2.6.7  Persons with Mental Illness

Mental illnesses (not to be confused with mental retardation) are brain disorders of a biological nature that can alter mood and/or rational thought processes. The most disabling of these illnesses include schizophrenia, bipolar (also called manic-depression), and major depression. However, because of recent discoveries of very effective medications, many of those who suffer from these illnesses can now have successful, productive, and healthy lives that include marriage, with only mild to moderate effects of their illness remaining.

On the other hand, other, usually less disabling illnesses, such as phobias, obsessive-compulsive disorder, anxiety attacks, anorexia, personality disorders, and post-traumatic disorder vary in their severity and can seriously disrupt married life.

Because of past experiences of stigma, persons with mental illness may be reluctant to provide necessary information when asked about their illness. They need to be reassured at the very beginning that mental illness in itself is not an impediment to marriage. It still presents, however, many extra issues that can be challenging in a marriage. It is important to reassure couples that the Church’s only motive in asking is to be of support to them in their decision to marry. Failure to do so may likely result in their concealing their illness from the pastoral minister entirely. 

Procedure

Since both marriage partners must be well-informed about the illness, its symptoms and its effects, the following questions would be appropriate:

·         Are both partners well-informed about the illness and its symptoms?

·         Is either in denial about the illness or about its effects on married life?

·         How severe or persistent are the symptoms? How well do these respond to medical treatment?

·         Even with the best of medical treatments, some of these effects may remain: fatigue, reduced motivation, social withdrawal, low self-esteem, impulsiveness. Is the couple aware of any of these, and how can they be of help to each other when and if these symptoms occur?

·         Do both partners understand that even when feeling perfectly well, medical treatment must be adhered to strictly? What has been the history of compliance?

·         Have they worked out a plan of what to do if the symptoms cannot be controlled? Will he or she allow the partner to be part of medical consultations and decisions?

·         Are their expectations (job, future, marriage, children, etc.) realistic in keeping stress levels manageable?

·         Does the person ever use street drugs or alcohol? Do they understand that alcohol and street drugs, even in relatively small amounts, can alter the effectiveness of their medications (even to the point of making it impossible to control the symptoms of their illness)?

·         Because medical treatment for mental illness can be very costly, do they know specifically to what their total medical costs will amount? How will these medical costs impact their overall budget?

·         How often has this person changed jobs? Is the partner willing to be the main provider should there be an interruption in employment? Could they manage on one salary?

·         What are their views about God, faith, and the Church? Do they understand that this illness was not a curse or a punishment from God?

Preparation

In addition to discussing the above questions with the couple, the pastoral minister should advise the couple to acquaint themselves with local professional mental health resources.

Paperwork

On the pre-nuptial form, there is a question about mental illness. If one or both parties have been treated for such illnesses in the past, the pastoral minister should make note of the results of the above conversation. Unless a dispensation is needed, there is no need to send the papers to the Office for Canonical Services.