A marriage strained by illness and caregiving
Writing as "Self-imprisoned," the husband says his wife has treatment-resistant depression and/or bipolar disorder and has tried various treatments over 30 years without success. Mental health professionals and close friends have advised him to leave, saying the relationship is harming his mental health.
His reasons for staying include his marriage vow, his wife's dependence on him and his belief that leaving would devastate her. He says he still feels compassion, but no longer love or respect. He agrees with counselors who describe the couple as codependent and tell him that refusing to abandon his wife amounts to abandoning himself. He also fears starting over at 75, with friends but no family to rely on.
Thomas acknowledges both spouses' suffering and suggests that illness and caregiving may have changed the nature of their partnership. Rather than simply endorsing the advice to leave, he asks whether those offering it have helped the husband consider where he would live and how a separation would work.
The health issues described in the letter have broader clinical context, though they do not establish an individual diagnosis. In guidance medically reviewed and updated May 16, 2023, the Cleveland Clinic defines treatment-resistant depression as major depressive disorder that has not improved after at least two different first-line antidepressants, each taken at an adequate dose for at least six to eight weeks. The clinic estimates that it affects approximately 30% of people with major depressive disorder who have tried medication.
Research also documents mental health differences among spouses. A 2010 population-based study of 9,740 Norwegian couples, published in BMC Public Health using the Nord-Trøndelag Health Study, found more anxiety and depression symptoms and lower subjective well-being among spouses of people with a mental disorder than among spouses of people without one. The differences were moderate, roughly one-third to one-half of a standard deviation. The authors cautioned that their findings do not mean most spouses in this situation have a clinical disorder.
Planning a change, not just an exit
Thomas says couples can recognize that their current arrangement is not working and develop a different one that accounts for both partners. He recommends Melody Beattie's book "Codependent No More" and a marriage and family therapist experienced in helping codependent couples. His central advice is that the husband should not navigate this alone; his wife's dependence does not make him solely responsible for deciding the marriage's future.
The letter concerns a possible separation, not a decision already made. Research on later-life divorce provides context for the husband's concerns about starting over. In an analysis of federal data published October 16, 2025, Pew Research Center reported 10.3 divorces per 1,000 married women ages 50 and older in 2023. The comparable rates were 3.9 in 1990 and 11.0 in 2008. Divorce rates among adults ages 15 to 49 fell over the same period. Pew also found that marriages lasting at least 25 years accounted for 22% of divorces in 2023.
Financial losses can be substantial. An October 1, 2024, Vox report, citing Bowling Green State University sociologist Susan Brown, said older women who divorce experience a 45% drop in household income, compared with 21% for men. Both men and women lose about half their wealth and do not recover that loss, according to the report.
Vox's reporting, citing Brown and Rutgers professor Jocelyn Elise Crowley, also described a longer adjustment period for older divorcees: up to four years for people over 50, compared with one to two years for younger people. Gray divorce is associated with increased depressive symptoms lasting about four years. The report said men tend to bear the social costs because mutual friends and adult children often side with women.
When finding a therapist becomes a costly search
The column's second correspondent, "Seeking help," questions how readily readers can act on recommendations to get therapy. The writer says online profiles provide limited information about a therapist's education, approximate age and specialties, leaving prospective clients to pay $175 to $300 for an hour with someone they may not connect with.
The reader describes two disappointing appointments. One therapist offered to pray for the writer, who is an atheist. Another spent the session praising the writer's life and personality. Asked how she could help, that therapist asked what the writer wanted. The reader explained that, without prior experience in therapy, they did not know what kinds of help were available. The therapist then requested a credit card number and another appointment.
The reader's question is how to find a suitable therapist without spending thousands of dollars trying different practitioners. Broader cost estimates illustrate the expense, although they differ from the prices the reader encountered. Therapy provider SonderMind puts the national average out-of-pocket price for an individual session at about $140, with a typical range of $100 to $250. It says couples sessions frequently cost $150 to $350 or more. Weekly appointments at those rates can add up to $400 to more than $1,000 a month.
Questions to ask before booking a session
Thomas says the reader's experiences do not reflect how therapy intake should work. He emphasizes professional training and trust, while acknowledging how difficult it can be to establish that trust with a stranger. That difficulty is why he tries to offer options in addition to therapy, which he says can nevertheless be effective and fulfilling.
He recommends using a directory such as Psychology Today to review therapists and filter results by specialty, demographics and insurance. Many therapists offer a free 15-minute intake call, he notes. Prospective clients can use that conversation to ask about a therapist's working style and how they would approach the problem prompting the search.
Thomas also encourages readers to ask for explanations of unfamiliar treatment approaches, including Cognitive Behavioral Therapy, rather than assume they should already understand them. He suggests taking notes and researching further afterward, using well-sourced websites or a library rather than AI.
