A glance at Family Rules Okay: Becoming Whole Without the Need for Approval (Hudson, 2023) makes it evident that the text is alluding to the psychological challenges that may emerge from a demanding and emotionally manipulative parent-child relationship. The book then highlights the potential effects this may have on an individual, even into adulthood. From a psychological perspective, this kind of interaction could foster a multitude of mental health issues and cognitive distortions.
For example, when we look at the following statement from mother to child in a dysfunctional relationship:
“If you loved me then you would know how to make me happy”?
The child could be trapped in a “mind read” where they have to guess, create or invent what they feel the other person is feeling. One might begin to think that the child is being indoctrinated into a delusional disorder. Here are some of the possible constructs the child may make:
- Survival depends on loving my Mother.
- Mother doubts that I love her therefore survival is threatened.
- I should know what my Mother needs to make her happy so that I can survive.
- I don’t know how to make Mother happy, therefore I must not love her, and survival is threatened.
- I must do something to make Mother happy to survive.
- I have done something, and Mother is still not happy, so I must do nothing to see if that makes her happy and survive.
- I thought I loved Mother but if Mother is still unhappy then I mustn’t love her so I can’t trust my own feelings to survive.
- I can’t do right for doing wrong!
Let’s develop this a little further. Chronic pain is, in itself, a multidimensional experience which often overlaps with emotional and psychological distress. The role of the environment, past experiences, and psychological factors can play a significant role in one’s perception of pain and their coping mechanisms. Let’s expand on the text in the context of chronic pain, as well as draw from psychological principles:
- Attachment Theory and Chronic Pain:
Based on attachment theory, children develop attachment styles depending on the responsiveness and availability of their primary caregivers. A mother, in this case, who constantly questions the child’s love and sets uncertain conditions for acceptance, may contribute to the development of an anxious or disorganised attachment style in the child. In adulthood, this can manifest in the form of heightened anxiety, difficulty trusting others, and a constant fear of rejection or abandonment. Chronic pain patients with such backgrounds may find it harder to seek and accept support, fearing that they won’t be understood or that they’ll be a burden (see Meredith, 2016)
- Cognitive Distortions:
The mother’s statement, “If you loved me then you would know how to make me happy”, is an example of emotional blackmail and can inculcate cognitive distortions such as ‘mind reading’ and ‘all-or-nothing thinking’ in the child. For chronic pain patients, such distortions might manifest in thoughts like “If I can’t manage my pain perfectly, then I am a failure” or “Others can’t possibly understand my pain.”
- Learned Helplessness:
The repeated trials and errors, as the child tries to please the mother, can lead to a feeling of helplessness. This concept, known as “learned helplessness,” is when an individual feels powerless to change their situation despite their efforts. For chronic pain sufferers, this can manifest as a belief that no treatment will help or improve their condition.
- Uncertainty and Chronic Pain: Uncertainty in childhood, as created by the mother’s inconsistent demands, can foster a heightened sensitivity to uncertainty in adulthood. Chronic pain, by its nature, is often fraught with uncertainty regarding its cause, progression, and treatment outcomes. For someone with a history of emotional manipulation, this uncertainty can be especially distressing and may exacerbate their pain experience.
- Triggers and Pain Flares:
The term emotional memory image “EMI” (Hudson and Johnson, 2021, 2022, 2023) refers to an emotionally charged memory or trauma. Encountering situations that evoke uncertainty or resemble past traumas can act as triggers, re-engaging the individual with distressing memories or emotions. For a chronic pain patient, such emotional triggers could also precipitate pain flares.
- Avoidance Behaviour: The point about the patient being “adverse to changes that have uncertain outcomes” can be likened to avoidance behaviour. Avoidance can be both emotional (avoiding feelings or memories) and physical (avoiding certain activities or situations for fear of pain). Over time, this can restrict the patient’s life and further reinforce their pain experience.
To summarise, a manipulative and emotionally uncertain environment in childhood can lay the groundwork for various psychological challenges in adulthood. When combined with the inherent uncertainties and challenges of chronic pain, these foundational issues can compound, making the pain experience even more complex and difficult to manage. Effective treatment for such individuals may need to address not just the physical aspects of pain but also the emotional memory images, which drive psychological traumas and mental distortions. If an an individual finds themselves “people pleasing” or overly compliant then there may be a Family Rule at play, which will impact health and wellbeing.
Meredith, P.J. (2016). Attachment theory and pain. In J. Hunter & R. Maunder (Eds.), Improving patient treatment with attachment theory (pp. [specific page range if provided]). Springer. https://doi.org/10.1007/978-3-319-23300-0_5
Hudson, M., & Johnson, M. I. (2021). Split-Second Unlearning: Developing a Theory of Psychophysiological Dis-ease. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.716535
Hudson, M., & Johnson, M. I. (2022). Definition and attributes of the emotional memory images underlying psychophysiological dis-ease. Frontiers in psychology, 13, 947952. https://doi.org/10.3389/fpsyg.2022.947952
Hudson, M., & Johnson, M. I. (2023). Past Adversity Influencing Now (PAIN): Perspectives on the impact of temporal language on the persistence of pain. Frontiers in Pain Research, 4. https://doi.org/10.3389/fpain.2023.1244390