It will eventually occur in nearly any marriage that old age will take effect, and the mind will become worn, and at time confused. Mental problems, along with physical disability, can create unique challenges in how a man leads his wife, and how she submits to him. To a degree this can be worked around, but if the problems are severe, it extremely limits the functioning of headship and submission, just as it limits the body or soul. A wife will need to accept the fact that her king is losing his strength, and the one she loves and honors deeply needs her help more than ever. Naturally she will want to submit, but the challenges to submission on a practical level become greater.
The most obvious difficulty would come not with disability, but with mental illness. Even some mild senility can lead to confusion or forgetfulness. This is not a very rare situation after many years of marriage. A husband with dementia could become gradually more confused, until he cannot recognize even basic things. How does a wife continue to do her husband’s will, if he is very confused? How does she follow when he cannot lead coherently?
The basic answer to this lies in the fact that the husband is not confused all of the time. Surely, before he gradually lost his faculties, he made some basic things about what he desires very clear, and a wife can continue to do those things for him, just as she can continue to serve him in other ways, such as caring for the home, and preparing his food. This too is submission, even if it is not in response to commands in the moment. Moreover, people who suffer from dementia are not always without their faculties. Especially early on, it may be a cloud that comes and goes. That means in his clear moments he can tell his wife what she needs her to do, and she can carry this out, even when he is unable to communicate well another time. It does demand some discernment, as a wife must tell when her husband is clearly lost mentally, but she must do her best to recognize when he is lucid, and then do his will.
The same principles apply to a man who suffers from other severe mental illness. This could be a man who experiences psychotic episodes, such as would be regular with schizophrenia. His wife may have known him before it started to take over, which often occurs with male schizophrenia in the early 20s. If not, he may like many have plenty of periods when his mind is with him, and he can use these times to communicate what he wants. A psychotic episode is much easier to recognize than some milder mental confusion, so it will be easier as well to tell when he has his mind about him. If mental illness is serious enough, it may be best not to marry at all, because it naturally will interfere with an ability to do the job of spouse or parent, at times making it nearly impossible. However, for some people, mental illness starts mild or periodic, and grows more severe later, being a very serious disability in the long run.
Even if a husband has lost his mind permanently, a wife still knows basically what she needs to care for him, and likely knows his preferences, and will care to do them. Even without the clear regular leadership that his words provide, she can know she is submitting to him through these common sense things that he needs and desires. She can still look to him as lord, although a broken one, and honor him daily. In some respects, she can become even more of a helper than before, as now he needs greater help in getting by with his disability. A damaged king is still the king. She should never stop loving or serving him.
A man who suffers from a physical handicap is not as challenged in leading his wife as one who has lost his mind. He is simply unable to do some of the tasks a man ordinarily could do. Some men tragically may end up in a wheelchair young, while others may become seriously injured due to an accident later. However, the man can still think and speak clearly, so his wife knows what he wants and can easily submit. She may have to be his helper on a deeper level than usual, taking care of him physically, being literally his hands or his feet. While a challenge, this can deepen a woman’s submission to him, and teach her, as sacrifice usually teaches us, to love more fully and to give more fully of ourselves. It is not what anyone expects marriage to be, but helping a man with his disability is a beautiful expression of love and service to others. God will be pleased with her work.
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