In health and in sickness…

When making these promises at the marriage altar, do couples really know the challenges that life might have in store for them?

wife caring for a sick husbandThe wedding vows pledge undying love and togetherness under all circumstance— in health,in sickness, in joy, in sorrow, for better, or for worse. But, what happens when sickness—in one or both partners—becomes an integral part of the relationship?

Sickness affects the physical and emotional relationship between the couple. The emotional relationship goes through several lows; the relationship dynamics change as both partners battle their way through the changed circumstances, and try to cope with the loss of their dreams of living the perfect life together.

Grieving process-four stages

The loss of dreams has to be dealt with the same way as any other loss, i.e. by going through all the phases of the grieving process. Namely,

  • Denial
  • Anger
  • Mourning
  • Moving on.

Doing this is not only important for the partner who is sick, but also for the one who now finds himself/herself in the role of a caregiver.

More often than not, this process is better handled and successfully completed with the help of a counsellor, a supportive friend or some self-help reading. Of course, the will to move from being a victim of the situation to being a survivor is more important.

Mismatch in stages

The relationship suffers tremendously if the patient and the caregiver do not go through their own individual grieving process. But even if they do go through it, there might be a temporary down-swing in the relationship when the patient and the caregiver are at different stages of their own process.

The patient might be in the angry phase and the caregiver might be lagging behind in his/her process going through the denial phase. Or the patient might be in the mourning phase, and the caregiver might have proceeded and accepted the new relationship.

At such times, both partners, being at different stages of their own grieving process, perceive the situation differently. This is where a counsellor plays a crucial role: helping both of them go through their own sense of loss, and understand each other's the frame of reference.

Some examples of stage-mismatch

Jamila and her husband are one such classic example. Jamila suffered from psoriatic arthritis—an ugly looking skin disease coupled with aching limbs. This made her self-conscious and less mobile. Being an ambitious and active woman, the self-consciousness and the reduced mobility angered her. Her husband was in denial of the serious repercussions of this ailment.

He took her disease lightly and would insist that she accompany him for social occasions, which she refrained from. As you can well imagine, the conflict level between them was extremely high with neither of them managing their emotions or grieving appropriately, or working towards settling into a new lifestyle.

Shobha is yet another example. She was an athletic and fun-loving woman who was confined to bed due to a spinal injury. She had dreamt of a life filled with adventurous treks with her husband, who headed a mountaineering institute. Her confinement depressed her. Her husband, after completing his grieving process, decided to get back to mountaineering. Shobha felt devastated seeing her husband move on so quickly, as she had not yet made peace with her situation. This created a tense environment between the couple whenever he returned from his expeditions.

Effect of stage-mismatch on the relationship

In certain cases, the patient and the caregiver are on their own with no external intervention or facilitation. There is no one to help them understand what they are going through.

In such situations, the problems in the relationship only multiply, adversely affecting the couple, the children, and the extended family and even spilling over to the workplace. This creates more stress, anxiety, anger, depression and guilt as the problems increase.

For instance, if the patient is in denial, s/he refuses medication; or if s/he is in mourning, broods or is depressed. At this point, if the caregiver reacts with anger s/he might fee guilty for having being angry.

The caregiver might experience self-directed anger for having expressed the anger. S/he might experience anxiety about the effects of that anger on the patient, and depression for not knowing how to deal with the situation.

The guilt and self-directed anger often result in the caregiver feeling angrier towards the patient for putting him/her in such a precarious position. The caregiver is thus caught in a vicious cycle of guilt and anger.

On the other hand, if the spouse who is ill feels depressed about the sickness and sees himself/herself as not being the partner the caregiver deserves, it leads to more depression. It results in depriving the caregiver of companionship. Finally, both are deprived of the togetherness they, as a couple, could have had. However, this would not be the case if the patient copes better with his/her sickness and depression about the sickness.

Besides having secondary emotions about his/her own emotional responses, each partner uses the other as a punching bag to work out his/her own emotions. This further strains the relationship.

An example of the effect of mismatch

One of our clients, Kavita, suffered from manic depressive disorder but refused to take her medication in the manic phase. This would anger her husband and he would be verbally abusive and blame her for ruining his and his family's life. Soon after, he would feel guilty and beat himself up and get anxious about the damage he might have caused to her psyche with his words. Pretty soon he would get angry with her, again blaming her for his complex emotional state, and the anger only escalated with each episode.

Support is crucial for both

An important point to be noted is that whenever there is illness in one of the partners, the focus of attention is usually the patient, and s/he is seen as the sufferer who needs to be supported and comforted.

While that is true, it is equally important to support the caregiver who is feeling cheated out of a relationship and is trying hard to be the support and strength of the ailing partner. Both need to be helped to come to terms with the changed reality, and to re-establish a new equation that has some semblance of normalcy.

In conclusion

Sickness if not handled with sensitivity and empathy can scar the relationship forever. However, with the support of the counselling intervention, both of them can find their own new equilibrium with themselves and with the other. They can meet the challenge with a solidarity that brings to life their wedding vows: 'in health and in sickness, in joy and in sorrow, for better or for worse, till death do us part'.

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Minnu Bhonsle
Minnu R Bhonsle, PhD, is a Mumbai-based consulting psychotherapist and counsellor. She conducts training programmes in Personal Counselling [Client-centred Therapy] and Rational Emotive Behaviour Therapy, and also workshops in Stress Management, Art of Listening, Couple Therapy, and Communication Skills. Minnu has co-authored the book, The Ultimate Sex Education Guide along with Dr Rajan Bhonsle.
Rajan Bhonsle
Rajan Bhonsle, MD, is a consultant in sexual medicine and counsellor. Along with his wife Minnu R Bhonsle, PhD, who is a consulting psychotherapist and counsellor, he runs a unique therapy centre

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