Low Self-esteem


Having low self-esteem is not just a global sense of being worthless; it manifests itself in action—or in inaction–whenever the child–the grown child—attempts to do anything. That person feels inadequate in social situations, including dating, and incapable of accomplishing any demanding (and desirable) work. When these feelings are severe, that individual becomes a failure. Feeling profoundly pessimistic, he/she will not try to accomplish anything worthwhile. Anything challenging will seem to be too difficult. Expectations of failure become self-fulfilling.

Such persons are also likely to feel guilty besides feeling inadequate and ineffectual. They blame themselves for everything. They are suffering from a chronic, low-level depression which does not respond to anti-depressant drugs, although psychiatric practice being what it is nowadays, they are likely to be given a trial of these drugs. This is the reason that some studies suggest anti-depressants are no better than placebos. This population of patients does not respond to them. They are not suffering from an illness, such as a major depression, which is a remitting and relapsing disorder; they are suffering from a set of long- held beliefs– from misconceptions they have learned growing up. From ideas. Treatment has to be directed towards changing these ideas.

Changing ingrained ideas is very difficult. Some people with low self-esteem continue to feel bad about themselves despite having had signal successes in the world. This is called the “faker syndrome.” They think that, although everyone thinks well of them, and they themselves know they have accomplished specific goals, that very soon they will be asked to do something beyond their abilities. The world will see, then, that they have been “faking it.”  One such man, a leader in his scientific field, came home from Europe with a plaque denoting his having won an international award. When he showed it to his father, his father shook his head sadly. “With your brains,” he said, “you could have been a doctor like your brother.” His experience demonstrates that sometimes these childhood influences continue into adulthood.

For the treatment of this chronic, low-level depression, ordinary conventional psychotherapy works best, although treatment usually has to extend over a period of years. When I refer someone for treatment I am more interested in whether or not the therapist is a sensible and caring person, rather than which professional credentials that person has. A psychologist or social worker can be as effective—or more effective—than a psychiatrist. The success of treatment will depend on the nature of the therapeutic alliance.

The first task of treatment is for the patient to come to understand the particular distortions of his/her perspective.  If that person thinks that in general people do not like him/her, that point of view must be recognized as a prejudice. If someone thinks that people of the opposite sex are likely to be exploitative, or unfeeling, that prejudice, too, must be recognized. Then, in those specific circumstances, the patient must learn to ask himself/herself whether this is one of those times when that feeling is justified, or whether it grows out of the prejudice.  It is like looking through a colored set of classes. If the glasses are colored brown, everything tends to look brown.  If something looks blue, that perception can be trusted, but when something looks brown. the wearer of the glasses has to be circumspect in deciding whether or not that object is truly brown. Someone who always suspects men of being insincere has to make a special effort to decide whether the particular man she is looking at is really that way, or whether he just seems that way. It is an argument for hesitating to make a judgment. It is an argument for doubting first impressions. We may continue to see things pessimistically, if that is our unintended practice, but we need to learn to compensate for those distortions.

There are some people who have a contrary experience growing up. They develop the fixed idea that they can accomplish anything. In general, being positive leads to success, but it is possible to get into trouble by being too optimistic. (See my blog post, “Is it possible to be too optimistic?”) Ideally, as adults, we should be able to see ourselves and the world around us realistically. The goal of therapy is to facilitate that judgment. Each of the patient’s mistaken assumptions has to be challenged individually. If the person who has low self-esteem imagines he/she is incapable of doing a particular task, that supposition has to be challenged. If the same person thinks he/she is unattractive to the opposite sex, that idea has to be examined properly and convincingly. It is not possible to simply get someone with low self-esteem to “buck up” and see the world more optimistically. Therapy has to deal with specific details.

The second goal of therapy is to encourage the patient, despite his/her doubts, to behave in ways that are likely to succeed. For example, if a woman such as the one who has commented above can be persuaded to give the next guy a real chance, her experience of men will change. Sooner or later, to a greater or lesser extent, her expectations will change. If some man will unmistakably care for her, her opinion of herself will change. Patients have to be encouraged to do the right thing. Sometimes they have to smile when they do not feel like smiling. Sometimes they have to pretend  to be friendly when they do not feel that way. We become the people we pretend to be. Unfortunately, they resist—for two reasons: they do not feel they are capable of being different, and doing the right things almost always means doing something that will make them uncomfortable. 

Luckily, even small changes can have big effects. (see my blog post, “Psychotherapy: Small Changes Can Have Big Effects.”)  A woman who learns not to snarl at men meets someone, finally, who is caring and reliable. A man who pretends to be ambitious is better respected on the job and is promoted. Being taken seriously by others helps the chronically discouraged person to feel better about himself/herself.

I have been thinking about what few words of advice I can offer the young, demoralized woman who wrote to me above. (I am of an age where every woman is young.) Two things come to mind:

  1. DO NOT JUDGE ANYONE’S REACTION TO YOU TOO READILY. In particular, do not judge someone’s reaction when they are talking to you over the telephone. You are inclined to think the worst, and without someone’s facial cues, you are likely in particular to misjudge that person’s reaction.
  2. DO NOT SAY ANYTHING BAD ABOUT YOURSELF WHEN DATING—OR WHEN GOING ON A JOB INTERVIEW. If you tell someone with whom you have a relationship that you are not worthy of him, he may be flattered initially that you think he is terrific. If you say it again and again, it becomes annoying. After all, you are impugning his judgment. If you continue to say it, you become convincing.

It is possible for people with low self-esteem to rise above the influences of their childhood. After all, the world is full of people who are not their parents.

Tags:
anti-depressant medication, attitudes, circumstances, crap, failure, feelings, feelings of inadequacy, global sense, grown child, guilt, inaction, loser, low self esteem, low self-esteem, mentality, parents, proportions, psychotherapy, social situations, subtle ways, worthlessness

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