Red flag, green flag: A few words about marriage

In my last piece on tips for surviving family medicine residency, I touched on the red flags and green lights for choosing a partner. I also want to talk a bit about marital maintenance and how to stay married. Marriage, which I define as a long term committed relationship, is something that I have had a keen interest in all my working life. As a family doc and teacher with a maternal-child focused practice, I have witnessed the formation and dissolution of many marriages. I have my ideas about how this works. I am not an expert and as one of my patients said to me, “What do you know about marriage? You’ve only been married once. I’ve been married four times!”Choosing a partner is one of the most important decisions in one’s life, which can have a rippling impact on anything you do.When we think about good marriages, we know that, statistically, men who are married live longer, healthier lives. Women and children are less likely to be poor when they are living together with their husband and father. A good marriage is the equivalent of a healthy diet or regular exercise in the prevention of cardiovascular disease or improving survival from MI and stroke. It also leads to improved survival from cancer. A good marriage is good, so how do you get one? First, you must avoid marrying a jerk. Easier said than done! There are however some clues. If you detect negative attitudes, with poor emotional impulse control and a tendency to shame and blame during arguments, it does not bode well for the future. Many years ago, I had a resident who was planning her wedding. One day, when we were having our faculty advisor meeting, she told me that she was feeling anxious about her upcoming nuptials, an elaborate affair with 600 people, three months away. She mentioned that the last time they had a fight, it reminded her of one of her patients describing her abusive boyfriend. “He called me a stupid cow and told me that I should stick to medicine and that he would decide what to do with the family finances.” We discussed her options. After much soul searching, and surprising advice from her very conservative spiritual advisor, she called off the wedding. A year later, she met her husband. “The difference was so evident,” she said. “Even when we are fighting, I know that he may be angry, but he always respects me.”Difficulty expressing emotions openly and constructively can be a formula for these emotions to explode in inappropriate and sometimes damaging ways. On the other hand, being incontinent of emotion is also a recipe for disaster. A partner that blasts anger with every frustration and insists that only their plan can be the right one, is practicing a form of emotional abuse. Don’t marry that person! And certainly, be careful not to be that person!Functional couples are invested in each other’s happiness and support each other’s lives. Someone who does not care to celebrate your successes or is not there for you in times of stress is not the person to choose as a life-partner. One of the things that I have learned from taking care of couples who have arranged marriages is the very intentional way people go about dating. These dates are similar to a job interview. The cards are laid on the table. They discuss the major issues that people need to work out before they commit to a life together. These are what I call the Five Fs: family, finances, fighting, faith and sexual relations. Take the time to have some candid discussions about how you are going to deal with the inevitable disagreements which these issues will engender. Be sure when you fight, to fight fairly. A little screaming and yelling may be inevitable, but ultimately you must get down to the issues and be willing to change. Once you are married, the trick is to stay happily married. John and Julie Gottman, a researcher and clinical psychologist respectively, did a landmark study on what makes a good marriage. They put couples in a completely wired-up cottage and videotaped their interactions. They then followed the couples over time. After analysis of these interactions, Gottman was able to predict, he claims with 70%-to-80% accuracy, which couples would break up and which would flourish. They reported that in their daily interactions couples make what they call “bids for attention.” These do not need to be about big issues. A bid can be something simple, like “do you see that cool bird?” It can be something obviously important, like “I’m afraid that Michael is not happy in his new school.” And it can also be non-verbal, such as a sigh when reading an email. What is important is how the other partner responds to this bid. In a functional marriage the partner “turns towards.” They respond with attention and positivity to the bid. For example, “where, what bird?” or, “If Michael’s unhappy, what do you think we can do to help him?” or, “What’s wrong, sweetheart?” In each of these examples the partner responds, acknowledges the feelings, and pays attention. In dysfunctional marriages the response to bids is often dismissive or at worst contemptuous. “See the cool bird” leads to the partner continuing to read their book. To the partner’s concern about Michael’s unhappiness, the answer of “Well why did you want to send him to that stupid school anyway?” And with the sigh, a response of “What are you complaining about now?” These are not responses that will foster the trust and commitment needed for marital harmony. Gottman calls these dysfunctional responses “The Four Horsemen of Relationships.” Criticism: This is an ad hominem attack on the partner’s character. “When you take your clothes off, please put them in the hamper” is a valid request. “You’re such a dirty slob, what’s wrong with you?” is a criticism of the partner’s personality.Contempt: Treating others with disrespect, using sarcasm, ridicule, name calling, doing ugly imitations of them with eye-rolling or scoffing. The effect of contempt is to make the partner feel despised and worthless. This is the worst of the “Horsemen.” It is the behaviour most highly associated with unhappiness, divorce and even long-term health problems. Treat each other with respect!!!!Defensiveness: Often a response to criticism. It is normal to defend yourself when you feel attacked, but when you try to turn it around, cast the blame back on your partner rather than accepting and apologizing for an error, it just escalates disintegration of the relationship.Stonewalling : Can be the final stage of marital disintegration. Often a response to contempt, it counters the physiological overload by protectively withdrawing. The opposite of love is not hate. It is indifference. When people are overwhelmed emotionally they may completely tune out, ignore their partner and use distractions to block out overwhelming emotions, until there is effectively no real communication left. There is a time when it is healthy to say, “I’m too angry to discuss this right now, give me a minute to cool down.” Then take a walk, play a little Candy Crush, and get your emotions under control, so you can address difficult issues with less anger and reactivity.In my life I have found this framework very useful to me for marital maintenance. I try hard to notice when Dave is making a “bid” for my attention. To notice when he is being the kind, useful, attentive person that he is. The five to one ratio of positive interactions to negative ones which is needed for marital happiness is a lot easier if paying attention and saying thank you for daily kindnesses becomes a habit. Another piece of marital advice that has shaped my life is Dan Savage’s column written many years ago, called “The price of admission.” In this column he discusses the fact that since there are very few perfect people in the world, there is no settling down without some settling for. There is no long-term relationship where you are not putting up with your partner’s flaws. You accept them and live with them. Very often these flaws are in fact an extension of what drew you to the person in the first place. My husband calls it “riding the extrovert wave,” when I pull him out of his comfort zone and force him to socialize. Accepting and even treasuring what drives you crazy is a good way to stay happy. For someone who claims not to be an expert, I sure have talked a lot! Thank you, Gentle Readers, for indulging this rant. Thank you, Dave, my adored, annoying, not quite perfect man for putting up with me for these fifty years. Let’s keep going!

Red flag, green flag: A few words about marriage

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Perle Feldman

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