Case assessment and treatment
Dr. Pradnya Ajinkya
Roopesh, 34, Indian, male and Parineeta, 24, Indian, female were seen in counselling for marriage related support. They have been married for almost 12 months. She is from Bangalore another city and he is from Mumbai. They met through family friends and later found themselves to be also distantly related.
Roopesh: The problems started on the first day of the marriage. The first time was over a missed call at from a lady family friend known to my family members for more than 22 years. This made my wife furious and next what she would say is that she wants to commit suicide. We made up and everything would be fine only for a while. But, since we have been married it’s happened several times, the evening before coming to counselling being the most recent. Every time we fought over telephone calls, parents, involvement with family members, time, and my wife would act like she’s going to slit her wrist with a blade or run towards the railway tracks or would be identified by friends while she stomped and paced angrily on busy roads in the neighbourhood. I initially agreed that her behaviour is to get my attention and to take the attention off of what she has done wrong, and it worked, because instead of continuing to ignore her, I am forced to follow her around taking away whatever dangerous objects she picks up, and eventually talking to her to calm her down and talking her into just going to sleep. I remain absent from my workplace for several hours and even days. I think that my wife just doesn’t realise responsibility of what’s important and what’s not for her age. I really don’t know where to go from here. I recently read a diary my wife is writing. My wife is talking about killing herself. I decided to seek mental and legal help.
Therapist: She should get professional help to deal with her emotions immediately and get mental help. Even if there's only a slim chance that she's truly suicidal, do you feel that you're professionally equipped to deal with someone who is considering suicide? It sounds possible that this is a convenient way for her to turn arguments around, but are you ready and mentally prepared to hit on that?
Roopesh: Just even until before I’d been married, I’ve been leading a normal life. In fact life was good. I have a great family. Good parents and a sister who is married and is happily married. I have a wealth of great friends and a steady profession. I was on the top of the world, until, seemingly overnight, everything changed after my marriage. I am seeking mental and legal help to protect myself and family.
Therapist: I am suggesting, both of you get ahead of the problem curve. While you are at peace, try to get things in place to create sanity for both, so as to extend the periods of peace between the trouble spots. You may want to make yourself a list of rules in marriage, to avoid suggesting a mistake of any kind. You may want to find ways to point things out to her in a way that is the presentation of your feelings, or an idea, and then only if it is really necessary.
Roopesh: By changing some things, I agree can avoid falling into a routine, that might feel like a rut or feeling trapped. But it has happened that some situations have gone from bad to worse. My fear is that she has a tendency to end her life. And what if she really commits suicide? I have no control over her loss of control, so the only way to have control is having control over whether you live or die. What is difficult is that sometimes I feel so threatened that I feel she is using this as a manipulation tool too. I am no expert, and I don’t know how to handle her tendency to fight, argue, and tendency to commit suicide, but know that any threat should be serious. I have to even use physical pressure to stop her couple of times. I can’t continue like this. I am losing myself. Please help me. I know that I am living with a patient. She is my wife.
Therapist: Shall we take some time for some supervised professional help for your wife? Certainly you can feel sad about your wife having difficulties, and you’re not being happy in this marriage. And above that your fear and also you are uncertain about your future.
Roopesh: It could be reasonable to fear extended from anger, argument, aggression to suicide and a sudden shift to luring me into the bedroom and kissing me. We finally go to sleep. Now, it’s the next day and we're not fighting but we're not talking either and I have no idea what she's going to do next. I will become a patient. I am not able to focus on my work. I need help. I can’t live in a fear that my wife will threaten me and my parents are in constant fear for me and my wife. And they wonder how we will live as a couple. They suggested that we go to a counsellor. We finally decided to seek immediate professional help with a counsellor (crisiscounselling) and help to save a situation (suicide). My wife suggested we have children and all will be well. Where do I stand on children? This brings up my context of chaos.
Parineeta: A lot of our problems started with the missed call of my husband’s family friend. I had a problem when ever her calls came. My husband’s family called her up and told her not to call up since I objected to her incoming calls. I was completely aghast when she was present at a friend’s place who had invited my husband and me as a newly married couple over for dinner. However, my husband explained that she is a common family friend and his friend can’t be stopped from inviting friends over at his place. I did react with anger and sarcasm towards my husband and his friends on impulse at the dinner. I have decided to work more on myself lately. I am realizing that I can improve a few things in myself by starting a family (have children), then I can start trying to work more on the relationship. I have decided not to take up a job until relationship issues in the marriage are resolved.
Therapist: Your husband feels threatened that you would get easily irritated and explode on him and parents and friends?
Parineeta: I don’t feel I have a supportive husband. I married Roopesh because he has a good profession. Am I suicidal? I don’t see the light at the end of the tunnel at any time. I am exhausted but not ready to quit from this marriage. Thing’s haven’t gone my way. I feel I have a supportive husband financially and I don’t wish to work outside the home since I am married. We have visited many places and enjoyed good times together too. Intellectually, I agree that I have made a decision to make this relationship work and only later take up a job. I wish my husband spends more time with me.
Therapist: There are lot of regrets your husband is experiencing after his marriage with you? He feels threatened with your arguments, yelling and suicidal threats and notes. This is increasing the emotional gap between the two?
Parineeta: Though I have recovered from the first night episode where my thoughts were getting deeper and deeper into a black hole since the missed call episode things have not improved. I didn’t actually believe I needed help. I am so angry with my husband that I end up troubling myself. I have tried in a number of these difficult treatment problems to manage my emotional problems but it has never been successful.
Therapist: You actually don’t believe you need help?
Parineeta: I have come to believe that my troubles are due to lack of understanding and uncontrolled behaviour.
Conclusion: It may be mentioned that the individuals Roopesh and Parineeta were seen in psychological counselling for more than 17 sessions. Parineeta’s husband expressed that Parineeta had difficulty in thinking and communicating. This hindrance led to frustration and anger. There was also a lack of perception to smooth social relationships with him and other family members, facial expressions, intonations of voice and gestures. He said that the ultimate results were impulsive actions, destructive enough to evoke antipathy and invite retaliation. He felt that his wife is not able to cope with even the day-to-day routine activities and cannot understand the true state of affairs and she suffers from extreme emotional distress and suicidal ideations which can have dire results on him and other family members. He expressed his inability to manage his wife’s violent behaviour, bad temper, sexual behaviours, and suicidal tendencies. In addition, she would try getting a blade to slit her wrist or find herself screaming with rage running on busy roads or find her on the railway tracks and he worries that his wife’s behaviour endangers her safety and feels she will bring him and his entire family under legal and mental scrutiny.
Diagnostic Aids: The dyscontrol syndrome and suicidal ideations and tendencies require a complete medical history which must go all the way back to the womb. Other things to be looked for include personality disorders, an ungovernable temper, and constant threat on family members and lack of affection towards family members.