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Impact on wives of having hospitalized husbands with cardiac illness
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Impact on wives of having hospitalized husbands with cardiac illness
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Content
I .ACT CN VvlVES OF H VING HOS I'l,ALIZED
HUSE.A DS WITH C DIAC ILLNESS
by
Gordon Astor
Thesis
C TY OF
I E I ... 0
re ented to the
SC OOL OF S OCI L
S C LI 0
In artial Fulfillment of the
Re uire ents or h De ree
0 SOC L 0
J une 1959
ORK
I
().
This thesis, written under the direction of the
candidate's Faculty Comrnittee and approved
by all its members, has been presented to and
accepted by the Faculty of the School of Social
W 01·k in partial fulfilment of the requirements
for the degree of
MASTER OF SOCIAL WORK
Dan
Date .. ~ .. ~.
. ... ... ! ..... ) .............. .
Thesis of ..................... ®~········~ ···································
FacultJ Committee
I
... .... . .............. . ............ .... 1 ···· ········· ·············· · · ·
Chairman
. I
,,
•••••....• . 7 ······· · ··········· ··············· ······ ······ ········· · · ·
I
TABLE OF CONTENTS
Chapter
I. I TRODUCTIO
• • • • • • • • • • • • • •
II.
Purpose of the Study
edical spects of Cardiac Illness
Study Design
Nature of Report
• • • • • • • • • • •
Identifying Data
Impact on T ife rior to Hos italization
Impact on ife ince Current
Hospitalization
lanning for the Future
III. C CLU I J
• • • • • • • • • • • • • •
IBLIO
• • • • • • • • • • • • • • • • •
DIX Sample Schedule and Int rview
• • • •
Page
1
9
30
37
39
CHAPTER I
INTRODUCTION
This is a study of the impact on wives of having
husbands who are hospitalized with cardiac illness.
· we are beginning to understand that the family ful
fills many needs in the individual and many needs in soci
ety. The husb · nd nd wife live in a climate of inter
dependency and role expectations. Vhen the husband is
hospitalized for an acute cardi c illness, we can ex ect
that the wife is affected materially, socially , and
psycholo ically. It i ossible that the wife takes on
new roles or looks t other members of the femily, rela-
tives, and community fo su ort. h a ex erience the
revival of neurotic feelin or deprivati on of needs. This
is often reflected i the roble sand hr w ys or meeting
her current f mily situation.
athan ckerman states:
one of us lives alone . Those ,h try re ore
doomed; they di integrate as human beings. Some
aspects of lie ex erience are , to be sure, mer
individual than social , others more soci 1 than
individual; but life is nonetheless a shared ex-
erience. In the early years this sharing occurs
almost exclu ·vely ith members o our family.
The famflY is also the basic unit of illness and
health.
Purpose of the Study
2
Social workers need to know more about physical
and mental health of married couples under stress since
this is a time when new demands are made in their relation
ship, and the survival of the family may be at stake.
Florence Kluckholm mainta·n that the ar nts in sick fam
ilies have oor co unication with e ch other and they
ch racteristically deny that there are ny tensions between
them or that they a
they face.
2
in ny way to bl me for the roblems
Soci 1 ork r s ho ork in medical sett·ngs are
confront ed with th ycho-socia r oble of the ti ents'
souse hoot ive dr m at· clue s from their lie ex-
periences whi hi i ate f actor co ri butin t o the onset
of the illnes. Dr. c n c onte d th t studies of
psycho o atic i lness, ta kin i l r e ati onshi s nd con-
flict et· een rso nd vi on nt s a m in oint of
r er nee, const·tute as· nif·cant em hasis for uture
amily
1
ath n r. ck r
Life ( ,ew ark:
The
00
sychodyn mies or
, Inc., 1958), p. 15.
2
lorence uckholm, "a ily Dia nosis," 1
Ca ework, IV, o. 2-3 ( ebr · ry- arch, 1958), p. •
3
research.l It would appear that external factors and
social role strivings might contribute to the total diag
nosis and treatment (medical-social-emotional) of a patient
and shed light on the wife's r ole and a daptability under
the pressure of her husband's illness.
spects of Cardiac Illness
When individuals develop cardiac di sease , their
concept of themselves a d their relati onship to their en
vironment chan es; as a result certain sychol o ical
chan es are necessaril y m ade. fue ickness devel ops,
emotion is withdr aw n f r om o j e ct r el a t ion his nd the
self bec ome s the cent e r of 11 I
•
o ject co cer
•
r ev1 ous
r l at· o
•
_ 11p s
ere
wit h
t ·
nt'
•
. .
1 n rc1.ss1.
d
•
or
•
ti
~eve e t r t t o
deat. Thi m
•
ove r i shed, t ill e es l e s
C C y . e o e s 0
•
.
- i be l S
'
y
usuall
•
rdi
•
l nes ex e r1.en s C C l
d s i te it w· t h dden
e i n ro r· te s i ne t her r e de ees
o heart illne s as wel l oualit t ·ve di erences . or
s
e am le, a t i ent my not d · s t in ui sh between t he ef fects
l
ckerman , op. cit.,
2teo old ellak and
ical s cts of Cardi ac I ll
C sework, , o. 10 (
• 247.
l or ence aselkorn, " sycholog nd ehabilitati on," s oci al
m , 1 9 6 ) , • 8 •
4
of rheumatic heart disease as compared with a coronary
disease. The result may be undue fear.
There is some evidence that those who have not
made satisfactory adjustments to their he rt diseases may
hasten to re-establish their re-sickness atterns of
livin. These findin s al so indicate that the emotional
implication s o cardiac illness vary, nd depend mainly
upon the ersonal~ty and life situation.
1
Car iac ill es c n be utilized for the ur ose
of h' ndlin or voidin mo ion lly ch red life situ-
ati ns. or exam le, eo le ho 11 their l ives have
sou t re u e , shelter nd security y in C rdi C ill-
ness as ti actory men o satisfyin these needs. It
i o ten dif icul to reh bi it e atien t who utilize
their illnes to void nxiety - rovok lie itu tions.
C
(
Th henomenon f mili r to 11 cho atholoty nd
co on y to or nic il n ss is cond ry in.
Ga in tte tion, avoidin res on ibility, con
trollin tyrannizin the f mily, nd similar
mean of ca italizin o the ex loitin illness are
all too and can be seen most dramatically
in "insur nee neurosis" nd the" ension syndrome",
here illnes has brou t about some adv ta e to
the atient n my o erate uncon ciou ly to re ard
•
is rec overy.
1 t
ley 1 n, "sycho o ic sects of
•
r 1
c Illness~ "
Psicho omatic edicine, II, o. 3
ov er , 195 , 21 .
2
e lak nd s lkorn , cit., 485.
OE•
•
5
rthur Schlnale conducted a study in which he
looked for seven categories of affects which might have a
bearing upon acute illness.
1
e sought anxiety , anger,
fear, guilt (feeling of blame), shame, helplessness, and
hopelessness (a feeling of des air), in the atient's life
situation. The resent study assumes t hat the wives have
been aware of and reacted to these feelings if they were
expres ed. If the husband ex erienced an emotional re
action before the illness, the wife was robably on the
receivin end of the emotional im ct.
ow does the wife sustain herself? ow does she
see and meet her roblems? t w her re tionshi with
the atient before the onse of he ·11 ess 0 oes she
ma a e d what de h x ect o t e utur. e r
tud 0
•
l. s h 0 s .
t th o s o t e tu y it s ec 1 ted t t
the ives old robably ne d o s · come outs de t e
immedi te family and that ho ital·zatio uld re-
ir can in roe. Th con ue c of ole c
.
l.
r se t et , re llion , ncreased neu tic
t
. ht
sym to
•
I may in ta .. ces t i feel mbiv let
about t em rria e due oor co unication be re the
1
'rthur • Sch ale, "De
Illness", Psychosomatic _ edicine,
1958), p. 188.
ssion receding cu
, o.4(Jul-u st,
6
ons et of t he illness . In all cases the children might ex perience derivation due to the fathers' hospitalization .
It was thought possible that t he illness would compel the
wife to withdraw socially and to focus her attent ion com pletely upon the husband .
This study does not ttempt to emphasize the intra psychic interacti on of the acutely ill husband and his
wife . It is concerned with the im act on the wife ' s life
situation of a ho pitalized hu band, and of the separation
due to the illness .
The tudy Design
Th study was cond cted with the wives of veterans
hos itali zed on the cardi c e ice at the G neral edical
d uric 1 os ital o the etera inistration Center
in vest Los n les . The cardi c service vera es eventy
tin 0 ard d i
•
he p tie t s a sou es are not
•
to Soc 1
•
h criteria necessar1 y v,n rvice . or
arti i io
•
he tudy im ry diagnosis ot a in ere
rdi ·11ness , esid
•
n the roximity of the greater C nc
Los n e s re
'
a t le st o e de endent child or
a olescent in the amil . Th latter criterion intensifies
th n ture o th res o s·bility of the partici atin wife •
is an ex loratory s udy of si c es . The
•
ives were
int rviewed · th home wher they wee seen in their usu 1
role .
7
The clinical records (me ical records) nd tne
resident hysician ' comments wer. us d or h object ve
di gnosis and pro o h pati t .
A study condu in 1957, "Im ac t on Childr n of
,..v · c Hospitalized ntally Ill Fathers , " dealt wi t h some
or the same uestions s the resent study . similar
schedule w s em~loyed , nd with om additi o s, h find-
in S 0 tu y C b co red in
• •
ith 0 o n eries
f W V r· a
l
~ is
une' conducted with s . oro s u y w s
mothers in the int rest of children who had me tally i l l
fathers . The focu of the resent study nd the feeling
about heart d. ea e are different .
Th mat rial derived from the interviews was sum
marized nd analyzed cc ordin to the schedule . The na -
l yzed d ta s divided into four actions : (1) identifying
data , (2) i act on wife rior to hos italiz tion, (3) i -
pact on
•
1 ice current hos italization, nd (4) 1 nning
of wife or the f ture .
The irst sci can be co ared to the "face
sheet" of a social c se record hich incl des birth date ,
race, reli ion , and ccu tions o t e memb rs f the
family . It lso incl e the d. osis nd rognosis of
1
Tanya orotune , "Im ct on Children of aving
ospitalized ental ly Ill Fathers" , (Un ublished ster ' s
Thesis , niversity of So th rn C lifornia , School of Social
' or , 1957) • 49 .
8
the patient. The second section is concerned with how
the wife saw the illness developing, what her relations
were to her husband and what changes were necessitated
before hospitalization. The third section deals with how
the hospitalizati on has ¥ffected the wife and what her re
lationships are to her husband. The fourth section revels
the lans of the wife now that the atient is hos italized.
ature of Report
The thesis h s bee divided into the followin
cha ters: (1) intr auction , c verin ur ose of the study,
st tement o the roblem, sco e, rofession 1 si ificance,
locale, ethod of the s udy , nd limit tions; (2) resen
tati o o re rch interview analysis; nd ( 3) summary
and conclusions. n a en ix incl des sa le c se re-
e ed c ordi to the c ed • biblio r · hy is 1 o
included.
CH.APTER II
ANALYSIS O DATA
Identifying Data
The spouses' ages ran ed from 32 to 52 years. Two
of the wives N re in the·r thirties . Thre were in their
fort es nd one wife sin her fifti
•
One husband was
i is thirti sand to ,er in their ort·es . Three
usbands were i th ir fifties .
In th o e f ·1y,l he t·ent was 18 ye rs
oder th n the wife. rs. Jo e lained that she
matur v ry youn nd th u ht o her husband as
being much youn r tha hew • Shew an extr ly
de endent oman who sou in m rr· e fulfillment
of her de endency n ds for f th r fi ur e •
Int c · es
•
ve 1J re o der than t hus-
•
nds . , ho eve r , id no s e t ve parti 1 r
g-
nif c nc i e o t o h i act o o italiz tio u on
•
h d thre il four f milies 0 am1 C n
d t
•
dren . ly chi
.
d endent nd out 0 C on w a
the home . f
·1ie
d ten- ge il
•
the 0 C in
home .
•
f ilie Ca
•
f mily 1V r s n one s
-
1
Th
• •
ed. case n mes a e sgui
10
Negro . There were two mixed rotestant-Catholic families,
two Protestant families and two Jewish families.
Occupations or the patients varied from engineer
ing to custodian. Two were salesmen, one a punch press
operator, and one a teacher. There were two working wives
and four housewives . Only one wife had worked through the
course of her marriage . Another wife , ~ rs. Levy, had gone
to work for a year "to sh me my husband into su orting the
family ." The husband w s r occupied with his inventions
and did not concentrate on his salesman's job . The work
histories of the tient were varied and of no particular
significance t o this study. rs. ones w s the only wife
who h d no revious work ex erience.
In f our f· i ies th husb· nd nd ife had r du-
ted fro hi school . In ne o~ t s ili s both the
husband nd wif w r coll r u tes . r s . o es e:x-
ceeded her hub d'
e uc t· o
h obt
•
ed
•
•
1
• •
in
• • •
h ool te . OC1 c ence C r
Th 1 s
•
bet 1930 and 1950. 11 C U ma r1e een
were
·rs
marria es . e o et of the i lne es r n ed
ro 1954 to 1958 nd the res issio s er et ee
e t b r, 1958 ebru ry, 1959. Three atients r
OS it li zed befor e or ot er c nditio s . Thi s the
first dmis ion for one tient .
11
Diagnosis through medical charts and resident
physician's comments.--It is necessary to mention that
within a month of the collection of the data, four of the
six patients died. The researcher has thought about this
in retrospect nd believes that two thins had been o er-
tin in the selection o cases . One f ctor h d been the
seriousness of the c ses. In 11 bu one c se the tients
were seriously ill. The secon fa ctor had been the re-
se r cher ' s tendency to sel ect tients who had been ex-
periencin
diagnosis.
reater than avera e difficulty accepting their
Two atients were diagnose d as having severe ma -
li nant hy erte si on doe o these patients h d the
added dia nosi of ost- o erative se tic defect . Two
atients suf ered fro
One atient ' s di nosis
inf rcti o . n o r
b c eri o- ndoc r diti
rt ri scler tic he rt dis ase .
coronary in shock , my oc rdi l
· nt ' i no
•
a - cute
d h rt v lve d a
•
ro -
si o ive o he tie ts was oor. ~ r . :iles , or
ex
co
l e ,
nit 1
•
s ein r r ed or he rt su ery due to
•
1S
rt de ct . r. o e , lthou h holdin his
on hysic lly , see ed to e ithdr
•
in from the world •
The hysici s .uestio ed 1 r • . uill's cardi c sym toms and
they believed he oul m ke a com en atory recovery .
12
Impact on W ife Prior to Hospitalization
The relationship between patient and wife before
present illness.--In all instances, increased dist nee
seemed to be a factor in relationships .
rs. ~iles felt the loner she was married the
harder it was t o discuss things she felt im ortant
with her husband. To a significant but lesser
degree than the other cases, r. T iles became pre
occupied with earning a living and argued more when
his own dependency feelings were threatened.
In three cases the di t '·nce was renounced and
there was open resentment. :rs. Jo e , for exam ·le:
Dist nee ch racterized their relationshi.
he worrie d bee use he would not t alk about im
portant thins . n instance of the thins she
considered i m ortant s his eelin about his
job; he wonde r ed if they liked him at wor k. · vb.en
he would c onfide this to her, he ould bri skly and
irritably announce its uni ort nee an woul usually
walk out o the home . lw ys ickin up his
hat and ru i off hen they touched u on m ort nt
thins.
Th f llowi exam 1 is ith th uill amily :
~ r. uill s he only s rvice- connecte
v te r n nd a dischar ed wit sin 1 i ·ury.
Tw ye rs o he s o er te u o r r condition
and 1·c ti o d v lo ed re eri i phy i-
ol o ll y i m ot t le toner ·ae th s
ra the est o o · c o- soc· a1 ctors in
tisc itio.
he ·r di cur e on ct r t ·
rri · e believe e si c t . Sh
l th t i s i r1 e r tiv t t both t e m d
wom n ful ill t e·r roles in m rr1 a e . The us b nd s the r i m sculine fi ur. The
wife w st e c rrier of the fa mily v lues "whose
job it was to sty in the home n bring u the
childr n." Ii t h bitterness, o hich she ay not
13
have been aware, she rel ated how difficult it ha d
been for her to work and what a paradox it ha d been
for the husband to have to mother the children every
evening. She believed it was hard not to be able
to have intercourse and rationalize d that it was
even harder on the man. She reassured her husband
that she loved him very much and that there were
other thi.I1 gs in their marriage which compensated
for sex, "but nothing seems to reas sure him."
In five cases the need f or excessive emotional
dependence upon tne ~ife was apparent. In thr ee c s s
hus and. I n one c se , t e Jo f mil y , th husban
's
nee d was f ru tr te d by er de endent w i fe .
.fuen r • J ones ' s mother di , she mov h r
i ly i nt o t e he r sister
•
r to be ome nor
nea s en on s e could "co t on."
acto
•
t ncr C s s l. r e-
t · on h i 0 nd
•
d r ent
•
t~
ife
•
en reco l.Z l.
.
1
t·o
th
•
se en in 0 e n OS l.-
liz ti
•
t · ent ' s
d.
oi nt l.
n l.O
•
n
b
.
f
•
1 0 hi I e 0 a r co z C or r
•
f
fiv out of
•
d
.
.
r e rob-
1 s , e C n
U' C
of t
t·ent ·r
•
d b fo t he
•
0
e C l.Z OS
-
._,
t
.
ti on • oi to
.
ti l.Z e ·c 0 s e 0 l. y r
n-
.
be t h
•
.
•
s l. 0 e e s e V r co ze l. S
-
•
t t d d
... Ct
• •
hus- l.
.
r1c s co 0 l e
'
ior be 0 e z
t·o
•
. - - he
to s t o set e
•
V' l
•
h e , · t e s u -- er , s t i
14
comfortable favorite chair , yawned and felt a severe pain
in his chest . From that moment on he could barely ambu late . Mr . Jones ' s onset was gradual .
The .-ife had difficulty lacin the onset of
the illness. She believed that she recognized
that he wa~ becoming ill about two years ago .
She could not dis ssociate his "dist nee " from his
illness . There were times hen she ould talk to
him about seeing a doctor nd he would reply he
was seein a doctor inform lly in the e · 1th
Department where he worked . He would state he had
hi h blood pressur and let it oat that . The
ife nev r felt th thews seriously ill until
December of 1958 hen he suddenly develo ed chest
pains . he called a doctor des ite his rotests
and the doctor recommended imme i te hos ital
ization.
In another case, the ,u·11 f mily, the ife
cl · im d t e hub d "cried olf'" too many times
nd she did not reco ize his he rt tt cks when
heh done .
Th v ried s
t d d to conce· y
to so th~ tients at on t
ter th th· d si i ic ce . In
t
to
tudy there w
t onset d i
no rent r latio shi
ct upo thew· e.
teensy -
p tient's i lness nd im ife.--I n ive out
of six c e t e e d o t o or or a t·ci t d e-
tur in t o
•
r • 1ile wa encour ed to 1 for · id to
eedy Children lternat i ve t o orkin
'
ue
t o her c ·1dren's ee or her.
n another inst nee , :r
•
Ley t to ork
.
' s
.
•
t o ortin
h · s
· mil
"
1 0 er 0 ' e l SU
and found herself "stuck to full-time job."
i rs. Jones was the only wife who had no plan
involving herself . She stated her brother-in-law
would assume support for her family until the
patient re~urned home. To some extent this is
culturally encoura ed among Negro grou- s.
1 5
The change of roles is significant . In five cases
the wife s aw herself as t he breadwinner.
In all cases · su lemental income was utilized or
in co si ered .
been s u le nti
n .... r
c es t t
l._ 0. • ex pl
d city is b. lity
r :
o t __ d ice of t re ident hysician, r s .
Levy had a lied for a non-service-connected
veter n ' s ension nd .rs. ·iles w s eceivin an
id t eedy Childre 's grant.
11 of th wives co idered t eir incomes er e
ea er. ive ives 1 nned to it int s me reside ces.
.rs. ~uill, th e e tio, s undecided :
h w s tive bout the a rtment they were
•
t
•
.
th ve be n dis 1 ce - occu
•
n, l. 1
ant
•
t ostile to d er husb nd or since s e
f ustr tin o· , new home .
.
would old rho e 0 s e e ,
• •
ent cost old- or ~ 10 e 1 ,
•
•
o to t e med tor ect of oldin onto e omes ay
the or 1 tab e as ect 0 their l ives. Ith s been
d tr ted
•
the tud that e vironment 1 m ni ul tion 0 in
ece sit te d vhen t e husband was hos it lized had c used
a
•
or hi t in roles • 11 the i ves t lked of being
both other nd father to the children nd of the
16
necessity of a new source of income. Five of the wives
felt that the survival of the family depended upon the
ability to work although one acce~ted id to Peedy Children
with the reco nition that the children would benefit.
rarious forms of income maintenance progr· ms were
sup ortive factors in all cases but they were grossly in
sufficient to meet the needs of the family. Five wives
made or were contemplatin serious role ch nges des ite
inco e aintenance ro r m s . ork w st e only · ns er
they could see to the i act of the usb nd's illness u on
them. One v ry de endent ife contem 1 tea shiftin m te-
rial dependency to brother-in-l·w i n time of crisis.
e related to the p tient's
illness.-- 11 t e ives ex re ed their roblems with overt
emoti on. e c · r · cteristic re cti ons in 11 inst ces
ere r et ent nd fru trati o . Three of the ives felt
there h d een eri ous c n e i t1eir childre.
-rs. ~ile, f or ex m le, s ok o h elf s
ein " i ority rou of one." he felt on the
other hand th· t t e ho it liz ti on of her husb n
rovided relief from the "eve y y tre es nd
trains o rria e." he was uzzled bout her
ol de t son's ebelli ou behavio nd sou ht hel
throu h school uid nee clinic. She an her
husb · nd l ea rned, but did not fully cce t, that it
tied to the husb d's hysic · l co dition and
1 ck o ttenti on . he w resentful of the
authority nd the res onsibility the illness in
flicted u on her.
17
1
1
rs . ahn , a woman char cteristicall y preoccupied
with her own probl ems , said , "I took care of him to
make him feel good so he could bring home t he money .
Now I have to care for him and do everything . "
Implicit in the wives ' responses were frustrations
over f mily oals nd the onset o new roblem.s . These
oals were refle cted in ex ect ti ons of the fa milies, such
shoes, j obs, n self-dem ndin c ievement .
re
w i
e
!.:rs . \:iles t 1
st·ndar of livin
lectual ursuits .
in their i • ·· r
security nd ft
to e strivi f or
~it his sibl i ,
a t e only s no
J e .
- 4
ole J
.
lly 1 0
the
"
ree OU
-
· 1ity
~
1 -- C
lJ
C r · C
l.
t·
t ely ti d to
e t e ti t
' Q
....
e d t o e irect1.o
OS
1
1. t ti t
.
z n , e J].
ro , sue s on
the 1 s ,
Sin t ese r b no
ed about orkin to~ rd a hi er
n reco nition of their intel-
r . nd rr s . Jones were con licted
• J o es t ed ore rt nd
e 1 u b n d. i r . ones se me d
r eco nit·on ands t u on level
who wee colle r duates . He
t l r e who ha d no~ on o co -
11
•
·e
0 J. u
C e
•
ut
les
n .
d
h .
C
-
ucces
•
.
ir icts C
.
11 l.O an 0
t oble t
. .. .
ced e -- s e e e l
it lize l fa
.
i e s
•
0 e
0
I
r e ct n 0
•
•
.
d e X eri e e 0 ec V n
, · ck 0
t·
e to ve to t e C J.l -
~
n ce u on e u a ds .
0 y lted strivin to oal
but burce t e
,:, l
the resul ·rustrati on
ex- ..l. ,
r io 0 t
•
e V r u con .uences of n er lus
18
feeling of dealing with the -roblems alone . Therefore ,
i n all cases , the frustration of emotional needs and
family goals had decided im act upon the wife .
J 1fe ' s awareness of patient ' s illness . --In four
insta ces , the wife described nd u~ed the correct termi-
nology in talkin bout the illnesses . Two wives could
descri e the illness only s a" eart attac . "
in
O ne o t e ives, ,.r • uill , co 1 ined that
s e was unable to see a doctor nd therefore did
not knov1 the terminolo y connected with the hus
band ' s illness . lthou h this is true , it is also
a ration lization. - art o th ro 1 sin her
in bility to acce t her usb nd s e w s nd as
a conse u ce , s e dis 1 ced hos ility u on the
hos it 1 staff .
ene all h J V who e · e ter inolo y co
cted it t hu b d ' s il to
•
nvol e e
re wa i t he
. ti
ts'
ro 1
•
e t 0
-
.
l
ho
·a
ot t e t r
•
nolo extre ely de 'e dent
_ o ~
e e
e l
•
One 0 the 1 t r iv s h t e e pro l e 0
limited
.
e UC 10
•
In t
•
r e C e l V s e t e n tur 0 t e
.
es
illnes a
~
C ul derst d t e co e u ces .
The Qe i ve
coul t lk bo t the
· 11
.
ic lly in ul
es l n e e
11
•
iv , o ever , needed to ce t
.
hu eir b ds 0 the
oQit "ve
.
t ry sea hou h
t ·o sso- 1. e 0 e recov e even
ci ated " e· rt attack" it sudden de t .
... rs . ,il es , f or ex
condition Vi e r m·n 1
le , knew
d t · l ked
th r husb· d's
out hi "oor
y .
19
chances" in the beginning of the interview. Later
in the interview she t alked about taking art les
sons when "he is gone." Sne immediately needed
to remedy this statement as if it ware a sli of
the tongue.
rs. Levy was ersistent in learning more about
her husband's illness and uestioned the doctor
thorou hly about t he conse uences of the illness.
rs. Levy wei ~ he d emotion 1 f· ctors heavily. She
believed her hu· · d nee e to ork o hi s rol e
before oul et , 11 . ~e r ri .c 1 t h
friend i syc or alysi s h d c ce d he r ft e
he li _ a · lities i n thi ex· eri nne. rr s . Levy
filed to co r hend the hysiolo ic · l dam e er
husb nd h~d lre dy ex eri enced.
I to c es the ives verb ll y soc· ted the
illness with sudden de th lthou ht ey needed to state
their usb n ds would rec v r.
rs.
escribi
dro pin
ahn , for ex
it "e rt
I
dead."
The four r m inin
le, h d only on e w yo ~
tt c m n suddenly
tt1t e s se ed to reflect t e
indivi ual
.
1 s ' w so re o
o s re in t hei
t nd
li s .
i
n
•
11 he ,ives e ~
e
0
o the illn ss .
Th
vent le di
s e ui t , re e t
' l 1-
0
C 0
ey er e. eri
•
Clll result
u to os it liz t· o seemed
t o av
calle e · v
.
S1 i ic nee nd
r e to u ort
a er n of a· s
intent int e li~e style of the i di-
•
1 1
i t
r el
20
Nrs . Jones felt that her husband had become in
ere singly dist nt . Be didn ' t t lk and many ti me s
didn ' t respond wh n oles ke to hi . He seemed
preoccu ied . Finally , after months of attributing
his condition to his cha r acteristic dista nce, she
called a hysician while he was experiencing angina
pains .
rs . Levy described it in this way : She could
neve r remember him being sick until a few years a o
when he repeatedly took anti - cids . e denied
be i n sick but one day he blurted out that he had
been to see a docto r nd found that he had an ulcer.
·_e claimed that all he needed was a little medicine
to sustain him and he went on this way until his
first heart attack .
During the ast ye r he a d t a en his medi
cotion but had completely i nored the rest routin .
e worked late in the garage on his inventions and
mana ed to find few yi hoto .ra hy contracts
durin the year. ~ was on hi way to the Central
V lley en h ex ri enced i econ e rt tt c.
e retu ·ned home nd went tot dmittin room of
the hos ital .
rs . Slo n h d difficulty" in i tin" hr
husb d ' s e ling . lthou ht e if ex -re ed
littl eelin r · r i t e tie t' dis
oint en , I felt tat he e· nt disa oint t
hens es ok o his orryi • Se egan o
eel th t so tin on hi in in the s ring
o 1958 en thy took c in tri. Later she
associ t his no feelin ood to iQ rryin
bout his d"smi 1 on the jo in the de ert .
Th dra ati · ct hen he took ·ob on
t e co st ·nd ha de t eri r ted r idly .
Th t the
'
•
oint ran er 0 s OU e 1
.
• •
e
e x er .. e eco ed by t r e 0 the ve
event din to ho it liz ti on. These
•
e u 'JlVe
t
t d
•
1 de d eeli
•
· de
cy to
·11-
001 s 0 l. u
• •
n s . I t 0 cases dis oint ent s l. ied nd 1n on
co niti on o the hus nd ' s di
•
t e t .
the r w s
21
The latter wife saw long chronic illness in her husband
as a kind of malin ering. It appeared that the atients '
ex ectations of themselves and their failures to live up
to ex ectation my be a si nificant factor in heart ail-
ments .
In five cases the ~ives needed to take the initi ative in hel in the husb nd contact the doctor. In these
cases the husbands used denial to ost one contact with
th doctors . It ape ed th tu timately, in time of
crisis , the five husbands de ended u on the wives. It
also u ested th t inade uacy w shard fo r thes e men to
d ·t. The wives ' char cter· tic re ction w s fear with
•
ul e to C 11 the do c immediately . an 1 or
1 r
•
uill s the o 1 exce tion. e r husb nd
a ounced he was to he hos ital , nd lthough
rb rov 1, he lt
•
ointment. ave v 1.sa
ee e d 0 th t illne s w s def ns for
his ro
•
Changes i tionships.-- ive out of
ix c es the ive r orted curtai nt of soc· 1 re-
1 tio ue o th
•
l. a C o h sit liz tion • .r . ile
o er a ri o o ye s radually withdre f ro a circ e
0 iend it an aunt
ho" iv d down h street." The unt lso ill . en
he ied, ir . riles bee me more er ul of her husb nd's
co ditio . he ssume some res onsibility for her orph ned
cousins nd ex res ed mbiv lence re arding the task.
n rrs. r . . iles explained that before her husband's
illness and hos italization they went out at least
once a week. They liked to eat out a lot and
occasionally they saw friends and went dancing .
rs. Levy stated with considerable bitterness
t hat she had time only t o work . sne did a lot of
talking on the phone to friends but r rely saw
anyone. During the period between hospitalizations
her husband and she m i ntained n ctive social
life . They partici p ted in weekly bridge club,
s aw plays , entertained and visited freauently .
M rs. Sloan claimed her family sent most of
their free time c mping out. Her husban w snot
co unicative and did not have any real friends .
She had many fri ends u nd down the street .
After he r husb nd w s hos· it lized , she felt
leasurable ex eriences were t boo nd had wit -
drawn from all but a fe friends who ere close
neighbors.
y nd 1 re , fi ve ives' ctivitie nd rel tion-
ships were r estricte by th husb ds ' hos it l iz tion.
he s ci 1 d mor· 1 de nds m de u o the ee e to be
the mai re o for r tr·cti o
•
ach ife cho e
characterist·c tiv way of ex res in r nt nt over
t e ho it liz t·
•
of
•
nt ' s
•
me ns in s t o
.--
·i e 1
I
0 t h r e t r o e n d t
d .
.
h · r u e e 0 1.ve
:r fell
.
or r C t eg
u.n
•
•
e~
1.
uotin fro
- e
sche ule:
Th , ife d no · r ss o. t e tr t nt
technioues . he left t e det ils of his illness
to her brother-in-1 w. The brot r-in-law saw
d
0
y .
the do ctors · nd nurses and talked to them about
hi s condi t ion . She explained
in- 1 ·- 1 un erstoo the u l i
ness he had not a de ·t 1m wn
m.e t e i Jort nt thin s . "
th t if the brother
lie tio of the ill o er, "ut h t 11s
23
n the ot e r nd , Nr s . L vy · volv a rs l f in
e t e t oc ss :
The her t
•
t of s 0 s in r re n
•
r e r ue er
•
· w 11
twill the attack
•
•
mean in
terms of
•
recovery? fu t about his li it tions? 1.S
.Jh t
about his work ca acity? C n he et sychi-
· tric hel
.
the hospit l? l.Il
he ttri uted lot to
• •
tr t ent nd
el t h r ho es lay here .
•
h a d li ited kno~ledge oft tre tment our l. V s e
0 1~ .
•
-
e· red to er l · te to th ir r ce 1
of ath o of he
•
d n about the o n e
r lo,,j
r1.
ro -
•
of the t·ents • Two
.
h d xtens ive kno l e 0S1.S 1ves e
of t tre t e t
•
.
e oce
•
0 ~ ver, 1n e e n
h e w rel ti nshi et e n t e willi nes to f ce
ill at r 1 d und rst
•
of
.
s l.Il e 1S 8 se r oe
r ct
.
tic ction to
•
l izat · o
•
C r1 re OS l. l.
C e a to e
u·1t . r
•
i bl C en
h ced
·t
t he t er
•
n 1 ct of her husb nd ' s s
• •
r se o e uilt • rs . Levy
co l 1.on . r • o es e
fe l e uilt . s te t
• •
te and 1 r 101
rt 0 r usb _ a' s t e t e t ro r
•
T e res 0 se ~
t
• •
ves in e e 1 t· ces as C · r ct ristic eo
\hO live to ether in ti
.
1
• •
e 0 e 1.C cr1. 1s .
•
24
Family living arr ngements.--Three families were
buying a home, two families were rentin, nd one family
was living ith relative.
The Sloan family home was locate d in a desert
town within the 90-mile radius of Los ngeles. It
was a modern lo -slung home built for desert livin .
The rooms ,
1
ere sp· ciou s and I. r • Slo n cl i n1e d she
was satisfie ith th living rr n e ents .
rs. -r. a n li ke d
apologetic about the
uted thi ~ tc _ r
·elt th t t h et
lems bout li i
er rented location but
1 c of furniture . She
q _ d's "hol - out" on y .
s
ttrib Sl e
· rr n
c i dre
· cti o
OU
I
h o e
ne home
e
T
r
e
b r ot
cone _ tr
•
i
, s f i r a n re e r n o
rob-
r me ts .
ui 1
ents
diss ti
i...,liked
er ~ rtment
to · ect t
i e f
e
0
, b· ic
o r
'
eed.
.
i
0
I one
er li in
c tr· tion of
This dis atis
ily' s o 1 o
t e e e str·vi
•
t
· 1 i li e . Th
t ce t 0 0
fr y t n s • e ent resi-
e
•
C 0 · s _ r • Jo e :
•
y i
.
S VJ 8 S in
ion o o
•
i on ,
.
C i
is c ountry • .r •
e ' s
N it
•
C
•
rr
· t to
live ith
de ende c
geme t
kee i
e r sister
ee d .
one i
etc y . es ti
in t t -r • ones 's nee to
-
is clo ely s oci ted ·th her
I
i edi te
e c · es t e o se ol
.
1 y. t ·o c · s th
i i ted to the
oth r-in-law w s
.
i
te · or rily i t e hoe . O ne ily l ived i th r 1 ti e s .
25
There was no particular significance in the study associ
ated with the family members livin in the home.
In all cases inco e maintenance programs were
utilized or an application was pending as a result of ill
ness. In all cases the wife did not feel that the programs
were sufficient to meet the f amilys' needs .
~ rs. :_iles a plied for c te orical · id to eedy
Children. She ~as encoura ed to do this by the
hospital social service as an lternative to ork
ing. rrs. ~ile~ felt , nd it s a arent, that
her chil ren had a re t need tor her . C was
her only source of income.
rs. Kahn exploined that she had encouraged
her husb nd to a ly for a non-service- connected
disability pension . The family w s receivin
C li ornia t te i bi ity benefits , 42 . 00
weekly. rs. ~ hn felt "ash med" of their need
to de end upon her t een- e son d m rried
dau ·hter for su leme tary inco e . he believed
she would soon ee t re urn to ork.
rs. lo· n re orted th ts e de ended he vily
on er husb nd's other and brother to sustain
her f mily til Q e coul id ork. he thoug t
her monthly riv te di~abi ity c.eck b rely
worth mentio in . hey r ceived 50 m n h.
In o yo e c e i come ai ten nee used to
sust in the f ·1y' t t 1 need. iv of the six wives
needed to utilize th
elves or r lat·ves to sust in the
fa il • rt of t e er 1 reset ent the wives ex res ed
can be attribute d to the 1 c o su icie funds hich
forced the f · mily o seek e, men of support .
26
Impact on V ife Since Current Hospitalization
Reaction to the patient's hospitalization.--In
three cases the wives admitted to a sense of relief over
the husbands' hospitalization.
1 rs. Jones felt relief as a reaction to her
own guilt about not recognizing her husb nd's
illness. he did not distinguish between his
customary distance and his illness •
. rs. Levy believed that her husband would
finally et the treatment he needed. She was
"tired" of bickerin with him bout medical neg
lect. ·rs. evy was convinced th t her husb nd's
way of life c ontributed to his illness. She felt
they both needed hel emotion lly.
Two of the ives projected their er o to the
ho it 1 star nd they et the o it· 1 s the bl me for
s i they ere not able
to f ce bein ry the s lves.
ne ·i en eded to s e 1 e r time ith her us-
nd o ~rd t o the exclu ·o o r c o izi the im ort nee
oft et ent . She ee d stro su o t rom the octor in
order to
tie.
th t he need ot be clo Qe to him all the
lt ou h the tudy does no oint to ny ch acter-
y of re ctin , three ive ex re e e ief on
hos italiz tion o the hub d. Tw o ives ro·ected their
n er o to the hos it 1 over his illness nd one
reoccu ied 1th uilt.
•
1 e w s
27
In all cases the relationships seemed to be an
intensification of or a reaction to their former relation
ships.
Mrs . Jones felt that her husband was charac
teristically strained and hostile. She was disap
pointed that he didn't respond to her display of
warmth. rs. Jones felt he was preparing her for
his death but she thought he was getting better.
rs. Levy claimed there was more open hostility
between them. She recognized that his denial of
his illness was detrimental to getting well. V ith
the doctor's ap roval, she shouted at him about
his need to remain in bed and undergo tr atment.
rs. Levy w s fr nk and o en about her feelings
but she implied it was difficult to communicate
with her husband.
rs. ahn stated, me don't t al k much . I
tol him everythin i s oin to be all right. I
don't tell him t e troubles e have at home."
he wives co unic ted v ied and i tense feelin s
re a din thei r current relati on hi
ref ected feelin s that led u to the e ent ho itali-
zation .
ch r
ri i see ed to pr ove e less inhib·ted dis-
of eeli
•
ch r ct it c response s guilt.
l anning for the uture
Pl ns o ife in rela ion to the patient's Erog-
nosis.--In fiv c ses th
•
wives 1 nned t o o to o k ,
incre e work tim , or continue to work s result o th
tients' r o osis. 11 of these ives elt tat the
need t o ork as irectly re ated to the husban ' s illness .
28
The wife's concept of the husband's. role in recov
ery and as a member of the famill.--Three wives saw the
husband returnin to part-tim e work.
r s . Jones believed that her husband would
nev er completely recover but believed he would be
able to return t o a light job . She stated (but
it was difficult to think that she believed) that
their roblems would resolve themselves as a result
of the illnes.
rs. Sloan saw her husband as being disabled,
in need of findin ne work or rt-t ime job.
She sentimentally stated th t he r husband needed
to come home soon in order th t the family could
go on a planned cam in tr· •
I n one case the atient s terminal and in two
case the wive felt th ir husb nds ould u e their illness
to kea from wor i
•
r s . Kah ex res ed bitter ess . She s sure
her husb nd s usi his illness to force ork
u on her . he see ed con u ed nd mbivalent bout
hi r eturnin home .
Int e ives 0 the·r hub n s et urnin
thee s n 0 o e . t e t o es ho elt
m ni ul ted
e e
e e dee - se ted feeling o bitterness .
Int e termin 1 c se the ire bloc ed emo ion lly.
In 11 c · se th ives under tood th t hen the
hub nds ould e urn to he mily it ould limit their
a rtici tion
•
social ork ctivity . The d ree of
in n
limit
•
eculatio to the d c or s . In 11 ion s
, eve
cases , to re ter or lesser de re , the ives s them-
selves t onsib e ctive member
•
the family nd re in
took the initiative in family m tters.
CHAPTER III
This study has explored the impact of cardiac ill
ness u on the wife of a hospitalized veteran. The study
utilized the research interview, and six wives were seen
in their homes. Each family had at least one dependent
child and all the marria es ere first marriages .
Ones eculation was th t the ives would be af
fected materially, ocially nd sycholo ically and that
they would t eon new roles or look to other members of
the f ily, rel tives and community for su ort . They
mi t ex erience the revival of neurotic feelings or de ri
v· tion o need nd this mi ht be reflected in the roblems
s they ere eetin their current mily situ tion.
It was a umed t t there ould em ny sy t oms which
ould lect syc o-soci 1 roblem, s~ s oor communi-
cation between er on nd environment, nd oci 1 role
strivin
•
noth rs eculation w st t th tient would ex-
erience c rdiac illne a evere threat to lie and
~ould s ociate it ith sudden death ; nd that thos who
h d ot made a ati factory adju tment to their heart
dise e mi th sten to re-establish their re-sickness
atterns of livin. nother ossibility was that cardiac
30
illness could be utilized for the purpose of handling or
avoiding emotionally charged life situations.
The final speculation was that the ~ife could re
flect the feelings of anxiety, anger, fear, guilt (feeling
of blame), shame, helplessness, and hopelessness (feeling
of despair), in the patient's life situation before the
hospitalization if they were expressed.
Conclusions
It was found that in all cases the wife needed to
shift roles in order to sustain the family. She needed
to work, utilize income maintenance rograms, and depend
upon relatives for su port. The characteristic response
to role shifting was resentment. The resentment was inti
mately tied to the conflicted or mutual goals of the
patient and wife.
In three cases the oals were mutual in husband
and ife and in three cases the go ls were conflicted in
husband and wife. For example, the husb nds and wives
were strivin together for status and homes or they ere
divided and conflicted as to what they ex ected to achieve
in marriage. The mutual goal strivers could not be con
trasted from the conflicted goal strivers in any meaning
ful way. However, all cases were characterized by threat
ened or real emotional and economic dependency or the
31
husband before the onset of the illness and hospitalization.
Implicit in the wives' responses was frustration over
family goals and the onset or new problems. Goals seemed
to be related to status,which was an important factor in
all cases. Disappointment in status striving or, in
psychological terms, the inability to achieve self-esteem,
was a pattern of the husband in all oases. This pattern
was reflected materially, for example, in job attainment
and the value placed u on the home. In three cases recog
nition for achievement was a stron motivating goal in
life and overshadowed the reco nition of failing health.
This striving su orted the remise that the style of life
may be an im ortant factor in all illness.
iv husba ds re lected ex essive emotio al de-
ende ce on the
•
1 nd in three c ses thi a charac-
terized by a ub i sive attitude in the husb nd. Into
cases the hus nd ov r-re cted to hi aut itative ascu-
line rol and in one case the if 's de endency over
bal need the husb d' de endency. In fou cases ther
was renounced te de cy and i tJo c ses an im lied
tende cy to rd incre sed di~t nee i th f mily u until
t e time of admission to the hos ital. The dist nee seemed
to reflect the ro res ive co lict of o ls or the in
creesin in bility o the husband tom intain his self
esteem. In contrast to the husb nds, five of the six wives
32
were adequate women ~ho appeared capable or sustaining
themselves in time of crisis.
The wives restricted their social activities for
good reasons. They needed to act as both a mother and
father to the children and keep the family running finan
cially. There was also the tension of the illness to con
sider and the serious im lications of a husband in an
acute hospital.
The element of resentment raises uestions for
further study. fuat art does expectation in marriage
play in contributing to illness Is there any relation
ship between the value of the marriage in itself, expec
tations of self and rtner in marria e, and illness?
The stu y demon trate d th t the characteristic
feelin s of the hush nd nd i e are intensified as a
result of illness and hospitalization. or exam le, if
a cou 1 shied away from roblems, they did so in the
hos ital ard 1 o, or if one ar ued nd the other ith
dre , they follo ed through in this characteristic manner.
In hat may be indicative of heart disease, but
d serve further study, s the af ect seen in the atient
by the i e be ore the hospit lization . 11 wives im
plicitly cha r cterized their husb nds s men who demon
strated feelin s of des air (ho~elessness) before the onset
of the illness. feelin of unex res ed disa pointment
33
seemed to run throughout the lives of all the men before
the present hospitalization. Equally important was the
fact that the wives understood the nature of the disap
pointment but could not resolve it with their husbands.
In the study, the fear of heart disease as seen
by the wife was not as strong as expected, yet four out
of the six patients died within a month of the collection
of the data. The wives' feelings may be tied to the
doctor's original rognosis for the atients . One patient
was terminal and five were seriously and chronically ill.
However, in five cases the wives and families were told
and the doctors believed that the ch nces for a com en
sated recovery ere fair. The doctors ere seriously con
cerned and uzzled over the number that failed to recover.
The researcher felt the life situation was an important
f ctor in the deaths . 11 of the atients were having
difficulty in djustin to ward routine ad res ondin
t o medic tion. The doctors turned to the atient ' s lie
ex eriences for more kno led eable diagnosis. e talked
t o the atie t about his ·o, his marria e nd his rob
lems. It may be i portent to study the family and life
ex eriences of the atients having difficulty djusting
to the hospital nd the routine of the sick role. This
designates an ea for future research.
Since limited knowledge was gained about the
34
children in the study, the need for further study involving
the children is suggested. In three oases studied the
children developed serious reactions to their father's
illness and hospitalization. Two children had develo ed
noticeable and observable behavior problems which could
be characterized as open rebellion. One child suffered
severe re ression. He could barely make himself under
stood, whereas, formerly, he develo ed a functioning vo-
cabulary. It eared the impact u on the children of
the fathers' cardiac hospitaliz tion might be severe.
Finally, the wives sa themselves as taking a more
activ and res onsible role in family functioning. Desp·te
resentment, they believed in kee ing the family intact and
modifyin the husb nd's ctivity. In three instances they
s·w th husband m kin a limited re co ery and sustaining
a art-time job . Into c ses they ex ected tot ke total
res o sibi ity forte
mily . In one o se the husband w s
terminal ad the ife implied it was her res onsibility to
sustain the f mily.
Th study su ests the need for family diagnosis
and treatment in hos it 1 s tti s s el
s family
service a encies.
n t e roblem of illness is a ro ched
throu h the confi uration of the family, or a s in this
study, from the im. act u on the ife, it su gests the need
for treatment of all members. The oal striving families,
35
the dependent physically ill husbands, the resentful wives,
and the disturbed children--all of these problems fall
within the scope of social casework treatment.
In restating the question for further study, it
might be of value to consider the role of the family in
contributin to a family member's illness. It would also
be important to study the social factors of families that
have ood physical and mental health.
The less seriously ill cardi c tient did not
fall within the sco e of this study and deserves further
investigation. The roblems and res onses of wives whose
husb nds h ve m de a co ensated recovery ould be of v lue
in the treatment nd the underst din of reventive
health f ctors inf mily life.
BIBLIOGRAPHY
BIBLIOGRAPHY
Ackerman, Nathan w. The Psychodynamics of Family Life.
New York: Basic Books, Inc., 1958. 379 pp.
Bellak, Leopold and Haselkorn, Florence. "Psychological
Aspects of Cardiac Illness and Rehabilitation,"
Social Casework, XXXVII, No. 10 (December, 1956),
483-489.
Kaplan, Stanley M. "Psychological spects or Cardiac
Illness," Psychosomatic Medicine, XVIII, No. 3
(November, 1956), 219-225.
Kluckholm, Florence. "Family Diagnosis," social Casework,
XXXIV, No. 2-3 (February-March, 1958), 63-~~.
Kortune, Tanya. "Impact on Children of Having Hospitalized
Mentally Ill Fathers." Unpublished aster's Thesis,
University of Southern California, June, 195?.
Schmale, Arthur H.
Psychosomatic
1ae-191.
"Depression
edicine, XX,
receding cute Illness,"
o. 4 (July- ugust, 1958),
APPENDIX
APPENDIX
SAMPLE SCHEWLE AND INTERVIEW
A. Identifying Data:
1. Date or birth (patient)
2. Date or birth (wife)
3. Children: Boy
Girl
12
month
l
month
3
montli
5
mon'fh
5
day
27
day
23
day
21
day
• a
Husband Wife
1914
•
year
1917
year
1948
year
1953
year
4. Race
Caucasian -c-au_c_a_s_f_a_n
5. Religion Jewish Jewish
6. Occupation Salesman Clerk
Photographer
7. Education or patient: Circle highest grade
completed:
a. 1 2 3 4 5 6 7 8 9 10 11 (12)
b. College 1 2 3 4 5 6 7 8
e. Education of spouse: Circle highest grade
completed:
a. 1 2 3 4 5 6 7 8 9 10 11 (12)
b. College 1 2 3 4 5 6 7 8
9. Employment history or patient:
At sixteen the patient became a cadet in the
Merchant ~arines. He spent tour years at sea.
Later he wandered in and out of jobs associated
40
with being a jewelry salesman until he was
twenty-seven years old, at which time he en
listed in the u. s. Army. He saw active duty
in the Pacific. When he was discharged from
the Service, he returned briefly to the jewelry
business as a partner in a small store. When
his mother died in 1947 he inherited $8,000
which he used to finance a three-dimensional
photography business. This tailed completely
and he went bankrupt. In 1949 one of his three
brothers died of a "congenital heart disease."
He inherited several thousand dollars. He used
the money to finance a deep freeze business
which flourished tor about a year. He bought
a new Cadillac and this was the highlight of
his life. This effort failed ultimately and he
returned to the photography business in 1951.
This has been his primary livelihood to date.
10. Employment history of spouse:
11.
12.
13.
14.
The spouse worked for a large N ew York Insurance
Company as a clerk from her eighteenth birthday
until her marriage. In M arch of 1958 she went
to work as a clerk for a large industrial re
search concern near her home.
Date of marriage 10 7 1946
month day year
Date of onset of illness: arch a, 1958
Date of present admission: January 29, 1959
Date of previous hospitalization:
arch 9, 1958 to pril 3, 1958
15. Diagnosis:
The patient was admitted with a diagnosis of
"coronary in shock." In M arch of 1958 he was
admitted and diagnosed as having a myocardial
infarction. e responded well to digitalis and
was on about the same medical regime. Nitro
glycerin was administered on admission because
of severe pain in his chest.
The patient claimed he had a history free from
medical ailm ents until his first admission to
the hospital. He indicated that his family had
a history of congenital heart disease and both
41
his brother and rather died trom heart attacks
in their forties.
When he was admitted last year, an upper gastro
intestinal series was done because the patient
persistently asked for anti-acids. The tests
disclosed two small duodenal ulcers.
16. Prognosis:
Guarded. The patient's life was at stake the
first seventy-two hours of his present admission.
The moment he felt better he wanted to get out
of bed and walk around. He was extremely rest
less and this factor had kept him on the critical
list. The medical feeling was that he would be
100% disabled if he made a compensated recovery.
The 100% referred to his work capacity.
17. The patient:
When I interviewed the patient briefly, he
began by asking what he could do to help me.
When I explained the purpose of the interview,
he complied but added, "Why are you only a
social worker? fuat does your father say about
that?"
He indicated that he needed to get back to work
as soon as possible. He acted as if it were
impossible to lie still even though he was under
heavy sedation. He said he was not in pain but
just restless. ithout a logical sequence he
expressed bitterness toward himself, hate for
a brother who had only seen him once in the
past two years, and stated he thought he should
not have gone ice skating a few weeks ago--he
liked ice skating. He added that maybe he got
sick because of this. 1th a great deal of
hostility and frustration which seemed to be
directed toward himself, he stated that none of
the Levy family lived long. ''What am I good
for now?"
18. The spouse:
This attractive and trim woman happened to con
front the doctor as we were reviewing the
patient's medical chart on the third day of his
hospitalization. The doctor bluntly told her
that he couldn't do much for her husbEnd unless
she could make him calm down and stay in bed.
42
She quickly went to her husband and began shout
ing at him, "For once please do something for
meJ" It was my impression that this was devas
tating to both the husband and wife. However,
as a result of the interview in the family home
with her, I found the doctor had given her license
to do just what she had been wanting to do for
the past three days. She thought her husband
had responded well to her plea.
The spouse was born in the home of her husband's
family. Her mother was a servant and a "devout
Catholic." She never lmew her father, who de
serted before she was born. I/hen her mother
died, she was fourteen years old and she decided
to convert to Judaism. She did not remain in
the home but went to live with friends near by.
She claimed she had always been a great admirer
of her husband and felt that he was a strong
individualistic man . fuen they were courting,
she liked his high goals and ur ose in life nd
thought or him as a dependable man who could
give her security in life. On the other hand,
she thou h t he was eccentric "in a charming w y"
and was always t alking about inventions he nted
to create and becoming successful man . She
felt she never took this art of him too seriously
and was disappointed to find this as the re
dominant theme of their marriage. Life bee me
one disa ointment after another for him and all
their arguments centered on her wanting " j ust
security" and hi wantin to make "just one big
kill." She felt they wer alw ys basic lly co -
patible y t s time ent on she s carryin the
res onsibility for the family, and he wor eddy
and ni ht at his invent·ons.
The spouse im ressed me as being a oman ith
cons·derable e o stren th, who was in need or
and lookin or hel · •
B. Impact on ife rior to OS£italiz tion :
1. Length of illness in re ati o to ifa's ge :
The wife was forty-one years old hen th illness
began. One month from the date of the interview
would have been a year since the initial attack.
2. Manifestations of illness in relation to wife:
Symptoms at onset:
She stated that he was working on a three
dimensional prism in the garage last year when
she called him to rem.ind him of how late it
was. He came into the house "looking green."
He denied being sick and went to bed. Later
she woke up and saw him doubled up in pain.
She phoned the doctor and he immediately re
ferred him to the v •• Hospital.
She could never remember him being sick until
a few years ago when he re eatedly took anti
acids. He denied being sick but one day he
blurted out that he had been to see a doctor
and found that he had an ulcer. He claimed
that all he needed was a little medicine to
sustain him and he went on this way until his
first heart attack.
During the past ye r he had taken his medi
cat·on but had completely i nored the rest
routine. He had worked late in the gara eon
his inventi ons and mana ed to find a few pay ing photo raphy contracts during the year.
e was on his way to the Centr 1 Valley hen
he ex erienced his second heart attack. He
returned home an d he ent to the admitting
room of the hospital.
3. Relationship between at ent nd ife before
present hos italization:
The wife felt her husb nd a become increas
in ly de endent u on her. e loved the chil-
dren buts ent ittle time ith them. or
the ast ei ht years she had asked him to go
out and et a regular salesman's job . She
felt he could make enou h money to sustain the
family. he thou ht he was a ood salesman.
She felt she seemed to talk and n g more as
time went on and he just looked worried. She
claimed it had become im ossible to rue 1th
him. She see ed to be sayin that she did not
!mow how to help him. I felt that she was
su estin that there was warmth as well as
distance leadin u to the current hos itali
zati on .
43
4. Wife's awareness of patient's illness:
She knew the medical terminology and she knew
that his condition was serious. She talked
freely about his being close to death.
44
5. 1Vi:t'e's awareness of nature of patient's illness:
I thought the wife had a good picture of the
nature of the patient's illness with perhaps
too much weight on the emotional side. She
talked of the congenital factors in the patient's
illness and being aware of family background
when she married him. She seemed to know and
integrate as much as the doctors knew at the
time of the interview. She was interested in
the details of the impact u on him totally .
She wanted him to enter "analysis" so that he
could be cured "like a friend we know. The
friend is a new man now." She was interested
in knowin what i mpact she might have u on the
patient's illness and in this way began to ask
for help.
6. Environmental manipulation necessitated by
patient's illness and impact upon the wife:
Taking note of her husband's increased de
pendency u on her, she went out and ot a job
a year a o. he said she wanted to shame him.
It w son the eve of her second d y of work
that he ex erienced his firs t heart attack.
The wife did not think there as any connection
between the two incidents. ow she needed to
ork in order to su port t he family. They were
living in a home which they had been buyin for
the ast twelve years. he children needed to
be "boarded out" during the day no th the
was in the hos ital . Durin the ast year the
patient took care of the children durin the
day.
There was no signific nt chan e in their income.
?. roblems of ife related to atient's illness:
"I can't take all this res onsibility. I need
help." She had noted chan es in her children.
"y son is etting poor r ades in school and is
irritated all the time. [y daughter clings to
me and doesn't want to go to bed. I need thirty
hours in a 24-hour day." The souse was openly
angry (frightened) about being in this osition.
c. ImEact on ife Since Current Hospita~iz~tion:
1. Reactions to patient's hospitalization:
Late in the interview the wife felt free to
focus directly upon herself. She stated she
needed counseling as a result of her husband's
hospitalization. She had called Jewish Family
Service and did not leave her name ~hen she
found there was a long waiting list.
She felt the attack and the hospitalization
had intensified her negative feelings toward
her husband an she wanted. to "work thi o t ."
Se wanted someone to help her also with the
decisi ns she would be needing to make when
her husband came home.
I felt that she was talking about the role she
ought to assume when he returned. "Naybe we
both need analysis."
She claimed that she warned him of the ossi
bility of a recurring attac but he would not
li
0
ten. he stated that she was angry because
she sa thi ha enin.
2. Events leadin u to hos it liz tion:
The first hos italization was receded by the
45
if goin to ~ork in order to shame him. Thi
ca e abou fter hi reoccu ati n 1th his
inve tions , tote exclusion of ork . The re
occupation was a result of years of dis oint
ment inn t chievin his oal.
The second attack c e durin tri to fulfill
e lef home
ife as at
a sm 11 hoto ra hie co tract.
late in he afternoon hil his
work and he ex erienced an attack
the ride route.
hile crossing
The wife elt th t lie had been very much the
same before the second ttac. he thou ht
their f ily tress h d been ersistent and
constant . "The s'"' e r ument , the same re-
s onses."
3. Imp ct of these on ife:
She felt it as tie for decision. She couldn't
slee. he felt she couldn't work ef actively .
46
She had little support except from friends.
"I feel my husband will have to listen to the
doctors and me or it will be the end for him.••
4. Changes in social relationship:
The wife admitted she felt more hostility
toward her husband since he became ill. She
felt he had changed little in the past four
or five years. She claimed they both liked
family life and liked to attend plays and
the opera together. They had a lot of friends
in common and most looked up to her husband as
an intelligent, creative man. During the past
year, despite their troubles, they managed to
see their friends and go out occasionally.
They had a steady bridge group which they both
enjoyed. She thought that even when her hus
band felt ill and she felt tired they managed
to keep this activity.
The wife, however, did not ive a icture of
their inter-relationshi s.
5. wareness of wife of what atient's hos itali
zation means in treatment and results for him:
The wife was "on her toes" in terms of treat-
ment. er questions ere: at will this
attack mean in terms of his recovery? at
about his limitations? at about his work
capacity? Can he et sychiatric help in the
hospital?
She attributed a lot to the V •• treatment
nd elt her hoe lay here.
6. roblems of ife in relation to this:
She felt she as involved in his treatment.
She felt that they both needed help .
7. Family living arran ements:
This was a 12-year old sin le home that as
nicely furnished. The home had a iano and
many magazines like Fortune and isdom . The
books on the shelves were all classics. She
claimed they liked their home and she tried
to convince her husband that she could never
move out of the neigh orhood even if they had
a lot of money.
47
Each child had his own bedroom. The home was
to be paid for in three years.
s. Number of others living in the house:
The number in the family had always been limited
to the patient, spouse and the two children.
9. Source of support:
For the past year the wife had been earning
300 a month. The patient had averaged $600
a year for the past two years.
10. Current relationshi between patient and spouse:
She felt her former feelings had been inten
sified. She believed she could admit the good
and the bad about him. She felt he was denying
his illness and therefore it was harder to reach
him. In some ways she found it easier to talk
to him; for example, he listened to her when
she warned him to stay in bed. On the other
hand, s e continually characterized things as
"pretty much the same."
I believe she was es entially a bivalent about
their relationshi.
D. Planning for Future:
1. lannin of ife in relation to patient's
prognosis:
The ife anted hel in thinkin throu her
1 ns. he believed she ould need to continue
workin. She anted e otional hel for her hus
band and herself. She saw this help s related
directly to the urviv 1 of her husband. She
also felt it ould help i n thei marria e.
2. The wife's conce t of husband's role in recovery
and as member of th e family:
"I feel he will h vet o change before I c n
acce t him home. I cannot have him work out
in the ara e all day while I am out working.
I can't stand to see him killin himself."
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Asset Metadata
Creator
Astor, Gordon
(author)
Core Title
Impact on wives of having hospitalized husbands with cardiac illness
School
School of Social Work
Degree
Master of Social Work
Degree Program
Social Work
Degree Conferral Date
1959-06
Publication Date
05/06/1959
Defense Date
05/06/1959
Publisher
Los Angeles, California
(original),
University of Southern California
(original),
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Digitized from microfilm by the USC Digital Library in 2023
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McBroom, Elizabeth (
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