It seems like with chronic illness in marriage you either hear the extremes of horror stories or, on the other end of the spectrum, some very beautiful stories. I’ve heard of a wife getting a bad form of cancer, the husband deciding he just didn’t want to deal with that and bailing out on her. And then there’s a much-loved couple in our own church and she developed Alzheimer’s fairly young and his response has been to double down on his faithfulness and care for her, saying, “I guess it’s my turn to pull the wagon now”.

Any kind of long-term illness can be extremely tough for married couples as one spouse struggles to cope with the symptoms and effects of illness and the other takes on a carer role, trying their best to look after their ailing spouse. It looks very different for each spouse, but for both it can be hard to know how to cope.

Instead of focusing on individual things each spouse can do, it is helpful to think in terms of joint coping: both spouses taking responsibility for coping with the illness and sharing stressors and resources[i].

Joint Coping with Health Problems

What you need to know is the way you interact and respond to each other's coping strategies is just as important as the strategies themselves. For example, the non-ill spouse needs to be able to see what kind of support the ill spouse (called the "patient spouse" in the research) is in need of at any given time: do they need practical support, problem-solving, or emotional reassurance?

Coping as a couple is affected by two main factors: the patient and spouse's "appraisal" or understanding of the illness, and the coping strategies they use to deal with it.

Appraisal of Illness

How the patient and their spouse each view the illness will affect how well they support each other through it. There are three specific issues that we want to draw your attention to[ii]:

Understanding of the Illness

Do both spouses fully understand the nature, possible duration, and consequences of the illness? If an understanding of the illness differs between spouses this will naturally lead to different expectations of how much support is needed (e.g., if the spouse thinks the illness is not a very big deal then they will naturally put less effort into helping the patient spouse cope). So we want to be sure that both parties understand the scope and prognosis of the illness.

Ownership of Illness

Is the illness viewed as a joint problem, or as the patent spouse's problem which the other spouse may or may not be required to help with? Mismatches on this will again naturally lead to ineffective coping. This also raises the issue of togetherness: is the illness your problem or is it our problem?

Broader Context

How much support do you expect from your spouse, based on culture, family of origin etc? Were you raised to share all burdens between you, or to respect their independence and dignity by being more hands off? Again, different expectations here could lead to poor coping.

Different appraisals or expectations in these areas can lead to poor coping with the illness, so couples should try to make sure they are on the same page regarding the nature of the illness and how much support is required/desired.

Dealing with Chronic Illness in Marriage

When you look at all the ways a spouse can support their patient spouse, they fall into two main categories[iii]:

Problem-focused: providing practical support such as helping provide or facilitate treatment, assisting with practical needs or taking care of needs and responsibilities while the patient spouse is unable to

Emotion-focused: providing emotional support to help the patient cope with the stress of the illness

Problem-Focused

Each of these styles of coping can be either helpful or unhelpful, depending on what you do.

Helpful problem-focused coping is often referred to as "active engagement": both spouses taking an active role in discussions with doctors,