“Behind Every Healthy Man...”

The Jewish Exponent, July 24, 1997

When my father was in his 60s, he was diagnosed with diabetes and had to lost 30 pounds. A highly disciplined man, he set out methodically to lose weight. Each night after dinner, he’d sit at the kitchen table with my mother and report what he had eaten for the day. “What did you have for lunch?” she’d ask. He’d recite everything that had passed his lips since she saw him at breakfast.

“Any snacks?” she’d query. She looked each item up in her pocket calorie-counter and with an accountant’s precision, recorded it and the accompanying calories--down to the last potato chip--in her steno pad. Then they went over what he ate for dinner.

As she added up the numbers, he sat across from her patiently watching. When she got close to the total, he invariably asked, “Do I have any left-over calories? Can I have a snack tonight?”

My father was vice president of a large retail store, handled complex real estate deals and yet he couldn’t add up his calories by himself at the end of the day. What’s wrong with this picture? While the scene at my parents’ kitchen table took place almost thirty years ago, they have plenty of company today in homes across the Delaware Valley. Yes, even in the liberated ‘90s. Why do men, who successfully manage so many parts of their lives, have difficulty taking responsibility for their own health? What role does a wife play in getting her partner to take better care of himself? And how does a woman’s involvement in her man’s health affect the marital relationship?

A Common Scenario
None of the experts interviewed for this article would guess the percentage of men whose wives drag them to doctors or nag them to exercise or lose weight, yet almost everyone agreed that a significant trend exists. No one knows either whether this trend is higher among Jewish couples.

“It’s a very common scenario,” says Frederick Cogen, M.D., a board-certified allergist and immunologist in private practice in Philadelphia and South Jersey. “Women schedule the appointment and make their husband come in. She usually brings him because he’s not breathing right or because he’s snoring. Then when I try to discuss treatment with the man, he’ll often say, ‘Tell my wife.’ Or when I ask him to call for a follow-up report, she calls.”

While allergies affect men and women equally, Cogen says that 70 percent of his patients are women. “Men see it as a sign of weakness to come to a doctor,” he believes, particularly when it is not a life or death matter.

Jeffrey Miller, M.D., Clinical Director of the Division of Endocrinology and Diabetes at Thomas Jefferson University, agrees: “There’s no question there’s a significant amount of males who are literally forced by women to come in. Typically the scenario of uncontrolled diabetes is not feeling well, erectile dysfunction.” The latter, in particular, is a sensitive issue that men would prefer to ignore.

“It’s easier to deny it rather than do what’s necessary,” Miller says. “With diabetes, you have to follow a strict diet and you have to lose weight. Being a a diabetic is tough. One needs the motivation or or you need a push.”

The same holds true in cancer treatment, says Ann Marie Romansky, coordinator of cancer programs at Bryn Mawr Hospital.

“Women are a big push in getting men screened for prostrate cancer. Men have a lot of fear with any exam but especially one that is threatening to their masculinity,” she says.

However, men have come a long way since she started running prostate cancer support groups six years ago. Again, it often takes the wife’s nudging to get him to the group but Romansky says, “Once the men come and see how open people are and how willing others are to help, they get involved.”

Likewise, at the Center for Advancement in Cancer Education in Wynnewood, wives usually initiate the involvement when the husband is ill and are more committed to lifestyle changes. Executive Director Susan Silberstein, Ph.D., sees part of her mandate as teaching wives to back off. “We try to show wives how they are enabling their husbands by doing for them. Wives have to take a back seat. Once they do, I often see the husband jump in to fill the gap.”

In a poignant example of this, Silberstein counseled a man, who lost part of his tongue to cancer, and his wife. She insisted she had to talk for him. Silberstein continued to direct her questions to the patient. At first he started nodding in response, then he made indistinguishable sounds. By the end of their meeting he was talking freely.

What’s Going On?
It seems that in relation to their health, many men revert to acting like children with their mothers rather than husband and wife. But the situation is far more complicated than it appears. “Historically, traditional marriages dictated that men provided the income for the family and women took care of the health and diet,” notes Iris Rubin, LSW, of the Jewish Family and Children’s Service in Ardmore. “While there have been monumental accomplishments in terms of marriages becoming more equal and many men do take good care of themselves, in reality there are still a lot of traditional roles in today’s marriages.”

She believes that it’s easier for men to accept a wellness perspective than to face that they have a health problem. “Wellness is not a blow to one’s self esteem and has no implications for the future. But illness has all sorts of implications--dietary restrictions, losses, dependencies,” Rubin says.

“Men see a health problem as a blow to their self-esteem. To be sick means that something is wrong. For some men, it’s important to always be able, to be on top and to be a good provider. Sickness means an imperfection that’s hard to tolerate. And it’s also frightening,” she adds. “That may create some regression. It’s just easier to rely on one’s partner.”

Acculturation also plays a role. “When I was growing up, men ignored pain, cuts and bruises and forced themselves not to cry. If I got cut on my arm playing ball, I didn’t feel it. I had to keep playing,” says Gerald Evans, LSW, Director of the Men’s Resource Center in Wayne. “That acculturation still goes on. So men are not as sensitive to issues related to health.”

In addition, he says, men are taught to be autonomous and stuff their feelings. They depend on their wives to express their feelings (for them) and to nurture them. “They just don’t know the language of feelings,” he says. “It’s not their fault; it’s the culture.

“My sense is that if men are out of touch with their feelings, they can’t take their own temperature, so to speak, and don’t have an internal barometer of how they feel,” Evans says. Research supports his contention. Studies have shown that men who have positive attitudes and who feel good about themselves have strong immune systems.

Some men also have a type of martyr mentality, says Richard J. Shapiro, LSW, a psychotherapist in private practice in Wynnewood. “They think, the more they suffer somehow the more they’ll be loved. This is a perverse way of thinking,” he says. “People who are inclined to think this way--and it may be unconscious--don’t have a healthy sense of self. They tend to minimize their health concerns.”

Balancing the Relationship
When a man faces a health crisis, it can be frightening for him and frustrating for his partner. She may take control to alleviate her own helplessness, which makes it easier for him fall into a dependent role. But it doesn’t have to be that way.

“Couples need to talk to each other,” says Rubin. “They need to talk about their concerns and decide how to enhance their health and be clear who is responsible for what. If they decide one is more responsible than the other, it’s important they don’t create a dependency or a parent-child relationship.” In such unequal relationships, resentment builds.

Couples can achieve a more equal relationship, she believes, by making decisions together and by supporting each other’s healthy behavior. That means not ridiculing or embarrassing each other in public.

To women, Rubin stresses the importance of talking, rather than manipulating a mate’s behavior or launching a crusade for him to lose weight or exercise. She suggests wives “invite” their husbands to participate in all sorts of health-related decisions: choosing restaurants, planning meals, weekends and vacations.

If he refuses, “Talk from your own experience about how his behavior is affecting you--not in an accusatory way but in terms of your concerns.”

Couples may decide that the wife will be responsible for dietary planning or that she will be the one to work with a medical expert. That’s fine as long as both partners agree. “Then you will prevent resentments because you are both treated as adults. When a man gives away his power, it has to be with his consent. He is not asking her to be his mother,” Rubin believes.

Ideally, a woman has no more responsibility for a man’s health than he has for hers. But we don’t live in an ideal world. Nor do we live alone. When one person has a health problem--whether it’s smoking, obesity or cancer--it affects the whole family.

Pursuing good health, however, should never come at the sacrifice of the relationship--a lesson Susan Silberstein learned the hard way. When her first husband was dying of cancer and they had exhausted all the conventional medical avenues, Silberstein began exploring alternative methods. One day she came home with a bag full of supplements and began a vigorous campaign to get him to eat in a healthier way. He told her very firmly, “Since my diagnosis I have lost control over everything in my life. I can’t control the pain, I can’t control my physical appearance or the outcome of my illness. I lost my work. You just gave birth to two children I will not see grow up. Everything is gone. There’s nothing left for me except one thing: that’s my relationship with you. Do not destroy that too.”

That was the last day Silberstein fought her husband about what he put in his mouth. “I listened real hard and I never said another word,” she recalls. “I teach that lesson to couples I counsel.”