THE FAMILY SCRAMBLE: PRETENDING NOTHING HAS HAPPENED
Heart patients and their families sometimes cooperate in denying that anyone in the family has heart disease; they seem to be playing a game of pretending that the illness is not real. This might lead to the nine signs of poor family coping described earlier in this chapter. In my experience, it is a mistake to assume that patients who deny illness are necessarily afraid of being sick. Although they often are, denial of illness frequently has more to do with the patient's fear of the impact that open acknowledgment of the illness will have on loved ones. Mr. Russo was an example.
Mr. Russo was the elderly, powerful patriarch of a close-knit family. He had lived much of his life accepting the role of protecting his wife from worries in order to help her cope with her tendency to suffer bouts of depression. When this man had a massive heart attack, he refused to implement cardiac rehabilitation recommendations. Whenever he was confronted by his doctor for his failure to begin exercising or stop smoking, Mr. Russo would simply say, "I'm not the only one to consider here."
This patient's reaction to his illness was certainly unhealthy from a medical standpoint, but his reaction made sense according to the unique logic of family teamwork. He denied his illness rather than force his wife to remember that he was sick. He did not have undue fears for himself; he was protecting his wife, just as he always had.
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