When illness tests marriage vows

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HEALTH SENSE

When illness tests marriage vows

By Judy Foreman, 7/17/2001

Several years ago, Dr. J. Glantz, a brain cancer specialist, was

struck by what appeared to be an extraordinary number of divorces and

separations among his patients, many of whom had primary brain tumors that

were expected to kill them in 15 months.

Not only did there seem to be lots of breakups, but most of them seemed to

occur when the women got sick. So, Glantz, who was then at Brown University

and is moving this summer to the University of Arizona, began keeping track.

To the surprise of his male but not his female colleagues, Glantz found that

17 out of 183 married brain cancer patients had endured a divorce or

separation within about a year of their diagnosis - an overall divorce rate

of 9 percent. More importantly, he said, 14 of the 17 divorced or separated

patients - 82 percent - were women.

To see whether this was tied to something particularly stressful about brain

cancer, which can alter personality and cognitive function, Glantz also

studied two other groups: 107 married patients with multiple sclerosis, a

chronic disease that is not usually fatal, and 172 married patients with

cancers that neither arose in nor had spread to the brain.

Divorces in those cases, too, he found, disproportionately occurred when it

was the wife who was sick - 96 percent of the cases with MS, 78 percent of

the cases of systemic cancer.

One rather unappealing interpretation is obvious: That women hang in there

with sick husbands while men bail out on sick wives. But stay with this a

bit longer, guys. And, ladies, don't despair. This is not heading to the

all-men-are-cads conclusion you may be expecting.

For years, when researchers probed the emotional impact of cancer and other

serious illnesses, they usually focused on the patient. Today, there's a

growing realization that, at least in the emotional sense, it's the couple

or the whole family that ''has'' the disease.

In fact, the well spouse sometimes feels more distress than the sick one,

who at least can throw his or her efforts into survival. And, while some men

do have trouble taking on the nurturing role, researchers say, many do it

quite well. In fact, many couples get closer when one member has cancer,

especially if the marriage was strong to start with.

Beth and Savard of Methuen can vouch for that, though things got very

shaky while she was in the midst of chemotherapy for breast cancer six years

ago. Both 35 now, they were 29 and the parents of a 2-year-old when Beth was

diagnosed. could deal with the factual issues about cancer, she said,

but he shut down emotionally.

''He was not talking about his feelings. I was trying to talk about mine,

but I couldn't talk to him because I was not getting a response.''

They were about to see a divorce lawyer when they went to a We Can Weekend,

an annual family retreat sponsored by the American Cancer Society. During

that weekend, began to talk and cry with other men whose wives had

cancer. He began to tell Beth how helpless he felt, she recalled. He even

voiced the most frightening feeling of all - that she would die and he would

have to raise their child alone.

Many couples say that ''when cancer came in, communication went out,'' Beth

Savard said. But it needn't be that way. Today, Beth said, she and are

''very, very talkative. We share a lot.''

Having cancer or a spouse with cancer, particularly brain cancer, has ''got

to be the most stressful thing in the world,'' said Dr. Henson,

executive director of the brain tumor center at Massachusetts General

Hospital. And generally, he has found, couples are extremely supportive of

each other.

But often, he said, the spouse with cancer often has some level of denial,

''which is probably a healthy coping mechanism.'' The healthy spouse even

may be more emotionally affected, something that Henson said has nothing to

do with gender.

McCaffrey, a clinical social worker who runs support groups at Beth

Israel Deaconess Medical Center for men whose wives have advanced cancer,

agreed. If the spouse who gets cancer has historically been the one who has

provided most of the emotional caretaking, he said, the well spouse,

regardless of gender, ''has to evolve and be able to understand that the

patient, the ill spouse, can't provide the same emotional caring and support

that they have been.''

Not surprisingly, this is easier if the marriage is good to start with. ''If

the marriage was teetering before, it gets harder. They are the ones at most

risk,'' said Dr. Jimmie Holland, chief of psychiatry and behavioral science

at Memorial Sloan-Kettering Cancer Center in New York.

Even Glantz's data, alarming as it seems at first blush, does not actually

prove that the divorce rate is higher than normal among couples in which one

spouse has cancer or MS.

If anything, the opposite may be true.

According to data released in May by the National Center for Health

Statistics, 43 percent of first marriages end in separation or divorce

within 15 years; 20 percent end within five years.

It's statistically risky to compare national divorce rates, which include

many young couples, with divorce rates in couples in which one spouse gets a

serious disease, in part because the latter couples are often older, and

possibly more mature. But Glantz's study suggests that couples dealing with

at least one serious illness, MS, have a lower than average divorce rate,

just 24 percent after a median of 14 years of followup.

That doesn't surprise Marcus, 58, a free-lance editor in Brookline

who has been married for 25 years to Kit Crowe, 51, a librarian who was

diagnosed with MS just after their marriage. In recent years, he said, Kit

has not been able to work full time, and ''it's been scary for me to be the

primary wage-earner - that freaks me out sometimes.''

But splitting up has never crossed is mind.

''You do the best you can,'' he said. ''It's a question of love. Even if

you're freaked out, that's not enough to make you run.''

And even when a couple divorces soon after the woman gets cancer, that

doesn't prove that her husband abandoned her.

Laurel Northouse, a nurse with a doctorate in research who studies the

impact of cancer on couples at the University of Michigan School of Nursing,

has studied couples in which the wife has breast cancer. She has found not

only that the divorce rate within the first 12 months of diagnosis is a

fairly low 3 to 4 percent, but that sometimes it's the woman who decides not

to spend whatever time she has left with a man she no longer loves.

A divorce soon after cancer may look ''like the husband is leaving her, but

she may be saying, `Enough already,''' Northouse said.

In a study of colon cancer published last year, she said, female care givers

of men with cancer actually reported more distress than their husbands. One

reason for that, Northouse said, is that when husbands become care givers,

they are often seen as heroes doing more than society expects.

''Nobody brings casseroles to women when their husbands are sick because

people assume a woman can do the caretaking, that she's a natural care

giver. But women need help, too.''

On the other hand, when men become care givers, they often don't ask for the

support they need because they may be too stoic, said Betty Ferrell, a

nurse-researcher at City of Hope National Medical Center in Duarte, Calif.

Men ''really do feel the financial burden. They feel they must try to keep

things normal, to keep going to work.''

The bottom line is that when life-threatening disease strikes, the marriage

needs attention as well as the disease itself, said psychologist Cella

of Northwestern University Medical School. ''It's very easy for people to

put all the attention on the treatment. But some attention should be spared

to focus on the couple.''

The American Cancer Society is enrolling volunteers in a new study of

quality of life among cancer survivors and their families. Call

1-800-ACS-2345. Judy Foreman's column appears every other week in Health &

Science. Her past columns are available on Boston.com and

www.myhealthsense.com. Her e-mail address is foreman@....

This story ran on page C1 of the Boston Globe on 7/17/2001.