In Sickness and In Health: A Place for Couples Dealing with Illness

Check Out This Week's Grand Rounds

2012-01-24T09:03:00.000-08:00

It's hosted by USA Today. It will appear serially in four separate postings throughout the day today. The four topical areas are:

Health tips
True stories
Myth busters & controversies
Healthcare costs

Cohabitation or Marriage: Which is Better for Your Health and Happiness?

2012-01-22T07:06:00.000-08:00

My guess is that this study did not look at couples living with serious illness in one or both partners. I wonder what the findings would have been if they had? I'm not suggesting that marriage weathers the stress of illness better than cohabitation, or vice versa. Nor am I suggesting that the legal ties of marriage mean couples tend to stay together during illness (nor am I suggesting that staying together is the right thing for all couples). It's just interesting, and not surprising, to me that the inevitable period of illness in a long-term relationship is not part of a study like this.

What are your thoughts? The study summary is below:

Study finds few well-being advantages to marriage over cohabitation

Benefits of marriage reduce over time while cohabiting couples experience greater happiness and self esteem

A new study, published in the Journal of Marriage and Family reveals that married couples experience few advantages for psychological well-being, health, or social ties compared to unmarried couples who live together. While both marriage and cohabitation provide benefits over being single, these reduce over time following a honeymoon period.

"Marriage has long been an important social institution, but in recent decades western societies have experienced increases in cohabitation, before or instead of marriage, and increases in children born outside of marriage," said Dr Kelly Musick, Associate Professor of policy analysis and management at Cornell University's College of Human Ecology. "These changes have blurred the boundaries of marriage, leading to questions about what difference marriage makes in comparison to alternatives."

Previous research has sought to prove a link between marriage and well-being, but many studies compared marriage to being single, or compared marriages and cohabitations at a single point in time.

This study compares marriage to cohabitation while using a fixed-effects approach that focuses on what changes when single men and women move into marriage or cohabitation and the extent to which any effects of marriage and cohabitation persist over time.

Dr Musick drew a study sample from the National Survey of Families and Households (NSFH) of 2,737 single men and women, 896 of whom married or moved in with a partner over the course of 6 years. The study focused on key areas of well-being, considering questions on happiness, levels of depression, health, and social ties.

The results showed a spike in well-being immediately following both marriage and cohabitation as couples experienced a honeymoon period with higher levels of happiness and fewer depressive symptoms compared to singles. However, these advantages were short lived.

Marriage and cohabitation both resulted in less contact with parents and friends compared to remaining single – and these effects appeared to persist over time.

"We found that differences between marriage and cohabitation tend to be small and dissipate after a honeymoon period. Also while married couples experienced health gains – likely linked to the formal benefits of marriage such as shared healthcare plans – cohabiting couples experienced greater gains in happiness and self-esteem. For some, cohabitation may come with fewer unwanted obligations than marriage and allow for more flexibility, autonomy, and personal growth" said Musick.

"Compared to most industrial countries America continues to value marriage above other family forms," concluded Musick. "However our research shows that marriage is by no means unique in promoting well-being and that other forms of romantic relationships can provide many of the same benefits."

Does Lisa Swayze (wife of actor Patrick Swayze) Have Super Powers?

2012-01-15T07:25:00.000-08:00

Lisa Niemi Swayze has written a book about her experiences loving and losing her husband Patrick Swayze after a 21 month battle with pancreatic cancer. The book is titled: Worth Fighting For.

One review I read said:

"...The memoir reveals just how much one woman can change, when forced to confront the horrors of illness and the inevitability of those final moments. We witness the transformation of Lisa from a terrified creature who begs her just-diagnosed husband ‘Please don’t make me do this’, to the superwoman who refuses to give in, confronts every grim aspect of his nursing care and brings him home to die..."

They were two exceptional and normal people, as we all are, who loved each other and did the best they could. I confess I find it unfair to Lisa, and to the rest of us, to characterize her as a "superwoman." This makes it seem that her efforts came from some special source of rare super power she has access to, as opposed to the power that naturally derives from love and empathy - and that she is in a different class of being than the rest of us who live in the realm of illness with our partner.

What do you think?

One Illness; Two Victims

2012-01-02T14:50:00.000-08:00

This comment just came in on an older post. I think it is well worth re-posting:

Married 36 years and the last 7 years my husband has been a paraplegic due to a mass on his spinal cord. There are TWO victims here. Him and I, and I feel like I am paralyzed right in the middle of my life. I wish I were the one dying or dead. I was not happily married to him before his surgery and I was waiting for the kids to at least be in college before I left the marriage. Now I am stuck taking care of a man who hit me and verbally abused me up until the day he got sick. Now I do it to myself because I am too much of a wimp to leave him. Thank you for letting me say this out loud, my mom died 6 years ago and I have no one to hear my pain.

I have found readers of this blog to be very sensitive to the complexities of living with illness as part of your relationship. Solutions can be elusive. Problems are complicated and simple advice that usually has the word "just" in it (like - "why don't you just leave him" or "why don't you just eat less and get some exercise) often isn't substantive enough to be of real help.

What thinking can you offer the writer of the comment above? What have you learned from your experiences as ill partner or well, caretaking partner that you can share with this author?

May this holiday season and New Year bring you what you most desire

2011-12-24T11:12:00.000-08:00

I'm a sucker for these interspecies relationship clips. Here's one that shows not only can love cross boundaries, but so can kindness.

If Your Partner Had Become Sick While You Were Dating, Would You Have Committed to the Relationship?

2011-12-07T13:49:00.000-08:00

For many of us, first came the relationship and then came the illness or serious accident.

We met, fell in love, committed or got married, and then illness became the uninvited third member of the relationship. By the time illness entered, we had joined bank accounts, mixed laundry, combined dish sets, and co-mingled friends and dreams. There was a relatively solid platform for the relationship, and illness landed on that platform. When you're still dating, you might be in love, but the platform isn't that solid yet.

If your sweetie had become ill with a serious condition (perhaps the same one he or she has now) while you were still dating, would you have committed to the relationship?

The sad-sweetness of holidays

2011-11-26T07:17:00.000-08:00

My friend lost his wife eight months ago to leukemia. One month ago his grand-daughter was born. Her middle name is his wife's first name. This was his first Thanksgiving without his life partner in over 35 years. No one mentioned her name or spoke about Thanksgivings past - perhaps for fear of upsetting him. He did not speak of her either - perhaps for fear of darkening the day.

I think the not speaking made the day more lonely for all of them. Since they could not talk about the sadness of her absence, they couldn't reach the sweetness her presence brought to the table in years passed.

I don't know about you, but I think it's far better to speak and hold the sorrow than to sit alone together in silence.

Remember Love?

2011-11-13T19:08:00.000-08:00

One of my favorite poems - and the only one I know by heart:

When in disgrace with fortune and men's eyes,

I all alone beweep my outcast state,

And trouble deaf Heaven with my bootless cries,

And look upon myself, and curse my fate,

Wishing me like to one more rich in hope,

Featur'd like him, like him with friends possess'd,

Desiring this man's art, and that man's scope,

With what I most enjoy contented least:

Yet in these thoughts myself almost despising,

Haply I think on thee,--and then my state

(Like to the lark at break of day arising

From sullen earth) sings hymns at heaven's gate;

For thy sweet love remember'd such wealth brings

That then I scorn to change my state with kings'.

Sonnet 29, William Shakespeare

This weekend I went to the wedding of two exquisite people. I've known him since he was a child, and although I just met her a few years ago, I feel as if she is my sister/grandmother/daughter/friend. They are in love and in health. They can make beautiful plans and unravel tightly wound knots with optimism. They have time. They have the luxury of taking today for granted and concentrating on building their tomorrow on a foundation of great expectations.

It was a joy and a liberation to join in their celebration. Because even those of us who have passports to regularly visit the kingdom of the sick, as Susan Sontag describes it, need to be reminded of how penetrating love can be. Love is the hand that can point us toward a better moment, the arm that can encircle us when we are shrouded in our own misery, and the essence that can metabolize a depleted spirit into something lighter and more buoyant.

L'chaim -- to life!

Grand Rounds is Up

2011-10-18T17:41:00.001-07:00

Grand Rounds is a weekly collection of posts from all corners of the healthcare blog world. This week it's hosted at: Sumer's Radiology Site.

Sharing the Worry

2011-10-14T17:32:00.000-07:00

One habit Richard and I got into when I was at my worst was to share the worry. Some days I was so laden with worry -- What if I can't get an appointment with the one specialist who can cure me? What if I have to wait three months to see her? What if she winds up letting me down too? What if the new meds undo whatever slim good the old meds were providing? What if I'm in too much pain to make it to my niece's graduation celebration next year? What if... what if... what if...???

A wise person once said to me, "Don't worry twice." Don't pre-worry about a set of circumstances that live in the future. Good advice....but...

Sometimes worrying was the most energetic I could be. Worrying kept me tethered to the possibility of some other reality, one in which I didn't suffer, in which I didn't have to watch Richard flail, helpless to make me better.

Sometimes worrying was the only lifeline I could muster. You know what I mean?

But sometime worrying became too encompassing, too heavy. It flattened me.

Those were the times when Richard would step in and ask me if he could carry some of my worry load. "What can you let go of, even for an hour?" he would ask. There was always something. I pretended to put it on the table, and he pretended to pick it up. Sometimes, you are what you pretend to be, and this little scenario would often make me feel a bit lighter. On more enlightened days, I would realize that if I could let go of one worry, why not two, five, all of them. As long as Richard was safeguarding them for me and could return them upon request, I could let them go.

What do you do with your worries - as ill or as well partner? Do you protect your partner from them? Do you share them? Do they overwhelm you quietly? Do you release them?

Pat Robertson is Dead Wrong!!

2011-09-25T19:36:00.000-07:00

Many of you probably read about or saw clips of Pat Robertson's recent foot-in-mouth episode. He recopmmended that a man who had been taking care of his wife who is ill with Alzheimer's think of her as the "walking dead" and get a divorce and find a new companion. Oh yes, and make sure his wife is getting good "custodial" care.

WHAT!!!!!! you may say.

Well here is what I and my colleague said in a recent op ed published in the Chicago Tribune:

Pat Robertson is dead wrong

By Barbara Kivowitz and Roanne Weisman

September 23, 2011

A person with Alzheimer's is not "kind of" dead. Not by a long shot. And televangelist Pat Robertson should know better than to speak flippantly from a position of authority on a matter that is complicated, nuanced and deeply personal.

As we learned through interviews with many couples, as well as with medical, spiritual, legal, rehabilitation and psychological experts, while writing "In Sickness As In Health: Helping Couples with the Complexities of Illness," couples find their way to deal with illnesses and catastrophic injuries.

We know what we are talking about when we say Robertson should beware of trying to make blanket statements without the benefit of knowing all the facts and issues. We have found that dealing with illness is a deeply intimate part of the couple relationship. What is right for one couple may be completely wrong for another.

When illness invades the couple relationship, partners ask themselves and each other some really hard questions: "What do I want to do for this person whom I have loved for many years?" "How much of my life do I give up to take care of my beloved?" "How do I sit by my beloved's side and watch her suffer?"

Robertson's assertion that divorcing a spouse with Alzheimer's is justified because she is "gone" is more than simply callous and insulting to anyone who has ever loved another. It goes to the heart of both morality and medical ethics. Physicians struggle every day to counsel families about the right time to cut off life support. Ethicists struggle to balance the impact of devastating disease with the persistence of the essential self.

To announce that someone is "gone" when she still has an emotional life — not to mention sensation in her skin, organs and tissues — is to dismiss her as a human being.

For those who find themselves at the intersection of lifetime love and overwhelming obligation, the right path is often painful and difficult to find. Robertson should have counseled this husband — and all partners grieving over the illness of their loved one — to seek psychological support, medical information, spiritual guidance and ultimately to look inside themselves and their relationship to determine the right thing to do. Instead he advised the husband of the ill woman to make sure the wife has custodial care before divorcing her and starting all over again.

He presumes too much.

Barbara Kivowitz, a consultant and psychotherapist in Boston, and Roanne Weisman, a science writer and author in Boston, are co-authors of the forthcoming book "In Sickness As In Health: Helping Couples Cope with the Complexities of Illness."

What Couple-Related Decisions Have You Made Because of Illness?

2011-09-03T12:32:00.001-07:00

There is so much uncertainty that accompanies illness, but one thing is certain -- illness brings change into how you think about yourself and your relationship. Illness can be a suppressant, but it can also be an activator. Illness can become a box into which you and your partner put your dreams; or it can be a catalyst to accelerating plans and making new decisions.

My illness led to our getting the most amazing dog in the universe (as is yours). It also led to writing a book about couples and illness. And it deepened Richard's and my ability to talk about the hardest topics.

Below is an excerpt from an article about a couple who decided to get married because he was about to undergo surgery for a cancerous tumor.

Geneva couple marries days before life-threatening surgery

by Frank Vaisvils, 8/31/11

David Bieszke of Geneva wasn’t going to give up on asking his girlfriend of 18 years, Jennifer Pedersen, to marry him, and she returned that persistence by insisting doctors treat her would-be husband for his chronic illness even when they were told nothing was wrong.

David’s health slowly deteriorated in recent years, and his family doctor was perplexed about the cause. Meanwhile, David experienced chronic fatigue and pain began growing in his abdomen.

In April, Jennifer’s persistence led doctors to diagnose David with a 10-inch cancerous tumor choking a major blood vessel in his chest.

He underwent a six-hour surgery on April 29 at Loyola Hospital in Maywood.

Fearing she might regret not marrying him if anything happened during surgery, Jennifer finally said “yes” to David and the two were married in front of a Kane County judge three days before the surgery.

At a time when most newly married couples would be celebrating their future together, this pair’s fate was anything but certain as David entered the operating room.
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What significant positive plans or decisions have you and your partner made because of illness?

Is There a Cure for Divorce?

2011-08-30T10:37:00.000-07:00

While this article doesn't refer to illness, I thought it might be interesting to you for it's take on how to thwart divorce. Divorce and serious illness are not strangers to each other. In one study, when the man became ill, only 3 percent experienced the end of a marriage; but among women, about 21 percent ended up separated or divorced.

Excerpts from:
IS THERE A CURE FOR DIVORCE?
by David Wygant
Huffington Post
8/22/11

.....A relationship does not just end over night. It takes time. But there is that point in the relationship where the marriage "jumps the shark," as they say. It's often that one thing that happens over and over again, without the ability to change or compromise, and both partners emotionally close down on each other.

So when that one thing comes up, instead of shutting down, putting up your dukes, or setting down your battleground lines--basically letting your ego take over--what if that moment, when everything started going haywire, you actually do the exact opposite of what you normally do? What if, instead, you thought to yourself, "What does my partner need right now, what does my partner need today that makes them feel loved, and how can I provide that for them?"

So many times we really do know how to love the other partner, we know what they need and how to provide it. But we refuse to do those things because they're not doing things for us, they're not giving us what we want. That's probably how the majority of relationships end. The If-you-don't-do-it-for-me-I'm-not-going-to-do-it-for-you syndrome, and then a couple years later you're divorced, angry, pissed off, and ready to start over with the hope of a fresh new relationship. One that will probably repeat itself if you did not learn the lesson the first time around.

We refuse to love our partner the way they need, so the battlegrounds are drawn. Once the battlegrounds are drawn, you can kiss that relationship goodbye because there is no way in the world you're going to give in at that point. And neither is your partner. It often becomes a very dangerous tit-for-tat game that has no chance in hell of ever surviving or finding the love in the relationship again.

Relationships are a beautiful thing, and we could cut down on the divorce rate dramatically if we just spent a little bit of time every single day loving our partners instead of responding by how they treat or have treated us.....

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Your thoughts?

Daring to Hope?

2011-08-13T10:59:00.000-07:00

I recently started a new medication, which may be having a positive effect on my pain condition. This is the first major, desirable shift in over ten years.

For the first few months on this medication, I couldn't even allow myself to think that my pain could be controlled with only one, relatively benign drug. And I certainly couldn't express hope out loud. I did not want to offer any bait to evil spirits lingering in my vicinity, eager to pounce on optimism and turn it into yet another disappointment.

Over the years I have consulted most genres of specialists - from neurologists to gynecologists to uro-gynecologists to orthopedists to rheumatologists. I even saw a tropical medicine specialist. In my desperation, I also wandered over onto the fringe side of the healing spectrum and got some comfort from crystals and potions - although no decrease in my pain.

I have been primed to expect defeat. Richard, an optimist and scientist, has always believed in probability. And probability tells him that if I try enough options, some of them will work. His mantra has been: "There's always something more to try."

More often than not, I found this phrase to be exhausting. It left me feeling like a parched wanderer in an endless desert forcing myself to rise up to scale one more sand dune in the hopes of reaching an ever-vanishing oasis.

Recently, Richard began to give voice to hopes of recovery. I told him, "Shush. Be quiet." I'm not ready yet to broadcast.

For now, reaching toward hope is harder than anticipating more pain.

Grand Rounds is Up

2011-08-09T19:04:00.000-07:00

at Dr Deb's site. It's a collection of posts from the health care world. Have a look.

Dislocated Shoulder -- Relationship Realignment

2011-08-03T06:48:00.000-07:00

While hiking a steep mountain trail on vacation in Acadia National Park in Maine, my foot found the only rock with slime on it. I went down with a bang and dislocated my shoulder.

Richard and I had to hike back up to the road and hail a ride to the local hospital. Now, I've known pain, years of it. But this pain was a new taste treat and had me groaning and cursing and counting down the seconds until the nurse dripped some morphine into my vein, and then some more.

They were able to relocate my shoulder fairly easily and with that, the pain subsided.

Richard was by my side throughout -- helping me hike to the road, holding my stuff, sitting by my bed in the hospital. He was present and hugely helpful. And as the days passed and I had to learn to meet the world left-handed, he continued to be responsive to my requests for assistance and to problem solve.

He was wonderful, but I felt alone and wanted more -- and illegitimate for feeling greedy when he was trying so hard.

What was missing for me was overt empathy. At the same time I worked to be independent and do it all myself, I was a wounded bird who just wanted to be sheltered and babied. I did my best to tie my shoelaces one-handed while trying to ignore my yearnings to have my needs anticipated without speaking them aloud and to be cuddled and coddled and told that it would all be OK.

After a few days, I could no longer sustain this inner tension. I was growing weary of the strain and resentful of Richard's helpfulness without emotional empathy. We finally had a talk.

I tried to tell him what I was missing without blaming him for not providing it. I cheered his efforts at practical support and told him, as explicitly as I could, that I both accepted him and loved him, and still felt the sadness of not getting the kind of loving my injury had awakened.

He listened. And he tried to give me more emotional support. When he saw me struggle to wrap my sling around my shoulder he said to me, "I am so sorry you're having to go through this. I wish I could make it all better." His saying that made it far better for me than any attempts to help me adjust my sling.

The more I thought about the specifics of my current situation, the more I realized that the condition of being in a close relationship periodically involves the existence of a gap between what you get and what you feel you want. The gap of life.

The tricky part is not to deny the reality and legitimacy of your wants; while at the same time not punishing your partner for not fulfilling them and (and this is the trickiest bit) accepting him, with love and gratitude, for who he is and for staying in the conversation with you.

To hold both the love and the sadness, and sit side-by-side in the gap of life, together.

Do you know what I mean?

What Do You Do When Illness Makes Sex Impossible?

2011-07-15T10:35:00.000-07:00

What do you do when your partner is no longer interested in or capable of sexual intimacy with you?

Illness takes many tolls, on both partners. One of them is too often sexual intimacy. Medications, pain, and exhaustion can not only turn a libido off, but it can also make intercourse painful for the ill partner. The well partner may be just too drained after a long day of caretaking, working, caring for the kids, and running the household to want anything more intimate than falling asleep side-by-side. And the shift illness produces in some partner relationship -- turning a bond of equals into one of caretaker - patient -- can make sex feel like a taboo.

For some couples, their sexual connection had always been a source of joy that filtered into the rest of the relationship, making it glow. For other couples, sex was routine and its effects remained in the bedroom. For others, sex was never a strong part of the connection.

Whatever your pre-illness sexual habits were, illness too often disturbs them. Intercourse may no longer be possible. Even touching can be problematic. Some couples whose sexual experiences were mainly physical, now find they actually have to talk about what feels good and what doesn't.

Through talking about sex, couples may find themselves entering surprisingly deeper levels of connection, and describing desires that before illness were invisible.

Some couples find ways of being intimate without intercourse. Some are able to stay connected without any form of physical intimacy. Some break apart. Some partners seek sex outside of the relationship, with or without the knowledge of their partner. (note: for the sake of safety and integrity, I would recommend that this be discussed between the partners).

I'm interested in hearing about your situation. Has your sexual relationship changed? How have you managed to deal with illness and physical intimacy?

Grands Rounds is Up

2011-06-28T09:03:00.000-07:00

at Colorado Heath Insurance Insider - a collection of the week's health care blog posts. Have a look.

When You Feel Your Partner's Pain

2011-06-24T10:10:00.000-07:00

This is a guest post written by Patricia Walling. It is a fascinating topic. Enjoy!

We often feel like when we really love someone we can feel their pain, and their suffering affects us greatly. Usually we explain this to ourselves as being the result of really caring about the one we love, and that it's completely a matter of the heart, but that may not be entirely the case. A recent study done at Monash University in Australia by Bernadette Fitzgibbon and some of her colleagues reveals that some people not only empathize with the pain of others, but can also feel it themselves. The study was done by using electroencephalography to monitor the brainwaves of amputees observing images of other people’s hands and feet in potentially painful situations. As it turns out, even if they don't normally feel phantom pain in their amputated limbs, amputees will actually feel real pain if they see others in pain or about to be in pain. This effect is called synaesthetic pain, which comes from the Greek syn-, together, and aisthe-, to feel or perceive.

Fitzgibbon and others propose that amputees are more able to feel synaesthetic pain in these instances due to a pain hypersensitivity, owing to the traumatic event of losing a limb. When we are threatened, our minds go into overdrive and are hypervigilant to pain anyway, and this is even more pronounced for those who have experienced such traumatic pain. This is much like when you are waiting to get a shot at the doctor's office, and the anticipation the pain of getting stuck with a needle is that much worse than if it happened randomly. Yet while you're waiting for the office to write up your bill and you watch someone else get a shot, something called our mirror neurons are also at work, making us wince when they stick them. These are the parts of our brain that allow us to “feel” the emotions of others, and enjoy drama in the theater.

However, that we can feel the suffering of others as though it were our own is nothing new to committed couples. Once my partner cut his hand wide open while cooking, and I could hardly look at it to bind it because it felt as though my own hand were cut open. In the past, I explained this experience as a result of our closeness, and that it was nothing to worry about. But with this new knowledge in mind, it is important to remember that when our partners are hurting, we hurt too. It can be easy to write it off as heartache and continue caring for them as much as we can, but we can end up hurting just as much, literally. Whether you're a full time caregiver or just helping your partner get through a nasty cold, it is important to remember that you also need to take care of yourself.

Grand Rounds is Up

2011-06-14T06:23:00.000-07:00

The weekly collection of posts for the health care world is up at Heath Business blog. Have a read.

How To Claim Your Alone Time

2011-06-09T15:30:00.000-07:00

How do you let your partner know that you need alone time?

Chronic illness is a demanding intrusion. It can determine when you and your partner can go to a movie, what you can eat, and even when you can be intimate. At the same time, illness can force intimacy in areas where it may not be wanted -- discussion of bodily functions, acts of physical caretaking like dressing or washing, exposing helplessness.

The experiences of the ill and well partner are different. Both may feel sadness and anger - at the illness and at each other. But the experiences that provoke strong feelings can be different. And both may need a break from each other in order to simply be quiet or to re-energize or to not feel obligated or dependent.

How do you take a break from your partner without wounding him or her? How do you claim your alone time without without giving the impression that you are rejecting your partner?

For some couples this may be easy. They may have even built alone time into their weekly routines. For others, especially where communication is more labored, taking alone time can be more fraught.

Richard and I both require lots of alone time. That is our nature and it was part of our relationship before chronic pain entered our picture. So now, if one of us closes the door or walks out of the room, the other is not wounded or offended. Sometimes we will say to each other, "Time for alone time."

Do you need alone time? How do you communicate this to your partner?

Grand Rounds is Up

2011-06-01T10:38:00.001-07:00

The weekly collection of the best posts from the health care blogosphere is up at Medgadget. Have a read.

Also - PFAM (Patients for a Moment), a collection of posts write by patents aobut their experiences is up at Getting Closer to Myself.

Health of Older Couples is Linked to Each Other

2011-06-01T10:26:00.000-07:00

As if we didn't already know this........ (quoted from an article on the University of British Columbia's web site):

Physical and emotional health of older couples linked for better or worse, study finds

A study of older married couples that gives new meaning to the matrimonial adage “for better or worse” finds that spouses have a much greater impact on their partner’s health than previously known.

The study, published in the current issue of the American Psychological Association’s journal Health Psychology, finds strong associations between the physical and emotional health of older married couples – and provides important new information on the psychological toll of physical limitations in old age.

Researchers from the University of British Columbia and Pennsylvania State University tracked the emotional and physical histories of more than 1,700 older couples over a 15-year period, using data from a major U.S. survey. Participants ranged in age from 76 to 90 and many had been married for more than 40 years.

In individuals and couples, the researchers found a strong relationship between “depressive symptoms” (unhappiness, loneliness and restlessness) and “functional limitations” – the physical inability to perform such basic tasks as climbing stairs, picking up objects, cooking and shopping. While previous studies have linked physical and emotional health in individuals, this is the first study to show the phenomenon in couples.

“This study shows how important marital relationships can be in determining old age health,” says lead author Prof. Christiane Hoppmann of UBC’s Dept. of Psychology. “In addition, we show that many of the associations between functional limitations and depressive symptoms that have previously been found in individuals are in fact related to spouses.”

The researchers found that spouses’ depressive symptoms waxed and waned closely with those of their partners. Functional limitations in one spouse was not only associated with their own depressive symptoms but also with depressive symptoms in the other spouse. Increases in depressive symptoms in one spouse were also associated with greater functional limitations in both spouses.

“When people are depressed, they tend to want to stay at home – but that causes a spouse to stay home more too,” says Hoppmann. “That’s a problem, because when older adults stop being active – going for walks, socializing, shopping – they risk losing that functional ability. It’s that old saying, ‘use it or lose it.’”

“These findings help to illuminate the often vicious cycle between depressive symptoms and our physical abilities,” Hoppmann adds, noting that associations remained after controlling for individual (age, education, cognition) and spousal covariates (marriage duration, number of children) and did not differ between women and men.

Surprisingly, the researchers found that the relationship between depressive symptoms were slightly stronger in couples than some individuals, suggesting that a spouse’s physical or emotional health can have a greater impact on their partner’s health than their own in some cases.

“Being married for a long time is a very specific situation, it really ties your lives together,” says Hoppmann, whose previous research has explored happiness in older couples. “These findings show just how interdependent, emotionally and physically, long-term couples can become.”

Hoppmann says the findings point towards a greater need for holistic healthcare approaches. “This interdependence suggests that we cannot simply focus on individual patients, while disregarding the major impacts their illnesses can have on the people in their lives,” she says, noting studies have shown caregivers to be at a greater risk for mental and physical health problems.

The researchers – which include Anita Hibbert, a graduate student in UBC’s Dept. of Psychology, and Prof. Denis Gerstorf of Pennsylvania State University – say further studies are required to determine whether these spousal associations are specific to long-term married couples and whether they generalize to aging Baby Boomers who enter old age with more diverse relationship histories, including divorces and remarriages.

How Do Men Grieve?

2011-05-20T09:42:00.000-07:00

I spent a week staying with a friend whose wife died from acute myeloid leukemia two months ago. He is, of course, bereft, but shows it in ways that are not like the womenfolk I know who have lost partners. I am used to women really crying, with all their sisters, and being somewhat immobilized if work and children permit that. Women also look sad and exhausted. Women also seem to know that grieving takes time and that being lost and lonely don't mean that you're stuck and not healing. Of course this isn't true for all women, but it is for many I have known.

My friend wants to be doing "better." And by better, I think he means getting back into life with vigor. After a few days of the sanctioned mourning period, he started going back to work for hours, then days, and now weeks. He socializes with friends many evenings during the week - friends who loved them both, and now sustain him. He started doing a vigorous training program to get back in shape and is running and eating well. There are pictures of his wife all over the house and he likes to engage in conversations about her. He asks, "Don't you think I am doing better?"

I know his heart is shattered and that he misses her with his entire soul. But his ways of grieving and engaging in life I find are somewhat foreign to me. So I ask myself, and you, the question: How do men grieve? I am very interested in your thoughts.

Being Selfish

2011-05-06T14:39:00.000-07:00

Richard has a rash on his feet. It's gray and white. It puddles mostly around his toes. It looks like pond scum. He is treating it with ointments and antibiotics. He has to steel himself to keep from scratching it. I have very little sympathy.

In fact, I am a bit disgusted. Mostly avoidant. I don't want it to get on me, anywhere. I want it to go away. And if it is on him, I want him to keep away.

I am being utterly selfish. And, it feels OK. Maybe even good.

I also know that this is about as minor an ailment as it gets. And it will go away with no harm done.

But I am asking myself, if this kind of response is in me for an insignificant thing, will it be in me for more serious health matters? Have I already been hard-hearted when he suffered with cardiac symptoms or vision problems? How awful is that?

Is it OK to be ungenerous when your sweetie is ailing?

I would tell anyone else -- of course it's OK. It's normal to have moments of wanting to run away. And it's healthy to actually get away from time to time. Replenish yourself before your well of empathy runs dry.

But right now, I don't feel as liberated as I did when I began to write this post. I think I'll go find Richard and tell him that even though I don't really care about his foot condition, I do care about him.