What to Expect From Your Marriage

"In relationships, if you always do what you always did, you'll always get what you always got." ~ Amy Dickinson

A common complaint in letters to advice columns is that a spouse is chronically neglecting various needs of the complainer, or refuses to do something that the complainer fervently desires.  Sex may be the most common missing element described by people who write this type of letter – and women complain about the lack of it at least as often as do men – but it can be anything from refraining from cussing to refraining from describing embarrassing or quirky attributes of the complainer to outsiders.

To me, sexually frustrating one’s spouse seems to me to be the most strange of all such complaints, because it would be so easy and take so little effort to give the frustrated spouses what they say they want.  Do these spouses really care that little about keeping the other spouse happy?  That would seem really mean if not vicious.

After all, sex doesn’t take all that much effort, especially if you are not especially concerned about your own pleasure.  Why not make the other person happy occasionally even if you don’t enjoy it yourself?  A mere half hour every week or two might be just the ticket. 

You say it’s a chore?  So is going out and buying your spouse gifts on birthdays, Valentine's Day, and Christmas.  A lot of people seem willing to do those things.   How about meeting all of your other responsibilities at your job and at home?  Chores all, at least much of the time.  For most people, willing!

Even if the man is completely physically impotent and incurably so…and there's no G-rated way to say this... let’s just say his tongue probably works OK, doesn’t it?

Here is a typical example of a letter from a sex deprived wife, from the column Annie’s Mailbox from March 10, 2012.

"Dear Annie: "John" and I have been married for 15 years. He is a wonderful person and a great father...Our relationship is fine on the surface, but it's emotionally empty. There is little intimacy, which has been an issue throughout our marriage. It manifests itself periodically in arguments that never seem to get resolved… He wonders why I cannot "just be happy," because from his perspective, everything is fine. I have told him clearly that I need more attention and affection, but I have come to the realization that he is "just not that into me.

… Annie, I love my family. I am not asking for a magical romance. I don't think it's too much for a woman to need occasional loving physical gestures from her husband. I can't figure out why it's so hard for him to express his love if he cares for me as much as he says.


I don't want to leave, but things could be so much better if John would only put a little more effort into our marriage. Any suggestions on how to improve things? Or am I just destined to have an emotionless relationship?" 


The Annies answer: "There is a variety of reasons why a man may not show any interest in his wife: He could be gay, asexual, not attracted to you or having an affair. He could have low testosterone or other medical or emotional issues. The real problem is that he refuses to address it…"

Well those are all possibilities, but why would she have married someone like that in the first place if she craved affection so much?  It sounds from the letter like she just thinks hubby might just an A-hole, does it not?  I mean, she seems to think that he is someone who is depriving his dear wife of that which she craves, for no apparent reason.

But is that what is really happening?  Could be, but I have another, more likely explanation. The writer starts by saying that they have been married for fifteen years.  It doesn’t sound like this is a new problem, so what that probably means is that she has been putting up with this treatment for fifteen years.  And, after she mentions that, she praises the guy for being a “wonderful” person.  What, you may ask, is so wonderful about a guy who is more than willing to almost totally neglect your needs just because he can?

I find the husband’s response to be telling.   He asks her why she cannot "just be happy, because from his perspective, everything is fine.”  She also says that she has made it clear that the lack of intimacy bothers her a great deal.  So why would he think everything is just fine?  Why wouldn’t he already know the answer to the question of why she just “can’t be happy?”

Well, unless the guy has the IQ of a turnip, the only reasonable explanation for his apparent obtuseness and confusion is that he doesn’t believe her when she say she wants more intimacy.  Remember, she has been putting up with this for fifteen years.  In her letter she says he is wonderful and that she does not want to leave.   If we are hearing this in a letter she writes that may be up for public consumption, then the odds are extremely good that he has heard her say this stuff.  Many times.

The much less obvious explanation for this state of affairs – and so often the less obvious interpretation turns out to be the correct one for patients who I see in therapy - is that he takes her passive acquiescence of the state of affairs as a signal that she actually prefers it!  So, when she complains about it, he becomes confused and asks her why she is not happy, since he is doing exactly what he thinks she wants.  Maybe she really wants to avoid sex and affection, but also enjoys complaining!

He will never tell her about such thoughts because he knows that the thoughts will probably be greeted with great defensiveness, outright derision, or indignation from her that he is blaming her for his problem with intimacy.  That will get him exactly nothing but grief, so why bother?


More important, he is helping her to not face her issue with sex and affection, because he is volunteering to pretend to be the bad guy by denying her.

So could she really be covertly avoiding sex as much as he is?  And if so, why?  Well, the answer to the first question is a resounding, hell yes.  This does not mean that on some level she really does wish for more sex, but that for some reason she is more comfortable with the current state of affairs than with the “improved” version.  The answer as to why might be a one of many possible issues between her and her own family of origin, but she does not give us any clues in her letter about what those issues might be.

And what happened to his libido?  Again, we don’t know.  Maybe he has a whore/madonna conflict about his wife being a sexual being.  But it could also be many other things.

The point is, they are both avoiding sex, not just him. 

A different letter writer in the Dear Abby column of 3/15/12, says that she has been married for 32 years, and for all these years her husband has lied continually.  He fabricates the most outlandish stories, and the whole family knows it.  Furthermore, he is said to never own up to anything he has done wrong, but instead blames the letter writer for his actions. If she confronts or challenges him, he gets defensive and says she’s "always" belittling or challenging him in front of others. 

The probably translation, according to my scenario, is that she covertly thinks that he has a need for continuous humiliation - so she helps out by humiliating him -  and he thinks his wife needs to humiliate him - so he gives her plenty of opportunities.  After all, from the perspective of each, that is exactly what the other has always done.  For 32 years.


"In relationships, if you always do what you always did, you'll always get what you always got." 

More Great Quotable Quotes from People Who Agree with Me About Stuff

Today's post is the second of a series of two containing some of my favorite recent quotes that center around themes discussed in this blog. 

As mentioned, I have been collecting the quotes and putting them on my Facebook fan page at http://www.facebook.com/pages/David-M-Allen-MD/80658565761?fref=ts. The ones posted here started in January of 2014, and are loosely organized by topic. 

Family Dysfunction

"Taking responsibility for something and self-blame are horses of two entirely different colors. The former is empowering; the latter is paralyzing." ~ John Rosemond, Ph.D

Chronic Mental Illness

Our prison population is bigger than Slovenia
Cause we put people in jail instead of treating schizophrenia 
        ~ John Oliver

On trying to find the cause of schizophrenia: "30 wasted years of looking for bad mothers followed by 30 wasted years looking for bad genes." ~ E. Fuller Torrey, M.D.

Psychiatric Practice, Electronic Medical Records, and Managed Care

"The shift from benzodiazepines [for anxiety disorders] to antidepressants is one of the most spectacular achievements of propaganda in psychiatry." ~ Giovanni Fava, M.D., clinical professor of psychiatry at SUNY in Buffalo.

"You're complaining about a Freudian slip? Freud should be able to wear whatever he wants." ~ Tony Kreitzberg

"Why would anyone want to teach me to tolerate my pain? My only interest is in removing it!” ~ Cynthia Mueller, a blog reader, when first exposed to the DBT treatment model for borderline personality disorder.

"Methadone and Buprenorphine [suboxone] should be our first line opiates for use in the treatment of severe acute pain. That way, if patients become addicted to them, they would already be taking the appropriate treatment for their addiction!" ~ Steven A. King, M.D.

"The current EHR has destroyed the narrative, especially in psychiatry, and converted the basis of care to a checklist." ~ George Dawson, M.D.

"It's not just about doing the right thing for your patients, it's about proving to someone else that you've done the right thing, and sometimes "I can't quite remember if I'm an underpaid physician or an overpaid data entry clerk!" ~ Dr. J.D., Family physician.

"The proving [that I did right by a patient] takes longer than the doing." Chrisitine Sinsky, M.D.

"You don't need any research to show that if you are cycling people with serious mental illnesses in and out of short stay psychiatric units in 3 - 5 days and basing their stay there on whether or not they are "dangerous" and using treatments that take weeks to work that by definition you are appearing to treat many more patients but providing adequate treatment to very few. You don't need any research to show that when you shift mental health care from psychiatric units run by psychiatrists to county jails that the outcomes will be worse. You don't need any research to show that when people do not get research-based psychotherapies in the manner that they were designed and instead get a few crisis oriented sessions that do not address their basic problems that outcomes cannot hope to be better. When your attitude is that all mental health treatment can proceed by treating common problems with definite social etiologies with medications as fast as possible and not having an intelligent conversation or working alliance with the person affected - it is logical that treatment outcomes will not improve. Treatment outcomes do not improve if you do not provide effective treatment and that is the mental health landscape at this time." ~ George Dawson, M.D.

"I don’t know if anyone has ever not tensed at being told to relax." ~ Carolyn Hax

"Health care systems that allow patients to rate their doctors on satisfaction ratings without considering that patients might be dissatisfied with reality should be held to task." ~ George Dawson, M.D.

"You want a tale of two cities...look how the financial services industry has captured regulation to their advantage vs. how doctors have been battered by regulation. But it's based on the mind-set of Goldman Sachs vs. the mindset of the family practitioner...who politically shows up for a gunfight with a butter knife." ~ James O'Brien, M.D.

"Managed care has done an expert job of cost shifting by developing business friendly treatment criteria, abandoning the social and community mission of treating difficult problems associated with mental illness and addiction, and removing the element of humanism from psychiatric treatment. When I first started to practice, discharging people from a hospital when a psychiatrist had serious concerns about whether or not they could make it or whether they would be safe was very uncommon. Today those discharges are the rule rather than the exception largely due to the imaginary dangerousness criteria. "~ George Dawson, M.D.

Drug War

"When we talk about marijuana as a gateway drug, we have to remember that the last three occupants of the White House have smoked marijuana. We can very well say marijuana is a gateway drug to the White House” ~ Carl Hart, Ph.D

Psychiatric Diagnosis

"Then there’s the matter of testing a child to determine if he has ADHD. The plain fact is that none of the published diagnostic criteria depend upon test results. They refer to behavior, period." ~ John Rosemond, Ph.D.

"A [mental] disorder does not operate with [social environmental] discrimination. If something was “wrong” with [your child], she would be obnoxious in front of friends, their parents, teachers, and the people in white coats who came to take her away (tra la, for those who appreciate the reference)."
~ John Rosemond, Ph.D.        

            ("Actually, "Ha Ha" and not "Tra La" ~ Napoleon XIV)

A reader writes that her friends 'recently spent around $300 on their daughter’s birthday party—her first. They bought lots of stuff to entertain their young guests and extended family. The child, a baby, obviously had no clue what was going on. I should mention that the parents are struggling to make ends meet.' As my readers know or should know, I am a psychologist. That qualifies me to determine and assign psychological diagnoses. As such, it seems obvious to me that these parents suffer from a now-commonplace parenting malady known as just plain nuts." ~ John Rosemond, Ph.D.

"One symptom does not make a diagnosis " ~ John Rosemond, Ph.D.

"Test anxiety is frequently not an aberrant psychological response - it is instead the normal anxiety anyone would feel in facing a situation for which they were inadequately prepared." ~ Barbara Oakley, Ph.D.

"Under the influence of intense affects, EVERYBODY becomes an idiot."~ Otto Kernberg, M.D.

"Only in America does 'gotta' substitute for 'wanna' so we can avoid the guilt. " ~ The Last Psychiatrist

ADHD

"An often trivialized cause of irritability, difficulty concentrating, reduced vigilance, distractibility, decreased motivation, lack of energy,and disturbed mood: insufficient sleep syndrome. People with this syndrome, common in our 24 hour society, intentionally curtail sleep for work, social, family, or other reasons. According to the International Classification of Sleep Disorders, a practical and effective remedy does exist: more sleep." ~ Psychiatric News.

"The maps of child obesity in the U.S. look suspiciously like those of the ADHD epidemic, with the highest rates in the deep South." ~ Psycritic

"It’s truly surprising how many parents have been told that if their child did not have ADHD the child would not respond to stimulant drugs. In the blitzkrieg of World War II, German bomber pilots took a stimulant drug with a chemical structure similar to that of Adderall. When the American military discovered how much the stimulants helped German pilots, they put stimulants in the kit of every American and British bomber pilot to improve their concentration and alertness on long-haul missions. Surely not all these pilots had ADHD." ~ Marilyn Wedge, Ph.D.

"...after taking the [drug company-designed screening] ADHD quiz, I've realized that both I and my cat have the dreaded disease. I'm off to get us both the treatment we need." ~ Anonymous comment on one of my blog posts.

Evolutionary Psychology

"Selfishness beats altruism within groups. Altruistic groups beat selfish groups. All else is commentary." ~ David Sloan Wilson, Ph.D.

"We mammals are curiously preoccupied with social hierarchy. You may say you don’t care about status, but if you filled a room with people who said that, they’d soon form a hierarchy based on how anti-status each person claims to be." ~ Loretta Breuning, Ph.D.

Do we have to Fully Recover from Depression Before we Can Get Back out There

Depression is a debilitating illness, and it is normal for someone suffering from depression to withdraw from life, doing little more than hiding and waiting. This is especially true during depression’s darkest phase.

This is what I wrote while in that phase:

What is this storm that rages within me?
Why won’t it abate, why won’t it subside?
It comes in like a storm, and devours me.
And it won’t go away. It’s near four months now.
Four months of doing nothing, just hiding, hiding, and waiting.

In my previous post I spoke about the foundation for my recovery that had been laid during those dark months. This included going onto anti-depressant medication to dull the pain, counselling from a Christian counsellor to help me to face and find the correct perspectives regarding the deep fears and traumas in my life. Many other things also played their role, such as physical exercise, pursuing hobbies and interests, and so on.

In July ’90, after eight months of despair and hopeless, I read “Self Help for Your Nerves” by Dr Claire Weeks. Everything changed after that, as hope returned to my life, I finally understood what was wrong with me, how I had gotten into such a state, and had a strategy for recovery.

In October ‘90 I went to see my counsellor again. Since reading “Self Help for Your Nerves” three months earlier, many of depression’s symptoms had gone, while most if not all others had reduced in severity and duration.

I was not better, though, not by a long shot – that would take another four years. At this stage I still felt uncomfortable or slightly disturbed most of the time, I was still suffering from fatigue to the extent that I needed a 45 minute rest every day when I got home from work, I still struggled with anxiety, had occasional panic attacks and heart palpitations, and felt pretty gross when I woke in the mornings.

However, in seeing how much I had improved compared to what I had been like earlier in the year, and noticing that a spring had returned to my step, my counsellor told me that her impression of me was that I was hiding behind Jesus like a small child hides behind his father’s legs, watching the world but too cautious or scared to get out there and experience it.

She told me that although I was still suffering from plenty of depression’s symptoms, she said that I was better enough to stop getting counselling and to get back out there.

Had she said this earlier, I would have been terrified, but as she gave me this advice, I knew she was right. I felt the Lord confirming that it was time for me to stop hiding and waiting and get back into life.

It took four more years for me to recover from depression, but I spent those four years living an almost normal life. I accepted the remaining symptoms of depression as being part of my life, and was content to let them be there like background music to my day, and got on with living.

After that final meeting with my counsellor I joined a new home fellowship group and became the group’s pianist. I joined all the social activities this group ran such as jazz and badminton nights – all things I could not have done even a few months previously. A few months later I started teaching Sunday school again. I asked if I could be a helper, but the organiser laughed (he had more confidence in me than I did) and put me in charge of an entire class, a responsibility I was able to handle with ease.

Everyone recovers from depression at their own rate, there is no formula. But it is encouraging to know that we do not have to wait until we have completely recovered before we can get back out there and enjoy life again.

And the good news is that we do not have to do this by our own strength. Jesus is there, ready to help and empower us with His divine strength.

I can do everything through him who gives me strength. Philippians 4:13

I love the way the Amplified Bible says this:

I have strength for all things in Christ Who empowers me [I am ready for anything and equal to anything through Him Who infuses inner strength into me; I am self-sufficient in Christ's sufficiency]. Philippians 4:13 (AMP)

“Remain in me, and I will remain in you. No branch can bear fruit by itself; it must remain in the vine. Neither can you bear fruit unless you remain in me. I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing.” John 15:4-5

But he [Jesus] said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong. 2 Corinthians 12:9-10

Learning from anxious monkeys

A recent study of anxious monkeys illuminates subtle aspects of why and how they are anxious:

- Young rhesus monkeys from a large, related family showed a clear pattern of inherited anxious temperament.

- Monkeys with anxious temperaments had higher activity in the central nucleus of the amygdala and the anterior hippocampus. In addition, researchers could predict an individual’s degree of anxious temperament by its brain activity.

- Genes and environmental factors affected activity in the amygdala and hippocampus in different ways, providing a brain-based understanding of how nature and nurture might interact to determine an individual’s vulnerability to developing common psychiatric disorders

The hope is that what researchers are learning about anxiety in young monkeys may someday help identify and intervene with anxious children:

The new discovery may ultimately lead to new ways to detect anxiety in children, says Drew Fox, a graduate student ... and a co-author on the study.

"Markers of familial risk for anxiety could be identified by understanding alterations in specific genes that influence hippocampal function," says Fox.

The study suggests that there is a tremendous opportunity to modify the environment to prevent children from developing full-blown anxiety.

Doctors and Tales from Their Old Wives the Woozle Effect

In my blogpost of 2/24/25, I made fun of scientists who waste research dollars proving things that are already obvious. Some people may object that things that are thought to be obvious sometimes turn out to be false. Of course that happens, but because it happens so rarely, it tends to make the news. 

This may lead some to think such discoveries are common. They are not. As I have said, you really don't need a study to prove that the sky appears blue to non-colorblind humans at noon on a cloudless sunny day on the equator.

There is another related situation which is also quite common - scientific ideas that were thought by many to be obvious turn out, on closer inspection, not to really be obvious at all. 

And not true. They are basically old wives' tales, and are instead based on frequent citations from the scientific literature of poorly-designed studies and/or less-than-well-thought out conclusions drawn from those studies. Such ideas become urban myths.

I have written about several of these in previous posts, and there are undoubtedly dozens and dozens more, many of which I may not be aware. Some completely fictional ideas that come to mind: the human brain only works at 20% of its capacity. We are born with all the brains cells we will ever have. Debriefing for first responders (reviewing in detail what they had just witnessed during a gory disaster) helps prevent post-traumatic stress disorder. Benzodiazepine drugs like valium and xanax interfere with a behavioral treatment called systematic desensitization.

Much to my surprise, I recently learned that there is actually a name for this phenomenon. It is called the Woozle Effect. 

According to Wikipedia, "A Woozle is an imaginary character in the A. A. Milne book Winnie-the-Pooh, published in 1926. In chapter three, 'In Which Pooh and Piglet Go Hunting and Nearly Catch a Woozle,' Winnie-the-Pooh and Piglet start following tracks left in snow believing they are the tracks of a Woozle. 

The tracks keep multiplying. Christopher Robin then explains that they have been following their own tracks in circles around a tree."

The Wikipedia article also points out something about this phenomenon that relates to another frequent topic of this blog: groupthink. The Woozle belief persists because it serves the needs of some group of scientists, doctors, or other interest group - whether those needs are ideological, economic, or bureaucratic.