In addition to my personal experience, as an expert on chronic illness in America I’ve spoken to and heard from thousands of women who are reeling from the damage disease is doing to both their bodies and their marriages. “I see this trend every day in my work,” says Deborah Ross, 59, a psychotherapist whose husband battles epilepsy. “The baby boomer population is aging and a growing number of couples are struggling to integrate long-term medical challenges into their marriage. Clients come in saying that they’ve been unable to find the tools to handle what they’re facing—and their relationship is in crisis.” Many couples assume that the situation they’re experiencing is more the exception than the rule. Not so, says Ross: “The reality is that chronic illness happens frequently in marriage. There is no way to get around that—only through it.”
Increasingly, a diagnosis of chronic illness occurs in midlife. Women in their forties and fifties are particularly vulnerable to a range of disorders, including auto-immune diseases (rates of many have doubled and tripled in recent decades); back pain (which hits a third of women between 45 and 64); arthritis (affecting 26 percent of women between 40 and 60); and cancer (afflicting about 200,000 women between 40 and 59). In all, nearly 133 million Americans deal with a chronic health condition. “Illness requires so much extra time and labor—between medical appointments, insurance bills and health regimens, the need for rest, or just added time for the smallest things, like taking a shower or getting dressed,” Ross says. “Meanwhile, the healthy spouse often has to take on more of the to-do list for home and family life. People can get caught up in just doing and plowing through.”
Many marriages disintegrate under the pressure. In the general population, the lifetime divorce rate is roughly 50 percent; for chronically ill people, the rate is 75 percent, according to one often cited statistic. That number, extrapolated by some advocacy groups from the National Health Interview Survey data, is not universally accepted, but the dozens of experts I interviewed for this piece agree that an unusually high percentage of chronically ill patients are divorced, and that illness is often the precipitating factor. Among the dozens of women I spoke to were a few who added a heartbreaking twist: that although the relationship with their spouse had fallen apart, they stayed married for the health insurance. Too ill to work, they knew they couldn’t qualify for any other kind of coverage. “As if it weren’t enough to face the terrifying things happening to her body, a woman has to cope with her feelings of loss and fear about her future—and on top of all that she has to manage her spouse’s feelings,” says Susan McDaniel, PhD, professor of psychiatry and family medicine at the University of Rochester. “It’s too much to ask of one person.”
So what distinguishes the couples who do make it through? After hearing from many people across the country about their need for support—and their disappointment in discovering that so little help exists—I decided to find still-married couples and talk to them about how they make it work. While the specifics varied, I discovered that for the most part, the successful couples weren’t dealing with fewer or easier problems. But each of them was somehow able to use the challenges to strengthen their relation-ship rather than weaken it—often in ways that would benefit any marriage.
TALK—EVEN WHEN IT SEEMS HURTFUL
Only two months after Rosalind Joffe’s wedding 29 years ago, she found herself bedridden and blind in one eye. The diagnosis: multiple sclerosis. Just out of medical school, her husband was well aware of what the illness could mean for them as a couple. They went on to have two kids, but after Rosalind received several additional autoimmune diagnoses, they were both overwhelmed by the magnitude of her physical challenges.