IS MENTAL ILLNESS A GROUND FOR DIVORCE ? Dr Harish Shetty

IS MENTAL ILLNESS A GROUND FOR DIVORCE ?

Dr Harish Shetty

( Dr Harish Shetty is a Psychiatrist at Dr L H Hiranandani Hospital )

1 Delhi High Court recently annulled a marriage on the grounds that mental illness was not disclosed before the nuptials.

2 This Judgement has many ramifications but cannot be generalised for all cases where one spouse is under treatment for mental illness

The Delhi High Court Judgement on Dec 21, 2021 that granted annulment on the grounds that the spouse had not revealed her mental illness of Schizophrenia to the husband has raised many issues.

The Judgement stated that , ‘The failure on the part of the respondent to disclose her mental disorder before the marriage with the appellant – as alleged by him constituted a fraud perpetrated upon the appellant.’

The Judgement has set a precedent but let us all understand that the order is specific to the facts in the case. It can never be generalised as a sine qua non for every marriage with one partner under treatment for mental illness.

As Psychiatrists, we face such situations all the time. A father of a boy recently asked me a question, viz ” What are the chances that the girl whom his son liked and wanted to marry will get an episode of mental illness again.” In this case the girl had Schizophrenia.

I then softly shared that ‘If she takes her medicines and sees her Psychiatrist regularly the probability of having an increase in symptoms are less.’ Medical Science is the art of the probable.

Mindfully again I added that,”Those who use Doctors as fire engines and report when there is a crisis, the relapses and deterioration will be more. After every relapse the ability to feel, think and perform one’s daily tasks gets worse.Those who see the Doctor when their symptoms are well under control,regularly, remain reasonably well adjusted and the probability of a relapse is less ! “

The couple agreed to marry after a detailed chat with me. Two thumb rules that I have learnt from my Teacher Dr D R Doongaji Ex H.O.D of Psychiatry at K.E.M Hospital, Mumbai are –

1 Always meet the parents of the couple who propose to marry along with the prospective partners together and never alone.

2 Have open discussions and let both the partners ask all their doubts. Never entertain a secret or a confidential phone call about the issue from the non affected partner. All discussions have to be with both the partners and their families. Choose your words carefully.

To this I have added, a third point after a frustrating experience. I still remember after a similar meeting, a couple got married.The facts of the illness, its prognosis, Do’s and Don’ts were all explained in detail.

Everything went of well for a while but one day, two years later, the boy forced the girl to stop her pills. She relapsed and the boy packed his wife and their infant to her mother’s place. When told that he was aware of the illness, he simply denied being informed. Now he has filed a divorce saying that he was cheated. So the third thumb rule is as follows:

3 The family whose son or daughter is being treated for mental illness should always send a mail and document the discussions with both families and the Psychiatrist. This should be sent to the other partner and their parents. The Psychiatrist also should send the gist of the conversations to both the partners.

For all those who do not know, what Schizophrenia is, I would like to share that it is a brain disorder that affects, thinking , feeling, perception and behaviour. Some of the symptoms one can see are –change in behaviour where one can get abusive, aggressive, hear imaginary voices, refuse a bath, lock himself/herself in a room for long or being excessively quiet, talk to himself/herself, withdraw himself/herself from the world etc.

The mainstay of the treatment are medicines. Counseling alongside helps recovery. Counseling is useful like the a ‘dessert ‘ after the dinner (medicines). One can do without the ‘dessert’ but can never avoid the ‘meal’.

The most important cause for a relapse is , ‘stoppage of medications’, by the patient or the family on their own. 52% relapse after stoppage of medications after 6 months-(The Nature of Relapse in Schizophrenia’ BMC Psychiatry 2013). These figures have not changed much. Most of the patients need lifelong treatment. A little over 75% of patients lead near normal lives.

In my opinion Major Mental illness such as Schizophrenia, Bipolar Disorder and others need to be always shared before marriage.

The Judgement echoes this sentiment when it states in its order that, ‘Apart from stating that the parties had met a few times before the marriage, the respondent has not specifically averred , or established that the appellant was made aware of the mental disorder suffered by the respondent, which was passed off as mere headaches. Headaches by themselves are not a disease. They are symptoms of a disease.’

That brings us to a moot point, Are those under treatment for major mental illness fit to marry ? Dr Avinash Joshi my senior colleague who regaled us by playing the Santoor elegantly at K.E.M Hospital, Mumbai during our formative years and also taught us great insights as students has embarked on a path breaking unique plan.

He and his wife Dr Sulabha who is a Gynecologist have initiated a unique creative project. Practising in Nagpur they want to marry those who are under treatment of mental illness with those who have other disabilities such as Orthopedic, skin, hearing, visual and other disabilities with 100 % transparency. Their website is http://www.manomarriage.com.

A brilliant Doctor, he says, ‘This is a perhaps a better way of their rehabilitation – two families sharing their load of the disability.’ Avinash’s experiment had more than 150 applications, but he finds little support from the Doctors treating other disabilities. He successfully has got some couples married.

The bright doctor couple have dared to walk a difficult path laying seeds of change that others can also follow. The success in a stigma and shame afflicted country where mental illness is a taboo will always be slow.

Critics of such an approach vociferously state that every person with mental illness always desires a partner with no such illness. On the ground the picture is neither utopian nor ideal. 99% of proposals break when they here the word ‘mental illness’. In such a scenario many experiments will evolve naturally across the horizon from those who swear to make a difference.

In my opinion the family with the person who is being treated need to be clear about four issues. S’/he needs to be reasonably aware of the simple responsibilities of marriage, should be moderately physically and sexually fit, needs to have coherent skills of managing normal life stressors and should be regular with treatment. A counseling process will help in assessment as well as creating awareness of the issues related to marriage.

Many parents believe that marriage is a cure for mental illness. That is one of the biggest myths in our society. It is not uncommon for parents reporting that their ward has a very high sexual urge making marriage a ‘dire necessity’ ,in their words. This premise is false and it is also a common myth.This can lead to dangerous consequences for the couple and lead to a sure divorce.

I can recall a strange case of a father falsely blaming the girl’s side for the sudden mental illness of his son after marriage. This is not uncommon but the truth was that the boy during the honeymoon shared his entire history of his treatment of Major Depressive Disorder and his continuous medications, with his spouse. Remember do not view the word ‘Major’ as a huge mountain or interpret it as one used to describe something big. It is a just an expression of science.

He spilled all the beans honestly. This is a common scenario, where parents lie and the kids are very honest.The marriage did not break as both loved each other and he went to a fresh Psychiatrist and a Psychologist with his wife supporting him wholeheartedly.

I have also seen the families of girls blaming the boys families in such situations. This is outright fraud where parents believe that their lies will help them through the crisis situation. Most of the times the marriage breaks with a lot of acrimony and long battles in the court.

In some, where the love is strong or also when the power equation is unequal, where the boy has taken heavy obligations such as dowry or financial perks from the girls side the marriage continues. The boy finds some balance in life with his spouse and most of the times seeks mental health assistance to keep the ship sailing.

Dr Avinash Joshi also shares that, his desire is a humble attempt to prevent divorce rates. He enthusiastically adds, ‘ Most of the broken marriages are not due to the illnesses but because of their concealment from the opposite party. I just seek a certificate of reasonable functioning from the treating doctor before moving ahead’.

He is also aware not to marry two partners suffering from major mental illness as he says it has its inherent risks. That’s so true !

It is not uncommon for parents of the non affected spouse to seek the advice of mahajans, matchmakers, the family doctor and significant others to resolve their queries and dilemmas. And we get calls from them like, ‘Doctor what do you think of the girl or the boy’. I do not entertain such calls as the chances of the chinese whisper exaggerating the illness is very high though the intention of the inquiry may be very honest. Confidentiality issues also stop me from revealing any details.

Then I call for a fresh meeting. Sometimes there may be a need for more meetings for better understanding. And that is fine. During the process one needs to prepare the person under treatment to accept that the non affected individual may turn down the proposal at the last minute. Sometimes the family may accept and is happy with the proposal but the prospective partner is not and vice versa. This is a difficult situation.

In a Study by the Family court , Mumbai of 503 new cases of Divorce Petitions during 2014, 2017, 2019, reasons of dispute where responses were 10 % or more, mental illness as a category does not appear where as Addiction appears that ranges from 13 % in 2014, 14 % 2017 and 31 % in 2019 , complaints by women against men.

This could be a reflection of poor awareness among the litigants of mental illness or the number of such cases were less than 10 %. Oblique responses suggesting mental ailments (reasons for dispute) are Black magic, Cruelty and Suspicious nature.(Surekha Rankhambe : A gender Perspective towards matrimonial disputes: A study of Petitions filed for Divorce in Family Court Mumbai. 2021).

A very usual query that I and my peers get is, ‘ What will you do in this situation ? Will you marry a soul who is under medication for mental illness ? My answer here is,’This is a hypothetical situation and I would not be able to opine. Having said that I would like to share that 1/7 Indians, ( 200 million] are mentally ill and this can affect any of us across life’. But inspite of all pressures we should desist directly or indirectly to influence their decision. It is their call !

A study published a few years back states,”It is noteworthy that women with severe mental illness are discriminated in a big way. While wives are more tolerant, husbands are not and many of the marriages, women with the mental illness end sooner or later. The women with severe mental illness are ostracized on three accounts. First, the female status, second the psychoses and third, marital status (divorced/separated). These three together constitute the “triple tragedy.” Most disturbing is the observation that they are abandoned more often because of the negative attitude toward mental illness, rather than the illness per se” (”Hinduism , Marriage and Mental illness’ published in the journal Indian Journal of Psychiatry 2013 January)

The Delhi High Court Judgement has an interesting point to make i.e, ‘ The fact that the parties could not live together beyond nine weeks itself shows that the mental disorder suffered by the respondent is of a kind, and to such an extent as to be unfit for marriage and the procreation of children’.

A short cohabitation of marriage and disruption may aways or most often end up in Divorce. Marriage and Mental illness has another facet. A young boy shared , ‘I am, prepared to marry her, I love her and accept the fact that she is under treatment but I will not tell my parents now.’ Such quick unprocessed acceptance may not last long

These statements are visible outcomes, following joyous dating and hot chats. The treatment details are buried beneath the newly found ecstasy. They do not reach the neurons of those blindly in love.

After marriage he came and asked me to stop the medicines. His refrain was, ‘ She has me, why does she need any medicines. She is completely normal. I am her meds ‘ These are routine ‘state of affairs’ we face. It requires real hard work to convince and get them around and we do not succeed always.

The case of a 28 year man, a computer professional was very interesting. He suddenly discovered after marriage that his wife had discontinued treatment for Obsessive Compulsive Disorder.

She confessed that her parents asked her to hide the disorder and stop taking medicines after the wedding. She worsened !The boy tried hard to talk to her family for support. They stayed away and in fact threatened legal consequences.

The boy was keen to help her and continue the marriage. Her parents filed false complaints against him and he was arrested and bailed. The Family Court tried their best to put some sense in both the families but failed.

The boy moved the high court who asked a Psychiatrist from a Govt hospital to evaluate the lady. Her parents refused and the boy was subsequently given divorce. Here the girl had no say and the parents played truant.

In the judgement being discussed here, by Hon Judges , Jasmeet Singh and Vipin Sanghi they observed, ‘ The outright refusal by the learned counsel of the respondent to subject the respondent to such medical examination, leaves the situation at a stalemate, and prevents us from arriving at a definite truth. The Respondent has scuttled the effort of the court to arrive at a definite finding of the truth’

Parents destroy the lives of their children in so many cases by attempting to bully the partner of their young girl or boy and harass them. In the case referred in the judgement where the father of the girl was arguing the case refused to subject his daughter to be examined by the medical board appointed by the Hon Delhi High court.

An issue raised by many is whether one needs to share about brief treatments such as of stress, distress, disorders following a break up or failure in examinations etc. I believe that they need to be shared but some of my colleagues have a different viewpoint i.e, ‘ Is it necessary to share every episode of flu, malaria, dengue or a common cold’ ?, they ask.

Across the last 25 years , parents have been coaxing me to say that one need not share any details of treatments by a mental health professional. Their fears expressed form sentences such as, ‘If we share who will marry my girl/boy in India.We are so orthodox.’ My answer is NO and that they should reveal.

Many also push me to give a milder diagnosis of a mental illness. I refuse ! Others push me to share that the illness began due to exam stress and s/he has just mild anxiety.’ This is a No No.

The issue of Marriage and Mental illness is vexed and complicated. There are no straight answers. The Delhi High Court Judgement needs to be understood and interpreted in a context. One thing that is simple and straight in an otherwise a maze is that , ‘ All those who want to enter into a wedlock should be transparent about the treatment for mental illness before slipping the ring and taking the proverbial oaths !

A Retd Chief Justice of the Supreme Court long ago once remarked that ‘Mental illness is not what it is, but what it does,’ ! Just on the grounds of a person taking psychiatric treatment,a divorce plea can never be entertained after the family has been transparent about the facts. When the functioning is normal , s/he is like anyone taking medicines for any physical illness.

Towards the end of this piece I would share one of my popular maxims, i.e :’Dil kholke hi nahi , aankhen kholke shaadi karo’ ! ---------------------

http://www.manomarriage.com.

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