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Marital Discord and Therapy

Dr Vijay Nagaswami MBBS,DPM (Psych)


"Relationship problems are among the most common causes for depression,” says Dr Vijay Nagaswami MBBS,DPM (Psych). Dr Nagaswami is a practising psychiatrist, and has been a marital therapist for over a decade.

You have defined yourself as a Marital Therapist. How would you describe your role?

I help couples understand the dynamics of the relationship.

This area of intervention appealed to me most for two reasons: One, there were very few people working in this area. Two, the role has universal applicability. Besides, I was working pretty hard at my own marriage!

Do couples actually come to a therapist for help?

Increasingly, yes. In the past thirty years the Indian society has seen many changes. People are trying to redefine the institution. I believe that marriage as an institution is evolving. It is not like a dinosaur.

There is an impression that there is less faith in a marriage today, as divorce rates are increasing. I do not think that this is an indicator. It only shows that more people are opting for a legal resolution to marriage If you take into account emotional divorce within a marriage, I think the incidence must have been pretty high in the past too.

Is there a typical patient profile? Are children of broken marriages more prone to making bad marriages themselves?

I believe that there are areas of disharmony in every marriage. Today couples are looking for more out of a marriage. I get patients who are in their fifties as well as young couples. But by and large my patients are from the middle and upper classes and in their thirties.

In the poorer classes too marriages are problematic, but their parameters are at the survival level. So a woman may hold on to a “bad” husband because his mere presence may protect her from harassment from neighbourhood goons.

I feel all couples should go for counselling. Marriage is not what we are trained for.

It is often said that in India when you marry, you do not marry a person, but a family. Does this put more pressure on a marriage?

I do not believe that the idea is true. Marriage is between two people. The couple creates a bubble around itself, a space in which the relationship is nurtured,. It is important to keep the family or friends, as the case may be, out of this space. I do not mean that people should cut relationships with their parent families after marriage, but just that they should keep them out of this space.

A marriage, I believe, rests on four pillars: love, trust, respect and intimacy. In our society there are enormous pressures that keep pulling at these pillars. But finally it is between the two people to keep the marriage alive.

How true is the proverbial seven years’ itch? Does disharmony creep in on a marriage with years?

There is no pattern. But I often find that problems begin in the second year. Two – five years is an unstable period. Once a marriage weathers the fifth year then it settles and the couple has worked out a level of communication.

Do your patients actually suffer psychaitric problems because of marital discord? Are they aware of this?

Relationship problems are one of the most common causes for depression among patients who approach clinical psychiatrists.

Are there any medical problems like sexual incompatibility or infertility that can sour a marriage?

I think there is a lot of awareness about coping with infertility today and couples seem to be able to handle this.

As for sexual incompatibility, there is a surprising amount of ignorance. But even this is not a problem that can break a relationship.The key factor is emotional.

What about Alternate sexuality?

I do have gay patients. Since our society is still very conservative, they keep their sexual preference secret till they are forced to marry by their family. Some of them even get married. They need help in accepting the fact the spouse’s life is devastated, if a such a marriage is entered into.

In a place like Bombay society is a little more open. So gays have groups to turn to. In Chennai, it is very difficult. Some gays are uncomfortable about being gay. All gays have to cope with a society that refuses to accept them as normal.

How much does therapy really help in saving a disharmonious marriage?

A therapist is not a saviour. Sometimes I get patients who have even met their lawyer before coming to me, as if this is a part of the last rites. Firstly, you have got to want it ( therapy) to help.

In a difficult marriage people can make choices hot headedly or for the wrong reasons. I help them to make a considered choice.

Is therapy replacing the traditional “ agony aunts”, mutual friends or family members who would help out when a marriage hits a rough patch?

I think the traditional buffers are still there and are important. They provide a lot of emotional support. But a therapist helps the couple look at the unconscious dynamics that are rocking the relationship.

Your professional practice involves meeting people who are having rough marriages. Your book is about the various problems couples encounter while trying to keep their marriage going. Recently you threw open the debate “ Will marriage survive the next millenium” to people from a cross section of society. What is your personal response to the question?

The consensus at the gathering that discussed the future of marriage, was that it will survive.

I think so too. We are going to be more demanding about the relationship within a marriage in the future. That means the institution is being taken seriously. I think this will benefit the institution.


Dr. Vijay Nagaswami MBBS,DPM (Psychiatry)

Dr. Vijay Nagaswami completed his MBBS,DPM (Psychiatry) at MMC, Chennai. He has served the Schizophrenia Research Foundation (India), SCARF, as Deputy Director and was a consultant to the World Health Organisation and the International Labour Organisation and other international organisations. He has also worked in the corporate sector heading Human Resources Development activities.

Since 1997, he has focused on Individual and Marital Psychotherapy. A book for married couples titled 'Courtship and Marriage : a guide for Indian couples' (Penguin) written by him was released recently and has entered the Asian Age bestseller list. He also conducts workshops and seminars for business corporations as well as individuals on personal relationship management.

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