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How will you cope with a health crisis?

People respond differently, and divergent coping styles can create conflict in relationships.

By Abigail Trafford, Washington Post
Published August 28, 2007


My friend talks rapidly on the phone. Her husband has just been diagnosed with a rare skin cancer. It is a second marriage for both, a good marriage. But suddenly they've started to bicker.

This is not like them. The change is scary. What is happening here?

Diagnosis shock: the jumble of emotions in the days after getting a life-threatening diagnosis. It can create havoc in a relationship.

My friend responds to this crisis as a rationalist. As soon as she hears the news, she rearranges her work schedule and postpones a business trip.

But her husband interprets this as a sign she is more focused on her work than on him. The first thing he wants to do is to touch base with the people he loves.

He's not interested in medical details. So when she goes to the computer to find out all she can about the cancer, he feels abandoned.

"We have different strategies for coping with uncertainty," my friend tells me. Those different strategies, she continues, create "a filter to communication that sets you at odds - but you really are not."

This gap in coping styles is a common phenomenon. Jessie Gruman, president of the Center for the Advancement of Health in Washington, said people respond differently to crisis.

Citing research from the Fox Chase Cancer Center in Philadelphia, Gruman divides people into "blunters" and "monitors":

- Blunters keep anxiety at bay by avoiding scary details.

- Monitors gain confidence and a sense of control when they gain information.

Unfortunately, their different coping strategies may cause a rift just when they need each other most.

"What happens when you get a diagnosis, you have no schema for it. You don't know how to behave," says Gruman. "That is the source of incredible conflict in families."

Gruman, a veteran of cancer and heart disease, is author of After Shock: What to Do When the Doctor Gives You - or Someone You Love - a Devastating Diagnosis (Walker). She remembers meeting with doctors when she was diagnosed with colon cancer. She just wanted them to take care of it.

When her husband, a medical scientist, asked to see the pathology report, she was furious: He was "challenging" the doctors! She was afraid they would punish her.

Now, she says, her husband was right to ask questions and to have her get a second opinion. Patients and their families must seek the best information to decide on a strategy for treatment. This is what the Center for the Advancement of Health promotes.

But in those first moments in which a health crisis is announced to the patient, coping styles can be at odds.

Diagnosis shock is a hallmark experience for older men and women. Gains in health and longevity are starting to postpone disability and death to the later decades.

The most common killers are chronic disorders: heart disease, cancer, diabetes, Alzheimer's. Nearly 60 percent of newly diagnosed cancers occur in people 65 and older, according to the National Cancer Institute.

Just as young couples face predictable challenges to their relationship when they have children, older couples come to a predictable turning point when one - or both - face a health crisis.

My friend and her husband were able to bridge their gap in coping styles. He is now grateful that she is his advocate, helping him negotiate the health care maze. They share more openly their mutual needs for love and support.

In time, the acute phase of diagnosis morphs into a longer period of caring. Most people survive the initial assault of a chronic illness, and many manage their condition for years. The experience has the potential to bring families and couples together.

"People can grow beyond anything they ever imagined," says Washington psychologist Dorree Lynn, author of When the Man You Love Is Ill: Doing the Best for Your Partner Without Losing Yourself (Marlowe).

"They suddenly realize this person is important to them. Once they get past the terror, a lot of the junk of life tends to fall away."

But not always. Illness can drive loved ones apart - or lock them up in a lonely prison of bitterness.

Getting a diagnosis sets the stage for redefining relationships in the wake of illness.

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Learn more

The Center for the Advancement of Health does not provide medical advice or consultation to individuals. The nonprofit organization "believes that a systematic, science-based focus on behavior is critical to capturing the value of health research and to improving the health of the nation."

The Web site is www.cfah.org. The telephone number is (202) 387-2829.