Being cared for as an infant and child is clearly of fundamental importance to our survival. Because of this, humans have evolved, through Darwinian natural selection, forms of behaviour which help to elicit care from others, particularly, of course, from the primary care-giver (an obvious example is that of the baby who will scream and cry for the attentions of his/her mother).
If, later in life, we develop a psychiatric condition as a result of our poor care in childhood, this will tend to disrupt our lives; however, it may too carry with it what are known as ‘secondary gains’ which have the effect of encouraging others to care for us. Because of this, it has been hypothesized that some psychiatric conditions, particularly those which follow the collapse of important relationships, may develop, at least in part, due to an unconscious attempt by the sufferer to elicit some form of compensatory care from those around him/her.
Examples of such conditions include :
1) Neurotic depression
3) Abnormal Illness Behaviour
4) Conversion Hysteria
5) Anorexia Nervosa
Let’s take a closer look at each of these in turn :
1) NEUROTIC DEPRESSION – this type of depression frequently follows the loss of an important supportive relationship and may include care-eliciting behaviours (eg crying). It is often the case that this will produce sympathy, concern and support from others (such as family and professionals) which can serve to reinforce the condition.
2) PARASUICIDE – this is attempted suicide which is non-fatal. Again, it often follows the ending of an important relationship. It is not necessarily a deliberate way of influencing others to provide emotional support, but in some cases there may have been an unconscious desire for the act not to be successful, resulting in a ‘half-hearted’ attempt. It is often called ‘a cry for help’, and this phrase was originally used by the psychologist Stengal in 1964.
It is important to point out, however, that many suicide attempts fail even when the person unambiguously wanted to end their own life – it must not be assumed, therefore, that a failed suicide attempt was intentionally unsuccessful.
3) ABNORMAL ILLNESS BEHAVIOUR – This was first described by the psychologist Pilowsky in 1969. It may manifest itself in the form of hypochondriasis or psychogenic pain, for example (psychogenic pain is pain which has no obvious physical cause but is generated by mental distress).
As with the previous conditions, ‘abnormal illness behaviour’ often follows interpersonal problems. It is particularly likely to occur when those close to the sufferer tend to treat him/her significantly better when s/he is unwell.
4) CONVERSION HYSTERIA – this condition was first proposed within the framework of psychodynamic theory. Essentially, it refers to the physical expression of of internal mental conflict and distress, frquently following on from the loss of emotional support.
It is thought to be especially likely to occur when the individual is restricted in his/her ability to express his/her inner mental turmoil through other channels (eg not skilled at articulating emotions and feelings).
Like the other three conditions already described, it often attracts the care and support of others.
5) ANOREXIA NERVOSA – Because the individual suffering from this condition refuses food/proper nutrition and may well become emaciated, it creates anxiety in those close to the individual and is particularly likely to elicit care-giving from both them and from professionals. This can reinforce the symptoms.
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David Hosier BSc Hons; MSc; PGDE(FAHE).