Wednesday, October 15, 2014

To Be (Intimate) or Not to Be (Intimate)

As Hamlet said about a quarter of the way into his famous soliloquy"  "...'tis a consummation devoutly to be wish'd..."

Hamlet was talking about death.  That's not the consummation I have on my mind.  I am thinking about physical intimacy with one's partner.  Many couples think that the switch that controls intimacy lives in the genitals and is binary - either on or off, either intercourse or watching a late night TV comedy show.

That switch actually lives in the brain, with hundreds of thousands of outposts permeating the skin.  The brain is the key sexual organ.  It takes its cues from the body, but ultimately the brain decides how much physical contact it wants and when it wants it.

For many couples living with illness, sexual intimacy is problematic.  They physicality of the act may not be possible, may cause pain, or may require activity that is just not on a radar screen already overflowing with medications, side effects, exhaustion, and anxiety.

However, sex is also a bridge.  A way of bypassing practical and emotional turbulence and surrendering to the flow of the physical.  An escape.  A way of connecting and feeling greater than you are separately - beyond the reach of what Hamlet calls the "mortal coil."  Indeed, a consummation devoutly to be wish'd.

So what do you do when illness interferes with physical intimacy, but the yearning for the passion and liberation of sexual connection is still active.  

Of course you wonder -- how can couples be intimate without touching?  The solution lies in using the brain as the sexual organ it is.

Your brain can make anything into something else.  Just close your eyes and imagine a perfect lemon. See the textured skin and the bright yellow color.  Smell the fresh lemony fragrance.  Now imagine biting into it.  Most people, as they imagine the bite, pucker their mouths at the imagined tart flavor.  If we can do all this by putting our minds to a lemon, think what we can do if we just imagine playing sensually with our partner and a sponge or a pile of clean laundry.

Both partners, through the words they use with each other and the sensuousness they can bring to everyday activities, can use their brain to create the feeling of the bedroom anywhere, any time.

Here are some ideas:

1)  You can really look at each other.  You can spend more than .05 seconds glancing at each other's face.  Linger on the the face.  Notice the contours, the textures.  Imagine you are touching through eye contact.  This can be a powerful catalyst to intimacy.

2) You can use language to show that you truly see each other.  In addition to saying, "I love you," you can say, "You are beautiful to me," or "It makes me smile to see you smile."  Use words to convey that you are "home" to each other.  There is no script.  Don't assume that your partner knows what's in your heart.  Speak it out loud.

Of course there are not only loving sentiments in your heart.  You may be carrying anger, fear, and despair.  If you can, put those feelings in a separate compartment, temporarily.  Dig down to wherever you shelter your love and compassion for your partner.  Give voice to that.  There will be other times to discuss the hard stuff.

3)  Coping with the demands of illness can be exhausting and demanding -- both states are antithetical to relaxing and connecting.  Playing together can counterbalance that tension and can lead to emotional intimacy.  Partners can convert the mundane into a playful event.  Loading the dishwasher or cooking together or wandering the aisles of Costco can be a chore, or it can be a time of silliness and connection.  Imagine how children would behave if engaged in any of these activities.  The dishwasher is a puzzle to put together.  Cooking is mud play.  Wandering the aisles of Costco is finding Neverland.  Try not to focus on accomplishing, but rather on enjoying - the activity and each other.

One woman I interviewed for our book said that one of the biggest brain turn-ons she had occurred when her husband was in intensive care after having had open heart surgery.  She was laying on the couch in his hospital room suffering her own pain flares and trying to quell them with an ice pack.  She said to him, "I feel so useless.  I wish there were more I could do for you."  He responded, "Just having you here helps me breath easier."   She said that this was a truly intimate connection, even more intimate than some of their physical love-making.

For some people brain intimacy can be enough, or can be all their physical condition will permit.  For others, brain intimacy can be the runway for physical contact.  In future posts I hope to explore how couples can be physically intimate when illness prevents intercourse.

How do you and your partner "do" intimacy when illness interferes with physical love-making?  How do you use your brain to be intimate with your partner?

Tuesday, September 30, 2014

Coping with the Ups and Downs

My pain condition has a circadian rhythm of its own design.

I used to think pain spikes correlated with increased stress or shifts in the weather or travel.  And that if I could only control for these variables, I could control the pain.  Over the fifteen years I have been living with pain and studying its habits, I now conclude that its vicissitudes are of its own making; or are so multifactorial that any search for a root cause is like trying to find a snow flake in a blizzard.

Pain spikes and declines are just as likely to be connected to the chocolate bar I inhaled three months ago or to a butterfly belching in China.  In other words, I don't really have a clue about why the pain rises and subsides or what gravitational pull it is responding to.

Right now, I am in a period of wellness, of absence of pain.  Hurray!

The tricky part is that I still have the habits my illness taught me.  These habits include:
  • Not making plans to socialize
  • Not buying advance tickets to a concert or play
  • Not exerting scarce energy on cooking or house cleaning
  • Not making travel plans
  • Accepting only shorter term work projects
  • Relying on my sweetie to run errands
  • Relying on my sweetie to comfort me
  • Relying on my sweetie to hold the hope of healing
  • Relying on my sweetie to be the bridge to the outside world
  • Relying on my sweetie...
  • Relying on my sweetie...
In short - counting on my sweetie to be my guardian and isolating myself from the world.

This is neither healthy (for either of us), nor sustainable.  I have been trying to kick the habit of excessive self protection and spousal dependency.  I have been positive self talking myself into more risky behaviors like:
  • Walking alone the endless aisles of the new Wegmans super-store that just opened in my neighborhood
  • Tangling with my health insurance provider to get them to pay their fair share of an out-of-network expense
  • Making a dinner reservation three weeks away
  • Saying, "I can," before I say, "I can't."
  • Doing whatever I can do to make my sweetie's day a little sweeter
Does your health condition (or your partner's) have its up and down swings?  How do you shift between down-time coping behaviors and up-time wellness behaviors?

Friday, August 29, 2014

Learning to Redirect Your Anger

The following is a guest post by a fellow traveler on the road of couples dealing with illness.  Helena Madsen is a wise woman who is the founder of Chronic Marriage whose mission is to help couples with chronic illness build extraordinary marriages.   Helena is a wife, mother, counselor, and writer who lives with Limb Girdle Muscular Dystrophy.  Get her free resource guide:  For Better or Worse: A Guide to Talking About Illness in Your Marriage.  

In this guest post, Helena offers perspective and advice about managing anger in your relationship.

If there’s one emotion that seems to surface repeatedly in marriages with chronic illness, it’s anger!

You’re angry at your illness and all that you’ve lost – strength, vitality, roles and routines and specific plans for the future. 
You’re angry at your spouse for not always understanding what you need.    
You’re angry that others view you as less dependable or competent because of your limitations. 
Your spouse is angry that his wife is no longer interested in sexual intimacy.
He’s angry that most of the household and parenting duties now fall on his shoulders.
He’s angry that he can’t alleviate your physical pain no matter how hard he tries. 
Both of you have plenty of reasons to be angry.

Anger is not bad.  It’s merely an emotion and a signal that something is uncomfortable, wrong, or undesirable. 

Unfortunately, many people do not process their anger well in the heat of the moment.  When you’re angry at the illness, you often rage at your spouse instead.  Misdirected anger causes you to wound the person you love the most – your mate. Repeatedly lashing out does two things – it weakens your relationship and makes you appear unsafe to your spouse. Both are tragedies. 

Is there a better way to handle anger over your illness?  Yes. 

The most effective way is to distance yourself from the illness.
By that I mean regard your illness as a distinct entity apart from yourself. View it as the third party in your marriage with its own needs and demands.

Marsha and Bob struggled with misdirected anger for years after she was diagnosed with Multiple Sclerosis (MS).  Whenever Bob expressed any frustration with Marsha’s illness, Marsha interpreted it as a direct affront on her character.  The message she received was that she was somehow a failure or disappointment for having MS.  Feeling hurt, Marsha would unleash her anger on Bob who would then strike back. 

Neither Marsha nor Bob knew how to talk about the illness in a healthy way.  Most of the time, they chose not to talk about it until they got to the point where their pain was intense enough that it threatened to swallow them up. 

In counseling, they learned how to take a step back and view the MS as separate from themselves.  Their counselor suggested they view it as an uninvited yet permanent guest in their home.  This idea of a demanding houseguest who refuses to leave was so helpful to Marsha and Bob that they decided to give him a name - George.  Whenever one of them was angry or frustrated with the MS, they gave themselves (and each other) permission to express their true feelings about George.  It allowed them to remain true to themselves and yet not wound each other at the same time.    We may view naming an illness George as silly but for Marsha and Bob, it was effective.  They were at last able to separate their anger towards each other from the anger towards the MS.

What are some other helpful ways to avoid misdirected anger?

- Remember that anger is a secondary emotion

Anger isn’t the first feeling to come, although it’s generally the first one we express outwardly.  Wherever it surfaces, another emotion already existed.  Because emotions like rejection, loneliness and sadness are so strong and painful, we substitute anger because it makes us feel less vulnerable.   
We falsely believe that anger helps us feel in control when we’re feeling out-of-control and powerless.  The first question we need to ask ourselves when we feel ourselves getting angry is “What’s going on inside that’s making me angry?" To resolve your anger, you need to identify the root reason for it.    

Consider using the Anger ABCDs
The Anger ABCDs help you deal with your anger in a basic and easy-to-follow format:
1) Acknowledge that you're angry.  Don't deny it or stuff it; accept and acknowledge it.
2) Backtrack to the primary emotion.  Ask yourself: Why am I angry? What am I really feeling? What is the root reason for my anger?
3) Consider the cause.  Ask yourself: Who or what caused it to occur? Who or what frustrated me? Who hurt or wounded me?  What plans fell through?  What happened?
4) Determine how best to deal with it.  Ask yourself: How should I respond? What should I do? When? How?  

What role does anger play in your relationship and how do you handle it?

Tuesday, August 26, 2014

Sweating the Small Stuff

I had a Hungarian grandmother.  I can still see her strong arms rolling out a sheet of dough and cutting it in strips for her sweet cheese and raisin kugel (casserole).  And if the wind is right, I can just about smell the secret spices in her chicken paprikash as it bubbles on the stove.

She also gifted me with her white glove test.  You know -- running a gloved finger over a counter top to test for spotlessness.  Her standards for cleanliness bordered on psychotic.  Dust and dirt specs did not stand a chance.  They were captured and ejected almost before they hit the floor.  If she had a mop in her hand, you wanted to be sure you were in another part of the house and not vulnerable to her manic, but oh so powerful, swings.

I am not like her.  I swear.  My standards are lower.  I let dust settle for at least a few hours before I banish it.  OK.  I like clean.  To see a string of rooms, all in order, with floors shining and  pillows plumped, gives me ridiculous satisfaction.

Part of this tendency comes from grandma.  But another part of it comes from being sick.  When I get stricken by a pain flare up, I go down.  I tend to spend a lot of time in one place trying to relax the pain away or drug it down.  My world shrinks to the room I am in, and my safety totems become the objects in that room.  Clean space matters.  It gives me hope.

So when Richard, my husband, puts a wet drink glass down on our granite counter top, again,  after I've asked him not to three times in the past ten days, I get upset.  It leaves a circular ring where the base of the glass rests on the granite.  And it takes work to make the mark disappear.  I really do get upset, and I insist on showing him how hard it is to remove the mark.  I ask him repeatedly, "Why do you have to leave a wet glass on the countertop?"  A silly question, I know.  What could the answer possibly be?  "I was attacked by an army of dust mites and had to put the glass down to defend myself!"

It doesn't really matter why.  What matters is that he caused a disturbance in my spacial equilibrium.  If my home is in balance, maybe I can be too.  If everything is in its place, maybe my pain will also be in its place - in a corner of a locked and forgotten trunk in the recesses of a dark basement room.

Sometimes it's OK to sweat the small stuff.  Some small stuff has meaning and is worthy of attention.  And if you allow yourself to be curious about the small stuff, it may just reveal its underlying message to you.  The message that says: "You're OK.  And it's OK to get upset because this means something to you."

Sometimes a glass ring on countertop is more than just a glass ring.

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.