While briefly perusing the Catalogues of two well-known addictions publishers recently, I ran across an outstanding number of titles directed toward women and codependency. Codependent No More, Beyond Codependency, Caring for Ourselves: Hope for Health (sic) Relationships, Back From Betrayal: Recovering From His Affairs, Women Who Love Too Much, Setting Boundaries, Letting Go, Codependency: A Second Hand Life, Boundaries for Codependents; the list goes on and on and on... Stacks of self-help books, primarily aimed at women, continue to invade bookstores. Peter Vesgo, President of Health Communications, Inc. estimates that eighty five per cent of the codependency market is female (Kaminer, 1990). At best this is a reflection of reality, women in the latter Twentieth Century are not happy, at worst it is a statement that women are unhealthy.
It is the latter which necessitates comment, as John Bradshaw emphatically proclaimed on his TV series, “Codependency is a primary disease.” Codependency, in fact, is the “in” disease of the 90s, and as the proliferation of literature on the subject suggests, it is ill-defined, haphazardly applied, and primarily directed toward women. Cermak (1986) recognized this; he compared a number of different definitions of codependency and defined what aspects might be used as diagnostic criteria, advocating its inclusion in The Diagnostic and Statistics Manual of the American Psychiatric Association.
(1) continual investment of self-esteem in the ability to influence/control feelings and behavior in self and others in the face of obvious adverse consequences; (2) assumption of responsibility for meeting other’s needs to the exclusion of acknowledging one’s own needs; (3) anxiety and boundary distortions in situations of intimacy and separation; (4) enmeshment in relationships with personality disordered, drug dependent and impulse disordered individuals; and (5) exhibits in any combination of three or more; constriction of emotions with or without dramatic outbursts, depression, hypervigilance, compulsions, anxiety, excessive reliance on denial, substance abuse, recurrent physical or sexual abuse, stress-related medical illnesses, and/or primary relationship with an active substance abuser for at least two years without seeking outside support, (p. 16- 17)
Two aspects of this warrant discussion. First is the disease concept and second is the issue of “boundary distortions” as they relate to women.
The inclusion of Codependent Personality Disorder in the next version of DSM (DSM IV or will it be DSM III RR?) will codify codependency as a disease, a disease that has been defined by male standards of mental health. Phyllis Chesler in her commentary (1972) on women and the male oriented psychiatric establishment, points to male- defined standards of health against which women are judged; the verdict, women do not fit into the mold and are therefore unhealthy.
The ethic of mental health is masculine in our culture. This double standard of sexual mental health, which exists side by side with a single and masculine standard of human mental health, is enforced by both society and clinicians, (p.69)
Prophetically, Chesler proclaims “no longer are women sacrificed as voluntary witches. They are, instead, taught to sacrifice themselves for newly named heresies” (p. 34).
Frankes (1986) echoes this, “women have been brought up differently from men and sex role stereotyped training has contributed to many mental health problems of females.” This clearly leaves women trapped between a rock and a hard place. The rock is clinical judgements set by male standards, whereby healthy adult behavior is equated with healthy male behavior, and healthy female behavior is that which is stereotypically feminine, i.e., submissive, dependent, excitable, passive. (Boverman, Boverman, Clarkson, Rosenkrantz and Vogel, 1970). The hard place is that assimilated cultural norms often leave women powerless and trapped in damaging relationships, at which point they are judged by clinicians as depressed or codependent.
The fact that women often have difficulties with “boundary” issues is not an arguable point. Substance abuse counselors and domestic violence advocates will agree that women will take responsibility for the abuser’s behavior, excuse it, deny it and try to control it at the expense of her own emotional and safety needs. It may be safe to say that all women have experienced some degree of “boundary distortion” at some point in their lives. Is it possible to hypothesize that all women are infected with this disease called codependency? Before jumping to a hasty conclusion to this question it may be wise to examine the issue of boundaries and why women and men perceive themselves in relationship to others so differently.
Carol Gilligan (1982) noted that in the field of developmental psychology, developmental theories are routinely postulated on studies of boys. Later when research attempts to fit girls into the model, they appear to be stunted in their development. Whereas male- defined theories value logic, autonomy and individuation as indicators of mature development, girls in this study were primarily concerned with relationships and communication, thus appearing less mature on the established scales.
Thus women not only define themselves in a context of human relationship but also judge themselves in terms of their ability to care. Women’s place in man’s life cycle has been that of nurturer, caretaker, and helpmate, the weaver of those networks of relationships on which she in turn relies. But while women have thus taken care of men, men have, in their theories of psychological development, as in their economic arrangements, tended to assume or devalue that care. When the focus on individuation and individual achievement extends into adulthood and maturity is equated with personal autonomy, concern with relationships appears as a weakness of women rather than as a human strength. (p. 17)
Based on Gilligan’s research it becomes evident that from a very early age girls are taught to value relationships over the self and to consider the needs of others first. Consider the following case study as an example of this process:
Amy was an unusually bright, verbal and outgoing two and a half year old. She enthusiastically told everyone she met that she wanted “cars and trucks” for Christmas. The response was always the same, “But you’re a girl. You don’t want cars and trucks, you should want a doll.” that Christmas, she found her cars and trucks under the tree, and although enjoyed playing with them, she knew she could never feel comfortable asking for another “boy toy.”
Two years later, Amy opened a Christmas package that contained a broom, mop, dust pan and brush and an apron. She tied the apron around her waist and stood proudly with a doll in one hand and the broom in the other as she received the praises and adoration of the adults around her.
This case makes an important point about women’s early socialization. The child is told that because she is a girl she should prefer dolls over cars and trucks. More importantly, it is reinforced that she should not want cars and trucks, symbols of autonomy and economic power; what she should want is a doll, symbolic of care and nurturing. Girls’ boundaries are perceptually different from boys’ at the very moment that first baby doll is placed in their arms.
If the child in this story grows up to find herself in a relationship with an abusive and/or alcoholic husband, to survive she will first rely on her early training, nurturing, caring, cleaning, (it’s your responsibility to fix it and make it nice). When her fruitless attempts to control the uncontrollable makes her life miserable, she views the failure of the relationship as her personal failure. She reaches out for help and is told that she has a Codependent Personality Disorder -- something is wrong with her (she knew it was her fault all along).
Placing codependency in the next version of DSM, and defining it as a disease with a prescribed treatment, will do a great disservice not just to women but to the whole of humanity. Concern with relationships is a human strength, to “treat” women for this “disorder” by “teaching” them masculine boundaries and sense of self is to devalue the feminine role even further. A more effective response lies in social change and empowerment. By giving real power and status to the role of care taker, nurturer and child-bearer (instead of just paying it lipservice), women will be able to exercise more control over themselves and their lives and relationships. The balance between the needs of others and the needs of the self will always be an intricate dance; needs often conflict and choices will have to be made. When women have real power, they will have more choices.
The human species is, beyond any shadow of a doubt, a social animal. Both sexes need to break new ground in reshaping the rigid social/cultural roles assigned to them. I look forward to the day when book publishers will carry 130 different titles for men on how to heal their “Independency”, How to Blur Your boundaries, Become More Caring, Nurture Your Inner Man: A Guide for Improving Your Relationships.
Boverman, I., Boverman, D., Clarkson, F.E., Rosenkrantz, P., Vogel, S.R. “Sex role Stereotypes and clinical Judgements of Mental Health”. Journal of Consulting and Clinical Psychology. 1970, 34, 1-7.
Cermak, T. “Diagnostic Criteria for Codependency”. Journal of Psychoactive Drugs. 1986, 19(1), 15-18.
Chesler, P. Women and Madness. New York: Avon Books, 1972.
Franks, V. “Sex Stereotyping and Diagnosis of Psychopathology”. Women and Therapy. 1986, 5, 219-231.
Kaminer, W. “Chances are You’re Codependent Too”. New York Times Book Review. February 11, 1990.