A Rejection Complex

A rejection complex was a bugbear that I struggled with for many years, stemming back to my earliest years. Its claws gouged deep wounds in me that I feared would never heal. Here is a poem I wrote recently about part of my decades long struggles with it.

Twisting Roots
Winding,
twisting roots
have ensnared me.
I am weary,
a beast burdened by
the weight
of past hurts.
To protect myself
I create
the Golden Rule:
“I must never reach out,
I must hide my heart,
for I cannot risk
being rejected again.”
I withdraw behind
these lifeless walls.
Safe, yet
without hope.
Empty.

Time passes,
I question why
I have such little faith.
Nothing ventured,
nothing gained.
So I tear down
those walls I built.
And like a toddler
taking his first steps,
I venture forth
and risk my heart
yet again.
I persevere
and in the fullness of time,
I meet her.
And gain
so much.

Characteristics of a Rejection Complex

One characteristic of a rejection complex is the tendency to read rejection into everything: a cancelled appointment by a friend or acquaintance, a raised voice, an ambiguous statement, a frown – any of these actions can be misinterpreted as rejection, even when rejection was not even present.

To further complicate matters, when someone with a rejection complex is actually rejected, it is quite common to spend hours mulling over the rejection clues, as we try to convince ourselves that this is only another case of misreading the other person.

And then to cap it all off, once we acknowledge or recognise that we have been rejected, it is common for us to pick up the ball and reject ourselves. This is typically linked to past episodes of rejection, especially if it occurred during our childhood. We may parrot the criticisms that others have spoken over us, telling ourselves that we are worthless and useless. Descending into self-hatred, we may even punish ourselves in an attempt to stop ourselves from repeating the behaviour/ mistake/sin that caused this particular episode of rejection. And worst of all, we may try to force ourselves into becoming someone other than ourselves in a vain attempt to please the other person.

A typical characteristic of a rejection complex is to surround ourselves with rules or walls that are designed to protect us from ever being exposed to the unbearable pain of being rejected again.

Conditional Love and Unconditional Love

Understanding the difference between conditional love and unconditional love is crucial in being set free from the fear of rejection.

Conditional love says, “I’ll only love you if you do what I want you to do.” Conditional love sets impossible standards that we can never meet, it is never satisfied, and when we fail to meet those standards, it classifies us as useless and worthless and then rejects us. And if we make a mistake or sin, it is treated as deliberate rebellion and we are judged for it. Conditional love is not love at all. It is self-centred, neurotic, controlling, paranoid, and fearful.

God desires to set us free from the bondage of conditional love. He wants to set us free from the trap of living to please men, and bring us into the freedom of living to please Him. We are not trying to please men but God, who tests our hearts. 1 Thessalonians 2:4. God’s love, in stark contrast to conditional love, is unconditional, and He not only extends it to us through His grace and mercy, but He also forms it within us as the fruit of the Holy Spirit.

God’s unconditional love is patient and kind. It does not seek to manipulate others, it does not set impossible standards, it is not self-centred, and it accepts us. If we make a mistake, unconditional love recognises this, and does not judge. If we commit a sin, unconditional love illuminates the sin in order to bring conviction, and encourages repentance and a change in behaviour. Unconditional love restores us to fellowship, and it says, “Even if you blow it, I will still love you.”

Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. Love never fails. 1 Corinthians 13:4-8

Let us keep our eyes fixed upon Jesus, and dwell in the security of His unconditional love. He will never leave us nor forsake us. The LORD himself goes before you and will be with you; he will never leave you nor forsake you. Do not be afraid; do not be discouraged. Deuteronomy 31:8

Medical Racism in America a Giant Mind Boggling Game Without End

An explosive book that came out last year, Black and Blue:  the Origins and Consequences of Medical Racism, should have reverberated throughout the medical community and caused we physicians to closely examine our own prejudices and how they have affected the behavior of, and our relationships with, our black patients. 

So of course there has hardly been a whimper in the medical community. I did see a rather bland, "balanced" (almost namby-pamby) review by two African-American psychiatrists in the American Journal of Psychiatry, the official journal of the American Psychiatric Association. I don’t think much will come of it.

The author of the book, University of Texas professor John Hoberman, explains many of the reasons why the medical profession does not look at itself much in this regard, most of which I will not discuss in detail here. One of the biggest reasons can be summed up in one phrase: the mutual estrangement of puzzled Whites and resentful Blacks.

John Hoberman

Just to be extremely clear, there is no doubt that the problem of racist beliefs in medicine started with white racists and not their black victims. Many of the ideas about physical and mental differences between Blacks and Whites came from the colonialist opinions of Europians that Africans were more primitive than white people – less further along than Whites on the evolutionarily scale and therefore sub-human. Thus, their bodies and minds were supposedly simpler and therefore less or more prone to certain diseases. 

As seen originally by colonialists,  the black body, being more simple, was hardier than the white one. Black skin, for example, was thought to be tougher. This conveniently provided slaveholders a justification for working their slaves in the cotton fields for long hours in the hot sun. At the same time, being supposedly simpler mentally, slaves could be thought of as less likely to get depressed, so the myth was born of the happy black slave, grinning from ear to ear with his strong white teeth while eating watermelon, content being taken care of by his benign white masters.

While physicians in general no longer express these ideas, derivatives of them became part of medical folklore and were passed down as an oral tradition from medical student to medical student. For example, observations by white doctors of what a non-naïve individual would see as the understandable reluctance of Blacks to be put under anesthesia (and therefore under the complete control of a potentially racist doctor), was instead put together with the notion of black hardiness, and voila!  Black patients are far less likely even today of being given adequate anesthesia during surgery.

Hoberman describes in detail how racist ideas from the past have morphed into medical folklore about Blacks concerning the treatment of diseases of nearly every organ system.

Disparities in the health care of white and black patients such as the one just mentioned have been endlessly documented, so their existence should not be in the least controversial. White doctors unfamiliar with the racist history of American medicine, however, are likely to misinterpret the mistrust of their black patients as an innate tendency to be non compliant - or just plain lazy - which in turn makes the white doctor reluctant to put a whole lot of energy into convincing black patients to follow their advice.

Black patients have good reasons for their mistrust of the medical profession, including of psychiatrists.  White physicians tend to think that 1962 was a long time ago.  That was the year the American Medical Association stopped deferring to Southern state medical associations (doctors have to join the state and national associations at the same time), and allowed all African American physicians to become members.

Then again, I guess 1972, while more recent, seems like the distant past to such physicians.  That was when the Tuskeegee Syphilis Experiment came to public light -  a clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of the untreated disease in rural African American men who thought they were receiving free health care from the U.S. government. The men were never told they had syphilis, nor were they ever treated for it.

When I moved to Memphis, I was impressed that seemingly every African American I spoke with was aware of this history – even those who were not particularly educated.  For white doctors, not so much. Unfortunately, human beings have very long memories. The Serbs and Albanians, for example, still have strong feelings about a battle that was fought in the year 1389! 

It doesn’t help when white doctors like conservative commentator Sally Satel blame treatment disparities entirely on the resistant attitudes of black people without any reference to this history.  She also writes that racial profiling is important in medicine and justifies this idea (http://www.nytimes.com/2002/05/05/magazine/i-am-a-racially-profiling-doctor.html?pagewanted=all&src=pm) with the example of the implications for choosing medications based on the real difference in the racial distribution of different versions of enzymes that metabolize certain drugs (different alleles on the genes responsible for producing the metabolizing enzymes). 

In picking on one of the extremely few areas where there actually are racial differences, she ignores the far greater quantity of ideas within medical folklore purporting differences that do not in fact exist.  Like the supposed proneness of the black brain to produce hallucinations in psychiatric disorders, for example (originally attributed by doctors to its “primitive” state).

The mistrust of racism in medicine has unfortunately led a significant proportion of Blacks to believe in some seemingly far-fetched conspiracy theories. Many Blacks believe HIV and birth control programs were invented and designed by the white establishment in order to commit genocide against minority groups. 

These conspiracy theories even reached all the way to Africa, leading to the disasterous AIDS policies of South African president Thabo Mbeki. To most Whites, these theories sound completely irrational and paranoid. Of course, historically, Planned Parenthood was indeed founded by an Anglo-American eugenicist, one of whose goals was to limit the number of children of east European immigrants to the United States, whom she considered genetically inferior beings.

There is also a rather crazymaking problem for Whites who attempt to take an interest in the whole problem of the consequences of racism on black folks. This problem was exemplified by the vicious attacks on Senator Patrick Moynihan for his 1965 report, “The Negro Family: The Case for National Action.” The report discussed the “pathology” that racism had created for many Blacks and their families.

According to the Hoberman’s book, the black intelligentsia protested the report with sentiments something akin to, “How dare some white social scientists tell black people who and what they are?”  They thought that the report pathologized and stigmatized black urban culture, and that it seemed to be an oblique endorsement of old racist biology that regarded black people as inherently diseased and beyond salvation.

This has led to a situation where even today it is considered a breach of academic etiquette for any white social scientist to theorize about Black culture. I personally was crazy enough to do some of that in my first book, since a problem seen frequently in the Black urban poor community provided the clearest example of a point about the development of family system dynamics I was trying to make. Fortunately - I guess - that section of my book was completely ignored by reviewers. Whew!

So one of the reasons that white doctors are reluctant to look at their own attitudes and the history and consequences of medical racism is a fear of open discussions about that very subject. They do not want to be considered racists. So what are they supposed to say?  That racism did not create a host of problems for African Americans, so they do not seem to pathologize them and over-generalize about them? If it did not, then what is the big deal? If they ignore the problems, they could then be accused of covertly wanting racist practices to continue. Damned if you do, damned if you don’t.

Maybe if we just do not bring up the subject, no one will notice. Except maybe for that troublemaker Hoberman.

So here we have the explanation  for the “mutual estrangement of puzzled Whites and resentful Blacks” phenomenon. To oversimplify a bit, Blacks will not tell doctors that they are mistrustful of white doctors (and of Black doctors as well, for reasons discussed in the Hoberman’s book) for fear of being labeled as paranoid, and white doctors are afraid of getting labeled as racist no matter how they discuss the problem!

This is a perfect example of the family system game without end on a larger, societal scale, which makes solving this problem so devilishly difficult. No one trusts anyone else who claims they want things to be different, so anything anyone does or says can be - and invariably is - reframed as just the same old thing – just another manifestation of the Black belief in the incorrigible racism of all Whites, or of the White belief in the presence of innate Black pathology and inferiority. No wonder we get stuck!

This game without end can lead to paradoxical and at times bizarre situations. Hoberman bemoans the fact that black kids are much less likely to get stimulants for “ADHD” than white kids, which he attributes partially to white doctors’ subconscious belief in the stereotype of the “happy Negro” described above. Black mothers, on the other hand, do not want their kids to take these drugs because they believe that the drugs would be used to pacify young black males and rob them of their spontaneity, thereby making social control of Black people easier.

I doubt that the motives of most White doctors are that pernicious, but the mothers are actually right about the effects of the drugs. In this case, the idea that stimulants are being used to control behavior is correct, and the black kids are better off not getting the drugs. The problem is not, as Hoberman implies, that black children are not getting a needed medication, but that too many white kids are getting medication they do not need instead of getting family therapy! Of course, black families are not getting as much of that as white families either.

The author’s solution to the problem of medical racism, although he probably does not know about the concept of the game without end nor necessarily totally appreciate the intricacies of interpersonal miscommunication, is for medical schools to teach the history of medical racism and about the presence of incorrect folkloric beliefs that many physicians still hold. This way, the doctors would hopefully not misinterpret the lack of cooperation they receive from their black patients, and take time to explain more about what they are recommending, and reassure the patients that they understand any reluctance the patient may have to follow their doctorly advice. 

Hoberman admits, however, that there are not very many people available who are qualified to even begin to teach such a course.

As to his book itself, it is sometimes annoyingly repetitive, and at time a little confusing. When he discusses discrepancies in the care of black and white patients, it is sometimes unclear if his examples are due in his opinion to medical mythology, a misunderstanding of actual differences, black mistrust of white doctors, or all of the above. Nonetheless, since there aren’t many books that take this whole subject on, I recommend it.

Hatefulness as a Gift of Love Part I

Lorna Smith Benjamin, a well-respected researcher on the relationship between interpersonal psychology and personality disorders, has a saying that “Every Psychopathology is a Gift of love.”  In other words, she believes people develop maladaptive traits because, as she explains on her website:

“… problem patterns…are the result of one or more of three copy processes started in relation to an important early caregiver…Those are (1) Be like him/her (identification); (2) act as if he/she is still around and in charge (recapitulation); ( 3) treat yourself as he/she did (introjection). Sometimes the copying is in negative image (e.g., be the opposite)…The purpose of the copying is to seek reconciliation, approval, love of the internalized representation of that original object (person). People unwittingly act accordingly to the "rules" laid down by these early relationships and even when they believe they hate the original copy person. Every psychopathology is a gift of love.”

If you're looking for a therapist, find one who knows this stuff

[Some trivia for you: Dr. Benjamin started out as a student of Timothy Leary, way back when he was a respected academic interpersonal psychologist and before he went off the deep end as a hippie guru telling everyone to “turn on, tune in, and drop out.” Don't hold it against her].

Ellllllesssssdeee

That people may mistreat themselves because of loyalty to their kin group and a sense of altruism in that context seems to me to be due to a biological imperative (see my post on kin selection), albeit one that we can consciously choose to ignore.

This idea is understandably difficult for most people to wrap their heads around.  Self destructiveness as a sort of altruism?  (I explained some patterns associated with this phenomenon in my posts of 2/6/11 and 2/11/11).  The idea that the biological forces of kin selection may lead individuals to act in hateful and/or frustrating ways to other people for altruistic purposes within the kin group (although certainly not altruistic to outsiders) is even harder to swallow.  But the idea that individuals are willing to sacrifice their own children as a gift of love to the family system is the most difficult of all.

I think that the attraction of the Biblical story of Abraham nearly obeying a command from God to kill his own beloved son, not to mention the story of God being willing to sacrifice his only Son for the good of humanity, stems from the pervasiveness of this phenomenon within our species.  Certainly, the common willingness of parents to send their children off to war illustrates how powerful this human tendency is.  

The military in this country honors the mothers of fallen soldiers as “Gold Star Mothers.”  The government gives them a folded flag and a dead son or daughter, and usually they somehow consider it quite an honor.

That parents somehow still love their children even if they are acting out a hateful, nasty, and/or abusive family role is something my patients often have a great deal of trouble accepting, and understandably so.  In order to explain their parents strange hatefulness, which I also refer to in my post of July 6, 2010 as distancing behavior, they have usually come to the conclusion that their parents are heartless, evil, insane, or stupid. 

If I were in their shoes, I am absolutely certain I would have come to the exact same conclusion. Still, as they tell their stories to me in psychotherapy, I always hear of those rare times when their parents were not hateful but actually loving.  Sometimes such parents even will unexpectedly express their love directly, although often in a way which undermines their own credibility.  However, because of the total context of the relationship, these positive acts and statements are discounted.  Again, discounting such contradictory double messages is perfectly understandable.

Why would you believe the professions of love of anyone who generally tends to treat you like sh*t?  That would really be insane. Why should you believe them when there is so much evidence to the contrary?

And who knows if they are not doing those positive things for you on purpose to set you up once again for disappointment?  Letting you start to hope that they could finally be the parents you always wished you had, only to dash those hopes to pieces.  Like waiting for your estranged father to come and pick you up as he promised, when he has broken such promises time and time again.

Still, what does one make of a mother who, for the first time, admitted to her adult daughter that she had severely verbally abused the daughter when she was very young, but then told her not to bring it up again because she would deny ever having admitted it?  

And therapists tell patients whose parents do this crap that they have “trust issues” as if somehow that indicates that there is something wrong with them.  If such patients did not have trouble trusting people, then there would be something wrong with them.

I have been corresponding with two women whose mothers are described as having many traits that are suggestive of the diagnosis of borderline personality disorder.  While they both really want to believe that beneath all the horrible distancing behavior their mothers really did and do care about them, they of course find that the idea induces a lot of cognitive dissonance.  Again, I do not blame them one bit for thinking that I am just a little bit crazy for thinking so.

In part II of this post, I will describe some of the “maternal” behavior that one of them described to me, as well as translating some of her mother’s behavior and verbalizations into what I think is really being expressed covertly.

Becoming domesticated by Louise Emily Jones aged 19 years minus a few days

Turns out you can't live on beans and cheese.

Bit of a problem.

A quandry.

Such a good word.

Mum took me to Asda the other day and made me shop for myself, because I'm moving to Bournemouth in three weeks. I actually did alright in my A Levels (asterisks turned up out of the blue, uninvited. they couldn't stay away, couldn't fight it wait hold on) and UCAS said I could go to Oxbridge instead. I thought about it, but the only plus point I could conjure up was being on the rowing team, and therefore improving my chances of being in Rio 2016. Because I WILL be in Rio, 2016, winning Gold. Okay? OKAY? Good. As you were...oh right no I'm still talking. AS I WERE....

So I'm moving to Bournemouth and therefore need to learn how to be an autonomous individual, without frantically tweeting, "THE OVEN'S MAKING A NOISE HELP WHAT."

or, "AM I MEANT TO BE INSIDE THE DUVET COVER, OR IS THAT NOT PART OF THE PROCESS?"

or, "IT SAID 1-2 MINUTES BUT I THOUGHT IT WAS A TYPO AND PUT IT IN FOR 12 AND NOW EVERYONE'S DEAD AND OH DEAR." etc etc.

I would happily have bought just a week's worth of Quavers in my Asda shop, and maybe a banana, but mum said no. Then I suggested perhaps a Quavers multipack to vary the flavour. She said no. So I had to buy proper meat and put some broccoli in a bag. But I couldn't buy any meat, oh no. APPARENTLY some meat doesn't have a lot of meat in it so you have to check. .... .................... I don't get it either. So I wasn't allowed any chicken nuggets. Pff.

"You could buy a whole chicken and do a roast for your flat!!1!!!1" Yep or we can go to the Harvester. I think mum's really overestimating my culinary skills. After our shop, mum dropped the bombshell that as well as having a go at doing my own food shop, I in fact was also cooking ALL OF MY MEALS. All of them. Along with the washing, ironing, cleaning, LOVING, I had to do all my own cooking too from now on. Haha. Oh.

Oh.

No really, when I say I cannot do my own cooking, I really can't. This was meal 1...

and this was meal 2...

Mum's developing a very nasty rash that seems to intensify every evening at about 7pm (time depending on how hard I've tried to escape to a friend's for dinner). To clam her rash (can we just all agree to change 'calm' to 'clam', because my fingers really don't like putting the 'a' before the 'l', and it'll save so much hassle, thanks), my family came down from Birmingham and we ate out a lot. My mum told me to watch how the chefs present food (like really), but I was too busy watching my cousin. She's a vegan, and demolished a tomato so impressively that I was almost jealous. 'Almost' because I demolished a pollo mariano so impressively that I fell back in my chair going, "LIKE A PRO." when I finished. 

Cooking I will learn. The washing I can do. The only thing I have to get over with washing is feeling racist when I say, "I'M PUTTING A COLOURED WASH ON." I'm just too up for equality, y'know. LET WHITES AND COLOURS BE TOGETHER, MAN. No, no let's not let that happen, Louise. Stand down.

By 11am today I had put a load of light washing on, emptied the tumble dryer, hung out clothes on the line, sorted out my ironing, and cleaned up the kitchen after baking flapjacks and cookies, which varied in success. The cookies? I was so proud of them I did the cha cha slide, then I stopped doing the cha cha slide, sat down, and had a think. 

The flapjacks?

Well they look alright from this angle, if you want to eat them from this angle...eat them from this angle...

So baking I can do. Washing I can do. Ironing I can do. Look at me holding this iron with such vigour and determination. Like an Iron Warrior.

The putting stuff on the line bit WOULD have been successful, if this didn't happen (it was raining, okay, but the camera didn't catch the rain so i did this editing thing and LOOK IT LOOKS LIKE RAIN or something good okay).

I'll get there. Tonight I'm cooking lasagne. Nothing could go wrong. In the meantime, while I become a domestic goddess, let ME teach YOU something. FlatFace. You're oh so very welcome.