The surprising reason why some chronic pain patients act like they don't want to get better—and how to help them.
While many chronic pain patients are desperate for relief, medical professionals quietly agree that a certain fraction of patients tend to self-sabotage their treatments—almost as if they don’t really want to get better.
Psychologist Tobi Fishel guesses that around 20 percent of her patients show self-sabotaging behavior: they might make appointments to complain about their pain, but never follow-through with the exercises or treatments that could help improve their quality of life.
Fishel says it doesn’t appear to be a conscious behavior—she doesn’t believe the patients are malingering or fabricating their illness. But, she thinks, they may have a deep emotional attachment to their pain—such as a childhood where the only time they received attention was when they were ill.
“It’s not that we want to be sick, it’s that we want to be cared for and loved,” she says.
Patients, especially women, who struggle with their recovery can be brushed aside by health care providers, says Jo Anne Dahl, psychologist and author of Living Beyond Your Pain.
“Just generally, if you don’t get well from pain, the health care system tends to shun you and you can even get blacklisted,” she says. “You get to be known. They start talking about you as a difficult person. It’s even implied that you’re pretending—you’re making this up to get [workers comp or disability benefits]. There are a lot of insulting ways that they’re treated, and these patients definitely feel that they’re not being taken seriously.”
Dahl believes that “very, very few” of the patients she sees would consciously try to keep themselves in pain. But, she adds, the very experience of living with chronic pain can erode a person’s will or ability to help themselves.
“For most people, once you get into an avoidance circle, it’s hard to get out of it,” she says. “I think you lose this feeling of self-efficacy.”
Treating patients who self-sabotage can be a long journey, but it is possible, says Fishel. Mindfulness training can help the patient become aware of their unproductive behaviors, allowing them to make different choices. Fishel and her staff also help the patient create realistic goals, and give the person lots of positive reinforcement for making even small steps forward.
“That moves people in the direction of feeling like they can feel really good and loved when they do things to take care of themselves,” she says.
She says many physicians get so frustrated trying to treat self-sabotaging patients that they eventually refuse to see them anymore, believing the person doesn’t really want to get better.
“I don’t believe in that philosophy,” Fishel says. “We know that everyone, on some level, wants to get well, otherwise they wouldn’t have walked through our door.”
Learn more about chronic pain, including new research into groundbreaking mind-body therapies, in "A World of Hurt", our in-depth report in the May/June issue of Spirituality & Health, on newsstands now.