Lawrence D. Blum M.D.

Beyond Freud

Counterdependency and American Health

Counterdependency prompts postpartum depression, the opiate crisis, social rifts

Posted Aug 12, 2020

Counterdependency is an important psychological defense mechanism and a form of adaptation highly valued in American culture. It has major influences on mental, physical, and societal health. 

The essence of counterdependency is the need to deny that one wants to be taken care of. Typically, it involves efforts to show that one does not need to be taken care of, that one is self-sufficient, and, often, that one can take care of others.

American culture, which valorizes personal independence and self-sufficiency over interdependence, is steeped in counterdependency, with a wide range of far-reaching consequences. I will comment briefly here on the role of counterdependency in postpartum depression, the opiate crisis, the gaps in our social safety net, and our tolerance of extraordinary wealth and income disparity.

Postpartum Depression

I have observed that counterdependency is a frequent contributing factor in postpartum depression (Blum, 2007). When a woman is disposed to handle everything herself and can’t allow herself to ask for help, she may capably handle a job, home, and many other responsibilities, but when a baby arrives, the counterdependent, accept-no-help orientation becomes impossible to sustain. Moreover, in a culture that emphasizes self-sufficiency and isolated nuclear families, help is unlikely to arrive unbidden.

Such women, who often have been quite successful and have no history of depression, can become depressed and incapacitated very quickly after a baby arrives. If their conflicts about asking for help are addressed, and they can allow themselves to ask for and accept help, they often recover remarkably quickly.

These clinical observations have recently been bolstered by a study that my colleagues and I have conducted in which we present empirical evidence for the contribution of counterdependency to postpartum depression. The study was published online in Psychoanalytic Psychology and is due in print shortly (Blum et al, 2020).

The Opiate Crisis

This denial of wishes to be taken care of also contributes to our opiate crisis. If people’s economic prospects have declined (as they have in areas where the opiate crisis has been greatest), and they feel sad and fearful, they are likely to long to be taken care of. Some people, if they can’t allow themselves to voice this wish or need, will experience their emotional pain as physical pain, which becomes an acceptable avenue to seek care, and drugs become the tokens of care as well as a means to quash both the pain and awareness of the intolerable wish for care.

This is one reason why the United States, with less than five percent of the world’s population, is responsible for about 80 percent of global opiate consumption. We are extremely inclined to deny dependency, or wishes to be taken care of, and equally adept at finding ways to be taken care of without asking for it. American objection to acknowledging wishes to be taken care of (dependency conflicts) is also a major reason why in all of the vast amount that has been written about the opiate crisis, the psychological factors mentioned here are rarely if ever considered.

The Gaps in Our Social Safety Net

The counterdependent attitude, that one should do everything for oneself and not need or ask for help, has far-reaching social consequences: No other developed country does as little to help new mothers or hungry children.

The programs that form our basic social safety net, such as Social Security, Medicare, and Medicaid, were all initiated over intense opposition. The Tea Party movement showed how many Americans oppose the very idea of government assistance to those in need. But Tea Party members also sought to maintain their own subsidies, and similarly, many of the states whose people most strongly oppose social programs are states that are the most heavily dependent on federal subsidies.

Wishes to be taken care of must be denied, even violently opposed, but are always secretly still present. The hyper-emphasis on self-sufficiency appears also to contribute to the United States’ failure to contain the coronavirus.

The Income and Wealth Gap

I believe that American counterdependency also affects our moral compass, and recognition of this helps to solve a puzzle. How do we understand that numerous politicians routinely propose to balance the federal budget by increasing tax benefits to the wealthiest while decreasing aid to the poor and sick?

The answer is that if neediness is scorned enough, it is regarded as a moral failing, a sin, and the needy thus do not deserve our sympathy or support. The rich are not needy, and therefore morally better, deserving of our beneficence. Related dynamics contribute to racism: Neediness we deny in ourselves is projected onto others, especially minorities with darker skin, who are then regarded with contempt. 


Given the evident contribution of counterdependency to such a wide array of health and societal problems, it merits increased recognition and study. A tempering of our overuse of it, with greater acceptance of wishes and needs to be taken care of, as well as more emphasis on interdependence instead of only independence, might lead to a healthier, happier society.


Blum, Lawrence D. (2007). Psychodynamics of Postpartum Depression. Psychoanalytic Psychology, Vol. 24, No. 1, 45-62.

Blum, L.D., Horenstein, A., Carper, M.M., Stange, J.P., Cohen, J.N., Doyle, A. & Smith, V. (2020). A New Instrument to Assess Counterdependency, Evaluated in the Context of Postpartum Depression. Psychoanalytic Psychology, Published online June 25, 2020, .