Who Cares?

I just finished a MedFT clinical internship at the Loma Linda University Transplantation Institute where I worked with couples in which one member was severely chronically ill and needed a kidney or liver transplant. I have a heightened awareness of how emotional and tangible support, caregiving, and impact on the family typically differs depending on whether the patient is a man or woman. I just read a study by Glantz et al. (2009) which documented divorce rates in patients diagnosed with brain tumors, cancer, or MS. They found that 11.9% of marriages ended after the introduction of these serious illnesses. In 88% of these separations the ill person was the woman, compared to only 12% of men – a significant difference (Glantz et al., 2009). Two factors that appeared to protect against divorce were higher age and longer duration of the marriage. They labeled separations as “partner abandonment” and they resulted in poorer health outcomes in patients, more hospitalizations, higher use of anti-depressants, and less compliance with treatment regimens. This study supports the notion that relationships are important to both physical and mental health. It also confirms what I have seen in my practice with severely ill patients, that women are more dedicated to the care of their sick partners. Why does this happen?

I have an idea…

I think for all people in our society there is an entitlement to personal happiness over the needs and happiness of others. So why should anyone suffer to care for a sick person? I have heard things like, “this isn’t what I signed up for, she/he is not your responsibility, and you need to do what is best for you.”  No one in this culture wants to be a burden. I frequently hear sick people, but in particular women, say they feel bad for being a burden to their loved ones. For women this is one of the greatest sources of stress when they are ill. Men on the other hand don’t report this as often and seem to have a sense of entitlement to care when they are ill. Society also doesn’t seem to look down on men as harshly for leaving their sick partners, but a woman who leaves a sick man? What is wrong with her! What a terrible person!! We all learn from strong messages that put responsibility for others and relationships on women.  Just look at this picture I found when I googled the word “care.” Notice how it is a woman’s hand on top of a mans – where she is in the caregiving role.

I think men may abandon their sick partners out of a sense of entitlement to not being bogged down. I also think that fear about inadequacy around caregiving and their ability to cope with the level of stress that comes with severe illness in a loved one plays a major role. Maybe even more so than the sense of entitlement, but for men I think it may be easier to go to the place of “this isn’t what I signed up for” rather than “I am really scared, I don’t know how to be a caregiver, and I don’t want to get closer to someone I will likely end up losing.” Another contributing factor is since she is now sick the female partner does not have as much time and energy to devote to caring for the relationship and her partner – so things fall apart.

The couples I see are often in the beginning stages of adjusting to having a severe illness intrude into their partnership. This allows me to intervene at a crucial point, often before the illness has done serious damage. This seems particularly important for men because many of them are not spending a lot of time looking into what motivates their behaviors in relationships. I often use my experiences with my dad and the conversations I have with him about masculinity. This facilitates the joining and that is crucial for the next step. I give voice to what I think they can’t because it is too vulnerable. I voice the presence of fear, not-knowing, feeling inadequate, and doubting their abilities to handle this. I also voice how I think they wish they could be in relationship. This allows us to go to a place where we can discuss ideas in society which have likely influenced their behaviors, thoughts, and feelings within relationships. This takes away the shame and guilt they have about being relationally inadequate and allows us to explore new possibilities. I often find that the introduction of illness can be positive in that it can bring partners closer than they ever imagined. I feel so privileged to be a part of this process!