I’ve come to learn that a common reaction to a heart attack is others’ utter shock that this could happen to “YOU, OF ALL PEOPLE!” Women in particular report reactions like this because, generally speaking, we’re used to being the strong glue that holds our family life and relationships together.
How dare we get sick. . . . . .
Dr. Wayne Sotile, in his very useful book Heart Illness and Intimacy: How Caring Relationships Aid Recovery, talks about the “family scramble” that can happen when somebody in that family is diagnosed with heart disease. Few things can heighten the family scramble, he claims, like the “wrong” family member getting sick.
Just who is the “wrong” family member?
Dr. Sotile suggests that, ironically, it may be easier in some families to adjust to a new cardiac diagnosis in a family member who already lives with another chronic condition. He gives the example of a family accustomed to dealing with the health problems caused by a husband’s alcoholism:
“If he now has a heart attack, the specific problems change, but the process of living with a husband with health problems simply continues. The shock of this cardiac diagnosis may be less than if he had never been sick before.”
But what if it’s the woman in this same family who suffers a heart attack, the one who has “never been sick”?
Dr. Sotile predicts that the rest of the family may now have greater problems coping when she is “temporarily unavailable to hold the family together in the face of escalating stress”. Family adjustment to this illness might be understandably challenged, especially if the freshly-diagnosed heart patient is healthier compared to others in the family. See also: When a Serious Diagnosis Makes You Feel Mad as Hell
Any time that an illness requires family members to make major shifts in how they relate to one another can be prime time for adjustment issues, according to Dr. Sotile. Both of my grown kids flew home immediately after the shocking news of my own heart attack, at which time our usual roles were dramatically reversed as they took over shopping, cooking and cleaning for their Mum. They just couldn’t believe that somebody who had been a healthy and active distance runner for 19 years was now an overwhelmed heart patient who needed afternoon naps. Dr. Sotile reminds us that people who are shocked by illness in their family, or are drafted into unfamiliar caregiving roles that they didn’t sign up for, often struggle to remain organized in ways that feel familiar.
For example, Dr. Sotile tell us that some families make one of two unhealthy choices when the “wrong” one develops heart disease:
1. DENIAL that the illness exists: both heart patients and family members sometimes cooperate in denying that anyone in the family has heart disease, or that the condition is as serious as they’re being told it is. They’re playing a game of pretending that the illness is not real. This dynamic may be due to the patient’s fear of the impact that open acknowledgement of heart disease will have on loved ones. (I could immediately relate to this unhealthy option, as I wrote about in When Heart Disease Wears a Smile. Our worried loved ones want and need us to get better. We know that, and will often become co-conspirators with them in pretending that we are).
2. GETTING SICKER than the patient: if the “wrong” family member gets sick, other family members may develop symptoms that require the patient to maintain a sense of importance and power in the family despite their heart disease diagnosis. Dr. Sotile calls this “one-downing” the heart patient. He cites research suggesting that family members of heart patients may even develop psychosomatic ailments that require medical attention. These ailments can result simply from the sheer emotional stress of dealing with a loved one diagnosed with a serious heart condition. See also: Oneupmanship: You Think YOU Have Pain?
For some female heart patients, just the fact that we are women may still be reason enough to make our families believe that the “wrong” person has been diagnosed with heart disease.
It was in the 1980s, for example, that the venerable American Heart Association launched its clearly male-focused ad campaign that reinforced the male heart attack stereotype by posing this question:
“If your husband had a heart attack in bed tonight, would you know what to do?”
And it was this same organization that, in 2016, issued its first ever Scientific Statement on Myocardial Infarction in Female Patients, reporting that women are significantly more likely to be under-diagnosed, and under-treated even when appropriately diagnosed, compared to our male counterparts. I can’t say what part of that scientific statement I found more upsetting: its appalling conclusions? Or the fact that it had taken this organization NINETY-TWO years to come up with an official statement about women? See also: Finally. An Official Scientific Statement on Heart Attacks in Women.
Other studies also support Dr. Sotile’s observations on caring for adult heart patients. We know, for example, that spouses who suddenly become caregivers generally report greater financial and physical burdens, more symptoms of depression and lower psychological well-being,1 especially when reported along with “physical and psychological exhaustion, lack of support from other family members, the patient’s degree of dependency, and their new role as caregivers.”
I learned a lot about family dynamics in Dr. Wayne Sotile’s book, Heart Illness and Intimacy: How Caring Relationships Aid Recovery – highly recommended for you and your family, too.
1. Pinquart M et al. “Spouses, adult children, and children-in-law as caregivers of adults.” Psychol Aging. 2011;26(1):1-14.
Q: How shocked was your own family by your cardiac diagnosis?
NOTE FROM CAROLYN: I wrote much more about how families respond to a new diagnosis of heart disease in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your nearest library or local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press. (*BOOK SALE!* Until June 7th, use their code HMEM to save 30% off the price of all JHU Press books!)