Through the process of reading and analysing the comments and data and exploring the literature I sometimes found myself criticizing and blaming diverse people and groups for their attitudes, ideas and actions, and the hurtful affect these have had on some respondents and other people with M.E. One respondent remarked:
I do not feel that therapy can help me with my illness, except possibly to help me deal with the anger and disdain I have for the political football this illness has become.
The meaning of this for me is, "something is wrong - so who or what is to blame?" I believe that blaming can be an instinctive response to a loss or suffering, and may be an inevitable aspect of illness or injury, just as anger may be an instinctive response to loss (see p.41). If the cause of suffering or loss can be identified, 'named', then this conveys a sense of understanding the nature of the problem and some control over the suffering. Chetwynd (1998 p.344) observes, 'Naming is always a symbol of becoming conscious of the exact nature of whatever is named.' Correctly identifying the cause of suffering might mean that steps can be taken to eradicate or reduce the pain and as importantly, avoid the same cause of pain in the future. This could relate to basic and instinctive survival adaptations which mean that blaming (or attributing) is a normal response to suffering. (A child who does not learn to blame the hot kettle for burning its fingers is likely to suffer many burns.)
It is interesting to note that while Bowlby considers anger a perhaps inevitable response to loss he seems to regard blaming differently and tends to explain it socially (1998, p.128), as psychopathology when misdirected or seeking to divert blame (p.146; p.238), or circumstantially (p.289; p.358). In many instances when a person dies the cause of death is known and can be attributed. When people die in circumstances that are not satisfactorily explained then there appears to be a problem with blaming and creation of scapegoats can occur (pp.184-185; p.358). It is bereavement in such circumstances that perhaps correlates to what some people with M.E. experience, and is further complicated by the fact that the 'lost person' is sometimes actually recovered - as with those people who substantially or fully recover from M.E. Bowlby remarks of those bereaved through suicide (1998, p.184):
Relatives and neighbours, instead of being helpful, may shun them and overtly or covertly hold them to blame. For their part the survivors...are tempted to challenge the verdict, to suppress or falsify what happened, to make scapegoats of others...
Blaming can become a problem when attribution is inaccurate or no suitable object can be discovered to carry the blame. In such instances the instinctive drive to blame is frustrated and could result in irrational blaming - creation of a scapegoat. The person who is suffering is in an existentially precarious position, the cause of the suffering cannot be rationalized or altered and failure to learn what has caused the pain means that it cannot be avoided in the future. Additionally, the person in pain cannot justify or validate their behaviour to others and this makes them vulnerable. Others might accuse them, become angry or make them a scapegoat if their behaviour cannot be validated. This is a position that some people with M.E. seem to find themselves in. Illness and disability has sometimes devastatingly affected sufferers lives, yet the cause is unknown and no suitable object can be blamed. When a person states that they have M.E. this does not always explain their incapacity or provide legitimacy to their suffering - rather, it sometimes raises doubts and scepticism about attribution, due to the unknown causes of the illness.
The drive to blame (or attribute) might represent an overriding gestalt, i.e., 'I must discover the cause of my suffering and take control of it,' and 'I must recover and get my life back'. Identifying and understanding the cause of the problem could mean that the possibility of eradicating the problem can be examined, or a decision can be made about accepting and adapting. A person with M.E. can be driven by loss and suffering, and constantly strive for relief in the form of improvement or recovery. All other needs and wishes might occur within this overriding gestalt, generating constant tension. A grieving process and the development of a 'new sense of the normal' (Clarke & James, 2003; see p.37) appear be the main processes in resolving the constant struggle. When recovery does not occur, these processes could dissolve the irresolvable gestalt. Grieving for, and relinquishing (sacrificing) the old self and developing a new sense of self can mean effectively that - I am no longer a person who is suffering due to unknown causes that demand that I identify the cause and blame. Rather, I am who I am, in the here and now, with my own self-defined and self-accepted experience; not the person I was one year or twenty years ago who is being threatened by illness. A respondent with M.E. wrote:
The reason why I feel I do not need counselling is quite simple. I do not need it now, but certainly needed it several years ago when this was a new, and at that time an unidentified illness with me. Over the course of time I have learned a great eal as well as becoming quite self sufficient. The help I need now is of a practical nature rather than an emotional one. Emotionally I have already come out the other side, sadly this is not the case physically.
Achieving emotional adaptation to disability does not mean that hope need be abandoned, rather that hope could take on a new meaning and no longer represents a compulsive struggle to recover the 'lost person'. Recovery might no longer represent an essential condition, neither would blame be essential to restore safety. Improvement or recovery could be seen as growth and welcome change but are not essential for a fulfilling existence. Donoghue and Seigel (2000, p. 77) remark:
… you can hope for an increased capacity to cope with your illness. You can hope to learn new ways of accomplishing tasks despite fatigue and pain. You can hope to accept your illness more graciously. You can hope for patience and for growth in those qualities that make us more human…
People with M.E. sometimes appear to be blamed by others for their illness. Words such as 'malingering', 'yuppie flu', 'hysterical', occur in the literature. It seems to be sometimes implied that people with M.E. could recover if they pull themselves together, show more moral fibre and correct their thinking and behaviour. What are the implications of such attitudes for the people with this illness? These could equate to false accusations against which the sufferer has no defence to exonerate their behaviour and validate their experience. Carl Jung experienced being the subject of a false accusation, when he was at school a teacher accused him of copying an essay. Jung (1995, p.83) wrote:
Vainly I swore my innocence. The teacher clung to his theory…
My classmates threw odd glances at me, and I realised with horror that they
were thinking, "Aha, so that's the way it is." My protestations fell
on deaf ears.
I felt that from now on I was branded, and that all the paths which might have led me out of unusualness had been cut off… How in the world could I possibly prove that I had not copied the essay?
For days I turned this incident over in my thoughts, and again and again came to the conclusion that I was powerless, the sport of a blind and stupid fate that had marked me as a liar and a cheat.
The modern world is full of stories of false accusations. Soap operas, films, documentaries and news stories frequently feature true and fictional themes based on false accusations and the social exclusion and stigma that they cause. In the past, illnesses that had no known cause could be blamed on divine punishment, evil spirits, witchcraft or humours, but today there appears to be a general assumption that if medical science cannot find out what is wrong with you, then quite simply, there is nothing wrong with you. Interestingly, many scientists and doctors do not hold such beliefs, their research continues. It has been seen in some comments from respondents that time has been spent in their counselling explaining and justifying their illness, apparently trying to convince the counsellor. Such dialogues are unlikely to be helpful and they might establish the counsellor as a sceptic and a false-accuser. A concept in some approaches to counselling is to help a client to lower their defences and this is not likely to be accomplished if the counsellor represents an attack on such defences by questioning the validity of the client's experience. Jacobs (2000, p.100) remarks:
The second way in which the counsellor shows respect of defences and resistances is in the way they are confronted. Meeting a defence head-on often leads to the strengthening of the defence, and to further resistance.
Counsellors working with client's who have M.E. may need to be aware of their own blaming instincts. A counsellor working empathically and with deep understanding is in some ways sharing in the experience of the client's suffering, experiencing pain from which there may be no escape and for which there is no attributable cause. The counsellor might feel powerless, inadequate and invalidated in their role. In such work a counsellor might want to blame, to gain some power over the suffering, and this could result in the counsellor making the client a scapegoat for their discomfort. The Penguin Dictionary of Symbols (1996, p.832) states:
Individuals are termed 'scapegoats' in so far as they are charged with the crimes of others without being able to appeal to justice, offer anything in their defence or be lawfully condemned. … It stands for the deep-seated human tendency to project one's own guilt upon someone else, thus appeasing one's own conscience which always requires some victim to bear responsibility and punishment.
It has been remarked earlier that some people with M.E./CFS can experience 'moralizing' of others. This is a defence that some counsellors might be tempted to use and could represent a way of blaming. Donoghue and Siegel (2000, p.100) warn:
The moralizing therapist conveys to the patient that if one has faith, then illness and its attendant problems will be overcome. If one changes lifestyle and does what is "good" and "correct," the disease will be reversed or halted. The harmful implication, of course, is that patients who do not get well are either sinners or deficient in some way. The moralizing therapist uses the stance to protect against uncertainty and the onslaughts of disease and death.
Some clients with M.E. might have to go through a process of struggling to blame something or someone for their suffering and loss, this could be an inevitable stage in adjusting, just as with grief (Bowlby, 2000, p.51):
Only after every effort has been made to recover the person lost, it seems, is the individual in a mood to admit defeat [isn't this a victory?] and to orient himself afresh to a world from which the loved person is accepted as irretrievably missing.
For the counsellor supporting a client through such a process the work could
become frustrating, and a counsellor's attitude could become - as seen above
(see p.42), 'accept your limitations and move on'. A client might present for
counselling because they want some relief from their suffering. If the work
is perceived as failing to provide such relief, or for other reasons, a client
might tend to blame the counsellor - and a counsellor needs to be able to withstand
the affects that such blame could have on them.
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