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Logical Consequences And The Chronically Ill

(Names Changed)


 


Last week I tried to explain a discipline technique called “Logical Consequence”. I gave several illustrations about how it would work with children. The idea behind it is, that instead of yelling, threatening and exhausting yourself by spending all that negative energy simply trying to get your children to listen to you; just stay calm and let the logical consequence of their behavior happen.

 

In doing this, a child who forgets his lunch, goes hungry. A child late for a ride to school, walks there. A young child who refuses to get ready for preschool, goes in his pajamas. And so on. The idea being that the natural outcome of the behavior, when we let it happen, will be unpleasant enough to change the child’s behavior in order to avoid the logical consequence.

 

But how does this work in a marriage? Any marriage, but especially in a relationship between a person who is chronically ill and his or her well spouse?

 

To my mind, it’s all about determining whose responsibility it is. Of course you want to help someone who is sick and feeling poorly. You want to help them for a week or two or maybe even a year. But are you hurting or helping when you have told a sick person, by your helping behavior, that they are not capable of doing for themselves? Who are you helping when taking on every care-giving task has left you exhausted, angry and irritable?

 

And as for support from others who are not well spouses, forget it. I have seen women who cannot tolerate their husband moaning about a cold for three days, not understand the emotions of a woman who has catered to her ill husband more often and in more ways for the last 10 or 15 years. Yet in the same conversation that expounds the tedium of taking care of their husband with a cold, many woman refuse to hear the feelings of someone who has had to bathe, dress and in some cases feed their spouses for years.

 

Nancy was a well spouse. Like many well spouses she jumped in when her husband was first diagnosed. She took care of him. She tried to keep him upbeat when he was depressed. She organized his medications and arranged his doctor’s visits and transported him. She attended every doctors’ appointment so she could speak with the doctor and help her husband deal better with what was going on.

 

Now, 10 years later, Nancy doesn’t understand why her husband doesn’t know when to take his medication or even what his various pills are for. She has asked him to keep track of his own doctor’s appointments, but he just can’t seem to deal with it; and though his illness has not effected his memory, he can’t seem to remember when the appointments are without his wife telling him. Nancy wonders how this happened.

 

Karen remembers very well the first year after her husband was diagnosed with a serious chronic illness. Karen jumped in to help and assist. But when the doctors said he would not be getting better, Karen thought about the future. She wondered how she’d manage down the road. How would she be able to keep up this pace of nursing her husband, raising her children and not lose sight of her own needs and desires?

 

Karen made an appointment with her husband’s doctor. She wanted to know exactly what her husband was capable of doing for himself and what he would needed help with. At that point, any time her husband asked for help with things he could do for himself, Karen refused. When he asked her to make his doctor’s appointments, she told him to do it himself. When he asked her to call a cab for his appointment, she refused. Karen told me it was hard for her to do this, but she felt that she had no other choice if she were to have an intact marriage.

 

I met Irv when he was midway between Nancy’s situation and Karen’s. His wife had been diagnosed about three years earlier. In his desire to help and support her, he feared he was responsible for turning her from a fiercely independent woman into a totally dependent one. She seemed to have become totally dependent on him for everything, even those tasks she could easily do for herself.

 

Discussing his fears of her dependence with her brought about no change. It was at this point that Irv began refusing to do things for his wife. When she asked him to reorder her medication, he refused. When she asked him what she would do if they weren’t ordered; he told her that if she needed them she better get on the phone and asked them to be reordered or she simply wouldn’t have them.

 

And so Irv made his wife see the “logical consequences” of her lack of doing for herself. Irv told me it was very difficult to do. But he could think of no other way to get his independent wife back before that became impossible. Very slowly, forcing his wife to do one task at a time or bear the consequences, Irv began to see an independent woman return. He told me he only insisted she do the things he was sure she was capable of. He gladly did all the rest. He just refused to do it all. Today, his wife is thankful that Irv made her see the “logical consequences” of her behavior.

 

I am neither endorsing using “logical consequences” when dealing with the dependence that shadows chronic illness nor condemning it. I simply think that it is far healthier for a long-term ill person to maintain some control over his or her life. Though dependence may feel good initially, over the long term it attacks the ego, spirit, and positive outlook of the person. Simply put, the well spouse is the coach. His or her job is to help, to encourage, to plan. The ill person, to whatever degree he or she physically and mentally can, must play the game.

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When one is blind one learns to use Braille to read. When one cannot walk, a wheelchair gives mobility. Sign language allows a mute person to speak and ocular implants assist in hearing when one is deaf. These are all compensatory strategies that help a person function despite his disability. But compensatory strategies are not just for physical problems. Understanding our psychological weaknesses and setting up our lives to ensure that we are not tempted to repeat our past mistakes, is as necessary as any aid to the disabled.

Well spouses have often discovered that their friends and relatives, despite their closeness to the situation, often don’t realize the tremendous emotional impact living with chronic illness has on the family. With the best intentions, suggestions, ideas and criticism are offered, based on the non-experience of those with healthy families. Even when the good intentioned get a taste of the difficulties, it is sometimes not enough for them to then identify and understand what the family of the chronically ill must face on a constant basis.

Over the past two weeks I have shared letters from a therapist and a well spouse. Both of the letters gave personal insights into the process of losing hope, how we react when that happens and some ways of coping when test scores, diagnosis and just simple repetitive behavior indicate that change for the better is impossible.

Dear Ann,

I’ve read your last few articles on psycho-neurological testing (Oct.8-22) with interest. As a therapist who has counseled couples dealing with chronic illness, I’d like to give you another perspective.

Dear Ann,

Your articles on the Neuro-Psychological Testing were right on (October 8-22). My husband underwent testing twice and your articles explained it things exactly the way they were. Besides the test, we also tried therapy.

Very often when we can’t face our big hurts or big loses we focus on the little ones. We can discuss those. We can cry over the small loses, be angry at the smaller hurts even though it may look trite and sound ridiculous to others.

Over the last two weeks we have been discussing one way in which well spouses can determine whether behavior displayed by their ill partners is caused by their illness or is a way they have chosen to act. We have focused on Psycho-Neurological testing, what it can tell us, as well as its pros and cons.

Last week I discussed a question that haunts many well spouses: not knowing if the difficult and often inappropriate behavior frequently displayed by their partners are caused by the disease and therefore not-controllable, or if the behavior is a choice the spouse makes and can therefore be changed. This doubt can be the source of much frustration and many marital disagreements. One way of alleviating this doubt is by having a psycho- neurological work up done. But that path is not so simple.

Printed from: http://www.jewishpress.com/sections/magazine/logical-consequences-and-the-chronically-ill/2006/08/09/

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