Which one’s right? Eight ways that patients and families can view heart disease

by Carolyn Thomas   ♥  @HeartSisters

An interesting phenomenon that I used to observe in bereaved family members during my years working in hospice palliative care is the range of personal grieving styles, and the resulting conflicts over the “right way” to grieve.    

Let’s take the example of two grown daughters whose mother has died. One daughter may be emotionally incapacitated and fragile, needing to tearfully tell the story of her mother’s illness and death over and over again to help herself deal with the loss.

But another daughter copes with her own sorrow by trying to make life as “normal” as possible – throwing herself into tasks like organizing the funeral, writing the obituary, going back to work right away, and keeping very busy.

She may feel impatient and frustrated with her emotional sister, urging her:

  “Pull yourself together! Mum would not want you to be turning into such a weepy mess like this!”

The first daughter, meanwhile, might respond in horror:

“Look at you! You’ve gone back to work, you’re throwing dinner parties and making vacation plans. Don’t you even care that our mother has died?”

Each sister is convinced that the other is doing it wrong.

The same response to differing coping perspectives can happen in families when heart disease strikes one member.    

After meeting countless other heart attack survivors who approach their new diagnoses in very different ways, I’m struck by the similarity with those grieving sisters.

For example, I’ve met survivors who decide not to sign up for cardiac rehabilitation even after their doctors’ referral, survivors who continue to smoke despite knowing the very clear risks to their damaged hearts, survivors who march back to work as if nothing’s happened.

Dr. Wayne Sotile, in his book Heart Illness and Intimacy: How Caring Relationships Aid Recovery, explains that few events in life create as much of a scramble in how we function as heart disease in the family does. And family members of a heart patient can get pushed to the point of losing the organization that holds them all together.

He lists eight ways – each different but each quite understandable – that patients and their family members might view a significant heart disease diagnosis, based on coping strategy assessment tools from the late Dr. Zbigniew Lipowski of the University of Toronto:

1.  as a challenge – a life situation that consists of multiple tasks that must be mastered

2.  as an enemy – like an invasion of harmful forces that have entered your body and your life

3.  as a punishment being delivered justly or unjustly for your lack of perfection

4.  as a sign of weakness

5.  as a relief from your typical life stresses

6.  as a strategy to use in trying to get more nurturing attention from the family and the rest of the world

7.  as an irreparable loss of valuable aspects of life

8.  as an opportunity for growth and development

Dr. Sotile warns that these perspectives, which can vary from day to day for the same person, can also cause serious conflicts within the heart patient’s family.

For example, one family member might view this illness as a challenge to be aggressively overcome, while another might insist that it’s a reason for the patient to finally slow down and be less goal-obsessed.

So the first believes that working extra hard in cardiac rehabilitation will absolutely change the patient’s cardiac risk factors.  The second, however, defines success in cardiac rehab as finally learning to take it easy and not be so driven all the time.

It’s important to remember that most coping skills and world views are based on personality tendencies that have been practised for decades before any traumatic event even happens. There isn’t a “right” or “wrong” way to cope. Each perspective may make perfect sense to that person, even as it mystifies or infuriates others in the family.

Dr. Sotile’s advice for heart patients and their family members who feel stuck in their differing views on “doing it right” after a cardiac diagnosis is this:

“Honestly evaluate whether this disagreement is a symptom of unresolved problems in other areas of family relationships.”

Find out more about personality and coping with heart disease from cardiac psychologist Dr. Wayne Sotile.

NOTE FROM CAROLYN:  I wrote more about how families can affect our cardiac recovery in my book A Woman’s Guide to Living with Heart Disease, (Johns Hopkins University Press). You can save 30% off the book’s cover price if you order it directly from Johns Hopkins University Press (use their code HTWN). Or ask for it at your local library, your favourite independent bookshop, or order it online (paperback, hardcover or e-book) at Amazon.

See also:

Why hearing the diagnosis hurts worse than the heart attack

How we adapt after a heart attack may depend on what we believe this diagnosis means

Six personality coping patterns that influence how you handle heart disease

Denial and its deadly role in surviving a heart attack

Surviving the crisis: the first stage of heart attack recovery

The new country called heart disease

‘After the Diagnosis’: two books, same title, one hope

A tale of two women: how we react to a heart attack diagnosis