Entering into the marriage with post traumatic stress By Dr. Pradnya Ajinkya

Abraham is having trouble sleeping for past several weeks and his mother is concerned about his health. He wakes up at irregular intervals and refuses to go to sleep at his regular bed time. As a child his mother rocked him back to sleep. The cycle has come to repeat. Abraham who is 33 years old today is completely dependent on mother to get back his sleep. Abraham's wife complains that she grew less tolerant and the two have become sensitive and argumentative.


Several questions relating to Abraham and his family:

a] Abraham's mother is a widow who lost her husband when Abraham was 7 years old.
b] Abraham was the youngest of four children. 
c] Abraham's mother resumed college after her husband died on a part time basis and completed her education when Abraham was 12 years old.
d] Her plans were definite. She spends a lot of time with her children and lived in a small home and managed to make ends meet. Finances were a concern to the family. She met all the educational needs of her children through student loans and grant-in-aid and child-support-payments from various institutions. 
e] The description of the circumstances surrounding the development of Abraham's sleep difficulties and the factors that affected the problem started with the typical evening event and beginning with dinner progressing through the following morning.
f] Mother is completely overwhelmed by Abraham's current situation. She was exasperated and felt that she was able to rock him to sleep but his wife and her understanding to the situation was something she was completely unable to control.
g] Mother's eyes are watery and on the verge of tears. 
h] It became clear that Abraham's mother's mood had been sad since her husband's death. Though she encouraged herself she felt lonely and discouraged. She remembered telling Abraham how 'down in the dumps' she felt. She later cheered herself up though she cried frequently and for long periods of time. She was preoccupied by her husband's death and Abraham was the only child who was around her while she was brooding about the events that led to husband's death.
i] These worries interfered considerably with Abraham's ability to concentrate and seemed directly related to his sleep disorder.
j] Mother blamed herself for her attitude and becoming increasingly pessimistic, although she harbored considerable resentment towards her daughter-in-law.  This placed additional strain on the already problematic marital relationship citing that Abraham's wife was a poor marital partner with several examples of her misconduct, like she spends more on clothes and shares less enthusiasm on the current problem.  
k] According to Abraham's wife, his sleep is about his personal habit and she was annoyed by his imperfections in their relationship.  Of course, they could easily argue about the sincere efforts to work on their marital difficulties and view them as evidence of failures. They were totally out of proportion and generalized their problems from the mother's failure in her parenting to other relationships in their life.
l] Their future looked bleak from their current perspective, but their interest in solving Abraham's sleeping problem was an encouraging sign.
m] Abraham's childhood had been uneventful. Having siblings, he spent most of his time with his mother. He remembers his relationship with his mother as warm and pleasant. His father died in an accident. When he arrived home from school he heard his mother crying and saying ,” life ahead is going to be very difficult and I am overcome with grief about this young and reserved boy Abraham who will have to struggle for years through my normal schedule of activities.” Overcome with grief over her loss, Abraham feels that in retrospective, his mother attributed this lack of assertiveness to his fear that he would feel abandoned if anything happened to his mother. This thought persisted throughout school and college days and became a pattern. As time wore on, Abraham found himself brooding more and more and this worsened after his marriage. He worried his wife may leave him. The added worry about losing his wife contributed substantially to a decline in his mood and he finally decided that he would book in with a mental health counselor for:

1] Insomnia 

2] Psychomotor agitation 

3] Fatigue or loss of energy nearly every day

4] Feelings of worthlessness or excessive or inappropriate guilt

5] Diminished ability to think or concentrate, or indecisiveness, nearly every day

6] Recurrent thoughts and clearly a prominent feature of constant brooding about losing mother and wife.


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