Buffer Zone

CURE, Summer 2010, Volume 9, Issue 2

Hiding worries from the patient may do more harm than good.

I cried in the car. I wept while Ray Charles sang “America the Beautiful” on the radio. Tears flowed because my wife had just been diagnosed with breast cancer, and I wasn’t sure how she and I would get through it all.

So I sobbed. Then I wiped the snot from my nose and manned up. I didn’t tell my wife about my breakdown, lest she think I was losing it at a time when she needed my support.

I didn’t know it, but I was practicing what psychologists call “protective buffering.”

Is that like applying a coat of car wax to protect the paint? In a way, yes. A protective bufferer aims to preserve his or her partner’s mental health with a shield of silence. James Coyne, PhD, the University of Pennsylvania professor of psychiatry who helped coin the phrase, offers this definition: “withholding emotional responses that otherwise the person might be inclined to express, based on the perception that [expressing them] would hurt the partner.”

Protective buffering occurs in many circumstances—perhaps a wife worries she’ll be laid off but doesn’t tell her spouse. It often pops up when a disease like cancer barges in.

An emerging body of research argues for full disclosure during a health crisis. In studies of couples dealing with cancer, bufferers don’t fare as well as nonbufferers, says Shelby Langer, a research assistant professor at the University of Washington School of Social Work. A study led by Langer and published last year in the journal Cancer found that among cancer patients and their caregiver spouse or partner, bufferers, both patients and caregivers, reported less satisfaction with their relationship and rated their mental health on a lower level than nonbufferers. Even in happy marriages, zipped lips can lead to bad results, notes Sharon Manne, PhD, a professor at Philadelphia’s Fox Chase Cancer Center who studies buffering.

“I would rather have an authentic conversation,” observes Hester Hill Schnipper, LICSW, chief of oncology social work at Beth Israel Deaconess Medical Center in Boston and a breast cancer survivor. “I would assume my husband is scared. If he said he weren’t, I wouldn’t believe him.” In studies of cancer patients and their spouses, following guidelines for sharing feelings can help facilitate a conversation and have a positive impact.

Yet buffering is not always a bad idea. “If we blurt out whatever we feel about our partner without some self-censoring, that wouldn’t work very well for some couples,” says Laura Porter, PhD, assistant professor of psychiatry and behavioral sciences at Duke University Medical Center in Durham, North Carolina.

Porter is quick to add that people buffer more than they should. Elissa Thorner Bantug of Columbia, Maryland, suffered in silence when she fought breast cancer six years ago at age 23. “I was terrified,” she admits. “But I felt I had to be perfect.” A single mom, student, and dedicated runner, she refused to slow down. Complications from surgery made her feel lousy. Still, when her then-boyfriend, A.J. Bantug, came over, she’d have dinner ready.

‘‘I was terrified. But I felt I had to be perfect.’’

Some bufferers report no negative aftermath. Ann Ridgeway’s husband, Chuck, knew about her breast cancer before she did—he got the news after her surgical biopsy. It was Christmas 2002, and the Eldersburg, Maryland, couple’s anniversary was coming up on January 1. Chuck didn’t want to bring the family down. In an extreme case of buffering, he kept mum for a week. When he spoke up, Ann was shocked: “I thought it was a bad joke.”

Years later, Chuck says, “I’d probably do it again.” Ann says, “I think it was a good choice. I enjoyed my holiday.” Meanwhile, she buffered, too. During treatment, she says, “I’d cry my eyes out” in the bedroom, then “come out a happy camper.” Her reasoning: “Chuck was already upset. Why make him more upset?”

By contrast, Ed Levitt of Atlanta is the ultimate anti-bufferer. Diagnosed with stage 4 lung cancer in 2004, he has defied a grim prognosis. Now an activist with the Lung Cancer Alliance, he says what he thinks to Linda, his wife of 36 years, and to everyone else. “I find it much better when I let everything out. What have I got to lose? I’m dying.”

Does Linda defer to her spouse in an argument? (That’s another kind of buffering.) “I’m answering that—no,” says Ed.

Linda laughs: “Ed likes to argue. I don’t go nearly to the extremes I would have before.”

Ed laughs, “Don’t let her kid you—she treats me pretty normally.”

Of course, one trigger for buffering is that, suddenly, nothing seems normal. Which brings me back to my dilemma. Should I have told my wife about my car cry?

One therapist told me my discretion gave Marsha space to deal with her diagnosis rather than feel she had to tend to me.

But what if I had said, “Honey, the oddest thing just happened … .” Psychologist Anne Coscarelli, PhD, director of the Simms/Mann UCLA Center for Integrative Oncology at the Jonsson Comprehensive Cancer Center, says, “Your wife might have mustered up some support. That support might have come as a hug.” Or some kind words: “I know this is hard for you, too. I appreciate that you’ve been there for me.”

So I asked Marsha: What if I had shared? Her response: “I think I would have felt, ‘Oh God, we’re all falling apart.’ ”

Could she have summoned the strength to console me? “You’re going back in time,” she says. “I don’t know.”

And that’s another lesson in the guidebook to buffering. If you’ve done it and things worked out, don’t look back. Then again, if another crisis arises, maybe you’ll be inspired to see if honesty is a better policy.

The result of her buffering was “awful, awful, awful,” she says. She’d tell A.J. she was fine, so he’d treat her as if she were. Then she’d wonder: “Why does he think we can go to a party and dance until 2? I’m sick!” When the cancer returned a few years later, she was more open about her feelings, and today is in good health.

Elissa and A.J. are now married and the parents of a 4-month-old. She is opposed to buffering—and distressed that her husband doesn’t share his own health issues with her. “It’s a guy thing,” he says. Actually, men and women both buffer to protect each other. But women tend to confide in friends, which can help, Porter says. Men often “bottle it all up.”

Buffering led to divorce for one husband. His wife made him vow to quash negative thoughts as she fought late-stage cancer. A gap grew between them. The husband urged her to let him speak, but the wife would not change. The couple even visited a therapist. The wife survived; the marriage did not. “In one way, I’d done the right thing,” the husband reflects. “How do you say ‘no’ to a woman you think is going to die?” And yet: “That wasn’t a very good agreement for me.”