Dear Ginger,

I am a little embarrassed to be writing this, but here goes. My husband sometimes just acts spacey. I don’t mean he has dementia—he is really a very bright man who has a responsible job—but there are times when he just doesn’t seem to hear me or to even know I’m in the same room. I must admit, this is not new behavior for him—he has been somewhat like this all through our marriage of 40+ years—but it seems to be getting worse, and I don’t know how to handle it any more. The reason I am writing you is because I don’t feel very attracted to him when he is doing this, and since it sometimes is hard to get turned on anyway at our age, I am beginning to wonder if there is any hope for the future of our sexual relationship. Thanks for any help you can offer.

Marlene

Dear Marlene,

I think there must be an epidemic going on—you are the third spouse in a short period of time to ask me almost this same question. I am going to approach it and the issue of what happens to a sexual relationship when there is a diagnosis of dementia in this month’s and next month’s column.

First of all, I’m glad you feel certain there is no dementia in your husband because when that diagnosis has been made it is often the culmination of a difficult period of uncertainty, followed by a tragic certainty about major transformations in relationships. What you are dealing with, Marlene, sounds like the exaggeration of long-standing patterns or traits that may or may not be a diagnosable or definable condition.

Second, several questions and ideas come to mind when I read your letter, and I wish I could ask you more in-person to help me sort this out for you. If he has been doing this for years, what have you been doing to either enable or confront the behavior? Have you nagged him or ignored him, both of which are typical spouse reactions, though neither is usually very helpful in the long run. Does this happen with any pattern, like at the end of the day but not early in the morning, or after he has been having an alcohol drink, or when he is tired? Does he seem to hyper focus in some area (like watching TV or being on the Internet) and under focus in others, like noticing you and his surroundings? Is the behavior just noticeable to you or do others, like your children or your friends also notice his tuning out?

Based on what you know about his life as an adolescent and a younger man, do you think he has had attention deficit disorder (ADD) with or without the hyperactivity component? Many adolescent boys have traits of ADD, which they often outgrow or learn to compensate for as they mature. Often these ADD-type guys marry a woman with the opposite traits—those of Obsessive Compulsive Disorder (OCD). As therapists, we often see these marriages of seemingly opposites that function to keep both sides in balance—for instance an ADD- type husband may value play and lack of structure while an OCD-type wife will value hard work and staying on task. Each spouse seems to have the “job” of helping the other one have a little of what he or she has—a little more fun and relaxation for the OCD-type and a little more seriousness and focus for the ADD-type.