Co-Dependence

Anne Wilson Schaef

• Publisher: HarperOne
• Year: 2012
• ISBN:
  9780062271167
• Topic: Psychologie
• Subtopic: Psychotherapie

The explosive bestseller that revolutionized our understanding of the addictive process. With a new introduction addressing the backlash to the co-dependency movement.

Chapter One

The History and Development of the Concept of Co-Dependence

We are beginning to recognize that co-dependence is a disease in its own right.

Since the concept of co-dependence has evolved so recently, we have not yet seen an integrative theory developed about it. Co-dependence has the beauty of being a “grass-roots” idea. That is to say, people who admit to having the disease themselves and are in the process of recovering from it are developing theories about co-dependence, not professionals who have only a “left-brain” interest in the disease. The awareness of the dynamics of co-dependence comes directly out of the struggle, the pain, and the elation of working through an illness and beginning to know that there is another way to live and be with others.

This process of understanding and evolving a theory about a disease from within is not foreign to the chemical dependency (or CD) field. In the CD field, the persons most trusted are those who can honestly say, “I know how you feel” — those who, themselves, are struggling (and have struggled) internally with the ravages of alcoholism and admit it. In the field of mental health, on the other hand, practitioners generally do not admit to having any problems and are seen as less effective if they have to admit to some of the problems with which they work.

At this point in its development, co-dependence is understood and used almost exclusively within the field of chemical dependency. Most professionals and lay people who are not somehow involved in the CD field know little or nothing about this disease and its treatment. I firmly believe, in fact — as many others have suggested (among them, Sharon Wegscheider-Cruse, Jael Greenleaf, Charles Whitfield, to name a few) — that most mental health professionals are untreated co-dependents who are actively practicing their disease in their work in a way that helps neither them nor their clients. The ignorance of the mental health profession about this disease has resulted in costly, long-range, and ineffective treatment for co-dependents. It has, however, kept the professional’s pockets lined, and it has probably served to perpetuate her or his own co-dependence.

The Chemical Dependency Field

As I understand the development of the concept of co-dependence within the CD field, it has been employed in relation to the treatment of the alcoholic. We all know that prior to the development of the disease concept of alcoholism, the alcoholic was considered a bad, weak person who just had no willpower. Alcoholism was a disease from which the individual recovered in isolation from the family and usually only with the support of other “drunks.” As Virginia Satir developed her concepts of family therapy, Vernon Johnson, Sharon Wegscheider-Cruse, and others began to look at alcoholism as a family disease, and the entire field opened itself to the awareness that the alcoholic was not the only person affected by the disease. It became clear, in fact, that the entire family was affected and that each member played a role in helping the disease perpetuate itself.

Since many of the initial contributions in the CD area came from people who were themselves recovering alcoholics, the emphasis in treatment continued to be on the recovery of the alcoholic and on describing elements that would impede that recovery. It was accurately believed that alcoholics would have less chance of staying sober if they returned to untreated families, which would enable them to drink by making excuses for them and by otherwise continuing to practice their own co-dependence. Hence, CD counselors began working with families to serve the recovery of the alcoholic. Since the entire family had revolved around the alcoholic and the disease, it was not difficult to convince the family to continue focusing upon the alcoholic. So the family members dutifully learned about the disease of alcoholism and were told that they were sick. Exactly how they were sick and how they were to recover remained a mystery.

I want to emphasize here how much, historically, the initial treatment of the family focused all of its energies on the alcoholic. The term enabler, for instance, which is used in chemical dependency circles to describe the person — usually the spouse — who subtly helps support the drinking, is obviously oriented toward the alcoholic. The focus in working with the enabler was on helping her or him learn not to help perpetuate the disease in the alcoholic; little was done to help the enabler recover from her or his disease. Those providing this focus were usually recovering alcoholics, who had a vested personal interest in alcoholism per se.

There then was a time when the terms enabler and co-dependent were used almost interchangeably. The enabler/co-dependent was usually the spouse of the chemically dependent person, and there was tacit recognition that other members of the family were also co-dependents. However, the focus of treatment remained primarily on the alcoholic, on the spouse secondarily, and on the children least of all, a procedure that simply replicated the experience of the sick family itself. Family members were often described as co-dependent to the alcoholic, and their disease was not understood as a disease process in its own right. Even though Al-Anon (the major support group for co-dependents) says that the co-dependent needs to focus upon her or his own disease, much of the actual focus is on how to live with an alcoholic.

I think the next phase in the development of this concept was recognizing that the enabler, or co-dependent, was also in a great deal of pain and needed help. Concurrently with this phase was the realization, statistically, that children of alcoholic families tended to become alcoholics and/or develop serious problems adjusting to life. We began to see that the disease process was perpetuating itself and that it functioned on a larger scale than we had previously thought.

Currently, we are beginning to recognize that co-dependence is a disease in its own right. It fits the disease concept in that it has an onset(a point at which the person’s life is just not working, usually as a result of an addiction), a definable course(the person continues to deteriorate mentally, physically, psychologically, and spiritually), and, untreated, has a predictable outcome(death). We now know that co-dependence results in such physical complications as gastrointestinal problems, ulcers, high blood pressure, and even cancer. Indeed, the co-dependent will often die sooner than the chemically dependent person.

As a result of this progression within the CD field, co-dependence is now coming into its own as an area of concern and an area of specialization.

The Mental Health Field

The mental health field is yet another matter. Basically, the traditional specialties in the field of mental health have steadfastly refused to recognize the incidence, extent, and severity of addictions and co-dependence. Many traditional mental health professionals do not even know what co-dependence is. There are several reasons for this.

First, most mental health professionals learn little or nothing about addictions in their graduate training. As Charles Whitfield, a clinician and writer in the fields of chemical dependency and the family, states: “I estimate that today, conservatively, 80 percent of all helping professionals remain untrained in this crucial area.”1

In fact, most mental health professionals have had a unit on alcoholism and/or addictions that makes us even more dangerous. We have just enough knowledge to think we know something, which successfully prevents us from confronting our ignorance.

Second, traditional mental health techniques and theories have been singularly unsuccessful in the treatment of addictions. Even so, many mental health professionals continue to receive exorbitant fees and schedule endless hours with persons who are making little or no progress. Through this process, the mental health professional exhibits one of the major characteristics of co-dependence itself — denial.

For example, I recently conferred with a professional who was seeing a couple for therapy. I had been working with the wife separately for some time, and I had seen the husband for a few sessions, although he had refused to come back when I confronted him about his alcohol and money addictions. He was, however, willing to see the other professional both alone and with his wife. During our conference, the professional complained that the couple was not making progress using his techniques — making lists of what they liked about each other, etc. When I suggested that he might not be treating the real problem, he replied that there was nothing wrong with his techniques. Unfortunately, he said, they had a chronic problem relationship and what could be expected?

When I asked him if he was familiar with the treatment of addictions, he told me that the subject had been included in his graduate program. I then began to discuss the work of Wegscheider-Cruse, Johnson, and Black with respect to the dynamics of the addictive family. He had never heard of their work, and he did not feel he needed to know about it, since he had been trained in family therapy and considered himself to be a family therapist. I asked if he was familiar with the Twelve Step program of Alcoholics Anonymous and Al-Anon. Again, his answer was yes, but he said that his clients were not “the kind of people” who needed to be involved in that (clearly revealing his ignorance).

So far, I was batting 1.000. When I asked if he was familiar with the term co-dependence, he said that he thought perhaps he had heard it, but he could not give me a clear definition of what it meant. I told him that I found it discouraging that when our joint client recommended that he read Another Chance, I’ll Quit Tomorrow, and other pertinent material, he had done nothing. He became defensive, saying that I seemed to feel that I was superior to him. I told him that I thought he was acting unprofessionally in not becoming informed about an illness that obviously related to one of his clients, especially when this illness frequently results in death. I used diabetes as an analogy. If we had a joint client who had diabetes and if, in ignorance of the disease, he was recommending that the client continue to use sugar, I would be obliged to express my concern for the client’s welfare. Unfortunately, this professional persisted in using techniques that denied the disease and were singularly unbeneficial to the client.

This pattern, I’m afraid, is typical of many in the mental health field. The technique is rarely wrong; the patient is simply “unworkable.”

The third reason why the mental health approach to addictions is unsuccessful relates to a fact mentioned earlier — most mental health theories are developed by people who perceive themselves as free of any disease. Hence, the theories and techniques are developed abstractly, rationally, and logically, quite apart from the experience of the theorist. In fact, the validity of any theory is based on the non-involvement of the theorist, which provides the necessary “objectivity” and distance to treat the disease in that model. Unfortunately, this approach to developing theory is especially susceptible to certain aspects of the disease itself, such as denial, rationalization, “stinkin’ thinkin’,” the need to control, etc., none of which enhance treatment.

Despite all of these factors, traditional mental health professionals are now much more interested and involved in the field of addictions and co-dependence. There are several reasons for this.

The first is a humanitarian concern for healing in an area where a need is perceived. The mental health field sees that millions of people in this country are affected by addictions. An epidemic of this scope is bound to come to the attention of the medical and mental health professionals, as well it should.

Second, the treatment of addictions has become a big business. Addictive diseases have reached an epidemic proportion and not only derelicts but the wealthy and famous are admitting to problems with them. What was previously a field relegated to “quasi-professionals” — who themselves were recovering and who did not have graduate degrees — has suddenly become a multimillion-dollar concern. The development of theories and techniques had previously been left to persons who fit no major professional category or were not completely “within the fold,” and the process of understanding the disease involved looking at it from within, not observing it from the outside. But because the treatment of addictions now involves money and prestige, traditional professionals believe that it should be within their domain, and so they are generating theories and techniques consistent with a mental health perspective.

Lastly is the issue of control. Who will control a treatment industry that is changing fast and has suddenly become very profitable? Will tradition prevail and will this field move under the control of the established professions? Will the group with the most viable and functional theory prevail? How does control relate to what has essentially been a nonprofit, volunteer movement (A.A.) with one of the best success rates of any approach to treating this disease?

Fortunately or not, the issues surrounding co-dependence are even less clear than those related to addictions themselves. Where does the co-dependent fall within the chemical dependency field? Is the treatment of co-dependence an adjunct to the treatment of addictions? Does the co-dependent really fit into traditional psychiatric and psychological categories and, if so, can she or he be treated using traditional approaches? Is it possible to put co-dependence within the traditional categories of diagnosis, even if it does not fit? Since co-dependence does not fall under the CD diagnosis, should it be treated by mental health professionals and, if so, how? Where does insurance coverage apply in this confusion? Many of these issues almost seem to overshadow effective treatment at times.

The Women’s Movement

No discussion of the development of the concept of co-dependence would be complete without a reference to feminism and the women’s movement.

Since many co-dependents are women, and since many women are thought to be co-dependent, women’s issues are intimately related to co-dependence. In our attempts within the women’s movement to understand and therefore free women, we have looked under many stones and found many addictions.

As we have tried to understand our lives and the influences upon them, we have had to look more closely at the factors that externally limit and control us. In order to do this, it has been necessary for us to describe our realities and the way we relate to them.2 As we have delineated the forces that oppress us and contribute to our disease and unhealthiness, it is not surprising to find that those forces parallel the characteristics found in addiction and co-dependence. It seems to be no accident, then, that many of the characteristics of the nonliberated woman are also those that are emerging as characteristic of the (male or female) co-dependent: low self-esteem; passivity; not taking care of yourself physically, emotionally, spiritually, and/or psychologically; compromising yourself; ignoring your personal morality; perfectionism; and so on.

Nor is it surprising that the women’s movement, like the field of addictions and co-dependence, is a grass-roots movement, where knowledge is first developed by those who are affected and is then synthesized into theory, rather than being gleaned from analyzed material and objective data.

Hence, in mental health circles, the women’s movement has borne the same stamp of illegitimacy as the chemical dependency field. As renegade enterprises, however, each field has much to offer the other. Much of what has been learned in one field is congruent with what is known in the other; each field helps clarify and inform the other.

Since I have been active in the women’s movement, am a traditionally trained mental health professional and a trained family therapist, and am personally involved in the CD field as an actively recovering co-dependent, I hope to weave together what is most useful in each field into a comprehensive theory of co-dependence.

Before I do that, however, I want to comment on some of the best known conceptualizations of co-dependence and describe what I think is helpful and not helpful about them. Since so little has been written in this fast-growing field, I want to take the opportunity to recognize and summarize current thinking, as I understand it, and build my own theories upon present knowledge.

Chapter Two

The Range of Definitions of Co-Dependence

I agree that it is absolutely urgent that we recognize that persons who are around addictive behavior have a greater difficulty maintaining their own sobriety and are more likely to slide into their own disease, and it is important to recognize that it is their disease...