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THE SECRET OF INTIMACY: PERMISSION TO BE COMPLETE PERSONS

Getting married does not mean you will stop growing. This fact seems to escape many spouses. In taking the scary step of falling in love and creating a marriage, we all tend to lock in perspectives on each other. We assign and assume roles in the relationship that allow us to fit together comfortably. We eventually outgrow, or grow tired of, these roles. Then the marriage faces the stress of having to reorganize in reaction to our individual changes. Let me elaborate.
In joining together, we tend to see what we need to see in our partner and be what we need to be in order to create harmony in the partnership. In so doing, each of us is creating and participating in a relationship that excludes some important parts of our total self. For example, a strong woman may put aside her own need to be nurtured so that she can fulfill the role of caretaker in the marriage. At the same time, her compliant husband may put aside his own capacity for independent functioning to fit with this partner who has a need to take care of others. He assumes a dependent role in reaction to her assuming a caretaker role.
As life progresses, we all experience an increasing psychological need to express all aspects of our total sense of self. Anxiety-generating events such as illness tend to heighten this need. Particularly as we are faced with aging and its effect on our health, we feel compelled to incorporate into our marriage those aspects of self that we originally put on the shelf when we connected with this particular mate. This means that as we progress in marriage, we experience increasing need to change, both individually and in how we relate to each other. The meek become more outspoken. The angry become more gentle. The fearful become more brave. The seemingly fearless become more aware of insecurities. The compliant become more aware of their own needs.
These changes are first expressed in marriage because marriage is supposed to be the safest place to be psychologically vulnerable and free. Unfortunately, as we have seen throughout this book, any change on the part of one person in a relationship can cause anxiety throughout the relationship. In reaction to such stress, many spouses fail to nurture each other as they grapple with the marital changes that are forced by such individual growth. Nurturing understanding and encouraging such psychological change are hallmarks of an intimate marriage. Healthy partners do not resent each other's growth, even though growth on the part of one partner has real consequences for both. Unhealthy partners, on the other hand, act as though they are being double-crossed if their partners change in any way. They act as though they had established an ironclad contract to remain the people they were when they married, and they fight any change in this contract.
Unhealthy attempts to prevent a spouse's growth can take many forms. In response to his wife's complaints and concerns about his regular weekend golf tournaments, one man moaned, "I feel double-crossed that she's changed so drastically. She knew I golfed when we got married, and it seemed acceptable to her then. So why not now?" For other couples the intimacy-eroding response may be to tease, make light of, or refuse to participate in some new and important aspect of a mate's life. Leo and Betty provide an example of this mistake.
Betty was an athletic fifty-seven-year-old who had recently returned to part-time pursuit of her college degree. She had also become much more health conscious since the recent death of her father from a stroke. Accordingly, she joined an aerobic dance class, began cooking healthier meals, and significantly tapered her use of alcohol. Her husband, Leo, however, was a beer-drinking television addict who hated exercise. He constantly complained to Betty about "wasting time acting like some kind of yuppie with all this school and healthiness business." He refused Betty's repeated invitations to join her in exercising or in attending special lectures on topics being covered in her classes.
These two originally came to me for help with their failing sexual relationship. That Betty and Leo were experiencing intimacy difficulties was certainly no surprise. They simply had failed to grow together because of Leo's refusal to participate graciously in Betty's becoming a more complete person. When such emotional stinginess occurs in a relationship, imbalance always follows, and intimacy is compromised.
To grow as a couple, you must keep up with each other's growth. You must make it your business to remain interested in who your partner is becoming and to learn to relate to this new version of your mate. Doing so can lead to continued excitement and intimacy in your marriage.
As important as it is to nurture such growth in each other, it is also important to remember that change always starts from within yourself. No matter how encouraging and nurturing your spouse is about your right to be a complete person, you must give yourself permission to be a complete person if you are to grow. Yes, you chose and agreed to fulfill a certain role during a certain chapter of your marriage or of your individual life, but you are not locked into that role for the remainder of your existence—unless you fail to give yourself permission to change. Intimate couples are made of healthy individuals who grant themselves and each other permission to continue growing throughout all the years of their life.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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