As regular readers already know, I like to include the work of cardiac psychologist Dr. Wayne Sotile on this site, mostly because what he writes about the psychological challenges of heart disease and recovery rings so true for me since my own heart attack.
His 1992 book Heart Illness and Intimacy: How Caring Relationships Aid Recovery looks at the profound emotional impact that the stresses of heart disease can have on patients, spouses and children.
I was especially intrigued by the chapter called The Personality Factor: Can We Change? which explores how our personalities and coping patterns can often determine how we’ll react to a life-changing cardiac event.
Based on the 1987 pioneering work of Stewart and Joines on Transactional Analysis, Dr. Sotile outlines in this chapter the six basic coping patterns that seem to drive our perceptions, our behavioural choices, and our corresponding emotional reactions to both everyday life and to a chronic and progressive diagnosis like heart disease. He explains:
“These six personality drivers become especially influential in shaping our reactions during stressful times like a serious illness.”
I was surprised to recognize myself in more than one pattern on this list. How many of these six personality coping patterns seem familiar to you?
1. Being Strong: These personalities are taught to cope with life by being stoic and shouldering burdens without complaints or requests for help. Overwhelming or frightening situations (like having a heart attack) can fill them with shame and discomfort.
♥ Heart patients in this group are often in denial, and can suffer serious depression from the perception that others do not care, or they may focus on physical symptoms only as an indirect way to get support.
2. Being Perfect: Since perfection is never attained, those who are stuck in its pursuit may feel anxious, guilty or never good enough, but may also believe that their internal anxiety will just go away if only they can just “do it perfectly”.
♥ Heart patients in this group exhibit “all or nothing” self-critical thinking like developing irritatingly rigid rules around their cardiac rehabilitation, and may worry obsessively about every details of the illness.
3. Trying Hard: These personalities have learned to feel valued for their ability to try harder than the next guy, for struggling longer and more tenaciously than others. They may have great difficulty determining when they have worked hard enough to deserve a rest, and may even feel anxious when they do try to relax or play.
♥ Heart patients in this group may feel demoralized and frustrated (with themselves and others) because of an excessive work ethic that interferes with enjoyment of everyday life.
4. Pleasing Others: These self-sacrificing folks think they’ve been put on earth to take care of others, not themselves. It’s hard for them to set appropriate limits for responding to the needs of others and expressing (or even identifying) their own important needs, so they often feel drained and martyred. They like to give to others the kind of attention and care they’d like to receive, but rarely ask directly for these gifts of love or attention.
♥ Heart patients in this group may go through recovery and rehabilitation feeling lonely due to reluctance to express their emotional needs, and may also blame themselves excessively for the discomfort they cause in others, like “putting the family through all this”.
5. Hurrying: These personalities may feel uncomfortable, agitated and frustrated with a reasonably-paced lifestyle. They have become accustomed to an internal sense of urgency, and fill their lives with more to do than time allows, as if hurrying is necessary to survive.
♥ Heart patients in this group are similar to Trying Hard copers in their sense of urgency but feel more frazzled or chaotic in response to the urgency, expressing frustration and irritability when they realize, for example, that cardiac rehabilitation is a lifelong process, not an event that will soon be finished. They may go for dangerous quick-fix cures, or just impatiently give up recommended heart health improvements.
6. Being Careful: Some people believe that living is a frightening proposition at best, filled with obsessive worrying and distressing anxiety in reaction to changes, big or small. They may doubt their own and others’ abilities to cope with changes in the status quo, and have difficulty relaxing and enjoying themselves.
♥ Heart patients in this group sometimes suffer depression, questioning their own value as their self-esteem suffers during recovery and they become obsessive monitors, observers and worriers who withdraw from life instead of trying to improve their quality of life.
Finally, no matter which coping pattern seems to fit either the heart patient or the patient’s family members, Dr. Sotile suggests these four things required to help each other cope with serious illness:
- 1. a basic understanding of each others’ coping patterns
- 2. the courage to steer your own reactions in healthy directions
- 3. the perseverance to put up with discomfort until new coping patterns feel familiar
- 4. the loving support of family and friends while everybody learns new ways of reacting.
Dr. Sotile’s book is, sadly, now out of print, but may be available at your local used book shop or through Abe Books.
NOTE FROM CAROLYN: I wrote much more on this and other important patient issues in my new book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017).
Q: In your experience as a patient, did any of these personality patterns ring true for you?
- 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
- Which one’s right? Eight ways that patients and families can view 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