In Sickness and in Health
- Robert Reynolds
Professor Daena Goldsmith BS ’86 studies communication in couples dealing with a chronic health condition such as heart disease, cancer, or HIV.
Her husband’s heart attack was a shock to Cindy.* She was grateful he survived it but terrified it would happen again. When the doctor sent Jim home from the hospital with instructions to change his diet, Cindy cleaned the pantry and fridge, removing anything that might count as junk food. Jim’s favorite ice cream, bacon, and eggs were no more. When he confronted Cindy, she said, “You can’t eat those things. I can’t believe you’d be so irresponsible after what we’ve been through.” Jim, feeling resentful, indulged in milkshakes and onion rings when he went golfing with friends. After all, he was still the same person, wasn’t he? Cindy was mystified when, at Jim’s three-month checkup, his weight and cholesterol levels were unchanged.
Couples like Cindy and Jim represent one approach to talking about illness. According to Daena Goldsmith BS ’86, professor of communication at Lewis & Clark, anxiety and stress often create such (mis)communication. Research shows that strategies such as criticism and attempts to control behavior actually decrease patients’ compliance with health advice.
Goldsmith studies couples who are coping with one member’s chronic health condition, such as heart disease, cancer, or HIV. Her work is based on findings that the quality of a couple’s communication can predict other aspects of the relationship, including the partners’ overall satisfaction. Health research also shows partners play important roles in illness and recovery. Health-care providers frequently enlist partners to support patients who need to make lifestyle changes.
Because chronic illness is so prevalent in the United States— more than 11 million people are living with cancer, and 1.1 million have heart attacks each year—Goldsmith’s research has far-reaching implications. Her former colleague John Caughlin, associate professor in the communication department at the University of Illinois, says, “Daena’s research gives insight into how people can successfully manage some of the most difficult but important challenges of their lives. Questions like ‘How do you get your spouse to enact more healthful behaviors without coming across like a nag?’ seem simple, but the consequences of handling these challenges poorly can be dire, ranging from undermining one’s marriage to damaging one’s health and well-being.”
From Student to Professor
A native Oregonian, Goldsmith grew up in Redmond on the east side of Oregon’s Cascade Mountains. She wanted to attend an in-state college, and Lewis & Clark recruited her for the debate team. “It was just far enough from home,” she says. The school’s urban setting was also attractive. “I planned to study broadcast journalism, and Portland offered the most opportunities,” says Goldsmith, whose friendly demeanor and warm smile might still make her a natural on television. “Ultimately, I majored in communication, minored in political science, and considered going to law school.”
Her direction changed when Goldsmith did a research project with communication professor Leslie Baxter, looking at communication in dating couples. “We asked, ‘What do couples not talk about?’ There were definitely taboo subjects, including one’s past relationships and the state of the current relationship.”
Goldsmith was hooked on communication research. “I loved talking to people about relationships, gathering data, and solving puzzles.” Baxter, now the F. Wendell Miller Distinguished Professor of Communication Studies at the University of Iowa, recalls her former student: “Daena Goldsmith was the best undergraduate student I have had the pleasure of working with,” she says. Inspired by her first foray into research at Lewis & Clark, Goldsmith attended the University of Washington, where she received an M.A. in communication in 1988 and a PhD in 1990.
In graduate school, Goldsmith began developing her own research direction. “I worked with one of my professors on a paper about social support for test anxiety,” she recalls. Studying which types of communication were helpful—and which were not— prompted her to study advice giving. Among other questions, she investigated how hearers’ perception of advice affects their responses, a strand that continues in her current research.
After she earned her PhD, Goldsmith was assistant professor in the Department of Speech Communication at the University of Maryland at College Park. In 1993, she joined the Department of Speech Communication at the University of Illinois at Urbana-Champaign, and began studying how couples communicate about health issues. “There was some illness in my family, and several of my colleagues were in health communication,” she says. “Those things sparked my interest.” To date, she has authored numerous articles on communication as well as the books Communicating Social Support (Cambridge University Press, 2004) and Communicating to Manage Health and Illness (with colleague Dale Brashers; Routledge, 2009).
Goldsmith’s research is based on interviews with couples. While much couples research is conducted by administering surveys or observing interactions, she says interviews allow researchers access to different information. “We can hear directly from both members about why they communicate as they do, and ask for interpretations,” she explains. “We can also ask if they avoid certain subjects or treat them cautiously.” For example, Goldsmith and research assistant Greg Miller BA ’10 recently found that couples dealing with cancer find it hard to talk about relationship burdens and inequalities—how one person has to do more or make sacrifices because the other is sick. Partners tend to discuss this difficult subject infrequently.
Creative Communication vs. Criticism
Among Goldsmith’s research subjects were Sandra and Mary. When Mary, a librarian, was diagnosed with ovarian cancer, she planned to have a local surgeon remove the tumor. Her partner Sandra researched Mary’s condition and discovered that patients treated by a specialist in gynecologic oncology (cancers of the female reproductive system) had better outcomes than those treated by nonspecialists. Mary wasn’t interested. “I just want the cancer out,” she said.
Still concerned, Sandra bought a book on ovarian cancer that explained the importance of specialized treatment. She told Mary, “I got this book for myself, but I think it might interest you.” Mary read the book, decided to see an oncologist, and was successfully treated.
Sandra and Mary’s story illustrates a key tenet of Goldsmith’s work. “Communication should validate the patient’s identity and the relationship,” she says. This sometimes means not talking, but finding other ways to communicate. Knowing Mary was an avid reader, Sandra used a book to convey her message. She didn’t dismiss her partner’s right to select her own treatment, but she also refused to abandon her concern or her conviction that specialty treatment was best. Whether they are communicating verbally or nonverbally, Goldsmith suggests partners consider three things: the urgency of the message, their desire to honor the relationship, and their wish to honor the partner as an individual.
The Impact of Illness and Anxiety
Among Goldsmith’s other findings: verbal communication is more effective if the patient perceives it as supportive and encouraging rather than controlling and critical. She writes, “Most people will interpret ‘Why can’t you remember something as simple as reading a label?’ as more critical than ‘I know it’s a drag having to read all of these labels, but if we look before we buy it, we won’t have anything we can’t eat sitting around the house.’ ” Partners can also communicate their support nonverbally. Other communication researchers have found that in some cases, nonverbal communication is more effective than talking; for example, preparing nutritious foods is more effective in helping patients follow healthful diets than nagging about dietary changes. “Changing the environment and your routines may mean you actually need to talk less,” Goldsmith says, emphasizing that each couple can develop a range of verbal and nonverbal communication strategies that work for them.
If your partner is chronically ill, getting support for yourself can improve how you communicate, Goldsmith says. Having an ill partner can create anxiety about many issues, from the possibility of losing the partner to illness to finances and household chores. Seemingly mundane concerns such as who mows the lawn become challenges, and partners can be tempted to air their frustrations in ways that can worsen the relationship and the patient’s health. “As spouses, much of what we say comes out of our own need to cope,” says Goldsmith. “Nagging can result from our anxiety,” more than from something the partner is or isn’t doing.
Goldsmith notes that having a chronic health condition affects a patient’s identity, and how partners communicate about limitations can affect the character of the relationship. While someone who can no longer do yard work or lift heavy things might feel less competent, “they often want to remain the same person,” Goldsmith says. If a partner communicates excessive concern, he or she “risks crossing the line from partner behavior to parental behavior,” and straining the relationship. According to Goldsmith, “The key is to think: What mental and emotional place is my partner in? How is my partner hearing what I say?”
Effective communication can reinforce a couple’s shared identity. Another couple in Goldsmith’s studies, Heather and Joe, were coping with the aftermath of Heather’s uterine cancer when they spoke to the research team. Heather was in her 30s, and her treatment meant she and Joe could not have children. “They viewed the diagnosis differently,” says Goldsmith. “Joe saw his wife’s illness as more dire than she did—she kind of took it in stride.” After they discovered these differing perspectives, Heather and Joe didn’t talk much about her prognosis, but they spent time playing the video game World of Warcraft as a team. “It was almost as if they were saying, ‘Even though we see things differently, we’re in this together.’ ”
Their story shows how, as Goldsmith says, “People are tremendously resilient and creative in the ways they communicate.” She adds, “There doesn’t seem to be a single ‘right’ way for couples to talk—the frequency, the style of speaking, and the type of conversation vary, and each strategy may work under some conditions.” Her research provides key data about the effectiveness of various strategies. This evidence is crucial for health-care providers— trained to look for hard evidence that something works—who need to give patients and partners more nuanced communication advice. “There’s a tendency to say, ‘Just be open,’ ” Goldsmith says, “but research shows effective communication isn’t that simple.”
Instead of teaching one-size-fits-all skill courses, Goldsmith suggests that health-care providers encourage couples to explore how they are communicating, what the communication means to them, and what other options they might consider. (For practical tips based on Goldsmith’s research, see related story at right.) In her long-term research, she aims to further discover “how, when, and in what conditions communication helps.” From there, her findings can continue shaping the advice couples receive.
Mentoring Current and Future Researchers
Since 2006, Goldsmith has been back at Lewis & Clark. From her airy Howard Hall office, she gestures toward the lush foliage outside her windows. It’s late spring, and the rhododendrons are in full bloom. Working on the campus where she studied as an undergraduate feels like coming home. “In Illinois, I missed the mountains,” she says. “I love seeing Mount Hood from the Lewis & Clark campus.” Academically, it’s also great to be back, she says. “Some of my former professors are still here, but it doesn’t feel like I’m still an undergrad—my career was well established when I returned.” She also relishes teaching Lewis & Clark students. “They write well, they think well, and you don’t have to sell them on doing research,” she says. “Many communication students are working on senior theses or research projects. Just as I did, they find it exciting to gather data and solve puzzles.” Recent Lewis & Clark graduate Gregory Miller BA ’10 has worked closely with Goldsmith since the spring of 2009. Though his degree is in international affairs, he spent time as a communication major and has benefited from Goldsmith’s help as an advisor and mentor. “If I didn’t understand something, I’d go and talk it out with her,” Miller says.
Former student Kristen Lindholm, now associate professor of communication at Trinity International University, concurs, “Daena is an encouraging mentor. I could not have asked for a better guide, a more constructive critic, or a greater supporter of my efforts.”
Miller took all of Goldsmith’s courses, beginning with Introduction to Communication his first semester at Lewis & Clark. In their research work together, supported by a student-faculty research grant, they studied her interviews of couples living with cancer. In April, they presented their findings at the University of Kentucky Conference on Health Communication.
In addition to making a valuable contribution to research as an undergraduate, Goldsmith points out, Miller will be able to enter graduate school already experienced at analyzing data, writing up findings, and sharing them with colleagues. “It’s a wonderful opportunity students have at Lewis & Clark, one that most institutions don’t offer until grad school,” she says.
Miller and Goldsmith have been discussing his next steps as a researcher. In 2009, he spent the fall semester in India studying how the government of that country communicates information about elephantiasis, a mosquito-borne parasitic disease that causes enlargement of certain body parts. “Officials put information on posters and in radio announcements,” he says. “But in many cases, the people they are trying to reach don’t respond to these methods of communication.” Like his mentor, Miller is interested in discovering the strategies that work best for real people struggling with illness. His studies in international affairs and communication give him many good options for graduate study, says Goldsmith.
Whatever direction he chooses, Miller’s interest in research has been ignited at Lewis & Clark, just as Goldsmith’s was. “The field of communication studies is stronger because of her scholarship,” says Erin Donovan-Kicken, another former student, now assistant professor of communication studies at the University of Texas at Austin. While this is undoubtedly true, Goldsmith’s dedication to her research has strengthened the field in another way: by inspiring younger scholars to find their own research directions and continue piecing together the communication puzzle.
Genevieve J. Long is a Portland freelance writer and editor.
*Throughout this story, couples’ names have been changed to protect privacy.