In the past emails, I have written about some of the changes in modern relationships – the load many couples are carrying, and the impact of a highly sexualised culture on intimacy and expectations.
There is another layer that also impacts relationships: health and mental health issues.
These challenges are not new. People have always lived with depression, anxiety, neurodivergence, chronic illness, hormonal shifts, trauma histories and pain.
What has changed is the visibility, the language and the level of recognition. And the way these experiences are now understood – and sometimes misunderstood – in everyday life.
We are living in a time of greater awareness and openness around mental and physical health. For many, this has been helpful. Experiences that were once minimised or not mentioned are now better recognised. More people are receiving support that is tailored and appropriate to their needs. There is less shame in saying: I am struggling.
And at the same time, it is more complex.
Labels are easily used.
Online information is constant and not always nuanced or accurate.
Self-diagnosis and other-diagnosis happen all too easily.
Couples often find themselves trying to make sense of what is impacting what and how – and the answers are not always straightforward.
Partners may be navigating changing energy, mood, focus or capacity. Neurodivergence may be newly recognised in adulthood. Menopause or hormonal changes may alter sleep, desire, and emotional regulation. Chronic pain or illness can impact availability for intimacy and connection.
For some, medication brings relief and stability. For others, there are concerns about numbing, dependency, side effects, or whether medication aligns with values. Access to good assessment and support is not a given, especially if expensive.
It’s not uncommon for partners to sit in different places with this – one feeling validated by a diagnosis, the other unsure what to make of it, or both trying to understand what has actually changed and what has not.
There is no fault here, yet it does change the dynamic in a relationship.
It can also place real pressure on the partner and the relationship system. Changing capacity, mood, focus, pain or energy ripple outward. Couples may find themselves negotiating new limits, responsibilities, and emotional experiences, without knowing how to.
At the same time, we may wonder: does what we are dealing with stem from depression, burnout, neurodivergence, trauma history, hormonal change – or is everything just adding up?
And even when there is more clarity, the practical question often remains: What do we actually do with this, and how do we keep getting on with life and with each other at the same time?
Addiction and coping behaviours often sit somewhere in this landscape too – sometimes obvious or normalised, and often functioning as attempts to regulate stress, overwhelm, loneliness or nervous system activation. This can include alcohol, drugs, pornography, gaming, work, over-exercising, screens, shopping, or other forms of checking out or speeding up.
Most of the time, this isn’t really a conscious choice. It’s people trying to cope, regulate, or simply get through periods where life feels like a lot.
Although our society now has many specialised lenses – mental health, AOD, neurodivergence, trauma, disability, hormonal health – our experience doesn’t do boxes like that very well. Most individuals and couples are navigating some combination of these across the lifespan, often while trying to maintain work/career, family life and connection.
The real task is not finding the perfect label, but working with what is actually showing up in daily life.
Without open and practical conversations, couples can start to personalise what is actually systemic, physiological, or contextual. Distance grows where understanding was needed. Frustration builds where clarity was missing. Or partners begin walking on eggshells around each other, unsure what is supportive and what is over-accommodating.
In some spaces, or even within us, health and mental health issues are still minimised or dismissed. In others, every struggle is quickly given a label. And many thoughtful people find themselves somewhere in the middle – wanting both accuracy, validation and perspective.
The reality for most people is that some combination of tension, adaptation, vulnerability and resilience is present much of the time. Periods of feeling fully resourced and settled do happen, but they are often temporary rather than a permanent state.
Seen this way, changes in capacity, mood and connection are not necessarily signs that something is going wrong. Often, they are information about what the system – individual or relational – may be needing next.
What matters most relationally is not the label itself. It is the shared understanding of impact.
When couples can talk openly about how health, capacity, hormones, neurodivergence or mood are showing up between them – without blame – things often begin to get easier.
Expectations become more realistic.
There is usually more breathing room for both people.
And kindness comes in alongside accountability.
Long-term intimacy was never built on everything running smoothly.
It grows through awareness, flexibility, and the willingness to keep finding each other as capacity changes over time.
And in the current landscape, those skills are becoming even more important. More on that next.