Case Study Mrs. Marilyn Holden is a well-groomed, white, 40-year-old woman of average height who came to the outpatient mental health center at the suggestion of the admissions director at a nursing home where her husband was recently placed following a stay in the state psychiatric hospital. Mrs. Holden had told the director that ever since she had her husband committed to the state hospital, she has felt depressed. Mrs. Holden told the clinical social worker at the mental health center that she had her husband committed because he was "acting up" at home. He was drinking a keg of beer every three or four days, cursing loudly, and hitting her and the children (a boy and a girl who are 12 and 14, respectively). In the past, he has choked her, pulled out her hair, doused her with beer, and has threatened to hurt the children. When he raised a knife at their son recently, she called the police, who brought him to the state hospital. Mrs. Holden explained that her hus- band was given the diagnosis of Huntington's disease several years ago, but he refused to take the medication that was prescribed after he was told that he could not drink alcohol while taking the medicine. He has not worked for five years because of difficulties he had holding a job. He has been receiving Social Security and Medicare. She has been working part time. Mrs. Holden said that she and her husband have been married twenty-two years. They met in high school and married after they graduated. Mrs. Holden said that during the first two years of their marriage they lived with her parents, who supported them until she and her hus- band were able to obtain stable jobs and save money for housing. During that period, her par- ents were critical of her for marrying when she was young. Later the couple was able to buy a home, where Mrs. Holden and the children live now. Mrs. Holden expressed affection for her husband "the way he used to be" but said that he has changed. During the last few years, he has followed her around the house and has made her account for her every move. Although his sexual demands have increased, she has felt increasingly repelled. Mrs. Holden expressed feelings of guilt about "dumping him" in the state hospital and a nursing home, at the same time she admitted feeling relieved. Mrs. Holden said that during the past few years, the children have taken "breaks" from the family by staying with her mother and friends. They have spoken of "hating" their father and fearing that they would inherit the same disease. Mrs. Holden said that she had no idea when she married him that this disease ran in his family; she learned about it only after her Biopsychosocial Analysis husband was diagnosed and she began to ask questions. Since then she learned that his moth- er and uncle died of the disease and that cousins have the disease today. His family does not like to talk about it. Mrs. Holden said that when Mr. Holden was living at home, she thought about killing him with a billy club. Since he has been out of the home, however, she has thought about killing herself. She said that she felt confused about "what she owed her husband and what she owed the children" and believes that over the years she has been a "bad mother" and now she is a "bad wife." She said that she had been ignoring his abusive behavior and drinking in the past, even though these behaviors affected her and the children. She reported feeling like a failure and wished that she could feel better about herself. Mrs. Holden said that her mother continues to provide support to her family. Her moth- er believes that Mrs. Holden did "the right thing" in placing him in a nursing home but did "the wrong thing" over the years in ignoring the feelings of the children. Mrs. Holden has fre- quent contact with her mother, a widow in poor health, whom Mrs. Holden helps with house- hold chores and shopping. Other supports include friends and a Huntington's disease support group. There are relatives on her husband's side who are critical of her for placing him in the nursing home. Nevertheless, none of them was willing to have him stay with them. Mrs. Holden requested support from the social worker in sticking with her decision to leave her husband in the nursing home and asked for help dealing with the children. She also expressed bewilderment at how she would live her life without her husband at home.