Self-destructive Behaviors, Masochistic Dynamics, 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 strikes, people become aware of the limits of their bodies. Once sickness sets in, we cannot change the fact that we are ill. On the other hand, illness can cause us to seize control by following medical regimens, improving self-care, and changing lifestyle behaviors that increase the risk of disease. This chapter will focus on parameters of self-care and how they relate to control over illness. I will begin by exploring this issue 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, but also represent complicated internal dynamics related to rage, confusion and feelings of powerlessness. Although some people behave with habitual self-destructive behaviors in illness, I will also address the common occurrence of those who engage in risky behaviors outside of the context of being ill. Given the high degree of noncompliance 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. Though self-destructive behaviors can be differentiated from calculated risks (since we are all subject to activities, behaviors, and environmental influences that could be harmful and yet cannot avoid), 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 be covered loosely under the heading “masochism.”