An understanding of ways in which older carers' perceptions of their marital relationship and duty to their spouse underlie adjustment to care-giving is required for the development of acceptable and efficacious services for spouse carers. With this aim we conducted qualitative interviews with 20 spouses of older people with a mental illness identified in a representative community study. While carers acknowledged distressing changes in their spouse, a history of reciprocity and intimacy emerged, comprising positive themes and perceived continuity which favourably influenced adjustment to care-giving. Those who still experience closeness in the relationship see themselves as coping and are reluctant to accept formal help. Others describe long-term unhappiness in marriage and experience feelings of entrapment in the role of carer. They require early and comprehensive services. Hypotheses regarding these themes are proposed.