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Dating Maze #219 - What's the Prognosis

May 9, 2009 | by Rosie Einhorn, L.C.S.W. and Sherry Zimmerman, J.D., M.Sc.

After being diagnosed with MS, she may lose the man of her dreams.

Dear Rosie & Sherry,

I am a 28-year-old woman in an advanced stage of courtship with a man I admire and respect very much. We have been steadily and consciously moving toward marriage since we first started dating, and at this point we're very involved in each other's lives and families. In general, I could not ask for more.

The problem is, just about the time we were ready to get engaged, I was diagnosed with multiple sclerosis. (Thank God, I'm not impaired in any way and am otherwise totally healthy.) Since then, this man has told me that my having MS gives him pause in wanting to move forward. While he says he ultimately wants to be married and start a family, he also says it will now take him much longer to be ready for those things.

He's also incredibly pessimistic about what the disease will do to me, when the facts indicate that my course will be mild and, at any rate, unpredictable, as MS always is.

Do you have any advice for facing both the difficulties of a potentially debilitating disease and the leap of faith into marriage?


Dear Susan,

We can only begin to imagine how challenging it was for you to receive your diagnosis of multiple sclerosis. Suddenly, you've had to alter your lifestyle and expectations for the future and to gather a tremendous amount of information about your illness, its progression, your prognosis, treatment options and lifestyle modification. This is a monumental task, but it is something that you must do in order to be able to manage your condition in the best way possible. We wish you the best of health and the ability to live a rewarding, active life.

Of course, anything can happen to surprise anyone in life. A medical diagnosis, accident, or tragedy will unsettle anyone, but a couple who has built a history and life together usually rises to the challenge as a unit. When a spouse develops a chronic medical condition that requires lifetime management, and will have an unpredictable effect on future level of functioning, the husband and wife view it as a family issue as well as an individual one. They come to terms with the diagnosis and how it will affect the person they love, their relationship, and themselves.

It's a completely different story when two people are in the midst of a courtship. Even if they have begun to discuss the possibility of marriage, neither of them has made a commitment to the other. Furthermore, they haven't developed a significant history together that can provide the stable foundation to enable their relationship to withstand an unforeseen challenge, such as a significant, life-changing medical diagnosis.

It is only natural for someone in this man's situation to take a few steps back. He has to be able to evaluate many aspects of your new reality and decide, not whether he is ready and willing to move forward, but whether he is willing to change direction and forge a new and uncharted path forward.

When you started dating, there was one set of expectations for the future. With your diagnosis, you have no choice but to adapt to the new expectations. However, he has a choice, and he has to figure out if he can adapt, and if he wants to do so. He may need extra time to see how well each of you is able to deal with your new reality and some of the early challenges that may come your way. This may go against our romantic notions of "love conquers all," or "if he truly loved me he'd accept me as I am," but they are important practical and emotional issues that one must address before deciding to marry.

He's probably asking himself many of the following difficult questions: How much will this change her life in the immediate future and further down the line? What limitations may it place on her life? What will life be like for her on a day-to-day basis? What is the worst-case scenario, the best prognosis, and the most likely course of this illness? How will all of this affect our leisure activities and our career paths? How does this affect our ability to have and raise children? What will the long-term cost of this illness be? Will insurance cover it? Does this change the roles we will play in our marriage? What added responsibilities will I have? Can I handle these emotionally and physically?

Of course, anyone asking these questions should obtain as much information as possible about the other person's illness, treatment, and prognosis and weigh this information along with all of the other factors he would take into consideration when deciding whether or not to get married. This isn't just common sense -- it is also a matter of Jewish law. Our rabbis hold that someone must disclose a significant medical condition to the person they have been dating seriously (there are different rulings about the timing of the disclosure), because this is one of the many issues that person will factor into the decision to marry.

Understandably, you're concerned about having to wait while this man formulates his questions, gathers info, and determines his ability and desire to adapt to the new reality. There are two ways that you can help this process along. One is to continue with the activities you've always enjoyed together, and find some new ones as well. The "enjoyable dating" element of your courtship is very important. Your "dates" are not the time to discuss your condition or how each of you is dealing with it. This is the time for you to enjoy each other's company for its own sake. Schedule other times for any "heavy" discussions you may want to have.

At the same time, it may be a good idea for this man to address his fear of the unknown with an exercise that has helped many other people deal with similar worries. We suggest that he begin by writing down his stream-of-consciousness fears and concerns about your condition and prognosis and how it will affect your relationship. He can later read over what he has written and clarify his specific fears and concerns, both small and large.

Then he can discuss (either with you or a trusted friend/mentor) the different ways to address each concern. Often, this exercise helps people see that there are realistic ways to deal with the uncertainties that may arise in the future.

Fortunately, you are filled with optimism about how your medical condition will affect your life. An individual's optimistic outlook can significantly affect, for the better, her physical symptoms, her ability to adapt to her situation, and her quality of life. Your positive approach and adaptability has a lot to do with your emotional make-up and how your life experiences have prepared you to deal with adverse situations.

Unfortunately, not everyone is able to address your challenges in the same positive way. Sometimes, in spite of how close a courtship has come to marriage, and how much affection a couple has developed for each other, a dating partner will not be able to take on the new challenges. And sometimes he can.

We wish you good health and all the best,

Rosie & Sherry

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