Is Your Medical Problem Really A Marital Problem?

*My partner Jeffrey Rediger, MD, MDiv was supposed to be delivering a TEDx talk about the topic of our next book together last week, but the tech outage that disrupted flights for days made it impossible for him to get there. So…because it was an idea worth spreading- and now it’s not happening, I wanted to publish the script for that TEDx talk here. If you’re interested in Jeff Rediger’s book CURED or wish to subscribe to his newsletter, visit him here. We’re also teaching a weekend Zoom workshop Healing Attachment Wounds In Relationships, as well as a live, in person retreat for health care providers and therapists in transition in Mill Valley, CA, Transitions & Transformation.

Anyway, here’s the TEDx talk he didn’t get to give!

What if your medical problem was actually a marital problem? Or maybe a problem with your oppressive parent or your narcissistic boss? Likewise, what if your psychiatric problem was a completely natural reaction to being treated in dehumanizing ways by someone who doesn’t see you as a whole, valuable, equal person?

Has it ever occurred to you that your medical or psychiatric symptoms could actually be more of a relational problem than a biological problem? It certainly never occurred to me when I was serving as a medical director of Harvard’s McLean psychiatric hospital while also the Chief of Behavioral Medicine at Good Samaritan medical center in Boston.

When a Harvard student with bipolar disorder was admitted to McLean, it never occurred to me to wonder whether that person’s symptoms were related to the controlling behavior of his perfectionistic father. And when I was rounding on a woman with cancer on the medicine service, I never wondered whether her immune system might have broken down because she was being oppressed by a narcissistic spouse.

But that all changed after circumstances forced me to face at a deeper level what it meant that I’d grown up in a cult. Our parents distorted the teachings of our church and used them to justify child abuse, as a way of breaking the will of their children.  Because of that indoctrination, I wound up as an adult under the thumb of an oppressive relationship that left me with mental and physical health struggles of my own and caused me to lose almost everything I’ve ever valued.. As part of my deprogramming and recovery,  I started studying attachment trauma, narcissistic abuse, coercive control, spiritual bypassing, and the nervous system and physical health ramifications of oppressive relationships.

That’s when I realized that people suffering from acute psychiatric crises might be having a completely normal reaction to being controlled, oppressed, gaslit, and then scapegoated as the “identified patient” who was acting out because of what was happening at home. And those admitted to the hospital for medical reasons might be suffering from the chronic nervous system dysregulation and immune system impacts of narcissistic abuse.

I’ll never forget the first time I realized that a brilliant patient of mine was not the disturbed, mentally ill young man his parents insisted he was. He was doing the most mentally healthy thing he could possibly do – resist the oppression, and refuse to be dominated by someone who thought they had the right to override his human rights and individual autonomy. He was fighting for his own agency, in spite of all the forces trying to break his will. Yes, it was messy, and yes, he had symptoms, but this is the deeper, hidden story of what was going on.

I realized that at the deepest level he wasn’t really mentally ill. I also realized that coming from a low caste in India had done a number on his self esteem. Not only was he reeling from the oppressive influences of his domineering father; he was also dealing with a lifetime of being told he wasn’t equal to those in the Brahman class. He was less than.

He had resisted the idea of medication because in his view taking medication confirmed that he was the problem. I could see that he was so much more than his diagnosis. In a flash of insight, I realized that his father was sicker than he was. His father was the one who needed to back off, to let his son get a real life. To give him a chance to flourish – on his own – as an American immigrant trying to find his own way, against all odds.

Surprisingly, when I said this to my young patient, his eyes lit up, his shoulders relaxed, and it became clear that nobody in a position of authority had ever had his back and taken a stand against his oppressive father. I also initiated a heart-to-heart conversation with the person in his life who was oppressing him the most – his father. His father surprised me by being willing to listen to what I had to say. That doesn’t always happen. He thought he was helping his son by exerting so much control over him.

When I suggested that he might be the cause of his son’s psychiatric symptoms, I could see remorse wash over him. It turns out that the same thing had been done to him when he was young. And he had suffered the same issues of being from a low caste. My young patient then became willing to take the medication he had been refusing because he saw it now as an opportunity to enhance his life rather than as capitulation to being the identified patient. Sometimes, with these kinds of interventions, medications are no longer needed.

It’s not just psychiatric illnesses that helped me start looking at patients through fresh eyes. Over time, I started to see how the nervous system keeps the score for medical patients as well. How the body’s nervous system can become dysregulated and therefore disease-prone under the burden of narcissistic abuse. I first noticed this during the 17 years that I researched people with medical evidence for remarkable recoveries who surprised doctors by actually winding up cured. One story I heard over and over from people who had unexpected cures was the story of mild-mannered, kind and accommodating people-pleasers who had often spent their entire life accommodating someone powerful, overbearing, demanding, entitled, and narcissistic. Someone who wasn’t so interested in accommodating their needs once they got sick.

Faced with cancer, an autoimmune disease or chronic pain, some of these patients woke up. They finally took a real stand and started standing up for themselves, fighting back, pushing for their own liberation as if their life depended on it, which, often, it actually did. Some of them developed what one of my patients called a “selfish bitch project.” What she had been taught was selfish was actually authentic self-care. She is convinced that this played a critical role in her recovery from breast cancer.

I don’t have time today to make the scientific case for you that links oppressive relationships to medical and psychiatric illnesses, but my partner Lissa Rankin, MD and I are writing a book about it. So you’ll have to trust me that the neuroscience is solid, and this is not just conjecture.

But I do have time to let you know your rights.

YOUR BILL OF RIGHTS

1. You have the right to control you. You do not ever have the right to control someone else, even if it’s your child.

2. You have the right to protest and resist oppression.

3. You have the right to act out if nobody is listening.

4. You have the right to not be treated or perceived as “less than.”

5. You have the right to boundaries.

6. You have the right to bodily autonomy.

7. You have the right to press charges.

8. You have the right to say NO.

9. You have the right to a life of pleasure and genuine connection with others.

10. You have the right to have doctors and psychiatrists who better understand all of this.

Which leads me to wonder. What if we started getting curious about our psychiatric and medical patients and screened them to see if they were having an understandable reaction to being oppressed? What might be possible then?

*On September 14-15, Lissa and I are co-leading a weekend Zoom workshop about healing attachment wounds, as support and education, but also preventive medicine, for the partners and loved ones of people with severe attachment trauma, who might create a lot of relational stress for their loved ones, through no intentional fault of their own. We invite you to join us!

Learn more and register here.