"I took him for better or worse, and he was worse than I took him for." It's, an old joke. But the other marriage vow - to love and honour your partner in sickness and in health - which may be lightly taken when you're young and carefree, can become a heavy burden if one becomes ill.
Sadly there's no shortage of people with serious illnesses and diseases, from cancer and heart disease to accident victims, physically disabled people and those with chronic conditions such as ME.
Add on the thousands suffering from mental or emotional illness and those needing care due to frailty or old age and it all adds up to a lot of minding - much of it done by partners miles of running up and down stairs, sleepless nights, lifting trays and monitoring medication. And alongside the physical demands - there are she emotional ones.
Both nurse and nursed need to care for themselves and each other. Some marriages do not survive such an unforseen agenda. "If you're ill it can be all consuming. It becomes the centre of your life, and you can expect it to be she centre of other people's lives too - in fact in your fear you want it to be the centre of their lives," says Mary Paula Walsh, cofounder of the counselling service Turning Point, the name of which reflects the concept that illness can be a turning point in someone's life - for good or ill: "Or it could be just a nasty bump and they go back to what they were".
A good proportion of the people she counsels are patients and families. "How we respond to illness will depend on our early experience of illness. When we are ill we tend to regress. So people feel like children again in that they need to be minded and cared for. There are sexist stereotypes and people say that men are hopeless patients. An ill man may have to lose his macho image and an ill woman may have to give up a caring role and accept being cared for herself.
"With long term illness the well partner may become obsessed with the other getting cured. There is the feeling these days, particularly with cancer, that mental attitude can affect the outcome. You see death notices saying after a long and courageous fight, as if someone is expected to battle against themselves. People suffering from depression can also be at the receiving end of the pull yourself together model. It's important to allow the ill person to be ill. Someone insisting you fight can be a terrible strain. It's also vital for the well person to take time off for themselves and not to feel guilty about it."
When Brendan's wife contracted a chronic condition he went out and had an affair. "I couldn't cope with things," he says. "I hated seeing her as she was. For a while I just wanted to escape."
Mary Paula Walsh says a chronic illness quite often destroys a relationship, partly because the well person cuts off for their own protection.
"Normally a couple grow old together; it creeps up and people: can get used to the change. But with illness there can be a kind of, instant ageing because of the loss of strength, independence. The sexual side can be amazingly difficult. A couple may have to find new ways and means of being sexual together and to achieve this they may need to be able to talk about it. I'm not in favour of counselling for everything. People coping with illness can get a lot of help just by talking to a good friend, but when it comes to sex or relationship issues a good counsellor can, help to mediate the whole thing."
Marriages where one of the couple suffers from depression have a higher than normal breakup rate according to Clive Bailey. He should know. Himself and his wife Geraldine have battled with his depression for over 20 years. "I think we survived only because we always had a very good relationship and are great friends," says Geraldine.
Depression first manifested when he was a young Dad of 30 as manic attacks, loss of confidence, tiredness and insomnia. For years it was thought to be high blood pressure, and then diagnosed as reactive depression caused apparently by external stressors.
"When Clive was down he would be tired, aggressive, unlike himself," says Geraldine. "It was a strain trying to keep the peace in front of the children. I was walking on egg shells.
"When he was really bad he wouldn't get out of bed. I did everything. I shouted, banged doors, cried and cajoled. Finally when Clive would come downstairs, he'd say `I'm up, what will I do now?'
"I was aware she was trying to get me to shift," says Clive, "but I felt totally paralysed, in despair, suicidal. I was never conscious of the strain and hassle I was causing her."
"I knew he was suicidal so I would take his pills and car keys with me when I went shopping," says Geraldine. "I was beginning to feel very isolated and had nobody to talk to. I felt disloyal talking to my friends, and sometimes they said something hurtful or unhelpful. Part of the problem was my explaining things badly because I didn't really understand what was going on. We lost a lot of friends at that time because when you consistently refuse invitations out, people stop asking you.
When each bout of depression passed they put it behind them and hoped it wouldn't come back. "We were both in denial," says Geraldine. "I didn't want to rock the boat by bringing it up again."
Then Clive's condition worsened and he began experiencing the elation phase of manic depression: "I felt marvellous," he says. "I would go for a drink after work and not want the party to end."
"The phone would ring at 3 a.m., and he'd say `I'm in Leeson Street, will you collect me? I often felt like leaving him there but I'd go in, screech to a halt and say `get in' through gritted teeth.
"It all rolled completely off me," says Clive. In elation phase, Clive spent money lavishly and neglected family bills. The turning point came in 1987 via a book on depression by Dr Patrick McKeown, consultant psychiatrist at St Patrick's Hospital, Dublin. "I said that's me, got into the car and made an appointment to see him. As my doctor I trusted him and he put me on a treatment plan."
Clive discovered he was suffering from endogenous depression mainly due to a chemical imbalance. It's been a long slow road to recovery because three heart attacks and two heart by pass operations since interrupted his drug therapy. He's been well since spring and this is the first summer he hasn't swung up to elation phase. Through membership of Aware, the self help organisation for patients and families, the couple have learned new ways of coping together.
"During bouts of depression Clive can focus his anger on me," says Geraldine "If you don't talk about hurts, they fester. Now we deal with them. I know he didn't mean to hurt but I need him to acknowledge that."
Aware is just one of dozens of self help organisations formed in the last decade responding to illness as a social and familial issue rather than just a clinical set of symptoms affecting one person.
Raymond and Karen Sherlock have reason to be thankful to Headway Ireland, the National Head Injury Association. Five years ago Karen, then 25, was knocked down crossing the road, was severely brain injured and stayed in a coma for two weeks. Slowly, she regained consciousness, learned to walk again and came home to Raymond who had to adapt to a new life.
"Karen used to be very outgoing and confident and worked as a computer operator," he says. "She will never work again. She has severe concentration and memory problems, becomes depressed, can be aggressive very small things can cause her a lot of stress.
"At the beginning she was emotionally detached and I became very lonely and separate. I felt depressed and was beginning to crack up myself. Then I went to a family forum organised by Headway and realised that what I was feeling was normal. That was a great help.
"We've had to change our lives. I used to work in the advertising industry, all hours. I've changed my job. Now I come home at night by choice to be with my wife. We are very close. We've had a little girl since, Catherine, who's four and that's great. I've had to dig deep within myself. I didn't know what resources I had."
Mary Paula Walsh, who is also the author of Living After a Death knows full well, too, the pain involved when an illness or disease does ultimately prove fatal. Families have a lifetime of handling things in a particular way and they will handle the dying in the same way. If they can be open, fine. If their way is to deny it, equally fine. We cannot impose. People face illness very individually. Some get great meaning from it and they are able to find a graceful way to die. When people are dying they need to find some way of letting go of the relationship. The ideal way, not always realistic, is to leave it until the last few weeks or days."
Until death do them part.