SETTING BOUNDARIES IN A MARRIAGE COMPLICATED BY MENTAL

ILLNESS
KATHY BAYES
In a marriage where one partner is mentally ill ("MIS"), the well spouse ("WS") must
aggressively set and enforce boundaries if the family is to survive. Setting boundaries must
not be confused with setting limits. imits are daily struggles to control undesirable behavior,
some won, some lost. !oundaries are much more fundamental and are absolutely vital to the
survival of the family. "he MIS does not have an option to conform to boundaries. "hey are
not negotiable. "hese boundaries are particularly necessary when the mental illness is chronic,
but they are also important in managing an episodic illness li#e manic depression. We have
found that if the WS communicates e$actly what his or her e$pectations are without emotion,
the MIS will hear even through the static of illness %&' the chaos of psychosis. "he WS
must believe in these boundaries absolutely and without a shred of doubt. "he WS must also
communicate undebatable harsh conse(uences if the boundaries are violated.
Setting and maintaining boundaries actually improves the MIS)s sense of security, stability,
predictability and order, even though the MIS may not li#e some of them. Setting boundaries
will encourage a more rela$ed, non*udgmental family atmosphere. "he need to set boundaries
must not be confused with the need for an understanding atmosphere. "he Mental Illness
must not be allowed to dominate or grossly disrupt the household, spinning it into chaos. If
the following boundaries cannot be enforced, then the well spouse must consider alternative
care, and consider carefully if the marriage will survive.
THE BOUNDARY OF SAFETY
+irst, the well spouse must ensure safety for the family. "he WS)s first responsibility must be
to any young children in the family. If the MIS refuses to cooperate with doctors, participate
in the treatment program, ta#e medication, and is abusive, the WS will not be able to stay
with the MIS. ,ven though well spouses believe strongly in the sanctity of marriage and in
eternal commitment -or they would have been "out of there" a long time ago., the WS)s first
responsibility must be the children. If the WS doesn)t loo# out for the welfare of the children,
then who will/
"he WS should not tolerate physical abuse. Whether this behavior is a function of the illness
or the person, it must be stopped immediately, Sometimes medication must be ad*usted to
control anger and violent behavior. "his ad*ustment should be made immediately, or the WS
should leave until the danger has passed.
"he WS should not tolerate verbal abuse. "his behavior is more li#ely to be a function of the
illness, not the person. 0egardless, it should be stopped or controlled. "he WS certainly must
learn not to internali1e abuse. "he WS must protect young children from verbal abuse.

THE TRUTH BOUNDARY
"he Well Spouse must categorically refuse to hide the illness from children, e$tended family
and friends. 2nly if the MIS is wor#ing is there *ustification for hiding the illness, and then
only from wor# colleagues. &ot telling creates enormous isolation. &ot telling and tal#ing
creates enormous confusion for children. &ot telling and tal#ing prevents education. &ot
telling and tal#ing prevents development of good coping s#ills. &o +amily Secrets3 &o
Stigma3 "his is a biological brain disorder. It is an Illness, li#e any other.
IDENTITY BOUNDARIES
In the initial e$perience of mental illness, the WS often is so consumed by trying to fight a
battle he or she has little #nowledge of that the WS loses his or her identity in the battle. It is
li#e shooting darts in the dar#, with no direction, no logic, and little success, but a
tremendous gut feeling that something is seriously wrong. 2ften we hear spouses say, "%nd I
#new if I left him, he would die". "hey are probably right3 When the series of events and
e$periences is finally given a name, efforts to control its effects can begin to ta#e on direction
and become much more successful. %fter the initial diagnosis, it often seems that everything
and everyone revolves around the MIS. "he WS must find his or her identity once again,
apart from the battle. "he WS cannot fi$ the MIS, and should (uit trying. 2f course, the WS
can help, but he or she must learn to let go and to find himself. 4obbies long abandoned
must be rediscovered. Interests must be cultivated, children en*oyed, talents e$plored and
e$panded, #nowledge e$ercised. 'o nice things for yourself. +ind freedom. 'emand space.
5," % I+,.
MORAL BOUNDARIES
Mental illness does 66 or does not ma#e a person a nice person, worthy of your respect and
love. "he mentally ill can respect your moral boundaries even in the midst of psychosis if you
ma#e them very clear. If the MIS is not willing to respect the WS)s value structure, then the
marriage may not survive. We do not tolerate violence, dishonesty, street drug use, se$ual
unfaithfulness, and criminal behavior. "he WS must communicate grave conse(uences for
these behaviors. "he WS is deeply committed to the sanctity of marriage, and for the MIS to
violate this value is profoundly discordant and intolerable to the WS. 2ften the WS)s report
that "the MIS never gave me a good e$cuse to leave" is because the WS)s moral boundaries
were never violated. "hat "non6occurrance" was not an accident. 0ather, it illustrates
commitment by the MIS to the marriage.
MEDICAL SYSTEM BOUNDARIES
"he MIS may not want the WS to participate in treatment decisions, but the WS must #now
what is going on and communicate assertively with the doctors and therapists. "he WS is the
best person to communicate what is really happening with the MIS to the doctors. "he WS
must #now what the treatment plan and prescribed medications are. "he WS must help
watch for unwanted side effects and give feedbac# on the effectiveness of medication. We
have found that the WS often must push doctors into trying new medications. "he WS
simply must be an e$pert in the treatment of the illness and participate assertively. "o not
participate leaves the WS too much in the dar#. ,ducation obtained through the 7ourney of
4ope is invaluable here.
PRACTICAL BOUNDARIES
"he Well Spouse will probably need to ta#e over the practical, day to day responsibilities of
the family. "hese responsibilities may include the following, depending upon the severity of
the illness8
9. Ma#ing sure the family has a permanent place to live. 2ften Mentally ill persons
will want to move and:or change *obs often, running from the illness and failures to cope.
"he WS must affirmatively and une(uivocally put a stop to this constant moving. If the WS
has the finances, he:she should buy a house, put down roots, and deal with reality.
;. 4andling the finances. Most mentally ill persons do not handle money well. "his
may mean withdrawing credit cards from the MIS. "his usually means setting up a separate
chec#ing account. "his means paying all or nearly all of the bills. We have found that even
when the WS has tried to share some bill paying responsibility with the MIS, it usually fails.
If the WS is a woman who is not wor#ing, she M<S" get a *ob.
=. 4andling the discipline of the children. "he MIS often is very inconsistent and
unpredictable in disciplining the children, which creates stress and confusion. "he MIS may
interpret misbehavior merely because normal childhood behavior is disturbing to him:her. "he
WS must establish firm guidelines, and aggressively intervene if the MIS is totally out of line.
4e:she will not li#e it, but the damage that can be inflicted upon young children can be
irreparable. "he WS will feel confused about the best way to raise children, and may be
susceptible to pressure from the MIS, but the WS must trust his or her instincts. &one of us
have all the answers, but the WS is more li#ely to be right. %t the same time, children should
not be allowed to use Mental Illness in the family as an e$cuse for disrespect and bad
behavior.
>. "a#ing charge of home maintenance. Many mentally ill persons simply don)t see the
tas#s that need to be done. "hey also may lac# the organi1ational s#ills to ma#e a plan to get
them done. "he MIS may also lac# *udgment in hiring wor# done. 2f course, the MIS
should participate in household chores, but the WS will probably have to organi1e it.
?. Maintaining the automobiles. "he MIS may be oblivious to mechanical difficulties and
lac# *udgment in getting repairs done.
@. 2btaining and maintaining insurance. 2ften the necessity of insurance is lost on a MIS.
A. 4andling family paperwor#. "he MIS will lose mail, and is probably not capable of
doing income ta$ returns. In our household, my husband refused to even open the mail, even
though he is a licensed attorney. 4e doesn)t have a clue as to how I do the income ta$.
B. ong range planning. "he MIS is barely able to handle today, let alone worry about
tomorrow.
C. Maintaining +amily "raditions. 2ften a MIS is stressed by family celebrations. "hese
events are important to the family and the WS should not let the MIS steal them from the
family, even if the stress is uncomfortable. "he MIS *ust has to deal with it.
HOW TO SET BOUNDARIES
9. Dnow yourself and what you can live with. 4ave confidence in your right to demand
conformance to these boundaries. Eommunicate them une(uivocally and unemotionally.
!elieve in them without reservation.
;. !e prepared to enforce conse(uences. 2ften the mere threat of leaving scares the MIS
into compliance. "he MIS really #nows how dependent he or she is and how much he or she
needs the WS. "hat is a powerful tool for gaining compliance, to be used very selectively.
'on)t feel guilty, these boundaries must be observed if the marriage and the family is to
survive. ,stablishing boundaries is in the best interest of the MIS.
=. 5et family support. 'on)t allow the MIS to "divide and con(uer".
'iscuss your needs with influential family members. 5et them to help.
'iscuss your needs with the psychiatrist and therapist, enlisting their help. 5et reinforcement
and courage from your %MI support group.