CODEPENDENCY : A CONCOMITANT FIELD OF INTEREST IN RESEARCH INTO THE PHENOMENON CARING

The growing popularity o f caring is evident throughout the nursing pro fession . Research into the phenom enon caring, however, necessitates that caring as an ethic be distinguished from pseudo caring actions and experiences. Codependence and codependency are proposed as being o f a pseudo-caring nature. Research interest into this field o f study needs to be kindled.


INTRODUCTION
The main objective of this article is to kindle an interest in the phenomenon codependency as a concomitant field of research into the phenomenon caring.
The growing focus on caring is evident throughout the nursing profession; in nursing education, nursing management, nursing practice, theorising and research.Not only has th e p h e n o m e n o n o f c a rin g b ee n conceptualised in various ways, but it has been c la s s ifie d e m p h a s is in g its d if fe r e n t dimensions.Regarding the latter, Morse et al. (1991) gives a decorous classification which attributes to caring the dimensions of: caring as a human mode of being, caring as a moral imperative and ideal, caring as an affect, caring as an inter-personal relationship, and caring as nursing intervention.Focusing on the c o n c ep t caring, h ow ever, does not illu m in a te c e rta in s u b tle tie s o f th e phenomenon which could easily be confused with phenomena other than the construct caring.It is necessary therefore, especially in the light of the present wave of concem about, and interest in the phenomenon caring, that caring be distinguished from any possible counterfeit or illusionary phenomenon and experience.Codependence appears to be such a counterfeit phenomenon.

DEFINITIONS O F CARING
In defining and clarifying the concept caring, I would like to range myself with Gaut (1981: 19) who states: ... "I do not mean to imply that there will be a single clear and precise meaning [of caring], but rather that the term being defmed has a family of meanings, related and broad in scope."A fter having studied numerous defmitions of the concept caring, Nyberg's summative definition of caring applies.To Nyberg (1989: 15) the preferred d e fin itio n o f carin g is: "an interactive commitment in which the one caring is able, through a strong self-concept, ordering o f life activities, an openness to the needs o f others, and the ability to motivate others, to enact caring behaviours that are directed toward the growth o f the one caredfor, be it an individual or group.Thus, caring is both a philosophy and a milieu created..for the purpose o f encouraging caring relationships"... (Nyberg 1989: 15).T h e la tte r tw o c o n c e p ts, philosophy and milieu are noteworthy.These are related to the main components found in the reconstruction of a caring encounter nam ely, an em o tio n s/co g n itiv e and an activities component.The emotions/cognitive com ponent and the view of caring as a philosophy are both further directly related to the underlying assumption of caring as an ethic in nursing and thus as a collective diffuse moral and ethical conscience within the nursing profession.

D EFINITIONS O F CODEPENDENCY
Codependency can be defmed on several levels -as a psychological concept, as a working guide for patients (codependents) and as a new and discrete disease (Cermak et al. 1989:132).Codependency is both a condition and a process and is self sustaining and addictive (C happelle & Sorrentino 1993:42;Ralph 1993:87)  • any act or behavior of a nurse that meets others' needs at the expense of her own (Yates and McDaniel 1994:33); • a neglect of one's personal needs because of an extreme preoccupation with external objects and persons ( Cerm ak et al. 1989:131) From the above definitions, certain features and outcom es o f codependence can be abstracted but it must be noted that some of the behaviours identified with codependency can exist outside the disease entity (Sherman et al. 1989:27;Farnsworth and Thomas 1993:181 ).
T he general fea tu re s and outcom es o f codependency include: • Caring for others at the expense of caring for oneself (Caffrey and Csifrey 1994:13); • E nm eshm ent o f o n e's own personal identity, needs, and feelings in caring for others, (Caffrey and Caffrey 1994:13), distorted boundaries, and not being able to distinguish other's responsibilities and problems from one's own (Yates and McDaniel 1994:34).Codependents thus have difficulty perceiving themselves as having an identity outside that of their role as carer; • Both participants in the relationship are involved in attempts to control one another, places, things and the outcome of events and neither participant is empowered in a way that fosters self-actualization (Caffrey and Caffrey 1994:13;Yates and McDaniel 1994:34); • Feelings of powerlessness that precede burnout (Caffrey and Caffrey 1994:15); • Codependency (or caretaking) is motivated by false feelings of duty or of responsibility for others and has a basis of fear rather than love (Caffrey and Caffrey 1994:15); • Codependent "caring" is fuelled by fear of rejection, abandonment, failure, or conflict which leads to feelings of shame, guilt, anger, or jealousy (Caffrey and Caffrey 1994:15); • Codependent "caring" is dependent on clients and others in a bureaucracy/ patriarchy to feed one's self-esteem, to make one feel worthwhile, competent and happy (Caffrey and C affrey 1994:15;Yates and McDaniel 1994:34); • D is h o n e s ty an d s e lf d e c e p tio n by minimising one's problems and emotions; • Being out of touch with one's feelings; • Perfectionism; • Low self-esteem; • Inability to accept one's innate worth as a person; • Fear, anxiety; • Depression; • Self-centredness; • Going to extremes with work relationships; • Assuming a martyr role;  H erricks (1992:12) points out that the codependency rhetoric uses words that define "caring."To be codependent is to be a caretaker, to be an enabler, and the like.This naturally necessitates a distinction between the two terms -caring and the counterfeit codependency.However, Mallison (1990:7) and Shelly (1991:3) quote Benner in saying that the codependent label is the latest attempt to pathologize the caring professions -that in fact, it displays society's failure to distinguish between addiction and commitment.It would thus appear that Benner negates the existence o f the phenom enon codependence and codependency.In this regard.Summers (1992:70) warns that codependency is a disease so subtle that its symptoms may be perceived as desirable qualities rather than signs of a disabling disorder.On the other extreme, Mullaney (1993:6), in reaction to the "pop-psychology" (Koldjeski 1992:10)  Codependent nurses may be bom or made (Yates and McDaniel 1994:33).Fagan-Pryor an d H a b e r (1 9 9 2 :2 4 -2 8 ) e x p la in codependency in terms o f Bowen's concept of U ndifferentiated Self.According to Bowen (Fagan-Pryor and Haber 1992:25), the level of differentiation evidenced in an individual is determined by, what he calls, the togetherness force.The greater the togetherness force, the more an individual's thoughts, feelings, and behaviours are determined by other people, and the greater an undifferentiated sense of self.
Traditionally the cultural script for a "good woman" is the good codependent.Nursing, as prim arily a female occupation, provides ab u n d a n t o p p o rtu n itie s fo r p ra c tisin g codependent caretaking under the guise of caring (Caffrey and Caffrey 1994:13).
Nursing education and socialisation can also help foster codependency.The values of care giving and nurturing that nursing education emphasises make nurses more sensitive to patients' needs, yet they can drive nurses too strongly (Yates and McDaniel 1994:33).As Yates and McDaniel (1994:33) put it, many nurses can remember being praised by their teachers for exhibiting self-sacrifice, for doing even more at the bedside than was expected of them.In giving too much nurses are in jeopardy of losing themselves.Society, too, expects nurses to be achievers and care takers, strong and capable yet warm and nurturing.Nurses can try too hard to live up to these ideals (Y ates and McDaniel 1994:33).Hospitals and other workplaces may likewise encourage or even force codependent b eh av io ur.H ospital adm inistrators and managers may stress putting patients first, irrespective of the cost (Yates and McDaniel 1994:33).In this regard, K lebanoff ( in Caffrey and Caffrey 1994:14) points out that codependency develops to deal with the internalised oppression arising from living in a patriarchal world.According to Roberts (1983:21-30), this internalised oppression leads to self-hatred and low self-esteem, often expressed in "horizontal violence" towards each other and emulation/imitation of the d ep erso n alised te ch n o lo g ica lly focused practices valued by patriarchy.
It is plausible that the inability to distinguish between caring and codependency exists because social institutions (including health care and educational instimtions) depend on codependency and reward it under the guise of com m itm ent.A ccording to Montgomery caring that is free of codependence may a c tu a lly be c o n s id e re d th re a te n in g to health-care system s in w hich econom ic well-being is the goal and all decisions are carefully monitored for their contribution to these economic goals.A system that cares for and empowers others loses ultimate control over their decisions.And caring "is beyond control by any authority and therefore is an u ltim a te e x p r e s s io n o f fre e d o m and autonomy" (Montgomery 1993:29).In this regard Clark and Stoffel's (1992:827) finding that high scores on codependency are also associated with high scores on external locus o f control is significant.

IM PLICATIONS
It would seem that the major attribute of caring, as proposed by Mayeroff (1971:1), which codependence lacks, is growth -of both the care giver and the receiver of care and caring.Actualisation of the individual's full potential is thus frustrated.The implications for in patient care are obvious if concern is with holistic care.In nursing education, especially in an oppressive, objective Tylerian atmosphere, the counteracting of caring and th e p ro m o tio n o f c o d e p e n d e n c e and codependency are a grave possibility.In educational term s, codependency would further the interests o f an ill pedagogy, however, will not contribute to the goal of nursing education to produce independent, self-reliant and creative professionals.This is a concern imphed by Bevis and Watson (1989) in their exposition of a caring educative curriculum for nursing.It is, however, in research into caring that codependency can be used to some advantage.For instance, during purposive samphng of informants, existing measuring scales of codependency can be used to identify codependent individuals and to exclude them from participation in the research project.In addition to this, especially in nursing education, the need exists to revisit the concept codependence and to investigate its presence among student nurses and the reasons for the existence of this crippling phenomenon amongst them.

MEASURING INSTRUMENTS
Although several instruments exist, many of these are mere checklists for self-appraisal.The following instruments tested for vahdity and reliability are mentioned in the literature: _Codependency Assessment Inventory and Codependency N ursing Self-assessm ent Inventory (Yates and McDaniel 1994:33); and _Friel Co-dependency Assessment Inventory (CAI) (Chappelle and Sonentino 1993:41).

CONCLUSIONS
Different viewpoints regarding codepcndency are reflected in the literature.Among these are codependency as an addictive dependence among professionals in helping professions and an accusation of an attempt to pathologize caring.
In view of the present interest in research into the phenomenon caring in all spheres of the nursing profession, the counterfeit of caring, codependency and codependence, need to be considered as a concomitant field of interest for research.Research into the existence of codependency, especially among student nurses, deserves nurse researchers' serious attention.
R E F E R E N C E S Bennett, S., Robertsoo, R. & Moss.P. (1992): Education: learning the pitfalls of codependency.Nursing Marmgtment, 23(2):80B-C 80F, 80H.Bevis, E. O. & Watson, J. (1989): Toward a caring curriculum: a new pedagogy fo r nursing.New York: NU^.r Ralph (1993:87-88)identifies the codependent nurse as the professional rescuer caught up in the triangle of codependent roles of rescuer, persecutor, and victim, ultimately resulting in burnout.A cco rd in g to F ag an -P ry o r and H aber (1992:26), the core areas of symptoms in codependency are: levels o f self-esteem , Different major areas regarding codependence surfaced as different authors categorised these a ttr ib u te s .S u m m ers (1 9 9 2 :7 0 -7 1 ) summarises these features and outcomes in five categ o ries, nam ely; co n tro l, guil/, stru g g lin g c o n sc io u sn e ss, damaged boundaries, and denial.