Can a Marriage with Mental Illness Survive a Symptom Cop Spouse?

A few weeks ago, the Weightless blog published an interview with Susan Schulherr, author of EATING DISORDERS FOR DUMMIES, in which she explains the distinction between a symptom cop—someone who tries to control your symptoms—and a truly supportive friend or family member. The interview, of course, focuses on eating disorders, but it got me thinking about how to best offer support to a spouse with any type mental illness.

Being in recovery for an eating disorder myself, and being married to a man with bipolar disorder, I have experience with this issue from both sides of the fence. Interestingly, when I was in the thick of my illness—bingeing and purging multiple times a day—I didn’t think I’d recover unless I was being monitored/controlled by a symptom cop.

I daydreamed about getting locked up on eating disorder ward, joining the army, even going to jail—all because I imagined that in those places, finally, with someone else dictating what and when and how much I ate, I would lose weight and be okay.

At one point, I tried to enlist my mother as a symptom cop. I told her that having sweet foods in the house was bad for me. She understood, and stopped buying them. Of course, that pissed me off, and in the end, it only served to reinforce my sneaky behavior around food.

In my experience, relying on someone else to fix you never works.

When it’s your spouse who suffers from a mental illness, however, it’s hard to remember this fact.


It’s natural, I think, when you’re a witness to something as out of control as a spouse’s psychotic episode (or suicidal depression, extreme mania, severe bulimia, or whatnot) to want to impose some measure of normalcy. Taking charge of your partner’s recovery may feel like the only thing you can do to get your lives back on track.

When my husband became psychotic, I wanted to fix him. I could see where his thinking was strange, and I wanted to straighten it out. When I tried to explain to him that he was delusional, it only increased his anxiety and made him more eager to explain why his delusions were, in fact, real.

Fortunately, he went to the hospital and was put on antipsychotics. When he came home, though, I wanted to keep him on his medications, keep him going to therapy, and make sure he knew that he wasn’t misunderstood; he was ill.

For a time, I handed him his pills and watched him swallow them. One day, shortly after he was released from the hospital, he said he wanted to drive himself to his therapy appointment. I agreed, and then secretly followed him in our other car to make sure he had actually gone.

When he returned to work two months after his hospitalizations, I fantasized about how great it would be if his company could just set up a little work area for me, where I could read and write and be on hand in case John needed me. (I didn’t act on this fantasy, though, thank God!) His first day back, I insisted on driving him and picking him up, in case he was too tired to do it himself.

Until very recently, I pestered him at least once a week about keeping up with his mood chart.

I knew I was being controlling, I knew I was being a nag, but I needed to believe that I had some power over his bipolar disorder. I needed to believe that, as long as I was on top of things, our lives wouldn’t once again spin so suddenly, shockingly out of control.

Problem is, when you try to exert control over your husband’s illness, you wrest it away from him.


For a marriage to thrive, you need to be equals. You can’t treat your spouse like a child, even if the consequences of him (or her) not taking those meds, not going to those appointments, or overdoing it at work could be dire.

I’m not talking about times of crisis here. Obviously, someone who’s psychotic or suicidal isn’t going to be able to make rational decisions about his or her care and recovery. But once the crisis has passed, you need to trust your spouse to manage his own recovery. Doing anything else breeds only co-dependency and resentment.

Let your spouse tell you what he needs from you regarding his recovery from mental illness. For me and John, one of the most supportive, helpful things I did in the wake of his hospitalizations was to just treat him like I always had, do the things we always did, and not focus too much on the illness.

Being a symptom cop sends the message that your partner is defined by his illness, and that he’s powerless to recover without your help. Being his wife, however, says that he’s much more than the sum of his symptoms, and that you’re in this together; you’ll figure it out.


I’m grateful that John doesn’t take it upon himself to make sure I’m attending my Twelve Step meetings and calling my sponsor. He knows that those tasks are my responsibility and he has confidence in my ability to take care of myself.

Today, John takes his medications. He also sees a psychiatrist and a therapist. But he doesn’t fill out his mood chart anymore, and I’m okay with that. If he doesn’t think it’s necessary to his recovery, I trust his judgment.

And I have to say, I’m much happier being his wife than being his mommy, or a symptom cop.


10 Responses to Can a Marriage with Mental Illness Survive a Symptom Cop Spouse?

  1. David says:

    Thanks for this. As a therapist I see this all the time. You’re right, it can be a fine line between support and co-dependence. But the difference can make all the difference. Good luck on your journey.

  2. Li says:

    This is a wonderful post! My boyfriend of almost 8 yeaars has schizophrenia. He actually had foisted the role of care giver and subsequently co-dependent relationship on me. We`ve gone through so many phases of his illness: his manic highs and depressive lows, suicidal phase, constantly obsessed with me constantly wanting to break up when he couldn`t control me, his delusions, paranoia, his unwillingness to work at first, his fear of getting help. That went on for 4 years and then he hit rock bottom with a massive breakdown. Then he finally sought treatment both in patient and out patient day program which he successfully completed. Now he is mostly ok, not dependent on me or trying to control me anymore but I feel so lonely because he works, goes to technical school and helps out his family with choirs and by the end of the day he`s just too tired to work on our relationship. To make matters worse I`m in a different city for college. This lack of time on his part has been going on for a year. And that`s never happened prior to that, we`ve always been close. I feel so depressed by it all we have been talking about marriage for years but I feel worried about marrying a mentally ill guy I have my own issues including recent spinal problems. How would you suggest I work with my boyfriend and manage my own problems that are sometimes overwhelming? I wish I could marry him but the past year has been so difficult and its hard to get him to talk about stuff and it takes a long time for him to ever change his behavior when he does things that impact our relationship.

    • Hi Li — thanks for your comment. I’m so glad your boyfriend has gotten help for his schizophrenia, but I’m sorry that you feel like he doesn’t have time for your relationship.

      You mentioned that you’ve been together for eight years, and that you’re currently in college. Did you start dating him when you were very young? Sometimes people outgrow relationships they entered when they were in their teens/early twenties, particularly when one of the parties has undergone a big change (such as the completion of your boyfriend’s recovery program). Recovery changes the dynamic of a relationship — as you mentioned, you’re no longer in that caregiver role, and adjusting to that shift in roles can be tough, even if you wanted your role to change.

      Sometimes talking to a therapist can be helpful, particularly if your boyfriend has difficulty talking about relationship issues when it’s just the two of you. But maybe it’s worth taking a break from each other so that you can focus on college, making friends in a new city, and getting your spinal problems under control—and he can focus on technical school and his family. Time apart might help you get clear about whether the relationship is worth pursuing or not.

      Best of luck to you!

  3. Rachel says:

    I really appreciate your posts and have gained some insight into how my husband might feel about my bipolar disorder. Lately, though, he’s been adamant that I’m not bipolar and that I just had a rough spot when I was diagnosed and hospitalized three different times three years ago. He even went so far as to discuss this with a close couple friend and my father. This leaves me very frustrated with how to talk to him about my illness when he denies that it is this severe and that I was misdiagnosed. I don’t even consider it denial on his part. He just says that I’m so much stronger now and that he’s helped make me stronger. I am on less medication than before because I’m stable, but I know that the line between stable and unstable is paper thin. How do I help him to accept this?

    • Hi Rachel — I’m so glad you’ve found the blog helpful! And I’m glad that your husband supported you through your hospitalizations, although it’s tough that he’s now having trouble accepting that this is a disease you’ll need to manage—to some degree or other—for the rest of your life.

      Personally, I would put my foot down about him discussing your illness with other people. I would tell him that this is very hurtful and disloyal to you, and that he needs to ask your permission before talking to anyone about it. I would also ask him why it’s so important to him to believe that you’ve been misdiagnosed. Does he want you to come off your medication? Stop seeing a therapist? Are your health care costs very high? Is he the kind of guy who likes to feel like a hero?

      Having a better understanding of his thinking might help you have a more productive conversation. (And if you do see a therapist, you could invite him to one of your sessions to talk about it…)

      Those are some initial thoughts. Hope they help!

  4. Li says:

    Hi Heather, thanks for the reply. I think you`re so right about a lot of thing here. I feel like me and my bf are not compatible partners at all. I met him when I was 22, in community college and it was during a time where I was very unhappy with myself. He was 24. Now as I am almost 30, in university, I am trying to make the journey into having a healthier life and addressing and fixing my personal issues so I can have a happy life one day. Back in February I planned to break up with my bf but I chickened out and sent him an email asking if he really wanted to continue the relationship because I noticed he always seems busy and he said he didn`t want to break up. Over the past year the lack of communication is really becoming a problem for me so I try to be gentle but direct about telling him so but he has like a mini break down everytime I point out something but I feel like he does not improve his end. I don`t know if he even has the mental or emotional ability to fix his side of things. But as I think about the past and the present I can say that I was never truely happy with my bf because he had been so problematic and before he was treated for SZ I had no idea what was really wrong with him but I wanted to fix him. Well being 8 years into the relationship I now know I cannot ever fix anyone! I learned that the hard and painful way. Now that I`ve done some research about schizophrenia I don`t think I can deal long term with the uncertainty it causes in a relationship. But I am now wanting to fix myself that is a more important endeavor for me now. And while my bf is not terribly unstable anymore he is now terribly unreliable and inconsistant so one set of bad traits has replaced the other. I don`t know when he might shake these new issues of not being reliable but I don`t want to stick around to find out. If and when I walk away from my bf and not chicken out again hopefully I`ll start some real progress and after I get myself the help I need I want to find a normal bf who will be suitable to marry one day.

  5. singer51781 says:

    I wasn’t married, but I was engaged, living with a man. I can somewhat see now where he was coming from about the control thing, and how hard it must be not to try to control the situation. I think a lot of people who know someone is diagnosed with a psychotic disorder think the diagnosed person can’t handle their own lives. It’s a huge diagnosis! So he took control of every area of my life.

    One question: I’ve heard sometimes it is harder for the spouse to deal with the illness than the person dealing with the illness. Do you find that to be true?

    • Thanks for your comment. I’m sorry to hear about how controlling your fiance was. Re: your question, I think it’s a hard adjustment for both people. It’s different for both people, too. I feel very fortunate that my husband’s illness is under control and it’s not really an issue for either one of us right now. Hope you’re doing well, too!

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