THE MANY STRESSES OF ILLNESS
The necessary beginning point in understanding your own and your loved ones' psychological reactions to heart illness is to understand that illness is a stressor—a stimulus that causes stress. Stress is what happens psychologically and physically whenever you are faced with the need to adapt or to adjust behaviorally, emotionally, or physically.
Heart illness is a stressor that does not discriminate; it strikes with no regard for your frame of mind, life situation, or degree of readiness. Once it strikes, heart illness changes your life and your marriage forever. For the heart patient, the immediate change from being "well" to being "recovering" cuts to the core of self-concept and self-esteem. Just as rapidly, the patient's loved ones are shocked into a flood of emotions and a flurry of activities in reaction to the illness.
Consider for a moment the phenomenal number of adjustments faced by any individual or family suddenly confronted with this illness. Changes brought about by heart illness include, but are not limited to
- strange physical symptoms that leave you feeling out of control of your own body;
- a flood of preoccupation with death and, sometimes, overwhelming fears of death;
- immediate awareness of a new set of worries about your future ability to resume normal activities and to adjust to any lingering physical effects of this illness;
- sudden disruption of customary daily life-style, including participation in work, friendship, and family circles;
- obsessive questioning about why this illness occurred, what might have been done to prevent it from happening, or what needs to be done now to prevent a recurrence;
- dependence on the unfamiliar and often confusing environments of hospitals and doctors' offices and the people who work there (the medical staff);
- consumption of medications that often make you feel and act strangely.
All this, and I have not even mentioned the endless volley of stressors that are faced upon leaving the hospital and attempting to resume a normal day-to-day life.
Remember that all these stressors affect every family member in one way or another. The heart patient, of course, is the prime target of concern and is certainly the most vulnerable at first. But the patient is also the family member who receives the most targeted reassurance, consistent medical attention, and pharmacologic help in dealing with the fear and anxiety that occur throughout this time.
Although this intense focus on the patient is certainly necessary, merited, and deserved, it is important to remember that the family members of this patient—especially the spouse—are also faced with the stressors outlined above. Unfortunately, family members are not typically identified as "patients" in this process; they are viewed neither by themselves nor by others as needing the special care and attention that come with being sick. These concerned and involved loved ones are left to manage overwhelming stress without the aid of structured monitoring, charted progress, and nurturing permission and insistence from others to "Take good care of yourself."
So here is my first major point: Coping with heart illness involves both spouses dealing with an endless series of stressors. Rehabilitation is not an event with a clear beginning, middle, and ending; rehabilitation is a process that begins with the onset of illness and lasts for the rest of your life. The obvious question, therefore, is not whether you and your family will be affected by this process but how you will manage this unique and overwhelming series of changes in your lives, especially in your marriage.
As you read on, remember that (1) no couple adjusts to heart illness with total emotional smoothness and (2) not every couple has dramatic negative reactions to heart illness. Some couples change only gradually in reaction to the stresses that result from illness. Instead of falling into open conflict and chaos, some couples simply begin to bicker more or to show more impatience in dealing with each other.
Given the numbers of stressors faced in this process, it's a wonder that any marriage survives cardiac rehabilitation. Periods of intense anxiety and depression are par for the course during the first several months of adjusting to heart illness. However, many individuals, like the Hinson family from chapter 1, get stuck in this painful first stage of adjustment. Marriage and family life then begin to revolve around intimacy-draining emotions.
In contrast, many people just seem to float through this same period and these same scary transitions with amazing ease and calmness. Some families seem to be made up of individuals who finesse their way past the multiple hurdles thrown in their path by heart illness and who run the course of recovery without accumulating emotional bumps and bruises. Many couples actually report improvement in their relationship as a result of the many changes brought on by cardiac rehabilitation.
What determines these very different reactions to what is essentially the same stressor? The simple truth is that marriages that are intimate and healthy are better able to survive stressful times. It is also true that heart patients who live in intimate marriages are better able to manage the stresses of recovery.
I do not mean to imply that you can manage the stress of recovery for each other. No matter how much you love and nurture each other, you each must ultimately assume responsibility for your own emotional adjustment and for changing your life-style in ways that will improve your health. No matter how much you care, you cannot eat right, stop smoking, exercise, manage stress, or keep a positive attitude toward life for someone else. On the other hand, it is important to remember that you have only two basic choices in being married: you will be either a source of healing or a source of stress to your partner. How you treat each other has much to do with your reactions to the stresses of life, including the stresses of living with heart illness.
In the following pages, I describe how marriages and families work and what can be done to control the particularly stressful impacts of heart illness. Use the following chapters to stimulate your thinking about your own dealings with the many aspects of cardiac rehabilitation. Also note the concerns about your partner that come to mind as you read. Throughout your reading, discuss your reactions and your concerns with each other.
If you are having difficulties in your marriage, let the information in this book challenge you to become more cooperative teammates in developing a healing partnership. If you are among the many lucky couples who are working positively together in recovering from illness, use this book as a framework for better understanding what you are doing that is working so well.
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