I’m coming down with a cold. I felt it when I woke up this morning, the itchy throat, the blocked nose. When we’re sick people tend to treat us differently, and illness brings upon us an altered persona which makes others react in a different and often more positive way. Sometimes it feels as if it isn’t in our interests to get better too quickly.
I work professionally with people who come to me with the intention of getting better. But what is already a delicate and tricky procedure is made much more complicated when it appears that the person sitting in front of me may not want to get better at all. When this happens my coaxing and cajoling toward improvement can be the very thing which puts an intolerable strain on the therapeutic relationship. People get stuck and don’t thank me for pointing it out. So is it that we don’t know how to get better, or is that we just don’t want to?
The motivation of recovery is always clear in the conscious mind. Fitter and healthier obviously means “happier”, less anxious and more confident means happier, no longer depressed and more socially outgoing means happier, and free from emotional pain means happier too. It’s all perfectly obvious, but the subconscious isn’t always on the same page, because it focuses on something dark and devilish, secondary gain. Secondary gain is the state in which what we think we want is undermined by a far deeper desire or fear.
“I’m proud of my problem.”
I once had a client who needed and wanted to lose weight but he had an email address which began “bigjohn” As much as he said he wanted to get “better” he was, in a way, proud of not doing so and illustrated it to the world via his email account. When we dug a little deeper we revealed a deep fear of being slim. He felt it might make him less imposing, less powerful, less able to control his life, and, ultimately, less of a man. He literally feared becoming emasculated as a result of changing to make himself healthier. The fear of disappearing is far worse than the fear of existing but being dissatisfied.
“It’s just who I am.”
“I’ve always been a worrier”, “There is a history of depression in the family”, “I’m an anxious person”. These are labels which define the way we see ourselves. They are hair shirts but they fit snugly, and better an uncomfortable shirt than no shirt at all. We subconsciously wonder who we will be if we throw off the shackles of emotional ruin. So we stay sick while telling ourselves that we want to be well. We stay safe while maintaining the most debilitating dangers.
“Nobody will notice me.”
We all want to feel that we matter and being sick or broken often means we get more attention. It might not feel like very positive or uplifting attention, but it’s attention nonetheless. Depression moves those who love us try to coax us out of the darkness. They can become exasperated, angry, worried, sympathetic but at least it’s something. The big fear in getting better is that everyone else will be able to concentrate on their own lives and then, “nobody will notice me if I’m better, like everyone else”. There is uniqueness in being fucked up and often we are reluctant to give it up, unless we are sure of something more worthwhile taking its place.
“I’m only loved because I’m messed up.”
Susan has an eating disorder. She also has a history of self harm and her eating is just the latest in a line of self destructive behaviours. When we are broken we need more care and more love. Like a bee struggling to stay alive we hope that someone will rally to supply sugar water, as if it is our sickness which allows us to receive love. Being “OK” might mean we are in need of and deserve nothing. Even in this precarious state Susan feels a paucity of the love she seeks but her greatest fear is of what might happen if she gets better. “Nobody will love me if I am better because I’m not worthy of love just as I am. I only have a chance of being loved when I am in dire need of it.
“Life is a struggle, but it’s meant to be”
John does nothing to fulfil himself and engages only in pursuits which bolster others. It is emotionally draining on a grand scale and leaves him feeling resentful and exhausted, but at least it’s a purpose. There is nothing else in his life which provides one and he never learned that he has inherent value. To this end John derives meaning from his suffering, and therefore to end his suffering would be to lose meaning. If we have no meaning we are nothing. John is yet to consider the possibility of finding a more positive, self affirming, meaning because he doubts he is worth it, and he fears the consequence of trying, so he refuses to get better.
“I am defined by my unhappiness”
Clare looks at me and says “I’m stuck. I’ll never get out of this. Look at everything that’s happened to me. I can’t ever escape from it”. I can’t argue with the drama and the devastation of her story, but I also know that when we complain about how bad things are we give ourselves a kind of status. When we are convinced we are too messed up to be helped it makes us special in some way and means that we don’t have to try and change things because we have already decided they are unchangeable. “I am so screwed up. I just want to be normal” None of us really wants to be normal, we want to be special. Sometimes our utter pain makes us feel special and we don’t want to give it up. We use our brokenness to make us strangely “whole” and then we refuse to get better.
The wonderful thing about a cold is that we remember what it’s like not to have one, and so we’re happy to move right along back to that state of wellness. When we struggle emotionally sometimes we’ve forgotten or never knew what it was like to feel “well”. We mustn’t let that put us off taking the steps to recovery. I’ve never been to San Francisco, but I know it exists.