OST STUDIES of manic-depressive psychosis are based on the implicit or explicit hypothesis that the afflicted individual represents an interpersonally isolated system. The research strategy, based on this hypothesis, dictates that investigation be directed toward elucidating the internal biochemical, hormonal, genetic, or psychodynamic factors responsible for these psychopathological, affectual states. Unfortunately, little attention has been given to the possible influence of external factors and the interaction between internal and external factors as determinants of the mood swings associated with this disorder. This relative neglect is especially surprising in light of the knowledge that mania and depression are characterized by profound disturbances in interpersonal relationships. In the depressive phase, the patient withdraws from and avoids others; in the manic phase, the patient displays a type of “interpersonal hunger.” Since the manifestations of this disorder have such a great impact on others, especially those most closely associated with patients, it should prove of interest to investigate the extent to which the moods and behavior of the designated patient and those of a “significant other” are intricately interwoven, as well as the possible contribution of biological variables to this mutual relationship. From this perspective, the ideal context in which to study this disorder should be the marital dyad. The paucity of articles or formal studies on the marital life of manicdepressives belies the intriguing implications of their conclusions. In essence, all authors tend to concur that the manic-depressive patient and spouse must be regarded as a “dynamic structural unit,” exerting mutual influence on each other. Fitzgerald,’ for example, describes the shifting dominance-passivity balance between patient and spouse: mania begets spouse passivity; depression begets spouse dominance. While it is tempting to conclude that “the manic acts and the spouse reacts,” Humiston* offers speculations on the provocative nature of the spouse’s role and how this may contribute to the onset of mania. Janowsky,3 on the other hand, describes the tendency of many spouses eventually to withdraw from further emotional involvement as a means of coping with the constant stress of having to adapt to the vicissitudes of the patients’ moods. The marital relationship, while complementary for a time, tends to become progressively unstable and destructive, with divorce the usual outcome. In a study by Brodie and Leff,* 57% manic compared to 8% matched recurrent-depression patients had broken marriages, As these results imply, it is the manic component of this illness, often characterized by heightened aggressivity, grandiosity, and sexual acting-out, that generates the greatest source of stress for the spouse.
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