To paraphrase Mark Twain’s famous quip about the weather, “A lot of people talk about self-esteem, but no one ever does anything about it.” Self-esteem has been identified as a “risk factor” in developing any number of mental, physical, and emotional problems. A strong self-esteem movement is alive in the world of education, attempting to raise a new generation of kids with generous amounts of self-esteem.

But for all the talk about “self-esteem” … we don’t really know what it really is. Self-esteem is an amorphous term which people tend to define how they wish, so as to reinforce the point they want to make. I plan not to do that. Instead, I’ll say up-front what I think self-esteem is: quite simply, it is the way in which one regards oneself.

Now, poor self-esteem is considered a risk factor for developing mood disorders. But is this really the case? Do people have poor self-esteem, then become depressed; or do they become a little depressed, develop low self-esteem, then get more depressed?

I have no idea. Nor do any of the “experts.” No research is being conducted on this issue — that I know of — and even if there’s some going on, it will take years to come to anything resembling a reasonable conclusion.

If a person has low self-esteem, this contributes to the “perception disorder” model that I’ve already posited. Things that happen to or around the patient, are interpreted according to their low regard for themselves. Similarly, it’s impossible for a person to learn to regard themselves better, without somehow dealing with the dark perceptions of life that they already experience.

It’s a vicious cycle, one that a person literally cannot get out of. Nor can anyone lift them out of it. Adding to it, is that a lot of depressives have been through difficult life circumstances, which literally have taught them to regard themselves poorly. The past is very tightly tied in with their poor self-esteem and perceptions. Telling a person to regard themselves differently, is not only ineffective, but it implies that the life events they’ve gone through, are of no account; this can make people feel even worse than they already do (“You mean, I went through all of that, for nothing?”)

Even so, that hasn’t stopped the self-help industry. There are more books available promising to raise self-esteem, than there are devoted to mood disorders. They are, however, all uniformly flawed, and in precisely the same way: They cannot show someone who regards him- or herself poorly, how suddenly to decide to regard him- or herself positively. It simply cannot be done. This may seem an extreme claim, but think about it: If someone has come to regard him/herself poorly over the course of years, having had life experiences which taught him/her to think that way, how can a book even begin to overcome that, merely by telling someone to think differently? Of course it won’t work!

Of course, some of the self-help books come close to admitting this; a few I’ read say that ultimately, self-esteem comes from “within.” Well, what does that mean to someone who doesn’t already have any self-esteem “within?” It’s like telling someone to make a soufflé when they don’t have any eggs and don’t know what eggs are. They don’t have the “equipment” to get the job done!

Proponents of cognitive therapy claim that their techniques will improve self-esteem, by giving someone a more “realistic” view of themselves and of life generally. To an extent, this is very possible. Teaching oneself to see things in a different way might improve one’s regard for oneself.

The chances of this happening, however, are rare, much rarer than the harm that is caused to one’s self-esteem, by virtue of being in cognitive therapy in the first place. This is obvious: When you begin therapy by telling someone what is “wrong” with their thinking, how will they learn to see themselves? Of course the patient will see him or herself as someone who is always “wrong.” Eventually this will harm their own self-regard.

In fact, there is no psychotherapy which is even marginally effective for depression, which doesn’t somehow convey the implied message that the patient is “wrong.” In turn, this makes it very hard for any of them to do much to improve the patient’s self-esteem.

What would be far more useful, of course, would be research into what gives people good self-esteem, and use the lessons learned to help patients improve their own.

But don’t hold your breath waiting. No causative research of this kind is being conducted. The only research being done, is in finding “risk factors” or “help factors,” that is, things which — statistically at least — appear to help or hurt self-esteem. While knowing these things is nice, it will only go just so far.

< Previous   Next >

I’ve referred to depression as a perception disorder, several times. I’d like to explore this in greater depth, as it affects how depressives relate to life. Note that I will be making some gross generalizations here — but even if these assertions don’t apply to everyone, experience has shown me that they’re valid observations nonetheless.

Depressives tend to take everything more seriously, than average folks. They also tend to take things personally.

This much is well-known. It lies at the heart of a school of therapy which is thought to be very effective for depression, known as “cognitive therapy.” “Very effective,” however, is a relative term; it’s successful for only about 60% of patients, and in the case of bipolar disorder, it’s much lower than that.

This compares favorably to antidepressant medications, which are anywhere from 60-70% effective. So I guess folks in the field of psychiatry are satisfied with these statistics.

But I’m not. I think it’s disgraceful.

Would you hire a mechanic who only repaired 60% of the cars he tried to fix? Would you believe a weatherman who was right only 60% of the time? Would you settle for 60% reliability, in any other area of life?

The fundamental problem with cognitive therapy, however, as with so many other treatments for depression, is that, while we know that it can help somewhat, we don’t precisely know how, and in the cases when it doesn’t help, we have no way to know why it failed.

Really, though, it comes down to what I said already: Depressives tend to take everything more seriously, than “average” folks. They also tend to take things personally. These are not things can easily be changed, if they can be changed at all.

What happens in patients treated with cognitive therapy, is that they are taught how to argue with themselves; they must constantly tell themselves that their own spontaneous thoughts are somehow “wrong” and that things are not always as they seem. This sets them up for failures when they discover that their original thinking was correct.

Here’s an example: Let’s say I’m going on a date, but she stands me up. I wonder why; being a depressive, perhaps my instinct tells me she didn’t really want to go on the date at all. Using cognitive therapy, I then tell myself that there are any number of reasons why she didn’t show up: traffic, car trouble, losing track of time, whatever. Perhaps this is good enough, for the moment. But later, I find out — perhaps from a third party — that my instinctive thinking had been true, all along. My date really did back out merely because she did not want to go out with me. It was personal, after all.

It only takes a few of these “failures” to make someone realize that cognitive therapy simply amounts to lying to oneself. That, of course, is precisely what it is! Only no one in “the business” will admit to it.

Ultimately, it’s not one’s thinking that needs to be changed. Rather, what needs to be changed is one’s basic, initial perceptions. It’s not enough to be able to wrestle intellectually with one’s automatic thinking; that can only go so far, and often can fall apart.

What really needs to happen, then, is to remove the sunglasses from one’s eyes. But cognitive therapy cannot do that — in spite of proponents’ claims that it can. Cognitive therapy is inherently flawed, and there’s no way to repair the flaw.

In any event, the manner in which one perceives things, is both deeply personal, and penetrates to all aspects of one’s life. Each and every waking moment, we view life through our own individual “perception filters.” It is not possible to go without one, as to do without it would require one to absorb each and every impulse that hits our senses, and analyze it. This is impossible to do. Instead, we selectively choose what we pay attention to, and we selectively choose what to heed, and what to dismiss.

In addition to being psychologically indispensible, our perceptive filters are also not sharable. We cannot explain ours to others, nor can they explain theirs, to us. As the physician and philosopher Karl Jaspers said, each human being is, indeed, a universe to his or her own, and can only share glimpses of that universe to others, not the universes themselves.

Thus, anyone pretending that he or she can show you how to alter your own perceptive filter, is at best tilting at windmills, and at worst, lying. No one can tell you what to do with your perceptive filter. You can change it on your own, however, without some outside information to go on, this is exceedingly hard. Unfortunately, no such information appears to exist.

< Previous   Next >

The gulf separating patient and care-provider accounts for at least some of the reason why a majority of people who suffer a depressive episode, will suffer another within five years. Psychiatry calls this “recurrent depression,” and in cases when treatment is tried steadily, but episodes keep returning nonetheless, it’s called “refractory depression.”

These are both clinical phrases which indicate — essentially — that providers have thrown up their hands.

That depression recurs so often, is — all by itself — an indictment of the mental-health system. What is inexcusable is that this recurrence isn’t often addressed. Little research goes into discovering why depression recurs. Those who have recurrent episodes, are frequently labeled “trouble patients,” and sometimes are treated with disdain. Or else, they’re given high doses of multiple medications, in the hope that one or more of them might finally “take” and begin working.

The mental health industry is loath to mention the rate at which depression recurs, as I pointed out for good reason — it exemplifies better than anything else the system’s inadequacy. Also, many theorize, this knowledge might discourage potential patients from seeking help.

At this point, however, the situation is so bad, that I cannot see much benefit to keeping a lid on this information. Those who seek help, will. Those who won’t, won’t. Keeping this knowledge quiet, however, doesn’t serve anyone, since it discourages investigation into the causes and psychopathology of mood disorders.

It’s high time psychiatry finally seized the bull of recurrent depression by the horns, and did something about it … something more substantive and useful than just labeling patients as “troublesome” or “non-compliant” or anything else. Recurrent depression, as a phenomenon, isn’t going to go away by itself.

< Previous   Next >