The Opposite of Addiction

Former (… after he was caught plagiarizing in 2011) UK journalist Johann Hari put out this Ted Talk about addiction in 2015. It has become popular and, without making any claims about his credibility, I think there is still something to draw from the idea presented here. Hari says that the opposite of addiction isn’t sobriety, it’s connection. One of my observations about body-focused, repetitive behavior (BFRB) sufferers is that they don’t feel the urge to pick, pull, or bite when they are engaged in good conversation. They also don’t feel the urge to pick, pull, or bite when they are crying or yelling. What this suggests to me - if we think of BFRBs as behavioral addictions - is that connection may be at play here too. Connection may not be limited to social interactions either - it may refer to others, but can simply be to ourselves. I tend to think of BFRBs as occurring when we are subconsciously trying to feel or find something - when we need some kind of anchor amidst uncertainty or open-endedness. BFRBs offer us a mental and/or physical focus, which we wouldn’t need if we could already locate ourselves.

Clinically, this means that if we can work on engaging ourselves in a non-hair/skin/nail-based thought, feeling, or project, it may adequately compete. We are often zoned out while we pick, pull, or bite. Research has even substantiated such links between BFRBs and dissociative phenomena (Corfield et al., 2004). The antithesis then is mindfulness or presence, and doesn’t even have to mean formal meditation. The next time you are in a BFRB episode, see if you can turn your attention to anything else in yourself or your environment - it can be a colleague’s manner of speaking in your meeting, the feel of the water as you wash dishes, or even your desire to resist your BFRB. Zeroing in on a negative possibility like pissing off your boss, for example, may trigger more discomfort —> greater instincts to avoid —> more picking, pulling, or biting. But what if this thought could exist as more than flat out rumination? Consider a situation in which you could observe yourself having this experience of worry, almost as if you are an alien studying an anxious human for the first time. See if you can get curious about the reactions it brings not only to your mind, but also your body. Allow yourself to become fascinated by the speed at which your thoughts fly, the restlessness in your hands, or the impulse to seek reassurance from a friend. You’ll find that doing something mindlessly doesn’t work once you are actually mindful.

Beyond Achievement: Knowing ourselves as more than just our performance

A common scenario I’ve encountered in my practice is individuals who, starting a day, ending a day, or returning home after an extended period away, feel compelled to “check in” on their skin. Taking this measurement feels like a grounding ritual of sorts, but this need to know how we are doing (e.g. behaviorally) has seemed to take the place of who we are and how we are. In our society, our means of knowing ourself feels dependent on and limited to who likes us, who agrees with us, how many “likes” we get, how much we are getting paid, what invites we get, etc. We all need some baseline sense that we can be successful in this world, but this was always meant to be a stepping stone in our development. “Industry vs. Inferiority” was identified as only the fourth stage in Erik Erikson’s theory of psychosocial development. This stage is all about growing feelings of competence (our ability to feel “good at” things). There are eight stages total, however our society is largely stunted here! What was supposed to come next? Development of a personal identity, which can then fuel intimate relationships and creative instincts. Achievement was never intended to sum us up, it was meant to give us the confidence to keep on exploring.

We are a society that tends to overemphasize achievement. As a result, it makes us reliant on some external marker to tell us how we “should be” doing. Why, when we wake up in the morning, do we need to know the status of our skin to know if we can feel good or bad about the day? Can that not exist on its own? Do we not have internal sources for determining this?

I think the simplistic answer is “no.” I think our sense of ourselves is impoverished, so we are constantly, frantically looking for definition. We are so out of touch with innate feelings that we seek external indications to inform our well-being. When we pick in the morning/at night/after a vacation, we are saying that we feel unbounded. We feel lost and unsecured. Knowing the state of our face gives us some reassuring feeling of knowing our place again. When we want to check in with our skin condition, this is not the same as checking in with our actual self. This is not the question of, “Am I feeling unsettled right now?” or “Am I feeling an urge to pick right now?” It is simply the need to know how we are literally doing - our relative success. It’s like we need to know our skin condition to tell us if we’re allowed to feel good about ourselves or our life at the moment - [scans face immediately upon waking up] “Oh yeah, last night was a bad night…” If you just came back from a wonderful, pick-free vacation, why is your instinct upon returning home to plant yourself in front of a mirror and assess the clarity of your skin? It’s like we can’t trust that we can keep those good feelings about us unless it is verified by our face. Even then, our sensitivity to performance makes it so that we always fear failure and often pick just to preempt potential feelings of disappointment.

It is sad that we can’t connect with or hold onto natural feelings about ourselves above and beyond external circumstances. For example, instead of determining whether we care to read that book on our shelf, we surround ourselves with acute and painful awareness that we haven’t read it yet (FAILURE). We accept a position with an organization simply because the president tells us they think we’d be great at it (SUCCESS). We feel inadequate because we can’t hold conversation about film, even though our passion is really for poetry (FAILURE). We are being depleted by our job, but feel superior because most folks couldn’t last one month (SUCCESS). It is these incongruencies that point to our difficulty hearing (and responding to) what feels personally relevant vs. reacting to suggestions of success/failure. When we believe accomplishment is the key to acceptance, we become attached to measuring ourselves. However, once we can develop a relationship to ourselves that is personal, we can go to bed peacefully even if we picked ten scabs that day. Living without the need to regularly evaluate how we are doing is to live with exponentially more room for being freely and intentionally.

Why We Pull, Pick, and Bite

Basic principles of operant conditioning tell us that behaviors are usually maintained because they deliver pleasure (positive reinforcement), or because they relieve some source of displeasure, like anxiety and tension (negative reinforcement). The answer to the "Why?" in terms of body-focused, repetitive behaviors, such as hair pulling, skin picking, and nail biting, may be more an "AND" situation: These behaviors are both positively AND negatively reinforced. While they may provide subtle stimulation, they are also an important source of distraction or dissociation... which brings me to my next "AND"...

Body-focused, repetitive, behaviors, better known as "BFRBs," are behaviors AND much more than just behaviors. They are physical means of emotional coping. BFRBs allow us to reduce our attention (cognitive narrowing) to a simpler and thus more tolerable level of experience - basic, objective, and rote sensations of the body. In this process, we get to distance ourselves from all of the harsh judgments we hold about ourselves, and fear that others may hold about us. This explains why BFRBs often arise while we are doing or thinking about a task we tie to our performance; for example, writing a paper. It is also our mere awareness of ourselves in these behaviors that keep them going. We judge ourselves for succumbing to pulling, picking, and biting and not ___(fill in the blank with whatever else we are "supposed" to be doing)___, and that makes returning to reality even harder. We wrap ourselves up in our sensations to create an autistic bubble where we are insulated from uncomfortable, emotional feelings.

Stay tuned for more on the autistic bubble and treatment implications...