HEART ILLNESS AND INTIMACY: INTRODUCTION

This is not a book about cholesterol or diet management. It does not discuss treadmill testing, or how to quit smoking, or any of the other aspects of cardiac rehabilitation that are typically written about. Although those aspects of health care are important and necessary in recovering from heart disease, limiting the discussion of living with heart illness to those topics overlooks a nearly universal truth: illness does not affect only individuals; illness disrupts families.
Unfortunately, relatively little attention has been paid to this topic. Neither professional nor popular literature has addressed the emotional pains and stresses faced by heart patients and their loved ones as they struggle with cardiac rehabilitation. Far too little help has been offered to cardiac couples as they have watched their marriages and family relationships fill with the fears, anger, guilt, and regrets that inevitably develop when people are living with heart illness.
For some couples and families, these pressures ruin intimacy. When people are coping with illness, marriages and families can become arenas of tension. Unexpressed and unfulfilled needs and subtle or open power struggles often lead cardiac couples into lives of quiet desperation. What a pity! At a time in life when each spouse is most in need of the kind of soothing and nurturing that can come only from a loving partner, emotional distance and loneliness accumulate instead.
Fortunately, other couples report a very different family experience in coping with heart disease. For them, the shock of illness is a needed slap in the face that gets the attention of every family member. Prior unexpressed feelings get expressed. Unforgiven hurts are soothed, and forgiveness leads to renewed emotional closeness. Positive aspects of life are emphasized and shared, unhealthy habits are changed, and intimacy grows. Such couples and their families begin living each day to the fullest. For them, coping with heart illness actually stirs changes that improve relationships.
What makes the difference? How can you help one another to fall into the second category of couples and families? How can you help each other and yourself to cope with the often overwhelming series of physical and emotional tasks called "living with heart disease" and not let the coping kill your spirit of caring in the process? These are the topics explored in this book.
As director of psychological services at the Wake Forest University Cardiac Rehabilitation Program and a clinical psychologist specializing in marriage and family therapy, I have had a unique opportunity to learn about the psychological effect of heart illness on both individuals and relationships. I have had the privilege—and sometimes the agony—of spending literally thousands of hours over the past thirteen years privy to many individual and relationship struggles to cope with heart disease. The hundreds of individuals and couples who have allowed me to share in their intimate journeys of rehabilitation have taught me much. My main lessons have involved learning to recognize the differences between the people who experience heart illness as the beginning of the end of family intimacy and those who react to it in ways that improve their personal relationships.
The pages that follow will guide you and your loved ones in your efforts to manage your own, and to understand each other's, emotional reactions to heart illness and to cardiac rehabilitation. Throughout this book I discuss strategies and concepts that I have found helpful in controlling marital and family reactions to illness. Key among the concepts are these notions: (1) families are teams that are run by the marriage partners; and (2) the entire family is affected whenever individual members are undergoing stressful changes.
I also discuss illness as a stressor that stirs individual psychological reactions that must be understood and controlled if marriages are to grow. In this discussion, I present multiple guidelines for managing the stress of illness within your personal life, whether you are a heart patient or the concerned partner of a heart patient. I have tried to write the kind of book that will be of use to a wide variety of couples. No two marriages are exactly alike, and the psychological effects of cardiac rehabilitation vary depending on the unique factors that distinguish your marriage. Throughout this book I have incorporated numerous case examples of various types of heart illness and types of families. I know I have not captured every conceivable variation in these examples; to do so would be impossible. But I do hope you will find the descriptions of these problems helpful in further understanding your unique family situation. I hope you will find comfort in knowing that other people have gone through experiences similar to yours. But beyond this, I sincerely hope you will benefit from the practical advice that I offer.
Finally, I would like to say that I have written this book to apply to all cardiac couples, regardless of whether husband or wife is the heart patient. Other works have addressed the specific struggles faced by women in coping with their husbands' heart conditions. I believe certain differences do exist between the struggles typically faced by wives and by husbands coping with a mate's heart illness. However, most of the marital struggles faced by cardiac couples are universal, regardless of which member of the couple is the heart patient.
To my knowledge, this is the first published work that has addressed cardiac rehabilitation from a truly marital perspective. I hope that reading this book will be the start of new and better chapters in your rehabilitation and in your marriage.
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