PITFALLS OF FAMILY LIFE: SIGNS OF POOR FAMILY COPING

How can you tell how well you and your loved ones are coping with this illness? To begin with, you might examine the following nine signs of poor adjustment, and carefully consider whether your family is experiencing any of these difficulties.

1. Depression. Grief is a normal and healthy reaction to illness. While grieving, a family member may be sad and irritable, may cry frequently, may have insomnia, and may be preoccupied with rehabilitation concerns. Such grieving usually passes within several months as the reality of the illness settles in and motivation to rehabilitate begins to grow. However, some family members react to illness by becoming seriously depressed—a condition that paralyzes rehabilitation and family life in ways that grieving does not. Although grief and depression may look and feel similar in many ways, important differences between these two conditions do exist. It is essential to understand that clinical depression of this sort is a medical condition that requires appropriate treatment. No amount of pep talks, positive thinking, or messages like "Pull yourself up by your bootstraps and get on with life" will cure clinical depression. Most clinically depressed people require both medication and professional psychological help to overcome this condition.
   The good news is that not only can depression be treated—it can be cured. Typical reactions to current psychological, medical, and psychiatric treatments for depression fall into the category of modern medical miracles. Help is available. If any member of your family persists in showing the symptoms just described for more than eight weeks, help that loved one to seek appropriate treatment.
2. Failure to accept the diagnosis. Some families never say the H-word out loud; they never openly talk about the fact that a member of the family has heart illness. One such family whom I treated insisted on referring to their mother's angina as "upset stomach." Others constantly change doctors, searching for one who will participate in their denial. Still others refuse to accept the need for taking rehabilitation seriously and make statements such as "High blood pressure just runs in our family, and no one has died young yet. It's nothing to worry about."
3. Denying the symptoms of illness. One relative of mine who recently underwent quadruple coronary artery bypass surgery after his first visit to a cardiologist admitted that for years he had been experiencing crushing chest pains whenever he walked in the woods on cold days in hunting season. Rather than accept these pains as a sign of illness, he reported that he would usually just sit beneath a tree and pound his chest until the pain stopped. Now, that's denial!
4. Remaining ignorant about the illness. Unhealthy families refuse to learn the details of heart illness and cardiac rehabilitation. This refusal often signifies a passive, victimized attitude in reaction to the illness, an attitude that will surely work against successful adjustment.
5. Flights into activity. Some patients and families react to illness by running—not as in exercising; as in scared to death. They act as though they fear that life is almost over and that they therefore need to cram as much as possible into their remaining days. The result might be impulsive behavior that just makes life more complicated. For others, the flight into activity happens as part of staying stuck in the bargaining stage of grieving. These people believe, "If I try hard enough and behave perfectly enough, then this illness will disappear." This belief might lead to trying as many different rehabilitation strategies as possible, all in the shortest possible period of time; shopping for magical cures; doubling exercise or dietary changes; of engaging in superstitious behaviors.
   These frantic flights into activity can be mistaken for indications of a positive attitude. In reality, such hyperactivity can lead people to take unhealthy risks and to disconnect from others because they are obsessively focusing on all this action.
   Disconnecting from other people by focusing on activity is a way some families defend against fears of becoming emotionally close with the sick loved one. Many families live in fear that the heart patient will die, and they begin preparing themselves for this death as soon as illness hits. Unfortunately, such families sometimes stay stuck in the habit of keeping their distance even though the patient outlives everyone else in the family!
6. Persistent hostility. Many people are angry long before their lives are affected by heart disease. These people simply become even more hostile in response to the stresses of illness. Their typical grouchiness escalates to the point of losing emotional control in reaction to minor irritants. For other people, however, irritability, moodiness, snappiness, and temper tantrums seem to add up to a personality change. Many such people are stuck in the anger stage of grief and are failing to progress toward accepting their current reality. It is as though their anger is an expression of the desperate cry "I don't want to have to deal with this!" Any family member can become stuck in this syndrome. Families sometimes cooperate in fueling anger by collectively targeting their hostilities toward medical personnel. The pattern is often obvious. It may also be expressed quite indirectly, as in the case of Erin and her family.
7. Prolonged exaggeration of typical personality traits. Anger is not the only coping reaction that may become exaggerated in a family's efforts to manage the impact of illness. Any outstanding personality characteristics of any family member may become magnified when people are coping with scary levels of stress.
   The orderly individual may become compulsive about routines and details. The grouchy family member may become sullen and openly hostile. The suspicious, skeptical person may become over cautious to the point of appearing paranoid. The low-energy homebody may become withdrawn and depressed. The person who often complained of various aches and pains may become preoccupied with symptoms of physical illness. The generally gloomy, pessimistic individual may become paralyzed by fear of death. Such alarm reactions may be temporary responses to the shock of illness. But these patterns should calm down and the individual should return to normal personality patterns within four to six months of the onset of the stressful event. By that time, the disorientation and shock of reacting to illness typically lift. Continued exaggeration of coping style beyond this period may suggest the need for more open discussion and counseling from family minister, doctor, or therapist.
8. Discounting the possibility of coping. Some families have the attitude that coping with heart illness is impossible. Their passive acceptance of illness can lead to many unhealthy choices, such as the following:
• Refusal to accept referral for help with physical or psychological aspects of rehabilitation.
• No expression of interest in learning about the illness or the rehabilitation strategies.
• Repeatedly "forgetting about" or openly refusing to attend medical follow-up appointments.
• Subtly or openly refusing to participate in attempts to change long-held family traditions (such as eating unhealthily) that work against rehabilitation.
9. Children or teenagers showing signs of distress. Most children equate having a heart attack with dying. The idea of losing a parent is terrifying for children of any age. Unfortunately, children also tend to have difficulty expressing their feelings, and parents tend to fear that talking openly with children about upsetting topics will only frighten them. These factors combine in many families, with the result that children hold in a storm of emotions—fear, anger, grief, embarrassment, guilt—in reaction to a parent's illness. These unsoothed feelings can lead to various signs of struggle, depending on the child's age:

• Decline in school performance.
• Eating or sleeping problems.
• Frequent nightmares.
• Behavioral problems.
• Outbursts of temper.
• Vague or persistent physical problems.
• Fears of being alone with the heart patient.
• Clinginess.
• Excessive withdrawal or tiredness.
• Drug or alcohol use.
• Excessive efforts to please or to "be good."
• Oppositional, rebellious behavior.
• Refusal to discuss problems, especially feelings about heart illness.