Jan 10, 2007

Independence vs. Dependence

Joe Nelson

In my practice, I’ve seen some married couples lately that remind me of my own family of origin: the man has diabetes that he controls with insulin and has great pride in his ability to deal with it without depending on anyone else, for anything. These men do not tell anyone they have diabetes unless they are forced to do so (by severe hypoglycemia, or low blood glucose levels, for example), and they believe they need little advice on managing the condition.

They usually do not inform their doctor of much and certainly do not tell their families about the wrestling matches they are having with their blood glucose control. This wouldn't be so bad if their blood glucose were actually in control, but more often than not, their control is erratic. This erratic control leaves them vulnerable to severe lows, which require assistance from others in the family.

Don't get me wrong—I am not blaming these men for their lows. I understand that using insulin puts a person at risk for lows, and that they are not fun and no one wants to experience them. What I want to discuss is the struggle between the perception of independence and the shame of dependence. I believe that this struggle leads these men and their partners to be more vulnerable to the lows and the emotional pain that comes with the fear of this traumatic event.

I recall the many times I would witness my father, who had Type 1 diabetes, during such severe hypoglycemic events. At times he would be silly and joking, at times he would be angry and hostile, and then there were the times he would convulse. In all of these situations, my mom and I knew he wasn't himself, but that didn't change the fact that we were experiencing a traumatic event, fearing that if we didn't act appropriately, he might die, and if we did act correctly, he wouldn't remember any of it. This left us scared and quite diligent about preventing any further such events. I do think that we, in some senses, were traumatized from these events, and I suspect he was also. Although we never talked about it, as I sit with couples today I see the same level of trauma and how difficult it is to regain balance.

The couples I am working with report the same types of events, though less frequent. The same dynamics tend to exist with the man not sharing much, wanting to do it on his own, and the woman in the position of guarding against the hypoglycemic events. The woman is also often hypervigilant, like someone who is experiencing posttraumatic stress disorder (PTSD). This leads to anger and fights within couples trying to figure out how to deal with something that is both physical and psychological.

As I continue to work with these couples, I wonder how many others are out there with the same types of issues. And I wonder how much of this is related to the need for independence vs. the shame associated with feeling dependent. Finally, I wonder what impact this dynamic has on the couple and on the other family members.

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