Individual and Marital Adjustment in Married Couples with Breast Cancer

Historically, mental health professionals have been plagued by the need to show a relation between personality and physical illness. That quest dates to early Greek physicians but appeared full force in the early and mid-Twentieth Century. It was then that the etiology of disease was expanded to include the psychological or social context, thus giving a conceptual basis for ideas now prevalent in "alternative medicine." During this period, the term "psychosomatic" was adopted and effort was made to show that certain physical illnesses were more likely to occur among those with certain personality types. Others of a similar persuasion denounced that specificity and opted for a more generalized relation. That is, they reasoned that personality factors were more likely to have a general effect rather than cause a specific kind of illness. This position dominates today with widespread belief in the non-specific factor of "stress" being casually related to illness.

Patients do benefit from attributing the cause of illness to some external factors or even to their own behavior, such as a poor diet. This kind of attribution reduces anxiety, results in a sense of control, and may energize the patient to become active in treating the illness. However, the process of attribution can place the patient at risk particularly if the patient attributes illness to some personality characteristic which is then regarded as a defect or flaw. When that occurs, the patient may then enter an emotional sequence of blame-guilt-depression-hopelessness with the obvious potential for negative effects on physical well being. With that in mind we have been cautious about reaching any conclusion about psychological adjustment and breast cancer. It is well to remember that there are simply no data that consistently show a causal relation between personality factors and illness, the Greeks and all mid-century physicians and mental health professionals notwithstanding. That caution, does not, however, preclude effort to continue to explore the relation between personality and illness. It simply means that one needs to be cautious before reaching conclusions.

When we began to study the psychological adjustment of breast cancer patients and their husbands we were well aware of these issues and how they shaped the academic terrain we were entering. We elected to do several things that would guard against the pitfalls of "wildcard psychology." First, we decided to focus on post-illness adjustment and to ignore the question of pre-illness disposition. Prospective studies which deal with psychological issues are generally unruly things due to the need for very large samples and the length of time required before reaching any reasonable conclusions. Further, good psychological science does not rely upon retrospective analysis as would be necessary in studying pre-illness predispositions of levels of personality. Second, we decided to use two level analysis; one for adjustment of each spouse as an individual and one of the marriage. The logic of this approach was to provide data that would isolate adjustment problems and identify the source as the husband, the wife, and/or the marital relationship.

Typically, breast cancer patients and spouses are eager to help and quick to volunteer time for projects like ours. Clearly, that occurred in this study, since the 20 spouse pairs were asked to complete a substantially large number of paper and pencil inventories to measure the variables of interest. The inventories dealing with individual psychological adjustment indicated that both husbands and patient-wives were well within limits and that none was psychologically disturbed. Anxiety and depression levels were minimal. No psychiatric symptom was found. Further, the data can be regarded as reasonably valid since an built in measure of response bias indicated the subjects answered accurately and without bias. Measures of personality type indicated that husbands were introverted, yet cooperative, sociable and respectful. Essentially the same pattern was found for wives. Interestingly, husbands showed more chronic tension than wives whereas, wives, understandably, showed higher levels of anxiety about their bodies than did husbands. Both husbands and wives showed ability to deal with unfavorable diagnostic information. Wives, more than husbands, however, showed more emotional vulnerability to the stress of medical treatment. A measure of emotionality indicated that both husbands and wives were organized around positive affect rather than negative. Each pair scored higher on items measuring joy, contentment, vigor, and affection than on anxiety, depression, guilt, or hostility.

Several researchers have reported the breast cancer patient to be passive, very sociable, unable to place self first, devoted to the welfare of others and tolerant of the behavior of others while attempting to be exemplary. Some of these characteristics were found here. However, the close match between husbands and wives would indicate that these characteristics are not typical just of breast cancer patents but also of spouses and thus are not as likely, as previously thought, to be causally related to breast cancer.

Although our sample was small, we did find several couples who presented an interesting mix of personalities. That mix consisted of the wife being cooperative, social, respectful and sensitive. In contrast, the husband was forceful, overly confident, and lacked respect and sensitivity. Husbands of this type may regard illness as due to moral fault and tend to blame and control. This mix was not typical and occurred in only a few couples. However, its presence has intrigued us and we are now speculating regarding whether or not some marital interactions may be sufficient to lower immune system functioning so that the wife, over time, becomes more susceptible to breast cancer. From our work with men who have a heart attack, we have concluded that marital interactions may become so severe that he sustains a life threatening illness. The same type of interaction may occur in some marriages in which the wife develops breast cancer, thus demonstrating the power of interactions between dependent members of the marital twosome. Clearly, the typical breast cancer couple does not fall into this category. Care needs to be exercised before attributing any such marital interaction to a married pair before solid and repeated research has been carried out to determine if such interactions do occur. At this time we are planning a project to research this question. Until then, the risk of false attribution is substantial and should not be lightly made. Doing so could place the wife at risk due the withdrawal of support from the husband

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.