make sense of the enormous changes. Most of the family rules in that household were unspoken, and after a while no one talked with anyone about what was occurring. Mandi escaped from the environment with relief when she went off to college. Ross started using pot, and his grades dropped. Mary could barely keep her head above water, and just let it happen; she felt she had no choice.
As Amy became less functional, Chris became more and more isolated—from her and from others. He was terribly embarrassed by Amy’s limitations and behaviors, so he stopped calling and interacting with friends. Whereas previously they were a balanced, self-assured couple, the two of them became more enmeshed, and because of her progressive drug dependence, she became totally dependent on him for any support.
{exercise} 2.2
Identifying Effects of Chronic Pain on Your Family System ___________
1. Describe your family’s functioning in terms of the following (refer to the definitions provided in the previous section):
ADAPTABILITY
(Circle the word that best describes how adaptable your family is.)
Rigid Flexible Chaotic
COHESIVENESS
(Circle the word that best describes how well you stick together.)
Disconnected Interdependent Enmeshed/Codependent
INTERACTION PATTERNS (Are there any of the following?)
Triangles Coalitions Triangulation Splitting
BOUNDARIES (Circle the word that best describes how boundaries are within your family.)
Rigid Flexible Chaotic Nonexistent
FAMILY ROLES (Describe the roles that each of your family members plays.)
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
FAMILY RULES
(Describe any rules that control the actions of family members. How have the rules changed?)
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
2. Describe how the family responded when _______________ was first injured or developed pain problems.
3. As _______________’s pain became chronic or unchanging, how did the family seem to respond?
4. Comparing how things are now (refer to your answers to the first question in this exercise) to how your family functioned before the onset of _______________’s chronic pain problems, describe the most noticeable differences.
Codependent and Enabling Behaviors
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. 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
