Why Healthy People Abandon Their Chronically Ill Friends: It’s Probably Not Why You Think
Life with chronic illness can be very difficult and complex and others’ support is crucial, though sadly not always forthcoming. People are very complex. but we tend to neglect the complexity to lump others into categories like “he doesn’t care”.
This article focuses on why healthy or mostly healthy people sometimes abandon their chronically ill friends or family members, which usually isn’t because they don’t care, but for reasons people generally don’t even think about. These can also apply to romantic and romantic-like relationships, but of course domestic partnerships come with many additional challenges.
The TL;DR (short version) is: trauma. It’s not about you, or even your illness, it’s about them. Almost everyone has at least mild trauma. People get triggered by things they often don’t recognize as triggers which they tend to project on others. Many of those with the worst mental wounds dissociate it (block it) away and may believe they have little or no trauma.
Apparent lack of caring may mean something entirely different. Many would rather be seen as bad people than weak or emotionally vulnerable. Similarly, it’s often easier to think of those who have harmed us as cold-hearted rather than mostly good yet flawed and traumatized people. Being abandoned as a severely ill person obviously really hurts, and it can even put you in harm’s way. Explanations don’t make it more okay for you. But still, I strongly believe it was most likely done because of trauma, not because of lack of compassion.
Parts of the Mind
Most of us believe ourselves to have one singular mind: that we are one person with traits such as kindness, compassion, patience and a sense of humor (and of course also some less appealing ones). The reality is much more complicated than that. Our mind contains numerous, frequently conflicting wants, aversions, fears and beliefs. It can be helpful to think of them as parts of the mind. There are several theories with similar perspectives, which may call parts things like schemas or ego states instead. In this article I’m mostly drawing from Internal Family Systems (IFS).
No one is kind or patient in every situation. People often don’t do things they want to do (like treating others well, going to the gym or voicing their opinions) yet may find themselves doing something they definitely don’t want to do, like shouting, procrastination or bad habits. All of this discordance boils down to parts. Then other parts react to these failings and make us feel guilty or ashamed — not because they want to hurt us, but because they are trying to help. It’s possible and even common to believe things you know to be false, like many people believe they’re lazy or a bad person while knowing it’s not true. We are incredibly complex yet in daily life mostly ignore this complexity.
It is a huge cliché, but most of our personality is molded when we are kids, and often parts created in the childhood become stuck there with their goals and perceived solutions. Some people’s early years have involved deeply traumatic events. Others get off more easily, but everyone experiences minor hurts that can lead to so-called “microtrauma” or “small-t trauma”, which is how most parts are formed: something seemingly insignificant but that still hurts and drives a part of your mind to change your thinking or behavior. All parts all trying to help and solve your problems, but especially the “young” ones commonly only make things worse. You wouldn’t want to have toddlers running your life, but in practice, this is what happens to many people.
Interpersonal situations can be particularly hefty for parts running amok, as they react to both each other and other people’s parts, creating a nearly endless number of possible conflicts. When an angry kid on one side reacts to a hurt kid on the other, problems often grow insurmountable. This is why relationships, particularly romantic and romantic-like ones, can be so difficult. We may have a hundred reasons to love our spouses yet also sometimes find a hundred and one ways to be annoyed by them — not to mention situations where we really consider breaking up with someone and face a flood of parts voicing differing opinions on this.
A model is only good if it helps you comprehend things. For me the IFS model has been extremely helpful for understanding myself, other people and the society as a whole. You might initially be skeptical of the concept — and it’s healthy to be skeptical, of course. The skeptical parts do their best to protect you from potentially harmful ideas. If you want to learn more about parts, you can read my article on Internal Family Systems. Or you can just go through the examples in this article and see if they feel familiar.
One way to understand parts better is viewing them as different types. In trauma theory, they may be divided them into fight, flight, freeze, fawn and attach parts. Of particular importance to this article are the fawn (also known as submit) parts, which are commonly created in childhood to appease our caretakers or teachers at the expense of our needs. Many chronically ill people also develop strong fawn parts later on, as we need to stay on the good side of friends, family, doctors, bosses and carers. Even if they have wronged us, it may feel safer to gloss over it.
Fawn parts are also known as people-pleasing or lack of boundaries, but to the person being fawned, they may feel like the other person is just being nice, understanding and helpful. While fawn parts are often easy to like, they tend to form complex dynamics with other parts and trigger them. Parts can be polarized with each other, wanting opposite things and engaging in a kind of tug-of-war. After you’ve put on a good face for someone you really dislike or played down a hurtful situation, you may feel resentful and disgusted.
Fawn parts may be polarized with fight parts that don’t feel like pleasing anyone (and they have a point, aiming to please is generally not a healthy habit) and flight parts that just want to get away from everything. Despite their name, fight parts aren’t always looking for actual fights. Their anger may take the form of frustration, resentment or acting cold and controlling. They may shut down the fawn parts when they perceive someone else is acting controlling. Sometimes that person might be you, even when you didn’t do anything to warrant that, which can feel confusing and hurtful.
Psychologist Jay Earley discusses the polarization of people-pleaser (fawn) and passive-aggressive (fight) parts in his book Self-Therapy vol. 3. The people-pleaser dishes out promises, while the passive-aggressive part resents these offers and believes it must have been forced into them (because “it” didn’t make those promises, it was a different part!). The resentment makes it view the other party as controlling or manipulative. Someone may promise to e.g. help you with practical things on their own volition, yet their parts may feel like you manipulated them into it. I’ve sadly experienced this dynamic with several different people.
Mimics for Empathy
There are many different definitions for empathy and compassion, in psychology, neuroscience, philosophy and religious traditions (as well as different types of empathy recognized in psychology). It is commonly asserted that if you feel empathy or compassion for someone, you will also feel their pain. For some people with severe trauma and lack of emotional boundaries, this is a major problem: they may feel others’ pain so strongly it becomes unbearable. They can’t deal with it, which tends to activate freeze and especially flight parts.
This is not empathy. I’ve sometimes called it “toxic empathy”, but even that is a problematic label, as it suggests it is still a form of empathy. It’s parts reacting to trauma. It’s parts making others’ pain about themselves. As with all parts, they are trying to help, but end up only making things worse both for the person and their loved ones.
Like all trauma, these parts can be healed, though they are often very resistant to the idea, as they tend to feel morally superior. They believe they represent real empathy or even a special form like “hyperempathy”, that they are what makes the person “an empath”, a good person or more specifically, makes them a good person, unlike those horrible, ruthless people who treated them badly in the past.
None of this is true. But the parts really believe that and believe that not crumbling from others’ pain would be terrible.
Having this kind of parts doesn’t mean one isn’t empathetic or compassionate underneath them. When you’re in the state of Self, as IFS calls it, you’re not blended with any part. Instead of wanting to fight, flight, freeze, submit or to attach, you feel grounded and spacious. In Self you naturally feel compassion for yourself and others, yet their suffering does not burden you. That may sound incredible to someone who has only experienced parts-based “compassion”, yet this is an innate capacity. It does not make you “cold” or “distant”, quite the opposite. In this headspace you project authentic caring and the problem doesn’t become about you. You can think clearly about the best course of action and need not worry about compassion fatigue.
In short, many people who abandon their chronically ill loved ones don’t do it because they don’t care. They care in a way that hurts them deeply and they believe this is what caring means. It becomes too much and the only solution they know is getting away. Does that make it okay? No, it doesn’t, but we don’t always have the clarity to do the right things, let alone when emotionally overwhelmed.
I’ve talked to quite a few people who’ve admitted to having this kind of parts, but most people lack the emotional skills to realize any of this happening. Those with severe trauma are often in a constant state of turmoil and only really notice whether it gets better or worse. When they’re in contact with someone who “causes” them to feel more pain, they conclude that the other person is “bad”. They may even get angry at you for “making them” hurt and make up an explanation as to why you caused this anger and it’s justifiable. Remember, they are likely blended with parts that are effectively young children.
If you are chronically ill, you won’t have missed other people’s rescuer parts. They tend to be similar to the fawn parts that find your pain unbearable, but while your suffering makes some parts feel really helpless and awful, rescuer parts see it as a challenge: they will save you. These parts have always wanted to save a family from a burning building and now they see smoke.
Different rescuer parts may have different ideas of how to accomplish this. Some choose to help you practically, which can be lovely, but these parts are difficult to satisfy. Whatever they do, they can’t save you, and eventually they may blame that on you. Others rely on God to save you (also not the best track record for success), while some try to come up with medical solutions. They may ruminate for hours pondering the best ways to change your life, which makes other parts resent you “for using up” a lot of this person’s energy!
You’ve no doubt encountered some rescuer parts online, asking if you’ve tried yoga, CBD or going gluten-free. But these can also be parts of loved ones, who may have more sophisticated and personal approaches or may not, but even if they base their suggestions on medical literature, it usually feels like they “mansplain” and talk over you. It’s like they consider you completely helpless (if you were more resourceful than they are, how could they possibly rescue you?). Rescuer parts can lead to codependent relationships, where one person becomes the rescuer and the other, the rescued.
Occasionally rescuer parts or parts associated with them can act in extreme, unhinged ways, as happened to me with a new friend I barely knew, who yelled at me on the phone and believed she could force me to see a new doctor even though I didn’t consider that a helpful idea. In this case, I was the one who decided to let go of this budding relationship, even knowing she had good intentions. In my experience, rescuer parts are very likely to sour the friendship. And it’s a big letdown: while sometimes these parts irk you from the start, in other cases it may have felt like you finally found someone who cares. And they do care, their parts just don’t know skillful ways to handle it.
Of course this doesn’t mean everyone who wants to help you in some way does that because of rescuer parts, but they are often involved in at last some way.
Other Trauma-Related Issues
A lot of the ableist attitudes in society are caused by parts believing in the Just World hypothesis. You will surely recognize people with such a belief: those convinced that if you eat healthily and go to the gym, you’re immune to disease (sometimes it’s hard to differentiate rescuer parts that try to help you from morally righteous parts who just want your inconvenient disability to stop existing, and ultimately it may not matter). The world is a scary place, but it can be comforting to believe that if you just “do everything right”, you’re safe from nasties like illness. Many people with chronic conditions prove this idea wrong just by existing, and it’s very unpleasant for such parts to handle.
A somewhat similar attitude held by parts who are frightened of reality is “the law of attraction”: the idea that if you want something enough, you’ll get it. Like with Just World, if reality did operate with this logic it would surely make life much nicer and easier. If only! Of course, this world-view suggests if you’re sick, it’s because you want to be, which can be disturbing to them (and has the potential to endanger the nice, fluffy world-view), but much more disturbing to you.
Many people really struggle with the concept of death. Your illness may make them face their own mortality in a way that puts the Just World hypothesis in question, or they might be terrified of you dying, perhaps because the previously mentioned parts that fear their own unbearable suffering that would result from it. Such fears are mostly not voiced or necessarily even admitted internally, as fear of death is considered embarrassing, a sign of weakness.
It’s common to have parts that struggle with responsibility, duty or commitment. Fear of commitment is not just an issue in romantic relationships! If people with this kind of parts end up in a situation where they’re helping you, including in ways that are considered ordinary and noncommittal when helping out abled acquaintances, such as giving someone a ride, their parts may begin to resent this responsibility or “being your carer”. This usually relates to the already mentioned dynamic of people-pleasing parts polarized with passive-aggression.
The Role of Disbelief
One of my own disabilities is chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), a highly debilitating neurological condition, which still doesn’t have the recognition it deserves. People with poorly understood chronic illnesses such as mine often believe this lack of recognition is why others disappear from their lives: those people don’t believe the illness is real. I don’t doubt this can happen, but I think it is often more complicated. Those with widely accepted diagnoses tend to experience similar levels of abandonment. Not to mention that a caring person not burdened by their own trauma would not desert a loved one even if that person did suffer from actual hypochondria. Or if someone was making up their whole illness, that clearly suggests they are doing very poorly.
Even if people say they’re stepping back because of not accepting your diagnosis, I think it is more likely related to the factors I described earlier. In cases of actual disbelief, it is often about Just World hypothesis: rather than your diagnosis, they actually disbelieve someone could be sick without it being their own fault. The skepticism can also be a front for the lesser socially acceptable feelings, like fear of death, feeling helpless or not being able to deal with your suffering. I suspect it may also be about those earlier explained parts that unfairly and misguidedly believe you’re manipulating the person. If they can’t figure out what you’re supposedly manipulating them with, they may conclude it’s actually your illness.
Of course there is a social acceptability factor: it’s considered the sign of a truly awful person to abandon someone with cancer. Cutting contact with someone with e.g. fibromyalgia, anxiety or mast cell activation syndrome would not be viewed as nearly as deplorable, even if in practice that person was sicker, needed more help and had less of a support network available. That’s not to say those with cancer never get dumped — but in such cases, people may be more likely to begrudgingly stay.
How to Fix This
The sad thing about this all is that even when you understand someone’s problems, you can’t fix them. Only that person can. It sucks and it’s hard to accept, but there’s nothing you can do about it. Most people who have severe trauma are terrified of healing it. Others do go to therapy, but how they react to your illness (which they may view as your problematic behavior anyway, instead of their own) is not likely to be a priority among their issues.
But if there is someone in your life, or perhaps among the people reading this, who is hoping to change their ways, this article can serve as a starting point. These parts can be healed like all trauma, with the help of a professional or using Internal Family Systems in self-therapy, as detailed in my article on IFS. If you are someone who believes themselves to be an empath who can’t deal with others’ pain, the good news is that you can heal from that and discover real empathy. That will greatly help you deal with even the most difficult situations in life.
And if you’re the person who’s sick, because deep down this is not about you or your illness, it means hopefully you will find more people without trauma triggered by your disability. If someone says or implies that you are a burden, what they are really saying is that their own trauma is burdening them. Perhaps one day, some of these people learn to heal and you might reconcile. Either way, I hope you will find people who appreciate you as you are.