Mike's impulsive brain

Gerry's overfocused brain

Mike and Gerry had been in marital therapy for four years when they first came to see me. Their therapist had heard me lecture in their hometown. After my talk, she’d gone straight to her office, called Mike and Gerry, and told them to make an appointment to see me.

“Mike,” she said, “I think you need to take care of some biological brain problems before we can make any progress.”

This couple had been in trouble for most of their twelve-year marriage. They fought constantly. Mike had had two affairs, seemed prone to pick fights, and had to work excessively long hours because he performed inefficiently.

Gerry had a tendency toward depression, was angry that their marriage was such a struggle, and would hold on to hurts from years in the past.

The therapist had tried all the techniques she knew. She even went to a conference on “the resistant couple” as a way to find help for Mike and Gerry. She was frustrated because she couldn’t make any progress with them.

When I first met them, Mike was the IP (identified patient). The therapist felt that if she “fixed” Mike, the couple would make progress. Mike, in fact, had ADD. He had underachieved in school. He was restless, fidgety, inattentive, disorganized, and impulsive.

He had trouble listening to Gerry. His marital affairs had not been planned but impulsive. He tended to seek conflict from others and often inflamed situations by making thoughtless comments.

It takes two to create turmoil

In the first few meetings with the couple, however, I felt that Gerry also contributed to the marital turmoil. She tended to voice the same complaints over and over. She argued over insignificant things. She had a strong tendency toward repetitive worry, and when things weren’t “just so,” she’d be upset for hours.

I decided to do brain SPECT scans of both Mike and Gerry. Mike had markedly decreased activity in his prefrontal cortex (PFC), which is consistent with ADD symptoms. Gerry had a significantly overactive anterior cingulate gyrus, which is consistent with overfocus issues.

I placed Mike on Adderall, a brain stimulant to treat his ADD. Within several days, Mike felt more focused. He was more organized at work, and he acted in a more positive, thoughtful way toward Gerry. Even Gerry noticed a difference.

I placed Gerry on Zoloft, an antidepressant to decrease her tendency to overfocus. After several weeks (Zoloft takes longer to be effective than Adderall), Gerry also felt a significant difference within herself. Her thoughts no longer tended to loop. She was better able to hold on to positive tthoughts. She was more playful, less easily set off.

Mike and Gerry could spend time together without fighting constantly. They began to use effectively the marital techniques they had learned in therapy.

Their therapist was ecstatic to see the couple’s progress. She was initially surprised that both of them had brain misfires. Although she had at first attributed the failure solely to Mike, after seeing the brain pictures, she was struck by how “cingulate” Gerry had been, recalling how she overfocused and had trouble letting go of hurts.

Fixing their brains fixed their marriage

The missing link for this couple was in their brain pattern and neurotransmitter irregularities. They continued in therapy for several more months to solidify their gains.

It was important that they really understand the magnitude of the biological contribution to their problems and that they see each other through new eyes. This allowed them to be more forgiving of each other and to heal the painful memories associated with 12 years of marital struggle.

If I had treated just Mike and not Gerry, she might very well have stayed stuck in the pain and frustration of the past, seeing herself as a victim of Mike and being unable to let go of the past.