A Delaware Wave reader sent an email asking me why some health professionals sometimes refer to her son’s behavioral problems as a ‘disease.’ She says it makes her son feel worse about himself and even seems to deepen his depression.
The whole idea of calling behavioral problems (like depression or alcohol/drug abuse) “diseases” was to encourage people to STOP viewing them with shame. If you view your problems with shame, you’ll more likely deny or ignore them rather than “treat” or face them. That’s a good point. But the problem is this: By calling something a “disease” (and this is what the reader’s son could be sensing on some level), you imply that, (1) there’s no choice or personal responsibility involved, and (2) somebody else must fix you. Both of these things are false.
A mental health or behavioral problem can only be fixed by the person who has the problem, perhaps with the guidance of a professional. But ‘guidance’ is not the same as having something “done to you,” like a heart surgeon operates on you or an antibiotic clears up an infection.
Mental health professionals were right to get rid of the shame, but wrong to skip the personal responsibility and realism. This does not help the patient. You help someone by saying, “I care, and I’m here to help you.” But it’s also crucial to say, “You have to change your thinking and your habits if your life is to improve. I’ll help you, but YOU have to do it.” This is empowering and inspiring. I’d rather feel that I have control over something than not. The root of self-esteem is confidence in the use of your mind. We can control what we think and, in some measure, what we feel. No one else can do that for us.
Shame gets in the way of personal responsibility. It imprisons you in the past, clinging to negative emotions and never-ending analysis of your old mistakes—real or imagined. It’s healthier to embrace responsibility for your mistakes and then MOVE ON. Moving on means telling yourself that you need never make that mistake again.
Aimee Liu, author of “Gaining: The Truth About Life After Eating Disorders,’ aptly describes the voice of shame in anorexia and other severe eating disorders: ‘I often went entire days without speaking — unable to get a word in over my inner taskmaster, who never shut up: ‘You fat, disgusting slob, you’ll never be thin enough, good enough, smart enough, tough or talented enough’.”
What a great way to describe the ‘self-talk’ that accompanies a severe emotional or behavioral problem: Inner taskmaster! And it’s harsh, self-defeating and destructive. Though the notion of ‘mental disease’ was originally conceived to counter this sense of shame, it’s also not particularly reassuring to hear that ‘You’re diseased.’ It can encourage the depressed person to embrace passivity and to withdraw even further into themselves. To me, it makes a lot more sense to help somebody understand that he or she can talk back to this ‘inner taskmaster,’ using facts and reason to instill control rather than retreat.
There are two types of shame: deserved and undeserved. Deserved shame comes from doing something you know is wrong or counter to your sense of integrity. True self-esteem requires that you try to make amends without harming anyone or anything further. In this context, embracing shame is healthy. It becomes a call to action, allowing you to freely acknowledge what you did, repair it if you can—and then move on.
For others, however, shame is tied to everything one does or feels. This vague, non-specific emotion is usually undeserved, and often appears in people thought to be emotionally troubled. Psychotherapy and other methods can aggressively challenge the sense of shame and, hopefully, over time, rebuild self-esteem and confidence, ‘brick by painful brick.’ Not very inspiring, maybe, but it is realistic and possible. And it’s better than retreating into ‘I’m ill, I’m dysfunctional, and there’s not much I can do about it except sit back and wait to be ‘cured’ by someone.’
If you suffer from problems related to low self-esteem and depression, it can be helpful to do what parents sometimes do with young children: Distinguish between shame over what you DID, as opposed to shame over who you ARE. A healthy person thinks, ‘Wow, I messed up. That’s not like me. I have to make this right,’ implying that ‘I’m still OK. But what I did here isn’t.’ On the other hand, the troubled person feels, ‘I’m terrible. I’m awful. I’ve never done anything right and never will.’ Ahhh, there’s that NASTY inner taskmaster!
The reader’s son should explore the difference between seeing himself as a bad person who never does well, versus a good person who sometimes messes up. ‘We’re only human’ is neither an excuse nor a rationalization. It’s a statement of fact. Oh, we can mess things up all right, but we can also work to repair them as well.