Self-Destructive Behaviors and Illness

Abstract

Medical illness and, to some extent, physical decline associated with aging are linked with the dynamics of power and control. When illness or aging strikes, people become aware of the limits of their bodies, perhaps for the first time. Once sickness or the drawbacks associated with aging set in, we cannot change the fact that our bodies are compromised. On the other hand, illness specifically can motivate us to seize control by following medical regimens, improving self-care, trying to have good relationships with our clinicians, and changing lifestyle behaviors that increase the risk of disease. Curiously, not everyone does this and it is important to understand the dynamics that are linked with taking control in a healthy way, versus those who become passive in response to illness, or sadly those that respond to illness by actively disregarding the needs of their bodies. This chapter will focus on parameters of self-care and how they relate to control over illness, through the discussion of power and control and anger and self-destruction. I will begin talking about this through the lens of the paradoxical situation when people with medical illness engage in behaviors that put themselves at further risk. These cases illustrate an extreme scenario in which feelings about oneself are physically manifested through unhealthy and self-destructive behaviors. At times such behaviors are often conducted with a specific aim of provoking a response in another person and also represent complicated internal dynamics related to rage, confusion, and feelings of powerlessness. And it is through this relational viewpoint that I will try to explain what can appear to be a “masochistic” response to illness. Although some people behave by habitual self-destructive behaviors when coping with illness, I will also address the common occurrence of those who engage in risky behaviors outside the context of being ill. Given the high degree of nonadherence in the United States pertaining to lifestyle factors and illness, I will suggest that there are common components of a self-destructive instinct in many people, or what Adam Phillips (2012) has called a desire to “get away with” breaking the rules. Though self-destructive behaviors can be differentiated from calculated risks (since we have to make decisions on a daily basis about behaviors that we are told will make us more or less healthy), I will make a case that certain psychological states, related to fear of illness and death, and the resulting issues related to power, control, and omnipotence can cause some people to behave in a way that can be described loosely as masochistic.

Do I dare

Disturb the universe?

T.S. Elliot