I was talking to friends last evening about their frustration in having their adult son living with them while he is actively addicted to alcohol. Their son has been struggling with addiction for a number of years. In recent years he has been in the hospital twice for acute alcohol related illnesses. Yet, he has been unable to allow himself to use a program such as a 12-step program to get he support he needs. As those with a loved one who have an active addiction or a loved one who has had an active addiction and not learned to change his/her thinking know, it is difficult at best to live with or have a healthy relationship with the person. The same can be said which someone has a mental illness which has not been successfully treated.
Many health care professionals and some others would recommend that the family practice tough love. For some this has meant not allowing the person to live with them even if they are homeless, not giving them money even if they do not have gas for work, not paying for their love one to see a doctor, and not responding to angry accusations that they are heartless.
For many years family and friends who refused to practice this so-called tough love have been easily dismissed as co-dependent. They have been accused of not wanting to deal with the pain of the helplessness one must face in such a situations. It seemed to me that the term co-dependent could become another way of beating up the person for not being a good enough friend, partner, son, daughter, grandparent or even a health care professional. Many of my colleagues, in the name of love, have told individuals and family that they cannot be helped if they are unwilling to follow directions and practice so called tough love.
So what is a co-dependent? In one goggles the term one finds that there is no shortage of opinions.
One of the better articles I found written on co-dependence is by Dr. Shawn Burn. He says:
Are You In a Codependent Relationship?
A few things to think about before making your declaration of codependence
Post published by Shawn M. Burn Ph.D. on Jul 14, 2013 in Presence of Mind
"Popular definitions of codependence are so broad that Jesus would be classified as codependent. The meaning (and usefulness) of the codependence concept is diluted by these broad definitions. Since beginning my study of dysfunctional helping, I have tried to nail down the co-dependence concept.
I prefer to think of codependent relationships as a specific type of dysfunctional helping relationship. Broadly speaking, in dysfunctional helping relationships, one person’s help supports (enables) the other’s underachievement, irresponsibility, immaturity, addiction, procrastination, or poor mental or physical health."
The helper does this by doing such things as rescuing the other from self-imposed predicaments, bearing their negative consequences for them, accommodating their unhealthy or irresponsible behaviors, and taking care of them such that they don’t develop or exhibit competencies normal for those of their age or abilities. Although these unbalanced relationships can go on for some time, they are ultimately unsustainable due their consumption of the helper’s physical, emotional, or financial resources, and because they lead to resentment and relationship strain.
Dysfunctional helping relationships don’t necessarily involve codependence, but they may. Codependent relationships are close relationships where much of the love and intimacy in the relationship is experienced in the context of one person’s distress and the other’s rescuing or enabling. The helper shows love primarily through the provision of assistance and the other feels loved primarily when they receive assistance. The intense shared experiences of the other’s struggles and disasters and the helper’s rescues deepen the emotional connection and feelings of intimacy.
In the codependent relationship, the helper’s emotional enmeshment leads them to keenly feel the other’s struggles and to feel guilt at the thought of limiting their help or terminating the relationship. This motivates them to reduce the other’s suffering (and their own) by continued helping and makes them quick to back off of any limits they set.”
Despite the fact that this author does acknowledge that we have overused the term co-dependence to include even the loving help of Jesus, I still feel very confused about the line between loving and unloving behavior. To begin with, I have no idea what the term dysfunctional means. Back to goggle for me. Looking up the word dysfunctional did not provide any clarifying definitions for me. When I looked in thesaurus.com for synonyms I found the following:
Flawed, broken, debilitated, decayed, defective, deteriorated, inhibited, maladjusted, malfunctioned, sick, undermined, unfit, wounded
This was minimally helpful. When I think of dysfunctional I think that the behavior of the system is such that it is impossible to achieve the stated goal of the system. If that is the case then there are three possible solutions
· Change the goal even it is as simple as “Survive without any dead bodies.”
· Change the composition of the system – one or more person might leave this system. The addict might leave to enter treatment or to live on his/her own.
· Change the behavior of the members of the system so that it is more realistic in terms of achieving the stated goals.
· The sick person gets treatment, which allows their brain to function within the normal range.
The problem occurs when one talks or acts as if there is a “right” answer. If one does not choose answer “A” one flunks as a parent, partner, friend, employer, or friend. This helps no one. Sometimes the best one can do is to survive and just hold one’s own. Addiction, for example is a disease. One’s brain is not working well. The addicted brain seems unable to make a choice to change their behavior. We expect the addict to make a logical decision and put him or herself in a treatment or recovery program when their brain is not thinking logically. The addictive craving overrides the logic. Anyone who has ever struggled with any addictive craving for nicotine, food, sex, knowledge or anything else knows what I am talking about. I do not have an addiction to donuts but, as I am sitting here typing in the Nissan service department waiting room, I keep looking at that box of donuts. I can even smell them. Even without an addiction/intense craving, I am having a difficult time restraining myself from eating something I know is unhealthy for me. For many years I continued to smoke cigarettes even though I hated the taste, smell, expense, and the fact that I was supporting companies which specialized in selling a product designed to kill many people. I was very embarrassed and yet I kept smoking until I was able to get the support I needed to deal with the extreme discomfort of not smoking.
I also get confused when Dr. Burn says that the addict or other person “feels loved or gratitude when he/she receives assistance”. In my experience the person often feels terrible. They may or may not experience temporary relief but they do not usually feel love. Often, they feel extreme guilt and/or shame. This causes additional stress, which, in turn, makes it even more difficult to make a decision to get the help they need. They often know that their addictive thinking has manipulated the situation; that it is not love, which has motivated the behavior of their family member, co-worker or friend.
Let’s suppose the system changes by one or more persons leaving. If the leaving is because the addict is now healthy everyone can begin to relax and learn to trust the new behavior. If the addict is still actively addicted then the loved one, employer or other concerned person, perhaps following a brief period of relief, is going to continue to worry and feel as if there is something that they “should” be doing. If the worst happens and the addict dies while “out there” the loved one is likely to feel not only sad but also partly responsible. I personally do not know any parent or sibling who is able to become so hardened with tough love that they are able to completely relax and enjoy life while their loved one is actively being destroyed by addiction.
Another option is that the system changes it goals to match the power of the addiction. While this may sound good and provide some temporary relief, the truth is that there is a level of distrust and worry, which still invades every molecule of the house.
Another concern I have with what Mr. Burn and many other say is the following:
“I prefer to think of codependent relationships as a specific type of dysfunctional helping relationship. Broadly speaking, in dysfunctional helping relationships, one person’s help supports (enables) the other’s underachievement, irresponsibility, immaturity, addiction, procrastination, or poor mental or physical health.”
The sentence with which I struggle is “one person’s help supports (enable) the other’s underachievement, irresponsibility, immaturity, addiction, procrastination, or poor mental or physical health.” It seems to me that this sentence is a perfect example of the confusing messages from even the professional community. We expect as family members and professionals to have the insurance companies and the general medical field to acknowledge that the loved one is suffering from a disorder which affects their thinking process and, at the same time, we expect the addict or mentally ill person to make decisions which require a healthy brain. We want it both ways. We in the mental health professional have participated in making it almost impossible to have someone declared mentally incompetent and forced into treatment while, at the very same time wanting the insurance companies and other health care professionals to recognize and honor the seriousness of the illnesses which affect how the brain functions. Unless someone is actively suicidal or homicidal right now, it is almost impossible to get someone committed to a hospital for treatment. If we do get them committed it is likely that the physician or committee in charge of the evaluation will decide that they do not then meet the criteria for being immediately dangerous. It seems that anything short of actively shooting everyone in sight is considered within the normal or healthy range of behavior. Then when someone does shoot everyone in sight we questions why someone did not so something! The distinction between medical and mental health issues has further muddied this situation. For example, Alzheimer’s is considered a medical condition, over which the afflicted person has no control. Thus, it is much easier to have empathy for the family and other loved ones of the people. It is also easier to get them declared incompetent to make their own decisions. The same is true if one has a diagnosis of a brain tumor, which is evidenced by the results of a brain scan or other test. With active addiction and many mental illnesses the person might, at times, appear to be functioning “normally” which then leads us to expect them to think like “us”.
For now, I do not see any solutions to this confusing situation. We can:
· Attempt to be more aware of the inconsistencies in our expectations of the sick person.
· Continue to lovingly encourage the person to get help for their addictive behavior.
· Quit blaming our partners, parents, siblings, friends, and others for their difficulty in accepting that tough love or lack of tough love.
· Do our best to take good care of each other and ourselves.
· Quit acting as if there is a right answer or a right way to handle the situation.
· Gather with others who are experiencing the same situation and offer each other support. We do, however, have to be careful with support groups. I personally love Alanon and similar 12 step support groups, but I also know that, at times, there are those in such groups who are try to act as if they have the answer and criticize anyone who does not agree with their answers.
Certainly it is understandable why words such as co-dependent are so attractive and seem so useful. It makes the situation sound very manageable. The truth is that many human conditions and situations are very, very messy. As is true of all issues and conditions we must face addiction, mental issues and other such conditions with being honest and realistic. We can certainly pray that the addict or mentally ill person has a moment of clarity and is able to the help they need. That is what I would call a true miracle. In the meantime we will continue to flounder with what some will call enabling, tough love, and co-dependence. They have no idea or they have taken an isolated example and generalized to the situation, which appears similar.
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