Ken and Melissa had been high school sweethearts with marriage following his basic training in the Marines. Two children and a new house followed in the next three years. Despite the usual irritants and money issues, they felt they had a great marriage. Melissa was even handling his deployment to Afghanistan, becoming part of the tight support system of wives and families in a similar situation. That was until an exploding IED ripped through Ken's legs. He was now in a military rehabilitation center, learning to walk with his new artificial legs and adjusting to his new reality. When he looked around the hospital he considered himself fortunate in that he could still kiss his wife, hold his children, and interact with them from a thinking and emotional standpoint. As hard a time as he was having adjusting, he knew that his brain injured comrades were struggling to recognize their families and may never be able to live by themselves. He never mentioned it to Melissa, but at night when the lights were off and it was quiet, he often wondered if Melissa would stay with him? Would their marriage survive this horrible event and would Melissa love the "new" Ken the way she had the "old" one?
As a neurologist who specializes in neurorehabilitation I have treated thousands of patients who have faced the same concerns as Ken. Disabilities come in all forms and with different challenges. A spinal cord injury or amputation will result in dramatic physical changes but usually leave the person cognitively intact, while a brain injury or stroke not only causes physical disabilities, but also causes cognitive and behavioral disabilities that can substantially change the person.
Many years ago I heard a quote attributed to Barry Rath Ph.D., a neuropsychologist in Texas. "That which makes us most human is most vulnerable to brain injury." We form relationships based upon unique bonds and attractions to each other. Unfortunately, I have had many a parent tell me that they loved their brain injured son or daughter and would care for them, but they were taking a stranger home from the hospital. The same is true for a spouse who now becomes the caregiver for someone who is very different than the person they had been living with. Over 40 years ago my wife fell in love with me and we decided to marry. Trust me, I suspect there is a lot about me that she is not particularly happy about, but she is still in love with some portion that brings a smile to her face. If I have a brain injury, stroke or become demented and that special part she fell in love with disappears, she is left with only the parts that are annoying or difficult to deal with. You can see the problem.
I decided to ask my friend and the psychologist at our Rehabilitation Hospital, Hal Hoine Ph.D. to talk with me about what makes for a good relationship and whether we can predict who will weather the storm of a disability and stay together. For simplicity sake I will refer to all forms of opposite and same sex partnerships/marriages as relationships.
It quickly became clear that all relationships are a balance between what you like and don't like in the relationship. Dr. Hoine notes that when he sees couples in counseling he may refer to the "cost equation" of staying together versus splitting up. It applies to every aspect of the relationship: physical, emotional, financial, children, social pressures etc. Take the benefit of staying together and subtract the "cost" of staying together. Then look at the benefit of splitting up and subtract the cost of splitting up. Relationships take work and having a disability can unbalance the equation. If dealing with the disability is difficult, it may be too hard to work on both the relationship and the disability. I have had many a person say to me, "I didn't sign up for this." No one "signs up" to be a caregiver, but it happens.Relationships Fall Apart Because Of:
- A lack of trust. How reliable is your partner? Are they someone you can count on? All relationships want predictability and security as well as fidelity.
- People take the "good" for granted and focus on what they consider to be bad.
- A loss of empathy. The ability to view the relationship from the other person's perspective is essential in dealing with the stressors of a relationship.
- They no longer have common interests or their needs change. Not everyone deals well with change.
The Impact Of A Disability
Disabilities break down the basic structures of relationships. Roles may be reversed overnight with the woman becoming the bread winner or the man becoming the homemaker. These are traditional roles and it can easily be the opposite where a woman is forced to put a career on hold or abandon it altogether. We typically talk about how brain injury, stroke or dementia will exaggerate a person's preexisting personality traits. A difficult, short tempered and impulsive individual becomes just that much worse as a result of the disability. However, we also need to look at it from the caregiver's point of view. A nurturing partner is more likely to do well and adapt more easily than someone who is more self centered. The disability places increasing demands on the relationship.
The common wisdom had been that the divorce rate was higher after someone has a brain injury. However, a recent article, "The Truth About Divorce After Brain Injury," notes that in a study of 120 brain injury survivors, 75 percent were still married at the time of follow up.Important predictors were:
- Older persons were less likely to get divorced.
- People who had been married for longer periods were less likely to get divorced.
- The more serious the injury the greater the likelihood of divorce.
- In severe injury groups, minority group members were more likely to stay married.
A Relationship Checklist
Dr Hoine and I sat down and created an unscientific checklist that you can use to evaluate your relationship and how it might weather the storm of a disability. We can tell you from the experience, that these storms are not predictable and show up at your front door both unexpected and unannounced.
- Communication: Evaluate how well you and your partner communicate and remember that it is less about what each of you say and more about what each of you hear. A simple request to take out the garbage may be heard as just one more unreasonable demand or an unfair criticism.
- Competence: The individual's perception of their competence. The more an individual has a sense of self competence the more secure they feel in their lives and their relationships.
- Maturity: Do you have a mature relationship? The prominent psychoanalyst, Eric Fromm, discriminated between mature and immature relationships by writing that in an immature relationship the individual says, "I love you because I need you," as opposed to the mature relationship saying, "I need you because I love you." I don't need you to make me feel important or special; I need you only for the relationship.
- Empathy: This is the ability to see the relationship and world from the other person's perspective.
- Coping Skills: The healthier the individual's personality the better one's chances of adapting to change. The preexisting personality of the able-bodied partner is critical to the post disability relationship.
- Financial Resources: We can quote studies on happiness that diminish the importance of the relationship of money and happiness. However, it does make a significant difference whether one has the financial resources to deal with the disability. This may mean having good medical insurance or the financial resources to help with care taking, or just provide a little relief to recharge your batteries.
Just writing this article made me think differently about things; hopefully it will do the same for you.
Follow Richard C. Senelick, M.D. on Twitter: www.twitter.com/RichardSenelick