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In Sickness as in Health, by Barbara Kivowitz and Roanne Weisman.

March 26, 2014

 In Sickness as in Health: Helping Couples Cope with the Complexities of Illness, by Barbara Kivowitz and Roanne Weisman.   Roundtree Press (2013), Paperback, 224 pages

A compassionate and thoughtful guide for couples facing critical and possibly terminal illnesses and for those who want to help them.

 Barbara Kivowitz is a psychotherapist who has worked with couples coping with illnesses.  Roanne Weisman is an accomplished science and medicine writer.  Both of them have had severe illnesses themselves and worked their way to recovery.  Their partners were critically involved in the experiences.

 In Sickness is not meant to be another how-to-do-it book.   Instead Kivowitz and Weisman seek to help couples see that they are not alone in their pain by offering many personal stories from others who have been there.  Despite the feelings of hopeless that serious health problems and medical institutions encourage, couples can make choices about how to cope.  Each couple must find their own responses.  There are no guarantees.  Sometimes partners recovered and sometimes they died.  Sometimes individuals separated and sometimes they created closer relationships.  Sometimes they managed the inevitable grief and sometimes they got caught in it.  Overall these authors offer the hope that illness and death can bring a couple into more meaningful bonds with each other.  They state that “illness can be a gateway and not an epilogue; and that, even in the absence of a cure, healing is possible.”

 Although Kivowitz and Weisman are nonjudgmental about the variety of ways in which couples face illness and death, they hope that their book will assist couples to ease their pain and find personal meaning.   Their guidance is gentle and somewhat conventional.  Their assumptions are simple. “When one person is sick, both lives are dislocated,” but each will experience that dislocation differently.  Illness may push couples to develop new and better communication skills.   A new balance of closeness and separation will be needed.  As much as practical, the couple should put priority on nurturing and support.  They should continue to live as normally as they can with the ill partner contributing to their life together.  Perhaps someone needs to be hired to help with the daily drudgery of nursing so that partners have the energy to be emotionally open with each other.  They should use their time together to recall their strengths and what their relationship has meant.   Falling into being only patient and care-giver to each other can be hurtful.

 What makes this book somewhat unique are the stories of couples caught in the throes of serious illness that make up a major portion of this book.  These are stories of what it has meant to real people to “bear the insufferable.”  The stories are varied and vivid, often reading more like fiction than case studies.  Nonjudgmentally told, they expand the range of possibilities for couples to consider as they deal with disease and disability.  The stories are supplemented by the words of experts with experience with those facing death.  Each chapter ends with a brief summary of issues raised and questions to consider.

 The authors are aware that couples facing illness are often also hurt by the way in which medicine is practiced.  Sometimes they view doctors as heroes with the power to conduct miracles when in reality they are only humans, pressured to see many patients in too little time.  Kivowitz and Weisman view the medical establishment as necessary for the seriously ill, but they see its flaws.  They encourage couples to not simply be passive and do what doctors say.  The healthy spouse must be willing be aggressive about asking questions about proposed tests and treatments.  They must be willing to say no to the medical establishment if something threatens to do more harm than good.   In addition, couples should feel free to ask for second opinions and to explore complimentary medical procedures.

Although In Sickness does not advocate religion of any kind, its authors recognize that for some people, faith can play an important role in retaining hope in the face of illness and death.  Some of the experts whose advice is included have a religious orientation and work from a pastoral care perspective.  The overall approach remains secular, however, with religious faith considered as an option, not a necessity.

The stories in this book vary widely in their content, but not demographically.  Almost all of them are about white, middle and upper class couples with enough money to have real choices.   Perhaps that is not surprising because those are the ones most likely to be working with psychological counselors and most likely to read this book.  Only one couple who is both black and gay is included as a token.  While understandable, readers need to consider that a lack of resources and other socioeconomic factors would further complicate the problems of many couples.   Death is inevitable, but it is made more painful than necessary by failure of our medical and governmental establishment to attend to the needs of all the people.  While psychological books like this one are valuable to individuals, we also need to work as a society and a nation for better resources for the dying and those who love them.

Although this is no glib optimistic book, its overall goal seems to be to help couples retain a measure of hope.  Grief is well treated, but less is said about the other negative emotions likely to surface.  I wish the authors had said said more about coping with anger in the face of illness.   Anger is an excellent example of how a couple’s previous communication skills can be inadequate when energy becomes scarce and must be rationed.

 I read this book because I have seen how my own health problems, while nowhere near as serious as those described here, have complicated my own marriage.  I came away from it with few answers for how to live with my own limitations, but a greater sense of the importance of not letting myself become unnecessarily helpless and of deliberately doing what I can to strengthen my bonds with my husband.

I recommend In Sickness as in Health to couples facing illness and death, as well as families, friends, and professionals who seek to help them through their ordeal.    I liked the book and think it could be useful.

I appreciate having received an ebook review copy of this book.


Through the Dark Forest, by Carolyn Conger.   A graceful exploration of how individuals, rather than couples, can heal their psychological wounds when facing illness and death.

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