Self Destructive Behavior

Everyone gives lip service to the idea that depressed people are self-destructive. After all, suicide is the extreme end of depression. Of milder forms, we say "He keeps shooting himself in the foot," or "She's her own worst enemy." We romanticize the self-destructive tendencies of artists like Dylan Thomas or Kurt Cobain.

What exactly does this mean, to be self-destructive? Freud originally theorized that depression was aggression, the destructive wish, turned against the self, an explanation which still has some poetic or intuitive appeal, though it doesn't tell us much about recovery. There are two more concrete meanings. One is to engage in behavior that is clearly dangerous or self-destructive, without appreciating the danger. The other is to engage in behavior that backfires on us. The behavior is not, in and of itself, dangerous or harmful, but it has unintended negative effects. Although this can happen to anyone, for the depressive it often becomes such a pattern that we assume there is an unconscious process at work.

The depressive's habit of procrastination, for instance, is a complex combination of defenses that the depressive uses very cleverly — I can say this because I am one — to make himself feel miserable. It's a way of expressing anger at a resented authority — but the authority is not the parent or the boss but the part of the self that says to the depressive "You really should (get a better job, wash the dishes, paint the living room . . . )." Instead of acknowledging the conflict between this part of the self that sets standards and moralizes and the part that feels entitled to always have the biggest piece of cake, the depressive will procrastinate. Instead of washing the dishes, he will go to the store to buy a new sponge, and while there be tempted by the display of canning supplies and decide now is the time to put up pickles. The next day he'll have more dirty dishes and no pickles, because in the middle of the project he'll get frustrated and sit down and watch Oprah. Daytime television was made to give procrastinators something to do. But his depression, his low opinion of himself, his idea that he can't meet his goals, has just been reinforced.

Finding more direct and healthy ways of expressing anger, of developing autonomy, of acknowledging a need for intimacy, are the obvious strategies to disrupt self-destructive behavior patterns. In clinical practice, many depressed patients are completely unaware of their self-destructive behavior, and many patients who come in because their behavior has gotten them into trouble are completely unaware of their depression. Getting these links established is not easy therapeutic work, but it's important, and it can be done.