While this article doesn't refer to illness, I thought it might be interesting to you for it's take on how to thwart divorce. Divorce and serious illness are not strangers to each other. In one study, when the man became ill, only 3 percent experienced the end of a marriage; but among women, about 21 percent ended up separated or divorced.
.....A relationship does not just end over night. It takes time. But there is that point in the relationship where the marriage "jumps the shark," as they say. It's often that one thing that happens over and over again, without the ability to change or compromise, and both partners emotionally close down on each other.
So when that one thing comes up, instead of shutting down, putting up your dukes, or setting down your battleground lines--basically letting your ego take over--what if that moment, when everything started going haywire, you actually do the exact opposite of what you normally do? What if, instead, you thought to yourself, "What does my partner need right now, what does my partner need today that makes them feel loved, and how can I provide that for them?"
So many times we really do know how to love the other partner, we know what they need and how to provide it. But we refuse to do those things because they're not doing things for us, they're not giving us what we want. That's probably how the majority of relationships end. The If-you-don't-do-it-for-me-I'm-not-going-to-do-it-for-you syndrome, and then a couple years later you're divorced, angry, pissed off, and ready to start over with the hope of a fresh new relationship. One that will probably repeat itself if you did not learn the lesson the first time around.
We refuse to love our partner the way they need, so the battlegrounds are drawn. Once the battlegrounds are drawn, you can kiss that relationship goodbye because there is no way in the world you're going to give in at that point. And neither is your partner. It often becomes a very dangerous tit-for-tat game that has no chance in hell of ever surviving or finding the love in the relationship again.
Relationships are a beautiful thing, and we could cut down on the divorce rate dramatically if we just spent a little bit of time every single day loving our partners instead of responding by how they treat or have treated us.....
While hiking a steep mountain trail on vacation in Acadia National Park in Maine, my foot found the only rock with slime on it. I went down with a bang and dislocated my shoulder.
Richard and I had to hike back up to the road and hail a ride to the local hospital. Now, I've known pain, years of it. But this pain was a new taste treat and had me groaning and cursing and counting down the seconds until the nurse dripped some morphine into my vein, and then some more.
They were able to relocate my shoulder fairly easily and with that, the pain subsided.
Richard was by my side throughout -- helping me hike to the road, holding my stuff, sitting by my bed in the hospital. He was present and hugely helpful. And as the days passed and I had to learn to meet the world left-handed, he continued to be responsive to my requests for assistance and to problem solve.
He was wonderful, but I felt alone and wanted more -- and illegitimate for feeling greedy when he was trying so hard.
What was missing for me was overt empathy. At the same time I worked to be independent and do it all myself, I was a wounded bird who just wanted to be sheltered and babied. I did my best to tie my shoelaces one-handed while trying to ignore my yearnings to have my needs anticipated without speaking them aloud and to be cuddled and coddled and told that it would all be OK.
After a few days, I could no longer sustain this inner tension. I was growing weary of the strain and resentful of Richard's helpfulness without emotional empathy. We finally had a talk.
I tried to tell him what I was missing without blaming him for not providing it. I cheered his efforts at practical support and told him, as explicitly as I could, that I both accepted him and loved him, and still felt the sadness of not getting the kind of loving my injury had awakened.
He listened. And he tried to give me more emotional support. When he saw me struggle to wrap my sling around my shoulder he said to me, "I am so sorry you're having to go through this. I wish I could make it all better." His saying that made it far better for me than any attempts to help me adjust my sling.
The more I thought about the specifics of my current situation, the more I realized that the condition of being in a close relationship periodically involves the existence of a gap between what you get and what you feel you want. The gap of life.
The tricky part is not to deny the reality and legitimacy of your wants; while at the same time not punishing your partner for not fulfilling them and (and this is the trickiest bit) accepting him, with love and gratitude, for who he is and for staying in the conversation with you.
To hold both the love and the sadness, and sit side-by-side in the gap of life, together.
A study of older married couples that gives new meaning to the matrimonial adage “for better or worse” finds that spouses have a much greater impact on their partner’s health than previously known.
The study, published in the current issue of the American Psychological Association’s journal Health Psychology, finds strong associations between the physical and emotional health of older married couples – and provides important new information on the psychological toll of physical limitations in old age.
Researchers from the University of British Columbia and Pennsylvania State University tracked the emotional and physical histories of more than 1,700 older couples over a 15-year period, using data from a major U.S. survey. Participants ranged in age from 76 to 90 and many had been married for more than 40 years.
In individuals and couples, the researchers found a strong relationship between “depressive symptoms” (unhappiness, loneliness and restlessness) and “functional limitations” – the physical inability to perform such basic tasks as climbing stairs, picking up objects, cooking and shopping. While previous studies have linked physical and emotional health in individuals, this is the first study to show the phenomenon in couples.
“This study shows how important marital relationships can be in determining old age health,” says lead author Prof. Christiane Hoppmann of UBC’s Dept. of Psychology. “In addition, we show that many of the associations between functional limitations and depressive symptoms that have previously been found in individuals are in fact related to spouses.”
The researchers found that spouses’ depressive symptoms waxed and waned closely with those of their partners. Functional limitations in one spouse was not only associated with their own depressive symptoms but also with depressive symptoms in the other spouse. Increases in depressive symptoms in one spouse were also associated with greater functional limitations in both spouses.
“When people are depressed, they tend to want to stay at home – but that causes a spouse to stay home more too,” says Hoppmann. “That’s a problem, because when older adults stop being active – going for walks, socializing, shopping – they risk losing that functional ability. It’s that old saying, ‘use it or lose it.’”
“These findings help to illuminate the often vicious cycle between depressive symptoms and our physical abilities,” Hoppmann adds, noting that associations remained after controlling for individual (age, education, cognition) and spousal covariates (marriage duration, number of children) and did not differ between women and men.
Surprisingly, the researchers found that the relationship between depressive symptoms were slightly stronger in couples than some individuals, suggesting that a spouse’s physical or emotional health can have a greater impact on their partner’s health than their own in some cases.
“Being married for a long time is a very specific situation, it really ties your lives together,” says Hoppmann, whose previous research has explored happiness in older couples. “These findings show just how interdependent, emotionally and physically, long-term couples can become.”
Hoppmann says the findings point towards a greater need for holistic healthcare approaches. “This interdependence suggests that we cannot simply focus on individual patients, while disregarding the major impacts their illnesses can have on the people in their lives,” she says, noting studies have shown caregivers to be at a greater risk for mental and physical health problems.
The researchers – which include Anita Hibbert, a graduate student in UBC’s Dept. of Psychology, and Prof. Denis Gerstorf of Pennsylvania State University – say further studies are required to determine whether these spousal associations are specific to long-term married couples and whether they generalize to aging Baby Boomers who enter old age with more diverse relationship histories, including divorces and remarriages.
Sorry for the short absence. Richard and I were helping my mother transition into an assisted living facility and sort out her medical needs. About six months after my father's death she hit the "alone" wall. Not loneliness, which can be tempered by social activity - but alone-ness. She became afraid.
She and my father were not very compatible. She experienced his questions about her activities as attempts to control her, and he experienced her wordless, stone-faced responses as either not having heard his question or as not having done the deed he was asking her about. So he would ask again, and again, with increasing impatience -- especially after he became physically disabled during the last two years of his life. And she would get stonier and stonier. You can see the endless, disappointing (to me) loop.
At the six month post-death point, it wasn't that she missed him or had regrets that disturbed her quietude, it was that she started becoming afraid of being alone. The night-time what-ifs intruded more and more into her awake time. What if I fall? What if I can't reach my cell phone? What if my alert necklace doesn't work? What if there's a hurricane? What if something happens and there's no one there?
So, we helped her move into an assisted living, where she is much more tranquil.
As we helped her settle in, I wondered: Must illness exacerbate the destructive behavioral and emotional patterns couples used during their healthier years? Does illness need to be the final stage on which the partners enact the same old script that locked them into battle or silence in healthier days? Or can illness be the catalyst that bulldozes the destructive relationship loops and spirals and clears a path to more nurturing interactions?
What is your experience? Can illness change relationship patterns for the better; or does illness just exacerbate the pre-existing negative behaviors?
The long haul of chronic illness can be back breaking work, for both partners. It certainly takes a physical toll. Couples know too well the exhaustion of dealing with symptoms and daily responsibilities, which don't wait for flare ups to quiet down. Illness certainly takes a psychological toll as roles shift and communication channels get clogged with emotional static.
Sometimes it doesn't take a big thing to break the tension and reduce the stress. Sometimes a very little thing can create a momentary oasis whose restfulness and beauty can then trickle back and lighten the ordinary for a while.
For me it's making sure we always say good night to each other, out loud and with intention. It's also laughing together, about anything, especially something silly or raunchy.
What about you? What are the little things that make a big difference?
The piece below is from a site called Zikkir, which seems to be an aggregator of news stories.
I'd be interested in hearing your advice about how to tell a potential partner about your health situation. -----------------------------------------------------------------------------------
1. Practice what to say Before you drop a bomb on a potential mate, rehearse your speech with a trusted friend or visit a therapist to talk it through, suggests Ken Robbins, MD, a clinical professor of psychiatry at the University of Wisconsin–Madison.
“It’s good to have somebody as a sounding board in a situation like this,” he says. “How you handle this is not something your partner is likely to forget.”
Laurie Davis, an online dating expert based in New York and Boston, suggests asking a friend what sounds most intimidating about your condition and getting his or her advice on how to smooth it over. Getting a second opinion can help you decide how much to say (and when and where to say it), and running through your script a few times can make you more comfortable sharing your story.
“You don’t want to overwhelm your partner but you want to be sure to give him or her all of the important facts,” Davis says. “You should definitely practice before you tell your match, or you’ll most likely fumble through the conversation uncomfortably.”
Mark Snyder, a 32-year-old writer from New York City, used to dread telling a new boyfriend that he was a recovering alcoholic. “I don’t think I was ever able to shake off the feeling I was springing the information on him, usually when we were either out to dinner and he wanted to order a bottle of wine, or at a party where alcohol was introduced,” he says. “I often blurted out, ‘Oh, I don’t drink. Sorry.’”
That changed, however, as he got used to talking about his condition. “As time went on, and I got more comfortable with this side of my life, so did the ease with which I told a man not to expect a tequila-scented smooch at the end of the night,” he says. “I realize my blurting-it-out style was my own insecurities about sobriety. I celebrate it now.”
2. Never tell on a first date “Never tell someone on a first date,” Davis says. “The results will never be favorable.”
Dr. Robbins seconds that, especially if you’re worried that your health secret “is likely to define you before the person has gotten a chance to know you at all.”
That doesn’t mean you should lie—just let your partner get to know you first. “[Revealing too much too soon] may color how your partner sees you,” Dr. Robbins says. “It defines you before you’re ready to be defined.”
Jenny*, a 25-year-old graduate student from New York, had a breast augmentation when she was 19. “I don’t really bring it up, not when I’m first dating people,” she says. “But I’ve had people ask and I’m always honest with them. I wouldn’t see a reason to keep it a secret, especially if we’re getting serious.”
If you’re worried that your health secret might be a deal-breaker, you’ll want to ‘fess up by the fourth date, says Rachel A. Sussman, LCSW, a New York City therapist and relationship expert. That way, if your secret does make a big difference, you won’t have wasted too much of their time—or yours.
“Of course it can be painful, but if that’s the case, it’s better to know before you get too involved,” Sussman says. “It’s complicated if you withhold it and they find out too late. Dishonesty can ruin a potentially good relationship.”
Jill*, the 33-year-old from New York City, is currently in a long-distance relationship. However, she hasn’t told him about her bipolar disorder —yet.
“Too much too soon is not a good thing…. [But] I truly believe when you share a life with someone, you need to be in it together,” she says. “Men go bald; women gain weight after pregnancy. It’s not all roses and Champagne.”
3. Be casual yet confident So exactly how does one reveal a secret without just blurting it out? “It’s hard not to kill the mood with your health secret, because it’s probably not something that can be easily segued from a topic you would normally discuss,” Davis says. She recommends a conversation bridge, such as, “I feel like we’re heading in a great direction, so I wanted to tell you something.”
Just don’t overdo it: “You don’t want to frame this in a way that ends up making a bigger deal of something you don’t want made into a big deal,” Dr. Robbins says. In other words, make your delivery as drama free as possible.
Allison*, a 30-year-old marketer from Baltimore, tries to casually tell dates about her multiple sclerosis.
“Usually I’ll work it into another aspect of our conversation,” she says. “It’s a lot easier to tell someone I have MS as a side note in a conversation than to sit down and have a formal discussion focused solely on MS.”
However, even a casual, well-prepared speech doesn’t always meet with success.
“One guy just clammed up and didn’t want to say anything or go anywhere because, in his eyes, I might get hurt,” Allison* says. “And another guy became very controlling and tried to tell me what I should and shouldn’t be doing for my health. Um, you’re not my doctor, dude.”
Allison’s dates probably have their heart in the right place. “They’re trying to be helpful because they care about her,” Dr. Robbins says. He suggests that she have a confident, straightforward response about how she would like them to react; something like: “I don’t see this as something that defines me—but if I need help, please leave it to me to ask.”
4. Don’t have this conversation in bed—or anyplace you associate with intimacy Although this is a good guideline to follow when dealing with all types of relationship secrets, there’s only one instance in which it is a hard-and-fast rule, Sussman says: “Don’t wait until you’re naked in bed with someone to tell them you have an STD.”
That’s true for any condition, Davis adds. But Dr. Robbins notes that if your health secret is a sexually transmitted disease, you’re going to have to open up to someone sooner rather than later.
“If it’s something that’s going to have a direct effect on your partner, it’s something you’re going to want to talk about sooner, as opposed to an illness that isn’t contagious,” Dr. Robbins says. “If it’s something like hepatitis C, you really do have to talk about that very early.”
Amy, a 29-year-old graphic artist from Chicago, jokes that hepatitis C is the only thing she has in common with Pamela Anderson. But she’s serious when it comes to telling boyfriends about her illness, which she got through a blood transfusion at birth.
“There is less than a 3% chance of transmission within a monogamous relationship, but I’ve always been truthful and upfront about it, whether I ended up in a sexual relationship with someone or not,” she says. “They have a right to know.”
An ideal place to tell someone about your health secret—whether it’s a communicable disease or any other condition—is a park, Davis says. Just make sure there’s no one within earshot.
“Do not tell your partner during intimacy. Telling your partner your health secret means you are opening up to them, trusting them, and becoming more vulnerable,” she says. “The place you choose to tell them should reflect this.”
5. Seek out relationships online If you tend to meet potential partners through online networks such as Facebook or Match.com, you shouldn’t hint in your profile that you’re concealing a health secret. However, if you’re nervous about rejection or misunderstandings, you might be more comfortable dating someone with similar health issues.
There are many niche sites that cater to people with specific conditions, and they’re a great way to be up-front with potential mates who are in the same boat, Davis says.
6. Know when to give your partner space Even if you do your best to deliver a snag-free speech, it’s possible that there could be an awkward moment. “[If that happens], say, ‘I can tell by your expression that this is a lot to digest and I completely understand, and I’ll give you the time and space to do that,’” Sussman says.
Then, offer some physical distance but stay in contact, Davis says. “Give them the following day to breathe and think,” she suggests. “Call them on the third day if they haven’t reached out to you. Let them know that they are still on your mind and you can’t wait to see them again.”
7. Don’t take rejection personally “A good person will listen and be kind and not judge, but if [your health secret is] something they can’t live with, that doesn’t make them a bad person,” says Sussman. “It just makes them a bad match.”
And there can be multiple reasons for a rejection—many of which have nothing to do with you at all. “If your mother was an alcoholic and you date someone who’s an alcoholic, you might have to make a choice that it’s not healthy to be involved with someone in recovery,” Sussman says.
Besides, your perfect match will accept you no matter what, Davis says: “If things were going well up until the time you told them, keep in mind that they rejected your health condition, not you. At the end of the day, it means that they were not the one.”
8. Accept support Tiffany Sanchez Conover, 28, a store manager from northern Indiana, settled into a deep depression after her grandmother died. She slept all day, stopped eating, and became socially withdrawn—even with her husband. Still, she kept her depression hidden, because she wanted to “figure it out on my own.”
“[Eventually] I felt like I had to tell him because I could feel the strain it was placing on our relationship,” she says. “A person can only take so much of their spouse not wanting anything to do with them before they start assuming the worst, an affair.”
Tiffany’s husband was hurt that she hadn’t told him earlier, but he was glad she finally confessed. “After I told him, he was as supportive as could be,” she says. “He would stay up late to talk with me just so I wouldn’t feel lonely late at night, even though I’m sure he really wanted to go to bed.”
It’s especially important for married couples to be open to avoid hiccups in the relationship, Sussman says. “In healthy marriages, people lean on each other and are honest with each other,” she explains. “You can never lose by being honest.”
Tiffany knows that now: She and her husband recently went through a series of failed fertility treatments after finding out she likely cannot have children on her own. “I probably share too much now,” she says, laughing. “But it works for us. If I didn’t tell my husband how I felt about it all every day, I probably would end up depressed again.”
A counselor also helped Tiffany to get through the initial rough patch. Therapy and support groups —whether online or in person—are excellent options, according to Sussman. “Name the illness and there’s a support group,” she says. “If you go to your supportive community, you’ll hear stories of how people have handled these things in the past.”
Damn. I had been doing so well for so many months. Then WHAM. From nowhere. The pain started snaking its way back in. Was it the stress of a presentation I had to make in front of a prospective client? Was it the humidity? The unseasonal chill in the air? The baba ganoush?
My first reaction is to churn with anger. No. Not now. Go away. Damn you to hell.
But then I realize that the anger only riles up the neurotransmitters that fuel the pain. And besides, the pain is part of me, and there's no sense in raging against my self.
So, what do I say to myself to get through this episode? This may sound a bit crystal-headed, but it works for me. I say:
"All the healing forces in the universe pass through my body."
With each breath, I take in the surrounding molecules and the ones they have come in contact with, and the ones they have come in contact with, and the ones they have come in contact with - to the end (or the beginning) of time and space. It all flows through me. And some of it must be healing.
What do you say to yourself when you have a relapse (or when your partner does)?
Judith S. Wallerstein and Sandra Blakeslee, authors of The Good Marriage, identify nine specific tasks couples must tackle in order to create a good marriage. The fourth task is a tough one: "to confront and master the inevitable crises of life, maintaining the strength of the bond in the face of adversity." This is probably the last thing a young couple is thinking about when they fall in love and look at each other-and life-through rose-colored glasses. But there is no doubt they will have to deal with some serious issues during the course of their marriage.
It's sometimes said what doesn't kill you makes you stronger. The same thing can be said about a marriage: tragedies, crises, difficulties have the potential to make or break a marriage. Couples will face illness, death of loved ones, loss of jobs, problems with children, and a host of other challenges throughout the course of a lifetime. The couples who pull together in times of trouble follow certain steps, according to Wallerstein and Blakeslee. First, they look at the situation realistically and are able to think how their lives, and the lives of other family members, would be affected. They avoid"awfulizing" the situation: while they recognize the realities of the challenges they are facing, they're able to also take time out from dealing with the problem and try to enjoy life.
They don't blame each other or say, "I told you so," because they know everybody's human and prone to error. "In fact, they went further by trying to protect each other from inappropriate self-blame," the authors said of the couples who managed this task successfully. "They protected each other against self-reproach and shame." But they don't have to pretend everything is hunky-dory: they are able to acknowledge their fears, anxiety, sadness, and anger in appropriate ways, and sometimes not so appropriately. They can allow themselves, and their partner, to lose their cool once in awhile (without being abusive) and not take it too seriously.
Finally, "they blocked the crises they could see coming," said Wallerstein and Blakeslee. "Rather than waiting until a spouse's drinking or acting out or depression was overwhelming, they intervened at an earlier stage." They don't allow their partner to go over the edge in response to whatever crises is at hand: they let them know how much they care about them, and also let them know they will not stand by and watch their partner self-destruct.
I know this is an odd question. For many of us, our conditions don't necessarily disappear, but maybe they do fade in and out. Perhaps some of you (both the ill and the well partner) have luckily had the experience of being without symptoms long enough so that you can think of life as a journey and not just as an intermission between pain or fever spikes.
I had the good fortune of being in a symptom free phase for a few weeks and I started to notice that I was forgetting to do things like a sick person. I wasn't planning my days around the phases of pain. I bought tickets to a play three weeks ahead -- not out of hope that I would be ok, but out of forgetfulness to take my condition into consideration. Out of the irrelevance of pain.
One day, perhaps perversely, I starting reflecting on the question: "What do I miss about my pain condition?" I realized that I missed a kind of intimacy I had with Richard when pain was the major force in our relationship.
We see each other a lot more when I'm in pain, mostly because I don't really go anywhere. And we sit quietly, in the same room, not necessarily talking or reading -- just being. It's not that I want pain back so we can reclaim this kind of intimacy. I just want to remember to call on my consciousness to create this intimacy and not wait for pain to dictate the terms we engage on.
What does your illness do for you? What do you, or would you, miss about your illness should it fade for a week or two?
Both Richard's parents died before I met him so I have no in-laws. My own parents were in their 70's when I first developed a chronic pain condition. Their reaction was surprising, although it shouldn't have been. They both backed away and assumed that Richard and I would handle it just fine.
We were not a family that discussed personal matters, and I guess illness is a personal matter. Or perhaps more accurately, the illness of an adult child, which in my family's taxonomy falls into the category that contains topics like sex, birth control, divorce, and emotion.
I think that my parents' reluctance to dive into my illness any more deeply than asking "How are you?" does not stem from indifference or callousness. Quite the opposite. I think it is their way of defending themselves against the consummate horror of knowing their child is in pain and getting sicker, and they are helpless to make it all go away.
Eventually they began phoning more frequently. My mother started sending me quarts of her home-made pea soup by mail (she shipped them frozen overnight and they would arrive partially thawed). I always felt their love, if not their caretaking.
What has been your experience (both as the ill and well partner) with parents and in-laws?
In a previous post I described levels of "jerkiness" in the well partner -- from unaware to indifferent to downright mean. Of course, the ill partner can act like a jerk too, but that's a topic for another post.
The first suggestion I offered (in part 1) for dealing with a well partner who is acting like a jerk is to try empathic communication. The second suggestion (in part 2) was to turn away from your partner's darkness towards the sources of light and support in your life. In this post I will offer the third suggestion -- couples therapy.
When your interactions with your partner are filled with more acrimony than sweetness, when even seemingly benign requests - like please take out the garbage or can you drive the kids to school this morning -- feel like they carry implied criticisms, when you say more to your pillow than to your partner -- it is time to consider couples therapy.
When silence stretches for days and is used as punishment, when you lose interest in doing the activities that used to be mutually enjoyable, when you exhaust your precious energy on pleading, cajoling, and berating, when there's been an affair -- it is time for couples therapy.
Why am I suggesting couples rather than individual therapy? Because if there is hope that the relationship can be renovated, it lies in working together, not apart. The problems manifest in the couple relationship, and it will take the will and insight of both partners to resolve them. Individual treatment may be a useful accompaniment to couples work at some point, but not at the start.
What happens in couples therapy? Both partners get to tell their stories, uninterrupted. But perhaps, more importantly, both partners learn to listen to each other. And with guidance, they learn how to communicate the often painful truths in ways that the other partner can hear. So instead of firing random shots about peripheral matters because of deeply held anger -- anger that's really about the illness, about unfairness, about the past -- partners learn how to address feelings and issues directly. They learn how to love and how to fight.
One of the greatest gifts Richard and I received from couples therapy we did decades ago was to learn how to "speak the unspeakable," to always talk with honesty and as much empathy as we can muster about our disappointments and heartaches with each other. We learned that it was the unspoken that caused damage, not the spoken.
How do you find a couple's therapist? Ask people you know for recommendations. Ask friends, doctors, nurses, physical therapists, clergy. Don't rely on advertisements or lists of approved providers. Dig deeper. The most important factor is that the therapist has indeed worked with lots of couples. Interview the therapist over the phone. Ask questions like -
how long have you been in practice?
how many couples have you worked with?
have you ever worked with couples and illness?
how would you describe your approach or style with couples?
how much do you charge?
what insurance do you take?
do you have any questions for me?
As you talk to the therapist, pay attention to your own inner intuition and feelings. If you get a sense that the person is "right" for you and your partner, set up an appointment for an initial meeting.
Couple's therapy may or may not help your situation. There's no guarantee. But if you both still want to try to make your relationship better, it's worth a shot.
I occasionally get emails and phone calls from people who are living with an illness who tell me about their well partner. In their stories, their Mary or Bob or Pete (fictional names) sounds like a real jerk. Of course, the ill partner can behave like a jerk too. But I'll write about that in another post.
Mary (let's give her that name) is indifferent to his illness. She doesn't ask questions like, "How are you feeling today?" or "What did the doctor say?" She ignores the topic entirely, as if it's a pile of dog poop she's stepping around. She goes to work, stays late, watches TV in the evenings and reads the newspaper on weekends. Sometimes she's having an affair with a healthy, younger man.
Bob (let's give him that name) goes one step further. He doesn't really believe his mate is sick, or as incapacitated as she acts. He accuses her of malingering. He thinks she needs to get up off her saggy ass and just do it. Just do the housekeeping, the grocery shopping, get a full time paying job, manage child care, and appreciate how hard he works to bring in some money. Bob is angry. He believes that his paycheck is his contribution and blames her for not rising above her illness to take better care of him and the household. He often tell her that "it's all in your head."
Pete is downright nasty. He'll tell her he'll come to her medical appointment and then will be a no show. When she asks him, "What happened?" he either says, "What appointment? You never told me" or "Something came up." Pete will point to her constant tiredness or repeated trips to the doctor and accuse her of being selfish. He will withhold affection. He will walk out of the room when she shows signs of exhaustion or too much pain. He will be kind to other unfortunates and small animals in front of her.
How can the ill person cope when the partner is acting like a jerk?
There are three options. Whether they can help or not of course depends on how willing both partners are to listen and change direction. Sadly, reconciliation may just not be possible for some couples. For others, though, tearing through the layers of silence and distance and consciously shifting communication patterns may help.
1) Empathic communication initiated by the ill partner. The main theme of this blog is that when illness falls into a relationship, it resides in one body, but two lives are dislocated. The well partner's present and future have also been rescripted, without his permission. He may be angry, afraid, ashamed, alone and unable to do anything other than instinctively fight or flee the threat, which he now sees as embodied in his ill partner. Empathizing with his emotional pain, especially when he is expecting blame, can potentially catalyze a shift in the toxic patterns that have gotten established. It doesn't make it all better, but it can create a starting point for the work.
Now this may seem almost impossible to do when you are the ill partner suffering the double whammy of illness and anger/hurt at your well partner. And you may even, covertly, have become invested in raging at his mistreatment instead of looking in the direction of your own fears about the illness or at the fractures that have existed for years in your relationship.
But if you can say to him, "Sweetie, I'm so sorry that my illness has caused you unhappiness and has disrupted your life." "I know you may see me as selfish or not trying hard enough and that must make it even worse for you." "I'd like to try to make things better." "I'd like to hear what this has been like for you - can you tell me?" Then you listen, with empathy. Isn't this what you'd like to hear from him? Over time, with repetition, this kind of empathic communication may become two-way and may lead to a mutual desire to build more companionable patterns into your relationship.
The two other options are:
2) Turn away from his darkness and towards sources of light. 3) Get professional help in the form of couples therapy.
Both these options will be described in a subsequent post. Stay tuned.
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?
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.
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.
Get some sleep. Tiredness puts us more on edge.
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.
Speak to a therapist. If you need extra help, get it. There is no need to suffer if help is available.
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.
The Myers-Briggs Type Indicator (MBTI) assessment is a psychometric questionnaire designed to measure psychological preferences in how people perceive the world and make decisions.
There are four dimensions of measurement. We each have qualities of all dimensions. But just as some of us have a dominant right or left hand, even though we use both hands all the time; we tend to have preferences for certain MBTI types.
THE FOUR MBTI DIMENSIONS
Extroverting <---> Introverting Which has to do with where you get your energy. Extroverts recharge when they're around people and they tend to think out loud. Introverts need alone time to recharge and they tend to process internally before speaking.
Intuiting <---> Sensing Which has to do with how you take in information. Intuitive look for the big picture and patterns (the forest). Sensors look for the details (the trees).
Thinking <---> Feeling Which has to do with how you make decisions. Thinkers use data to analyze situations. Feelers look to their intuitive gut responses.
Judging <---> Perceiving Which has to do with your basic orientation to the world. Judgers like to narrow options, make the choice, act on it, and move on. Perceivers like to keep options open and add more possibilities.
I have heard it said that when couples have different preferences on more than two dimensions, relationships are more of a struggle. Richard, my partner, and I differ on two dimensions, and they bite us all the time. I have preferences for Feeling and Judging. He has preferences for Thinking and Perceiving.
How does this play out?
Feeling - Thinking Scenario
B. (Feeler): Today is not a good day. I'm having some pain. R. (Thinker): Why not try a warm bath, or doing some yoga stretches. That often helps. Or we could watch reruns of the Twilight Zone. That might distract you.
When all I (the Feeler) really want to hear him say is: "Oh sweetie. I'm so sorry you're hurting. I'm by your side."
Judging - Perceiving Scenario
B. (Judging): I don't know what to do? Should I try myo-fascial physical therapy or acupuncture or different meds? I can't stand this confusion. I want to find the one thing that will work!"
R. (Perceiving): You can try them all! And if something doesn't work once, you can try it again later. It might help then. The good news is that there is always something more to try that might help.
B. (Judging): Groan...I just want to figure out what will work!
We are different. I recently wrote a post about how Richard's Thinking preference and my Feeling preference trip us up. I am Deanna Troi to his Mr. Data (for the Trekkies among you).
When you think about your own relationships in an MBTI context - what do you notice about how the differences between you and your partner show up?
Are you both Extroverts, or is one an Introvert? Do you both like to dive into the details (Sensing) or does that make you crazy because all you want is the big picture (Intuiting)? Is one of you a Thinker and the other a Feeler, like Richard and me? Is one of you a Judger who likes to make a choice and move on, while the other, the Perceiver, likes to add more possibilities into the mix and postpone making a final decision (again, like Richard and me)?
And for those of you who seem to be similar to your partner across all four dimensions -- what is that like? I can only imagine.
Disagreements between feuding spouses that continue without satisfying resolution could take a significant toll on one’s health, researchers at Ohio State University conclude. Among those who argued with ineffective conflict management skills, immune systems can be weakened and stress hormones increased.
In two trials involving 120 couples, psychologists found that partners involved in relationship disputes were at risk for sickness. The findings were similar across the marriage spectrum of participants, whether a couple was newly married or wed for many years.
One study focused on newlyweds, the other on husbands and wives married an average of 42 years. Clinicians involved with the study conclude that, with proper conflict resolution, marriage partners can enjoy less stress through real listening and honest sharing of feelings and attitudes. The men studied were more likely to withdraw from or tune out during arguments, while the women were more likely to be distressed about the argument well after a heated dispute.
With the study, mental health practitioners who try to save marriages–counselors, social workers, psychiatrists, psychologists, clergy–now have the science to prove that arguments between couples can lead to battles inside the body. Long term health effects are not yet known.
Ohio State researchers studied many couples, both newlyweds and couples who have been married for decades. They measured the stress hormones in their blood. Couples were brought in for joint counselling sessions on current disputes. Blood was analyzed intermittently.
The presence of the hormones are found to be linked not to the disagreements themselves, but to the way couples fight and resolve (or don’t resolve) conflicts. “They all had a problem that they were talking about, but those who talked about it in a hostile and negative way are the ones who had the negative immune effects,” reports Dr. George Solomon, MD, professor of psychiatry at University of California Los Angeles.
Solomon studies the way in which mind and the immune system interact. He says it’s important for couples to learn how to deal with the conflicts and stress that are inevitable in any committed relationship. In the study of the older couples, abrasive arguments were tied to a weakening of certain aspects of immune response.
Dr. Janice Kiecolt-Glaser, PhD of OSU’s new Institute for Behavioral Medicine Research who was involved in both studies, says that the findings from those headed toward golden anniversaries were more unexpected than the findings from the newlyweds. “You might expect that arguments would have less impact on older couples because they’ve gone through these disagreements many times before and have learned to deal with them,” says Kiecolt-Glaser. “But that’s not the case.”
Besides raised stress hormone levels, the older couples with weaker immune measures also described their usual marital disagreements as more negative.
In the study of newlyweds, researchers concluded that one key to lowering the stress during a couple’s arguments is to concentrate on the issues at hand and reduce the amount of negative responses that result. The style of the fighting is most important. “The sarcasm, name-calling and back-biting are the problems,” says Dr. Ronald Glaser, PhD, another researcher involved in the OSU study.
Of particular interest was the continued elevated stress hormone levels of the women having husbands who withdrew from the arguments. “We’re probably seeing the results of the women thinking about and reliving the argument throughout the day,” Kiecolt-Glaser says.
According to the researchers, while changes in immune response were seen in both newlywed and older couples, the effects may have greater consequences in older people as their immune systems are already waning. “Older adults have greater rates of illness and death due to infectious diseases compared to younger people,” Kiecolt-Glaser says. “Additional stress, such as from marital arguments, may put them at greater risk.”
The Myers-Briggs Type Indicator (MBTI) assessment is a psychometric questionnaire designed to measure psychological preferences in how people perceive the world and make decisions.
But it's so much more than that. It's a relationship emancipator. It's the knife that slices the Gordian knot that keeps partners entwined in endless, repeating patterns of point and counterpoint, argument and escalation of argument. It can take a world of communication trouble, and if you let it, pare it down to its benign and manageable essence.
What do I mean? Here's a light example.
One of the dimensions the MBTI assesses is the way people make decisions. In general, people either have a preference for what MBTI calls Thinking or Feeling. Thinkers like facts, practicalities, data, and analysis. They decide based on what is logical. Feelers like intuition, gut sense, fairness, and harmony. They decide based on what feels right.
I was having a very good, pain-free day and Richard and I decided to do one of the things we love best - go for a hike. The weather was California perfect. One part of the trail took us through a large redwood forest. For miles, we were encircled by these ancient mother trees. One tree in particular had had its lower trunk hollowed out by fire. What remained was the outer trunk and a cavity that was about 4 feet wide and 8 feet high. The space could easily fit three adults.
I entered into this sanctuary and stood silently for a few minutes, feeling part of something primordial and dignified. When I emerged I said to Richard, "Well that was a little bit of the sacred."
Richard entered in to the chamber, turned around a few times, came back out into the sunlight and said, "That place would be a good shelter from the rain if you needed one."
Before we had this language, it was easy for me to experience his responses to my needs as insensitive. It was easy for him to just not understand what I was asking for and to try harder to parse the situation rationally.
"I'm so miserable," I would moan. "I hate taking pills. And I hate having pain if I don't take them."
"What if you tried cutting back on one of the pills and see what happens," he would offer.
"You just don't understand. I hate all this!" I would moan with a little more volume.
"Well," he would suggest a bit more tentatively not sure of what he wasn't understanding, "what if you sliced one pill in half and tried tapering in smaller increments."
You can see where this conversation would be headed.
What MBTI gives us is a decryption key for this kind of interaction. I can now say to Richard, "You're doing that T-thing. I'd like you to try to be more of an F right now."
He can then filter that through his rational mind and say,"Ahh. You need me to say something like, 'Oh sweetie, I know this is so hard for you. You hate everything about having a pain condition. How can I help?'"
I say in a very succinct, practical, data laden way "Yup. That's what I'm looking for." (we Feelers can be logical when we need to).
He searches inside to find his empathy (Thinkers have feelings - it's just not what they lead with). He repeats what he just practiced, but lets it float on that empathy. "'Oh sweetie, I know this is so hard for you. You hate everything about having a pain condition. How can I help?"
It works. I feel soothed. I feel like we are now both inside the redwood together, sheltering each other.
These have been rough times. For the past six weeks, I've been feeling ripples of the old pain coming back. They usually slide around at a level 3 or 4, which means I can still follow a conversation and drive by myself. On some days they crescendo to a 7 or 8, which means I lay very still and try to make myself as small as possible, as if by doing so I can corral the pain into a narrower orbit.
Each day I wake up with the fervent belief that today will be the turning point. By late afternoon, I'm looking at my array of medications and debating whether I should take them in order of potency or just chug them down like a drunk doing shots. Pain will do that to you.
Richard so easily slips back into sage caretaker mode. We have been on this ride so many times that he automatically knows how to balance intrusion and distance. He also know how to ask to be invited to enter my orbit of pain, rather than clumsily assault me with volleys of helpfulness.
He will say, "Can I sit with you now or do you want to be alone?" "Do you want my help to problem solve about medication or do you want me to stay out of it?" "How do you want me to tell you if I think you are making a mistake?" And most of all, "How can I help you, my love?"
His presence, his questions anchor me to possibility, to choices that point to a realm beyond the pain. He can't actively stop me, but his steadfastness deters me from plunging into the vortex, which is always a pain spike away.
These have been rough times. But at least I am measuring this experience by time and not by eternity. I do now know that I will be helped, and I will, thankfully, find the next path out of pain.
What do you do when your partner is not taking care of his or her health...at least not in a way that is up to your standards?
If I have a new symptom -- an ear ache, a twisted ankle, a mysterious rash - I will at least call my health care team to describe what's going on and ask for advice. I do know a lot about my own body, and about basic care for basic conditions -- but even so, I will seek medical opinions and consider them as additional data to be factored into my decision about how to take care of myself.
Richard is different. He likes to wait to see if the symptom will go away by itself, or if it will shape itself into some pattern that he can describe. He will consult a doctor when he believes his situation is serious enough. But that moment comes way too late by my measure. Although, I do have to admit that he is pretty healthy, and there have only been a couple of times when his delay had potentially harmful consequences.
This is a real source of tension for us. We have not figured out how to resolve it. I certainly can't make him do it my way, but neither can I sit quietly and watch him injure himself though inaction (imho).
Have you had a similar struggle? How do you handle this situation?
Fibromyalgia, chronic fatigue syndrome, Complex Regional Pain Syndrome (CRPS), Reflex Sympathetic Dystrophy (RSD), endometriosis, lupus, chronic pain and on and on and on. These invisible illnesses (real illness in a body that looks ok from the outside) force the sufferer to carry an extra burden. In addition to the pain, fatigue, fever, and fear of the illness, these sufferers must continually face insinuations that they are not really sick but just stressed or tired, or even lazy and self-serving.
For couples invisible illness can become a two-way street.
Ruth and Ben
Ruth had always been gutsy. That was one of the qualities Ben loved most about her. She kayaked level four rivers, para-sailed over Ocean Beach, and could hold the revolved half moon yoga pose for as long as she liked. She wore her physicality as if it were a costume that proclaimed her warrior role in the world.
After Ben and Ruth had been married for two years, Ruth started to feel exhausted after walking the dog. Taking out the garbage left her arms aching for hours. Sometimes Ben would come up behind her and knead her neck and shoulders. Lately, if he touched the wrong spot, she yelped -- as if he had poked her with a hot needle. And even though she was sleeping more than usual, she sometimes felt as if the air itself were draining her of all energy and will. After many visits to specialists, Ruth was given the diagnosis of fibromyalgia.
Ben was sympathetic, for three months. He bought Ruth fragrance free bath oils and organic chicken soup. He walked the dog. He sat next to Ruth and massaged her fingers, which were a pain-free zone. And he stayed inside with her, in her new world, a world that had previously known no boundaries and was now tightly circumscribed by pain and exhaustion.
After three months, Ben got restless. He paced the floor as if looking for the path that would lead them back to their old life, the one that should never have been interrupted by this misfortune. His impatience grew with such force that it soon became the lens through which he viewed Ruth. When he tilted the lens in a more benevolent angle, he would say, "You seem more energetic today. Maybe this thing is finally turning around." On more testy days he might say, "Maybe if you did more, you'd feel better." Through any angle of the lens, he was seeing what she was or what he wanted her to be, not what she had become.
Ruth grew more introspective as she struggled to treat herself with compassion and to accept that fibromyalgia was a condition to live with and not an event to medicate. Ben grew agitated and pinwheeled desperately from possibility to hope to disappointment.
Ben couldn't bear to see Ruth's infirmities, and Ruth couldn't tolerate Ben's insistence on activity and optimism. It wasn't only that Ben, finding Ruth physically unaltered, found it hard to assimilate illness into his estimation of her. It was also that Ruth, in working to accept and accommodate to her new limitations, could not abide Ben's buoyancy, nor could she see the fear and sorrow that were underneath it.
They were becoming invisible to each other. This is the toll that invisible illness takes on couples.
The partners' trajectory, once so unequivocal and entwined gets split. Illness inserts itself into some very tender places in the relationship -- into the image partners have of each other, into the activities and routines the relationship depends on, into the kitchen and into the bedroom. Illness gets to make decisions that once belonged to the couple. Illness casts its broad shadow, and the partners are left to try to find each other in the ebbing light. And if the illness itself is an invisible one, its ability to distort the relationship dynamics is even more insidious.
What can a couple in this situation do?
To do nothing will lead to greater invisibility and distance. As with many couple situations the key is hard core, no holds barred, honest communication. The couple needs to develop a new language that incorporates illness rather than avoids it.
Ruth needs to be able to explain to Ben what she is feeling and how it is affecting her. He does not recognize the cues or have the sensors to know what she is experiencing, so she needs to draw him the map of her illness. One useful indicator couples can incorporate into their language is the 1 - 10 scale (where 1 is let's go to Cancun and 10 is shoot me now). In this way, both partners can see the illness and discuss its implications.
But it isn't enough to just understand how big or small the illness is at a given moment. Ruth and Ben need to talk about how to interact -- what questions can they put to each other, how can they state their needs wherever they are on the illness scale, how can they signal the need for attention or for alone time, how can they be together in silence and in inactivity.
And in addition to asking for what they want, they need to explain what they don't want. Ruth needs to be able to say, "I am taking care of myself in the best way I know how. When you tell me to try going for a walk or how well I'm looking, I feel diminished. Like you don't know me and don't appreciate how hard I'm trying."
And then Ruth can take it one step farther and ask for what she needs from Ben - who really does want to help. Ruth can say, "Ben, I know you're worried and want to help. What would really help is if you could acknowledge that you do see both my pain and my efforts; and just ask me how you can help instead of making suggestions."
And Ben needs to let Ruth know how confusing this is for him and that he can't always tell how she is doing and needs her to let him know if this is a good day (or hour) or a bad one. Ben needs to let Ruth know how alone he feels and that he wants her to invite him into her illness. That when he can help her or comfort her, he feels close to her.
And they both need to be able to have their own form of down time - whether that's meditating or watching football. Again the key is communication. Instead of disappearing into the ozone, each needs to tell the other that he/she is taking a break.
Sometimes, just putting explanatory words under the actions, like subtitles, helps the partners get through it together.
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While this article doesn't refer to illness, I thought it might be interesting to you for it's take on how to thwart divorce. Divorce and serious illness are not strangers to each other. In one study, when the man became ill, only 3 percent experienced the end of a marriage; but among women, about 21 percent ended up separated or divorced.
