Illness Suicide Pact

Warning: this is a tough, sometimes forbidden topic to bring up - the topic of illness and suicide. Raising the topic of suicide is by no means an endorsement of it. And I don't believe that talking or reading about it pushes people to do it. I am a believer that what you don't acknowledge can be more harmful than what you do. In this spirit, I offer an article about a couple who entered into a suicide pact. Read it if you want to. Don't read it if it will disturb you. If you are having suicidal thoughts, please get help - see a therapist, a clergy-person, or call a suicide hotline like the National Suicide Prevention Lifeline at 1-800-273-TALK

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Can you imagine a set of circumstances that would drive you and your partner to decide that double suicide is the only solution left?

I can. It's terrible for a couple to bear the debilitating illness of one partner. When both are sick and suffering, how is that to be borne? Illness, pain, and loneliness without resources or community can make "dusty death" seem like a better place than the "walking shadow" of life. I think some who suffer debilitating illness at some point, maybe only once, think about suicide as a relief.

Most don't take action. Some do. It's not for us to judge. Only to try to hold with compassion the realities of people's stories and wonder along with the writer in the story below -- what went through their minds at the end.
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from News.co.uk. February 11, 2009

Inquest told of couple's suicide pact

A pensioner was found dead in the back of his car following a pact with his wife that they would both end their lives, an inquest has heard.

Dennis Bramble, 85, of Garnett Avenue, suffered from a heart condition and his wife, Dorothy, was terminally ill with cancer. Mr Bramble did not want to be on his own should his wife die.

On the evening of October 6, 2008, the devoted couple had sat in the back seat of their car parked in the garage and taken morphine and temazepam to send them to sleep. It was then intended that Mr Bramble would turn the car engine on.

The following morning Mrs Bramble was found crouched down outside the garage by her daughter, and Mr Bramble was found dead in the car.

A post-mortem examination found he had died from a mixture of morphine and temazepam in his system. The car engine had not been turned on but the car headlights had been.

Mrs Bramble told police that she and her husband had gone into the garage at 6pm the night before. She said she had struggled to get out the car and when she finally did it was daylight and her husband was still breathing heavily, at which point she realized it was all 'going wrong'.

A diary documenting how bad things were for them both was found. Mr Bramble was becoming forgetful and Dorothy was often in agony with her illness.

It is still unclear what was going through his mind at the final moments.

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I'd like to know:

Have you ever reached the point of utmost despair and contemplated suicide? What kept you from taking action? What made you choose life?

This Week's Grand Rounds, Pain Blog Carnival, and a Reader's Book

Is up at The Blog That Ate Manhattan - the theme is food and medicine.

And the monthly Pain Blog Carnival is up at How to Cope with Pain

Also - a reader wrote to me about a book he has written about his struggles with MS individually and with his partner. I have not read the book yet but thought I'd point you to it so you can see if it interests you. Here is his book website:
www.LifeInterrupted-nolonger

Coping with the PTSD of Illness

In a recent post, I wrote about Post Traumatic Stress Disorder and illness. Some people who experience severe stress - war, natural disaster, abuse - continue to suffer even after the trauma has stopped. They may experience PTSD symptoms -- intrusive memories, flashbacks of the events, nightmares, and sleeping difficulties. They may be hyper-alert and startle easily.

I believe serious illness can also result in a PTSD-like responses in both the ill person and the partner. Memories or flashbacks of particularly difficult, frightening, or painful moments can intrude. Both partners can be overly vigilant about the slightest symptoms and fearful of a relapse, even if the illness is in remission or the chronic symptoms are well managed.

What can a couple do to manage these PTSD-like symptoms?

1. Talk about it with each other. Tell each other that you are worried and watchful. Talking about it won't cause a relapse to happen. If anything, it can reduce stress.
   
2. Remind each other that -"That was then, and this is now." Use this phrase almost like a mantra to repeatedly remind each other that the past is past and there is no need to respond in the current situation as if the past were about to resurrect.
3. Get some sleep. Tiredness puts us more on edge.
4. Distract each other. When one partner starts to become fearful or worried, turn on the TV, read a book aloud to each other, go for a walk, talk about the kids or the neighbors, even pick a fight about something petty.
   
5. Speak to a therapist. If you need extra help, get it. There is no need to suffer if help is available.
   

Anorexia and Couples

It always surprises me when clinicians and researchers suddenly decide that serious illness also affects the well partner and that the couple unit is an important healing resource. Here is a story about anorexia and couples.

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Credit: AP Online

Caption

From MYNC.com
UNC Seeking Participants for Anorexia Nervosa Couples Therapy Trial

Feb. 12 7:29 am

CHAPEL HILL, N.C. -

The eating disorder anorexia nervosa has a profound effect not only on the person with the disorder, but also on their close relationships. Spouses or partners of people with anorexia typically have not been included in treatment. This leaves partners in the dark about what is happening and robs the person with anorexia nervosa of one of their greatest potential allies in recovery - the support of a loved one.

Now the University of North Carolina at Chapel Hill School of Medicine's Eating Disorders Program is seeking adults with anorexia to participate in a 20-week comprehensive treatment course that includes couples therapy. Developed by the UNC School of Medicine Eating Disorders Program and funded by the National Institute of Mental Health, Uniting Couples (in the treatment of) Anorexia Nervosa, or UCAN, is the first and only NIH-funded trial of treatment for anorexia that emphasizes couple therapy.

Anorexia is stereotypically thought of as a disease of adolescent girls, but at any given time about half of the patients receiving treatment in the UNC Eating Disorders Program are adults, said Cynthia M. Bulik, Ph.D., director of the program and co-director of the trial. Partners of adults with the disorder want desperately to help but have no idea how and are often afraid of saying the wrong thing. "Anorexia nervosa is a complex disorder even for professionals to treat, so it's completely understandable that partners are unclear about their role and how best to help," said Bulik.

"In the past, families were often excluded from the treatment of adolescents. It's only within the last five to 10 years that we have realized we need to incorporate the family as a major part of treatment for adolescents," Bulik noted. "The same principles hold for adults.

The partner can be a powerful force in the recovery process if we teach the couple how to address the eating disorder together as a team."

Margie Hodgin and her husband Tom, of Greensboro, N.C., enrolled in the trial and completed the couples therapy. "The communication skills and problem solving we learned were great, because one of our biggest problems was that he didn't understand what was going on, and I didn't understand why he didn't understand," Hodgin said.

Hodgin developed anorexia at age 40, during what she said was a chaotic time in her life. She lost some weight because of a stomach illness and liked what she saw, then started dieting to keep the pounds off. When she got below her goal weight "It was on from there," she said. She lost about 40 pounds, more than was healthy.

A Florida residential treatment program helped her a lot, Hodgin said, but her husband felt out of the loop. "He always felt like I wasn't telling him everything, or that I wasn't getting better fast enough,"

She says. "Couples therapy has just given us both a voice and an ability to become better partners and to know how we can help each other. It has taken away the secrecy of everything."

Post Traumatic Stress Disorder and Illness

I recently received an email from a reader of this blog. The author nursed his wife back to health from cancer. Now that she is doing better, he suffers from "shell shock." Her every cough and pain sends him reeling back into the fear he lived with when he thought she might die.

PTSD - Post Traumatic Stress Disorder is a condition that trauma sufferers can experience. It can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD are usually considered to include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled.

Why am I writing about PTSD in association with this man whose wife is a cancer survivor?

Surviving illness, recovering from a potentially terminal disease, finding relief from pain and suffering are all joys to be celebrated. So where does PTSD fit in?

I believe that just as war and violence serve as external threats that damage the body and warp the spirit, so too can debilitating illness serve as an internal threat that harms body and soul. The result of living with this protracted internal threat, illness, can also trigger PTSD, long after the illness has abated or been controlled.

Violence contaminates the lives of its victims. During the abuse or the disaster, there is no escape from either experiencing fear and pain or anticipating fear and pain. One's world shrinks to the size of a tiny circle charged with the terrible energy of violence. Even after the violence ends, its energy continues to saturate the life of its victims.

Life threatening illness, chronic pain, and debilitating health conditions are also violent traumas -- to the body, the mind, and the spirit. Even if the illness is cured or the symptoms relieved, the reverberations of the stress the illness caused can continue for a long time.

When my pain condition was unconrollable and at its worst for months on end, there were no walks around the pond, no movies, no tasty food, no socializing -- there were only degrees of pain. Psychologically, being tortured from the outside may have different meaning than being tortured from the inside, by your own body, but the ongoing stress, exhaustion, fear, and constriction are just as powerful.

And if you share your illness experience with a committed partner, that partner suffers his or her own trauma and also lives inside the circle of fear.

For months, even years after my pain was under control, I trembled at the slightest pain ripple and re-experienced myself curled up on the couch in a fetal ball of hurt and desperation -- a position I could often be found in during the bad old days.

For months, perhaps a year after pain was not the determining factor in our lives, Richard still watched me like a hawk. Scanning. Vigilant. Looking for the tiny clues that used to signal an impending pain attack. I could hiccough, burp, groan after watching a bad movie, or rub my belly after eating too much and Richard would bark, "What's the matter?" as if he were a watchdog on alert. His morning greeting remained, "How are you doing?" for a long time. When he finally switched to "Good morning" we both smiled.

Living with serious illness, suffering the invasiveness of medical tests and surgeries and drugs, waiting for results, living in a closed circle of fear, being unable to govern your own body, enduring pain and exhaustion -- all this is a persistent traumatic ordeal that can result in "shell shock," in PTSD.

In an upcoming post, I will write about what couples can do to address the PTSD of illness.

Grands Round is Up at Emergiblog

It's a good read of this week's best posts from the health blogophere. It's up at Emergiblog

Valentine's Day Wish For You

My valentine to all you couples who are living with illness. May you find respite in each other.

from The Garden of Love
by William Blake

Love seeketh not Itself to please,
Nor for itself hath any care;
But for another gives its ease,
And builds a Heaven in Hells despair.

MBTI & Illness: Judgers and Perceivers

In my previous articles about MBTI, a widely used personality profile instrument, I wrote about the four dimensions of personality preferences MBTI measures and about one dimension in particular - Thinkers and Feelers.

In this post, I write about another dimension of personality preference- the dimension that is about one's basic orientation to the world. Within this dimension people tend to have a preference for either Judging or Perceiving.

Judging does not mean being judgmental. Rather it means that one prefers to move towards organization and closure -- to consider a defined set of options, make a clear choice, and head toward action. A Perceiving preference means that one likes to remain flexible, adaptable, and to keep options open and add choices to the mix.

Neither preference is better. And we all have both Judging and Perceiving capabilities and can be both flexible and decisive. But, we tend to have a natural affinity for one or the other.

I have a strong preference for Judging. Richard has a strong preference for Perceiving.

If I am hungry, I like to decide what food I want, pick a restaurant, and get in the car. Richard likes to play what he calls "the restaurant game." He likes to keep throwing out cuisine and restaurant choices up until the moment we arrive at the door of the restaurant we had originally agreed we would go to. For him, this is creative. For me, this is madness.

How does this Judging-Perceiving difference play out in terms of illness?

My pain condition was (and is) a diagnostic mystery. This meant that I saw dozens of specialists in different disciplines and had dozens and dozens of tests. The ongoingness of this experience and the increasing number of options for diagnosis and treatment pushed me so far out of my comfort zone that I fell off the edge of reason and landed into a stinky puddle of blithering anxiety. I wanted the answer!

In the face of the unknown, Richard was reassured by the plenitude of options. His mantra became, "There's always someting more to try." Each successive doorway was a portal that could lead to something that might work to quiet my pain. Another thing to be tried was another reason for hope.

Understanding MBTI gave us tools and a language for harmonizing our differences. He wasn't a foolish dreamer; and I wasn't a narrow-minded dogmatist. We were just different. I'm a "J" and he's a "P."

Richard learned to temper his plasticity with some empathy for my frustrated drive for certainty. And I learned, when the known doors closed, to find some solace in his faith that something else, some healer or medication waiting just around the next corner, might work.

Couples and Money Management

From Publishers Weekly - a book review about financial management. While not specifically about couples who are dealing with illness, it sounds like a useful resource.

Financially Ever After: The Couples' Guide to Managing Money Jeff D. Opdyke. Collins Business, $16.99 paper (240p) ISBN 978-0-06-135818-0

Opdyke, Wall Street Journal columnist, offers a sensitive and sensible manual for peaceably handling marital finances. Many newlyweds have difficulty handling the transition from being an independent agent, who can overspend like mad or pinch every penny till it screams, to a partner working to manage joint finances—the communication issues that crop up are myriad. When inevitable issues of power, independence, self-esteem, security and control come into play, the resulting arguments or silent avoidance can lead to terrible financial mistakes. Opdyke gives clear advice on managing both the real dollars and the real emotions of personal finance that course through every relationship, including scripts for questions partners should ask about each other's financial history, and gives cogent, easy-to-follow plans for the division of financial duties, budgets, prenuptial agreements and home-buying, particularly in light of the credit crunch. With its compassionate and pragmatic tone, this book is invaluable for newlyweds with stars still in their eyes—and longtime couples struggling to balance the emotional with the financial and ensure a healthy, thriving life together. (Apr.)

Grand Rounds is Up

at Not Totally Rad. It's a good read.

Patrick and Lisa Swayze Face His Cancer Together

From an article in Examiner.com about Patrick and Lisa Swayze's plans for writing a memoir together as they face his pancreatic cancer. This is their way of reconsecrating their relationship and love as they are dealing with the pain and turmoil of cancer.


"Swayze and wife Lisa, gave a touching and powerful interview about their 36 year relationship with Barbara Walters, which aired on January 8th. The couple told Walters about their belief that they were soul mates and had known each other before. Swayze credited his wife's support with his ability to endure and face his illness "with gracefulness."

Lisa revealed that when she first heard the news about his cancer and prognosis she said, " How dare you, you have to stay here." They both agreed that had this situation been reversed, he would have had an angrier reaction than Lisa.Understanding how they each react, can help them better support each other.

The Swayzes are doing many things that are helpful for couples facing a life threatening illness. They are discussing not only the impact of the illness on the everyday functioning of their lives, but also reflecting on how grateful they are for the life they have shared together.

They also recently renewed their wedding vows which can help couples ritualize their commitment to one another. The memoir may also serve as an important way of memorializing and understanding the life they share. The words on the printed page can make their experiences more concrete and provides an enduring legacy in a way that verbalization of their memories can not."

The courage to review their lives together,at this sensitive time, can provide inspiration to other couples who may be fearful that this would mean they were saying goodbye or giving up hope. Although it may be emotionally painful, this shared intimacy can actually be helpful to better cope with the challenges ahead."