Most marriages will be confronted with challenges. How we cope, make meaning from, and find benefit in challenges affects our overall satisfaction in our marriage. One of these biggest challenges marriages face is health
In Sickness and In Health Till Death do us part
We take our marriage vows in innocence and with deeply felt sincerity. That’s probably a very good thing, because the reality of coping with a chronic, debilitating illness such as a stroke, Parkinson’s disease (PD), or dementia, makes many question or regret their vows to stay together in sickness and in health.
When our love is new, we don’t vow to love honor and cherish until. And usually, we don’t intend to leave when our partner becomes ill—but we may feel like it at times.
When One Partner Becomes a Caregiver
In the United States, spouses are first in line to take on caregiving responsibilities (Pinquart and Sorensen, 2011.) We are living longer than ever before, so the likelihood that one partner will become a caregiver is high. Studies have shown that the caregiver burden when a spouse has a chronic illness negatively affects the non-ill partner both physically and mentally: more depression, more financial and physical strain, and lower levels of well-being.
Take PD, for example. PD is a chronic debilitating illness characterized by complex motor and non-motor symptoms. When PD is first diagnosed and during much of the illness, the non-PD partner provides most of the informal caregiving. Roles and division of labor often shift, with the caregiving spouse taking over such tasks as scheduling and driving to medical appointments, assuming the banking and paying bills, and so forth. Chores increasingly fall on one partner, making it difficult to find time for the non-PD partner to practice their own self-care or see friends.
Research on marital satisfaction and quality of life shows that social support is a key factor in coping with illness, yet sadly, couples often become more isolated, withdrawing due to an increase in interpersonal distress, shame, or apathy. The need to cut back on work-life or retire abruptly brings another set of challenges, such as loss of work identity, fading ties with coworkers, more dependence on family, and decreased income.
My Illness or Your Illness: Attending to the relationship
Chronic illness needs to be seen not only as an individual challenge but as a relationship challenge as well. Anger at the unfairness of life when newly diagnosed is entirely normal, for example, especially if the implications of the disease process are fully understood. Wanting to blame someone is understandable, but with an illness such as PD, it’s important to ascribe the difficulties to the disease, not the person.
Studies have looked at how dyadic coping—a process by which a couple works together to cope with the stressors that one or both face—might be one way of improving health and in turn, the quality of the marriage. Couples who see the illness as a relationship issue rather than an individual issue will be more satisfied with their relationship than couples that don’t.
Coping together: We-ness in marriage
One clue to how couples see the relationship is their pronouns. These seemingly innocuous parts of our everyday speech give us an important window into the inner workings of relationship. If one member of a couple comes into my office and is talking at his/her partner, using pronouns such as I, me, my, you, your, this shows a greater sense of independence and distance in relationship. Using words like we, us, our, implies a shared identification between spouses, more intimacy, and more emotional investment in their relationship.
Self and Partner Soothing
We-ness is also associated with more positive and fewer negative feelings, and with lower autonomic nervous system arousal—the fight or flight response. When one partner is anxious or distressed, we can calm them down by using we-ness words. This produces a soothing or emotion-regulating effect on the other spouse. I have seen this many times in my office when counseling couples. For example, when Joyce was becoming agitated about how she would cope with Al’s PD, Al reached over and gently stroked her arm, saying ”We’ll deal with this together.” This had an immediate impact on Joyce’s anxiety.
That simple act can make a big difference. We refer to these as emotion-regulating behaviors. Couples can help each other cope with anger, frustration, and fear and minimize the damage to the marriage. In couples therapy, we help partners understand the importance of self-soothing during difficult times and the value of providing that to their partner when needed.
Benefit Finding: Glorifying the struggle
When couples come to therapy, I assess their strengths and the areas that need work. Asking such questions as “Looking back over the years, what moments stand out as really hard times in your marriage? Why do you think you stayed together? How did you get through these difficult times?” Or, “How would you say your marriage is different from when you first got married?” With such questions, I am looking for growth as a couple and for a sense of how they cope. Are they a team? Or do they point fingers and accuse their partner of messing things up?
By developing a shared narrative, and finding meaning in how we strengthen our bond (or we-ness), we can improve our marriage and how we cope with problems. Couples who view their struggles as hard, but worth it, demonstrate hopefulness and togetherness. Yet when one partner feels out of control of the events that they face, they may slip into passive endurance, believing there is nothing they can do about a problem. They struggle to survive instead of growing closer through the challenges. These marriages are less likely to be happy and more likely to end in divorce.
But for couples that find meaning and growth in difficult times, they “glorify the struggle” and will have a better chance of staying together through hard times. Hope and commitment toward growth as a couple are elevated over disillusionment and negative perspective. I don’t want to be dismissive of the real, hard problems such couples face or expect them to have a Pollyanna, rose-colored-glasses approach. We can acknowledge the pain and suffering we face, but at the same time, try to find something in our experience that helps us learn something new, to grow from it.
By viewing the inevitable problems that arise in marriage as “our problems” rather than blaming our partner, we strengthen our bond. Moreover, when we work as a team rather than in parallel, we are less likely to complain criticize, or be defensive. This has a valuable outcome: we naturally reduce each other’s tension or physiological arousal. When we are relaxed when confronted with problems or conflicts, we are more likely to find ways to manage them—in sickness and in health.
couples counseling, and Mindfulness-based therapies in the San Francisco Bay Area for over 20 years.
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