The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.

KEYWORDS:

• Chronic illness
• container-contained phenomena
• internal pain
• noncompliance
• persecutory anxieties
• projective identification

Michele McShea, MSW, LSW, was formerly staff social worker for the University of Chicago's Adult Sickle Cell Care Team, where she practiced psychoanalytic psychotherapy with individuals and groups.

The author would like to acknowledge Hayley Marie Miller for her assistance in editing this document.