I opened an email recently from one of my Mayo heart sisters. She had dropped me a note because she was concerned about a woman (a recent heart attack survivor) who had told her she really wanted to attend their community’s next WomenHeart support group meeting for women living with heart disease (this one was a monthly meeting held from 3-4:30 p.m.). But this woman claimed that she couldn’t go to the meeting – because she “had to be home to cook dinner for her husband.” Although her hubby was retired and at home all day long, the heart attack survivor explained that “he expects to have dinner ready at the regular time that I have had it for him all the years he was working.”
My initial reaction (after checking the calendar just to make sure it’s not still 1950): I need to go have a wee lie-down to recuperate from reading this story.
My friend had asked this woman: “So you can’t tell him that you want this 90 minutes a month, this short time to be with women like yourself, to help you learn more about living with heart disease?”
My friend: “Did you make dinner for him when you had your heart attack, or during your recovery?”
“No. He asked my daughter, and she did.”
Of course, we don’t know the exact personal circumstances of this woman who couldn’t attend a support group following her own heart attack because she had to stay home and serve dinner. Perhaps hers was an abusive relationship and she was afraid of him. Perhaps she was old school and it hadn’t even occurred to her to tell him what she wanted to do. Perhaps he was bedridden and couldn’t lift a fork to his mouth on his own. Perhaps she had signed a personal servitude contract with him and could be legally liable if she missed a dinner.
I suspect that this scenario, however, is less about a demanding husband and more about a wife who has trained that husband on how to treat her, on what she’s willing to put up with, and on the place in life she believes she deserves. I’m guessing this is also about the profound belief that her own needs are simply not as important as those of her spouse and others.
This reluctance of so many women to let their own needs interfere with other people’s is not unique to this woman. You would think that there are few things more important in life than having/surviving a heart attack. But even in mid-heart attack, we already know that women are far more likely than men to come up with reasons to delay seeking emergency help for themselves in a way they’d never delay if the person having identical symptoms were their daughter, mother, spouse, sister or friend. In a Mayo Clinic survey(1) on women’s top priorities in life, the results showed that women tend to rank what’s most important in this order:
- spouse (yes, right below the dog!)
This survey’s truly pathetic last place ranking confirming women’s unwillingness to put ourselves first on our own priority lists may help to explain why this particular woman’s need to go to a support group meeting wasn’t as important to her as serving her husband’s dinner was. What the hell – this survey suggests that, for some women, they’d put the dog’s dinner needs ahead of their own!
Female heart patients may not only put serving dinner ahead of their own needs, but even lifesaving cardiac rehabilitation programs. Dr. Chris Blanchard is a health psychologist at Dalhousie University in Halifax whose research has shown that women are up to 30% more likely to quit these programs than men – despite knowing that completing a supervised cardiac rehab program can reduce mortality in heart patients by 25-40%. Even when women don’t drop out of rehab outright, they’re more likely to attend only sporadically. Out of a typical 20-session cardiac rehab program, Dr. Blanchard found that men will generally attend 80% of sessions, compared to women who will attend only 50-60% of the time. See also: Why aren’t women heart attack survivors showing up for cardiac rehab?
So why do women have such poor attendance records, or end up being rehab dropouts at these lifesaving programs? According to Dr. Blanchard, it’s because women put themselves low on their priority lists.
“Women are caretakers for other people, and they undersell themselves. That’s the biggest gender discrepancy I’ve seen.”
Perhaps the women who do put themselves dead last (only after everybody else’s needs are already met first) might also suffer from what’s been described as Type E personalities: ‘Everything To Everybody’. Is it because women are, from birth, socialized to be nurturers and caretakers, sometimes even at the expense of our own health?
In fact, when we do take time for ourselves, we can sometimes feel like we’re being selfish, which, as we all know, is the worst possible way to be. And we can even resent others who DO carve out specific time to devote exclusively to themselves and their own health.
Here’s another dangerous example of our out-of-whack priorities: a number of cardiac researchers have spent years investigating a unique phenomenon that they call women’s “treatment-seeking delay” behaviour in mid-heart attack. This delay is extremely dangerous because “time is muscle” when it comes to making the decision to get early cardiac symptoms assessed as soon as possible to prevent permanent heart muscle damage or death due to a serious cardiac event. See also: ‘Knowing & Going’ – act fast when heart attack symptoms hit
Being in an unhappy marriage in which your own needs are not considered worthy can also cause significant physical harm.
A University of Rochester study predicted that 83% of happily married women will still be alive 15 years after cardiac bypass surgery, versus only 28% of female bypass surgery patients living in unhappy marriages.
Research also suggests that being happily married can have a big effect on helping us recover from serious health crises like a heart attack. (For men, by the way, marriage doesn’t even have to be particularly happy to increase positive health outcomes. Just the mere state of being married, happily or miserably, apparently leads to better outcomes in males). But we know that just being married is not in itself a guarantee that women will be supported by their spouses during recuperation from chronic illness. A 2009 study on “partner abandonment” among married couples, for example, conducted at the University of Washington in Seattle found that men are six times more likely to leave a relationship because of their partner’s serious illness than wives are. Among those study participants, the divorce rate was 21 percent for seriously ill women, but just 3 per cent for seriously ill men. A control group divorced at a rate of 12 per cent, suggesting that if disease of a spouse makes husbands more likely to split, it makes wives more likely to stay.
The prognosis, for women heart patients particularly, seems directly linked to the quality of that spousal relationship. But what about women who are afraid to leave an unhappy relationship, reluctant to be on their own while struggling with a heart condition? As I asked here in 2013:
“Wouldn’t the prospect of being on her own after a divorce be far worse for a woman living with a serious illness than staying in an unhappy marriage?
Not according to a recent U.K. study of 10,000 people over a 20-year period, published in the journal, Economica. It suggests that, in general, women who leave an unhappy marriage are much more content than men after divorce – even more so than their baseline level of happiness throughout their lives. Study author Dr. Yannis Georgellis explained:
“In the study, we took into account the fact that divorce can sometimes have a negative financial impact on women, but despite that it still makes them much happier than men.”
Dearest readers, if you’re ever in a relationship in which you have somehow convinced yourself that you don’t have the right to make your own heart health a clear priority in your life, remember these fundamental human rights, as outlined by Preston Ni in his Psychology Today column:
- You have the right to be treated with respect.
- You have the right to express your feelings, opinions and wants.
- You have the right to set your own priorities.
- You have the right to say “no” without feeling guilty.
- You have the right to have opinions different than others.
- You have the right to take care of and protect yourself from being threatened physically, mentally or emotionally.
- You have the right to create your own happy and healthy life.
And if you need somebody to remind yourself that you deserve these rights, please seek professional help and a good lawyer.
“Hierarchy of Female Concerns”, Mayo Clinic survey, 2000; results presented by Mayo cardiologist Dr. Sharonne Hayes at the 2008 WomenHeart Science & Leadership Symposium For Women With Heart Disease, Mayo Clinic, Rochester.
Nancy Henry, Tim Smith. University of Utah. Presented to the 2009 American Psychosomatic Society’s annual meeting, Chicago.
Q: Why are some women reluctant to express their own needs?
- Marriage triples our bypass surgery survival rates – but only if it’s happy
- When being married makes being sick worse
- Poor Marriage = Poor Heart Health For Women
- Women heart attack survivors know their place
- Is family stress hurting your heart?
- Can denial ever be a good thing for heart patients?
- Knowing & Going: act fast when heart attack symptoms hit
- Downplaying symptoms: just pretend it’s NOT a 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
- Six personality coping patterns that influence how you handle heart disease
- The new country called heart disease