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Case History Part 2: Resistance to Getting Well

Last time I started the story of a patient I call Catherine and her chronic fatigue syndrome (CFS), a case history intended to illustrate the concept of resistance.

Now in my office for the first time, a sad Catherine asked if she could relate her story while lying down. I reviewed dozens of pages of medical history and during a physical exam found nothing notable except the pallor of a person who’d spent months indoors and the muscle wasting of someone who hadn’t exerted herself in years.

Catherine told me she was currently involved in two complex lawsuits and that I might be asked to testify about chronic fatigue and her disability.

I suggested four conventional and two alternative treatments, to be started simultaneously. My conventional approach was based on the DePaul University Chronic Fatigue Study several years ago. After enrolling more than 100 patients, researchers concluded that two forms of therapy were most effective:

  • a form of psychotherapy called Cognitive Behavioral Therapy (CBT)
  • a form of physical therapy called graded exercise

I’ll write a health tip about CBT in the future. Graded exercise pretty much speaks for itself. Day One: virtually nothing, just get up on the exercise bike. Day Two: spin the pedals twice and lift one-pound weights.

I also prescribed an antidepressant to boost her serotonin and Provigil to prevent her daytime drowsiness. The alternative therapies were Myers’ Cocktails and traditional Chinese medicine with my associate Mari Stecker.

After I handed Catherine the summary of all this (what we call a Healing Path) the look on her face suggested “Same old, same old,” even though she’d not tried any of it in the past except the antidepressant. Like a chess master, she blocked every suggestion (“I don’t want counseling.” “No acupuncture–I’m needle phobic” “I get side effects from all antidepressants.” “My insurance doesn’t cover…)

Two weeks later, she told me she tried a half tablet of Provigil (“it made me sick”) and abandoned physical therapy after two sessions (“I was exhausted”).

I’ll now press fast-forward on this seemingly hopeless case of a non-fatal illness that looked like it might go on forever. It was quickly clear that there was no place for medicine in Catherine’s recovery process. There would never be a pill, gentle exercise program, or acupuncture needle that would solve everything.

In my view, Catherine unconsciously was trying to accomplish two goals by not taking any steps toward resolving her illness. First, there was the issue with her father. She never revealed, or simply had repressed, what happened between them after her mother died. But now he was spending the last years of his life supporting her, physically and financially. The man had no life of his own.

Second, by developing an “untreatable” chronic illness, Catherine allowed herself to exit gracefully from a career that had been completely wrong for her. She was never meant to tolerate the incredible pressures she placed herself under. Her mind and body screamed OUT! and all systems collapsed.

You can see how Catherine’s case exemplifies resistance, which Freud emphasized was an unconscious but definitely counterproductive defense maneuver. There’s no blame anywhere here. Sadly, Catherine’s years are drifting by, she a professional patient, her father her purse-carrier.

Is she a hypochondriac? Definitely not. She is genuinely exhausted, and getting worse as her muscles progressively deteriorate from inactivity.

You might wonder how I continue to try to help patients like Catherine. The answer is “gingerly.” Tiny steps, a little at a time. Do I ever confront a patient about resistance? Almost never—they have to sense it in themselves.

What finally happened was that Catherine’s father died, and most of her disability money came through. Her health insurance was now covered by Medicare. She inherited her father’s condominium and some money. Not enough for a lavish life, but her cost of living is very low. She “gets by.”

Catherine has a new relationship these days with a nice enough fellow who drives her to her support group meetings and spends hours with her on the internet reading about the latest developments in CFS. Catherine’s health is virtually the same, but she does go out to the occasional movie, took a beach vacation last winter, and now is able to sit up during her visits with me.

Next time: more on Sigmund Freud’s idea of resistance.

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