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Where Does Compulsive Caregiving Come From?

Compulsive caregiving case study: Margaret and Matt (Part 2 of 3).

Our collective experience as clinicians shows that the need for tightly controlled irrelationships began to develop in early childhood in response to a perception of “environmental” threats to our personal well-being and safety. Since a small child’s environment is almost entirely the caregiver (usually his mother) and conditions closely connected to the caregiver, a disturbance in the caregiver translates into a threat to or himself. To continue to feel safe, the child will do anything he has to do to make his caregiver feel better so that he feels better. This is the birth of compulsive caregiving—irrelationship style.

Based on this dynamic, reversing roles and substituting caretaking for the missing caregiving, the caregiver and child unconsciously develop a pattern of relating that quickly become rules by which they operate. For the child, these relational rules become his environment and the primary condition for safety. Naturally, he internalizes the rules so that they determine how he relates to the world as he goes through life, usually without his realizing it.

Some of the unwritten—unstated, unadmitted, and often unknown—rules of compulsive caregiving require ignoring and repressing pain, as in the case of the child who learns “never ask for anything.” This was the case with Margaret, the performer in the previous example, whose job it was to make her mother feel better as a child. Her compulsive caregiver role (we’ve called it human anti-depressant) carried over from childhood, and she now feels compelled to make any would-be partner feel better (no matter what his actual condition, emotional or otherwise). That’s how she kept the world (i.e., her mother) from falling apart when she was a kid; that’s how she kept her heart safely out of range from being hurt and disappointed as an adult—in irrelationship.

“My parents are never wrong” was the anthem that drove the routine developed by Matt. Matt is the man from the previous example who, unbeknownst to Margaret (and only vaguely aware of it himself), was sick of his own tried and true typical song-and-dance routine (in the audience role). Breaking the irrelational rules, he was looking for a real adult—give-and-take—connection. His was a routine developed to make his neglectful parents feel like their parenting was effective (in a very general sense). And it left him, as the audience role tends to do, with feelings of emptiness, loneliness, and anger. Though he’d be hard-pressed to admit it, his compulsive caregiving left him feeling ignored.

However, since the child fears abandonment more than anything else, both Margaret and Matt developed routines to stave off the anxiety of being rejected and left all alone. The compulsive caregiver is the child who “goes along to get along,” to feel safe. This is the birth of the song-and-dance routine, the behavior that sadly carries into adulthood and creates the routines that result in what we have referred to in the previous entry as a “straightjacket built for two”—that is, a relationship that serves as a defense against relationship. More specifically, an irrelationship that protects those within against the anxiety that comes along with compassionate empathy, intimacy, emotional risk, and emotional investment.

In some cases, the rules demand more. When Margaret perceived negative emotions in her mother such as sadness or depression, she took on the role of cheering her up. When Matt’s parents seemed worried or fearful, he learned to hide his own anxiety even from himself. When his mother lacked confidence in herself, Matt reassured her with his own “abilities” and “achievements” even to the point of performing “self-care activities” inappropriate for a small child. When his father was insecure about being able to provide security, Matt suppressed his need—and desire—for a competent role model. To do so, he developed elaborate —though clandestine (so as not to hurt anyone’s feelings, or esteem)—caretaking routines. In so doing, he reassured his father and mother that “everything’s OK.”

Ultimately for Margaret and Matt, developing caretaking routines that would get their parents to take—or even fake—some minimal kind of care (if only an unconscious agreement to not reject and abandon them) became the definition of love.

Next we’ll go back to find out what happened—is happening—with Margaret and Matt.