Abigail Trafford - Author, Journalist and Public Speaker


Diagnosis Shock - responding to illness

By Abigail Trafford
Tuesday, July 24, 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 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," she explains. Those different strategies, she says, create "a filter to communication that sets you at odds -- but you really are not."

The gap in coping styles is a common phenomenon. As Jessie Gruman, president of the Center for the Advancement of Health, described in the Health section earlier this year, people have very different responses 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, author of "After Shock: What to Do When the Doctor Gives You -- or Someone You Love -- a Devastating Diagnosis" (Walker). "That is the source of incredible conflict in families," she says.

Gruman, a veteran of cancer and heart disease, remembers meeting with doctors after being 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 get a second opinion. Patients and their families must seek the best information to decide on a strategy for treatment. But in that moment, their coping styles were at odds.

Diagnosis shock is a hallmark experience for older men and women. Gains in health and longevity have largely postponed 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, the 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.

For all of us, diagnosis shock is a personal emergency: I know my Social Security number. I know my blood type. But what are my inherent preferences in crisis? As the Scout motto says: Be prepared.

© 2007 The Washington Post Company

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