pre-existing psychoses.Indian J Soc Psychiatry 2019;35:10-12
|How to cite this URL:|
Behere PB. Effect of marriage on pre-existing psychoses. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Aug 24 ];35:10-12
Available from: http://www.indjsp.org/text.asp?2019/35/1/10/255001
Marriage is defined as “the state of being united as spouses in a consensual and contractual relationship recognized by law.” However, in India, marriage is not between two people; rather it is a social affair and involves the families on both sides, thus a union between two families and not just two individuals. There is a common belief in community that marriage is the solution for mental illnesses, and many times, psychiatrists are asked for their advice regarding marriage of the patient. On one hand, a happy marriage can provide emotional support and improve the physical and mental well-being of both the individuals; on the other hand, marriage can also be a cause of mental distress if there are adjustment issues between them. Thus, there is a rather complicated relationship between marriage and mental illness. Many studies show that there is a high percentage of marital discord, separation, and divorce rate in persons with mental illness than compared to the general population.
Peculiarities of an Indian Marriage
In India, not only the individuals but their families are also under pressure to get their children married as soon as the individuals come of their age. Still in India, the marriages are arranged by parents of the boy and the girl, irrespective of their will and choices to marry each other, where maturity of the partner is not an essential requirement and the marriage is idealized by sexual fidelity and monogamy of both husband and wife and husband to be the head and principle earning member of the house. Other things that influence marriages in India are astrological compatibility, caste regulation, geographic proximity, and expectations of dowry. Mental disorders and problem in marriage are closely linked although there is a controversy about the sequence.
Marriage and Mental Illness
Females with mental illness face multiple psycho-socio-economic problems as compared to males as males dominate over females in the Indian setting. Almost all females face following problems in marriage: (1) stress due to uncertainty of fixing marriage; (2) dowry, which has to be given by the female's family is still prevalent in many communities in India; (3) female has to leave her parent's home, where she had spent her childhood and cope with new family members and new surroundings; (4) first sexual experience, which may be traumatic to her and may also be forced on her; (5) pregnancy is already identified as a stressor for females and it may further worsen by familial preference of male child over female child. The situation worsens if the female is suffering from mental illness. All these stressors may lead to exacerbation of the illness or relapse of the symptoms in the individual. Finally, after exacerbation or relapse of the symptoms, the female is not able to take care of the family and unable to do the daily chores, for which she is sent back to her parental home, abandoned, or divorced and the life of the individual is shattered beyond repair.
Studies Related to Mental Illness and Marriage
A pilot study on male psychotic patients was conducted in 1989 in Banaras Hindu University, and the report was submitted to the Indian Council of Medical Research in 1990. A prospective study was conducted on male patients who had psychoses and were under treatment and got married. Females were excluded from the study due to multiple reasons which was already discussed above, and also, many times, the family members of the female do not disclose past history of psychosis. The results showed 33% of the samples were already vulnerable for psychosis due to family or history of psychosis. In one case, patient developed psychotic episode after the first marriage but not after the second marriage. In four cases, patients developed psychosis after the second marriage and not after the first marriage. Thus, it was concluded that there are multiple factors involved in psychosis, and further studies were needed for the identification of factors responsible for precipitation of psychosis.
Understanding the effects of marriage on mental illness is complicated. As most of the mental illnesses especially psychosis develops during early adulthood, which further complicates the situation for the family members and also the treating psychiatrist whether to let the patient marry or not? Whether marriage will lead to improvement or further deterioration in the patient? Keeping this in mind, a case–control study was conducted on “Effect of Marriage on Persons with Schizophrenia.” The results of the study are as follows: Males were more prone for relapse of symptoms than females in both married and unmarried group of subjects; chances of relapse increased with increasing age of onset of schizophrenia, less years of education, family history of psychosis, and low socio-economic status of the family; among cases, maximum separation occurred within 2 years of getting married, and except paranoid schizophrenia, all other types of schizophrenia increased the chances of separation. Furthermore, it was found that marriage had no influence on severity of illness, quality of life, and disability in persons with schizophrenia.
To further evaluate the effect of marriage keeping female patients of schizophrenia in mind, a case comparison study was conducted. The comparison was made between subjects who got married after developing schizophrenia and never-married subjects with schizophrenia. The findings of the study are as follows: Among the cases group, 60% of subjects got married on parent's advice; 40% were currently living with their husbands; and only 24% had informed their spouses regarding illness before their marriage. In 60% of cases, marriages were advised by parents. It was also observed that most of the patients, and also, their relatives believed that marriage is a cure for mental illness; with increasing severity of illness, the marital adjustment deteriorated, and a significant finding in the study was that having children was a protecting factor for separation in marriage.
Another study by Goel and Behere was conducted to study the effect on marriage on mood disorders. In this study, subjects diagnosed with bipolar affective disorder and taking treatment were included, 55 never-married subjects were taken as cases, and age-matched 55 unmarried subjects were included in the control group. It was found that in both the groups, males were more prone for relapse of symptoms than females; that married men had longer duration of illness and suffered with more episodes of illness than unmarried men; and that marriage did not influence the severity of illness.,,
Marriage, Mental Illness, and Law
In different religions, there are different laws governing marriage and mental illness. Earlier, according to the Hindu Marriage Act (1955), the grounds for judicial separation were, if the respondent was incurably of unsound mind or suffered intermittently or continuously from mental illness of such a kind that the petitioner cannot reasonably be expected to live with the responded. However, looking at the serious violation of rights of persons with mental illness and that the mental illness is treatable and manageable at par with medical illnesses such as diabetes and hypertension, the Supreme Court ruled under the Hindu Marriage Act that: “Temporary ill-health including schizophrenia, a mental illness, which is curable, cannot be a ground for divorce under Section 13 (1) (iii) of the Hindu Marriage Act.” However, the laws for Muslim Marriage Act (1939) and Parsi Marriage Law (1936) remain the same, in which dissolution of marriage can be done if the spouse is suffering with mental illness.
Epilepsy has been removed as a bar for marriages since 1999 (by Act 39 of 1999, Section 21).
Although there is a belief in the society that marriage is the cure for mental illness, our studies suggest that there are harmful effects also, especially if the mental illness is severe, then it may result in difficulty in adjustment with the spouse. In addition, the studies suggested that there were more relapse of symptoms in married subjects than unmarried subjects. Due to the small sample size and limited number of studies, further studies are needed to explore the effects of marriage on mental illness. The Indian Psychiatric Society in January 2013 brought guidelines for marriage and mental disorder. A document was published entitled, “Recommendations for psychiatrists for managing issues related to marriage in patients with major mental illness” (helping patients and families to make informed decisions).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Merriam-Webster Dictionary: Marriage; 2019. p. 1. Available from: https://www.merriam-webster.com/dictionary/marriage. [Last accessed on 2019 Jan 07].|
|2||Mulmule AN, Behere PB. Effect of marriage on women with schizophrenia: A preliminary study. J Datta Meghe Institute Med Sci Univ 2016;11:24-8.|
|3||Behere PB, Tiwari K. Effect of marriage on pre-existing psychotic illnesses in males. Report submitted to Indian Council of Medical Research; 1991.|
|4||Behere PB, Rao ST, Verma K. Effect of marriage on pre-existing psychoses. Indian J Psychiatry 2011;53:287-8.|
|5||Behere PB, Kiran V, Goel N, Mulmule AN. Effect of marriage on mental illness. Proceedings of Sixteenth World Congress of Psychiatry in Madrid, Spain. World Psychiatry Association 2014;6:331.|
|6||Behere PB, Nikhil G. Effect of marriage on family functioning and clinical outcome in persons with bipolar affective disorder: A case control study. Indian J Soc Psychiatry 2013;29 (special supplement):A11.|
|7||Goel N, Behere PB. Effect of marriage on clinical outcome of persons with bipolar affective disorder: A case-control study. Int J Sci Stud 2016;4:46-50.|
|8||Behere PB, Goel N. Effect of marriage on clinical outcome of persons with bipolar affective disorder. J Datta Meghe Institute Med Sci Univ 2013;9:234-7.|
|9||Sharma I, Parial S, Rabindranath CP, Visweswaran B, Kallivayalil RA, Thirunavukarasu M, et al. Chhattisgarh (India): Recommendations for psychiatrists for managing issues related to marriage in patients with severe mental disorders (Helping patients and families to make informed decisions). Indian Psychiatr Soc 2012.|