About thirty years ago, at a small dinner party given by mutual friends, I had the privilege of meeting and talking with the late Sir Alec Guilmess. He was one of my favorite actors, so it was not difficult to compliment him on his work. I called to mind, among other roles, his part in the Broadway production of T.S. Eliot's play The Cocktail Party. Sir Alec played Sir Henry Harcourt-Reilly, a psychiatrist of sorts, profoundly wise, poetic, of course, and, perhaps, in keeping with the playwright's predilection, slightly mystical. I had seen the performance when I was a junior in medical school, a time when I was unsure what branch of medicine I would select for my specialty.
Although I realized that everyday psychiatry was a far cry from that portrayed by Sir Alec, I could not help being influenced in my final decision by the role. I told that to Sir Alec. He seemed amused and genuinely pleased. Many of the lines from The Cocktail Party have etched themselves in my memory. One such line occurred to me recently. Edward Chamberlayne, the attorney who has ended his affair with Celia Copplestone, says to Reilly:" … I am obsessed by the thought of my own insignificance." To that, Reilly replies: I puzzled over those lines for years. It was only as I began to gain some understanding of the concept of resilience that I really began to feel I understood what Eliot was driving at. The regulation of self-esteem is what counts, not a fixed state of self-satisfaction or discontent. Polarization implies that we have veered too much in one direction or another and that we have become frozen in a position of either persistently low self-regard or, at the opposite extreme, egotism. Rigidity and inflexibility are, as Eliot suggests, harmful, to the person himself and to those around him, however unintentional the harm may be.
This is obviously so when it comes to those who are engaged in an insistent search for self- esteem, either because they have too little or because they need to preserve a sense of self that is grossly exaggerated; either extreme sets the stage for self-absorption and self-centeredness, which are difficult enough to bear, and outright selfishness, which to paraphrase Petronius in Hamlet, destroys both self and friend. What, then, is the nature of healthy self-esteem? What part does its regulation play in the resilience process?
Maintaining and restoring self- esteem is a complicated phenomenon, filled with numerous important distinctions. There is yourself, as you view yourself, regardless of what skills you may have mastered or how others view you . Raw, fundamental, existential, emotional, conceptual, biological, you have formed a gut feeling about yourself during the earliest years of life. Whether you feel inherently proud, worthy, and enthusiastic, or shameful, unworthy, and helpless will be determined to no small degree by how you have been brought up. Loving parents help greatly as they praise you for what you do well and set limits on your behavior so that you don't hurt yourself, see that you eat your green vegetables, and go to bed on time. Mastering skills-learning to tie your shoes and do your numbers and read The Tales of Peter Rabbit-adds a sense of competence and reinforces self-esteem. How others regard you as you reach out to engage the larger world of playmates and school affects your self-concept too.
What you have been striving to create (without realizing it) is a complex self- structure. Your perception of that structure must be reconfirmed periodically throughout the various stages of the life cycle. Adolescence, for example, is one of those times when a radical transformation in the regulation of self-esteem takes place. How the teenager views his or her body assumes a disproportionately great significance. Acceptance by peers can seem a matter of life or death. Introspection emerges, leading to heightened self-consciousness and preoccupation with oneself. Teenagers experience wide swings in self-appraisal as they become much more reliant on a wider circle of other people whose opinions they value to help them define their own worth. This is the time to formulate a realistic picture of our assets and limitations, so that we can dream dreams and aspire to ambitions that legitimately suit our talents and potentials.
Hand in hand with the formation of self-esteem, we also create what psychiatrists have termed the superego, a place within each of us where our ethical and moral standards reside, where reign images of what we believe we should be and what we want to be, often in conflict with our appraisal of what and who we are. No person can always be or become what he thinks he should be. We will as frequently fall short of our target as achieve it. We will succeed. We will fail. And as we become adults, we will be repeatedly challenged by questions to which we will often have to find the answers all by ourselves, with less and less input from others. Am I a good husband or wife? Have I been a good parent? Has my career been successful? Have I made my life count? Do I know how to regain self-respect after a defeat?
Heidi's Struggle to Regain Perspective
I recall how vigorously Heidi Anderson struggled to resist my efforts to restore her self-respect. Heidi originally consulted me because she was depressed after an important love relationship had ended. She had hoped for marriage and was profoundly shocked and hurt to discover that her lover had never had any such intentions. She had long wanted to have a family of her own, but now, in her mid-thirties, she was beginning to feel that the chances of that coming to pass were fast diminishing.
Heidi was an attractive and accomplished young woman, with an enchanting smile, when she deigned to smile. She had majored in English at Brown University. She had been working for a number of years as an editor for a leading publishing house in New York. But, in spite of numerous promotions and much praise from her superiors, she was convinced that she had neither talents nor special skills that would permit her to establish a truly meaningful career. "I wanted to be a writer. But since college, I've written nothing. I feel like a servant to other writers, not much more than a copy editor going over manuscripts and correcting typographical mistakes." I asked her if that was, in fact, her job. To the contrary, she reluctantly admitted, she had been the primary editor of several articles that I had heard of and that had received critical acclaim.
Although the depression for which she had originally consulted me had abated within several months, she nonetheless persisted in her derogatory appraisal of herself. "I'm stupid, really," she insisted. "I had to work terribly hard all through school to get good grades. If I had been bright, I wouldn't have had to work that hard." I had learned a long time before not to contradict frankly and directly a patient's insistence on low self-esteem. Such a strategy often intensifies his determination to prove to me how worthless he really is. So, in an offhand way, I said: "Even hard work wouldn't have won you those grades if you were really stupid" Then, shrugging my shoulders, I added, "But if you say so …." Heidi did seem quite humorless. For her, life was a very serious business. Getting ahead was the goal, and it was to be achieved by mastery of detail, a tactic for which she paid a high price-forfeiting her spontaneity. Being a very private person, she also found it difficult to talk of her feelings and thoughts during our visits. She presumed that I would ask her what I wanted to find out and tell her what I wanted her to know. She also assumed that whatever I told her was calculated to make her feel better, whether I believed it or not. On the occasions when I complimented her about anything, she quickly dismissed such statements as "contrived." However, she was on the alert for criticism and could hear this even in my silences.
Her background offered me clues as to how Heidi had developed so little resilience in regulating her self-esteem. She was the only daughter in a family with three sons. She felt her parents had favored the boys whenever education or careers were discussed. Her father, who owned and managed a local McDonald's franchise, had regarded her as his own "special little girl" when she was a small child. However, as she entered adolescence, he could not let her gracefully say her first good-bye, and, subliminally perceiving the emergence of his daughter as a woman, he withdrew from her, completely ignoring her accomplishments in high school. She described her mother as a simple person, often helpless in her attitudes, very dependent on her husband, indecisive; she worked part-time as a courtroom stenographer.
Her mother often cautioned Heidi not to set her sights too high in life, lest she be bitterly disappointed in the end. "I had to shut them out," Heidi once shouted in a rare show of temper, covering her ears as if to prevent herself from hearing her own raised voice. ''I'd come home with a straight-A report card. They'd look at it in a terrible hurry. Then they'd start talking about how one of my brothers had made captain of the basketball team or another had just been accepted at law school…. But I've known this as long as I can remember. Knowing it doesn't change anything. They made me feel incompetent, and I can't get over it." Heidi's problem with self-esteem had influenced her choice of boyfriends. The last two men she'd dated, including the one with whom she had broken up just before coming to see me, were quiet, unassuming men, lacking in humor or spontaneity themselves.
One was an unsuccessful insurance salesman who was afraid to use the telephone; the other was a would-be artist who had yet to complete his first canvas and who seemed to deal with his own "endless struggle to think well" of himself by repeatedly putting Heidi down. Heidi's insight into all this gave her some perspective. But it was not enough to induce meaningful change. Something more had to be done. I chose to play devil's advocate and attack the very foundation of her problem, her values, the intimate connection in her mind between achievement and self-worth. Even at the risk of angering her, I started to question why anyone should believe that it was necessary to accomplish anythi.ng in the world's terms in order to feel worthwhile.
At first, she thought my comments absurd. "Are you saying that because I'm a woman? You wouldn't say that to a man, would you?" "Certainly. I don't think gender has anything to do with it. Don't you think we're all brainwashed into thinking that having a job and earning a living is the only way to get self-respect? Isn't that what keeps the economic cycle going? Mind yon, that's not to say that people shouldn't work. Quite the contrary. Work's an essential part of living. But what I mean is that work is one thing, while self-esteem is something else."
"If self-respect doesn't come from achievement," she asked, "then where does it come from?" Her question was so sudden and direct, she caught me off guard. I hesitated for a moment before answering.
"You see. You don't know the answer yourself," she said.
"When you first came to see me, Heidi," I said, "you were depressed. People who are depressed lose self- confidence. It's the name of the game. When they recover, most regain their own sense of worth. Others-like you–seem never to have enjoyed a reasonable amount of self-respect to begin with. Or if you did, you had to
fight to hold on to vestiges of it in the face of a family that failed to appreciate your talents and abilities. By and large, you bought their low opinion of you and tied it in to the idea of being a woman. Accomplishment, you came to believe, was considered the prerogative of men, a thesis you adamantly and correctly refused to accept."
She gave me a skeptical look, one I had grown accustomed to seeing. "Desperately seeking a sense of worth, you set out to succeed. But obviously, no amount of success filled the bill. You graduated from a first-rate college with honors. You've been employed and promoted in a highly competitive business. But you still haven't done enough to change the way you look at yourself. Maybe you're missing something altogether." "What?" I sensed that, perhaps for the first time, she had allowed me to get through her defenses and might actually be able to hear something positive about herself, and learn from it.
"You have a right to feel good about yourself regardless of how much money you make or whether the job you have right now lives up to all your expectations. I believe it's a right that all decent human beings should enjoy-to think well of themselves, as human beings." "That's easy for you to say," she said. "You've already accomplished a lot."
"True. But I've failed sometimes too. Listen. One of the articles I've learned the hard way is not to let my self-esteem stand or fall entirely on how well or poorly my patients fare." "That sounds positively irresponsible." "Not at all. Of course I care, a lot. But that kind of vulnerability would compromise my ability to be honest with you … to help you, or anyone."
My efforts to help Heidi excise her concept of who she was from what she did were beginning to work. The door was opening for her to reconsider what her talents really were and how she might best put them to use. As it happened, they weren't literary at all. Her desire to write was repeatedly frustrated by the fact that writing was not her strength; her real ability-and the reason she had won recognition from her superiors-was her ability to organize. In school, it was her skill in being able to distinguish between information that was important and that which was not that enabled her to obtain good grades. At her job, it was not her instinct for language that worked well for her; instead, it was her innate ability to set priorities, deciding what had to be done now and what could be postponed until later, combined with her passionate attention to detail.
Even Heidi had to admit that her managerial talents were real assets. The trouble was that she had placed no value on them. She used to feel that anyone could manage. Now she was beginning to admit that that might not be the case. "I enjoyed being the business manager of the college newspaper;' she recalled, confirming the insight.
Heidi quit her publishing job and enrolled in a business administration course at Columbia. In our final session, I cautioned her that in years to come, she might suffer relapses and lose some of her newfound self-confidence. Such reversals were an inherent part of our response to disruptive situations. The issue was not whether she could hold on to self- esteem, but how quickly and effectively she would be able to regain it after humiliation, failure, loss, or other adverse life events temporarily robbed her of it. I recently received a postcard from her from Bermuda, saying that she loved school and had a new boyfriend, and that sometimes she felt she might really be OK.
We must keep in mind that self-esteem and its companion, self-confidence, are not static entities. They are not produced by some magical sense of superiority that enables us to go through life unscathed by life's reverses. Failure, whatever its nature, is bound to compromise how we see ourselves. Again, the key to the regulation of self-esteem is resilience, how fast and how effectively we can restructure ourselves after such stress. In a sense, we can regard self-esteem as operating on several levels.
There is the satisfaction we derive from a job well done. Not doing well at something that we consider important can and should cause us some dismay, and such discomfort ideally will motivate us to do better the next time around. There is the respect and praise we receive from friends, family, and coworkers; this is something we all need, although we must be on guard not to become addicted to it and must be prepared for long stretches in adult life when it may not be readily forthcoming.
It's What We Value That Matters
Then there is the matter of values. Heidi Anderson's self-esteem was tied up with accomplishment. Although she was an attractive woman, her appearance meant nothing to her. Another person, however attractive, may never feel attractive enough and, hence, may be vulnerable to low self- esteem. Still another may feel financially poor and consequently unaccepting of himself because his net worth does not exceed a million dollars. Still another, in spite of academic and professional success, may suffer with nagging self-doubts because she has never been able to become an accomplished athlete.
Conceivably, a research scientist could win the Nobel Prize and still remain compromised with regard to self-esteem because he has never mastered the skills of sociability that he was told he must master from kindergarten on. We must be able to identify what we value and consider how realistic we are in the light of our abilities, opportunities, and actual life situations, so that we can bring into better balance the distance between what and who we are and what and who we want to be. Nor is there anything wrong with being dissatisfied with ourselves. Distress is a key motivator for learning. As one forty-three-year- old man put it to me: "I've always handled money badly. I'm a teacher.
When I went into this profession, I did it because I felt I'd love the work. I did. But I never paid any attention to money. I put my paycheck in the bank and paid my bills. That seemed simple. But with kids growing up, and inflation, I suddenly find I haven't enough money, and I don't know what to do about it. I awake at night worrying. It makes me feel like a failure, as if I've wasted my life, sidestepped opportunity, been lured into becon1.ing absorbed in work that could never give me what I need." "It's never too late to learn," I advised him. "Take some courses in money management. Look at your budget. There's nothing wrong and everything right about taking care of yourself and your family. It doesn't mean you have to care less about your work. It's just that focusing on money is something you never did before. You can find solutions once you stop castigating yourself about this."
Owning Up to Our Ignorance
Accepting our ignorance is part of resilient self-esteem regulation. I recall sitting in the university hospital cafeteria once, having lunch with several colleagues, including a former director of psychiatry. Someone brought up a name and the piece of research that that person was carrying out. An article about it had appeared in a recent medical journal. I believe it involved immune systems and their possible involvement in depression. My field was depression, but I was not familiar with this particular line of inquiry.
"What work is that?" I asked.
The director seemed startled and looked in my direction disapprovingly. Several others mumbled.
"Well, I had a choice," I said. "I could sit here and pretend that I knew what you were referring to. But then, I wouldn't learn what it was all about, would I? Tell me, how many of you actually were not familiar with this research either?"
Only one of the seven raised his hand, although three more later acknowledged their ignorance privately to me.
Being able to admit that you don't know something or can't do something is a vital part of resilient self-esteem regulation.
Here are a few more guidelines:
• Remember the child's story of the little train chugging up the mountain, puff by puff? The engine kept saying, over and over again: "I think I can, I think I can, I can, I can, I can." Conditioning yourself to think positively is a good start.
• Take each day and each task as it comes. One of the cardinal rules we physicians follow, in helping people who have had major episodes of emotional disruption to gradually regain confidence in themselves, is to identify specific jobs they can carry out successfully within the limitations of their current disabilities. The technique involves restoring a sense of competence by doing what you are capable of doing now. For instance, suppose you're a real estate broker.
For some reason, you don't have the energy to get on the phone or out of the house on a particular day. Maybe, then, you should simply stay home, sit down at your desk, and do nothing more than make a list of prospective clients whom you will call another time, when you feel more vitality. No one expects a person recovering from hip surgery to go out and run the marathon the first week out of the hospital. If disruption has forced you to crawl, crawl; later, you'll be able to walk.
• Play from strength, which implies that you know and have learned to deal with your weaknesses. Don't suffer humiliation when you fail, for humiliation delays learning and recovery. Humility is a strength, but it has nothing to do with being humiliated.
• Learn to laugh a little at yourself. In the Cocktail Party, Sir Henry Harcourt-Reilly tells Edward Chamberlayne:
• Recognize and nurture your spirituality and your relationship with that higher power often called God who can provide you with a real appreciation of your intrinsic worthiness.
• Most of us are vulnerable to others' opinions of us. We should seek and be open to constructive criticism, but discriminately, paying attention to input that is legitimate and passing off that which is destructive. Not listening can be as serious a limitation as being too susceptible to the influence of others.
• To the extent that it is possible, we should make every effort to surround ourselves with people with whom we share mutual respect and minimize our involvement with those who repeatedly provoke or diminish us.
• In assessing our environment and the kind of people who inhabit it, consider questions such as these: Does the boss commend us on jobs well done, or do we only hear from him when things go wrong or, worse yet, when he is in a bad mood and believes they have gone wrong, regardless of the facts? Are we married to a man or woman whose attitude seems to be supportive, or one dedicated to the deflation of our hopes and only too ready to remind us of our shortcomings? Have we, like survivors of prisoner of war camps, learned how to maintain our self-respect in the face of the enemy' Have we an escape plan in mind'
• Become part of a meaningful community. For most of us, a sense of community is a vital part of sustaining our self-esteem. It has to do with identity. People can more readily keep in mind who they are and respect themselves when those around them seem to know who they are and respect them too. Throughout the world, however, the traditional sources of one's sense of community and identification are threatened by change.
The immigrants who came to the United States created a community among themselves, sharing the same language and customs; but the homogenization of America is rapidly eradicating that community. The very architecture of the buildings in which we live is making our interactions with others more problematic. In Britain, for example, a study of high-rise living showed that the taller the buildings in which people live, the less likely it is that they will acknowledge each other's existence and afford neighborly recognition and support. You'll probably have to learn to build your own community, by chance or by design.
One of my daughters, for example, is the mother of twins; she has found a community with other mothers of twins. Some of you will find it on the golf course or the tennis court; some, by going to the same summer resort each year; some, with colleagues at work. But it is growing harder and harder, as people become more mobile and as the landmarks that provided our civilization with a sense of continuity are vanishing.