This past fall, the
European Heart Journal published an article on the increased risk of
depression, anxiety, and suicide for spouses of partners who had suffered heart
attack within the past year, when compared to spouses of partners with other hospitalizations
et al., 2012)
To family-oriented clinicians, this comes as little surprise.
The burden of medical crisis is carried not only by patients but also by
their families and communities, especially when need for caregiving requires
shifts in household and occupational roles.
Beyond the biological and logistical components, patients and families
must also cope with accompanying emotional, psychological, social, and
spiritual ramifications of crisis which can manifest as feelings of confusion,
hopelessness, fear, and isolation. And,
as Fosbøl and colleagues suggest, there may be something particularly
distressing about a loved one’s heart failing him or her.
While we have been
trained to look at the systemic impact of health and illness, the medical
contexts in which we work are just beginning to adopt this lens. The rise in the popularity of
patient-centered medical homes where patients can receive their medical and
behavioral health treatment from collaborating providers under one roof is a
move towards health care that considers the biopsychosocial needs of the
adoption of a systemic lens in health care is taking place within an
individualist paradigm. Electronic
health records are not set up for charting relational cases and insurance
companies require providers to bill under a single identified patient.
|Does this sound like
a revolution to you?
A paradigm shift?
I hope so.
But let us not
scapegoat the medical context. The individualist
paradigm pervades the majority of US institutions and is a paradigm that we and
the public generally endorse and enact in our day-to-day lives. As consumers, I believe we are not only
subject to institutional constructs, we also have a hand in how institutions
are constructed and adapted. We all have
some degree of agency—albeit, less or more depending on our socioeconomic power
and privilege—in changing health care through the policies we support, the
health care resources for which we advocate, and the ways in which we access
The fact that national
media reported Fosbøl and colleagues’ findings is perhaps an indication that
this is news to the public. Consumers may not consider the ways in which
medical crises in family members can impact their physical and emotional
wellbeing. Without structures in place
to offer relational treatment, consumers may not think to request family
support. Further, even if they do
recognize a need for behavioral health support, it is unlikely that family
members of ill loved ones will have the energy or time to advocate for
themselves in the midst of crisis.
So, what can we do as
practitioners to help patients and families access medical and behavioral
health support? We can start by
continuing to carry our own systemic lens into all of our encounters with
patients, families, providers, and medical staff. We can educate patients and families about
the relational impact of illness in a loved one and connect them with
resources, as needed. We can also be a
part of advocating for changes in medical and behavioral health care delivery
at the administrative level in the medical contexts where we work and on the
level of the state and federal policies that will best support these changes.
We still have a great deal of work
to do in substantiating our relational approach to health care. While the merits of this approach may seem
obvious to us and others within our field, we need to show everyone—from policy
makers and insurance company executives to the general public— how needed this
kind of approach is and the positive health care outcomes to which it can and
Does this sound like
a revolution to you? A paradigm shift? I hope so.
Imagine a world in which our medical contexts are set up to treat the
family as a whole. Where family members
are educated about the relational impact of illness in a loved one on their own
wellbeing and not only have resources available to them, but feel comfortable
reaching out and accessing those resources.
Better yet, imagine a world in which those resources are offered automatically
to families experiencing medical crisis, so they can then use their agency to
opt in or out of receiving them. Let us
as practitioners help to envision and evolve a system that reaches out to the
whole network of hearts that makes up our world.
Fosbøl, E. L., Peterson, E. D.,
Weeke, P., Wang, T. Y., Mathews, R., Kober, L., Thomas, L., Gislason, G.H., and
Torp-Pedersen, C. (2012). Spousal depression, anxiety, and suicide after
myocardial infarction. European Heart Journal, 34, 649-656.
|Aubry Koehler, MA, LMFTA, is a first-year
Medical Family Therapy doctoral student at East Carolina University in
Greenville, NC. She has interned as a
behavioral health specialist in integrated care settings over the past two years
and is especially interested in the impact of chronic illness on the family
system, culturally sensitive care, and closing health disparities. Aubry earned her Master’s of Arts in Marriage
and Family Therapy from Antioch University New England in 2012.|