When you habitually work to avoid stress, you risk becoming weak, passive, and dependent on others; your self-esteem suffers; you become self-critical, and vulnerable to serious problems like depression. At this point, you may resort to self-defeating – even destructive – coping actions that damage your mental and physical well-being. Therapist Michael Church has identified four self-destructive types: Direct-Active (blog entry 11/5/21), Indirect-Active (Blog entry 3/4/22), Direct Passive, and Indirect-Passive. The Direct-Passive type does not seek out or confront situations, but only reacts to problems and conflicts when perceived as threatening. Examples include people who are passive-aggressive, obsessive-compulsive in relation to anxiety and fear, panic-disordered, anorectics, avoidant personalities, hoarders, compulsive and withdrawn internet users, shopaholics, and those who commit “suicide by cop.”
Monica was emotionally deprived of the parental attention, approval, and recognition all kids need. Growing up, she received satisfactory custodial care but not much affection, guidance, and social support. Her religious parents regularly suggested to her that she was sinful and unworthy. Monica internalized those thoughts and struggled to compensate for them. Throughout her early schooling she was a good student, eager to learn and please her teachers, but always wanting what she did not get at home: attention, approval, and feeling that she was not a bad person. After graduating from high school, she went to nursing school and received an RN degree. She started to work as a nurse and met a young man she later married. He was a handsome young man, faithful to Monica, but as time passed, she became concerned because he drank excessively. They planned to have at least one child, but Monica could not conceive. She grew unhappy, but had no insight into what was bothering her. She slowly descended into depression, became suicidal, and had to be psychiatrically hospitalized.
After discharge, she started outpatient therapy with Church. Testing confirmed Major Depression, significant emotional deprivation during childhood, low self-esteem, non-assertiveness, emotional dependency in relationships, and a tendency to sacrifice her wants for the sake of others – to the extent she could be characterized as co-dependent. Over the years, this pattern progressed from revolving around her parents when she was a child, to revolving around her husband when she was an adult.
Monica talked about how she wanted a child, but worried about her husband’s drinking. She was ambivalent about staying in the marriage because of his drinking and self-centeredness. During her therapy, an infant was abandoned in the hospital where she worked. She asked her husband about adopting the child and he said he was on board. He also assured her he would cut down on his drinking.
Everything seemed fine for the first few months after their adoption was granted and they were able to take their infant home. Unfortunately, her husband slowly reverted to his old drinking ways. Monica became increasingly responsible for caretaking and they fought and argued more and more. A few years later they separated. She bought a home and filed for divorce. Her husband got a girlfriend who joined him in drinking and partying. Monica became self-critical, blaming herself for her husband’s drinking, for the divorce, and for being a lousy mother. Her suicidal intentions threatened to re-emerge, but fortunately she stayed in therapy and received the guidance and support she needed. She also had a purpose – her child – that motivated her and committed her to the future.
Monica continued counseling to help her from relapsing into her old pattern of self-defeating/destructive actions, which led to her depression and associated difficulties. She has a solid relationship with her now teenage son, and has primary custody. She has dated and had relations with men but has not found someone she wants to make a full commitment with, and that is okay with her. She has learned that she does not need a man, and is no longer willing to subjugate her wants and needs to someone else. If she cannot find a reciprocal and mutually satisfying relationship with a mate, she is okay without it. She looks ahead to a time when her son will be in college and she might be a traveling nurse, which would allow her to live close to him and see more of the United States and meet people she would not otherwise. She is even open to the idea of nursing in another country and going back to school to earn a graduate degree in nursing.
Monica understands how she became depressed for so many years. In many respects she was “too good,” in the sense that her identity, autonomy, and independence got lost in the shuffle. She would often ask Church whether a particular thought or feeling “makes me a bad person.” His answer was always, “Your thoughts do not make you good or bad. They are natural for you and part of what makes you human. You do not have to feel guilty about your thoughts or feelings. Every person has some extreme, distorted, bizarre, or self-centered thoughts from time to time. Your thoughts and feelings do not define you. Your freely-chosen behaviors define you. Those behaviors are what you need to concentrate on, not your thoughts and feelings.”
Monica came to understand that her concern about being a bad person was associated with her guilt-inducing family upbringing. These are issues that will likely plague her to some extent for the rest of her life. After all, when a child deals with shame, guilt, and self-criticism for years, those thoughts become strongly imprinting in the brain. But Monica has learned to accept, not deny, this reality. She has improved greatly in her recognition of this vulnerability to self-criticism, and how to correct it before it builds momentum and leads again to self-destructive patterns.