The article on the Dangers of Diagnosis produced very strong responses on both sides of the spectrum. I would like to acknowledge some of the issues brought up and clarify the message of the article.
There are many people out there, including some of our readers who are living with a spouse who is suffering with mental illness. It was in no way my intention to minimize this reality or the difficulties of such a situation. Depression exists. Obsessive Compulsive Disorder is a reality. Mental illness can be debilitating and can have a negative effect on a relationship. Medication can be effective in alleviating many of these symptoms and making life more livable. Many times, it is advisable to treat these issues before going to couples counseling as many of the external stressors can be eliminated by treating the illness.
With that being said, one goal of my article was to point out that it is not very useful for non-clinicians to diagnose their spouse. Unless one is trained and experienced in using the DSM-IV, the diagnosis may not only be incorrect, it may be harmful to the relationship as it labels one spouse as mentally ill. This sets up an unlevel playing field. Furthermore, all because someone is a therapist does not mean that they are making the correct diagnosis. It is a skill that comes trough consulting with experts and colleagues. It is not a right conferred when you receive your college degree.
This is especially important when it comes to more subjective diagnoses such as personality disorders. It is important to note that these abnormal behaviors need to generalize themselves to a range of personal and social interactions, not just in your marriage where there might be some type of trigger. They also need to impair your day-to-day functioning. While your spouse may be very sensitive to criticism and have a poor self-image, it does not mean that he/she is Borderline. Many of us may identify with some of the symptoms listed and we may somewhere along the continuum but unless it is getting in the way of our daily functioning, then it may not be pathological. (This is also the case with mood disorders such as depression. You may be unhappy and if your marriage is lousy, you have good reason to be. Does this make you clinically depressed? Can you get out of bed in the morning? Are you holding down your job? Did you lose twenty pounds? The point being that all because one’s mood is depressed if it does not interfere with your daily life, it may not be worthy of diagnosis. If the marriage were repaired, the mood may very well improve.)
Working on your marriage
Creating safety in your relationship can only help deal with the stress and anxiety that often triggers these disorders. Sometimes the symptoms go away when the relationship is in a good space. Furthermore, even people who are suffering with mood disorders can have a successful marriage. Mental illness can interfere but it does not have to interfere and ruin a relationship if you work together.
My article’s goal was to caution about the sometimes irresponsible labeling that goes on and how it can do a disservice to a marriage where in many cases working on the relationship may be all that is needed. Of course, this does not mean that there are not cases where there is mental illness, and sometimes serious mental illness, that need be addressed first.