Making meaning by sacrifice – self and relationship commitment in Finnish spouses and partners of people with mental illness

ABSTRACT

A person’s mental illness burdens their spouse or partner in multiple ways and significantly increases the risk that the couple will divorce. However, scant research exists about the impact of the illness on spouses’ experience of self and relationship commitment. The author investigates how 16 Finnish, heterosexual spouses and partners of people with mental illness make meaning out of their self and commitment, including the role of religion in this meaning making. The data was gathered through narrative, semi-structured interviews and analysed with a narrative approach. For these spouses and partners, sacrifice was central to meaning making. They drew on religion in marital sanctification, justification and coping. The results show the importance of mental health care in supporting the spouses' separateness from the relationship or as an avenue of expressing their commitment. This finding highlights the need to invest in couple-centred approaches to mental health care.

KEYWORDS:

• Spouses and partners of people with mental illness
• meaning making
• self
• relationship commitment
• marital sanctification
• religion

Introduction

Mental illnesses cause a significant burden worldwide (GBD, 2017). For the relatives of people with mental illness, the burden of care has been increased by deinstitutionalization (Stengård, 2005). Following COVID-19, mental health services have been further disrupted (WHO, 2020). For spouses of people with mental illness, the burden of care is significant as they usually live with the spouse experiencing the illness (Lam et al., 2005). In romantic relationships, mental illness impacts negatively on communication, sexuality and parenthood, and the risk of relationship dissolution is greatly increased (Lam et al., 2005; Metsä-Simola, 2018; Mojtabai et al., 2017). The wellbeing and health of the spouse or partner¹ of a person with mental illness is at risk too (Dore & Romans, 2001; Granek et al., 2016; Joutsenniemi et al., 2011; Lam et al., 2005; Van et al., 2009). However, wellbeing and health may also be reduced by divorce or separation (Hewitt et al., 2012; Metsä-Simola, 2018). Research is scant about why some persist in a relationship affected by mental illness, or how spouses of people with mental illness relate self and commitment. Traditional caregiving research has emphasized the experience of burden, but a few studies suggest that some may experience mental illness as having a positive impact on self and commitment (Granek et al., 2016; Lawn & McMahon, 2014; Ojalammi, 2019a; Ojalammi, 2019b). Religiousness is connected to higher levels of commitment but research about crisis contexts is scarce (Mahoney, 2010). Greater knowledge about how the spouses of people with mental illness express self, commitment and religion could help mental health services to provide more focused support. I investigate the narratives of the spouses and partners of people with mental illness with two research questions. First, how do the narrators make meaning out of self and relationship commitment? Second, how is religion employed in the meaning making?

Societal and cultural factors impact on romantic relationships (Prince Cooke & Baxter, 2010; Tsui-oTai & Hewitt, 2014). Western culture is supportive of leaving an unhappy relationship (Amato et al., 2009). This study was conducted in Finland where 64% of families are marriage based (Official Statistics of Finland, 2019). Compared to cohabitees, married couples tend to be more committed, also in countries like Finland, where cohabitation is common and socially accepted (see Tsui-oTaio Tai, Baxter, & Hewitt, 2014; Wiik et al., 2009). However, nearly half of marriages in Finland end in divorce (see Kiiski, 2011; Statistics Finland, 2020) and mental illness increases this risk (Metsä-Simola, 2018). Finns view divorcing a spouse with mental illness as socially acceptable (Paajanen, 2007). The majority of disability pensions are granted to people with mental disorders (Findicator, 2019). It is estimated that 20–25% of Finnish adults suffer from mental health problems (Reini, 2016).

Nearly 69% of Finns belong to the Evangelical Lutheran Church of Finland (ELCF, 2020). Church attendance is low and religion is considered a private issue (Ketola, 2011). In the public debate concerning marriage and family issues, the church still has significance, not least due to its right to officiate at weddings; the church is currently debating whether it will do this for same-sex couples (see Vähäkangas, 2019).

The process of making meaning is embedded in an individual's physical, emotional and social contexts: it is how a person makes sense of things. The process does not necessarily result in a product, called a ‘meaning made’ (Park, 2010, p. 285), which is a difficult concept to define. Meaning, more generally, refers to coherence between a set of relations, comprehensibility, significance/worth and purpose (see Baumeister, 1991; Lloyd, 2018; Martela & Steger, 2016; Park, 2010). Meaning making often becomes more vital, explicit and linked to coping when a person's orienting system is disrupted (Dezutter & Corveleyn, 2013; Lloyd, 2018; Pargament, 1997; Park, 2010). The orienting system includes fundamental beliefs, feelings, habits and ideals in relation to the self, others and/or the (transcendent) world (Pargament, 1997; Park, 2010).

Religion may be included in meaning making (Dezutter & Corveleyn, 2013; Park, 2005). Religion is defined as religious belief systems, traditions, practices and/or institutions. Within this more communal framework, religion includes a personal ‘search for significance in ways related to the sacred’ (Pargament, 1997, p. 32; see also Yeung & Chan, 2016). Sacred qualities may be projected onto a marital relationship: this is called marital sanctification (Mahoney et al., 2003; Pargament & Mahoney, 2005). For example, God may be viewed as a third partner in the relationship (Lambert & Dollahite, 2008). Sanctification may also refer to ‘ultimate value and purpose’ (Pargament & Mahoney, 2005, p. 185) without religion but, in this study, sanctification is viewed within the sphere of religion. Projecting sacred qualities onto a marriage improves conflict resolution, satisfaction, willingness to sacrifice and commitment (Davis et al., 2018; Demaris et al., 2010; Mahoney, 2010; Mahoney et al., 1999; Mahoney et al., 2003; Rusu et al., 2015).

As presented above, self is part of our orienting system and through meaning making, changes in sense of self have been reported (Pargament, 1997; Park, 2010). Self is approached here from a relational perspective (Cooper-White, 2011; Hermans et al., 1992; Kögler, 2012). Approaches to the relational self are characterized by postmodern views of the self as processual, multiple and socially constructed. An individual's experience of self integration is crucial. Integration may be based on the individual's ethical practices, narratives or relationships to significant others (Cooper-White, 2011). Relationality is supported by identity development, which is affected by early childhood relationships and personal commitments (Fivush & Zaman, 2015; Mannerström et al., 2017). Critics argue that the relational self approach ignores the role of personal commitments (Ellis & Stam, 2010). Empirical studies emphasize the connection between sense of self, a romantic relationship and commitment (Agnew et al., 1998; Mcintyre et al., 2015; Soulsby & Bennett, 2017).

Relationship commitment is linked to our orientating system about the other (e.g. Ojalammi, 2019b) and is a key element in maintaining a romantic relationship, but there is no consensus on its definition. The central aspect is intention or desire to persist in the relationship (Adams & Jones, 1997; Rhoades et al., 2010; Schoebi et al., 2012). Commitment involves dedication to and care for the spouse and relationship (May, 1969, pp. 287–306; Stanley & Markman, 1992). Commitment is dynamic: in different circumstances, people's reasons to stay committed may vary (Adams & Jones, 1997). When faced with relationship difficulties, spouses may become more aware of the reasons behind their commitment (Adams & Jones, 1997; Agnew et al., 1998; Amato et al., 2009; Rusbult et al., 2006; Schoebi et al., 2012). Many researchers have investigated why people stay in unhappy relationships. According to the investment model (Rusbult, 1980), an individual's commitment to (and dependency on) the relationship increases with their investments in it. Investments may be multiple, and include emotional factors (Johnson et al., 1999; Rusbult, 1980). Constraining elements may be moral or religious (Johnson et al., 1999; Mahoney, 2010). Cultural factors and gender issues are also important in commitment (Byrd, 2009; Hewitt, 2009).

Commitment is closely connected to sacrificing (Schoebi et al., 2012). Sacrifice means to ‘forego immediate self-interest’ (Schoebi et al., 2012, p. 246) or ‘an act of giving up something valued for the sake of something else regarded as more important or worthy’ (Stevenson & Stevenson, 2010). Another meaning of the word is to ‘make sacred’ (Bahr & Bahr, 2001, p. 1240). Sacrifices are part of a long-term relationship and help make it work. Sacrifices can be minor or significant and experienced positively or negatively (Ruppel & Curran, 2012; Van Lange et al., 1997). However, they are not always beneficial: it is important whether the sacrifice is reciprocated (Ruppel & Curran, 2012).

Materials and methods

Narrative method

In qualitative research, narratives have been considered especially suited for meaning making about self and personal commitments (Bamberg, 2012; Ellis & Stam, 2010). In lived experience, meaning is usually made over time (Park, 2010). The research value of a narrative is not based on accurate accounts of the past but the (co-)construction of meaning (Bamberg, 2012). For epistemological reasons, I consider the terms of ‘sense of self/commitment’ more accurate in a research context.

Participants

My research plan was approved and supervised by the University of Helsinki and Faculty of Theology, in line with research ethics guidelines in Finland (see TENK, 2019). The research advertisement, published in 2015, explained the study topics: view of life and relationship commitment. It stated that the study is conducted in the Faculty of Theology, increasing the probability that Christians would participate, but the call was for participants with both religious and non-religious views of life. Both cohabitees and married participants were called for: at the time, same-sex marriages were not legal in Finland but the term ‘cohabiting partner’ was used, which did not exclude same-sex couples. Participants were also required to be between 20 and 65 years old.

I recruited one participant through my social network, and 15 participants through the Finnish Central Association of Families of People with Mental Illness (FinFami). One participant withdrew from the study and later rejoined. Two were excluded as they did not confirm verbally that their spouses had psychiatric diagnoses. One more participant was not interviewed as we could not schedule a time to meet.

Of the participants, 12 were women and 4, men. They were born between the late 1940s and the early 1990s, their average age being 47. The majority were married; two cohabited and one of the married participants was separated. All married participants were in their first marriages. The average length of all relationships was 18 years, ranging from less than 1 to over 40 years. Most of the participants had children. Of them, four had children under 18 and two were expecting a baby. Most participants had the educational level of a bachelor's or higher academic degree. The majority belonged to the Evangelical Lutheran Church of Finland. Three participants belonged to other churches – a Pentecostal congregation, a Free Church and the Orthodox Church – and one of these had dual membership with the Lutheran church. Two participants were not members of any religious community (see Ministry of Education and Culture, n.d.; Official Statistics of Finland, 2015).

The spouses of 11 participants had bipolar disorder and four had depression. Only one participant's spouse had a combination of other psychiatric diagnoses. Additional diagnoses included personality disorders, anxiety disorders and alcoholism. The mental health information was received from the participants.

Interviews

Written informed consent was obtained from all the participants. I conducted the semi-structured, narrative interviews in Finnish, mainly in seminar rooms at the university or the participants’ homes, with an average length of 1.5 h. My aim in the interviews was to enable and co-construct connections between the narrators’ relationship stories and the themes of self, significant others, relationship commitment and existential issues. I supported the storytelling and rapport building with a visual elicitation method, asking the interviewees to draw a timeline of their relationship. In five interviews, the timeline was left aside or not used at all, mostly because the interviewees did not want to. Timelining is a method that should be used flexibly (Sheridan et al., 2011). I did not analyse the timeline products, but listening to the stories and encouraging reflection about the events drawn with related thoughts, feelings and meanings allowed me to ask story-specific questions, in connection to the research task.

I predefined topics and used these flexibly, adapting them to each individual narrative and the trust attained in the interview situation. One interviewee sent me some of his own writings, making me aware of possible topics in advance. Questions were only asked about God if the interviewees introduced the topic. The predefined questions focused on these key areas: how the illness impacted on daily life and the relationship; the interviewees’ views of life and/or God; sense of self, especially in their spousal role and (religious) coping. Concerning commitment, I asked the interviewees' thoughts and plans about leaving the relationship and why they had stayed in times of crisis. Sensitively and based on what they had already told me, I asked interviewees about sexuality and whether they would enter the relationship again. At the end, I guided the conversation toward more positive aspects and asked whether the interviewees wanted to share something not yet discussed.

The decision for a flexible interview method was based on the understanding that meaning is made in diverse ways and on ethics due to the sensitivity of the topic. This may threaten the data coherence (Schwartz-Shea & Yanow, 2006). To enhance the coherence, I guided the interview to focus on the spouse's mental illness, the main topics and wrote a reflective field diary after each interview.

Analysis

I employed data-driven, narrative holistic-content analysis (Lieblich, 1998). I started with listening to the interview tapes and writing notes, then transcribed the material myself. I thoroughly reflected on my own impact on the data: I recorded my opening topics and evaluated their suitability in context (see Holloway & Todres, 2003). After repeatedly reading the transcriptions, I focused on the interviews one by one, gradually moving to more detailed analysis. As suggested by Lieblich (1998), I put the ‘global impression of the case into writing’ (p. 2). Aiming to analyse the meaning making in context, I wrote down central episodes and events, and their relationship to the whole narrative. Then I chose key themes from the narrative, based on the research task, space devoted, repetition, conflict and/or intensity. I used different colours to mark themes and the overlap between them, divided some themes into two or more and renamed them. For each theme, I noted ambivalences, conflicts, contradicting details and/or omissions. Some interview themes were less event-based, more argumentative, co-constructive, and covered the whole interview (see Mathieson & Barrie, 1998). I created a file for each theme with the most important information and quotes. I wrote the detailed results for each interview and then visualized these using a mind map technique.

Three interviewees sent me supplementary material after their interviews: a text message and two e-mails, including one story about the interviewee's marriage. For the story, I applied data-driven content analysis (Elo & Kyngäs, 2008), but this did not yield significantly new perspectives on the participant's interview data.

Results

The spouses of people with mental illness made meaning out of self and commitment by reflecting on sacrifice. Some narrators included religion in their meaning making. My focus here is on the experiences represented as significant for the self and commitment at the time of the interview. This section is divided into three different approaches to self, commitment and sacrificing. The division should not be considered clear-cut. Although the representation is thematic, the results reflect other factors, especially the narrators’ ages and relationship duration. Narrator names have been changed and ages approximately rounded off to preserve anonymity. I translated the quotes from Finnish with the support of an English language professional.² In the quotes, I have used capitalization to indicate words that the speaker stressed.

Self and commitment in coherence – purposeful or rewarding sacrifice

Experiencing coherence between self and commitment was connected to viewing sacrifice as purposeful or rewarding. This was characteristic of the younger spouses and/or relationships. Although sacrifices were not without loss, they were not in vain. Religion was employed in supporting and justifying the sacrificing.

The narrative of the youngest interviewee, Hannah, 25, was characterized by a struggle with her sense of self. Hannah's (cohabiting) partner had been diagnosed with a mental illness recently, and she emphasized her continuing awareness of the diagnosis. She tried to make sense of the boundaries between the mental illness, the relationship and her sense of self:

[His mental illness] is like a third wheel in our relationship … It's not always even possible to separate what's because of US and what's because of [the mental illness] […] The separation has to be made that there's US, but also, he and I […] It felt like it [apparently the mental illness] PULLS the problems very strongly into the entanglement of US.

Here, Hannah describes the experience of the couple's selves ‘merging’ and reflects on her partner's mental illness as part of the experience. Hannah represented this as having both positive and negative consequences for communication in the relationship:

This has forced us to be very open and discuss openly about difficult issues […] Sometimes we overanalyse everything. […] I’ve had to learn things, to change, one should never change oneself, but I’ve had to change myself […] But, as long there's more plusses, what you get from the relationship, than minuses, it's worth it and I count them in my head all the time.

Hannah felt that her partner's mental illness made the couple's communication more open but also more difficult because of misinterpretations. This made Hannah feel pressured to sacrifice parts of who she was, herself. Although she viewed these sacrifices as losses, she justified them by the rewards received from the relationship.

Paul, 30, employed religion in his narrative to project the sacred onto his marriage. He referred to the biblical metaphor of the ‘cord of the three strands’, with God as the third partner in the relationship. For him, mutual commitment was also religious: ‘There's a shared calling [for us] […] we get to build the kingdom [of God] together’. However, being so closely involved with a spouse experiencing mental illness was not without major sacrifice. As Paul put it:

I feel, partly, I’ve had to ‘die’ because of the other's illness as the disappointments have been so enormous. […] However, rather than “dying”, at the end, I see us as having built very solid ground … I believe it's going to help in future. […] It's been a school of character.

Paul used metaphors reflective of the Christian theological ideal of sacrificing the self for higher purposes. He believed that his sacrifices ultimately strengthened his sense of self and mutual commitment.

Sandra, 30, had married young. She employed religion in projecting the sacred onto her marriage, for example describing a prophecy that had supported their intention to marry. Sharing similar Christian values with her husband was crucial for her and she described traditional gender roles as a value connecting the couple. Hers was the interview in which gender roles were a central theme. The traditional idealization of women's self-sacrifice supported the coherence between Sandra's sense of self and commitment:

I’m the kind of a person who largely conforms to other people's ways. I don't have a very strong ambition, vision or goal for my own life. […] As my childhood and youth were very serene […] there's a strong willingness and commitment to my spouse. I feel maybe I’ve been spared in my life earlier to be able to cope at this point in life and carry all these issues.

Here, Sandra connects her strong commitment and willingness to sacrifice to her childhood and past. Below, I represent another woman's narrative where childhood and sacrificing tendencies were connected in a negative sense. In Sandra's view, sacrificing was part of her sense of purpose in life. This was supported by her adherence to traditional gender roles. However, her husband's mental illness challenged these roles as he was now unable to fulfil the traditional masculine role of family breadwinner. As a result, Sandra had had to start working which made her feel that her self was disintegrating:

At that point [when Sandra started to work], the responsibility for taking and picking up the children from daycare fell on his [her husband's] shoulders. […] It has been a struggle for me to […] suddenly be the family provider, the working mother … it was emotionally challenging and a huge crisis for me. […] But when I got to work, I noticed it's good to get away from home and realize there's more to me, I can do more than just pamper and wipe bums. […] [However] when I go to work, away from home, I maybe distance myself too much from how [her husband] is coping […] and suddenly, we’re in the situation when I realize he's exhausted.

Sandra experienced giving up the housewife role as a crisis and felt some guilt for her husband's increased childcare duties. Simultaneously, she discovered a sense of self as separate from her roles of wife and mother, which supported her separateness and coping.

Making meaning out of self and commitment was connected to viewing sacrifice as purposeful or rewarding. For Paul and Sandra, religion supported this approach. Other interviewees employed religion to question the purpose of sacrifice.

Incoherence between self and commitment – questioning the value of sacrifice

Becoming overburdened, or expecting to, led to an experience of incoherence between self and commitment. This was connected to questioning whether sacrificing in the relationship was purposeful, rewarding and more valuable than self. In this process, interviewees needed support for their sense of self as separate from the relationship. Some considered leaving and seemed to get stuck in reflecting about whether to leave their spouse. It is important to note that in some relationships, there was emotional and physical abuse.

Helen, 40, was pregnant and her husband had recently had a mental illness episode. As the relationship was still young, this episode was the first for Helen, although she had known about her husband's illness. His illness behaviour had recalled Helen's difficult childhood experiences in her family:

I feel this is a learning journey for myself as because of my childhood background, I’m very sensitive to please others and sacrificing my own wellbeing for the good of the other person, I put myself aside, I don't matter. […] Now I’ve woken up to [see] that I MYSELF MUST defend myself, take care of myself and my own boundaries. […] It is my lifeline. […] Otherwise, I won't survive, I’ll have a total burnout.

In tracing her unwanted sacrificing tendencies back to her childhood, Helen questioned whether sacrifice would be a threat to her sense of self and aimed to recognize her own self-worth. In a similar process, a few other female narrators referred to their childhood. Helen cherished the ideal of offering the baby she was expecting a nuclear family. However, questioning sacrificing had consequences for Helen's commitment. She said: ‘If there's going to be more falls like this³ … I won't go there’. Yet she was unprepared for leaving, especially because of her pregnancy but also due to her sensitivity to guilt, in which receiving emergency health care with her husband had played an important role: ‘The emergency visit changed it all, it was a saviour … Through the visit, I realized this was not caused by ME’. Emotional support helped Helen to justify her separateness in the relationship and to cope.

Aileen, 60, told me that her husband's alcohol abuse had been a major issue in changing her approach to self and commitment:

When his use of alcohol got excessive there was a moment when I said that NOW is the point that you make the choice. […] I had had like a saint's halo because I thought you can't change another person. […] I went too far with the accepting. […] But I forgot to reflect on how I may be treated, and the halo started to tighten around my head for accepting so much.

Aileen's worldview was agnostic but the religious metaphor of a ‘saint's halo’ represented her sacrificing for something that was no longer worth it. For Aileen, giving up the ‘halo’ meant justifying her sense of self as separate and recognizing her own worth. She viewed her motherhood as significant in this process: ‘If he had clearly mistreated the children, they’d have become my children … it’d have ended there’. Instead of ending the relationship, Aileen felt that her separateness and increased sense of self-worth restored the couple's communication and mutual commitment.

Karl, 60, viewed his wife's deteriorating cognitive capacity as one reason for their communication problems. He bore the main responsibility for the household and was exhausted. Karl reflected on his sacrifices from a Christian perspective:

In recent years, I’ve been thinking about the double commandment of love from a new perspective. […] To love your neighbour as yourself has opened up to me in a somewhat new light: even I’ve hardly been born into this world to waste away and get ill beside my ill wife.

Karl reinterpreted the biblical commandment to love to question the purpose of sacrificing. In this process, he employed religion to support his self-worth and reconsider his commitment. When I asked Karl why he persisted in the marriage, he replied:

I’ve promised to will to love … I’ve promised before God and the church and I’m a person with a sense of duty: if it's up to me, I keep a promise. But now I think that the situation has become so burdening and difficult that it's not up to me anymore. […] It's important that at least one of the parents [of the adult children] is somewhat sane. […] It has to be taken into account in making the decisions.

Karl employed religion both to justify his decreased commitment and to support his view of marriage and commitment as sacred. Commitment, expressed as ‘a sense of duty’, was also part of his sense of self. However, sacrifice in his marriage was too costly for his mental wellbeing and fatherhood. When I asked whether Karl would choose to enter the relationship again, he considered the question absurd and the answer of ‘no’ too obvious.

In experiencing incoherence between self and commitment, Helen, Aileen and Karl approached sacrifice as exceeding personal resources. Karl used religion both to support commitment but also, to justify decreased commitment, sense of self as separate and self-worth. For other interviewees, the conflict between sense of self as separate and commitment was irreconcilable.

Conflict between separate and committed self – sacrificing in caregiving

In anticipating a caregiving relationship, a few narrators felt that their separateness from the relationship was threatened. They reflected on the right to maintain separateness or duty to give it up. Sacrificing was seen as significant in two conflicting ways: as a major loss for the sense of self as separate and as having major value for the sense of self as committed. This led to an irreconcilable conflict. In justifying the self as separate, religion was employed to deconstruct the sacred aspect of the marriage.

For Ed, 60, his wife's cognitive problems and the lack of intimacy were difficult experiences, but caregiving intimacy made him feel anxious:

There is no relationship […] we live like a sister and brother. […] To this point I’ve not experienced this as caregiving although I’m necessary [for her] […] but if my presence is demanded 24 h a day, it's going to get difficult.

For Ed, anticipation of a caregiver role meant giving up his separateness, supported by new, meaningful relationships. Ed emphasized his marital fidelity and intention to persist in the relationship but dreamed about romantic love. However, he pondered his age and moral questions: ‘Do I have the right to happiness anymore? … It’d almost be murder to leave her, she's that dependent on me’. Simultaneously with this moral approach, Ed deeply valued his shared past with his wife:

She has told me it's the best thing in her life that I entered her life. A man can ask nothing more, as [my friend's] wife has told him [...] that it was the worst decision of her life to marry [him]. That's like pulling [decades] of life away. […] It's a terrible statement when life is almost behind you, that life was a big mistake. […] I’d play the game [again], it was so good.

Although Ed's sense of self as separate pulled him in a different direction, he would enter the relationship again, as he did decades ago. As their marriage was a significant part of the meaning in his life and the narrative self, leaving would mean judging his own life as meaningless and disintegration of his sense of self.

Amanda, 60, indicated that she had no expectations in her marriage anymore in order to protect herself. The painful experience of her husband's past infidelity had led her to begin separating from him. To cope, Amanda had turned to her religious resources. In the interview, she emphasized her independence from and indifference toward her husband by saying he was free to go his own way. However, it was difficult for her to verbalize her thoughts about the future:

It's not fear but something as [in the past] he had a long period of time with strong suicidality. If he does something, at some point, to himself, collapses in a way, then I’ve to be there somehow. Now he takes care of himself, in every way. But, well, what [should I] think about this?

Amanda's care was revealed by her anticipation of her husband's caregiving needs and attempts to participate in his mental health care. She described one such attempt: ‘[The reception] was cold, like I shouldn't contact them anymore, they even said so. […] Apparently, I was too active’. Amanda's willingness to be involved in her husband's mental health care and disappointment at being rejected reflect the strength of her commitment to him. This was more than care, as Amanda said: ‘It's not compassion or pity but there's still love for him. […] And I suppose he has some love [for me] too’. Despite years of emotional separateness, Amanda still sensed reciprocal love.

Susan, 60, considered herself as her husband's informal caregiver. In the past, she had thought about divorcing him, but not anymore. She said: ‘We got married ‘till death’. It haunts me … However, this has taught me an awful lot about myself … I’d consider myself resilient, patient … I don't easily leave a person to suffer’. Commitment had great value for Susan, it was based on her marriage vow and was part of her. Yet she justified her sense of self as separate by deconstructing the sacred aspect of marriage:

I keep pondering whether I have permission to live my own life. Do I have to live it all with him? Do I have permission? I’m married to him, I’ve not divorced. [...] And then, I think, well, I’m Lutheran, marriage isn't a sacrament for us. It is a worldly order.

To justify her separateness, Susan deconstructed the sacredness of the marital institution by arguing that Lutherans do not see it as a sacrament. In the interview, it became clear she was fully aware that this was a choice in favour of her coping.

Some narratives, like those of Ed, Amanda and Susan, were characterized by an irreconcilable conflict between their sense of self as separate and as committed. In a caregiving relationship, commitment demanded sacrificing separateness. Religion was used mainly to support their sense of self as separate.

Discussion

I approached the narratives of the spouses of people with mental illness with two research questions. First, how do the narrators make meaning out of self and relationship commitment? Second, how do they use religion to do this? My main finding is that in this process of making meaning, sacrifice was central. The interviewees employed religion to sanctify their relationships, to justify relations in their meaning making, and to cope. They used religion to both support and question sacrificing; in the latter case, religion was more clearly a coping tool. The narrators valued the support from mental health care for their sense of self as separate and expected it to help them contribute to caring for their spouse, which was an expression of their commitment to the relationship. Their experience of sacrificing differed depending on the narrators’ ages, duration of the relationship, gender and parenthood, and the capacities of their mentally ill spouse.

The younger spouses connected coherence between self and commitment to purposeful or rewarding sacrifice. For them, sacrificing strengthened the relationship; it was part of life's meaningfulness and their sense of self (see Agnew et al., 1998; Soulsby & Bennett, 2017). Self-construal may impact on how people experience sacrifices (Day & Impett, 2018). It has been argued that sacrificing for a significant other does not decrease wellbeing if that other is part of the self as relational (Carbonell, 2018). However, at the early stages of a relationship, commitment, satisfaction and an experience of ‘merging’ may be closely connected. Especially, ‘merging’ increases willingness to sacrifice (see Agnew et al., 1998; Aron & Aron, 1996; Frost, 2013; Gottman & Gottman, 2017). Because young adults face many choices about identity and commitment (Mannerström et al., 2017), young spouses of people with mental illness may be at increased risk of ‘losing their identity’ (Aron & Aron, 1996, p. 50).

To support sacrificing, religion was employed to sanctify the relationship. Marital sanctification increases commitment, satisfaction and willingness to sacrifice (Davis et al., 2018; Demaris et al., 2010; Lambert & Dollahite, 2008; Mahoney, 2010; Mahoney et al., 2003; Rusu et al., 2015). Using religion to sanctify the relationship had its drawbacks. The results suggest that younger spouses who used the Christian ideal of self-sacrifice may be less able to use an important coping method: ‘drawing the line’ (Karp, 2002, p. 40) and separating their sense of self from the relationship. For one wife, her husband's incapacity for work due to his mental illness combined with her religious ideals of traditional gender roles led to role incongruence (see Davis et al., 2018) and identity crisis.

Incoherence between self and commitment was connected to questioning the purposefulness and rewarding nature of sacrifice. Interviewees who questioned the value of sacrifice had a greater need to recognize their self as separate and self-worth. According to Baumeister (1991, pp. 308–312), decreased relationship commitment is often justified based on the value of the self. Some female narrators referred to childhood experiences as the source of their unwanted tendency to sacrifice. Although Finnish society is relatively egalitarian, the idea that women sacrifice more still exists (see Bahr & Bahr, 2001; Baxter & Kane, 1995; Ranssi-Matikainen, 2012). Some male narrators talked about major sacrifices, but without referring to their upbringing. This may reflect cultural factors and gendered storytelling (Fivush & Zaman, 2015) where male sacrifice without a heroic element lacks a cultural narrative. Both women and men discussed parenthood, a significant part of the relational self (Carbonell, 2018). Children reduce the risk of marital separation (Hewitt, 2009). Although many interviewees expressed determination to leave their spouse if their children's wellbeing was threatened, the decision seemed to be postponed. However, religion was employed to support self-worth and the self as separate. Thus Christianity was used to support two different purposes: sacrificing and separateness (see Ojalammi, 2019a).

Interviewees experienced a conflict between sense of self as separate and committed when they anticipated sacrificing in a caregiving relationship as their spouse got older or more ill (see Cotrena et al., 2016). Previous research suggests that stable identity is connected to older age (Kroger, 2015, p. 72; Mclean, 2008). In this study, the narrators’ sense of self as separate represented a valuable achievement that would become sacrificed in caregiving. However, leaving the relationship was not a realistic option. According to Baumeister (1991), leaving a long-term relationship is harder as the threat of a meaning vacuum is more significant. This is supported by research showing that older age and growing relationship length are connected to dependency and decreased risk of divorce (Rodrigues et al., 2013; Rusbult et al., 2006). In my study, the older narrators’ commitment was based on the meaningfulness of the shared life, love and moral obligations to the marriage vow (see Agnew et al., 1998, p. 942; Johnson et al., 1999). This sense of duty may be generational, although older people today do not necessarily adhere to traditional marital values (Bildtgård & Öberg, 2017). In caregiving, however, moral questions are common (see Karp, 2002; Rolland, 1994).

This research suggests that caring and sacrificing for a spouse with mental illness may include reciprocal love, even after years of emotional distance. An intriguing glimpse into marital sanctification was offered by one narrator: to justify separateness, she deconstructed the sacred aspect of the marital institution, without intending to divorce (see Krumrei et al., 2011). More research is needed to understand marital sanctification for older spouses and in a caregiving context (see Mahoney et al., 1999).

Mental health care was important for the narrators. Although they stressed their negative experiences, they had high expectations of mental health care (see Stengård, 2005). They expected it to support their sense of self as separate and help them express their commitment to their spouse.

Conclusion

This study suggests that a spouse's mental illness can spark a coping-focused process of making meaning about self and relationship commitment. In debates about the relational self, commitment has not received sufficient attention. The interviewees connected their sense of commitment and self by changing their approach to sacrifice. Sacrificing was important to them because mental illness increased the risks to the self (see Karp, 2002; Ojalammi, 2019a). The results suggest the need for more dialogue between researchers into the relational self, caregiving and family (see Byrd, 2009).

In coping with relationship conflicts, culture and religion intertwine. Participants in this study expressed both religious and Western secular individualist values in making meaning out of their self and commitment. Some of them interpreted commitment to marriage employing traditional Christian values, but also, drew on individualism in interpreting the tradition, to favour the self and even to consider leaving the relationship. While this combination may make coping more flexible, meaning making may be endless and exhaustive, and making important decisions, impossible. Issues for future research include the cultural contexts of marital (de)sanctification, especially in family distress like in the context of a spouse's mental illness (Rusu et al., 2015).

Sanctification research has been criticized for excluding the sacred in secular cultures (Ahmadi & Ahmadi, 2018; Deal & Magyar-Russell, 2018; Rusu et al., 2015). The connection between sacrificing and the sacred may relate to experience. More research is needed about the language that people with more secular views use to describe sacrifice in their relationships.

These results have practical implications: mental health care providers should invest in approaches that involve both the couple together and spouses of people with mental illness alone. The findings bolster recommendations that mental health care providers recognize the role of the sacred in romantic relationships (Krumrei et al., 2011; Mahoney et al., 1999; Rusu et al., 2015).

Limitations

This study has several limitations. The recruitment advertisement may have encouraged spouses with higher-than-average religiosity and commitment to participate. Commitment was approached as the subjective experience of the interviewed spouse alone. The gender imbalance – 4 men, 12 women – may have impacted on the results. The participants may also represent a group with more difficult experiences than average. The range of diagnoses was limited – mainly bipolar disorders, which are different to other mental illnesses. Due to the narrative methodology, the findings cannot be generalized.

Acknowledgements

This work was supported by The Church Research Institute of the Evangelical Lutheran Church of Finland under grant number 10440€.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by The Church Research Institute of the Evangelical Lutheran Church of Finland: [Grant Number 20880].

Notes

1 For simplicity, I prefer the term ‘spouses’ as only two participants in this research cohabited.

2 Dr Kate Sotejeff-Wilson.

3 The interviewer drew a vertical downward line in her relationship timeline to describe how she experienced her husband's illness episode.