Last week I wrote about a woman who felt that her husband did not believe that she was ill.  At some point she had derived the impression that he felt her pain was not “real.”

First things first.  With rare exceptions, pain is always “real.”  Brain and musculoskeletal imaging studies show abnormalities in “pain-full” people who don’t show a clear abnormality on exam, blood tests, or routine X Rays.  It never pays to suggest to anyone that they’re exaggerating their discomfort.  For one, we are all going to get sick at some time.  We’d feel terribly embarrassed if we belittled a loved one on the one occasion that they had a serious problem.  So, as a matter of principle, an attitude of kindness and concern should prevail when our soul mates complain.

This sounds like an easy path to follow.  Why do I see so many couples that fall apart at times of illness?  There are many reasons:

1. Everyone has his or her limit.  We give, and give, until there’s nothing left to sustain our souls.  I ran into that problem when my wife and I tried to care for my mother, who had Alzheimer’s.  Her needs were literally bottomless.  Eventually the stress and our concern for her safety made her institutionalization necessary.  Both of us felt guilty that we had not been “strong enough” to keep her in familiar surroundings.
2. Often there are preexisting marital stresses or patterns that are disrupted by illness.  Early in my career I made it a habit to insist that all husbands/ boyfriends come to the office for a counseling session on the affected person’s illness.  In those days most men were not terribly involved in helping out with child care or household chores.  I firmly explained to these guys that the “old” way of doing things had come to an end, and that they had to perform their share of maintenance.  To society’s credit these days I need to intervene on rare occasions.
3. Some people develop a dependent behavior pattern after they have been ill for a long time.  They get used to the household revolving around their needs.  As a young doctor I treated a woman with serious rheumatoid arthritis who was bed bound.  She weighed 80 pounds.  Her family took turns taking care of her needs; she never left the hospital bed they had purchased for her.  I told her that I could help.  After two weeks of intensive treatment and rehabilitation she was vastly improved.  The day that she took her first step in ten years she fired me.  The prospect of taking care of herself was too frightening for her to bear.
4. There are relationships that are seemingly solid that show signs of wear with disease.  I see a fair number of spouses who become angry when the wife/ husband  becomes even partially disabled.  Many times this anger is directed against the sick partner, which at first glance makes no sense.  But remember that most of the time there’s no one else around to take the brunt of their stress.  And many people are not terribly insightful; they are not able to figure out on their own that their anger is a sign of concern for the loved one.  I think that this is what was happening with the couple  I wrote about last week.  The husband loved his wife and depended on her for a lot.  In a very twisted way, he felt that if he denied that her illness existed maybe it would go away.  Of course all he accomplished was to make her worse.  She not only felt guilty about being sick; when she began to improve she feared that he would tell her that he was right all along.  This gave her an incentive for staying sick: two loving souls wrestling with each other’s lives so that one of them could prove the other wrong.

Life is hard under ideal circumstances.  Illness makes it much tougher.  Clear communication between partners and an open line of conversation with the doctor are mandatory if we are to succeed.