Excerpts from Must Read Books & Articles on Mental Health Topics
Articles- Part IX


Charles D'Ambrosio, New Yorker- 6/24/2002

Poem by Father (1972). One Sunday morning when I was a boy, my father came out of his office and handed me a poem. It was about a honeybee counseling a flea to flee a doggy and see the sea. The barbiturates my father took to regulate his emotions made him insomniac, and I understood that he'd been awake most of the night, laboring over these lines, listing all the words he could think of ending in a long "e." This meant using many adverbs and the elevated "thee" as a form of address. My father was a professor of finance who wrote fairly dry textbooks, where the prose marched in soldierly fashion across the page, broken by intricate formulas calculating risk and return, and this poem was a somewhat frilly production for him. The poem was an allegory about his desire to leave our family. Like a lot of people, my father felt that a poem was a bunch of words with a tricky meaning deeply buried away, like treasure, below a surface of rhyming sounds. I was twelve years old, and I understood the sense of the poem instantly, but the strange mixture of childish diction and obvious content silenced me. I was ashamed. That Sunday morning, I was sitting on the living room floor, on a tundra of white carpet that my father considered elegant. The drapes were closed, because he worried that sun would fade the fabric on the furniture, but a bright bar of light cut through a gap in the curtains, and that's where I sat, since it was warm there, in a house where we were otherwise forbidden to adjust the thermostat above sixty-two degrees.
    Letter from younger brother (1997). Not long ago, I was in Seattle, sitting in a cafe downtown. It was raining. I'd been there for sometime before I realized that someone was staring at me through the window I turned around and saw worn tennis shoes and dirty gray sweats. The man outside the window was my brother Mike. My father had three sons. I'm the eldest; Danny, the youngest, killed himself sixteen years ago.
    In addition to the tennis shoes and sweats, Mike was wearing a white T shirt that hung to his knees and a black leather jacket he'd bought with V A. money at a thrift store. His thinning hair was soaked, and his face had the pallor of warm cheese. In a plastic sack he carried a carton of cigarettes he'd bought at the Navy PX. He's schizophrenic, and on some level I'm always aware that he's a stranger. I went outside, and we talked and, in talking, we were brothers again. He did not look good; he was shivering. He was several miles from his halfway house, but when I offered to give him a ride he said, quite happily, that he preferred to walk. He started up the hill, limping a little from a pelvic injury he received, years ago, when he tried to kill himself by jumping off the Aurora Bridge, in Seattle. Very soon he was gone.
    Only a few years ago, Mike was doing much better, and he wrote letters regularly, often two or three a month. Here is one:

Dear Char,
Mike here, who is there? I am fine as a blade of grass. How about you? As I was leaving church the other day there was an opportunity to be part of a poor person's Kriss Kringle. I decided to buy an AIDS patient some high-quality gloves. The situation reminded me of Danny-I don't know why. The gift will be given to him although I believe I will never actually see the recipient. I will give him a card that says, "To a friend I don't know" I don't think of Danny a lot. I don't feel pain about his death a lot either. Jesus has stepped into his boots and has replaced him. It caused me to heal and be born again. It is really quite beautiful. My heart is still with that kid like you cannot believe-or I suppose you could. Love can play a trick on you. It can cause you pain like you were suffering in hell, but it is still love and still beautiful like heaven and the heaven and the hell of it are woven into one fabric, which is love. It's a mindblower to think like that but that is what Danny has done to me. Call or write please. I don't own a cat or dog--but I do the same by looking at squirrels and crows. I plan to buy some peanuts to feed the squirrels and bread for the birds. It is so much cheaper and I enjoy it the same as having my own animal. When I pray I can see my life flash before my eyes. It is very beautiful. My life flashes before my eyes about twenty times a year. Other stuff like that happens to me also. I've been through so much since becoming mentally ill-most of it, believe it or not, was good. Because of that I became sort of an indestructible man.
Love, Mike

Letter from youngest brother (November 26, 1986). My brother Danny wrote his suicide note in my bedroom, and then, after a caesura that I know exists because he had to put down the pen in order to pick up the gun, he shot himself: For some reason, I've always been concerned about the length of the lapse, whether he reread what he'd written or stared dumbly at his signature, his name the final piece in a puzzling life he was about to end, before he pressed the gun to his head and pulled the trigger. Most suicides go about the last phase of their business in silence and don't leave notes. Death itself is the summary statement, and they step into its embrace hours or days before the barrel is finally raised to the roof of the mouth or the fingertips last feel the rough metal of the bridge rail. They are dead and then they die. But Danny wrote a note, or not so much a note as an essay, a long document full of self-hatred and sorrow, love and despair, and now I'm glad that I have it, because, this way, we're still engaged in a dialogue. His words are there and so is his hand, a hand I'd held, but, more important, one that left words that, like an artifact, are as real and physical to me as the boy who, at twenty-one, in a November long ago, wrote them.
    I read the pages he wrote two or three times a month, often enough so that the words ring like the lines of poems I know well. All the struggle is still there in the headlong sentences that tumble toward his signature, in the misspelled words and syntactical errors, in the self-conscious language of a boy starved for love and trying, instead, to live a moment more off pride. The note has the back-and-forth of a debate, of words equally weighed and in balance, of a slightly agonized civility. He says, "I stopped making dreams." He says, "I don't know why I am doing this. I don't want to. I have dreams." He says that there is no God and that God is looking over his shoulder as he writes, making editorial remarks. He says, "I am glorifying myself now I am afraid to stop writing though. I want to keep talking." He says, "I don't know what to say except I am sorry and I love. I love the whole family quite a bit and the terrible ____." He clearly wants to find a way back, but he can't. He asks that we keep "the way" he died a secret and, as though he were done, signs his name. But on the next page, the last, he again asks that we keep "the way" he died secret, and again he signs his name. Much of the note is printed, and those letters stand upright, but in the end Danny slips permanently into a sloping cursive as despair and self-hatred accelerate beyond return, as if he were being pulled down by the dark undercurrent of his life, his last words looping quickly across the page, continuous as breath.
    Letters from eldest brother (2001). Two years ago, I moved to Philipsburg, Montana. In the fall, I went for walks and brought home bones. The best bones weren't on trails-deer and moose don't die conveniently-and soon I was wandering so far into the woods that I needed a map and compass to find my way home. When winter came and snow blew into the mountains, burying the bones, I continued to spend my days and often my nights in the woods. I vaguely understood that I was doing this because I could no longer think; I found relief in walking up hills. When the night temperatures dropped below zero, I felt visited by necessity, a baseline purpose, and I walked for miles, my only objective to remain upright, keep moving, preserve warmth. When I was lost, I told myself stories, recounting my survival, implying that I would live and be able to look back at it all. At some point, I realized that I was telling my father these stories.

The above text covers the first one & one-half pages of this three page article. For the remainder, visit the archives of the New Yorker Magazine at www.newyorker.com/archive.


Sick With Worry
Jerome Groopman, The New Yorker- 8/11/2003

Amanda was sure that she had contracted leukemia, developed a brain tumor, and had a stroke--all around the same time. She made this self-diagnosis while experiencing intermittent discomfort in her abdomen and feeling a persistent wooziness in her head. She often felt off balance, as if she were walking on a warped floor. "I was also really worried about my spleen," she told me in a recent conversation. (Amanda is not her real name.) For almost a year, she had sought explanations for her various complaints, discussing her symptoms with twenty physicians in her H.M.O. All of them told her that they could find nothing wrong. These doctors spent little time with her, and none offered a follow-up appointment, although they readily referred her to other physicians.
    With growing frustration, Amanda visited more specialists, undergoing physical examinations, blood tests, and sonograms. Nothing abnormal was found, but with each test she became more convinced that she was seriously ill. She kept looking for a doctor who would tell her, unequivocally, that her symptoms could not possibly indicate a fatal sickness. When doctors couldn't give her absolute assurance, she concluded that something terrible must be wrong with her. I asked Amanda, a petite woman with a lightly freckled face, why she thought doctors kept referring her to others. She was perplexed by the question. "We live in a litigious society," she said. "Maybe they were afraid of lawsuits, if they missed something." She paused. "Maybe they were confused by what was wrong with me."
    Amanda, who is thirty-three years old and teaches theatre arts at a West Coast college, has suffered from medical anxieties many times before. Several years ago, she was in a travelling theatrical group for children, and played a role that required her to wear an elephant costume for more than a hundred days in a row. After a long day spent in rehearsal and onstage, she often felt exhausted and queasy. Most people would attribute these feelings to stress, but she was convinced that her symptoms indicated a dire disease; one day, during a prolonged episode of abdominal pain, she thought she might be dying and, in a panic, asked a colleague to take her to a local hospital. The doctors there failed to detect anything out of order. The next night, she went again, and once more the E.R. physicians sent her home.
    Amanda's fears about illness began when she was nine, after she heard that a schoolmate had almost died from a severe case of chicken pox. As a teenager, she was terrified each time she had to visit a doctor. "I remember when I was fourteen years old, and I was sitting in biology class and had a doctor's appointment later that day," she said. "I was so scared, I couldn't think." She entered college at the peak of the AIDS epidemic. Though she told me that she "wasn't strongly at risk for H.I.V. "--she had few sexual partners and regularly used protection--she became consumed by the idea that she was infected. "I really thought I had the virus," she said. Shortly after graduation, Amanda moved to New York City, where she got a job in a bookstore. "Each day, I checked reference books in the store, and called people about AIDS," she said. "It got so bad that my co-workers tried to keep me away from the health section."
    She finally decided to be tested for H.I.V. and, one day, stood for more than an hour in a long line at a New York public-health facility. Part of the free testing procedure involved undergoing a pelvic exam. "I was up in the stirrups," she recalled. "And this horrible doctor I didn't know said to me, `Oh, my God! There is something definitely wrong with your cervix.' " Her heart started to race, and she asked the physician whether her condition could be related to cancer. He replied that her cervix was inflamed, and that some women with H.I.V. had a similar condition. "I began to cry hysterically," Amanda said. "The doctor looked at me and said I should learn to relax--listen to music or something." Amanda ended up getting two tests for H.I.V. , in case one yielded a false result. Both were negative, and the inflammation was benign, but she was so traumatized that she didn't have another gynecological exam for three years.
    People like Amanda populate every doctor's waiting room. Studies show that at least a quarter of all patients report symptoms that appear to have no physical basis, and that one in ten continues to believe that he has a terminal disease even after the doctor has found him to be healthy. Experts say that between three and six per cent of patients seen by primary-care physicians suffer from hypochondria, the irrational fear of illness. The number is likely growing, thanks to increased medical reporting in the media, which devotes particular attention to scary new diseases like SARS, and to the Internet, which provides a wealth of clinical information (and misinformation) that can help turn a concerned patient into a neurotic one. Nevertheless, hypochondria is rarely discussed in the doctor's office. The "worried well," as sufferers are sometimes called, typically feel insulted by any suggestion that their symptoms have a psychological basis. Most patients are given a formal diagnosis of hypochondria only after ten or so years of seeing physicians, if they get such a diagnosis at all.
    Doctors often dislike their hypochondriac patients; they consume inordinate amounts of time, and strain hospital resources with their interminable complaints. In the United States, it is estimated, twenty billion dollars a year is spent on patients whose psychological distress requires repeated tests and procedures. Many doctors and nurses make fun of hypochondriacs, calling them "crocks" and "turkeys." The favored epithet among interns and residents is GOMER, which stands for Get Out of My Emergency Room. Many doctors are relieved when a hypochondriac leaves them for another physician.
    Perhaps unsurprisingly, research on the subject is sketchy. The most recent edition of the "Cecil Textbook of Medicine," a volume of more than two thousand pages that is one of the bibles of internal medicine, includes only two sentences on hypochondria: "Chronic preoccupation with the idea of having a serious disease. The preoccupation is usually poorly amenable to reassurance." The National Institutes of Health currently funds no studies on the topic.
    Among the few psychiatrists and primary-care physicians who are interested in the problem, there is little agreement about the reasons for the disorder and what to do about it. Only in recent decades has a working definition of hypochondria been formulated by the American Psychiatric Association: "The fear or belief of serious illness that persists six months or more despite physician reassurance." Conventional medical wisdom holds that hypochondria is a hopeless condition and should be treated by ignoring it, because a hypochondriac's recognition of his problem does not result in a change in his symptoms or in his behavior. Indeed, doctors like to joke that a hypochondriac's symptoms will disappear only when the patient lands on a desert island--and nobody is around to listen to his whining.
    The term "hypochondrium" can be found in the writings of Hippocrates. The word originally had an anatomical emphasis--indicating the area under (hypo) the cartilage of the ribs (chondros)--and referred to digestive disorders of the liver, spleen, and gallbladder. Starting in the seventeenth century, "hypochondria" was used to describe a melancholic disorder that was also marked by indigestion and vague pains. Leeches were the preferred mode of treatment. The diagnosis developed a certain cultural chic, particularly in eighteenth-century England, where it was called "hyp," and an anxious, gloomy temperament was considered a sign of high intelligence. Samuel Johnson and his biographer, James Boswell, both suffered from the malady. (In his "Life of Johnson," Boswell wrote of his friend, "All his labours, and all his enjoyments, were but temporary interruptions of its baleful influence.") Men were thought to be affected by hyp more than women, whose nervous behavior was typically interpreted as hysteria.
    It wasn't until the nineteenth century that hypochondria came to be narrowly defined as an excessive fear of illness. Not coincidentally, the disorder flowered at the same time that modern medicine began identifying one rare disease after another. In his novel "In Search of Lost Time," Proust wrote, "For each illness that doctors cure with medicine, they provoke ten in healthy people by inoculating them with the virus that is a thousand times more powerful than any microbe: the idea that one is ill."
    Modern psychologists have devoted surprisingly little attention to the disorder. Freud simply asserted that it was the result of libidinal energies being directed at one's own body, and declared that the disorder was not susceptible to "purely psychological inquiry." In later years, psychoanalysts offered a variety of explanations for hypochondria. Some saw the behavior as a general cry for help from the subconscious; others defined it as a targeted, if covert, expression of anger toward physicians.
    Hypochondria is so hazily understood that most doctors have no dear idea how to manage patients who suffer from it. The disorder is particularly tricky for the primary-care physician, who often sees patients with nebulous complaints and must judge how deeply to explore these ambiguous symptoms. The doctor knows that a fair number of people in his waiting room each day will prove to have no physical disorder--yet he must remain open to the possibility that each patient might truly be sick. Hypochondriacs, in effect, risk deafening a physician with their relentless background noise.
    I am a medical specialist who cares for patients with blood diseases, cancer, and AIDS. Several years ago, I was a consulting oncologist for a woman who had developed breast cancer. The tumor had been found early and was removed by surgery. I saw her only once or twice a year, but her internist had told me that she was a severe hypochondriac. At each visit, she unloaded a series of complaints, but almost always mentioned having a queasy feeling in her stomach. Her husband sometimes accompanied her to my office; once, when I asked her how long she had suffered from the stomach symptom, he interrupted and said, "Since I married her." The couple had been together for thirty years. I looked at him from the corner of my eye and we exchanged a dismissive look. Some weeks later, I was called by the patient's primary-care doctor, who told me that she had almost died from sepsis owing to an infected gallbladder. I was distraught that I had treated her complaints with such a cavalier attitude. Sometimes, even a hypochondriac's complaints are valid.
The above text covers the first two pages of this six page article. For the remainder, visit the archives of the New Yorker Magazine at www.newyorker.com/archive.


Untying the Knot
Melanie Thernstrom, New York Times Magazine- 8/24/2003

In most public accounts of divorce, there is no confusion as to why the couple is splitting up. The reasons are so sound -- the trails of manipulation, exploitation and betrayal so thick -- the only mystery is why the couple were together in the first place. Is it possible to imagine that Ronald loved Patricia or that Donald truly cared for Marla? What does love mean to someone who presents his bride with a prenuptial on the eve of their wedding, stipulating that she would get many millions of dollars for a marriage of four years, but only $1 million for less than that -- and then discards her on the deadline? And what does love mean to a woman who'd sign on that particular dotted line?
    In contemplating these questions, however, we neglect the more difficult ones. The truth is that most Americans do not marry for power, money and status. Nor do they marry out of social and economic necessity, as in an earlier era. They marry for love. Yet an enduring truth of our time is that marriage dissolves as often as it holds. So how is it that ordinary love ordinarily fails? If love is, as Wallace Stevens suggests, a dwelling ''in which being there together is enough,'' how does silence fall on a thousand evenings and the possibility of intimacy flicker and die? How do lovers become lonely?

Marriage: The Spaghetti
''It was a good story -- a story we liked to tell when we were together,'' Max says, in the slightly droll drawl he uses when speaking about his marriage now, as if irony will obscure his sentiment when its actual effect is more like chiaroscuro. Yet the story that Max tells of meeting Kate is simple. (Both of them asked to be identified only by childhood nicknames.) Fourteen years ago this fall, Kate showed up at an opening at the museum where Max was working. They seemed to have a lot in common; they were both 32, with graduate degrees in education and experience working in nonprofit agencies, although Kate was already on a corporate track. She was visiting from the Midwest; he invited her to lunch at an Italian restaurant near La Guardia, before her flight the next day. ''She had a slightly wicked sense of humor,'' Max says. ''She was from a rural town and had these appealing colloquialisms, such as 'cold as a witch's elbow.' '' He gropes for adjectives. ''She was energetic and enthusiastic, intelligent, athletic . . . beautiful. She surprised me. And as I got to know her, she continued to surprise me.''
    It's not hard to picture them together: everything each recalls liking about the other still seems true. In fact, if you met both of them today, you might think to introduce them. They are equally distinctly attractive, in differing genres: Kate looks a bit like Dorothy Hamill, with short, silky brown hair, fair skin, impatient blue eyes and a trim, compact build. Max looks like the man who ruins or rescues the heroine: dark, tall and lanky, with a languor about his body and voice. Kate remembers being drawn to his attentiveness and intensity. ''He had cool interests, jazz and wine and art and literature,'' Kate says. ''And he was very cute.'' She laughs, her voice lingering in the ''very'' in which she once fell in love.
    But the story she tells of their first date includes a layer absent from the one that Max tells. Like Max, she felt an urgency in their conversation -- a possibility of intercourse, in all senses of the word. But at the same time, there was a way in which she was already dropping out. When lunch was over, Max insisted she take the remainder of her spaghetti home. He must already have cared for her, he explains now; he had never done such a thing on a first date before. ''It was so him,'' she says, in the way that the fondest of phrases -- it's you, darling! I understand you! -- can metamorphose into the bitterest, as caring begins to be seen, through the lens of years, as controlling. ''I hate leftovers; I was hardly going to lug that damn spaghetti back to the Midwest. But I said, 'Fine,' and threw it out when I got to the airport. So there you have it, that's the whole thing -- the beginning and the end.'' It was the first of 11 years of things she said 'Fine' to while thinking something different.

Divorce: A Failed Conversation
In his radical address to Parliament in 1643, ''Doctrine and Discipline of Divorce,'' John Milton argued that ''in God's intention a meet and happy conversation is the chiefest and the noblest end of marriage,'' and that divorce is not only necessary but right when that special conversation fails. Does it follow, though, that divorce must maintain silence? Or is there a possibility of dialogue even in separation? Can two people come to a shared understanding of fractured love? And if so, is that valuable? What is the good of a good divorce?
    The questions have grown only more urgent: four centuries after Milton urged that divorce become a civil right, American matrimonial law is still punitive -- protracted, expensive, confusing, damaging. Yet divorce is now an ordinary -- perhaps even a likely -- outcome to marriage. Over the last two decades, the proportion of failed marriages had held stable at around 50 percent, but (while national data lags) some experts suggest that the rate may be tipping over half.
    Historically, periods of economic hardship tend to keep couples together; the current economic downturn, however, appears not to have had that effect. A survey by the American Academy of Matrimonial Lawyers found that 78 percent of divorce attorneys say that their caseloads are steady or increasing. Several studies, according to The Wall Street Journal and others, show that divorce filings have increased in many areas and, moreover, that there is an increase in the number of contentious divorces.
    Kate and Max vehemently disagreed on the terms of their separation. But they avoided the quagmire of litigation through an increasingly popular alternative to handling disputed divorce: mediation. Although mediation began in the 1970's, it is now beginning to reach critical mass. In California, Maine and other states, mediation is mandated in custody disputes in divorces, and other states are considering similar legislation. Oklahoma, which has one of the highest divorce rates in the country, has recently instituted a program that refers couples to free or low-cost mediation. If the trend continues, someday soon people may look at litigation as a last resort only for unusually contentious divorces (cases in which one partner is abusive or absent), rather than the norm.
    Jack Himmelstein, co-founder and co-director of the Center for Mediation in Law, which trains mediators, says that the trend is spurred by the grown children of baby boomers who were victims of their parents' 80's ''Kramer vs. Kramer''-style divorces, and who want their own divorces to be less damaging. And there is a growing interest in a concept that has newly made its way into our culture, ''the good divorce'' -- a phrase that once would have sounded not only oxymoronic but also unseemly -- something that implies permission instead of punishment, like ''happy hooker.''
    Litigated divorce inherently fosters enmity. In litigation, ''meet conversation'' immediately ceases: the first rule a lawyer conveys to the client is literally to not talk to his or her spouse -- lest self-scrutiny prove contrary to self-interest. Refusing to join the modern ''no fault'' trend, New York continues to require one of three extreme grounds for divorce: cruelty, adultery or abandonment. (Milton advocated that the 17th Puritan Parliament liberalize grounds to include incompatibility.) Individuals in contested divorces have to pay lawyers to establish grounds by creating false narratives about their spouses. Thus insensitivity becomes cruelty, a busy father turns into a negligent one and so forth. By the time litigation is completed, the anger -- if not the accusations -- becomes reality.
    Mediation, by contrast, ''relieves couples of the need to demonize each other,'' says Barry Berkman, a matrimonial attorney and mediator who drafted the final agreement with Kate and Max at the end of their mediation. Couples employing mediation have been shown to be significantly happier with both the process and the results than couples using litigation. As an article in St. John's Law Review noted, one study found that 73 percent of those in mediation were satisfied or highly satisfied. Trials yield little satisfaction, and even attorney-negotiated settlements were satisfactory to only 23 percent of divorcees. Himmelstein, who acted as the mediator for Kate and Max, says, ''In mediation, you have the opportunity to tailor the law to your own needs.'' Kate and Max ''wanted to create a separation that reflected the relationship they had.''
    The only problem was that Max and Kate had profoundly different notions about what that relationship had been. Like most divorcing couples, they found themselves disputing not so much their desires for separate futures as their beliefs about their common past: the nature of the marriage they shared -- or thought they shared.

Marriage: A Dangerous Intimacy
How do we describe the arc of a failed marriage? In one model, a period of happiness would turn into unhappiness, as if the marriage were a plant that bloomed and then withered. There might be identifiable adversities -- weather, soil, pestilence - and turning points, or at least a progression, as in a snowfall. The accumulation of moments might be too numerous for each to be observed, but the trend would be clear: you look once and see a light dusting, and the next time you look, it's an impossible snowdrift.
    Another model of a failed marriage holds that the crucial elements are written into the marriage contract from the beginning, and like genes, express themselves over time. Those elements -- the strengths of the bond -- might even prove to be the weaknesses, the way a certain kind of intimacy, for example, might protect against loneliness while weakening autonomy, the way a gene that protects against malaria also causes sickle-cell anemia.
    In the 11 years they were together, the dynamic between Kate and Max changed very little. But in the early years, the dynamic worked. Soon after that first lunch, their lives began to merge. Kate relocated to New York, and they moved to an apartment on the Upper West Side. When Max describes the joy of their relationship, he stresses their easy unity: the interests they cultivated together -- the pleasure of finding a partner. For Kate, the joy was one of transformation, as Max's world opened up to her. She had grown up in a rural town, the eldest daughter of a construction worker and a housewife in a Protestant household where money was tight, whereas Max was the doted-upon child of cultured, Jewish intellectual New Yorkers who reared their children in Westchester. Kate began to learn about bird-watching, baseball, wine and theater. They baked bread, went camping and tried to practice tsedakah -- acts of loving kindness -- by boxing lunches for homeless people in their neighborhood. They got involved in a local temple, and five years after they met, when they were both 36, Kate converted to Judaism, and they decided to marry. They went to a jeweler on 47th Street and picked out a ring with a modest row of small diamonds. Then they went for lunch to a Chinese restaurant where Max, teasingly, proposed. They each recall having paid for the ring. ''I told myself it didn't matter who paid for it,'' Kate says. After all, from the beginning Kate made more money, working in finance at a large corporation, than Max did at a nonprofit organization -- a gap that would grow.
    Their intimacy was sufficiently consuming that neither of them bothered to develop other friendships. Kate loved spending all her free time with Max. But while she was genuinely engaged by their joint hobbies, she secretly suspected her level of interest was slightly inferior to his. She'd find herself gamely tramping along on daylong bird-watching expeditions, when she'd rather have kept it to a morning and gone out to lunch, or she'd observe the Sabbath when she would have preferred to watch birds. And she never quite forgot that each of their shared interests had originally been Max's idea. When I ask Max, he exclaims, wounded: ''I can't believe she's trying to put these things on me. I wasn't into Judaism before her. These were things we discovered together.''
    A few years into their marriage, Kate had brief flirtations with hobbies of her own invention -- singing and horseback riding -- but they never really took. Kate had one close girlfriend, and sometimes in the summer, she'd take the train to see her on Fire Island, play tennis and come back late. ''He hated that -- he'd always be in a bad mood when I got back,'' she says. ''I guess I wasn't entirely sure I had the right to want that,'' Kate adds. ''I feel like it was very important to him that we have the same interests and do everything together.'' Max now acknowledges, ''Perhaps I was a bit threatened by it.''
    While Max found his job satisfying, it had fewer demands than Kate's did. She worked long hours, concentrating so fiercely she'd sometimes not eat or go to the bathroom. Max would pack a lunch for her or thrust an apple into her hand as she walked out the door, and then call her at work and urge her to take a break. He wanted to take care of her while she was away from him, and he wanted her to take care of herself, and those two things seemed indistinguishable to him. ''Good lord, the idea of deciding what you're going to eat in the morning is so unappealing,'' Kate says. ''Perhaps he didn't go to school every day for 12 years and take the same boiled-ham sandwich on white bread, but I did. You want caretaking, but you want it in the way that's meaningful to you -- which, for me, is not in a brown paper bag.'' Max does recall Kate mentioning she didn't want the food. ''I heard it at one level,'' he says slowly. ''But I didn't really hear it -- you know?''
    The only aspect of their home life that wasn't communal was finances. Kate insisted they keep their earnings separate and divide their bills proportional to their salaries -- a formula that shifted with Kate's raises. Each year when Max's parents gave them each a tax-deductible gift toward a down-payment on an apartment, Kate put hers in a separate account. The arrangements struck Max as a bit odd, but he tried not to think too hard about it. After all, he knew Kate was compulsively organized, and he reasoned, since they were spending their lives together, all her money was really theirs. If Kate preferred to have her name on an account, what did it really cost him?

Divorce: Balance of Power
It makes no sense to say that a good marriage requires parity, as most marriages in the world and throughout history have been based on entirely different principles. You might even conclude from America's unusually high divorce rate that the expectation of equality and personal fulfillment is itself a more problematic prescription than that of honor and obedience.
    Or perhaps the problem lies not in equality, but in the ambivalence that inevitably surrounds a titanic cultural shift only decades old. Many women today still sign up for marriages in which the man, to some extent, dominates. Traditionally those marriages have ended when the stronger party tires of the dependent. When Harriet Newman Cohen began practicing matrimonial law three decades ago, her clients were mostly women whose breadwinners had walked. But she and others have observed that today, it is as often the weaker party who calls it quits, tired of a role that is no longer culturally sanctioned. And, once equitable distribution laws -- which forced the higher-earning spouse to share the wealth equitably -- were passed in the 80's, there was no longer any financial penalty for divorce.

The above text covers the first one & one-half pages of this three page article. For the remainder, visit the archives of the New York Times at www.nytimes.com.