Sick Role
When someone in the family has chronic pain, family roles and responsibilities often change, with the chronic pain sufferer taking on a more dependent status, or “sick role.” The spouse or partner of the person in pain may start to take on too many responsibilities. He or she may feel more like a nurse or parent than a partner. This role shift can lead to feelings of resentment and frustration. The increased stress on the relationship often leads to arguing or conflict, as well as isolation, withdrawal, and even estrangement. This is especially problematic if you have good days with your pain, where you can function nearly normally, and bad days, where you can’t function well or feel like doing very little. This pattern can create uncertainty and confusion. Unlike acute pain, which has an end point, chronic pain goes on and on, increasing frustration in the family. Since you are not getting better and there is no indication of if or when you will be able to resume your usual healthy roles, everyone’s roles and expectations become murky. Knowing this seldom makes the strain, uncertainty, or resentment any easier to deal with. Family, friends, and coworkers end up feeling as controlled by the chronic pain as you do, and what’s tough about that is that they don’t have any socially sanctioned way to deal with their feelings. They may be afraid that if they talk about their feelings, they will be perceived as complaining or as a “whiner.” When the strain of trying to cover more responsibilities is added to this conflict, your loved ones’ suffering can be quite profound. Their suffering is increased by the unpredictable nature of chronic pain—their not being able to predict on any given day (or hour) how good or bad you will be feeling. By recognizing the impact of your pain on those around you and communicating clearly when you are feeling better or worse, without demanding attention or sympathy, you can help ease the pressure on your loved ones. In short, don’t overstate your case, but don’t leave them guessing. There are times when their pain, though not physical, is as great as yours. In fact, brain studies have shown that some people, when observing another person in pain, show increased brain activity in the same regions as the person in pain. In other words, they truly “feel your pain.” It is also not uncommon for family members to experience secondary gain from your illness. They adapt to your sick role and may even be uncomfortable as you improve, because the equilibrium is shifting yet again. In the extreme situation, their identity has become that of caregiver, so if you get well, they may lose their sense of purpose and direction. This dynamic makes it all the more important for families to receive help as you proceed through pain recovery.
Codependent Behavior and Relationships
Most 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. Dependent behavior is exhibited in many relationship dynamics. For individuals with dependent tendencies, being in a relationship that requires taking care of someone (e.g., a person with chronic pain) is a perfect scenario for these tendencies to flourish. Typically, a codependent person feels compelled to meet the needs of other people, and to fix or control others. As a result, the codependent person unknowingly enables and contributes to his or her partner’s continued imbalance (addiction, chronic pain, etc.). For example, your spouse, partner, or someone else close to you may enable your isolation and withdrawal from the family by not confronting you or not communicating how upsetting it is. There is a study showing that in the presence of a “solicitous spouse” (one who genuinely cares and expresses concern), your pain increases. It should be noted that this discussion of codependence barely scratches the surface of an important and complicated topic. Many good sources of information on codependence are available, and we recommend further reading on this topic. This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP).
