When Samantha was diagnosed with breast cancer during the COVID-19 pandemic, her life reoriented entirely around her illness. With only a couple of close friends in her bubble, lockdown left mostly her and her husband navigating a double mastectomy, chemo, and recovery together. She couldn't have asked for a more supportive partner, but what caught her by surprise was the aftermath. Once she was cancer-free, she felt like her husband expected their relationship to 'go back to normal' — after all, she was 'better,' wasn't she?
She felt guilty for feeling disconnected from her relationship, but also angry that her partner couldn't fully comprehend how facing a life-threatening illness had altered her physically and mentally.
Chronic Illness and Relationship Dynamics
Chronic illness doesn't just affect the body; it can fundamentally change how people date, communicate, and connect with their partners. Amy Kurtz, a chronic illness researcher and author of the new book But You Look Fine, says the emotional aftermath often lingers long after physical recovery, leaving many people stuck in what she calls 'Medical Trauma Brain,' where the nervous system remains in survival mode.
Kurtz explains, 'When you spend that much time in survival mode, constantly monitoring for threats to your health, your world shrinks to the size of your symptoms.' She says much of your attention goes to 'scanning outside you for threats, and scanning inside you for anything that signals something is about to go haywire with your health.'
Recovery Can Take a While
Kurtz says survival mode occurs at the level of the nervous system and doesn't disappear as soon as the threat, such as illness, does. Instead, it can take a while to recover. 'If you don't have the tools to change that behaviour and emerge from that space, it's difficult to be fully present with another person, whether you're dating or in a long-term relationship,' she says.
It can be especially challenging to be present in a relationship when illness has altered your identity. As Amy Kurtz explains, many people begin to see themselves primarily as a patient, with every other part of who they are fading into the background. Kurtz says, 'I felt like I was constantly wearing a mask.' 'I put on a “good patient” mask for doctors and an “I’m fine!” mask for everyone else.' Rather than expressing how she truly felt, Kurtz focused on making the people around her more comfortable, even as she struggled internally. 'I was smiling, but inside I was struggling. It was the loneliest I have ever felt,' she says.
Identity Shifts After Illness
Once you start feeling better, Kurtz says it can feel like you no longer know who you are. 'The world expects you to get back on the horse, but the horse is long gone!' she says. What many people misunderstand about chronic and serious illness is how traumatic it is — and how often the full scope of the trauma doesn't hit until you do start to feel physically better, Kurtz explains. Naturally, this impacts intimacy within romantic relationships.
Kurtz says, 'When you're in this mental and emotional space, it's really difficult to be vulnerable and intimate with another person. You worry about how they'll react to you. Are they still attracted to you? Do they still love you the same?'
Illness Can Bring Couples Closer
One of the best things friends and partners can do to support someone who is dealing with an illness is to recognize that just because they 'look fine' doesn't mean they are, in fact, 'fine.' Second, it's to get curious. Instead of saying, 'But you look great!' (even when it's well-intentioned), Kurtz encourages people to ask questions. For example, 'How are you feeling?' or 'How can I support you?' When you focus on connecting, Kurtz says, 'You're creating a space where they can be open and honest with you.'
While illness can strain relationships, it can bring some couples closer together, provided both people maintain open communication and choose to lean into the relationship rather than allow resentment or frustration to take hold. Kurtz says, 'Plus, once we've gotten through one really difficult thing, we have a track record. We know we can do it, and we know we both feel committed enough to the relationship to bring our best selves.'
Facing challenges together can help couples develop skills they can use in the future. Ultimately, it's about staying present and finding ways to grow together, rather than perfection. Kurtz says, 'We won't always get it right, but we're willing to keep showing up and doing our best, and that says a lot.'
