Sunday, January 25, 2009

Betrayal or Adaptation?: Revising the Wedding Vows

I received this email today. It was a very short description of a very complicated problem. When I opened it I originally thought it might be another Viagra spam, as we all get so many of these:

Hi. My name is Sam. I'm 54 with diabetes and can't get an erection. My wife, Mindy is 45 bi and wants me to give her my blessing to have sex with other men. I'd enjoy seeing her with others. Is that normal or OK? Sam

We all marry with good intentions and generally take this commitment to our partner very seriously. Along with the promise of mutual emotional and material support, fidelity is perceived as central to the marriage arrangement. A sexual experience enjoyed by either partner with a third party definitely breaks the deal. It is hard to slip on that ring with your fingers crossed.

That said, I believe marriage in this modern age can be redefined mutually to adapt to changes in circumstances. This flexibility may actually help preserve the marriage, given that adhering to the original contract might be so rigid as to make one partner feel trapped, form resentments and dissolve the marriage before any real substantial negotiation takes place.

Marriage is so multifaceted in its considerations: religious, relational, financial, its effect on extended family. But its primary role, as I see it, is to protect the well-being and future interests of the progeny produced by the reproductive union. In Sam and Mindy's case, both being in midlife, I am supposing their children, if any, are out of the picture. The introduction of infidelity into a marriage with children would more than likely cause irreparable harm to the family stability and emotional state of the children. But in this couple's case, this does not appear to apply.

If Mindy is truly actively bisexual, it appears that the practice of open marriage has already been introduced. So as long as this couple has negotiated the parameters of this defined open marriage, it appears valid. Note how much this truly complicates the relationship; health and communicable disease considerations and the potential for a myriad of negative emotions that occur from relational triangulation: the inactive partner may feel betrayed, jealous or discounted. The active member may feel objectified, unprotected, abandoned and confused as to who is the focus of his/her affection. Sam's enjoyment of a voyeuristic role may be an attempt to reenact and resolve a chaotic romantic relationship involving 3 in his past. His curiosity may have even been spawned by his observation of turmoil in his parent's bond. Once again, this letter is short, so I do have to speculate a little bit. But Sam has to truly ask himself what is meant by "enjoy," in terms of his upbringing and relational past and how this effects his internal processes and the overall health of the relationship.

Given the precarious effect triangulation has on a marriage, it would be wise to consider other alternatives. There are many diabetic males who can perform sexually with either mechanical or pharmaceutical interventions. I hesitate to give a "yes or no" answer to any personal question that has its "gray areas," and this one has many. So what is "normal" or "right" is a private value and moral decision, to be decided on a couple to couple basis. The mutual respect as well as the
emotional and sexual freedoms of both parties is what really matters, as we adapt to the changes and challenges of our marriage and life over many years.

Saturday, January 17, 2009

Pandora's Disgrace: The Bottomless Jar

I received this email yesterday, in the wee hours of the morning. The issues of marriage and family are very complex here as there are many considerations: culture shock and adjustment, depression due to illness, lifestyle changes. Included also are more familiar marital stressors such as financial difficulty and trust. The correspondence is printed as written, excepting the name which was changed to guarantee anonymity.

I married a Frenchman in California. Following a layoff and a narrow frame of "I am only qualified as an engineer to work with one specific product," we returned to France with our new born baby seeking stability and my understanding was that eventually we would return when the market picked up. Here we have too much stability. Stability that makes you not change, meaning you just sit in one place. Someone has to die or retire before moving up the latter. Salary increases are maybe 3%/year (if lucky) while cost of living increases by at least 10 - 20% per year.

Turns out now my husband doesn't want to return to the US and I feel totally betrayed, tricked, swindled...whatever the word is.
I spent the first three years in France raising our child without any family or support around. It wasn't easy, but I'm happy I was able to be there. Kids start school at age 3 in France, so when my child started school, I was hired at a French company. After I realized I was paying 50% in taxes (government retirement included), my contract was up and I decided to stop working. I had searched for work before my child started school but never found anything. It's a very difficult job market in France. Then when you finally do find work, you wind up paying most of your salary in social charges and taxes. I was hired for almost 3X minimum wage. After taxes my net was 400 Euros above minimum wage. Do you get what I'm saying?
So I have spent 5 years of my life in this country that I never really cared for, except the beautiful vacations, which entail 3 weeks/year. My husband is in hog heaven back in his country and has no intention of returning to the US, though he has said otherwise, his actions have led me to realize he really has no intention. I must say that he was diagnosed with Multiple Sclerosis about 10 years ago and doesn't want to live in the US without health insurance, and I do fully understand that. But so far his disease has not at all been progressive, yet this is the kind of disease that's very hard to predict.
I grew up in a divorced family. I didn't like it and said I would never put my child through such an unfortunate situation. But now I am like, at what point does my happiness count as equal value to the happiness of my husband's and my child's? I have always felt selfish for wanting to be happy when my child's needs are very important. But I have to acknowledge that if a child's mother is not happy then that could eventually radiate towards the child. I hide my unhappiness as best as possible, but after 5 years I know it can't go on. I don't want my husband to loose the house he so loves and paid for because of a divorce, which will happen, but at the same time - all of our money is in the house. I can't leave empty handed either. I need as much as possible to rebuild in the US.
We all know French stereotypes, and I have to say hygeine is another issue. My husband still uses cotton hankerchiefs. He blows his nose on one and then puts it back in his pocket only to reuse the same one throughout the day. This time of year, he has come down with a cold. So there is excessive mucus and he is still using and reusing the cotton ones. I have bought the pocket sized paper ones and put them in the drawer where he keeps the cotton ones but he refuses. He also left one full of mucus lying on the kitchen counter. He blows his nose in the shower only for me to find "remains" on the shower curtain. I think he has IBS and is constantly having diarreah and there are always spots on the toilette for me to clean up. I hate to sound petty, but these things really bother me. The good news is he does shower every day.
Also, the cost of living in France is more expensive than most Americans could imagine, except for maybe New Yorkers. Even then, electricity and gas (heating) and gas for cars are cheaper than in France. So we bought a house in a town with a really bad reputation, high-rise housing projects all over the place, full of Muslim immigrants, and I just don't feel safe in this town. I mean, I know most Muslims are innocent and kind people, but here we have extremists, women walking around in Burkas, with only a slit for their eyes. Men wearing long robes with long beards. It freaks me out. I guess I might have a slight phobia. But I just don't feel safe given the current political situation between the US and the Arab world.
We almost didn't get the loan for this house because of my husband's multiple sclerosis because in France, everyone is required to have a PMI (private mortgage insurance) in the case of death or disability, the insurance is required to pay our mortgage. So he doesn't want to buy a house anywhere else because of the paperwork nightmare and the high cost of this insurance.
I am just totally lost. I mean maybe the answer is obvious for you. I know the choice isn't easy. But I just don't know what to do. I was always an ambitious person. Always seeking to better myself through work and education. Working and education have come to a screeching halt in this country. And it's not from a lack of effort.
Please advise.....

This women is overwhelmed with negative emotions. In the last 6 years, her world has been turned upside down. This series of events has helped foster hopeless and helpless feelings regarding her life and future. Seemingly she is trapped in a foreign land with her child and a man she has lost genuine feelings for. Her mindset is such that she feels she has few alternatives. She feels subject to despair and isolation and blames her husband for her miserable condition.

We are culturally taught that times of adversity will be followed by some form of reprieve. Our situation can only get so bad then there will be a glimmer of hope, the light at the end of the tunnel, that the sun will shine tomorrow. In Sally's case, there is seemingly no possibility of reversing this negative trend. The adversity she experiences has been accumulating for so long, it will seemingly never end.

Understandably, her mindset is negative and her clarity of thought has been diminished. Because she has been bombarded with these personal challenges, she has narrowed her alternatives down to a lose/lose dilemma: Either live her life in a place where she can never be happy or betray the continuity of her family and return to the states.

The truth of the matter is there is always more than 2 alternatives to a dilemma. Sally must re nurture that part of her mind that gives us hope in the face of adversity. She must begin to consider what she can do to restructure her marriage and reconstruct her life. If after she has exhausted all of her alternatives and has come to the realization that despite her efforts her life in France will be woeful and miserable, then she can make that choice to leave, with the conviction that she truly tried to rectify her marriage and that leaving is the best action to ensure her child's happiness.

The 1st dynamic to consider is the mental state of her husband. From what is revealed in the letter, he appears to be chronically depressed. His pain inducing illnesses (MS and IBS) are one indicator. His deteriorating hygiene can not be chalked up to simply a difference in cultural norms. I am certain he did not present himself in this insalubrious manner when he 1st met Sally, or she never would have married him. He appears in need of professional mental health intervention and lacks the awareness to seek help.

So Sally can help him reach this insight. If his mood and personal habits change, it would provide much relief to her stress and the perception that she is being objectified by him. Which leads us to the 2nd dynamic, that there is a profound diminished communication between this couple. This would further explain his depression and Sally's dilemma. Both parties have no one to reveal their innermost thoughts directly to and receive nonjudgmental feedback. For Sally, this emotional isolation is furthered by being so far away from friends and family. Sally is reluctant to engage in any serious and productive conversation because she no longer trusts him. She feels tricked and manipulated into living a life she did not choose. Her husband is so distracted by his medical challenges and depression he can not organize his thoughts well enough to identify and elicit his feelings. And yes, he has become so focused on himself that he is severely ignoring the needs of his wife. There is an impasse in terms of honest discourse and she must make an effort to break it. The first step to improving their communication is for him to seek the aforementioned help he needs.

During this process Sally must ask herself some honest questions. One would be hypothetically "could I be happy in France if I had the love and support of my husband?" I have a feeling that with him as an ally she could overcome some of the discomfort and fears she experiences from living there and these cultural anomalies could be tolerated at least until the child is raised and she is released from the obligation to keep the family cohesive. If she feels she no longer loves this man, she must ask herself given her resentment, could she ever love him again.

If she can answer yes to all of these questions, if she can visualize tolerating the differences of those around her and a profound change in her husband's mood, she will once again become hopeful. She can envision a family life where everyone is working toward common goals of emotional stability and material betterment. If she makes this full effort to change her current familial and martial conditions and fails, at least she will have the peace of mind that she explored every option before her flight from France. She can wash her hands of this situation and never have to second guess this decision.

In these troubled times, all of us, like Sally, face some profound challenges. In order to endure our ills and the obstacles we are plagued with, we must summon all our energy and reach deeply into that vessel and obtain both strength and resolve. We must realize that hope is not to be utilized as our last resort or a means of comfort after we have conceded defeat, but is a valuable tool in addressing the seemingly insurmountable challenges of our lives.

I leave you with a quote by a colleague and coworker of mine, Dr. Ken Cunningham.

"The substance of hope is our entire narrative and our capacity to say we possess it. Our hope is a result of having lived with and being influenced by others, and when we are shaken, our hope holds us and we learn to reinvest in life. When our hope is gone, changed or altered, it takes something to give it back to us. Undoubtedly, that something is often relationship or experientially based, and in that, we learn to consider hope again."

Saturday, January 3, 2009

Nutrition and Mental Health Part 3: Treating Depression

Of all of the chronic mental disorders, depression is the one that can be the most impacted by our nutritional consumption. A good diet heightens the body's functioning and when you feel good physically, you are energetic and optimistic, more capable of dealing with stressful events and setbacks as they come about. Simply eating light healthy food will help your energy. Food that digests easily and is involved with the cellular repair and integrity that enhances the functioning of vital organs and glands should be emphasized. I focused on omega fats in part 1 of this "mini-blog.". Other considerations nutritionally for general health are antioxidants and trace minerals. These important nutritional aspects point to the need to shop frequently for fresh foods. Another viable approach consists of using vitamin and herbal supplements related to specific environmental stressors and events. For instance, using large doses of vitamin c, zinc and echinacea when one feels a cold or virus coming on. Or replenishing electrolytes after sweating profusely due to exercise, heat or illness. Or consuming garlic to fight off infection. Remedies such as this tend to be more effective when needed, as opposed to taking prolonged daily regimen.

Herbal Remedies for Depression

As I discussed earlier, there are many herbal remedies that are co indicated for anxiety and depression. One significant delineation that can be made between the two disorders is that remedies that tend to excite or stimulate the nervous system are effective in treating depression (especially during the active part of the day), while treatments designed to calm the nervous system are more effective in treating anxiety . Supplements that encourage falling asleep or staying asleep are helpful with both disorders. Here is a brief discussion of some popular herbal remedies used for depression.

St. John's Wort: This herb (the cultivated flower and leaf) has been the most bandied about depression remedies. It has been clinically confirmed to relieve mild to major depressive episodes and its efficacy is comparable or greater than SSRI medications. The chemicals
hyperforin and hypericin are thought to inhibit serotonin re uptake in a similar fashion to its pharmacological counterparts. Other chemicals in the leaf and flower may have a synergistic and buffering effect that help with its efficacy and deride potential side-effects. St. John's Wort has not been proven effective in treating dysthymia, a mood disorder with similar but less acute symptoms as depression that tends to be less episodic and have a longer duration of symptoms. Cognitive therapy alone can be successful in treating this disorder.

SJW is widely sold and quality greatly varies. A pill that contains at least 400 mg of
hyperforin should be sought so the minimum effective daily threshold of 1500 mg. can be easily reached.

Hypericin has a poisoning potential in high but easily ingested doses. This has been observed with grazing livestock. Sensitivity to light and a racing pulse are early signs of this poisoning. This supplement should therefore be secured in the household like any prescription medicine would.

There is a bit of an urban myth regarding combining SSRI's and SJW. The thought is that SJW creates a "serotonin dump," that increases the voracity of the inhibitors. There is, however, no clinical evidence that this increased neurotransmitter production occurs. As a CYA, I would say always consult your physician.

5-hydroxytryptophan: An amino acid, this is found in the seeds of the shrub Griffonia simplicifolia. It is a building block to the production of serotonin and is often used in combination with SJW. Like its chemically related cousin (it is a metabolite), L-tryptophan, it has a calming effect and helps induce sleep. L-tryptophan itself has been found to help treat jet lag, menstrual difficulties and seasonal affective disorder (SAD). It helps increase melatonin production, which in itself is an excellent sleep aid.

S-Adenosyl Methionine: or SAM, is another amino acid. It has been tied to the successful regulation of all major neurotransmitters and helps people that have poor receptor site binding. It has obtained recent attention as a potential preventative for Alzheimer's disease, although there is very little research in this area. It has been found very effective in treating depression related to physical discomfort, as it has a role in lowering the brain's sensitivity to chronic pain in liver conditions, fibromyalgia and osteoarthritis.

The use of these remedies are a valuable resource for those seeking an alternative to prescription medications. Those who do not have medical insurance or are under-insured can rely on these cures as perhaps their only resource. They are also proven to have a lower incidence of undesirable side effects then prescribed meds, i.e. weight gain and male impotency.

Research indicates that herbal and pharmacological intervention is most successful when combined with talk therapy. Any chemically induced depressive treatment provides temporary relief and allows the person to "step-back" and examine profound thinking errors, increase coping mechanisms and problem solve. When this liberation occurs, a competent psychotherapist can help guide the process of healthy cognition and improved quality of life.

This, for now, concludes my dissertation on nutrition and mental health.