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Lots has been written about relationships. Marriage is a unique one. You are bound by law, culture, society and sometimes, another's choice, to live your life, or certainly a large chunk of it, in close proximity to another person. Recently the institution of marriage has come under a great deal of pressure- from same sex marriages to the growth of the narcissism to discussions around polygamy and polyandry.

If one were to apply simple logic to this institution of marriage one could come to the conclusion that it's an entirely unnatural state doomed to trouble and strife. I mean how difficult it must be to “belong” to one person and be constrained within the bounds of that very small world when especially these days the world has become so accessible?  Surely your growth is being stunted? Surely one human cannot belong to another? These are all the quasi philosophical arguments i get in practice when a patient is going through a marital existential angst.
More worryingly though, many, many marriages exist today in a state of perpetual unhappiness either surviving on a diet of denialism or just plain fatigue to fight anymore. Unspoken truces. Incomplete lives. Doing what is needed. How sad is that? Not being able to grow and learn and become a vital dynamic part of humanity. 

So. i took a conscious decision a few years ago not to do marital therapy/ counseling just simply because it was way too draining and depressing. I was happier see a raging psychotic patient thrashing the ward and scaring the crap out of everybody than sit in front of Mr and Mrs Miserable! The main reason for this decision was that all that happened in these sessions was that they moved the battleground to my office! I was expected to be referee, judge , adjudicator and at the end they probably didn't absorb a word I said. The listening deaf! They hear sounds but no words register. So they end up reacting to tonal cues rather than actual meaning of words. So what was the point , I thought?
More recently however i had to have rethink after a wise person said to me that the age of information has passed and we are now in the age of wisdom. There is a ton of data on brain function. There is even more written about human relationships. There is unbelievably good studies which show how these two are connected. The brain is and organ, like the heart, lung, liver etc. It follows a certain set of rules that govern its function. It needs blood, oxygen , nutrition to function. It is affected by external forces more than any other organ in the body. If it's exposed to a constant high level of stress/ unhappiness its going to take strain and the fuels used to make it run are going to run out. So what happens when brain fuel runs low? Negativity ensues, irritability and anger emerge, helplessness and hopelessness start to take over, sleep appetite, energy levels, motivation and levels of interest slowly decline and eventually the person is just surviving physically. 

So if we take all these points of information, and apply a little bit of wisdom to it , it follows that couples in a state of marital strife are trying to fix their relationship with an organ that's dysfunctional and are progressively making their despair deeper and aiding and abetting a downward spiral in not just each other but also probably the kids and other close family members. 

What does this mean? The very organ required to fix the problem is being decimated by the problem. Of course this does not apply to all marriages , just the vast majority of them. The problem begins with either a catastrophic event (usually a bout of infidelity or an incident of abuse or substance induced behavior) and then the process of starting to fix the problem begins with endless discussions, emotional outbursts, no speaks for days and weeks, increased alcohol intake (husbands self medication) or painkiller intake (codeine- the elixir of the suffering wife), several attempts to “let's make this work” and eventually before you know its a cycle. The same words, the same emotions, the same outcomes. Groundhog day for couples.

Traditional marriage counseling focuses on opening up communication channels and getting couples to start looking at their roles in the problem rather than constantly blame the other. There are a myriad of techniques, some quite commercialized, that offer solutions and life lines to the drowning relationships. I'm sure most of these therapists will agree the outcomes are quite dismal and the process has just as much a chance of ending in divorce than before it began. This is not because the process is flawed or the theory behind it is necessarily untrue, it's quite simply that the very organ the couple needs to apply these techniques is not working properly.

Now as with everything with the brain, it does not apply to everyone, but I would venture to guess that it does apply to the majority of warring couples especially those who have been in an attritional relationship for years. They are clinically depressed or dysthymic (low grade depressed over a long period). The symptoms of depression are: low mood, anger and irritability, loss of interest, increased emotionalism, poor concentration and generally diminished ability to think clearly and reason, sleep and appetite changes, fatigue, various physical complaints like headaches, back pains, etc and a general sense of negativity and foreboding for the future. In the marital context I think the anger irritability and aggression (especially in males) is the main reason the attempts at reconciliation fail. Add to this mix alcohol, over the counter painkillers with codeine, and sleeping pills and the plot is ready to blow.

Often I see couples in strife and on the first consult focus on the clinical symptoms of depression (which they almost all fulfill criteria for) and suggest they do a 6 week trial of treatment first before embarking on the marital therapy courses. Many times I have seen the same couple 6 weeks later only to be told that they have opted out of the counseling and are actually able to work through their issues better now. It's not a magic bullet that solve the problem, it just allows an inherent sense of reason to emerge and it also allows other positive emotions to express themselves. The love that was always there, then compassion, the empathy and the caring. The marriage may still end in divorce but I bet that the process will be a lot more humane with less collateral damage ( also the lawyers don't take over the process).

So in essence what I'm saying is that there is a high probability that if you're going through a marital  crisis, one or both of you, may be clinically depressed and, just seeking the right type of help may make the healing process a lot easier. It scary to think how many families have been broken up over the years because this was not addressed.