How Shame Makes You Self-Sabotage, Without Even Noticing
During my time being involved with the mental health system, I would often hear tales of people stopping their psychiatric medications against medical advice because they felt better, and believed that meant they were cured.
Essentially, the pattern goes something like this: the person goes to a psychiatrist for some issue, who then prescribes medication to manage it. After a month or two on the medication, the person’s condition improves. Now that the person is feeling better, they believe they no longer need the medication, so they stop taking it. Once they stop taking it, the condition comes back, and the cycle repeats.
The idea of someone getting stuck in this cycle always perplexed me. Surely their doctor told them that this was a treatment, not a cure, and that stopping it would result in their symptoms returning. And yet, this still seemed to be a fairly common problem. Could people not understand the difference between a treatment and a cure? Why do people get stuck in these cycles, sometimes for years, when the solution seems so obvious?
After years of pondering this question, I finally found a plausible explanation. Because I realized: I do the exact same thing.
How I’ve Been Sabotaging Myself
Although I’m generally compliant when it comes to prescribed medications, there is another situation where I fall into a similar pattern of self-sabotage: disability accommodations. I only started seeking accommodations a few years ago, and even more recently realized that I’ve been self-sabotaging by declining necessary accommodations. Despite having plenty of evidence to be able to predict the consequences of this decision, I’m always shocked when it doesn’t go well.
Essentially, the pattern goes like this: A situation is causing me unmanageable levels of distress, so I seek disability accommodations. With the accommodations, the situation becomes tolerable, and I feel like I’m able to cope with it pretty well. Sometimes it even starts to feel easy. And then my brain jumps in with: “Wow, this is going so well! Do I really need these accommodations?” So then I stop pushing for the accommodations, and things “inexplicably” return to how they were before. Rinse and repeat.
This was certainly a humbling realization. And, it finally gave me the insight to understand why some people are repeatedly convinced that they no longer need their medications, despite ample evidence to the contrary. I certainly have plenty of evidence for my ongoing need for disability accommodations, and yet I repeatedly fall into the trap of believing that if things feel good now, that means I no longer need support.
Factors Affecting Self-Sabotage
Stigma, Shame, and Internalized Ableism
At its core, I think this pattern of self-sabotage stems from a feeling of shame. Society teaches us that certain types of struggles are unacceptable, that they reflect a moral failing or character flaw, and so they should be hidden away to protect oneself from judgement. Mental health struggles certainly fall into this category, with therapy and psychiatric treatments carrying a heavy stigma. Over time, people internalize this shame, believing that they should be able to handle it on their own. Taking medications is a daily reminder of this shame. If things have been good for a while, it makes sense that someone would want to stop the medications to ease their feelings of shame.
Of course, the amount of stigma someone experiences varies based on their social circle. And whether someone internalizes something as shameful is another whole conversation. Somehow, I avoided internalizing mental health treatments as shameful. However, I very much internalized the idea that needing disability accommodations is shameful.
It’s worth mentioning that this type of shame may or may not reflect a person’s conscious beliefs. For example, if anyone asked me about it, I would say that anyone who needs a disability accommodation should absolutely get that accommodation. Disability accommodations aren’t just not shameful, they should be actively encouraged, both for the direct accessibility benefits for disabled people and for the positive ripple effect they have on society.
And yet, clearly somewhere in my subconscious, I’ve internalized that needing disability accommodations is shameful. At least, it’s shameful for me specifically to need them.
Just because you have internalized shame about something, doesn’t mean those are your actual values, or that you’re a bad person. It just means that you’re a human living in an ableist society, and you’ve subconsciously absorbed that ableism. In fact, this happens to everyone; escaping these biases completely is nearly impossible. But, we can do our best to be aware of them and change our actions to reflect our actual values.
If you’ve found yourself stuck in a cycle of self-sabotage, awareness of your own internalized ableism and shame is the first step to breaking the cycle. In addition, it can be helpful to understand some of the other factors that make this form of self-sabotage more likely, so you know what to look out for.
Delayed Consequences
One factor that makes this form of self-sabotage more likely is if the consequences are delayed. For example, declining disability accommodations as an Autistic person might actually go okay, at least at first. For some Autistic individuals, the sensory and executive functioning demands of neurotypical society may be tolerable in the short term, but slowly chip away at the person’s ability to function in the long term. Eventually, going without accommodations can lead to full Autistic burnout, which can take months or years to recover from, sometimes permanently impacting a person’s ability to function.
Obviously, most people would want to avoid this. However, the fact that it often builds up over time makes it harder to draw an immediate connection between one’s actions (declining accommodations) and the consequences (Autistic burnout). And in the short term, the person is getting relief from any shame they might have felt around needing accommodations.
The same principle applies to physical conditions. For example, if someone has high blood pressure and stops their medication against medical advice, they may not see any immediate consequences. Although stopping the medication increases their risk of more serious conditions, such as a heart attack or stroke, the lack of immediate consequences makes it harder for people to see the connection. Instead, they mostly experience relief from the shame they were feeling from needing to take medications daily, which in the short term reinforces stopping the treatment.
Being intentionally aware of potential long-term consequences can help you remember how a behavior harms you, even if it feels good in the moment, which may help you take actions that are more in alignment with your values and long-term goals.
Factors Affecting Stigma and Shame
Another thing that’s helpful for catching these cycles of self-sabotage early is knowing which conditions are more likely to be stigmatized by society. More stigma means more shame, which means your emotional brain is more inclined to take action to avoid that shame, regardless of the long-term consequences. In general, mental health conditions, conditions where the patient is blamed, and chronic conditions are more likely to be heavily stigmatized. So, if your situation falls into one of those categories, it could be worth being extra mindful of the possibility of unintentionally sabotaging yourself.
Physical vs Mental Health Conditions
In general, there tends to be more stigma for mental health conditions compared to physical ailments. Mental health conditions are often less well-understood than physical, and treatments such as talk therapy depend on active engagement from the person in treatment. While there’s nothing wrong with requiring patient participation, it contributes to the (false) notion that if someone isn’t improving, it must be because they aren’t trying hard enough. This idea blames the person for their own suffering, as though they’re choosing not to get better. Thus, having a mental health condition is often seen as a character flaw, leading many people to shame the person who is struggling. As a result, people are more likely to develop internalized shame around mental health conditions, which sometimes leads them to discontinue treatment against medical advice, despite knowing it will make their condition worse.
Blaming the Patient
As discussed in the previous section, people often see mental health problems as the person’s own fault, which leads to increased shame. However, this principle also applies generally. Whether the issue is physical or mental, society blaming the patient increases stigma around that condition. For physical issues, this often includes conditions with strong correlations to lifestyle choices, such as high blood pressure or type 2 diabetes. Because diet and exercise can both cause and treat those conditions, people often see them as self-inflicted, with ongoing illness being a choice. As with mental health issues, this leads people to approach the person’s suffering with judgement rather than empathy. As a result, these types of conditions are more stigmatized and shamed.
Chronic Conditions
If a condition is chronic, that makes it more likely to be stigmatized, and therefore someone affected by that condition is more likely to experience shame for having the condition. To understand this, let’s first consider someone with a broken bone. Although it’s not guaranteed, in general someone with a minor fracture can expect to make a full recovery.
These types of conditions are among the least stigmatized, because they follow the standard narrative of healing: someone gets sick, they go to the doctor, the doctor prescribes a treatment, and after a short-ish period of time, the person makes a full recovery and is able to reintegrate into society exactly the same as before. In general, people feel relatively comfortable with medical conditions that follow this narrative. One can express some brief sympathy, maybe make accommodations for a month or two, and then otherwise continue as usual.
Now compare that to something like chronic fatigue syndrome, which has no cure and often gets progressively worse over time. In addition to dealing with debilitating fatigue, those with chronic fatigue syndrome often face harsh judgement from friends and strangers alike. Friends and family may initially be sympathetic, but for many people their support will fizzle out over time. Most people can handle a few months of bringing casseroles, but what about years? Or even decades? Those who are closest to the person may continue to support them, but many friends and family members will slowly distance themselves, moving on to less difficult social connections.
In short, chronic conditions tend to be more heavily stigmatized because they make those around the person feel uncomfortable. Whether it’s due to burning out on bringing casseroles, growing apart because formerly shared activities are no longer possible, or uncomfortable questions about their own life (what if something like this happens to me?), developing a chronic condition often leads to social isolation. Is it any wonder, then, that people feel ashamed of their chronic health problems? After all, it’s likely that a large portion of their social network abandoned them over it.
Conclusion
Society stigmatizes certain medical conditions, treating them as a character flaw or moral failing of the affected individual. As a result, people with these conditions are more likely to develop feelings of shame about their condition. This sometimes leads to a cycle of self-sabotage, where a person repeatedly discontinues effective treatments despite ample evidence that doing so is harmful in the long term.
Although a person may seek out treatment initially, those treatments may also trigger feelings of shame. So, once their medical condition improves, the shame of requiring ongoing treatments becomes their new biggest problem. To alleviate those feelings of shame, some people will genuinely believe that they’ve been cured (regardless of evidence to the contrary), and stop the treatment. Upon stopping the treatment, their condition worsens, until eventually it gets bad enough that they seek treatment again. And the cycle repeats.
If you’ve found yourself stuck in one of these cycles, know that it’s not a moral failing or indication that you’re not smart enough to understand long-term consequences. Instead, it simply speaks to the power of internalized shame, that even perfectly sane, rational, and intelligent individuals can end up in this cycle of self-sabotage. Oftentimes, these things occur entirely subconsciously, so people can get stuck in these cycles for years without realizing what’s happening.
If you want to break out of this cycle, the first step is to become aware of it, and learn about why it’s happening. Your default actions may seem illogical, but in reality your brain is protecting you from social rejection, which historically has been key to survival. Even after you’re aware of the cycle, you may nonetheless find yourself following its familiar path. This is expected, and completely normal. Over time, as you practice taking different actions, those actions will slowly feel easier. Eventually, they may even become the new default.