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Indeed, a failure to achieve marital satisfaction has been repeatedly identified as a major cause of psychiatric illness (Brown and Harris, 1978; Costello, 1982; Stewart and Salt, 1981). This does not mean, of course, that the psychiatric distress in the husbands of eating-disordered patients does not deserve any attention in its own right. On the contrary: regardless of his condition before the patient’s illness, the spouse’s emotional instability at the time of referral will most probably influence his ability to deal constructively with his wife’s eating problems.

Similarly, Biglan et al. (1985) propose that depressive symptoms represent a functional set of behaviours that are likely to be reinforced in a relationship characterized by high levels of negative verbal behaviour. Interaction in psychiatrically distressed couples The above hypothesis has been tested in interaction process studies involving a number of psychiatric populations. For example, in a study 22 Marriages of psychiatric patients of the communication between alcoholic patients and their spouses, Billings et al.

P. 426) The husbands in the third and smallest category were mainly older men, who established a firm power imbalance in the relationship by forcing their wives into a childlike dependency. They are described as: kind and loving, only as long as his wife does as he expects. She can have no life of her own. Everything she is and does must be an extension of her husband if they are to live in harmony. (p. 426) Dally’s conclusion is that, although not all of the relationships fit the same pattern, in most cases the relationship between an anorectic patient 30 The husbands of eating-disordered patients and her husband represents a collusive bond which is essential for the development and maintenance of the disorder.