Pitfalls of the "Sick Role"

I'm on the road to recovery, but I still want the attention I received from being sick.

This confession, made by a client in total candor, has always remained with me. It is honest and straight to the point. We all want attention, or love, or at the very least a symbol of concern. For many people, if we receive any attention at all it is usually when we are in emotional pain or physical illness. As people start to recover from a life threatening illness (or any illness for that matter), they usually place their main focus on getting well.

Wellness and the appearance of being well also can sometimes go hand in hand. Family, friends and peers can see you as well and treat you as such. There are no longer the worried looks, the hushed tones of concern, or conversation aimed to make you feel better about your situation. During that time you were understandably getting an extra measure of care, understanding, sympathy and, for some, a show of visible love. This attention may have come not only from your supportive circle of peers but in some cases from your former employer, and indirectly from the city, state and federal government. Psychologists, social workers, case managers and agencies may have also filled your life with appointments and services, which may have given you the resources to live.

If the people who worked with you to receive those services were mental health professionals, I would hope they were more caring and thoughtful than the people in the supermarket or at your bank or in the world of hard knocks. Sometimes people begin to view mental health professionals as their personal friends because they attempt to help them in many ways. However, they shouldn't be viewed as friends, they are people doing a job that they are trained to be good at. Naturally when you are no longer ill, they may move on to others who need them and may disappear from your life.

Given this background, it is not unreasonable to wonder what you maybe losing as you continue to gain your health back and run the risk of losing all these "payoffs." I certainly have worked with children who have created accidents and sicknesses to receive positive attention. The payoffs for these children are a warm bed and power over the TV remote and the telephone, while their parents cooked and fed them. Does injury and illness always work that way? Do we learn that illness equals loving attention when we are young?

Some psychologists theorize that illness can be, in part, a conscious creation. In the case of an adult with a life-threatening illness, there may be concerned friends, parents, social services agencies, and others who unknowingly contribute to the illness by developing a structure that makes the person more dependent on them. By losing independence, some may develop a love of being dependent and a continued attraction to being in the "sick role", something we all may have learned in childhood.

But what are some of the payoffs for the person in the sick role? Attention, sympathy, protection, martyrdom, control, manipulation, closeness and avoiding responsibility. What can a person gain by leaving the sick role? A sense of strength, accomplishment, independence and control over their illness, although for some there maybe also a sense of loss.

For the person who is losing the illness and gaining strength in being well, with that gain can come -- for some and just for some -- anger as they lose positive attention for being ill. With no attention to replace it, the former "sick" person is just another person. Some people can get their former attention back by throwing tantrums and making demands. When they don't get what they want, they get angry since that sometimes gets them the focus and attention they want. This misbehavior is to get attention, and sometimes even negative attention can be better than no attention at all. We all have to wait in lines and many things take time, but sometimes screaming and yelling do attract notice and sometimes do get quicker attention. But when a person goes through life causing problems just to be noticed, what is the payoff over the longer term?

I'm not saying that you, the reader, necessarily play the sick role. But you might want to take an honest look at what you're getting, or seem to be getting, from whatever negative thoughts, feelings or physical manifestations you put yourself through. If you want positive attention or negative attention, or just plain non-stop attention, that's a good thing to know about yourself. If you can find a way to get all the attention you want without having to go through all the negativity, wouldn't that be a lot easier? There is a simple way of getting payoffs directly, ask for them. "Would you please give me some attention?" "Could I please have some support?" "Tell me you like me." Yes there is rejection involved and you might not get the payoff. However, we all want you to get better and to leave the sick role.

J. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and will periodically write the "Psychologically Speaking" column.