Even teens who are popular and appear to be doing well may feel secretly isolated emotionally, harboring distress that seeks expression through self-destructive behavior.
Neurobiology of Breaking Habits
Self-destructive behavior patterns, such as addictions, are hard to break because they provide immediate relief. But their aftermath makes people defeated and ashamed, requiring more relief, and the cycle continues. These habitual, compulsive behavior patterns limit new learning and connections in the brain by obstructing opportunities to experience the positive rewards from sustainable, effective coping strategies.
Dr. Lynn Margolies is a psychologist and former Harvard Medical School faculty and fellow, and has completed her internship and post-doc at McLean Hospital. She has helped people from all walks of life with relationship, family, life problems, trauma, and psychological symptoms including depression, anxiety, and chronic conditions. Dr. Margolies has worked in inpatient, outpatient, residential and private practice settings. She has supervised others, and consulted to clinics, hospitals, universities, newspapers. Dr. Margolies has appeared in media — on news and talk shows, and written columns for various publications.
Editor: Nadeem Noor
Kaitlyn, 17, was bright, vibrant and charismatic. She was adopted at birth (and knew this all along), then struggled from early childhood with both epilepsy and an unbearable sense of psychological pain and inner isolation she could not articulate.
Kaitlyn’s shame and sense of herself as unlovable had its origins in feeling unwanted and abandoned. She was naturally outspoken, gregarious and likable, but developed an early pattern of self-consciousness and inhibition with peers, driven by fear of rejection. She learned to act according to what she thought friends and boys wanted – anxious to be liked and secure her relationships.
Shame, Rage and Self-Harm
Kaitlyn had a history of self-harm, typically provoked by real or imagined rejection. She harbored a secret fantasy of being hurt and then rescued, and impulses to make her pain visible and have it validated by others. This dynamic was an unconscious attempt to manage overpowering feelings. It brought others close enough so she wasn’t alone, while reassuring her she was still loved.
Shame is a terrible feeling of badness associated with wanting to hide one’s head and disappear. Kaitlyn’s feeling of shame and badness was fueled by episodes of rage at home, confirming her fear that she was a “monster” who drove people away and didn’t deserve love and happiness. Rage can be a defense against intolerable shame, when shame turns into blame and is projected onto others. In this way, the bad feeling is passed on like a hot potato, providing temporary respite from feeing terrible, but propelling the cycle of shame and self-destructive behavior.
Self-Fulfilling Prophecy and Self-Sabotage
Shame-based self-perceptions that are acted out through self-destructive fantasies and behavior create a self-fulfilling prophecy, providing rigged evidence of badness. Feelings such as worthlessness, badness, and inferiority have various origins in early experience when we are developing a sense of self. These feelings may later be experienced as factual — as if they represent the truth about who we are. When such compartmentalized experiences of oneself remain secret and unarticulated they can lead to unconscious pressure to make this inner “truth” a reality, leading to self-sabotage.
Dysfunctional behavior patterns are habits with psychological, often unconscious, motives. Breaking them requires insight into what function they serve and the discipline to stop them. It also requires courage and initiative to try out new behaviors and allow a different chain of events to occur. On a neurobehavioral level, new behaviors that generate positive feedback create new pathways in the brain, allowing momentum for psychological growth and change.
Kaitlyn had been caught in waves of powerful feelings and a difficult cycle of self-defeating patterns. But she wanted more than anything to be strong, self-respecting and independent and began to use her determination to work toward these positive goals, instead of hurting herself.
Kaitlyn’s first step was talking in family therapy about being secretly drawn to videos about suicide and self-harm on YouTube, especially when feeling sad or alone. She initially feared being judged and was scared that access to the videos would be taken away. However, as she trusted that it was safe to talk about these secrets without being judged and could make her own decision, Kaitlyn was able to evaluate what she wanted to do.
When taking a neutral step back to assess her thoughts and feelings, Kaitlyn recognized that exposing her mind to this content fed her fantasies, pulling her deeper into darkness, and created a cycle of regression which impeded independence and forward motion. Just as she could choose what food to put into her body based on its effect, she could decide whether she wanted to expose her mind to stories and images that made it harder to resist being self-destructive.
Trying Out New Behaviors
With encouragement, Kaitlyn became motivated to try out new ways to comfort herself. Learning better ways to regulate and take charge of her feelings gave Kaitlyn a jumpstart to taking healthy risks in the world.
Kaitlyn enrolled in a Saturday class in public speaking at a local college to develop her confidence. Having had a seizure at home after the first class, she missed the following class. She felt alienated and experienced a familiar sense of herself as defective, followed by the temptation to hide. In therapy she talked about the isolation and sadness she felt.
A week later, right after the next class, Kaitlyn burst with glee into the family therapy session, followed by her mom and dad. Grabbing the feelings list, she began the meeting as always — naming the feelings that fit her state at the moment: “Alive, amazed, confident, exuberant, happy, hopeful, proud,” she said. The excitement was contagious, but we glanced at each other curiously, waiting to find out what changed.
Kaitlyn went on to describe the class. The teacher asked for improvisational introductions by each student. Inspired by another student who made himself vulnerable, Kaitlyn bravely went up in front of the class and spontaneously spoke to her experience with epilepsy, telling her story in public for the first time. Looking around the classroom as she spoke authentically, Kaitlyn noticed people listening and completely engaged. Invigorated, she was fully present and one with herself. Everything felt natural. The class was mesmerized, responding with tears and applause.
Pride – the Antidote to Shame
Kaitlyn could barely contain the exhilaration brought on by this new feeling of pride (the antidote to shame) which emerged from a new experience of herself in relation to others. She took action that transformed her loneliness and alienation into a feeling of mastery and power. But the feeling of pride came not only from challenging herself with something meaningful to her and succeeding, but from something deeper.
Healthy Risk-Taking and Changing Behavior Patterns
Kaitlyn resisted the impulse to hide or pretend that typically escalated her feeling of being alone and ignited a self-destructive cycle. Instead, she took a healthy risk to let herself be seen, acting confidently from a position of strength and self-respect rather than a wish to be rescued.
Kaitlyn’s behavior created an opportunity for interpersonal feedback that challenged her sense of herself as defective and the belief that she could feel connected and affirmed only through pain. The key element here was that this challenge occurred experientially, not intellectually.
Healthy behaviors that foster connection and affirmation from a position of self-acceptance and self-respect offer the possibility of sustainable attachments. Here, Kaitlyn broke the cycle of feeling connected and affirmed only through darkness, potentially releasing herself from a treadmill of pain.
Choosing Happiness over Suffering: the Results
As she basked in the fact that people seemed to not only like her, but respect her and admire her courage, I said, “You see — you don’t have to hurt yourself to get people to see and care about you.” “ I like being happy!” Kaitlyn exclaimed, with a sense of wonder alongside awareness of the irony of this statement. She glance at her dad and they both smiled knowingly, “Who knew?!” her dad piped up in his good-humored way.