Medical marriages

Physician Executive, July-August, 1999 by Barbara J. Linney

The Medical Marriage, A Couple's Survival Guide was written in 1995 by Wayne and Mary Sotile, a husband-wife psychologist team. While I was always aware that the book was written by psychologists and I felt uneasy reading some of the case studies, much of what they described rang true for my medical marriage and others I have learned about through career counseling with physician executives.

I have been married to two physicians--the first one for two years, the second for 27 years. In my first marriage, I followed exactly the statistic listed by the Sotiles: "Approximately 50 percent of American medical students marry before graduation, and nearly 60 percent of such marriages end in divorce, compared to divorce rates of 40 to 50 percent for the general American population"

The stress factor

Medical students are under great stress. "As many as 80 percent of medical students reported having been verbally attacked and 24 percent claimed that they suffered physical abuse (being slapped, kicked, hit, or having things thrown at them) during their training." This is bound to have a negative effect on their relationships with spouses, colleagues, and patients. According to the Sotiles, "Sanctions on the extent to which residents can be worked are being implemented worldwide," but I still hear reports of abuse during training.

Medical students learn to delay gratification for years, thinking life will be wonderful when they finish training. Many cannot turn that behavior off as they enter busy medical practices, and some do not want to turn it off as they would rather work at the office than deal with home stresses. "Once in the 'real world,' medical couples encounter various flavors of stress....On average, male physicians work between 68 and 80 hours per week. Married female physicians, in addition to taking full responsibility for home and family, work 90 percent as much as their male colleagues."

Physicians are usually high-powered, fast-moving people who have a hard time slowing down and listening to others--what has been described in many circles as Type A behavior. "A large body of research supports our clinical impressions that healthy Type A's are among the most happy, most contented, dynamic, and successful people," but stressed Type A's tend to accumulate frustrating experiences. People disturb them; they annoy people. "In the words of one of our patients: 'Type A stands for Aggravated. What with? Type B, B, B, B! As in: 'Move your Big slow Behind out of my way so I can get about my Business and lower my Blood pressure!'"

"The most fundamental way of examining the stress in your life is to ask a simple question: When it comes to meeting my needs, is the territory of my life mostly toxic or nurturing? By toxic, we mean anything that makes you feel anxious, frightened, miserable, or generally uncomfortable. By nurturing, we mean anything that makes you feel reasonably secure, appreciated, and acknowledged." We most often look to our marriages to provide that nurturing. "We eventually develop a quiet refrain that organizes much of our psychological and behavioral energy: Will I be loved in a way that satisfies my needs and soothes my fears?'"

Renegotiating the marriage contract

Just like everyone else, medical couples "...find that life ends up being far more stressful and complex than anyone anticipated." In an intimate relationship, "growth...depends on your ability to renegotiate cooperatively, lovingly, and periodically your relationship contract. None of us--no matter how dynamic we are--will be an exception to this rule."

My husband and I seem to have renegotiated our marriage contract about every five years--when our children were three and five, when we moved so he could become a medical director, when I went to work full time, when our children left for college, when my father died, and when I suffered some illnesses. Now that our children have finished college and are on their own, we talk about how to really let them go, which means you stop paying for things. You decide again and again how you will be married.

The Sotiles say particularly stressful times are when a child is born or a parent dies. "The stress and disappointment that...'occurs when children are born'...can end the relationship or cause wounds that last a lifetime. On the other hand, this is the stage of marriage that welds most couples together. They reach higher levels of intimacy and deeper levels of trust as they clear hurdles that are unique to the experiences of co-parenting."

"Few things change the meaning of life more abruptly than the death of a parent. At such times, we are reminded that there is no dress rehearsal; this is the only life we get. We are also faced with the anxiety, awkwardness, and freedom that come from claiming our positions as the front-runners in our families." It's a time when people can do foolish things, such a ditch a spouse and look for a younger one so that the blush of new sexual desire can chase away the awareness and fear of death. It also can be a time when one takes stock and decides to pursue only personally meaningful activities no matter who would object to a change in income. There is an urgent sense that time is running out.