A Defining Moment

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A commenter on the blog yesterday prompted today’s post. (See, if you pay attention to what is going on around you, ideas just fall into your lap)

Why do some people feel the need to define themselves by their illness?

Why would they not, like most of the rest of us I guess, define themselves by their talents, their wealth, their ability to be perfect parents, or their skill at foosball? 

Let me offer a few random things that I think might play into this. As my time to write is limited this morning I trust that all of you , my very smart and not-so-shy readers, will fill in the gaps for me and add more as you see fit in the comments today. 

I have seen a lot of people over the years in a clinic setting who have applied for and achieved disability status. That is, they have amassed a truckload of paper work, gone to be evaluated by a separate (non-treating) mental health professional, had all of this information presented to a court system or administrative law judge, and then been granted the privilege of receiving what is in fact a very small amount of money to live on each month.

They are re-evaluated periodically, usually every few years, to insure that they still meet disability requirements. These re-evals are the source of intense anxiety for some of my patients, as they figure if they have not been presenting as “sick enough” or that my paperwork reflects any amount of improvement that they will no longer receive “their check” each month. 

I have also seen this happen in other systems such as the VA, where maintenance of livelihood (that is, staying sick enough to keep getting paid for it, in essence) is predicated on continuing to have a fixed number of documented symptoms or diagnoses that make you  “service connected” at a percentage that translates into a fixed amount of monetary compensation. 

Yes, these kinds of systems encourage you not to work hard to get better, but to put a lot of effort into documenting that you are still sick enough to keep getting paid for it. 

There are those who have conditions such as hypochondriasis. They are absolutely sure that they have something wrong with them that the doctors have just not been able to find yet. They go from place to place, doctor to doctor, clinic to clinic, trying to find that one elusive diagnosis that will tie it all together. They in a sense define their lives not by a particular illness, but by the search for an illness that may or may not exist in reality.

Malingerers, on the other hand, have something that drives them to fake illnesses, manufacture them, embellish them and work then for all they’re worth. Secondary gain plays a large part in this, of course, in that illness gets one out of jury duty, court appearances, military service and long periods of idle time in jail. These folks define themselves by very specific illnesses and symptoms, carefully crafted and maintained for very specific reasons and purposes. 

Keeping oneself in the sick role can serve many purposes. 

It sanctions your disability, at least for a certain time and to a certain degree. If you’re sick, you’re not a functional member of society, and that’s okay for now. You’re expected to get better and return to being that member, of course, and that’s where it breaks down for those with hypochondriasis and those who malinger. 

It gives you the added benefits of physical, emotional, and financial help when you really need it. Again, this is good to a point. The problem is, over the years people have learned to work the system and milk it for all they can, and that’s not the way things were designed to work. 

You know how people who are abused will stay in an abusive relationship, despite horrendous emotional, physical and mental anguish and pain? Well…

When you’re sick, you learn to be sick. You get used to it, for better or for worse. You learn what that means. You learn that to get well, while considered by most of us the the desired goal, may mean giving up interactions, attention and financial security. You’re not so sure you want to, or even can, go back to working and being “normal” like everyone else you see around you.

Sometimes, the devil you know is better than the devil you don’t. 

Comments, oh wise readers of mine?