Here is an advice column written by Boston Globe columnist Meredith Goldstein. Do you agree with her advice to the letter writer? What's your perspective?

Too much weight

Q: I love your column and would love to get some opinions on this. I don't know how to say this without sounding shallow, so here goes. I am no longer attracted to my husband because he has gained quite a bit of weight in the 6 years that we've been married (I would guess 40 lbs) and he was already short and on the big side when we started (which was fine with me, that's how I loved him), but this gain takes him from overweight to, well, obese. I am not slender either and have gained weight myself in the past few years (mostly due to having kids) but I do watch what I eat, go to the gym, jog, and am losing the pounds, albeit slowly - so I'm not expecting perfection. He, on the other hand, is just getting worse and worse and it disgusts me - won't go to the gym, use our treadmill or weights or boxing equipment and snacks on chips, soda, and greasy foods even thought I shop for and cook healthy meals.

The weight exacerbates other health issues such as his depression, high blood pressure, high cholesterol, etc. so it's more than just how he looks. We talk about the health issues but he doesn't actually DO ANYTHING to get started on the road to weight loss and better health. Anyway, this is affecting our sex life because he repulses me to the point where I flinch when he comes near me. Lately it hasn't been an issue because his antidepressants kill his libido but even hugging, kissing, cuddling etc. make me recoil. I don't see him changing any time soon and we aren't splitting up, so how can I change my reaction to him so that we can maintain at least some minimal contact and not grow even further apart? Would it be cruel to just lay it on the line and let him know that his weight is coming between us? Would that perhaps motivate him to get moving or just make him hate me for being mean and critical? I've tried the soft-sell (let's go biking, let's go for a walk, hey wasn't this dinner great it was only 300 calories!), we've been to couples counseling and individual counseling, he has had life coaches and career coaches, and I've tried ignoring the problem and no approach has gotten any results so I'm trying to shift the focus on how I can change my own reaction to him and find a way around the un-attraction.

Thank you,
Turned-off wife, Danvers

A: Turned-off wife – I don’t think it’s your responsibility to change your reaction to him. He’s putting his physical health at risk. His emotional health is already suffering. You have every right to demand a change. You ask if it’s cruel to put it on the line and tell him his obesity is killing your relationship. My answer is: no, it’s not cruel, it’s necessary.

I think you should go back to counseling, both as a couple -- and alone. Coping with a marriage that puts you in the position of having to love someone who is depressed must be overwhelming.

When you go to therapy as a couple, be frank. Be clear. Say everything you said in this letter – even the part about recoiling. And then tell him what you’ve also said in this letter – which is that despite all of these horrible feelings, at no point have you thought about leaving. He’s a lucky guy for that. And it means you love him.

I get the whole clinical depression thing, but he should want to keep you around and to keep himself alive.

-- Meredith

Grand Rounds is Up

at Six Until Me - a blog by a woman with diabetes who says, "Diabetes doesn't define me, but it does explain me."

What if Your Partner is a Jerk? (part 3 of 3)

In a previous post I described levels of "jerkiness" in the well partner -- from unaware to indifferent to downright mean. Of course, the ill partner can act like a jerk too, but that's a topic for another post.

The first suggestion I offered (in part 1) for dealing with a well partner who is acting like a jerk is to try empathic communication. The second suggestion (in part 2) was to turn away from your partner's darkness towards the sources of light and support in your life. In this post I will offer the third suggestion -- couples therapy.

When your interactions with your partner are filled with more acrimony than sweetness, when even seemingly benign requests - like please take out the garbage or can you drive the kids to school this morning -- feel like they carry implied criticisms, when you say more to your pillow than to your partner -- it is time to consider couples therapy.

When silence stretches for days and is used as punishment, when you lose interest in doing the activities that used to be mutually enjoyable, when you exhaust your precious energy on pleading, cajoling, and berating, when there's been an affair -- it is time for couples therapy.

Why am I suggesting couples rather than individual therapy? Because if there is hope that the relationship can be renovated, it lies in working together, not apart. The problems manifest in the couple relationship, and it will take the will and insight of both partners to resolve them. Individual treatment may be a useful accompaniment to couples work at some point, but not at the start.

What happens in couples therapy? Both partners get to tell their stories, uninterrupted. But perhaps, more importantly, both partners learn to listen to each other. And with guidance, they learn how to communicate the often painful truths in ways that the other partner can hear. So instead of firing random shots about peripheral matters because of deeply held anger -- anger that's really about the illness, about unfairness, about the past -- partners learn how to address feelings and issues directly. They learn how to love and how to fight.

One of the greatest gifts Richard and I received from couples therapy we did decades ago was to learn how to "speak the unspeakable," to always talk with honesty and as much empathy as we can muster about our disappointments and heartaches with each other. We learned that it was the unspoken that caused damage, not the spoken.

How do you find a couple's therapist? Ask people you know for recommendations. Ask friends, doctors, nurses, physical therapists, clergy. Don't rely on advertisements or lists of approved providers. Dig deeper. The most important factor is that the therapist has indeed worked with lots of couples. Interview the therapist over the phone. Ask questions like -

• how long have you been in practice?
• how many couples have you worked with?
• have you ever worked with couples and illness?
• how would you describe your approach or style with couples?
• how much do you charge?
• what insurance do you take?
• do you have any questions for me?
  

As you talk to the therapist, pay attention to your own inner intuition and feelings. If you get a sense that the person is "right" for you and your partner, set up an appointment for an initial meeting.

Couple's therapy may or may not help your situation. There's no guarantee. But if you both still want to try to make your relationship better, it's worth a shot.

Grand Rounds is Up at Diabetes Mine

The theme for the GR at Diabetes Mine is celebration. It's an uplifting read.

Among the Redwoods

When I was really sick, and I mean really, I spent my days mostly pacing, trying to stay a half step ahead of pain. My entire attention was turned towards noticing degrees of pain in my body. My ability to focus on the world outside of pain became not only limited, but eventually came to feel unnecessary. It was just pain and me. Even Richard was peripheral.

I made lists in my mind about the things I would never get to do again. Things I would mourn, but would sacrifice if it could placate pain and reduce its grip. (The mind takes some strange turns when you're in pain).

I gave up Paris. I knew I would never make it to the Latin Quarter and sit at an outside table at les Deux Magots sipping un grand creme. I gave up scuba diving. I had already felt the incredibly soft underbelly of a sting ray off the Cayman Islands, and could live on that memory. The hardest thing to give up was hiking. Hiking is breathing. It is heart. It is my connection to my body on the earth. But I offered it up to pain, if only pain would go away.

Now, years and medications later, I am hiking again. A few days after a recent relapse and pill recalibration, Richard and I were hiking through giant redwood forests in Armstrong State Park near the Russian River in California.

Wings sprouted and I glided on the wind currrents up and down trails. I inhaled panoramas of rolling hills, ocean, river, clouds, sky. I felt invincible and humble.

When we landed back at the trailhead, feeling the glorious pain of exhaustion and depleted endorphins, we celebrated.

This was a special occasion.

The Pill Game

Damn. Damn. Damn.

I had tapered down to a twice daily dose of smaller amounts of meds and was doing just fine. The kind of fine where I could start to take things for granted again. Things like looking at my watch to see if it's time to take afternoon meds. Like going out into the world without bringing a water bottle so that I would have something to help wash down my meds. Like eating spicy food and tomato sauce, and other trigger foods. Like paying attention to the explosion of wildflowers instead of signals of impending pain bursts.

Then the ripples began. Little spikey fish swimming around my insides. Then glass shards. Then water balloons filled to bursting. Nothing can be taken for granted in this state.

I tell Richard what's going on. Not that I need to. He can see the signs for himself. They're not subtle. I disappear, leaving a trail of pain crumbs for him to follow.

So I follow the instructions I have been given dozens of times. Don't play around with meds. Don't try to take one more blue pill for a few days and then stop to see if it worked. Then add the yellow pill and sprinkle a couple of brown ones here and there, for extra conrol, and color contrast. Then stop, start, stop, start. Don't do any of that.

Go back up to the pill regimen under which I last had the best pain control. And stay there. For at least a month, maybe longer.

So this time I remember the advice. I follow instructions. The pain recedes. I am filled with gratitude and resentment.

That's the way it goes.

This Week's Grand Rounds

is up at Getting Closer to Myself. It's a good read.

What if Your Partner is a Jerk? Part 2 (of 3)

In a previous post I described levels of "jerkiness" in the well partner -- from unaware to indifferent to downright mean. Of course, the ill partner can act like a jerk too, but that's a topic for another post.

The first suggestion I offered for dealing with a well partner who is acting like a jerk is to try empathic communication - to put yourself in your partner's shoes and truly empathize with the disruption illness has brought into his/her life too. Of course, this is just a starting point, and may not work for couple relationships that are more deeply stuck in indifference or meanness. For these situations, there are two more options:

#2) Turn away from his/her darkness and towards sources of light.

If you walk down the same street every day on your way to work, and each time you run smack into a brick wall that leaves you with some nasty bumps, what do you do? Do you continue to take the same path and try walking faster or slower? Or maybe throw in a few dance steps? No matter how you walk, if you're on this path, you will inevitably get bonked by that brick wall.

Einstein described insanity as doing the same thing over and over again and expecting different results.

I don't think we are insane if we repeat relationship patterns, but we are stuck.

When it comes to dealing with a difficult well partner, if no matter what your try - explaining your condition in detail, cooking a nice dinner, humor, asking for what you need, offering to give him/her a back rub, asking him/her what he needs from you, etc. -- nothing changes, then maybe it's time to look for alternative roads to walk.

Perhaps our own sense of self worth is so tied to how our partner treats us that we feel compelled to keep trying to get him/her to love us so we can feel lovable. Perhaps we have invested so much in our relationship and want it so desperately to be good that we can't abide the idea of letting go, even just a little bit. I am not equating letting go with separation or divorce -- that's another discussion. But if the relationship is causing you, the ill partner, a continuous string of daily disappointments and if at the end of the day you're feeling more defeated than strengthened by your encounters with your partner - it's time to turn away from his/her darkness and seek some light elsewhere.

In other words, it's time to stop expecting your partner to be different and begin to act differently yourself.

Begin by understanding that your partner is not the only source of oxygen available to you. Kindness, compassion, help, and empathy are waiting for you if you begin to look in other directions. Think about the range of people in your life and who among them can be a true friend to you. Do you have a mother, father, sibling, aunt, uncle, or cousin who can sit with you and listen? Do you have a few friends who can help with chores or take you out to dinner or a movie? Do you have a child you can play with and laugh with -- even for a half hour? Do you have a dog or a cat who will curl up with you when you need to lay down? Do you have a craft or a hobby you can immerse yourself into -- even for a half hour? Do you have a spiritual community or a spiritual place you can go to to feel part of something bigger than the moment you feel stuck in?

Letting go of the urgent desire for nurturance and understanding from your partner can be excruciating. It can feel like a defeat. Staying in a fruitless struggle may feel like the last tie left holding you two together. But ask yourself, "Is this struggle doing either of us any good? Is it pushing the well partner farther away while it depletes you, the ill partner, of the energy you should be devoting to dealing with your illness and your wellness?"

You need and are entitled to get support. Look for it and when you find it enjoy it. You may find that the loneliness you feel within your primary relationship begins to shift as you experience companionship with a larger community. You may find you start to feel less trapped and more loved. And who knows what may evolve if you become less stressed and less dependent on your partner for empathy.


In Part 3 of this series, I will write about the third option -- Getting help from couples therapy.