Ties That Bind and Boundaries That Heal: Balancing Family Love with Self-Care

Living alongside a spouse who is struggling with mental health challenges can place immense pressure on the entire family. While the commitment to support a loved one through difficult times is admirable, it’s crucial for family members, especially spouses, to recognize the importance of their own emotional and psychological well-being. This delicate balance between providing care and maintaining personal, mental and emotional health is not only essential for the spouse who has taken on the noble task of acting as caregiver, but also for children who may be impacted by the family’s dynamics. Research shows that prolonged exposure to emotional stress within the home can affect both the individual providing care and the children involved, leading to negative long-term consequences such as anxiety, depression, and poor emotional regulation in children.[i] The intensity and duration of these negative consequences depend in part on what the particular mental health challenge is.[ii]

Understanding when to draw the line between being a supportive spouse and self-preservation is a nuanced and often painful decision. For some, staying in a relationship or household may seem like the right thing to do out of love, commitment, or fear of damaging the family unit. Yet, there are times when stepping back, whether through temporary separation or something more structured, is necessary for the health of everyone involved. Maintaining an environment that is toxic can worsen the mental health of all involved.[iii] This article briefly explores how to navigate these challenging decisions, offering guidance on when to stay strong and when to prioritize individual well-being.

I had the great opportunity to work with a colleague and mentor for many years who taught me so much in the way of understanding healthy interactions with people. He often said, “Too good is no good,” a phrase I heard countless times and one that resonates with me to this day. Its wisdom lies in the subtle reminder that, in our efforts to do good, we can sometimes unwittingly enable or become entangled in the struggles of those facing significant emotional or psychological challenges. Sometimes one may even become the subject of their frustrations when there is a loss of control and specific setbacks. The comfort and safety of the relationship provide those who struggle with an erroneous carte blanche to emotionally hurt others, with or without recognizing the pain or abuse they inflict. I was speaking to a friend of mine who runs a Yeshiva in Israel. He told me that his father used to tell the story of a Rabbi who was asked to weigh in on how much a certain person should charge for his work and expertise. The Rabbi told him to ask for five Rubles for the work, but in return give him five small stones. The individual asked the Rabbi what the stones were for to which the Rabbi replied, no one does a job, be it from the goodness of their heart or otherwise that isn’t met with people that complain and throw stones back. The only thing you can do is provide them with small stones and not big stones, so it won’t be so bad.

At times, this can be the reality of dealing with those struggling with mental health challenges. Those who are suffering often take solace in having a supportive and loving partner and family. They seek guidance and reassurance, and the mutual respect and love within the family can help maintain a sense of structure. This dynamic often translates into a more stable family system, even amidst the instability caused by the mental health challenges.[iv] However, there are moments in a person’s life who is dealing with a spouse suffering from mental health challenges, that the answer is, for the good of the family and one’s own mental health, that there needs to be a break.

I remember, as a child, growing up near a wonderful family who were truly salt-of-the-earth people. One of the spouses developed an inoperable, non-malignant tumor on the frontal lobe, which tragically transformed this gentle, sweet individual into a physically abusive and constantly angry presence. Eventually, it became unsafe for the other spouse to remain in the home, and the difficult decision was made to place the struggling loved one in a facility with 24-hour supervision. This decision was not driven by a lack of love; rather, I would argue it was love itself, along with the need to ensure emotional and physical safety for both partners, that necessitated this alternative, albeit painful, choice. It’s not an easy answer and it’s not always the right answer, but when this option needs to be put on the table there are several different things one must be aware of.

It should go without saying that no decision can or should be made without the guidance of a professional qualified in this area. To the trained eye one can quite easily recognize the untenable level of toxicity in the family dynamic, the deleterious effect it has on those in the nuclear family, as well as the way it is manifested among loved ones including spouses and children. The most affected are usually the ones that will notice something is not working. They are also the ones that suffer in silence. The signs of a toxic environment include but are not limited to: constant tension, emotional and physical exhaustion, worsening symptoms, or general withdrawal.

Constant tension exceeds what one would reasonably expect in a healthy relationship. It is often caused by frequent arguments that become accusatory, abusive, or threatening. Tension can also manifest as persistent misunderstandings and suppressed emotions, leading to a hostile and emotionally unsafe environment. While some amount of exhaustion is normal in relationships, in this context, it refers to a state where individuals feel chronically drained, fatigued, or irritable. Most concerning is that toxic stress exacerbates health issues, including anxiety and physical illness, not only for the spouses but also for children in the household.[v] If a spouse feels compelled to leave the home to recalibrate their emotional health, it may be a serious indication that the stress has reached a breaking point and there is a systemic breakdown in communication and emotional connection.[vi]

So, when is it appropriate to step back and how? This answer is quite subjective and depends on the person and the situation. However, if one’s own mental health is being compromised then it is a no-brainer that there needs to be either professional intervention to help create boundaries, alternative forms of separation or both. If a spouse finds that they are enabling unhealthy behavior or they are met with resistance, aggression or rejection then it may be a strong gauge of the need to take a step back. The problem is that many who have spouses that require real help may think that they know what to do and recognize the trends. They navigate the ups and downs and as long as things don’t spiral out of control, they maintain a “peacekeeping” approach and there is no need to change the status quo.[vii] If it were only that easy! Research suggests that, irrespective of how things may appear outwardly and regardless of internal supports implemented at home, when there is a high level of toxicity and spousal support shifts to merely avoiding conflict, there may be something more sinister at play.[viii] This is important because the untrained spouse working hard to maintain the status quo may find themselves sinking in the proverbial quicksand and not understand why, nor should they. Their singular focus is on keeping things together. Unfortunately, sometimes it is not in anyone’s control and the unfortunate reality is that most people are not equipped to deal with mental health issues.

The most important facet of self-care in these situations, and this is the “how” part, is establishing clear and compassionate boundaries. This allows the spouse who has taken it upon themselves to help care for and support their loved one to protect their emotional health while still providing care and support. In fact, research suggests that when it comes to chronic diseases, care givers who take care of themselves actually have less of a risk of burning out and it leads to better care.[ix] While this study specifically addresses chronic disease, I think it is fair to allow for the extension to include any caregivers in such situations. This need for healthy boundaries and self-care does not equate to abandonment; rather, it helps protect the family unit. While this might be difficult for those who struggle with abandonment issues to accept (regardless of the root cause), this is why working with a trusted relationship coach or therapist can be invaluable in navigating the complexities of building these essential and healthy boundaries.

Self-care is not a luxury but a necessity, especially for spouses dedicated to caregiving in which they are involved in balancing the needs of their families together with all the other pressures that come across their desk in the day to day.  When spouses trying to help their significant other who is struggling with mental health challenge and prioritizes mindfulness, rest and speaking to someone be it a relationship coach or a therapist, they protect their well-being while strengthening their family dynamics. Children learn by example, and when a parent practices self-compassion and self-care it will be learned by the child, ensuring resilience and emotional health. Self-care not only gives one the ability to support others, but also impacts those around them. Families thrive when wellness and balance is modeled because it shows that taking care of oneself isn’t selfish, rather it’s the very thing that is needed to hold it all together giving the best chance for families to remain intact and evolve healthy and strong. While this article is in no way exhaustive, it should open our eyes to the complexities of having a spouse with mental health challenges and open our hearts to the most compassionate way to ensure safety, security and support for all involved.

—

[i] Reupert, A., Maybery, D., & Kowalenko, N. (2012). Children whose parents have a mental illness: Prevalence, need, and treatment. Medical Journal of Australia, 199(S3), S7-S9.

[ii]Hosman, C. M. H., van Doesum, K. T. M., & van Santvoort, F. (2009). Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The scientific basis to a comprehensive approach. Australian e-Journal for the Advancement of Mental Health, 8(3), 250-263.

[iii]  Leff, J., & Warner, R. (2006). Social Inclusion of People with Mental Illness. Cambridge University Press.

[iv] Van Loon, L. M. A., Van de Ven, M. O. M., Van Doesum, K. T. M., Hosman, C. M. H., & Witteman, C. L. M. (2014). Parentification, stress, and problem behavior of adolescents who have a parent with mental health problems. Family Process, 53(2), 252–266.

[v] McEwen, B. S., & Seeman, T. (1999). “Protective and Damaging Effects of Mediators of Stress: Elaborating and Testing the Concepts of Allostasis and Allostatic Load.” Annals of the New York Academy of Sciences.

[vi] Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. Crown Publishing Group.

[vii] Turnbridge. (n.d.). How untreated mental health issues can impact relationships. Turnbridge. Retrieved November 26, 2024, from https://www.turnbridge.com

[viii] Turnbridge. (n.d.). How untreated mental health issues can impact relationships. Turnbridge. Retrieved November 26, 2024, from https://www.turnbridge.com

[ix] Erdoğan Yüce G, Döner A, Bilgin A, Muz G. The effect of mindfulness-based interventions on caregiver burden, quality of life and psychological distress in caregivers of adults with chronic diseases: Systematic review and meta-analysis of randomized controlled trials. Worldviews Evidence Based Nurs. 2024 Oct;21(5):528-541.