Tuesday, October 10, 2006

Using Bad Health to Get What You Want

To get what you think you need.

This is a wonderful example of how some people use their resources (other people) to the max. Those who are emotionally impoverished or just low on their confidence think they have little to offer to others than their poor health. It can become the essence of every relationship.

It's easy to manipulate nice people to shell out attention and time, especially when health is poor. Manipulators who lack poor health to draw attention will even fabricate it.

This can get pretty ugly if the people we're talking about are relatives.

Let's start with elderly parents.

Those who squeezed everything out of their children throughout their lifetimes by exaggerating everyday aches and pains, undoubtedly become worse when they're older and their health really does deteriorate.

Children who have long since stopped attending to them might totally disappear when they really are needed. They refused to be pawns of what is called secondary gain, in the literature.

Secondary gain is getting psychological attention for a medical condition. It's certainly not always this sinister.

Those of us from healthy families WANT to care for our aging parents. We WANT to see them comfortable and well. We're grateful for the opportunity to help them when they need us, young or old, but especially when they're older.

And if they're emotionally healthy? Said parents can drive us crazy with their refusal to accept help.

But the emotionally healthy elderly not the population we're talking about today. We're talking about people who regardless of their age, have always wanted care-taking, who perceive that they have little else to use to capture love and attention other than ill health, one dynamic in this system.

Another dynamic is that there is a family culture of giving and getting attention ONLY for physical misery. Be miserable and you're golden.

Crazy lesson, I know, but there are these families. And the order of the relationship is absolutely irrelevant. Could be a child nagging for attention. Could be a parent nagging. Just keep the nagging going, man. That's the ticket.

It's like when my twins were babies. SOMEBODY had to be crying at all times. One of them had to be crying. But they were babies, under a year old, working together to be sure they weren't left unattended. I'd call that a Darwinian thing, teleological even.

What I'm talking about in this post is different. We might even think of it as co-dependent behavior (later see my posts on this, one, two, three, and four.) One needs the other to be dependent so the other obliges.

In the medical profession, docs and nurses see this perversity every day. Conceivably, in the patient's head, it's the docs and nurses who need to be needed. The patient is simply filling in the need.

Appointments are there to meet the needs of medical professionals, to fill their time, not to actually help sick people.

I said conceivably. Doctors and nurses often complain to me about people who are NOT sick who are chewing up the precious time they should be spending on people who ARE sick.

But let's talk briefly about how to change the dynamic in a family that fosters this weird dependency.

One intervention can be done cold turkey route if there's no risk of death or mismanagement of an illness. So if someone is manufacturing symptoms you really can do this, stop attending to them, get off the phone by hanging up on them. Abandon them, yes.

Of course that individual will not stop persisting that you help, but you'll feel better if you don't. This ultimately can end up as a Munchausen's disorder in which people MAKE themselves sick for attention to SHOW YOU. Those people WANT surgery and will find a surgeon to comply. Then you're the guilty one, right?

But let's say you catch it early.

A professional dealing with such a patient will try to refer to psychiatry. The patient will refuse, or go, perhaps, seeking emotional patting and validation of the illness.

A good therapist will provide that, engage the client, pat a lot, then get to work on finding this person, exacting the unique identity that is so layered and bound in that body/brain that even she (it's usually a she, but can be a he) has no idea who's in there.

A family therapist like me will see if it's at all possible to get the patient to recognize the actual needs of the significant others in the relationships.

Like if it's a 60 year old woman being sick to get the attention of an 80 year old parent, I'd go right for, OMG, your mom could die at any moment. We have to DO something to make her more comfortable.

This may or may not work. Whenever that happens, however, whenever I have a middle-aged person who is exploiting an elderly person and feels just the slightest bit guilty for not care-taking that person, I pile on more guilt.

Idiot, I say. You're supposed to take care of THEM at some point. When were you going to figure that out? THIS IS THAT POINT.

But what if the 60 year old really IS sick and is chalishing (hard "ch" a Yiddish word meaning relishing, sounds better, no?) the opportunity for attention from mom?

It's probably too difficult and too late to put her in charge of her mother. Her mother is perhaps captive now, has lost the battle and is lost in sadness. How does life get to this place where an elderly woman must care-take a younger one, one who INTENTIONALLY let her health go to extract this attention?


It being inappropriate or even impossible for an octogenarian to run back and forth to care-take a middle-aged person, I'd extricate her from that role if at all possible, find alternative resources, council the elderly person to let others do the job.

When the system is stuck like this, however, it does feel like a hopeless/helpless (freaking depressing) case for everyone but the patient who is chalishing.

The psychotherapy that I would do with the chalisher is still be about finding out who she is, was, and wants to do with the rest of her life.

I don't fold the cards, frankly, until the last hand is played. But these are the cases that can take it out of you.

Enough for today, I'm tired. I think I'll call my mom and ask her to bring me a cup of coffee.

Copyright 2006, TherapyDoc


cham said...

watched the carl rogers and gloria video today...interesting stuff- but personally i think it would drive me insane

gr8face said...

I've known several people who use illness as a weapon.

Rachel said...

i really enjoy your blog but have to disagree with some of the (neo-liberal?) ethics/politics of this post. is there any room for the ongoing illness in your philosophy of 'healthy' relationships? What if some people are highly aware of their own illness and self-sustaining, but in relationship, need to be with someone who comprehends that their version of 'normal and healthy' is not so robust. Understanding is key here, and I've found really fit and healthy people very hard to date because of their inability to be in the vicinity of poor health just as a fact of life. how to teach your fit and healthy people that being around the less healthy is NOT a matter of co-dependency or a threat to independence (their own or the others') but just a matter of a respect for difference, and different ways of being 'normal'.

I have fibromyaelgia, and energy issues due to the aftermath of PTSD. These days I am with a very sweet boy, who coincidentally has a rare form of bipolar II disorder (only in summer, which I am yet to see.) We both are fine with each others' rhythns of wellness and unwellness, because we don't take it personally, and don't think we need to fix the other. Sometimes we give each other subtle hints in terms of problem solving 'how to feel better' on specific days (might be exercise, sleep, staying in instead of socialising, socialising instead of staying in, sun, train travel, reading, music, cooking, micro-changes of attitude, self and other reflection, whatever!) It's subtle, pragmatic, and tender, and i would hardly call it problematic. Now that i am in a relationship like this i feel freeer to treat other people with similar emotional and physical/biological respect. That is i think a way of feeling active and responsible too, in terms of circulating the idea of "care" (Foucault). Am I misunderstanding your post or does this not fit into your own approach to "illness in relationships"?

therapydoc said...

In general I tell people not to think of any post as the law, or the only way to think of anything. Obviously there should be room here, and you've described how it should be very well, and I thank you. So glad you brought it up.

Better Things-- Seeing Ghosts