If you believe many of the things you read and hear about these days, just about everyone suffers from some kind of addiction. And despite how commonplace it’s become, I’m always a bit shocked (and outraged) when some disturbed character claims victim status by blaming his or her reprehensible conduct on an addiction of some sort (For a prime example of this see the articles: I Am Not A Monster: Impression Management Arial Castro Style and Mental Disorders and Accountability: Is Everyone a Victim?). Genuine addictions are actually quite rare and by definition must involve two essential features: tolerance (to a substance or activity) and withdrawal (a distinct syndrome of distress and impaired functioning upon cessation).
Just because someone habitually engages in dysfunctional behavior doesn’t mean they’re an addict. And just because on the surface of things there appears a compulsive aspect to a person’s behavior doesn’t mean they’re addicted or laboring under a true compulsion. Addiction is a real disease. Addicts have built up such a degree of tolerance to a substance that they can no longer function in any near normal way in the absence of it. In that sense they are truly dependent upon the substance to maintain some sort of equilibrium.
In the age of character disturbance, deficient self-control and management has become widespread. And along with that has come a fair degree of relational and substance abuse. But people who out of unchecked habit or pure preference simply won’t control themselves are very different from those who can’t control themselves any longer because of their addiction. And recently the Centers for Disease Control and Prevention has, in a wide-ranging longitudinal study, confirmed what those of us working in the field of character disturbance have long known: 90 percent of problem drinkers and bad actors, regardless of the diagnoses they might be given to get them into a treatment program, are not truly addicts – including, believe it or not, heavy binge drinkers! They’re abusers to be sure, but not truly addicts.
Why is it so important to get it right when it comes to addiction? Because it means everything as far as appropriate intervention is concerned. All too many folks with serious character disturbance go through addiction treatment programs and exhaust their family’s resources only to come out of those programs much the same as when they went in. When character is the problem (and abuse is the result), the focus of treatment needs to be on the twisted thinking and habitual but voluntary behaviors that cause all the trouble. Unfortunately all too many abusers go through addiction-model treatments only to have their character issues largely ignored.
Co-dependence is such an overly employed and misused term that it’s hard to determine where to start in clarifying what it truly means. It refers to a phenomenon that can indeed occur within the family system of a genuine addict. The chemically dependent person has his or her life controlled by their substance of choice. And many times, spouses and others in the family (including the “enablers”) also find their lives similarly controlled. Both parties – the genuine addict, whose life has been taken over by the substance, and others in the family system who end up doing and tending to all kinds of things they wouldn’t otherwise be doing if it weren’t for the influence of the substance involved – end up in a way equally or co-dependent on the addict’s substance of choice. Unfortunately, in recent years the term has been extended to encompass all sorts of other problems associated with substance or relational abuse, including, most especially, emotional dependency, which is an entirely different animal. When a person maintains a relationship with a substance-abusing or relational-abusing person (not a genuine addict but a disturbed or disordered character who uses and abuses everything in his/her life) because they’re too insecure, anxious,or otherwise hesitant to set firm limits or disengage, it’s not a case of co-dependence but rather emotional dependency. And when emotionally dependent folks buy into the notion that their abuser is in any way dependent just like they are (i.e. co-dependent) the chances are even greater that they’ll remain in a dysfunctional relationship. There are big implications for treatment, too. Emotionally dependent folks tend to benefit from dependency-modeled programs whereas their abusive relationship partners attending the same program tend to evidence little genuine change (For more on this topic see: Commonly Misused Psychology Terms – Part 2). I’ve witnessed this phenomenon all too many times. Co-dependence is also not the same as mutual dependence, a phenomenon that can happen when two fairly equally insecure and/or inadequate individuals depend too much on each other in a sort of symbiotic relationship. Unfortunately, I’ve seen the codependence label applied many times where a mutual dependency situation appears to exist but the reality is that character-impaired and abusive individual is habitually exploiting his/her relatively insecure partner’s vulnerabilities and emotional dependency. Such an erroneous perception can significantly adversely affect both assessment and treatment.
Dynamics similar to codependency can also be seen in families where someone suffers from true obsessions or compulsions, and I’ll have more to say on this in a future article.
Anxiety is a frequently misunderstood term. It’s a fear-like response the body experiences in the absence of a tangible threat. We have some primal responses built into us (e.g., fight vs. flight) that prepare us for dealing with threats to our well-being. When we’re scared, certain physiological responses are common (e.g., blood flow to our periphery is restricted – hence cold and clammy hands and feet, our heart rate increases, our level of vigilance increases, we can tremble or shake, etc.) as our body goes into protect mode. We call anxiety a fear-like response because it occurs not to an identifiable objective threat but rather in anticipation of a threat that’s either purely subjective or can’t be readily identified. In short, when you’re anxious, you feel threatened, but can’t identify why. Still, your body reacts as if you are in danger. Some folks experience anxiety that builds upon itself, creating a vicious cycle. Such cycles can spiral to the level of panic, which has its own symptoms (e.g., feelings of unreality, a sense of depersonalization, fears of imminent doom, “going crazy,” or losing all control, etc.). The symptoms of extreme anxiety can be quite distressing and debilitating even though in reality they’re relatively harmless.
Post-Traumatic Stress Disorder (PTSD) is a unique type of anxiety disorder. Folks who’ve been exposed in some way to a grossly terrifying event can experience fear reactions long after the immediate “threat” has past. They can also experience anxiety symptoms in situations and circumstances that either bear some degree of resemblance to or remind them in some way of the initial traumatizing event. Severe trauma often makes a deep impression on our nervous systems.
Not everyone who’s experienced a difficult situation or a stressful or tumultuous event and experiences some understandable problems adjusting afterward develops PTSD. And PTSD has some very distinct symptoms, including: intrusive recollections of the trauma, dissociative reactions such as “flashbacks” (having the subjective experience of being back in the traumatic situation), avoidance of activities and situations reminiscent in some way of the traumatic event, etc.). Despite the fact that PTSD is probably among the most distressing and debilitating conditions a person can experience, as an anxiety disorder, and contrary to what you might have heard, it’s a very treatable illness. All effective treatments for anxiety have some things in common, primarily being that they allow a person to gradually and gently expose themselves to anxiety-evoking situations while simultaneously allowing themselves to realize that there’s no longer anything to fear. And when discrimination training is added to the therapy, the person also learns that even though a situation might in some way remind them of the event that traumatized them, it’s in reality a different circumstance, so again, there’s no need to be fearful. For a unique and interesting viewpoint on PTSD you might want to read: A Combat Vet’s Take on PTSD.
Self-esteem is a much misunderstood concept, also. I’ve written about it in all three of my books In Sheep’s Clothing, Character Disturbance, and The Judas Syndrome, and in several blog posts (See, for example: Self-Esteem and Merit and How to Inflate an Ego in 3 Easy Steps). But inasmuch as there’s still lots that can be said on the topic, and considering the kinds of questions and comments some of the commentators have voiced on the blog recently, I thought it appropriate to delve deeper into matters related to self-esteem in the current series (For more articles in the series on commonly misused and misunderstood psychology terms and concepts see also: Misunderstood and Misused Psychology Terms – Part 1, Shame, Guilt, Regret, Remorse, and Contrition, Misunderstood Psychology Terms – Pt 2: Personality & Character, Misused Terms Pt 3: Defensive, Dissociation, Dependence, Denial and Misunderstood and Misused Psychology Terms – Part 4).
The term self-esteem literally means to estimate ourselves, and more particularly, our worth. All of us have an intuitive sense of what we have going for us and how we stack up among others. And how we appraise ourselves and our value reflects our self-esteem. Now, for a long time, many in the helping professions thought there was no such thing as too much self-esteem. They also believed that almost all relationship problems in some way stemmed from low self-esteem. But we live in the age of character disturbance, and there are plenty of folks out there who simply think far too much of themselves. Moreover, most of these folks aren’t, as we used to think, compensating for underlying feelings of insecurity. Ego-inflation is not always about pretense, either. There are just as many truly accomplished folks as there are slackers who think far too highly of themselves. They key is in the accuracy of self-estimation. I know plenty of folks who know a lot, but still always think they know more than they do. And I know plenty who have have done a lot, but are still not as great or as important as they think they are. And of course, there are plenty of folks with nothing to show for themselves who still think they’re all that! Again, it’s all about the accuracy of self-estimation. Folks with pathological high self-esteem always overestimate themselves and folks with debilitating low self-esteem always underestimate themselves even when they have ample objective reason to think better of themselves. Those who think too little of themselves can easily subject themselves to unnecessary abuse and exploitation. That’s why, when it comes to self-esteem, it’s really important to get this crucial dimension of character in proper balance (You can find many articles on this site about self-esteem and self-respect by using the blog’s search feature).
l’ll have more to say on the topic of self-esteem next week. In addition, we’ll be taking a close look at the mood disorders, such as Depression and especially Bipolar Illness. And I’ll be talking about self-esteem-related issues on Character Matters this Sunday at 7 pm Eastern Time.