HEALTHY FAMILY REACTIONS TO ILLNESS: ADJUSTING FAMILY ROLES AND RULES

Healthy couples teach their families to understand the need to be flexible in reaction to this ever-changing life. Flexibility is stronger than rigidity. In dealing with change, healthy families are able to adjust their roles and the rules that determine their reactions to one another. Healthy families are willing to change to become part of the solution to the problem they face rather than stay stuck in patterns that complicate the problem. This willingness to be flexible in adjusting roles and rules is necessary in both marital and family relations.
For example, even though the husband may always have functioned as the primary breadwinner in the family, the couple may have to adjust to the wife's working outside the home and the husband's assuming some of the domestic responsibilities now that he is medically disabled. Or even though the grandmother has always been available as a full-time baby-sitter and cook for her grandchildren, she and her family may need to adjust to the fact that she now has to devote more of her time and energy to her cardiac rehabilitation program.
Two characteristics stand out as healthy families adjust roles in reaction to illness: (1) No single family member loses because of these changes. (2) Changes are made in a way that allows the patient to keep a positive sense of self-esteem and value within the family. There are no martyrs in healthy families. To the extent possible, family problem-solving revolves around creating win-win outcomes. When a family is adjusting healthily to heart illness, no one person gets stuck with an unfair amount of the considerable stress caused by rehabilitation. Everyone continues to live a full life, even though changes in areas of responsibility may be necessary. This point is particularly important for cardiac couples. Fears of the consequences of heart illness to loved ones often lead to two problem patterns in the family. First, the heart patient may feel guilty for putting the family through this ordeal and then overwork in an effort not to do further damage to loved ones. Feeling guilty, the patient may withdraw from activities or relationships that always used to be enjoyable and focus exclusively on work and on the task of getting well. The problem with this pattern is that lack of pleasure in life leads to irritability and depression—emotions that complicate rehabilitation.
Second, and perhaps even more typical, the patient's spouse may feel overburdened with responsibilities to be all things to all people. It is easy to drift into exhaustion from attempting to be the family's emotional cheerleader, the family dietitian, the medical liaison between patient and doctors, the head of the household, the primary wage earner, and the patient's conscience about health care habits, all at the same time.
Living under such overwhelming stress would cause anyone pain and unhappiness. Loneliness, tensions, and physical and emotional symptoms of distress are likely to result. In coping with heart illness, it is important to be reasonably available, to be reasonably helpful to and supportive of each other. You should not feel alone in dealing with the fears of this journey, but neither should you demand excessive "rescuing" from your mate. Be flexible enough to help each other adjust to the changing roles in your marriage. Be honest with yourselves and with each other about what you need from each other. Be supportive of your mate's needs to have life involvements in areas other than cardiac rehabilitation. This is essential if your marriage is to remain healthy.
Perhaps the hallmark of the healthy couple's adjustment to illness is the ability to make changes that are realistically necessary because of the illness, but not to change so much that the patient ends up feeling left out of the family. Do not make the mistake the Hinsons made: the heart patient got put into the role of spectator in his own family, and he understandably became depressed when his wife and son lived stress-filled lives that excluded him.
It is important to see the heart patient's physical problems as being something of a handicap, but not as erasing the patient's worth in the operations of the family. I emphasize the importance of the family continuing to value and insist on the heart patient's participation in family operations.
It is not enough simply to convey continued love for the person who has survived the heart attack or the heart surgery—as was the case with the Hinsons. It certainly is important for family members to value one another simply for existing, but it is also important to remember that each of us requires the self-esteem that comes from being needed in tangible ways. In this vein, healthy families support and encourage the patient to participate in work and daily routine as fully as possible. A useful guideline for families that is worth repeating and remembering is this: Do for the sick family member what that person cannot do for himself or herself, and no more. By following this guideline, family members prevent heart disease from disqualifying anyone from being a valuable contributor in the overall teamwork of the family.
Each of the preceding types of changes in roles and rules leads to obvious modifications in family life. Not so obvious is yet another important variation of this theme: in coping with illness, healthy families often allow for change in the rules that dictate what kinds of thoughts and feelings get openly expressed in family interactions. That is, faced with the awareness that this is our only life—and that it is far too short—healthy family members respond to illness with increased openness and honesty in their dealings with one another. This often leads to new behavior that everyone may find both awkward and appropriate at the same time:
Strong personalities begin to share their vulnerabilities and fears.
Those who have always insisted on routine and structure try to be flexible and spontaneous.
The cold become more affectionate.
The meek show leadership.
The quiet speak up.
The angry attempt to forgive.
Trying to relate in new ways always stirs inner feelings of insecurity and fear of being rejected or misunderstood. If you notice your partner attempting to change in some basic way, react gently and nurturingly. Never criticize, ignore, or react with sarcasm or skepticism to a loved one's attempts to grow healthier.
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