The Dependency Curve – Guest Post from Dr. David B. Adams

This Week’s Topic: “It’s Curvilenear”

Question: “He clings to me, then resents me, then begs me and then rages against me.”

Dr. Adams replies: ”We enter life entirely dependent aside from vegetative functions. We cannot exist on our own, and this characterizes most living species.

We oft-times terminate our existence by returning to that same position, reliant upon others for the same functions that we had learned to perform independently so many decades ago. It is the curvilinear shape of dependence.

We learn to ambulate, communicate and negotiate our world in stages and steps that enable us to function as separate beings, and, in turn, we then rear our offspring to do the same. This is how society exists and advances.

There are obstacles and trauma that require us to briefly regress to deal with illness and injury, loss and disappointment, but in all cases we return to that path of autonomy.

We marry and become interdependent. We allow others to manage most of our lives and become passive-dependent. We become addicted and co-dependent. We resent those upon whom we must rely and become hostile-dependent.

An injury may require an acute period of return to dependency. We call upon emergency medical services, rely upon primary care, must defer to hospital policies, and for the most part we become conditioned, helpless to the point that we cannot even remove our own sutures (sidebar: Unless you are married to a nurse, but that’s likely off-topic).

Injury becomes a struggle between the inherent need to be independent and the concurrent and often pressing requirement that we temporarily accept our dependent role. This will include passively accepting our providers, their schedules, their treatment approach, as well as the consistency/inconsistency of receipt of benefits. Since this most often is in sharp contrast to how we existed only seconds prior to injury, this is arguably the greatest trauma of all.

For some patients, dependency is a characterological flaw. It is a personality defect awaiting expression. It may have presented multiple times during the patient’s history, times to which we are not privy. But the chronically emotionally dependent patient becomes a challenge in case management.

Those assisting the chronically dependent patient become the target of neediness, resentment and fear. The role must remain clinical and, to some degree, sterile in order to address objective damages. The dependency may be emotionally catastrophic for some patients, but it is not often addressed during the course of injury care.

It is essential to recognize that the dependency arising after injury is either something that the patient finds aversive or something to which the patient too readily acclimates.

An injury can be catastrophic to the point of complete and permanent inability to attend to the Activities of Daily Living. In all other instances, the goal from the outset must be a return to whatever level of independence can be achieved. Thus, the inpatient healthcare team includes discharge planning and goals in their initial assessment upon admission.

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