Marital Work

     It's trite to say that "marriage takes work." Dating back to the American culture's value of the Puritan work ethic, hard work is elevated as a moral value to be aspired to.  There is no surprise that the affection for work carries over into our views on relationships and marriage.

     The concept of marital work, or working on one's marriage, can encompass a variety of activities.  For some couples, this may mean formal couples' therapy with a licensed counselor.  For others, professional help may not be required, but having purposeful discussions about marital issues together could be considered marital work.  Another form that researchers have investigated is  the discussion of marital problems with friends.  Whether or not this form of work is beneficial, and if the effects are equal for both partners, is a topic of debate.

     I am a supporter of working through issues by using storytelling with a third party, whether it is a friend or mental health care provider. By sharing our experiences, and receiving honest feedback, we can gain insight and even humility.  Initially, communicating concerns to a spouse or partner, because of the fear of an emotional reaction.  Using an opportunity to prepare the ideas in an emotionally neutral environment may decrease anxiety when it comes to the actual conversation with the significant other.

Some people may have negative perceptions of marital work in these forms.  Some common arguments are:

"A stranger can't help my marriage."

"I don't need someone to assign blame in my relationship."

"I don't need a shrink."

"We're just fine."

     Some of these attitudes may stem from the negative experiences of peers in a talk-therapy environment.  Other individuals object to the sharing of such personal and sensitive issues with a stranger, despite confidentiality.  A desire to deny or diminish conflicts may also be a factor.  Associations between couples' therapy and individual therapy may also conjure the stigma associated with mental illness.

     Alternatives for couples who choose not to share with trusted friends or professionals are available, especially through books.  Not only are there books covering every possible topic within relationships, but workbooks have also been developed which promote communication between parties along with introspection.  However, denial of the existence of the problem or lack of motivation to communicate prevent working through issues in this fashion.

Associations between couples' therapy and individual therapy may also conjure the stigma associated with mental illness.

     Another form of marital work I have witnessed is organic discussions between couples that arise through routine social interaction.  Often, these conversations cover conflicts in the past which have been resolved to both parties' satisfaction, allowing the sharing of the story to demonstrate the resiliency of their bond.  This may offer the benefit of positive role modeling for other couples, as well as possibly illuminating new methods of compromising or problem-solving.  The informal nature of these discussions may avoid both obstacles of dealing with strangers and the stigma of seeking mental health care.

     Personally, I think all of these forms of marital work can be helpful.  However, one major contraindication to couples therapy would be the extreme opposition of one party.  It is counterproductive to a kind, loving relationship to force someone to do anything against their will.  Coercion,even with the best of intentions, will do nothing but breed resentment in the unwilling partner, and ultimately degrade the trust in the partnership.

     Although I advocate heavily for mental health care and talk therapy, I do understand how difficult it can be to return to therapy after a negative experience.  My first foray into couples' therapy was volatile and disheartening.  I felt as though the counselor had taken sides and judged me harshly.  Driving home with my (now ex-) husband after these sessions was miserable, with me feeling outnumbered and beaten down.  I know that this is an isolated incident, but a partner who verbalizes these feelings deserves to pick another therapist instead of returning to that negative space.  In hindsight, this experience was a good one for me within the context of understanding and sympathizing with why some people avoid couples' therapy, and mental health care in general.  Any experience of feeling torn down when so vulnerable is hard to forget.


Jensen, J., Rauer, A. (2015). Marriage work in older couples: disclosure of marital problems to
     spouses and friends over time.  Journal of Family Psychology (epub ahead of print).

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The Silent Magic of Watching My Children Sleep

My two sons lay sleeping in my bed.

The younger is tucked away under the comforter with only a tousled head of golden curls and one miniature hand visible.

The elder is stretched across the foot, wearing nothing but sky blue plaid shorts, dirty from long hours outside.

In the quiet I am distracted by their relaxed breathing and their tanned skin.  I want to stare at them until I can't, because they are so handsome and vulnerable and mine.  Their sighs from their dreams are breathy and deep and content.  They both linger in the sleep of long hours in the sunshine, of having light hearts and sated bellies.

I never knew I would feel this strongly watching them sleep.  I always expected the ferocious pride and irrational protectiveness at other moments.

Their sleep is my magic.  It is my window into my spirituality, my sense of purpose and connectedness and bliss.

It is not pride.
It is not what I expected from motherhood.

This love is the deepest stirring of things I never knew existed
within me.

The magic of them sleeping.
It is my peace.
It is my holy place.

Absolutely contradictory: "Pro-Life" and Anti-Medicaid Politics

     I have to be perfectly honest: I've never been a fan of politics.  I don't like debating, I don't like making people angry with my opinions, and I absolutely hate when I feel like my values are disrespected.  So since I was quite young, I've vehemently avoided open political commentary.

     Consider this me stepping out of my comfort zone, and speaking out on my local senatorial race for multiple reasons.  The most important of which is that I have met both Democratic and Republican candidates, in very different and informal ways.  One was briefly my neighbor, and the other was briefly my doctor.  I can't imagine a stranger scenario happening, especially to someone as young, politically-avoidant, and insignificant as me.  

     I'll be perfectly candid again--I've considered myself a Democrat for my entire adult life.  The reasons are mostly social, somewhat fiscal, but I am just so radically accepting of so many people's choices that I could never be labeled a Republican. I have friends in all walks of life, from a Microsoft employee making a six figure income to the polyamorous family with four children to the single mom of two who recently became aware of the necessity of programs like TANF and WIC (when she had previously identified as a Republican.)  Normally when I vote, I do a little skimming of the main issues, but it's mainly perfunctory, because I vote Democrat probably 80% of the time, unless I really like an Independent candidate.

     This year is different.  The Democratic candidate in my state is a career politician, who's been involved in multiple scandals, been convicted multiple times for a variety of offenses, and when he was my neighbor?  He just gave me a bad feeling in my stomach.  It doesn't truly matter to me about his personal life, or his illegitimate children, in view of his political values being consistent with mine.  However, knowing that he fathered a child with his young secretary makes me wonder if he shouldn't be more aware of power dynamics, and how that could be easily viewed as a gray area to many.  It's futile to elect someone who is at risk of losing their position related to further scandal.

     I didn't come here to talk about the Democratic candidate, though.  It's the conservative platform of the GOP candidate that made me so very upset today.  What first caught my attention was a friend's post on Facebook (of all places!) about a new commercial that my old obstetrician has aired locally.  Her website talks about how her mother raised her to be aware of her privilege, and to take care of others subsequently.  She uses this to say that she supports veterans, but then turns around and says she is against Obama-care and the expansion of Medicaid.  Of course, she is running, touting the misnomer of "Pro-Life" as well.

     Since she is an obstetrician, this is where my brain was absolutely boggled.  Medicaid provides obstetric and prenatal care to so many under-privileged women, and continues to provide medical care to the children after delivery.  If you want to get technical, forty eight percent of all births in 2010 were covered by Medicaid (or CHIP, a related, federally funded program) in 2010 (Markus et al., 2013).  In my profession, I see many, many patients who are covered by Medicaid, who would not be able to seek medical care otherwise.  The idea of denying the poor women of our state,  potentially even half of the women who bear children here, desired abortions because they are not congruent with her personal beliefs, and then deny them subsequent prenatal care for the child that they are being forced to bear?  

Forty eight percent of all births in 2010 were covered by Medicaid.

     This is unconscionable, unacceptable, and not what the women of my state deserve.  It's not what the poor deserve, and it's not aligned with how this woman presents herself.  She talks extensively about supporting veterans, but let's be realistic: veterans are a minute group compared to those of lower economic status.  I am a veteran, and I appreciate when politicians acknowledge the burden of combat veterans, but it does not mean that other poor or underserved persons do not matter by comparison.  The fact that it is an obstetrician running on this platform oozes of greed and judgment: Medicaid patients may pay her less at her practice, if she even takes them as patients.  Apparently her idea of 'empowering women' is denying them choices of what to do with their bodies?  If they don't have enough money, they don't deserve the care to ensure a healthy pregnancy and infant?  It seems like the only women who should be having sex are those with plenty of money, because otherwise you don't deserve to choose not to be a mother.  Heaven forbid, you're poor and have a birth control failure--you're just out of luck.  This smacks of the sexual policing of women, and is disgusting.  It is a fact that the advent of the control of reproductive function, through birth control and abortion, have contributed to the improved state of women in society.  They attain higher levels of education, improved economic security, and better control the size of their families (Frost and Lindberg, 2013).  

     It's beyond ironic that a female doctor who specializes in female health is advertising this rubbish.  In fact, it's not ironic, it's depressing.  And also a little bit galvanizing, getting me back into politics, even if it's just for the next few months.


Markus A. R., E. Andres, K.D. West, N. Garro, and C. Pellegrini. (2013). Medicaid covered births, 2008 through 2010, in the context of the implementation of health reform. Women’s Health Issues, vol. 23, no. 5, 2013, pp. e273–e280. 

Frost, J. J. and Lindberg, L. D. (2013). Reasons for using contraception: Perspectives of US women seeking care at specialized family planning clinics. Contraception, vol. 87, issue 4, 2013, pp 465-472.

Married with Children... And Mental Illness

     It is with a burgeoning awareness that our culture acknowledges perinatal mental illness. Postpartum depression is given far more credence today than it was in decades past--as it should be, considering an estimated 9-16% of mothers are affected.  The burden of this condition is becoming common knowledge, which is both commendable as well as overdue.

     It is no surprise to anyone who has been through postpartum depression, or any other serious mental illness, that the condition places stress on many interpersonal relationships. The most important of which, during the postpartum period, being that relationship between the mother and her significant other. A significant correlation has already been noted between several psychiatric conditions and divorce--it is not unrealistic to state that a postpartum mood disorder would similarly strain a marriage or partnership.

Postpartum Depression Fathers postpartum depression

     Parenthood carries many extra stressors for relationships--sleep deprivation, decrease in disposable income, decrease in time for leisure activities, altered relationships with peers without children, and massive change in daily routine being the first that come to mind. The impact these factors alone could have on a marriage, not even to add on the burden of decreased functioning and mood from PPD, is immense.

     Mothers may carry the burden of the depression, but rarely is the experience of the partner mentioned. I think this does a disservice to the marriage, the partner, and the mother, as well as the family as a whole. A family is a complex, ever-evolving machine. The parents complement each other, creating a protective, insular bubble of support for the children. When the mother experiences PPD, she may withdraw, enjoy her life, children, or partner less, or even contemplate suicide. This places the partner in a position to provide care not only to the children, but also to the affected mother. Imagine if the partner also works outside the home while the mother is home during the months postpartum, and the stress this may cause by being the sole source of income while also being required to emotionally be present extra at home.

     Taking this all into account, it's no surprise that PPD and other perinatal mood disorders could increase the chances of divorce. Marriage takes work and purposeful navigation, even when it is a strong, healthy marriage. When one partner is suffering, the other partner needs extra social support to carry the rest of the family. This social support may 'hold up' the partner while the partner 'holds up' the mother and other children while acclimating to the newborn.

     I'm a big supporter of in-home care.  I've experienced the significant difference it can make, to have an experienced, kind healthcare provider who comes to you in your home.  With my second son, I delivered him with an nurse-midwife in attendance, who continued to visit us in home until we had resolved my breastfeeding issues.  She also spoke with me frequently over the phone, keeping a close eye on me, as I suffered from PPD with my birth of my first son.  I feel like it made a huge impact on my physical recovery, as well as my processing of my birth and avoidance of a recurrence of PPD. 

     Developing this sort of long-term relationship with a family is the kind of care that cannot be accomplished with the current model of revolving door providers, especially with how difficult it may be for these families to commute to an office.  Traveling with an infant is hard.  Being depressed, or anxious, or hormonal, and being on time to another location to deal with more people is too much work for many mothers affected by PPD or other mental illness.  In-home care, combined with one or two consistent providers who are available by telephone for the whole family would be a huge addition to our healthcare system.  Maybe this niche could be filled by a variety of providers--midwives, psychiatric nurse practitioners, licensed clinical social workers, therapists, or even registered nurses with special training in postpartum mood disorders and case management.  Any of these professionals would be able to help, by listening to a stressed spouse, the affected mother, or even helping with appropriate referrals as necessary.  It could be a huge step towards addressing a gap in our social support system as well as our medical system.

     Families truly deserve to be 'met where they are' with their care.  If a family is struggling, it makes sense that the healthcare system should come to them.  The risks of not doing so are too high, as untreated postpartum depression can have lasting effects on the relationships within the family, as well as the development of the children therein.  An improved model of care could provide the temporary support these families need to hopefully avoid divorce and further suffering related to PPD, and help our society as a whole.


American Psychiatric Association. (2015). Postpartum depression.  Retrieved from
National Association for Mental Health. (2015). Women and depression: Postpartum depression. Retrieved from
Centre of Perinatal Excellence. (2014). Managing stress in early parenthood. Retrieved from

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