ADHD and Frontal Lobe Brain Injury

My spouse has both ADHD and a Frontal Lobe Brain Injury.  He took a nasty tumble down some stairs as a youngster and split his head open.  His parents didn't really address any of the learning issues, communication issues, physical challenges or other outcomes of having a traumatic brain injury so my spouse kind of stumbled through life, school, puberty/development, etc., with severe behavior issues.  

Mental health issues (depression, bi-polar/manic depressive, schizophrenia and addiction) run on both sides of his parents families so he got his issues honest however the brain injury made his undiagnosed ADHD worse.  Although he has never been diagnosed by a medical professional that he was willing to see for any reason (hates going to the doctor) he has all of the symptoms.  I have vast opportunity to interact with psychiatrists and neurologist who all share my opinion.  My spouse does as well (he is the person that initially identified he problem), however he is not really interested in addressing his challenges on a consistent basis and I get tired of being the nagging wife/bad guy so I just stop asking him to.

My challenge is that my spouse has sexually deviant behaviors, which from my research are a direct result of his head injury, which are hurting our marriage.  When we are in the midst of sex, he checks out and will do whatever he "needs" to for him to get an orgasm.  For me, it becomes more of a being the police person and keeping things on track enough to where I can tolerate the majority of what occurs.  When he does do things that I don't like or approve of I confront him about them.  He can be manipulative when it comes to this kind of thing and often tells me he doesn't remember doing it....  Down the road however, the truth comes out and its always about doing what he needed to do at the time to reach an orgasm.

This deviance has caused quite a few issues for us over the 10 years we have been together and it gets better when stress is lower, worse when it is higher.  He claims that all of the problems in our sex life are my fault because I want to talk too much about what occurs, or my medical issues don't allow him as much spontaneity as he would like, or that my mistrust of him doesn't allow him to get my body to do what he wants it to do.  (Mind you, sex sits on the front of his mind 24/7 and talks about it all the time.) In everything that I have researched about how married couples deal with sex, couples with medical issues (I had back surgery a little over 10 years ago and have some limitations in how I can function but mostly my medications make me tired or aren't working well enough for me not to be in pain during sex - which is more of a timing issue with what he wants as opposed to my meds not actually working.) addressing connecting sexually, dealing with ADD/ADHD in marriage, etc., I find that the things I am attempting to do are all along the norm.  He says that I am broken, have a sexual dysfunction and accuses me of having affairs outside of our marriage.  For him it seems that since I don't have orgasms with him during sex then I must be getting them with someone else.  I say the stress of how our household runs with me being the non-ADHD spouse and him being the ADHD spouse, the fact that we didn't know/understand what was going on with his head until here recently (last 3 years), the responsibility of running our household, taking care of him, managing his legal issues related to his divorce and children from that relationship, as well as the mean, angry, hostile, nasty things he says to me during every argument about what is happening in our unfulfilling sex life (same argument every week), and the deviance (which escalates when he is stressed and we are at a high point in our world right now) are the bigger culprit.

In all honesty, our sexual relationship was fabulous in the beginning but once the stress of his ex/children/court was introduced, our whole world was turned upside down.  We have lived the last 7 years in a state of chaos and survival mode dealing with court, money, lying (ex-spouse), damage to our property by the ex-spouse...  The list goes on.  And, the angrier he got about all of that, the more he blamed me for his issues with our sex life.  The times when was poor performance on his part leads to a less than desirable outcome, somehow it turns into that was my fault because I did or didn't move a certain way or did or didn't kiss him a certain way or did or didn't come to sex when he thought I should have - all just craziness to me.  Now, I spend time trying to anticipate the argument we will have after sex (especially if he doesn't orgasm). watching what he does so that he doesn't push too far past my boundaries, attempting to lay, bend, stand, sit, kiss, smell, etc., the right way so that we can get to the desired outcome of his orgasm, and praying that it will come reasonably quickly so that I don't get blamed again for things not working.  Part of our reality is my spouse is getting older and he has a prostate issue he doesn't want to deal with.  Part of it is some nerve damage in his lower back that challenge his performance.  Part of it is traditional ADD/ADHD distraction during sex which totally twists his performance out of whack.

I am depressed and concerned about both my health as well as our marriage.  I do love my spouse and enjoy other aspects of our marriage.  This issue however is so HUGE that it seems to over shadow much of the joy and pleasure I do get out of what aspects I do enjoy.  One of the results of frontal lobe injury is a hyper-focus on sexual display and release.  Many studies have talked about how this is seen with car accident sufferers who hit the front of their head.  They are constantly fondling themselves, groping others, masturbating, and in worst cases committing rape.  For most, this issue resolves over time  but there are those that never do, in which medication can help but may not take care of it all.  My spouse is against taking medication however wants me to be the expert on all things related to his interests/issues that I can answer his questions or give him advice; whether he uses it or not.  He also wants me to get into or up with his deviant ideas that he has known from the beginning I didn't like or want to do, which of course he presses me for more and more as his performance wanes, stress increases and our sex life drops.

We spend so much time arguing about our sex life that I am growing less and less interested in spending time with him during the waking portion of the day.  Since he works nights we only really get weekends together and they are becoming increasingly tumultuous.  

I am hoping a therapist out there can help me understand more about what we are going through and any tips on how to make our relationship better.  I have been applying the concepts from both of the books recommended on this site. (I must say that the information is both enlightening and infuriating; I feel like my life will not get any better and is destined to grow into a living hell...)  

We saw a psychotherapist for a while, the one I had been seeing for many years before I met my husband, but she was not versed in ADD/ADHD or head injuries.  It seemed to make things worse and our sessions became this peristalsis by my spouse of all of the things I had done to him and in our marriage that make him act the way he does.  We need to get into counseling for these current issue but I am not even sure which way to go with that.  Do I seek out one that has more knowledge of ADD/ADHD or one with more experience with the neurological challenges of frontal lobe injuries?  We are also dealing with a lack of finances due to his divorce and child support.  Augh.... 

I am worried I am going to spin into a pit of despair.  My growing hopelessness is not making our relationship any better, that is for sure.  I get tired of living depressed and want to be both happier as well as enjoy my marriage.  I want to be able to celebrate the person I am and try to get back to the positive, happy person I used to be.  All of this depression isn't helping the long term effect my back surgery and subsequent medications have on my pysche.  Something has got to give and I am hoping its not going to have to be my marriage.

Thanks for any feedback, thoughts, help or advice