Mental Health 521Adjustment to Chronic Illness
This man, let’s call him Bill, was 38 years old
and had suffered a heart attack. He had a strong
family history of heart disease. His father had
died of heart disease when he was in his thir-
ties, his mother had recently undergone bypass
surgery, and he had already lost a brother to
heart disease. Bill smoked two packs of ciga-
rettes a day. He did not have time for exercise
or to really think about what he was eating. Bill
owned a business and was struggling—not to
make ends meet, but to make the business an
overwhelming success. He was very stressed
by the business. Bill was married and had two
young children. How did he respond to his
heart attack? He was angry but resigned. He
had no intention of changing any of his behav-
iors. He would continue to smoke, continue
to work long hours at work and get little sleep,
and had no intention of spending more time
with family. The heart attack convinced him he
might not live as long as he had hoped, but his
response to this fact was to work even harder to
ensure the financial security of his family when
he passed away. He told me this was the re-
sponsibility he had as the “man of the family.”
A few days later, I interviewed a woman,
let’s call her Marie. Marie reluctantly agreed
to let me interview her while she was in the
hospital recovering from a heart attack. She
said she doubted she would have time for the
90-minute interview because she was certain
her physician would be in soon to discharge
her. (Having experience with the hospital dis-
charge process, I knew we would probably have
at least 90 minutes before the physician arrived
and the paperwork would be finished!) Marie
was anxious to leave the hospital to take care
of her husband, who was dying of lung cancer.
I asked Marie to recall the earliest signs of her
heart problem. She recalled having symptoms
of chest pain over a year ago. Her physician hadwanted to hospitalize her for some tests, but
she refused to leave her ill husband. Instead,
she used a nitroglycerin spray daily for the past
year to alleviate chest pain. Marie had difficulty
answering the questions I asked because she
could not keep her mind focused on the inter-
view. She asked me why I was asking so many
questions about her when it was her husband
who had the real problem. I wondered when
Marie left the hospital if she would take care of
herself. Somehow, I doubted it.
These two people are among the hun-
dreds of people I have interviewed with a
chronic illness, in this case heart disease. I
present these two cases, one by a man and one
by a woman, to illustrate two very different
responses I believe can be tied to traditional
gender roles—the man as the breadwinner
and the woman as the family caretaker.
In this section of the chapter, I describe
how people adjust to chronic illness, with an
emphasis on the implications of gender roles.
Studies of heart disease show that women ad-
just more poorly than men (Boutin-Foster &
Charlson, 2007; Ford et al., 2008; Hunt-Shanks,
Blanchard, & Reid, 2009). However, many of
these studies suffer from an important method-
ological flaw. They fail to consider differences
between women’s and men’s functioning be-
fore the onset of the illness. For example, one
investigator found that women were more de-
pressed than men one year after bypass surgery.
However, women were also older, were more
likely to be widowed, had less income, and had
more other health problems compared to men
(Ai et al., 1997). When these factors were taken
into consideration, the sex difference in depres-
sion disappeared. Sex differences in depression
following the onset of a chronic illness are es-
pecially suspect because of the research just
reviewed showing women are more depressed
than men among physically healthy samples.
One reason that women might have
more difficulty than men adjusting to chronicM13_HELG0185_04_SE_C13.indd 521 6/21/11 12:55 PM