An essay by Peter Kemp orginally published on Co-Cure
WordPress Shortlink: http://wp.me/p5foE-2lq
Medically Unexplained Psychologising of ME (MUPs)
Permission to repost
10 October 2009
In this essay I will explore some psychic phenomena that might be relevant to psychologising of illness.
Generalisations cannot practically be made, MUPs is not just heterogeneous from a psychic viewpoint – it is likely to be individual. So I can only explore my impressions and I hope you will read my theories as falling somewhere between the Origin of Speciousness and A Tale of Two Settees.
Use of some terminology has been unavoidable but I include a few definitions and illustrations as ‘Asides’ that I hope will help make the essay accessible to PWME.
PWME = Person (or People) With ME
MUPs = Medically Unexplained Psychologising of ME
Medically Unexplained Psychologising of ME (MUPs)
AN ILLUSTRATION OF ‘PROJECTION’
Jack thinks that it would be very bad to be envious; this might be something his parents taught him. He notices envy in other people and condemns them for being envious. The envy that he so often notices might be real or not, it does not matter because it is HIS envy he is seeing. He is Projecting his envy onto other people to try and hide and control it within himself.
WITHDRAWAL OF PROJECTION
Projection is an unconscious process, people are not aware when they are doing it, but if they can become aware of the true source of a problem there may be an opportunity for growth.
One day Jack says to Jill, ‘I think you are envious of Mary’s little lamb’; and Jill says, ‘actually, I love Mary so much I gave her that lamb. I think you are envious because I get on so well with Mary.’ Jack’s theories fall apart and his projection is laid bare. If he is honest and humble enough he can then discover his own envy and stop projecting it. It may help if Jill points out ‘what’s wrong with being envious anyhow? It is part of how I know what I like and what I want’.
Through this uncomfortable experience Jack stops projecting envy and finds that natural feelings of envy can help him to make decisions about what he wants in life.
PWME represent ‘ideal’ subjects for the projection of all sorts of fears, Fear of losing control, Fear of weakness, Fear of illness, Fear of physical inadequacy, and perhaps worst of all, Fear of fear. For some MUPs I suspect that subtler projections and issues arise, such as Fear of being wrong and Fear of being misunderstood. All these fears have their roots in the psyche and are most troublesome when their origins are unconscious and when strongly denied. This may result in odd behaviour that may nevertheless be easily justified, but the justifications do not reveal the true motives behind the behaviour, instead they contribute to their concealment.
To confront fear it must be acknowledged but if it originates from an intense inner conflict it might be that the ego is not ready to withstand it. In these circumstances an internal struggle is maintained to repress some aspects of a complex in order to protect the ego. Enacting these conflicts in the world is a common way of reinforcing defences and avoids addressing the conflict directly. Unfortunately, this never resolves the issue at its source and means that substitute conflicts must constantly be found. As such projecting Fear may be predisposing and initiating; and because projection is an avoidance strategy, it is likely to be a maintaining factor in MUPs.
Withdrawal of Projection
For some people in whom contact with PWME arouses issues with fear, the psyche may seize this as an opportunity for growth. If someone projects fear onto another they may sometimes be able to compare their projection with the actual person. If discrepancies are found then the projection might start to weaken, then the projector has an opportunity to challenge and eventually withdraw the projection.
For example; a person fearful of losing control might project this onto a PWME; if they then realize that the PWME is actually coping well (with what for many people is a terrifying aspect of disability), the projector may think something like; ‘I thought he was weak, but I could not cope so well with such a loss of control’. This represents a stage of withdrawal of a projection as the projector has discovered that the source of the fear is within himself. Such situations might be considered MUPs based on transient / opportunistic factors; and is I suspect, a very common occurrence. Some MUPs might be able to relate to this if they find they vacillate between impatience and respect towards a PWME. This could be a sign that projections are weakening and the source of fear might be discoverable.
Victim Role and Rebelliousness
MUPs may assume a victim role when PWME decide they do not like their ideas. When PWME have been ill for a few years, they have probably been given so many ‘good’ suggestions that they may lose patience. Some such suggestions are not wholesomely motivated examples of Christian kindness. Instead, they originate from fear of helplessness. Even the most puerile suggestion can give the ‘suggester’ some sense of control over fear of being helpless. But if a PWME rejects these the MUPs might feel victimized (and they are, to the extent that the PWME has deprived them of a defence).
MUPs that promote psychological research and interventions sometimes go rather further than people who simply recommend ‘Yak’s milk yogurt’; and sometimes appear to actively court controversy in the way they promote their theories. This suggests that among other psychological processes there may be a desire to be rejected and to become a victim.
Rejection and criticism result in a feeling of victimization which may provide psychic rewards and become a maintaining factor. MUPs may include in their persona the progressive thinker, dissenter, radical and challenger. Inspection of such notions among active MUPs appears to show that they operate within systems that ensure they are safe and encourage their activities; so they appear more like conformists playing at dissention, contriving a ‘victim’ role.
The victim role is revealed when MUPs complain about patients. Some MUPs also complain about patient activists and patient support groups. To these MUPs, patients that oppose their ideas might reinforce a belief that they are acting honourably and bravely, challenging convention and standing-up to wicked bullies to promote the truth.
A MUPs persona of being a victim might appear ridiculous but is probably not in the sense that they may be experiencing some unconscious persecution; in the form of guilt. This common human experience results in a frequently seen phenomenon. Films, TV programmes and stories, both fiction and non-fiction carry stories of people who are ‘wrongly accused’. This theme is common because almost anyone can identify with it as it connects to profound aspects of the psyche.
Being unjustly accused is a desirable occurrence – provided that people have the opportunity and resources to defend themselves (else they are simply Scapegoats). It is desirable because it provides the chance to suppress by denial and misdirection, deep inner guilt. The guilt may originate from aggressive feelings towards the parents – Good Breast / Bad Breast (Klein); and Oedipus / Electra (Freud/Jung). Also present may be denied anger at very critical or weak parents. These and other troublesome psychic factors can make a victim role an attractive defence; and this is aside from the fact that people who are falsely accused are ‘outside the law’ – so to speak; so their defensive behaviour is pre-justified.
So false accusations give an opportunity to be aggressively self-righteous, all other sins and crimes sink into the background, suppressed by the noble fight to achieve justice.
If the Freudian or Kleinian developmental stages mentioned above interact with a critical complex the result can be deep and painful guilt. The crushing fear and powerlessness created by this type of complex make them very difficult to confront – quite simply, the conflict destroys the courage needed to address the complex; making it a self-perpetuating feature of the psyche. One way of controlling such powerful conflicts without addressing them directly is by enacting them in the world through projections.
ARCHETYPE AND COMPLEX
An ARCHETYPE is a symbol of some aspect of being human. Some important archetypes are Mother, Father, Child, Self, Masculine, Feminine.
Around these symbols gather ideas that represent aspects of the archetype. i.e., the Mother COMPLEX might include; ‘nourishment, nurture, protection, boundaries, discipline, control’ etc.
A complex can become one-sided if only certain aspects seem acceptable. A one-sided Mother complex might acknowledge ‘nourishment, nurture, protection’ but deny or repress ‘boundaries, discipline, control’.
A person with such a one-sided Mother complex which becomes significant in an interpersonal relationship (regardless of whether man or women) may find that they cannot establish boundaries or discipline or have any control.
Associated with unconscious guilt is likely to be the rebellious child. MUPs may enact a characterisation of this aspect of the child complex which may have been suppressed in favour of the obedient child; or may never have had an opportunity to be satisfactorily expressed if parents were over-indulgent. The suppressed or undeveloped side of a complex does not disappear or remain completely powerless nor unexpressed. To put it crudely, it leaks out and as Freud and others recognised, it manifests itself in ‘Freudian slips’ and other unconscious behaviour including projection.
MUPs could cope with the rebellious child by projecting the characteristic onto PWME and then ‘deal with it’ there. This would provide 2 opportunities for the MUPs psyche, and these are likely to be attractive maintaining factors.
First is an opportunity to gain control of the ‘child’, enact parental control and superiority and enforce the parent’s will. This would be an expression of the internal struggle to contain the rebellious aspect of the child complex.
Second, the MUPs may attempt to relate to the ‘child’ in their projection. The MUPs may seek a point of contact through which they can start to understand the ‘child’ and through which relationship can be established. Because the process is unconscious, based on a projection and lacks a Mediator to relate the conflicting sides this would almost certainly lead to failure. Either of these enactments would almost certainly be a useless and confusing experience for the PWME.
When opposing sides of a psychic conflict are exaggerated; i.e., one side is very ‘good’ and the other very ‘bad’; they are unlikely to be managed or related without the help of a Mediator. In the example of the Child Complex opposing sides might be the Obedient Child and the Rebellious Child. In the richness of human experience there would also be within the complex other characterisations of the Child – for example a playful or mischievous child. These other aspects of the complex may be able to relate to both sides of the conflict so encouraging and developing them would reduce the power of the conflict. A benevolent Parent characterisation might be help to start this process – but the final goal would be a self-balancing complex rich with possibilities and choices.
If a MUPs doctor is enacting a one-sided complex through interaction with a PWME, they are likely to be entering into a confusing relationship with an aspect of their own psyche; and will find, as expected, they cannot control it. So rather than resolving the MUPs conflict, interaction with their projection reinforces the need for repression and projection.
In these interactions the rebellious child can slip into the proceedings and can be observed when MUPs fail to conceal contempt for PWME by casting aspersions, usually in an indirect but unmistakeable manner. This behaviour may be ‘justified’ by assertions of an intent to help but these barely conceal the urge to attack PWME. This is an unconscious expression of frustration and suppressed rage at not being able to freely express or adequately control the rebellious aspect of the child complex.
As such PWME may pose a constant challenge to MUPs which leads to circular reasoning and an addictive maintaining factor. Because PWME represent both rebelliousness and weakness, which MUPs both fear and envy – the possibilities for projection are endless. The psychic attraction of PWME to MUPs is immeasurable in their construction of a love-hate relationship that meets their conflicting urges. Unfortunately for the PWME, the most one can say is that they might be in there somewhere.
If this sounds excessively speculative, consider this: What is it about ME that attracts MUPs? A desire to help? Take a good hard look at the outcome of their ‘help’; now you get the picture.
People are drawn towards other people that fulfil their need for either psychic safety or growth – this can override everything (IMO). It is this drive that MUPs perceive in ME – in other words, they believe the patient will throw away almost everything important in their life in pursuit of some psychic need manifesting via erroneous illness beliefs. The irony is, that this is precisely what some doctors who are MUPs appear to be doing; throwing their lives away on ME. Their failure to actually help patients is irrelevant compared to the fabulous psychic reward of finding the ideal subjects for projection. That their time and talents are being wasted is a negligible price to pay.
People who have very frightening one-sided complexes might be burdened with the idea that they are cowards; and might desperately struggle to conceal this. As Stephen King points out in Dolores Claiborne, the one thing a coward must prevent at all costs – is allowing anyone to discover they are cowardly. To this end people suffering inner fear may try to compensate by doing things they believe are ‘brave’; and this does work in many instances when the realization dawns that it is acceptable to be afraid. The ego is then prepared to confront the real source of its fears. Until this is achieved some people may feel that it is not alright to be afraid or show fear. This can result in people not only denying fear in themselves but also attacking it wherever they perceive it.
Parents of Children with ME
If MUPs have significant issues relating to a parent or parent figure this will almost certainly feature in their interactions around ME. Parents who show concern for a child with ME may be seen as not behaving as ‘proper’ parents should behave. A MUPs with child/parent issues might be envious of the child and angered by the parent – whose natural behaviour they deem wrong. As a result, instead of attacking their own parents – which could be a repressed desire, a MUPs may attack other parents, accusing them of over protectiveness and causing the child’s illness.
When MUPs doctors blame parents for a child’s ME they supersede the parents. Both the parent(s) and child are self-deceived but the deceit is inferior to the MUPs knowledge and powers of perception – so here is superiority. The MUPs is being a ‘better’ parent and therefore they are assuming a parental role. This might result in an unconscious expression of , ‘I wish my parents had been firmer with me’, manifesting as inconsiderateness for the child and condemnation of the parents.
Alternatively, a MUPs may attempt to construct a reparative experience, psychically forcing themselves into the parent/child relationship as both parent and child. This could be done in an attempt to evolve some missing condition needed for their psychic development as a child. This would be a disastrous intervention in which neither the parents nor their child with ME would be real; but relegated to characters in a MUPs reconstructed and alternatively-enacted childhood.
Emerging from aggression and fear and directed at vulnerable people, bullying might be a tempting reward for some MUPs and a maintaining factor. Bullying MUPs may be torn between a longing to be treated sympathetically and a desire to be abused – and may unconsciously believe this is also what other people want. As a result of confused understanding of what constitutes a healthy relationship, some MUPs might feel justified in behaviour that equates to bullying.
Against all logic and evidence some MUPs claim that people with ME get sympathy for being ill. This is possibly because they themselves confusingly long for both sympathy and chastisement. They appear oblivious to the fact that the stigma of an ME diagnosis is horrible, or that no amount of sympathy could compensate for the terrible pain, disability and losses of ME; so they probably perceive stigma as more attention. Confusion over what makes a healthy relationship can become a regressive neurosis that prevents maturity and results in expression of either childish-weakness or childish-authoritarianism. The ‘childish’ aspect of these behaviours is recognisable in denial of responsibility; denying the feelings of others and ignoring criticism.
This is the ability to be sensitively aware of one’s own thoughts and feelings, even when subtle. In self-reflexive people these useful messages get through to consciousness and can be helpful in understanding interpersonal relationships. Self-reflexivity can be hampered if many thoughts and feelings are shut out by introjected ‘shoulds’ and ‘oughts’ (Rogers). These ‘shoulds’ can dictate not only what behaviour is acceptable, but also what thoughts and feelings are acceptable. This kind of internal censorship can obscure insightful thoughts and feelings.
This is the ability to understand another person’s feelings ‘as if’ they were one’s own; being able to put oneself ‘in another persons shoes’ and accurately sense what it feels like for them. This is different from simply observing other people and having feelings about those observations, because this lacks the ‘as if’ quality. Some problems may prevent or distort empathy such as autistic spectrum disorders, narcissistic personality disorder, etc.
The desire to control Weakness and Power may be an initiating factor in some MUPs if their psychic needs draw them towards vulnerable people. Many physicians and other healers have the predisposing factors proposed above, to become MUPs (sometimes termed ‘the wounded healer’) yet many do not succumb because they have, countering qualities.
The most important countering qualities are self-reflexivity and empathy. These can help as honest self-examination when the healer thinks; i.e., ‘God, I really hate that patient’, and then asks ‘why?’; continues to question their reaction and tries to understand the patient. In self-reflexive people this can bring the conflicting desires; 1. help the patient kindly and 2. clobber the patient with a bed-pan; into consciousness where they can be simply contained and not allowed to sabotage the healer/patient relationship. Because the self-reflexive healer has thereby dissolved potential rewards for MUPs; i.e., opportunities to project and bully, they do not succumb.
This kind of self-reflexivity is closely connected to psychic development and the gradual balancing of one-sided complexes; but can be challenging because it threatens the sense of knowing what to do and how to be. The conditions for resolution of many neuroses are created when people accept confusion and helplessness. When the taught and introjected rules of thought and behaviour are found to be inadequate in the complexities of adult interpersonal relationships, it is essential for a maturing individual to accept the confusion and lack of control inherent in such situations. Attempts to control or dominate these interactions is an enactment of the parental control over the child (or vice versa); and are an attempt to simplify complex interactions because of inadequate resources.
From this one might see that if MUPs insist on ‘knowing’ (what is wrong with) and taking ‘control’ of patients (symptoms) with ME they are setting up a Projective Identification. A suppressed part of the MUPs personality – for example, a rebellious and uncooperative child; is projected onto the patient. Once this has happened the patient, as a human being, all but disappears behind the projection.
The projection may be reinforced by the patient’s response. The vulnerable patient, who may be very ill and desperate for help may find it impossible to remain authentic; true to themselves. The patient may be drawn into the MUPs projection when they either respond as they believe the MUPs wants or react negatively. Once this happens the Projective Identification may set like concrete and will be very difficult to shift. From this point the chances for an authentic Adult-to-Adult, or Healer-to-Patient relationship are almost zero.
This occurs when a projection subject is manipulated into responding in a way that confirms the projection.
Jack thinks Jill has issues with anger. Jack is a passive/aggressive and anger is Jack’s unconscious problem but he is projecting it on Jill. Every time they meet he says something like, ‘I hope you are not angry’; ‘please don’t get angry with me’; finally Jill gets angry and tells him to ‘shut up!’. Now Jack’s projection is confirmed – ‘I knew she was angry’; and by now she is – so the projection is identified in Jill and becomes a 2-way aspect of their relationship.
The Self-Serving Bias
Maintaining factors of MUPs may include a phenomenon known as the ‘Self-Serving Bias’. This is a tendency to blame other people for personal or systemic failures along with a tendency to take credit for successes. This natural characteristic can become exaggerated in egotistical people; those for whom being ‘right’ and ‘winning’ are imperatives. It may be an expression of deep-seated insecurity compensated by a super(wo)man-complex. This common trait can go too far to the extent that people can lose the capacity to blame themselves. This means they are unable to question their logic; acknowledge challenges or admit fault. People with this trait, are highly susceptible to flattery (which they will hotly deny – believing that their honesty and powers of judgment are so excellent, that if they think they are right, that is praise enough for them). Their inability to question their logic is due to an imperative to not change their minds – not to be wrong; and may go beyond simple arrogance or overconfidence to indicate a fragile psychic structure propping up too much ego that must be protected by ‘being right’. In other words, the fragility must be constantly repaired and reinforced because the consequences of being wrong is feared to be (and could be) catastrophic for the ego.
Fear of Movement
Some research papers refer to ‘fear of movement’ (kinesophobia) in people with ME. In every human at every point in their life, there exists some potential – and at every moment of their life they experience at some level the struggle between stasis; remaining the same; and growth; ‘moving’ into the potential person. Stay still too long and when the change/growth/movement comes it is likely to be an upsetting – though possibly also a cathartic experience.
Transformation almost invariably includes loss of something along with what is gained. Theorists that study the Phases of Life tend to believe that major transitions occur every few years and can sometimes be traumatic or at least dramatic in some way; but that once the transition is accomplished the person is reasonably set and stable for the ensuing phase. Whether development is continuous or phasic or includes both, there is always a possibility of some difficult undeveloped aspects of the psyche presenting problems.
So ‘fear of movement’ could be a projection of ‘fear of (psychic) movement’. The person who is perceived as afraid to move represents an inner fear of moving and transforming – with the threatened loss that accompanies such change.
‘Fear of movement’ theories might also represent an enactment of the battle of wills that can occur between parent and child, often occurring during the ‘terrible twos’ and the anal stage (Freud). Simply, the PWME says that movement is difficult, painful, exhausting; the MUPs says it is not, the PWME is just afraid; so to the MUPs this is a battle of wills.
This provides the MUPs with an opportunity to enact a representation of parental ‘bullying’, exercising power against a physically weaker, less powerful person. The MUPs assumes the role of power which is the parent, so in their enactment the PWME represents the child.
In the Anal phase, children of psychologically healthy parents get enough of their own little victories to begin to find their independence. If parents are excessively controlling or obsessive then children may fail to gain a balanced and sharing view of power and control – losing their ‘self-will’ and introjecting the parent’s will. If the parents are neglectful or overindulgent the child might miss out on learning to strive for and eventually, negotiate for their wishes.
In this important phase of development a warped process would be likely to result in major control and power issues. Claiming that a person severely incapacitated by ME is afraid to move is an enactment of an excessively controlling parent and a projective identification (in which the PWME does not have to do anything – which is just as well).
A fundamental factor in MUPs is that the patient is not believed. Patient’s statements about symptoms and disability are untrue – whether false, exaggerated or originating from misperception; they are not telling the truth. PWME can encounter this attitude just about anywhere, from the supermarket to their doctor’s surgery; from relatives to complete strangers writing in a newspaper.
This might relate to MUPs fear of being misunderstood, whilst at the same time believing that they cannot be understood. No one will believe them and their actions will be misinterpreted. In the curious balancing (or rebalancing) nature of the psyche this means they unconsciously seek to discover and understand deception.
This gives them power over deception; and because it relates to an inner sense of guilt – when deception is exposed it brings a sense of safety. The defences against the danger of being misjudged have been strengthened and the guilt remains hidden.
One conflict that might arise is a longing to be completely honest conflicting with a desire to keep something safely hidden – which might relate to what Jung described as ‘the secret’, ‘the rock on which the patient will break.’
This might lead to cunning behaviour and dalliance with risks that would expose the secret, an exciting game of ‘chicken’ or ‘catch me if you can’; which might at the same time strengthen defences against discovery of guilt. This leads to the Trickster.
The Trickster Archetype
Looking for the psychic liar and deceiver leads to an interesting archetype, that of the Trickster. A good example of the Trickster archetype is Gollum in Lord of the Rings. The Trickster may appear friendly and turn nasty or vice-versa, but in the end their activities and interaction with them results in growth and is generally desirable.
When MUPs perceive deception in ME they are unconsciously seeking input from the Trickster. This indicates that the psychic status-quo is ready and waiting to be disrupted; there is an unconscious drive to seek the challenges and chaos from which a matured ego can emerge.
The problem with the Trickster is that it cannot be controlled – that is its whole purpose in being unreliable, to remove control and deliver the reluctant psyche into chaos. All one can do with the Trickster is respond to it on an event-by-event basis, all knowledge and experience prove inadequate as the Trickster leads to greater and greater confusion and danger; as well as excitement and opportunity.
The MUPs disbelief of PWME suggests fear of losing control conflicting with a longing to plunge into the crazy world of the Trickster; where fragile (and useless) structures of the conscious ego will crumble and a matured, stronger ego can eventually emerge. As the Trickster may be a companion of the Hero it is the Hero that embarks on the journey into chaos and battles with the monsters found there. So here again we see the need for courage – a characteristic that some MUPs appear to assign to themselves, whilst denying the same in PWME. However, Heroes fight monsters in order to be heroic; they don’t go tilting at windmills.
As mentioned above, at an unconscious level people are always seeking psychic growth and are drawn towards activities and other people that can provide opportunities for growth. As the greatest growth is almost always arduous and often frightening, the urge for growth is hampered by the longing for comfort and safety.
Considerable disability is seen in a substantial number of PWME, though they don’t always look ill or have obvious signs to connect with their disability. Therefore when the actual person and their illness and suffering is ignored or denied, PWME may be perceived as being like a dependent child. This might evoke envy in those who feel unsupported in some aspect of their lives and who long to regress into childish dependency. In such people any doubt about PWME’s entitlement to support is likely to evoke an aggressive reaction to what they perceive to be the fraudulent acquisition of what they desire.
Several theories/philosophies describe ideas about the importance of later life development with concepts such as Individuation, Self-Actualization, Psychosynthesis, Becoming, etc. A number of psychic factors can hamper this development to the point where they may render it an almost impossible goal. Fear is likely to be foremost among these when it is experienced from very one-sided complexes, but with almost equal power to stop growth, is ego-inflation. The sense of power and knowledge that come from getting some way into maturity can be highly seductive – and not altogether illusory. People who can get through the early, difficult and often embarrassing stages of developing the Inferior Function, integrating the Shadow and resolving some conflicts can gain some real wisdom – though not as much as is sensed. The sensation of power can lead to ego-inflation that without effort, honesty and humility can completely stop growth and lead to a warped personality.
Combined with fear, which makes movement challenging; ego-inflation could feel like a wonderful reward for staying right in one place – which would be the same as becoming psychically disabled. It would be little wonder therefore, if an egotistical MUPs was strongly attracted towards people who are disabled – but who ‘ought’ to get back into action. If this occurred it could be a projective identification with such an exquisite match that no input from the PWME is required – all they have to do is exist. In fact if they did not exist the MUPs would have to create them.
When honesty and humility are not enough to counter ego-inflation, people are sometimes helped by the astounding mistakes that can result from this warped state (though they may not always be ‘mistakes’ but unconscious contrivances; perhaps designed by the Trickster). Provided they do not wriggle out of these mistakes, they can be a powerful call to the inflated-ego to do some honest self-evaluation which restores human frailty to the ego; rescuing the psyche from stagnation and restoring the Self’s potential.
MUPs appears to be a defence. It can protect a fragile psyche from Fear, the discovery of guilt and subsequent blame and provides opportunities to project and avoid addressing inner conflicts. Because MUPs is an avoidant process it may become self-perpetuating.
© 2009 Peter Kemp