Why We Stop Appreciating the People We Love Most

A few months ago, an elderly couple came to my clinic for a routine follow-up for diabetes. The wife was my patient. The husband was not. Yet before the consultation was over, I realised I had spent almost as much time watching him as I had examining her.

He carried a thick folder containing every blood report she had collected over the previous five years. Before she answered my questions, he reminded her about the medicines she had forgotten to mention. When I asked whether she had resumed her evening walks, he answered only after looking at her, as if seeking permission to speak. “Five days last week, Doctor,” he said with quiet satisfaction. He even remembered the date of her last eye examination.

Nothing about him suggested sacrifice. He behaved as though these things were as ordinary as breathing. As the consultation ended, I looked at him and smiled. “You are taking wonderful care of her.” The gentleman lowered his eyes and smiled with the awkward embarrassment of a schoolboy who had unexpectedly been praised.

Before he could reply, his wife turned towards me. “Doctor,” she said softly, “nobody has told him that in years.” For a few moments, none of us spoke.

During more than thirty years of medical practice, I have forgotten thousands of blood sugar values, cholesterol reports and prescriptions. Medicine has taught me that numbers fade surprisingly quickly. People do not. That one sentence has remained with me far longer than any laboratory report from that morning.

Over the following week, I found myself thinking about the couple more often than I expected. Why had such an ordinary compliment touched him so deeply? He had not started caring for his wife that morning. She had not suddenly become more grateful. Nothing had changed except one small thing. Someone had noticed. Slowly, another thought began to trouble me. Perhaps the greatest threat to long relationships is not the disappearance of love. Perhaps it is the disappearance of attention. The people we depend on the most slowly become the people we notice the least. That may sound like a sad observation, but I suspect it is actually a consequence of something remarkable about the human brain.

Imagine moving into a house beside a busy railway line. During the first week, every passing train seems determined to ruin your sleep. A month later, visitors complain about the noise while you continue reading the newspaper without even looking up. The ceiling fan that once sounded loud has disappeared. The ticking clock has disappeared. Even the familiar smell of your own home has quietly slipped beneath awareness.

Psychologists call this habituation. It is one of the brain’s greatest achievements. If we noticed everything with equal intensity all the time, life would become unbearable. The brain, therefore, performs an act of quiet housekeeping. It gently moves familiar things into the background so that we can pay attention to whatever is new, unexpected or dangerous.

The trouble is that the brain does not stop at railway tracks and ceiling fans. It brings the same habit home. The husband who checks whether every door is locked before sleeping. The wife who remembers everyone’s medicines without being reminded. The daughter who telephones her ageing parents every evening. The son who silently pays the electricity bill before the due date. They do not become less kind over the years. They simply become less visible.

The better someone performs a responsibility, the less likely we are to notice it. Reliability carries a strange penalty. It is often punished with invisibility.

After years in practice, I have begun to notice something curious. Strangers often thank one another more warmly than people who have shared a home for forty years.

Patients thank my assistant, Ashwini, for helping them find an appointment. They thank the laboratory technician who draws a blood sample. They thank the pharmacist, Manju, who hands them their medicines. These are gracious habits, and I hope they never disappear. Yet I have often wondered why the same generosity of words becomes so scarce inside our own homes. Somewhere between raising children, paying EMIs, caring for ageing parents and arguing about leaking taps, the people who make our lives possible slowly become part of the furniture of our existence. We see them every day, yet we stop seeing what they do.

One afternoon, a middle-aged woman came to consult me because she was constantly tired. Her blood pressure was normal. Her blood tests were reassuring. After examining her, I explained that I could not find any serious medical illness. She thanked me, collected her prescription and walked towards the door. Then she stopped.

“Doctor,” she asked, “may I tell you something that has nothing to do with my health?” I nodded. She smiled politely, but her eyes filled with tears.

“I cook for five people every day. If I forget to add salt even once, everyone notices. But nobody has told me the food was good in years.” There are consultations that disappear from memory before the next patient enters the room. There are others that silently settle somewhere much deeper. I cannot remember the medicines I prescribed that afternoon. I remember every word she spoke.

That day, I realised that exhaustion does not always begin in the body. Sometimes it begins in the quiet loneliness of feeling unseen. Carrying responsibility is tiring. Carrying it without acknowledgement is even more tiring.

As doctors, we become skilled at recognising deficiencies. We look for low haemoglobin, vitamin B12, vitamin D, and thyroid hormone levels. Yet there is another deficiency that never appears in a laboratory report. It reveals itself only in conversation. It is the silent depletion that occurs when a person’s efforts are repeatedly expected but rarely acknowledged.

I sometimes wish relationships came with a blood test for appreciation. It would probably reveal deficiencies long before marriages, friendships, or families began to show symptoms.

Modern psychology has reached conclusions that sound surprisingly familiar to anyone who has spent years listening to patients. The work of John Gottman showed that lasting marriages are not free from disagreements. They survive because moments of affection, respect and appreciation continue to outnumber moments of criticism. Conflict is not what destroys most relationships. Living for years without feeling genuinely noticed often does.

Long before relationship researchers began counting conversations, Charaka offered a remarkably broad understanding of health. While describing a healthy person, he did not stop with the absence of disease. His famous definition includes prasannātmendriyamanāḥ—a mind and senses that remain content and at peace. It is a profound reminder that medicine is concerned not only with joints, blood sugar, and blood pressure. Human well-being has always included emotional life. Feeling valued is not merely pleasant. It is quietly nourishing.

Appreciation is misunderstood because we confuse it with praise. Praise celebrates achievement. Appreciation recognises faithfulness. Praise says, “You are brilliant.”Appreciation says, “I noticed what you silently did.” The difference is small in language but enormous in the human heart.

 I have also learnt that gratitude has an amusing habit of becoming inversely proportional to familiarity. Some husbands can remember the registration number of the scooter they sold twenty years ago, but somehow forget to thank the person who reminded them every year to renew their insurance. Some wives remember the favourite vegetables, allergies and medicine timings of every member of the family, yet quietly assume nobody even notices the invisible labour that makes a household function. We smile because these observations are familiar. We become thoughtful because they are true.

The elderly couple stood up to leave. The husband reached the door first. As his wife walked towards him, he quietly lifted the handbag from her shoulder and carried it outside. The gesture lasted barely a few seconds. It was so natural that neither of them seemed aware of it.

I was.

After decades in practice, I have come to an unusual conclusion. Most relationships do not suffer from a shortage of love. They suffer from a shortage of attention. The people who make our lives easiest gradually become the people whose work is hardest to see.

That is why long relationships slowly change their language. They begin with “I can’t wait to see you” and, years later, become “Did you pay the electricity bill?” There is nothing wrong with that. Families run on grocery lists, school fees and plumbers’ phone numbers. The danger begins only when admiration quietly gives way to administration.

As doctors, we write prescriptions every day. One tablet after breakfast. Two capsules after dinner. Complete the course in seven days. I have often been tempted to write one more instruction: One genuine “thank you” every day. Continue indefinitely. It may not lower blood sugar, but I suspect it would improve the health of quite a few relationships.

Whenever people ask me the secret of a happy marriage, I think of that elderly gentleman and of the woman who measured her loneliness in teaspoons of salt. Between those two consultations lies a lesson no laboratory can measure.

Love rarely disappears in a dramatic moment. More often, it quietly fades behind the ordinary. The happiest relationships are not built by extraordinary acts of love. They are built by people who never stop noticing the ordinary kindness that has been there all along.