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Description
I constantly tried to let go of resentments over her poor control
over herself and her constant denigration and despair. I internalized how to handle the reality for her, how not to have arguments with her, and how to acknowledge her feelings without getting caught up in her drama. I said loving things about how much I cared about and loved her and deferred to her about whether we would go out, meet friends, or have company. Sometimes when it was too much to take, I would get really angry and fight with her. She would remind me this makes her more depressed, and so I would apologize for exploding, rub her feet, and nurture her and help her get her chemical condition under control. I think of myself as a loyal person, and I love my wife.
These comments are taken directly from an interview with a person living with a depressed partner, and the passage illustrates the ways romantic partners try to help the depressed individual cope with difficulties of daily living. Depression is characterized by negative mood, or feeling sad, miserable, or numb, as well as loss of interest or pleasure, weight loss, sleep disturbance, fatigue, feelings of worthlessness and desires of death (American Psychiatric Association, 1994). In the United States, about 19 million adults, or 10% of the population, suffer from depression in any given year, and nearly two thirds of cases go untreated (NIMH, 2001). Symptoms interfere with everyday functioning and otherwise pleasurable activities and cause difficulty for those with the disorder and for friends and family members who care about the depressed individual. Spouses of depressed individuals complain of dissatisfaction and anger with their romantic partners as well as increased quarreling relative to non-depressed couples, and the same respondents report feeling hurt by their romantic partners and desire more love in the relationship (Hinchliffe, Hooper, & Roberts, 1978). Communication behaviors used by couples including one depressed individual may exaggerate negative tendencies. Inconsistent Nurturing as Control (INC) theory (Le Poire, 1992, 1994) suggests that individuals who seek to control their partners may instead reinforce the behaviors they seek to curtail. In particular, INC theory suggests that both the types of control strategies and patterns of strategy use may reinforce undesirable behavior. Recent research provides overall evidence for INC predictions in couples including one depressed individual: nondepressed partners change their strategies over time such that they reinforce depressive behavior more by contributing to the negativity or ignoring depressive symptoms before their determination that the behavior is problematic; actively help their partners get well more after they label the depression problematic; and revert to a mix of reinforcing and actively helping after their initial control attempts have proven unsuccessful (Duggan & Le Poire, 2006). Other research begins to assess and differentiate the styles of marital conflict associated with husband and wife dysphoria, but conclusions about sex differences in communication conflict with depressed partners remains largely inconsistent (Schudlich, Papp, & Cummings, 2004) The current research integrates research on depression and interpersonal communication and explores sex differences in strategy types of romantic partners' attempts to help curtail depression. Specifically, sex differences in strategy types (reinforcing depression, withholding rewards, helping the partner get well, and encouraging alternative emotional outlets) and patterns (consistent sequences of positive or negative attempts) used to curtail a romantic partner's depression are examined within the INC framework.
Depression in Romantic Relationships
The romantic relationship with a depressed individual provides a rich forum for studying sex differences in communication patterns, and control dynamics in particular, between depressed individuals and their partners. Interpersonal models assume that dysfunctional relationships play a critical role in the onset and maintenance of depression. For example, Lewinsohn (1974) suggested that depression was associated with social skills deficits, such as an inability to obtain positive reinforcement and avoid punishment in the social environment (Segrin & Dillard, 1993). Similarly, Coyne (1976) proposed that communicative acts of the depressed individual initially elicit reactions of sympathy and assistance but eventually lead to aversive experiences for relational partners who begin to feel anxious and depressed themselves. Interpersonal models of depression suggest that depressed individuals engage in more negative and less supportive communication with others and experience rejection from those in their social environment (Segrin, 1993b; Segrin & Abramson, 1994).
Depressed people are often devalued and rejected and induce negative affect in others (Segrin & Dillard, 1992), which may exacerbate depressive symptoms. Depressed individuals appear to internalize rejection when negative interpersonal feedback occurs (Segrin, 1993a) and over time seek higher levels of reassurance and exhibit more depressive behaviors (Segrin, 1993b). For both men and women, self reported health is associated with marital quality and cohesion, and poorer health is also associated with spousal behaviors that are perceived as unsupportive and punishing (Kiecolt-Glaser & Newton, 2001), but conflict and communication control tactics seem to alter physiological functioning differently for men than for women. Marital disagreement was reliably associated with heightened blood pressure and heart rates and reports of pain, and negative or hostile behavior during conflict markedly enhanced negative physiological change for women in particular (for a review see Kiecolt-Glaser & Newton). Hostile interactions and marital dissatisfaction accounted for as much as 50% of the variance in women's systolic blood pressure (Ewart, Taylor, Kraemer, & Agras, 1991). Greater physiological change is seen in women than in men, and sex differences seem most obvious in relation to negative behavior. For example, in patients with hypertension, wives showed larger blood pressure increases than did husbands during marital conflict (Ewart et al.).
Interactions between romantic couples where one individual is depressed may be withdrawn and avoidant at one extreme, or hostile and manipulative at the other. Families with one or more depressed individuals have been found to be less cohesive and supportive, less able to communicate effectively, and have more conflict and higher levels of expressed emotion (e.g., hostility, criticism, and overinvolvement) than families of nondepressed individuals (Downey & Coyne, 1990). Similarly, depressed individuals exhibit distorted patterns of responsiveness in interactions with their spouses such that there is a lack of synchrony between husband and wife, and depressed individuals may be most expressive when they are discussing issues that are negative in nature (Hinchliffe et al., 1978). In marriages, chronically dysphoric (low-level depression) individuals were found to be more reactive to changes in marital adjustment and more vulnerable to stress within the marriage (Beach & O'Leary, 1993).
Inconsistent Nurturing as Control theory (Le Poire, 1994) provides a model that explains how partners of afflicted individuals (whose negative behaviors interfere with everyday functioning) change their communication strategies over time and why roles of both romantic partners become ingrained in the negative behavior. The theory was initially written to describe romantic relationships with substance-abusive individuals, but recent research suggests that the theoretical underpinnings also apply to romantic relationships with depressed individuals. A qualitative analysis of types of strategies partners use to control compulsive behaviors suggests thematic similarities for partners of both substance-abusive and depressed individuals (Duggan, Le Poire, & Addis, 2006). Specifically, partners of substance-abusive individuals and partners of depressed individuals supported the compulsive behavior by giving up their own time needs to accommodate the partner; ignored or avoided the problem by withdrawal, denial, or avoidance; and attempted to help end undesirable behavior by involving professionals, offering advice, and setting relational boundaries. Similarly, partners of substance-abusive individuals (Le Poire, Hallett, & Erlandson, 2000) and partners of depressed individuals (Duggan & Le Poire, 2006) change their control strategies over time in ways that are likely to encourage the substance use and depression.
Within depressive relationships INC theory assumes nondepressed partners have competing goals of nurturing their depressed partners through difficult episodes through such strategies as providing social support, taking over daily tasks, and managing the social calendar to "keep the person going" and controlling the depression by actively helping the partner get well. Contrary to their goal to decrease depression, logical contradictions suggest curtailing the depression is not necessarily the ultimate goal (Le Poire, 1994). The nurturing behaviors are highly rewarding for depressed individuals who receive care through nurturing and for partners who may perceive they can help with their nurturing behaviors. For nondepressed partners, there is high cost to ending the undesirable behavior, because if the depressed individual does not need the nurturing or support he/she may also no longer... |
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