Mutual appreciation is key to saving marriage after a stroke, study shows

Laurel Sproule knew that something in her marriage of 18 years was changing when she entered the kitchen and found her husband Fred standing there.

He had had a recent heart attack and then a stroke, but he was home and responded slowly to therapy. Getting ready to go out one day, they needed to have lunch first, so Laurel put up sandwiches and, going upstairs to change her clothes, asked her husband – who had always loved to cook – to make one.

"I came back and he's still standing there. He did not know what to do."

Laurel realized that the dynamics of marriage would have to change. Fred, who always did most of the driving, shopping, and cooking, could not do any of this. The stroke had left him with almost no peripheral vision and with aphasia, a communication disorder. He could write sentences, but he could not read or recognize the alphabet.

"I really did not understand all of his deficits, but it was when I started to get out of my shock and figure out what it would be worth to focus on and what it is not in terms of what he could expect to do," says Laurel now, five years after.

It has become a reversal of roles, which is one of the biggest challenges and keys to helping marriage survive a stroke, according to a recently published University of Alberta study.

While marriage vows include the solemn promise to unite "in sickness and in health," the reality may be very different, said lead author Sharon Anderson, who studied how the stroke affects marriage to get her Ph.D.

"The assumption most people make is" I did not sign up for it, "she said. "Life has changed and you need to decide how you will handle it."

Three post-stroke phases

In the course of interviewing 18 couples, including Sproules, and reviewing other published research, Anderson identified three phases couples experience following a stroke: feeling downtrodden, resolving conflicts, and realizing the value of marriage.

The first few months after Fred's stroke, for example, were a jumble of anxiety as Laurel struggled to adjust to the situation of the couple.

"He was in that fog, he did not know what he could not do," she said. "Suddenly I'm making all the direction, all the food, the direction, the shopping. I resented it, but I thought it would get better."

For his part, Fred remembers little about this time.

"There was no challenge for me in the first six months. I just did as I was told and I really was not sure what was going on, so those early months were very difficult for her, but I was not aware of Mainly, I only existed. "

Later, he got angry sometimes.

"I remember screaming, going crazy sometimes. There's a lot of frustration that she has to live with, things that fall on her lap."

Recognizing what each partner is going through is important to preserve the relationship as it evolves after a stroke, Anderson noted. Some mutual understanding is essential.

"The marriages we found survived, they recognized this reciprocity. They appreciate what the other person did."

Conflict resolution, including the successful negotiation of mutually acceptable role shifts for both partners, was also a key step in keeping the post-stroke marriage intact, Anderson concluded.

"Some couples went through a definite difference in roles, from parent to child, nurse to patient, that's how they referred to themselves when they came back from the hospital. For the marriages that broke, they just could not figure out what reciprocity the spill survivor she would have trouble figuring out what to give and receive at a wedding.

"The survivor can not do what he used to do, and they need help." "Your care partner does not know how much help to provide and how much to give, and how does someone accept that care, and are they attracted to it?

Successful couples were able to talk about it without blaming or hurting their partners, Anderson noted.

"They recognized that life has changed and accepted this change in roles.

"Whatever happens, they still need each other and still want to be together, and the question then becomes, how do we deal together? It's not, that's your problem or that's my problem, it's the stroke that is the problem and we're working on it together. "

In many ways, it's the same as dealing with other challenges that marriage faces, she added.

"Think back to those times when it was difficult, when you did not sleep because of the baby, or a parent passed away or a job was lost. Think again about how you dealt with these tensions, how you fit in and how you're going to deal with it – is just another challenge. "

Cherishing marriage was also instrumental in overcoming tough times, Anderson said.

"Successful couples could see what they still had and not what they lost."

Adjusting successfully

Fred, through occupational therapy, time and practice, regained some of his skills. He can read now, though not as fast as before. Some of his culinary skills have also returned, and when he and his wife buy, his improved memory allows him to add one or two items to the cart. But his vision remains limited, which put an end to it.

Laurel realized that she would have to give up hope that her husband could do everything he had done before. But while she suffered from this loss, she also noticed something else.

"He was still the man I married, and that changed what we do, but that did not change our solid relationship, Fred Fred's things are still there."

About a third of the couples he talked to reached similar conclusions about the loved one and "went back to being a husband and wife," Anderson noted. "It was a gradual change for many of them." Others settled more in caretaker and receiver roles.

When the Sproules knew that Fred's vision would not fully return, they decided to continue life anyway.

"I realized we had plans," Laurel said. "It's difficult at first to accept things as they are, but when you do, you can move on."

In her case, she conquered her fear of bustling American highways to take them to Utah, where they walked – one of Fred's favorite pastimes – and later did the New York Marathon.

"I knew we had to do this because I knew it was Fred, and most of us still are."

Marriages that were strong before the stroke resisted the consequences better than those who were already struggling, Anderson said.

"If there had been stress at a marriage before or if couples were overworked with too much money, it was getting harder and harder to relate to each other. If they had not been so overwhelmed, they could have recognized someone else was doing it and it was able to walk a mile in his shoes. "

Sproules credit the strength of their relationship before the spill, helping them survive the challenges and changes that followed.

"I do not do it out of obligation, I do it out of love that exists from the moment we meet," Laurel said. "I spent the first year after his stroke, wishing that Fred would return to his full abilities, but now life is very good, regardless. We have much to thank."

Two Tips

In an American study of marriages and illnesses she reviewed, Anderson found that there was a high risk of divorce if a woman had severe illness with stroke, cancer, or heart or lung disease. But overall, the number of divorces was low, especially for couples in long-term marriages, who were much more likely to end up widowed (24%) than divorced (six percent).

"There's hope, it's a difficult situation, but people go through that. There's still a relationship to take advantage of," Anderson said.

There are ways to deal with a spouse who suffers from stroke, said Anderson, who offered these suggestions:

Ask as much help as possible

Soon after the stroke occurs, the caregiver should begin to seek resources that help couples adjust to new circumstances.

"There is no one-stop shop," but the hospital discharge is a good time to ask occupational therapists what is available, Anderson said.

"Ask questions about available rehabilitation services, enroll in any research you've been asked for, get help with home care, and enjoy the services you're entitled to."

That could include therapy through the Glenrose Rehabilitation Hospital or programming through the University of Washington Rehabilitation Medical School, which the Sproules have accessed, Laurel said. "You need to focus and insist on the help you need," she said.

Celebrate Recovery

"The way people recover from the stroke is by doing things – you learn by doing," Anderson said. For the caregiver, this means not doing everything for the partner.

"Let them do things for themselves – they'll get better at it." He acknowledges that life is harder, but we also have a few successes here.I, as a caregiver, go to the store for an hour and you manage on account own, and very soon, we can walk through the store together. "

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Mutual appreciation is key to saving marriage after a stroke, study shows (2019, January 14)
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