Pain Recovery for Families. Robert Hunter

people have heard the term “codependence.” Codependence originally referred to an addict being dependent on drugs, and the partner in the relationship being dependent on the addict, and thus codependent. However, codependency is not just a characteristic of addiction. Codependence is a cluster of behaviors that often occurs in people affected by an addicted person’s behavior. Thus, codependence occurs in relationships and can be defined as one person’s tendency to be overly focused or centered on another rather than on him- or herself. Typically, the codependent person feels compelled to meet the needs of other people, to fix or control others (e.g., the addict). Because of this unhealthy desire to meet the needs of the other person in the relationship, the codependent person can become the enabler of the other person’s addictive behavior. Additionally, the codependent person protects the other person from the natural consequences of the addictive behavior. For example, a codependent person may not mention, pretend not to notice, or make excuses (e.g., “He’s just tired.”) for obvious signs of intoxication in his or her partner, despite how angry he or she feels. This denial enables the addictive behavior, making it seem acceptable via the silence, and also protects the addict from being confronted about the behavior.

      Codependence can affect any relationship, not just those involving a drug-dependent person. For people with codependent tendencies, being in a relationship that requires taking care of someone (e.g., a person with chronic pain) is a perfect scenario for codependency to flourish. For example, in relationships involving a person with chronic pain, a spouse may enable his or her spouse’s isolation and withdrawal from the family by not confronting him or her about it. As a codependent person, you may unknowingly enable and contribute to your partner’s continued imbalance (addiction, chronic pain, etc.). Enabling allows this pattern to continue in an unhealthy fashion.

      It should be noted that this discussion of codependence barely scratches the surface of a very important and complicated topic. There are many good information sources available for further reading on codependence, including Choicemaking: For Spirituality Seekers, Codependents and Adult Children by Sharon Wegscheider-Cruse (HCI); Adult Children: The Secrets of Dysfunctional Families by John and Linda Friel (HCI); and Codependent No More: How to Stop Controlling Others and Start Caring for Yourself by Melody Beattie (Hazelden).

      Mary enabled Jim’s isolation and withdrawal from the family by not confronting him and not communicating how upsetting his behavior was. When Amy didn’t get out of bed for a week, Chris began feeding her in bed. His intention was to take care of her and to prevent her from starving; but when he feeds her in bed, she doesn’t have to get out of bed. He is reinforcing her pain, and she has become more and more dependent on him. This contributes to his sense of powerlessness and unmanageability.

      Enabling involves not being able to set appropriate boundaries. Boundaries become distorted when family members begin to take over responsibilities that the person in pain is capable of handling for him- or herself. This is usually driven by guilt and a desire to make up for the situation the person in pain is in. The enabling behavior is the natural response of the caretaker to the afflicted loved one, but instead of helping, it creates an unhealthy dependency and prevents the person in pain from maintaining self-sufficiency, which reinforces pain and helplessness. Family members often enable the person in pain to engage in victim thinking and behavior.

       {exercise} 2.3

       Identifying Codependency in You and _______________ ___________

      This exercise will help you to identify codependent traits in yourself and in _______________. Read the following list of characteristics and indicate which apply to you, to _______________, or to both of you (check both boxes).

Self	Other Person	Characteristic
		Problems trusting others (anticipating betrayal), making true intimacy very difficult.
		“People-pleasing,” an excessive need or desire to do what other people want, often at the expense of one’s own needs.
		Covering or making excuses for behavior so as to avoid having to deal with the consequences, e.g., telling family that someone is “sick” or “tired” when he or she has taken too much pain medication or is drunk.
		A need to be in control of self.
		A need to be in control of others.
		Always depending on another for guidance.
		Discounting or doubting one’s own judgment.
		Always being worried about making the wrong decision.
		Ending up in relationships with people who need to be taken care of.
		Ending up in relationships with people who initially need help, but later take advantage or become abusive in some way.
		Fear of feeling angry (i.e., losing control), to the point of avoiding confrontation or conflict and/or denying that you are angry.
		Lying, omitting information, or exaggerating, even when it would be easier to tell the truth.
		Fearing abandonment.
		Fear of being alone.
		Tolerating hurtful behaviors.
		Guilt about not being able to take away the pain.
		Guilt for being angry.

       THE SOLICITOUS SPOUSE

      Research has shown that in the presence of a “solicitous spouse” (one who genuinely cares and expresses concern), pain and disability increase. Studies on chronic pain sufferers found that when their spouses focused more attention on the pain problem and engaged in overlyprotective, solicitous behaviors, their reported pain and degree of disability increased. Solicitous behaviors can include asking repeatedly if the person is in pain, suggesting that he or she lie down, or asking if the person has taken his or her pain medication. When the spouse paid less attention to the pain problem or actively tried to get the chronic pain sufferer to focus on other things, his or her reported pain and degree of disability decreased. Though this research focused on the spouse, what it illustrates is that if you reinforce pain (through codependent and enabling behaviors), the pain is maintained.

      Mary’s tendency was to stroke Jim’s brow when he complained of pain. She’d coddle him and even use baby talk at times in an attempt to soothe his discomfort. This reinforcing behavior actually caused him to report and to feel more pain than when Mary was at work and he had to do for himself. He developed a lack of the ability to self-soothe. Sometimes, without realizing it, he groaned and complained to evoke a response from her. Imagine what would happen when she