THE FAMILY AS A TEAM IN SICKNESS: FAMILY IN DISTRESS

Maria Hinson was referred to me by her family doctor for stress management training. Maria, who was fifty-three years old, had been suffering from incapacitating migraine headaches for nine months prior to referral. She had recently begun having trouble sleeping and had lost fourteen pounds even though she was not dieting. It was obvious that Maria was depressed. In our initial interview, Maria shared with me her confusion about her physician's suggestion that her problems might be stress related. She described herself as happily married to a loving husband and as a person who generally enjoyed life. She and her spouse were proud of their successful family business, which was now being run by their only child, twenty-four-year-old John.
Maria did admit that she had undergone "quite a scare" three years earlier, when her husband had suffered a "moderately serious" heart attack. She emphasized, however, that her spouse's physical recovery had been uncomplicated and that he had breezed through subsequent triple coronary artery bypass surgery. Maria did not see that her husband's illness and recovery had any relationship to her current difficulties. She emphasized that she and her family had made "various necessary adjustments" in reacting to the illness. In her opinion, all was running smoothly in her life now, so why all this talk about stress?
As our interview continued, I focused on the "various necessary adjustments" that Maria and her family had implemented in reacting to her husband's illness. She explained that her spouse, Henry, had had a history of struggling with depression before his heart attack. She stated that Henry was a true mystery. On the one hand, he was an ambitious, energetic, self-made man who prided himself on meeting life's challenges head-on. But Henry was also a chronic worrier who stressed himself into periods of agitated depression by quietly obsessing about all that might go wrong in life. When he had his heart attack, Maria and John became understandably afraid that Henry would "worry himself into another depression and never recover." In reaction to their fear of Henry's potential for relapsing, Maria and John adopted what seemed to be a good strategy of preventive medicine: in hopes of keeping Henry from worrying himself into depression, they decided to buffer him from all stress.
John, who was a junior in college at the time of Henry's heart attack, promptly withdrew from school and returned home to run the family business. Maria devoted herself to running interference for Henry around the house. When bills came, she intercepted them and paid them without telling Henry; when the furnace burned out, she bought a new one and arranged for it to be installed "without bothering Henry with the aggravation of the details." She particularly made sure not to "worry and scare" Henry with any discussion of her headaches, insomnia, or weight loss.
I asked Maria how this antidepressant strategy that she and her son had cooked up was working. With fatigue in her voice and tears in her eyes she quietly discussed her continued love and growing concern for her husband. Henry seemed to be miserable. He had aged noticeably since his heart attack and surgery. He seemed to be disinterested in life; not exactly depressed, but generally melancholy and unresponsive. He seldom laughed, and he was acting more withdrawn and preoccupied with each passing month. Maria cried as she described how much she missed her husband's shining wit and energizing zest for meeting the challenges of each new day. She blushed and apologized as though she had spoken forbidden words when she admitted her longing for more romantic and sexual playfulness of the sort that she and Henry had always enjoyed before his heart illness. As she put it, "Even during his periods of depression, Henry and I could always block out the world and escape into the privacy of our love and passion for each other. Those times always kept us going; now, they are gone."
Maria's primary source of emotional support since Henry's illness had been her son. She and John jointly made decisions regarding the family business, and they spent many hours discussing their shared concerns about Henry. Mother and son had recently decided that it might be good for Henry if he and Maria began to travel. They hoped that Henry's mood would brighten if he reconnected with old friends and relatives from whom he had grown distant during the busy years of establishing and running his business. As our interview continued, I expressed concern and admiration for Maria's son; he seemed quite young for the responsibilities he had shouldered during the past several years. This time Maria's tears and words were those of a concerned and frightened parent who did not quite want to believe the refrain that echoed throughout her private moments of motherly reflection.
When John quit college, he had been engaged to be married, but his relationship with his fiancee, who had remained in school, withered and ended within a year. John showed no sadness; he just worked harder to learn the family business. He did have many friends from his high-school days, and he socialized to a reasonable degree. However, he did not date much, and he generally filled his life trying to take up the slack created by his father's illness. Maria was particularly concerned for John of late because he had been suffering from "chronic indigestion." He had recently undergone various medical tests to investigate what his doctors were calling a preulcerative condition. Maria summarized her concerns for her son; "I know he's just a kid who's been forced to live a man's life. But I don't know what we can do to make this better right now." Our first session ended with Maria's agreeing to my meeting with her husband next.
Henry was a well-dressed man with a powerful presence, but he looked rather tired and uncomfortably unsure of himself. The way he combined a powerful personal presence with awkwardness and vulnerability reminded me of how a great football coach looks on television when he is being interviewed after his team has lost a major game. It soon became apparent that Henry's discomfort was largely due to his suspicion that Maria had arranged this meeting with me as an indirect way of getting him to come for psychological counseling. He stated that Maria's taking control of his life "for his own sake" would have been par for the course, given the way their marriage had been since his heart attack. Henry very clearly did not like the spectator role that he had been assigned and had assumed in his family and his business during the past three years. In his words: "Yes, I had a heart attack and bypass surgery three years ago, but my wife and son act as if I'd died three years ago. Bills come to my house and my wife hides them from me, like I'm going to believe that we now live debt free if I don't see the checkbook. My son, who didn't know a profit-and-loss statement from a lost-and-found station, all of a sudden quit college without consulting me and moved into my office at the building that I built to house the business that I created.
"Now, don't misunderstand; I love and appreciate Maria and John. I know they're doing what they think is best for me, and I guess they're following my doctor's orders. But they must know something about my condition that I don't know. I simply do not feel ready to be put out to pasture. Hell, I'm only fifty-nine years old!" What is wrong with this picture? This very nice family is floundering waist deep in a swamp of emotional pain. At this time, when they most need and want their family relations to be sources of healing to one another, they are actually drowning in their mounting tensions, frustrations, and fears.
The Hinsons are caught in a family trap. Their attempted solutions to feared problems are actually making things worse. The hierarchy of authority that once organized this family is now in a shambles. The marriage that should be the core of this family team is dwindling in intimacy. The stresses felt by each of these good people are accumulating and ruining everyone's health. Their growth and development as individuals and as a family and a couple have been frozen by the stresses caused by the flurry of changes that began with Henry's heart attack. Communication is diminishing and despair is mounting for the Hinsons.
What could these people have done differently? More important, what can they now do to repair and reorganize their marital and family relationships? The following pages present information that can be used to answer these questions. By understanding the unique and fascinating ways marriages and families work—in sickness and in health— perhaps you can avoid the pitfalls that have trapped good families like the Hinsons.
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