*Dept, Neurology and Psychiatry, Gifu University of
Medicine
**Yohnan Hospital
ABSTRACT
The authors discuss co-dependence, a key concept used to explain not only addictional behavior in alcoholics and others with substance-use disorders but also characteristics of general human behavior in American society. From the viewpoint of degree of establishment of individualism in society, we study three cases of Japanese with psychopathology of co-dependence and refer to the concept of SEKEN, whereby social acceptance depends on self-sacrifice, consideration of others and self-discipline. As SEKEN fundamentally includes no basis for independent individuality, it is more likely to engender co-dependence than American society.
Key Words
co-dependence, alcohol dependence, addiction, Japanese society
(SEKEN), American society
INTRODUCTION
Co-dependence is a key concept used to explain not only addictional behavior in alcoholics and others with substance-use disorders but also characteristics of general human behavior in American society. In addition to substance and process dependence, this concept encompasses dependence on human relationships. In this study, we consider American and Japanese society from the viewpoint of co-dependence, by way of presenting three Japanese cases and discussing their psychopathology.
CASES
Case A : Since their marrige, A's husband, an alcoholic, was often violent to her. Although A divorced him, two years after the divorce they remarried on his request and with his promise to give up drinking. However, he did not give up drinking and was violent again to her and their children. In spite of considering a second divorce, A has devoted herself to caring for her husband. She participates in a regional meeting for alcoholics, which he does not attend.
Case B : B is a medical care worker. B's husband left his factory job, supposedly because of a small accident, and began drinking day and night. Although B worked hard to support him, he drank himself to death. Since then, B has become excessively concerned with taking care of her colleagues at work.
Case C : Although C's husband had been an alcoholic for a long time, he gave up drinking as a result of repeated hospitalizations. C earned their living during the period of his treatment. Her husband, however, did not appreciate her help. She has become deeply depressed in inverse proportion to his recovery from alcoholism.
DISCUSSION
The psychopathology of these three cases may be summarized as follows. A prefers to look after her husband even though she complains about his violent behavior. B derives great satisfaction from taking care of others, as if only caring for her husband was insufficient. C feels depressed because, as her husband recovered, he no longer needed her to take care of him. A common psychopathological characteristic of these patients is the tendency to take care of others. This tendency is based on comfortable feelings obtained in the relationship of co-dependence between care giver and care-recipient.
Co-dependence refers to additional relationships between care-givers attempting to control others and care-recipients attempting to be controlled by others. The concept, however, was introduced by American counsellors and social workers. That is to say, it is not a medical term in the strict sense but a concept formulated in the context of American society.
Schaef regards present American society as a system of controlling others by force. Because controlling others consists of two aspects, direction and obedience, this system engenders additional human relationships. In addition, this addictional system not forces individuals to behave addictionally but also functions to maintain social norms. According to Schaef, with respect to psychopathology of individuals, American society as an addictional system is characterized by self-centeredness, fantasy of controlling, dishonesty, thinking disorders, confused thinking, perfectionism, dependence, negativism, protectionism and frozen feelings. With respect to socio-cultural norms, American society functions as a closed system which gives individuals few choices in their roles and aims. In either respect, co-dependence is the core of the psychopathology of addictional human relationships.
In co-dependence, once the people fall into their co-dependent relationship, they feel as if they could not live without their relationship. At the social level, co-dependence not only is sustained by but also plays a central role in American society. That is, since people commonly can not help but become co-dependent as long as they live in this addictional system, co-dependence functions as a norm in this system.
It was observed that, in co-dependent situations, American people have difficulty behaving independently. The implication that American society, which is thought to be based on individualism, is in fact a system which tends to give rise to an addictional relationships, surprises us.
It is believed that, compared with American society, Japanese society has not established a clear concept of individualism. According to Abe, a key concept of Japanese society is SEKEN, which refers to a social world in which people who are self-sacrificing, considerate to others and self-disciplined are held in high esteem. That is to say, Japanese society understood as SEKEN originally has no basis for independent individuality. Consequently, it is likely to engender addictional human relationships than American society.
In case A, we find the attitude of self-sacrifice, and we see consideration of others in case B. Case C illustrates how self-discipline contributes to social status because C's taking care of her husband may be regarded as behavior to obtain a reputation as an ideal wife in the context of SEKEN. The co-dependent behaviors of A, B, and C are therefore regarded as expressions of additional human relationships in Japanese society.
CONCLUSION
Co-dependence is a feature not only of American society as characterized by controlling others but also of Japanese society understood as SEKEN.
Changes in social values and alternatives for individual lifestyle are essential prerequisites for recoverry from co-dependence, the core psychopathology of additional relationships.
REFERENCE