Mannen en vrouwen van psychiatrische patienten : een onderzoek naar verschillen in ervaringen, huwelijksbeleving en psychisch welbevinden

HUSBANDS AND WIVES OF PSYCHIATRIC PATIENTS: a study of differences pertaining to (marital) experiences and psychological well-being.SUMMARYThe present study has been designed in order to explain differences in psychological well-being between husbands and wives of psychiatric outpatients, found in preceding investigations. Chapter 1 contains an introduction to the study and the outline of the report. In chapter 2 the literature m general sex-differences in psychological wellbeing is reviewed as well as that on the correspondence on psychological distress between husbands and wives. The explanations for the sex-differences can be divided roughly into two models. in the first one, which starts from sex- differences in socialization, it is assumed, that women are better trained than men to discern and express emotions. There is more cultural acceptance of psychological difficulties when expressed by females than when expressed by males. Therefore women will sooner be inclined to report psychological symptoms. The second explanation contradicts the first by noting that the overrepresentation of women on psychological symptons is mainly caused by married women whereas among the never married, males report more feelings of distress than females. According to this explanation, it is the difference between the traditional social roles of married men and women that accounts for the higher rate of married women with symptoms of psychological distress. Compared to their husbands wives occupy fewer social positions, experience less variation, receive fewer structural reinforcements, and are psychologically more dependent on their marital and family lives. Consequently married women have less opportunities to compensate for stressful events with satisfaction derived from a job or from social contacts with colleagues: life areas less bound to the nuclear family. This implies that the risk of boredam and of dissatisfactory conditions of life is higher for married women From a role theoretical perspective these explanations have been elaborated into nine hypotheses, presented in chapter 3 . Together these hypotheses should explain the fact that wives of psychiatric outpatients reported more psychological complaints than husbands of such patients. Having a partner who is treated for psychiatric symptoms was supposed to be correlated with so-called role-discrepancy. Role-discrepancy has been conceived as the discrepancy bet~ one's expectations of the spouse's marital role-behaviour and the behaviour of this spouse as actually perceived. Therefore hypothesis 1 has been formulated as follows: "Spouses of psychiatric outpatients will report more role- discrepancy than "normally" married persons" (i.e. persons, who neither they themselves nor their partners have ever been treated for psychiatric symptoms). To test the assumption that rolediscrepancy would be characteristic of the marital disruption experienced by spouses of psychiatric outpatients, hypothesis 2 has been formulated thus. "The negative correlation between role-discrepancy and marital satisfaction is stronger among spouses of psychiatric outpatients than among "normally" married persons". Because women were supposed to be better socialized than men to discern emotional expressions in themselves and in others it was assumed that wives would note the deviating behaviour of their spouses to a greater extent than men. To test this assumption, hypothesis 3 has been formulated: "Women experience more role-discrepancy than men". Won" were furthermore supposed to be more psychologically dependent on their marital lives than men. Disruption of the marriage would therefore be correlated with psychological distress rather among women than among men. The assumption that the marital lives of the spouses of psychiatric outpatients were disturbed would provide an explanation for the greater proportion of female spouses reporting psychological complaints. To test this assumption hypotheses 4 and 5 have been formulated. Hypothesis 4 : "The positive correlation between psychological complaints and role-discrepancy is stronger among women than among men". Hypothesis 5 : "The difference between the role-discrepancy of the wives of psychiatric outpatients and "normlly" married women is larger than the difference between the role-discrepancy of the husbands of psychiatric outpatients and "normally" married men". Starting from the sex-differences in the socialization process during which women would have learned to value especially the socio-emotional aspects of life and men the functional-instrumental ones, the role-discrepancy perceived by male and female spouses would differ accordingly. This assumption lead to hypotheses 6 and 7. Hypothesis 6 : "Women will experience more role-discrepancy on marital areas concerning affection and joined activities than men". Hypothesis 7 : "Compared to women men will experience more role-discrepancy on instrumental and functional areas of marital life". Spouses of psychiatric outpatients would furthermore experience role-discrepancy on the areas secondary to them selves but primary to their partners, because the role-behaviour ofthe partners was supposed to be inadequate in these areas. The spouses of psychiatric outpatients would have to complement their partners in these areas. To test this assumption hypotheses 8 and 9 have been for mulated as follows. Hypothesis 8 : "Wives of male psychiatricoutpatients experience more role-discrepancy than "normally"married we~particularly on functional and instrumental areas of maritallife".Hypothesis 9: "Compared to "normally" married men husbandsof femalepsychiatric outpatients experience more role-discrepancyespeciallyon socio-emotional areas of marital life".In order to test these hypotheses a questionnaire to measuremaritalrole-discrepancy has been constructed. A pilot-study among189 "normally" married men and women (reported in chapter 4) showedthis socalled "Marital Change Desirability Scale" to be internallyconsistentand valid as a measure of marriage appraisal.The hypotheses have been tested in a study among thefollowing groupsof married persons: fifty male and fifty female psychiatricoutpatientsand their spouses, 72 men and 56 women from a randompopulation samplewithout psychiatric treatment at present or in the past, 50coupleswho labeled their marriage as "happy", and 28 couples whoreportedmarital problem. The design of the study is described inchapter 5.Data have been gathered by mews of questionnaires and bymeans ofopen interviews. The spouses of the psychiatric outpatientshave beeninterviewed in order to obtain qualitative material thatmight clarify the quantative data from the questionnaires. Allrespondentsfilled in the Marital Change Desirability Scale to measuretheir rolediscrepancy, the Maudsley Marital Questionnaire to measure their marital satisfaction and the Social Desirability Scale to control for response-tendencies. All groups, except the random population sample, filled in the Symptom Checklist-90 Revised, as a measure of psychosomatic symptomatology. The patients and their partners filled in the Dutch Personality Questionnaire, as a ~sure of neuroticism, the Attitude to Marriage and Divorce Scales, as measures of sex-role stereotyping, and a psychological complaints questionnaire, as a measure of general psychological well- being. The results obtained by means of the questionnaires are reported in chapter 6. Respondents with marital problems reported the lowest marital satisfaction and the highest role-discrepancy. Second in line cam the partners of the psychiatric outpatients. In accordance with hypothesis 1 both male and female partners reported significantly more role-discrepancy than "normally" married men and v~. There was a difference between the marriage in which the nun and those in which the woman was the identified patient. In the first cases the husbands (the patients) had roughly the same role-discrepancy and marital satisfaction scores as the "normlly" married men whereas their wives were distinguished negatively from the "normally" married women. Amongst the marriages with the wife as the identified patient both. of the spouses differed negatively from the "normally" married men and women. Hypothesis 2, the assumption that role-discrepancy was characteristic of the marital disruption of patients' spouses, had to be rejected. The same holds for hypothesis 3, that wives would experience more role-discrepancy than husbands. Hypothesis 5, assuming a greater difference bet~ the role-discrepancy scores of wives of male patients and "normlly" married women than between those of husbands of female patients and "normally" married men, had to be rejected too. The only sex-differences on role- discrepancy found was that wen reported more discrepancy on the affective and women more on the instrumental areas of their marriages. These differences held for all the men and women except the male patients and their wives. This means that hypotheses 6 through 9 have not been confirmed either. As had been expected the psychological well-being of wives was more strongly correlated with their marriage appraisal than the psychological well-beingof the husbands. This correlation was found particularly in a negative sense: wives of male patients and wives with marital problems reported more psychosomatic symptoms than "normally" and "happily" married wives and more than all husbands except the wale patients. The husbands of female patients reported roughly the sane amount of psychosomatic symptoms as the "normally" married men. This means that hypothesis 4 is only confirmed for women who experience a disruption of their marital relationship. These results might indicate that women "suffer" more from a distorted marital relationship than men. On the other hand, it is possible that man express their marital dissatisfaction in another way than through psychological complaints. The interview data, reported in chapter 7, for example indicated that husbands of psychiatric outpatients were also distressed by the psychological problems of their wives and the effects m their lives and marriages. Though male and female partners of the patients did not differ significantly, the raw data unanimously showed men to evaluate the changes in patient's functioning, in their own functioning, and in their marriages, that were caused by or correlated with the psychological problems of the patients, more negatively than the wives of the male patients. Husbands seemed to be more disapproving of the whole situation, wives showed more signs of acquiescence. It looks as if husbands' expectations of their wives, their marriages, and their lives in general had been disturbed to a greater extent than those of the female spouses. It may be that men are less familiar with psychological problems than women, as might be concluded from the general finding that husbands more frequently said that they never expected this to happen to their wives whereas female spouses more often seemed to have anticipated the psychological breakdown of their partners. Male and female spouses also had different strategies to cope with their problems. Men relied more frequently on information from professionals or encyclopaedias whereas women relied more on lay persons who had the same sort of experiences. Furthermore women were distinguished from men by more self- development. In spite of negative experiences they evaluated the increase in selfreliance, though initially enforced by their husbands' illness as positive and as an enrichment of their lives. These results gave riseto considerations about the tenability of the (sex)role theoretical explanatory ~1. Together with a Dutch summary of the results these considerations form the contents of chapter 8. It is concluded there that role theory can account for the present findings. Both male and female spouses were influenced by the psychiatric illness of their partners. Both had to take over responsibilities that originally belonged to the other sex. For men this mostly meant a step backwards: more household chores, more activities by which they were bound to the nuclear family, more stress because the work outside the 1~ had to be combined with these tasks without an increase in social status. Women on the other hand experienced as enlargement of their action radius by taking over their husbands' functions as family-representatives, by starting work outside the house, either because of the 'need to supplement family income or because they decided to do it because they considered that being at home all day together with the patient did not improve the situation. Con~ to the male spouses of the patients, the female spouses gained "priviliges" originally bound to male social roles. As has been stated earlier role theory can explain the results of this study, but it would have to be revised regarding stereotyped sexroles. Instead of describing (married) persons in terms of the social roles they are supposed to have according to their sex and marital status, it seems better to do this in terms of the social roles they will have according to their marital status alone.. It may be possible that the distinction between male and female spouses is fading away to make room for distinctions according to the positions a spouse, whether husband or wife, may occupy in the general society. The lack of differences between the male and female partners in this study might be interpretated as resulting from the second wave of feminism that started in the late sixties. The fact that the wives of the patients used more self-developing coping strategies than the husbands, can be seen as a confirmation of this interpretation for the female spouses at least.