Wednesday, August 13, 2014

How Differences Can Lead to Trouble

The impact of the illness is experienced differently by each partner.  They do not perceive the situation in the same way, and they are not feeling the same things about their situation.  Recognizing these differences in perception and feeling is critical to maintaining connectedness.

The ill person suffers both physical pain and soul pain – both are severe.  Her body has betrayed her and her identity has been hijacked by illness.  The life she had is gone and she doesn’t know what to do or who she can be.  There is a sharp and potentially demoralizing gap between her internalized image of herself (young and healthy) and the present external reality.  And while she is in this state she has to rely on specialists she might not really know.

For the well partner, his world has changed on him.  On top of his confusion and fear, he feels he has to be strong while he helplessly watches his sweetie suffer.   And he may feel resentful - of the illness, of doctors, and even of her -- and guilty for feeling that way. 

Here's a not unusual scenario about how these differences can play out:
The ill partner may need some alone time to adjust to her new state; and the well partner may be driven to find a way to help her.  If they don’t recognize that their needs are different in this moment, he is likely to feel rejected by her need for alone time, and she is likely to feel pressured by his attempts to help her.   

The result: she is likely to hold more tightly to her privacy, which will make him feel more excluded; and he is likely to pressure her more strongly to let him in so he can help.  They grow resentful and distant.   

If they could recognize and make space for their differences – she might be able to say “I need some alone time to think – but I am not retreating from you.”  And he might be able to say –“I want to help you any way I can so I’ll respect your space, but I need to check in with you periodically to see how you are, and hope that’s OK.” 

In this way they are respecting their differences while maintaining their connection.

Friday, July 25, 2014

Interview on Chronic Marriage

Interview with, Barbara Kivowitz, by Helena of Chronic Marriage blog.

From Helena's post:

"What are my personal “nuggets of gold” from reading In Sickness As In Health?  Here are just a few:

1)  Illness can be a gateway and not an epilogue; and that, even in the absence of a cure, healing is possible.
2)  You can end up holding so tightly to the old image that in order to sustain the illusion you reject the reality of the illness and in so doing, reject your partner.
3)  Illness compresses time and summons mortality and can help us filter out the trivial.  We can attend to what is truly important with intention and can live each moment potentially feeling more alive with illness than the deadness of life before illness.
4)  Revealing secret hopes and fears does not make you more vulnerable, but rather builds a strong bridge to your most powerful ally, your partner.  Speaking the unspeakable makes both of you stronger.
5)  Love each other, support each other, and don’t leave each other alone in the dark."

Thank you Helena.  I look forward to reading all your insightful posts.

Wednesday, July 16, 2014

When Illness Warps Your Relationship

Sadly, it's not uncommon for the illness to wrap the couple relationship around its nasty finger.  Illness, especially if pain and exhaustion are present, can consume way too much of your life force.

The ill partner can become focused on the illness, at the expense of relationships with partner, children, and friends.  The well partner can become more and more remote as s/he tries to hold onto normalcy.  And both partners can wind up blaming each other - for everything.

Underneath these scenarios run such deep fear and anger that often the couple avoids these feelings,  and in doing so, the partners grow more distant from each other's emotional centers.  It is natural to want to suppress such hurtful emotions - but they do tend to seep out, and often in subversive ways.  How many of us have screamed at a jar lid that won't come off, or at a medication with side effects, or at a partner for not making it all better (even though both of you are trying as hard as you can)?

What can you do?  No easy answers here - because our situations are just not easy.  Use your best judgment about trying any of the suggestions below:

  • You can try directing your anger and fear at the illness, instead of at each other.  Talk to the illness, privately or in each other's presence.  Tell it how much you hate it or fear it.  The illness is the true target.
  • Sit silently, side-by-side, and summon your compassion for each other and your appreciation of the qualities you each possess.  Give yourselves a 5 minute quiet break from the noise of illness, doctors, worries.  In that quiet, remember what brought you together in the first place.
  • You can try individual or couples therapy.

I'd like to ask you to try one thing.  That is -- be as compassionate and gentle as you can with yourself.  You are doing the best you can, every day.  If the illness has overtaken most of the kindness around you - it may sound cliche, but do try to be understanding and validating of yourself.  That too can become subversive and spread.

Let me know how illness has seeped into your relationship, and what you've tried to maintain your balance, as individuals and as a couple.

Monday, July 14, 2014

The Turmoil of the Caregiver

From an excellent article in the Washington Post, written by a woman who is the primary caregiver for her husband who has multiple chronic conditions.  The article, written in the first person, captures the physical and emotional turmoil many caregivers know too well.

Living with a husband's chronic illness has a bad effect on his wife's health
by Katherine McQuay Lewis

"My husband, Dave, may officially be the sick one in our marriage, but his steadily declining health is also doing a real number on my mental and physical well-being. Emotionally, I’m the little silver ball in the pinball machine. I’m alternately angry, resentful and critical; then I’m overwhelmingly guilty, so I careen into being loving, kind and almost a little clingy.
To borrow from the caregiver vernacular, I am the “well spouse.” But “well” is becoming an increasingly relative term..."

Monday, July 7, 2014

Arguing and the Immune System

excerpts from an article on Medical Press about the effect of arguments between partners (and other stressors) on the immune system:

"Rebecca Reed, a doctoral candidate in family studies and human development in the University of Arizona College of Agriculture and Life Sciences, is studying how a couple's recovery from an argument affects their immune systems and overall health....

Though we hopefully know the difference, our bodies' immune responses don't differentiate between a peeved lover and a predatory lion. When confronted with a psychological stressor, such as a tense discussion or giving a public speech, our immune systems respond the same as they would for an impending physical attack....

Essentially, too much psychological stress literally can make you sick, while the ability to recover from stressful situations may decrease risk of chronic illness and improve overall health and quality of life......."

She believes that one way to turn off the immune response may be for couples to foster effective interpersonal communication with attention to each other's emotional states. This could help them not only emotionally recover from stressors, but also immunologically recover, she said."


When Richard and I have a doozy of a disagreement both of us feel tender, even broken, for a while afterwards.  I go into my cave and hibernate until I feel reconstituted.  Richard immerses himself in his computer. After a bit of time passes, we reach out to each other again.

I really like the idea of each wounded partner helping the other to recover from the effects of arguing.  It's a hard task for someone who is angry or defended to also be empathic.  But the empathy is there, just retreated.  If you can make space for empathy in the rush of anger, the disagreement is likely to be more tolerable, with a quicker, more balanced resolution.

How do you and your partner do arguments and disagreements?  Do you feel the stress of arguing in your body?  How do you recover?

Monday, June 16, 2014

Help For A Couple In A Knot

When you're tied up in a know, it's hard to make progress.

I am about to speak with an elderly couple (friends of a friend) -- the husband has both physical and mental health issues; the wife is taking it upon herself to be not just his primary, but his sole caregiver.  And the situation is not working for either of them.

My going-in hypothesis is that this couple's mental reality is lagging behind their current circumstances by about 10 years.  A situation not at all unusual for couples living with chronic health conditions that deteriorate slowly over time.

I'm guessing that he sees himself as still able to walk without a cane and make important decisions without consulting others.  He has fallen, and has had his impaired judgement lead to some very bad decisions.

I'm guessing she still sees herself as able to take care of him, their health care needs, the house, the shopping and cooking, the financial matters, the extended family, and more - just as she has always done -- with skill and energy.  She has not yet factored in that her energy is depleted by aging and stress, and the skills now required to do all this are beyond her ability, and beyond the ability of most any single individual.

But their emotional identities are out of  synch with their actual capabilities.  They are stuck in a knot, getting tighter instead of making progress.

They have read my book and want to speak to me as someone who knows about couples and illness.  I am asking myself - what are the critical questions I can ask them?  What is the best guidance I can offer them?  A few questions that came to mind are:

  • "What is the one thing you think your partner would want you to do, that if you could, would make a big difference in his/her peace of mind?"
  • "What can you do for him/her, that nobody else can?"
  • "What do you imagine will happen if nothing changes?"

I remember an elder care manager telling me, when my parents were in their version of this situation, that I should get someone else to do the chores and deal with the medical systems; I should do what only I can do - the loving.

Perhaps the most important thing I can do for them is to understand.

I am interested in your advice and suggestions.

Monday, June 2, 2014

Divorce Rates Higher for Older Couples When Wife Becomes Ill

Excerpted from an article in Tech Times:  Divorce Rates Spike Among Older Couples if Wife Becomes Sick

"For older married heterosexual couples, the risk of divorce increases when the wife becomes seriously ill but such is not the case when the husband does.
According to social scientists from the Indiana University-Purdue University Indianapolis and University of Michigan, wives who experience health crises such as heart problems, cancer, stroke and lung disease increase the risk of divorce. Curiously, husbands who experience these life-threatening illnesses do not pose the same effect.
The researchers analyzed 2,717 marriages in the Health and Retirement Study from 1992 to 2010. These couples started out healthy in their marriages and how the onset of a serious illness affected the quality of their marriages were measured in the study."
This study did not analyze why this is so, but researchers speculated that gender norms around caregiving may play a factor.
Duh. You think so!?!??!!
Both Richard and I were surprised and reassured that he was able to be so selfless when my pain condition was at its worst.  He had never been tested like that before.  He was not only selfless, at times he was heroic.
But I always thought that he was the exception.  I have heard from a few blog readers that they too had heroic partners.  I have heard from many more that their (male) partner fit better somewhere on the awkward to negligent scale.
However, to put the entire blame on the male partner or on gender norms misses the way the couple is intertwined and operates as an integrated system -- with each move balanced by countermoves.  The couple dance is a complex one, honed over years of practice.  Illness plays a new tune and requires that the dance change and that couples adapt with new moves.
Illness puts a terrible strain on relationships.  And couples rarely have either the support or the education they need to adapt and weather illness together.  When the well partner feels sustained and engaged, both partners are uplifted.  Likewise, if the well partner is disregarded and disengaged, both partners will sink.
When I appreciated Richard's efforts, he felt seen and needed and could use that to bolster his caregiving efforts.  When I disengaged from him and chose isolation rather than connection, he too distanced.  When we talked about what we each were going through and needed from each other - there was more life force available from which we could each draw.
Has your partner disengaged?  How does that effect you?  Have you given up on him (or her) and sought support elsewhere?  Have you found ways to re-engage with your partner?