Time to Place the Concepts of Self-Esteem and Self-Worth on the Shelf Next to Hysteria and Lobotomies

 “Doctor, I’m here because I don’t have any self-worth, and that’s the cause of all my problems. I need help getting some, after which I’m sure I will be much happier.”  Some version of this is the opening score of so many psychiatric consultations, and I am sure many personal conversations you have been involved in. Self-esteem, self-regard, self-worth and self-love are all synonyms in a psychological context and refer to a value judgement about one’s character. Self-worth has become so prominent as a concept, its deficiency is a diagnostic criterion in a range of psychiatric diagnoses, as well as a frequent topic of my children’s television shows. Maybe other therapists are great at dealing with it, but when I’m told “my self-worth is at zero, please do something about it”, I break out in hives. 

Maslow inserted self-esteem into his pyramid of human needs in 1943, although when he published it, he had no empirical evidence to support it. The father of the self-esteem movement, however, was Nathaniel Branden who published in 1984 “I cannot think of a single psychological problem – from anxiety and depression, to fear of intimacy or of success, to spouse battery or child molestation – that is not traced back to the problem of low self-esteem". Fast forward 20 years, and self-esteem took on a life of its own. By that point, it was generally accepted that high self-esteem led to fewer violent adolescents, less bullying, lower risk of depression, and all the other good things. As a result, building self-esteem got incorporated into the school systems and other programs with devastatingly unimpressive results. As it turns out, bullies have many problems, but low self-esteem is not one of them. And after decades of research, none of our peer-reviewed studies have been able to lay any foundation for these fantastical claims driving the self-esteem conceptualization, other than that there may be a slight correlation between high self-esteem and life satisfaction and self-reported happiness, although we are still not able to prove causation.

The self-esteem movement was so successful, by the time research results dampened the professional enthusiasm for it, it had lodged itself inextricably into the way we think about our emotional lives and speak about ourselves. I sat next to my daughter who was watching her “My Little Pony” series on Netflix the other day and was quite disturbed to hear the messaging resonate these trends; kids should value the way they feel about themselves over anything else and be true to who they are. Rather than showing children characters that embody the age-old wisdom of “Sticks and stones may break my bones, but words will never hurt me”, the opposite message is transmitted: Feelings are paramount, and if something makes you feel bad, it’s because it is bad. My husband and I get horrified looks in public when we tell our kids to “walk it off” or “get over it”. People do not understand that we say this not out of callousness, but out of love. Rather than validate the emotional state, we want our children to realize that these states are temporary and may in fact not reflect reality. 

Before lunging for the remote during said “My Little Pony” episode I was thinking – “what does that even mean”!? No wonder you hear people say, “I feel like this isn’t true”, when rather “I think” or “I believe this isn’t true” would make more sense. It points to personal feelings being untouchable and that “who we feel we are as a person” is an immutable state that should be accepted no matter what. 

There are still countless courses and seminars promising to turn you into an extroverted “It”-person. My personal favorite is the advice from Schiraldi’s’ Workbook on Self Esteem from 2016, to “channel your inner rock star”. What does that mean? Do drugs and asphyxiate on your own vomit on a public bathroom floor? Probably not, but the gist seems to be learning to accept and even welcome your shortcomings and negative traits, by a combination of positive feedback and self-talk.

My statements above should not be confused with undoing depressive cognitive distortions; the theory that originated with Aaron Beck in 1972.  There’s an important difference between disqualifying actual positive achievements (a cognitive distortion common in depression), and truly underperforming in relation to one’s potential. In the case of the latter, no manner of self-affirming positivistic list-making from your therapist is going produce more than a momentary boost in self-worth, that will have fizzled out right about the time you make a new appointment. Like a skin growth that comes back. The thing we call self-esteem can really be explained by a combination of personality traits; those with high self-esteem seem to be higher in extroversion, emotional stability and conscientiousness. 

Instead of talking about self-esteem as an abstract feeling of worth or positive regard towards the self, which is untennable and not reproducible in therapy, it pathologizes people unnecessarily. The word self-worth is even written into the diagnostic criteria of psychiatric disorders. 

My classical case of “I have zero self-worth - help me”, is the middle-aged woman who stays late at work with tasks that aren’t her own or goes to care for the parent even though it’s the siblings turn for the third time in a row, gets pushed around by her teenage kids without support from her husband and lacks appreciation at every turn. Her problems don’t arise because she doesn’t feel worthy, she knows very well it’s unfair. She needs courage to face possible consequences of conflicts she should enter, and a therapist who inspires the motivation to make small consistent and appropriate changes.  I often wish I had been braver in facing requests of producing self-worth/self-esteem, but I was afraid of losing clients and of getting complaints up the chain. In a time when suicide rates are hurled at you when crossing the clinic threshold in the morning, being accused of contributing to someone’s depression by not doing as you’re asked is terrifying. Why should you go out on a limb and point your finger at a client’s unbuilt skills, poorly planned schedules and unfortunate interactions with others. It’s much harder and riskier than channeling someone’s inner rock star.

Let’s move on from the concept of self-esteem and self-worth and its ilk and raise awareness instead of different personality traits and the fostering of them. I want to show my kids some TV-shows where the characters are less focused and worried about every negative emotion more careful and thorough in their actions and turn their focus outward rather than inwards. I want to see parents correcting their children’s mistakes (lovingly of course), handle loss and daring to set expectations so they might reach their potential. We might make a less pathological future generation.