A28-year-old girl got married to a 35-year-old school teacher. The wedding was planned in haste since the boy’s (no pun intended) mother has a chronic medical condition that requires weekly hospital visits. A month or so before the engagement, the girl experienced some anxiety attacks and sought a psychiatrist’s help. The attacks were severe and there was an element of terror bordering towards misperception and psychosis. Except for this episode she had no history of psychiatric ailment.

Unfortunately, the girl was sent home two days after marriage since she could not fulfil the spousal and the family’s (nursing) expectation, and the marriage ended in divorce after a week of arbitration. The bone of contention was the diagnosis of schizophrenia by her psychiatrist. Her academic accomplishments were proof of her intellectual and emotional achievements in the past. She also had a religious bent; weekend Quran classes and lectures on Sharia were shared by her mother. The nature of the symptoms or the duration of illness did not justify the diagnosis of chronic psychosis (The term psychosis include schizophrenia among other mental disorders), but there are various learning points in this case history.

This article focuses on the common difficulties encountered by psychiatric patients when they plan to get married.

Mental illness, with the added burden of social stigma, brings a lot of problems for the afflicted individual in terms of prospects for marriage. When the illness is in remission, the the family makes a desperate attempt to marry off the person. At the same time, the individual and the families are faced with various paradoxes with no easy solutions at hand.

If the family informs the potential partner about the illness the prospects of marriage are reduced. On the other hand, if only some selective details are communicated it may also give rise to justified resentment on the part of the spouse and his family. It is a situation where one is doomed if one tells the truth, as well as if one doesn’t; there’s no win-win strategy. What is most commonly seen is that the individuals take the best foot forward approach, which can potentially backfire with a long term mental illness.

The foundation of a lasting relationship lies on trust. The partner-to-be (and his family) should be taken in full confidence regarding the nature and course of the illness. A joint meeting with the psychiatrist or a well-informed physician also helps in terms of information transfer. Carefully drafted information leaflets related to the nature and course of the illness go a long way in informed decision making. However, it is important to make it clear that the decision rests with the individual and the family.

More and more patients with mental illness are faced with the dilemma of getting married as the parents and care givers either move out of the county for better life prospects or face their own health issues. The absence of public sector social services and rehabilitation centres add to the burden of care for most patients. In places where they exist they are of limited scope. The occupational skills training are also outdated with emphasis on skills with no market economy. The social and communication skills training is also found wanting. With little respite for the care givers, parents deem marriage as a possible solution, oblivious of the consequences. This can end up in a bitter trauma of divorce or having to care for the grandchildren beside the patient himself.

In conclusion, the issue of marriage and mental health need attention from all stakeholders. While the institution of marriage is expected to fulfil the biological, social and emotional needs of the spouse in a culturally sanctioned way, the long term care, rehabilitation and supported work-opportunities should be looked into from a public health perspective.