Low Self-Esteem

A woman responded anonymously to my most recent blog post by saying, “…I really have nothing to offer. I can’t see why anyone would want to marry me.” Then, she goes on to add, “I’ve been treated like a loser throughout my life (starting with my mother, who abused me). Now I can’t shake this ‘loser’ mentality. I feel inferior to every single person I meet; and, of course, that leads to people treating me like crap…” She concludes by saying that this “sense of worthlessness" is “slowly destroying” her.

I know nothing about this woman’s age or circumstances. (I do not know for certain that she is a woman, except that she describes herself as “attractive—not stunning, but decent” and “stunning” is a word not usually used in connection with men.) The state of mind she is describing is what is referred to commonly as “low self-esteem,” which, in her case, seems to have reached devastating proportions.

She is correct in pointing out that the attitudes we have towards ourselves, and towards the world in general, grow out of the way we are treated growing up. Some children are told that they are “no good,” sometimes in subtle ways and sometimes explicitly. They may be compared unfavorably to other children. They may be ignored or abused. Sometimes, paradoxically, that message is communicated by parents who are always telling their children they are great, even when they are messing up. The message that comes through, then, is that it does not matter to the parents whether or not their child is doing well.

Having low self-esteem is not just a global sense of being worthless; it manifests itself in action—or in inaction—whenever the child (and later, 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 or 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, in addition to 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 part of 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, stemming from misconceptions they have learned growing up—from ideas. Treatment, then, 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 "imposter 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 or her perspective. If that person thinks that in general, people do not like him or 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 him- or herself whether this is one of those times when that feeling is justified, or whether it grows out of the prejudice.

Self-Esteem Essential Reads

“I’m Not Good Enough”

Mirror, Mirror: The Danger of Empty Reflections

It is like looking through a colored set of glasses. 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, for instance, has to make a special effort to decide whether the particular man she is looking at really is 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. 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 or she is incapable of doing a particular task, that supposition has to be challenged. If the same person thinks he or she is unattractive to potential partners, 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 or 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 could change. Sooner or later, to a greater or lesser extent, her expectations will likely change, too. If some man will unmistakably care for her, her opinion of herself will likely 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, patients tend to 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. 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 him- or 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, however, 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.

A patient of mine, a young woman, returns home for Christmas every year and is treated by the family, as usual, as a “silly and scatter-brained young girl.” However, since this young woman is now a physician and happily married, she can laugh off their caricature of her. It becomes possible to laugh at bad treatment.

I did not grow up experiencing any of the truly devastating childhoods some of my patients have had, but there were some moments. My father used to come at me with a strap unless my mother intervened. He also had the disconcerting habit of insisting that I perform on the piano for visitors—which I hated doing; and then afterwards, inevitably, he would say I was “no damn good.” He was a bad-tempered, stubborn, bigoted and very religious man; and I became (not by coincidence, I think) liberal and irreligious. My attitude toward him changed as we both grew older, though, and it became possible for me to take him less seriously. (I have written about some of these early experiences in a vaguely autobiographical novel, Superpowers.)

When he was about 85, my father was admitted to a hospital with complications of diabetes. I went to see him. He was in a rage because the nurses had tied him to a chair.

“Get me out of this,” he yelled, going on to describe the chair in rude terms.

“Okay,” I said.

I went to the nurse who explained to me that my father was tied to the chair because he had fallen out of it twice. I returned to the ward and explained this to him.

He started cursing and knocked everything on his table to the floor, including a pitcher of water, which splashed onto the people standing next to the adjoining bed.

My father was discharged from the hospital a few days later and went back home, presumably to continue brow-beating his third wife as he had my mother and me previously and everyone else in the family. (His second wife had asked for a divorce a few weeks after the wedding, saying she preferred to “grow old alone.”) I then found out from my brother that my father responded to the incident in the hospital by looking for a lawyer in order to sue me for medical malpractice. I had to explain to my father that he could not sue me since I was not his medical doctor and I was not involved in his care. He seemed disappointed.

About a month later, I got a phone call in my office from a woman who identified herself as someone who had been hired to help my father at home.

“You don’t know me, Doctor; but I’ve been taking care of your father. I have been with him for the last three weeks. This is the kind of work I do. I have always taken care of old people. I feel I have a special calling for it. A special sympathy. I have done this work for thirty-five years. I’m calling now just because I want you to know that your father is the worst human being I have ever met.” I did not ask her to explain why she felt that way. I just laughed.

If my ability to shrug off my father’s deprecatory behavior seems surprising, I should point out that I had a second parent who always thought I was destined to win a Nobel Prize.

(c) Fredric Neuman