Yes, loving too much can actually make you ill!! I learned this valuable lesson while interviewing a Japanese couple about their illness suffering. This lovely couple graciously agreed to a family interview as part of a teaching/learning experience I offered at Kitasato University in January 2012, in Japan. Dr Nami Kobayashi provided excellent translation for the family and me. Her knowledge of family systems nursing and familiarity with the models that I utilize when interviewing families was essential for competent and compassionate translation.

The couple asked if they might attend my morning lecture before our interview in the afternoon. Of course I agreed and it enabled me to garner some distinct observations and impressions of the couple that I could explore later. What was most striking to me were the differences in their physical appearance. Nori, a 45-year-old Rehabilitation physician, was permanently disabled due to treatment of a cancerous condition of one hip. Consequently, he has been confined to a wheelchair for some 15 years.

Despite a more recent and very troubling diagnosis and treatment of a brain tumor in 2010, Nori looked strong and robust with full cheeks; dressed immaculately in his suit and tie; and very attentive during my lecture. His 46 years old wife Hiroko presented a stark contrast. Although not disabled in her walking ability, she appeared more “disabled” in her physical appearance than her wheelchair bound husband. Although Japanese women often have more soft and small features than other ethnic groups, Hiroko was frightenly thin, pencil thin, with eyes that appeared vacant. She sat so still during my lecture, looking straight-ahead and very intent.

What was evident with this couple is what I have experienced with numerous couples and families, that the person with the illness diagnosis is often not the person suffering the most. It certainly appeared that it was Hiroko who was experiencing the most anguish.

As the therapeutic conversation unfolded, I learned more details about this couple’s illness narrative. I inquired about the impact of illness on their lives and relationship, especially their marriage. I also explored some of their illness beliefs about their current situation.

This couple had been married eight years at the time of Nori’s frightening diagnosis of a brain tumor in 2010. Hiroko claimed it was like a “nightmare” for her. This metaphor captured well her past and current torment and suffering about her husband’s condition. She reported that she worries about his condition 70% of the time and is anxious if it “will come back”. Her excessive anxiety and worry has resulted in loss of appetite, sleep and even needing to live with her in-laws for a time to be taken care of when Nori was hospitalized for his condition. She also contains her worry and does not share her concerns even with her own parents. Hiroko does all the worrying for this couple as Nori surprisingly claimed he did not think about his condition at all as he was “busy enjoying his work”.

The impact of the illness upon their marriage revealed that Hiroko has now taken on much more responsibility overseeing finances and completing their taxes. She also made a very touching comment that since they did not have children, Nori’s illness gave her an opportunity to “protect someone”! However, the protection of her husband had sadly evolved to erasing her own needs and aspirations.

As I normally do at the end of an interview, I offered this couple some commendations and recommendations. I offered Hiroko my conceptualization that she had a problem of loving her husband so much that she had made herself ill.

But first I commended Hiroko for the love, caregiving, and devotion to her husband. However, I suggested that it would be helpful in the future if she could find a way to love and care for her husband in a more “healthy” way. She then asked me how to deal with her feelings of worry and anxiety. I was pleased with Hiroko’s question as now she would be even more open to my recommendations.

Since Hiroko had been erasing herself as a woman and wife in the world, I encouraged activities that would focus on her and her current health problem. One recommendation I made was that she learn meditation as I explained it is often very helpful to persons suffering with anxiety. I also suggested she might seek out a cognitive behavioral therapist as another method of learning ways of gaining more control over the influence of anxiety in her life.

Since her husband Nori gains much support, love, and attention from his wife, I believed that shifting their couple dynamic from being less unidirectional (Hiroko to Nori) to more interactional, would enrich the marriage and enable Nori to show more of his love for his wife. His love shone through when he asked, “what can I do for my wife?” I asked him if he would be willing to take the leadership to inject more “fun” back into their marriage. I had learned that their only outings together were to attend conferences where Nori would speak about his condition and of course he would again be the focus of attention. They both appeared delighted with this suggestion and Nori said he would be willing to take the “leadership for fun”.

Of course it would have been easy to pathologize this couple (or any couple for that matter) but I prefer to be a strengths detective and uncover the competencies, strengths, and resources within couples and families and offer them back as commendations. The therapeutic intervention of “commendations” has the ability to invite family healing due to a new way for the couple to view their relationship with one another and their relationship with illness.

In a brief follow-up phone call the next day by one of my colleagues, Nori reported being pleased and satisfied with the interview while Hiroko reported that she was “uplifted”!

Perhaps the more specific lesson learned from this couple is that erasing oneself to love another, even a loved one who is ill, is perhaps not love at all, but rather a prescription to make oneself ill. Simultaneously loving oneself AND loving one’s partner in a marriage enables both to grow, mature, and thrive. I am hopeful that Hiroko and Nori will experience a more mature and healthy love as they continue on their illness journey. It was a privilege to have met them.

Clinical Practice Models utilized during this therapeutic conversation included the: Calgary Family Assessment and Intervention Models;
Illness Beliefs Model and
Trinity Model