Local authors create resource for spousal caregivers

"For better or worse, in sickness and in health..." Many, if not most, marriage vows include that passage. However, what happens when "worse" becomes "absolute worst" and "sickness" becomes "years of illness requiring constant care?"

A Spring Hill couple has drawn on both their respective professional training and years of personal experiences to create a resource for spousal caregivers. "The Tough & Tender Caregiver: A Handbook for the Well Spouse" is a book the authors say turns conventional caregiving upside down.

David A. Travland, Ph.D., is a clinical psychologist, and his wife Rhonda is a licensed nursing home administrator with a degree in gerontology. They are both also former "well spouses." The term is used for anyone who is the caregiver for a spouse who is disabled by injury or by physical or mental illness.

The Travlands say being a spousal caregiver is very different from being a caregiver to a different relation or a friend. There are intimacy and financial issues that are specific to the marital relationship. Their book deals with these issues in a frank and direct way, which they say is unprecedented in the field.

"People don't ask questions about other's marriages when both partners are healthy," Dr. Travland says. "They certainly don't want to pry when one partner is disabled."

Very often, these spousal caregivers are given platitudes such as, "Well, at least your spouse is alive," or "You're not given more than you can handle." The Travlands say these phrases of support are not only empty, but can lead to dangerously unhealthy situations.

"Well spouses are made to feel guilty for wanting more out of their lives than caregiving," Rhonda says. "Their entire identity is bound up in being the caregiver, when this is not what they signed up for in a marriage."

Travland expands on that idea by saying that society expects unconditional devotion from the well spouse, with no regard for the caregiver's needs. Additionally, well spouses are reluctant to self-identify when they feel overwhelmed with the changing marriage dynamic. According to the Travlands, this is the result of the idea that love is "forever" and means, "never having to say you're sorry."

"We do a lot of debunking of social myths in this book," Rhonda says. "Those vows of 'richer or poorer' and 'sickness or health'.... How poor? How sick? People don't like to ask those questions."

"The marriage dynamic gets out of balance when one spouse gives and gives and one spouse gets and gets," Dr. Travland adds. "The internal ledger sheet gets badly askew. The caregiver feels cheated, then owed, then resentful, then angry."

The Travlands say their book is meant to be the ounce of prevention to avoid spousal caregiver burnout, or as they call it, "Caregiver Hell." According to Dr. Travland, there are 500 incidents of caregiver violence every year. These cautionary tales spurred them to write their book in only three months.

This is not your usual, feel-good, self-help book that encourages you to plant a garden or start a journal to offset feelings of being overwhelmed with caregiving duties, they said . There is an entire chapter that addresses sex and intimacy, and not all of the solutions discussed are traditional.

"We're not advocating affairs, cheating on your spouse or divorce," Rhonda says. "But caregivers need to discuss the options available to them with their spouses. Human sexuality is a need, and it must be addressed."

Another controversial idea the book discusses is about who, exactly, gets to make the decisions about such issues like going outside the marriage for intimate interaction. According to Travland, the caregiver dynamic changes a marriage from the usual "50/50" arrangement.

"The well spouse takes on more than 50 percent of the marriage responsibility," Travland says. "Therefore, they get more than 50 percent of the say in what decisions will be made so that both spouses' needs are met."

According to the book, in certain circumstances, this means, "... the old marital contract is null and void, the new contract has no provision for sexual activity and the vows of the original marriage are not in effect. This provides a unique opportunity, free of marital promises, to pursue a brand new course of action."

The Travlands admit this kind of approach to spousal caregiving flies in the face of conventional social and religious ideas, but they insist that the caregiver's needs are more important than any societal objections.

The book is available on Amazon.com for $18.99, but if readers go to the Travlands' Web site at www.caregiverburnout.org, it is available for $15.99 and it comes with a free caregiver coaching session.

"We hope this book reaches the people who need it," Dr. Travland says. "If this were a parenting book, it would be about tough love. This is solution-oriented, tough-minded living. It requires objective decision making."

Rhonda smiles at her husband's analytical summary.

"It's about finding correct balance," she adds. "This book is to help the caregiver prioritize and say, 'Can we find a way for everyone's needs to be met?'

"Well spouses have to give themselves permission to say no to things that are not good for them as individuals," she says. "It's like the airlines tell you: You have to put your own oxygen mask on first."