Families Making Adjustments to Chronic Illness

Lawrence Kron, Ph.D.

Many of you will recognize the problem demonstrated by the following situation: A young mother, due to chronic illness, was required to make frequent trips to the hospital, sometimes two or three times in a year, for several weeks at a time. When her husband picked her up from the hospital, a consistent pattern of interaction between them emerged. No matter what the subject of their conversation, the husband would find reason to be critical of something or other, and an argument would follow.

At first we can only wonder, “What in the world is going on?” This should be a happy occasion, and yet the couple is in the middle of an argument before they have even reached their home. The explanation lies in understanding how families balance the roles they play in the family drama. To some extent, every individual in a family is expected to take care of certain family responsibilities. The youngest member might be responsible for cleaning a bedroom. An older child might have responsibilities for dishes, shopping, etc. Mom might make meals. Dad may do some of the “fix it” tasks. In today’s world, who assumes which tasks varies widely from one family to another. But however tasks are divided, everyone tends to be assigned a certain consistent role. You can imagine the chaos that would follow if there were no predictable roles. It would be like actors in a play suddenly being asked to play someone else’s part. Yet, this is what happens in a family each time an exacerbation or a remission in a patient’s illness occurs.

When a patient goes to the hospital, the rest of the family members have to do double duty, so to speak. They have to fill in for the missing member of the cast. They also need to take on new duties relating to the actual hospitalization demands. When the patient is sick enough to be taken to the hospital, our feelings of frustration are appropriately submerged. After all, “what right do we have to complain at a time like this?”

We do our best and adjust. But when the patient is feeling better and returns home, we again have to make an adjustment. It’s difficult enough if everything returns to “normal.” But even that is not always the case. The hospital routine may be replaced with a new routine for the home. The frustration of dealing with change once more rears its head. However, this time the patient is healthier. Our intuition tells us that we don’t have to be as solicitous of the patient’s feelings. The frustration of readjusting winds up being expressed by starting an argument.

Without realizing it, we are seeing the teeter-totter principle in action. If everyone is in perfect balance, we get upset with someone who changes position. We try to induce that person to remain in the place they occupied. If they don’t, or can’t, everyone else has to make a change in order to bring about a new balance. That changing of positions, of family roles, is what creates the problem I described above. It’s my hope that by seeing the difficulty for what it is, you will be able to short-circuit the problem. If it should begin to occur in your family, instead of expressing your feelings indirectly, as was done by the husband I mentioned, perhaps you will be able to talk, frankly with the patient about your concerns. The direct approach generally works best, and a great deal of heartache can be avoided.