Your Best Life: Overcoming Approval Addiction

Many of us entered a healing vocation to mitigate suffering, promote healing, and to make a difference in the lives of patients. Others, like myself, had additional, less-noble reasons to pursue a medical vocation. Did we not feel smart enough? Did we overcompensate by cultivating a relentless drive to get into medical school? Did we feel ignored at home? Did we think that donning the white coat would earn the attention of our loved ones [8]?

Are we approval addicts?

Origins of Approval Addiction

In her book, “Like Me or Not: How to Overcome Approval Addiction” [6] author Dawn M. Owens notes several characteristic traits of approval addicts:

• Are you overly concerned about what others think of you?

• Do you have trouble recognizing your own needs?

• Do you say “yes” when you really want to say “no”?

• Do you have difficulty expressing opinions contrary to those you are close to?

• Does your happiness hinge on the approval of others?

Approval addicts generally suffer from a lack of self-esteem [2], We often forfeit responsibility for our lives, defining our worth principally by what others think of us. We may have been raised by a critical parent or a caretaker who extended conditional love [2], and who validated or rewarded us based on particular behaviors. Love was awarded for doing; there was no intrinsic worth associated with just being.

Although approval addicts tend to be showy, ultrahigh achievers, we generally are not satisfied by our accomplishments because there is no validation of us, only of something we did or something we tried to become [7]. For approval addicts, there is no lasting peace. There is always a next mountain to summit, a higher-profile accomplishment to achieve, or a stronger competitor to beat. We are not our accomplishments, and we are not what we do for money. Deep satisfaction—and meaningful validation—ultimately cannot come from accolades. Rather, it comes from a recognition of our inherent intrinsic worth and alignment with purpose and meaning.

My Story

My father was a World War II veteran who sustained severe psychic wounds not only from the war but from an oppressive childhood. He turned to alcohol to ease his pain and exhibited several classic features of alcoholism, including a hypercritical disposition [1]. As a child, I did everything in my power to attain my father’s approval. I sensed my father’s fondness for certain violent sports—football, boxing, and wrestling—and I dedicated my youth to succeeding in these disciplines, even becoming a championship wrestler, skilled boxer, and a starting Division I football player. But these “successes” still left me with a deep and lasting emptiness inside.

At the time, I did not realize how much I was invested in gaining my father’s approval. If success in sports wouldn’t earn his love, I figured surely success in medicine would. I immersed myself in the profession and, while ignoring my own needs, gained a measure of success. Marriage and children followed, and I quickly found myself pulled in many approval-seeking directions, all the while trying to be a good husband, father, and surgeon. I even launched a second career in standup comedy, seeking the approval of strangers to ease my inner pain. The need for approval from my wife, children, father, and generally anyone I knew, laid the groundwork for a collision course with burnout.

Rock Bottom

After years of sacrificing sleep, rest, and emotional rejuvenation, my immune system suffered. I sustained innumerable viral infections and ultimately, I succumbed to a serious eye infection. I had developed a periorbital cellulitis, which invaded my sinuses and threatened to become a brain abscess. My eye surgeon informed me that the organism causing my infection was opportunistic and only seen in immunocompromised hosts [4]. My approval addiction nearly resulted in the loss of my vision.

The Epiphany

While recovering from my eye infection, I recognized that my approach to life was not working. I needed radical change in the way I saw life and myself. My dad always instilled in me an attitude of toughness and fierce independence, a good thing, but it caused me to believe that seeking outside help was a sign of weakness. At the urging of friends and family, eventually and reluctantly, I got some professional counseling.

Recovery begins when we relinquish our belief that our value derives from the approval of others. Then, and only then, can we begin to discern our true identity and feel our own desires. We become self-accepting, genuine, authentic, and benevolent. When approval addicts are able to perceive their true intrinsic worth directly, we become freed from the psuedoself’s relentless pressure of attaining value through achievement [7].

I replaced my many efforts to please others with new anchors in my life—dedication to my faith, self-care, and meaning. I reframed my vocation by seeking success in the lives I changed rather than through financial success or notoriety. As a practicing Catholic, I sought to reconnect to God as I knew Him and dedicated my life to true service to others, expecting nothing in return. This was a radical departure from my previous credo which was to be “liked” by all I encountered. This was hard and deliberate work, aided by countless hours of prayer, journaling, and managing my inner locus of control.

We all need an emotional anchor in order to maintain resiliency. An inner locus of control is a fundamental part of that anchor; it’s the degree to which individuals perceive events in their lives as a consequence of their own actions as opposed to events out of their control (outer locus) [5]. Simply stated, when we adopt an inner locus of control, we assume responsibility for our own lives.

Whether it is our inner locus of control and alignment with faith, love, values, or principles, we all need to be anchored to something within. Viktor Frankl, in his classic work, Man’s Search for Meaning stated that meaning, not pleasure, is man’s primary motivational force: “He who has a why to live for can bear almost any how” [3]. Meaning can only be derived from within—others will never replace the merits of dedication to our own internal work.

Tomorrow, Try This

• Reflect on the futility of pleasing others and how it breeds uncertainty.

• Remind yourself that we all have inherent worth and dignity, regardless of what others think.

• Write down your values and refer to them every day. Endeavor to live by them to the best of your ability.

• Reinstitute meaning in your orthopaedic vocation and recognize the real “why” we do what we do.

• If you recognize in yourself a strong need for approval, consider enlisting the help of a therapist (as I did). Watch your energy rebound!