wanting to be sick

There's an article by a psychiatrist, who refuses to see a patient as wanting to be ill. I agree, but in discussion at the institute I go to, there was discussion of a dynamic which is very invested in being sick and resists, and even gets pleasure in frustrating helping others. The teacher said, "If you hooked them up to a machine to record their physiological response, they would register pleasure in the pain." It was in the context of discussing Betty Joseph's "near-death instinct", which like this psychiatrist, I was rejecting. This is a wonderful topic, and I'd wished to have been allowed to comment on the article.

One thing operating is that we identify, at times, with our pathology. I am that annoying habit that everyone dislikes and drives others away from me. Oh well, that's how I am.

We love our habits, it's easier and familiar to maintain a habit than change it. Change is very hard. I think one thing that makes me a good therapist is that I have a healthy appreciation of that. I have worked my butt off in psychotherapy, and there's still so much more to do. Not every case has a dramatic cure moment, where some interpretation leads to an epiphany, and presto whammo the patient is cured. Working through the insights, correcting what we know on a surface level, with what we know in our bodies and in a deep level takes time. It's spade work, hard. That is where I like the humility in this article, the persistence.

A psychotherapist has self esteem too. To quote RICHARD A. FRIEDMAN, MD, the author of the article, "Chronically ill, treatment-resistant patients can challenge the confidence of therapists themselves, who may be reluctant to question their treatment; it’s easier — and less painful — to view the patient as intentionally or unconsciously resistant."

But later he does ask the question, "I wondered whether there was something about the sick role that she found rewarding." And later, "I felt chagrined that I had begun to write her off as a help-rejecting crank."

He ends the article not at any poles of this tricky dialectic, by saying, "To be sure, some patients really do want to be sick. People with Munchausen syndrome, for example, deliberately produce physical or psychological symptoms for the express purpose of assuming the sick role. And they will go to extraordinary means to defeat doctors who try to “treat” them.

But a vast majority of patients want to feel better, and for them the burden of illness is painful enough. Let’s keep the blame on the disease, not the patient."