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Summary
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An 18-year-old reports episodes of intense self-directed anger and self-injury but has hidden them out of shame. He asks whether the behavior warrants help or is something he has fabricated.
The response says the episodes merit professional help and recommends a medical evaluation because psychological, neurological, or medication-related causes cannot be distinguished from the letter.
It also explores the burden of feeling compelled to appear strong and encourages psychotherapy to address shame and emotional distress.
Asking for support is presented as an honest, courageous response rather than evidence of weakness.
Question
Reader · Identity withheldI am an 18-year old male who over the past few months has had several strange ‘episodes’ (for lack of a better term) in which I become very hostile towards myself. I hit myself over the head with anything I can find (or my fist if I can’t find anything), I argue with myself, and I have a very strong sense of resentment, usually wishing that I was dead.
\nAnd yet, I haven’t told anyone about the ‘episodes’ because I fear they may be nothing more than a cry for attention. I can’t figure out if I’m making it up, or if there is something wrong with me. And when I try to find the answer, it makes me feel like my brain is split in two. I don’t want to tell any of my friends or family in fear of how they might react.
\nJust as a sign of how clueless I am about where to turn to, here I am asking a complete stranger about my most intimate concerns.
\nMy question is an easy, and yet complicated one: at what point should a person seek help, and based on what I have provided you with, am I at that level? Or are my (other) thoughts correct in saying that this is all fabricated?
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Answer
Mark Vigil Dombeck, Ph.D.I think you are at the point where it makes sense to ask for help. Specifically, I think that you should make an appointment with a physician for a complete health checkup, possibly including a neurological examination. You don’t give any background history, but you describe “episodes” of angry outbursts which seem (from your shocked and ashamed tone) to be very out of character with your normal personality.
\nThese outbursts may be “psychological” in nature or very organic (e.g., medical) and only a qualified health professional will be in a position to say. Angry outbursts are possible for a variety of reasons, subtle and otherwise. Have you been under stress lately? Have life events occurred that have caused you to be angry or to have judged yourself a failure?
\nIf you are a perfectionist by nature, relying on over-control of emotions as a means of holding yourself together, any pronounced “failure” that may have occurred, could be enough to send you over the edge into a state of agitated depression (anger turned inwards, as the analysts would have it) that you aren’t prepared to cope with.
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The precipitating event(s) need not be failures in the eyes of others; only your own feeling of failure is necessary to set the process in motion. Then again, your episodes may have a more organic bent to them. Physical changes in the brain can result in out-of-character behavior. You may possibly have something wrong with your brain (grossly, as in a tumor or head injury, or subtlety, as in epilepsy, or agitated depression).
\nHave you been using any drugs (prescribed or otherwise)? Drug side effects could be influencing your condition as well. It is impossible to know what may be causing your outbursts without a thorough checkup by a doctor, which is why I’m encouraging you to go and get one.
\nThere is a deep current of shame in your letter. You present yourself as someone who feels the need to hide what is going on inside from those you are close to for fear of how they will react. There may be very good reasons for this fear; you may have been harshly judged in the past for revealing “weaknesses” and have learned to present a false self to those around you for protective purposes.
\nThough this sort of behavior is perhaps a necessary defense, given your environment, it will extract a heavy toll on the quality of your life. To feel the constant need to be strong is to live in fear constantly. It is good to strive to be strong, for sure, but no one is strong all the time, and when people are having difficulty, it is appropriate and courageous to ask for help from people who can provide it (such as doctors and therapists).
\nIt is not healthy to pressure yourself to be strong and self-contained all the time. Sometimes people need to be vulnerable. It is only when we are vulnerable, for instance, that we can love. Vulnerability is another word for openness, and only through openness and sharing can people support one another and love one another.
\nYou need to be discriminating with regard to who you share vulnerability with for sure, (for some people will try to hurt you). However, if you don’t allow yourself to be open some of the time, you will be miserable and depressed almost for sure.
\nI’ve mentioned the worst sorts of things that could be happening (e.g., tumors), and you should see a doctor to make sure that nothing like this is happening. When you are done with this medical checkup process and physical causes of your issue are ruled out (I hope will be the case), you should cosider making an appointment with a psychotherapist to talk to about all this shame you are carrying; this need to appear strong all the time.
\nA good therapist may be able to help you safely lessen your burden in this regard. Entering into therapy is not weakness (as you might think), but rather a sort of courage that a lot of men don’t have. Rather than requiring courage to appear strong when you are not (which is the common sort of courage that values appearance or honor over truth), therapy requires the uncommon courage of being willing to admit feelings of “weakness” honestly, so that you can learn how to cope with them honestly, and without pretence or fear or shame.
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