Q: Dr. Neuman, I have been an introvert all of my life, social anxiety is the diagnosis with chronic major depressive disorder. I am disabled from this condition, and I have lost faith in the current system for providing therapy and pharmacotherapy to alleviate my condition. I have had ect treatments, numerous drug cocktails, with no treatment benefit. I read your blog in Psychology Today in regards to self-esteem. In it, you note that some people are not depressed, but suffer from low self-worth or self-esteem. This hit home with me, I have always believed from my experience in therapy, that the subconscious mind is the crux of most of people’s behavior patterns and it is the reason why therapy is not helpful for everyone because most therapy is cognitive based, it can help you re-frame your irrational beliefs, but at your “core” you already have been programmed with false beliefs that you acquire as a child, and you re-inforce your thinking when you are young by looking at situations that you believe and you see them come to fruition, and it becomes a self-fulfilling prophecy. Can you elaborate on how negative false thinking and beliefs that are learned become to be your identity? And how one who does not benefit from current modalities of therapy can re-program these deep seated irrational beliefs? Thanks
– Stan F.
A: I think there can be no doubt that certain qualities of the nervous system (or mind) are inborn. Among these are the tendency to react or over-react, and also shyness. As part of our training, child psychiatrists looked at a group of toddlers and their mothers, and then looked at them again a few years later. The same kids who hid behind their mothers’ skirts were still hanging back. Those others who were going from one child to another comfortably were doing something similar years later. The shy kids are at a disadvantage learning social skills. Still, most shy kids grow up and manage well enough.
Similarly, early experiences growing up are likely to condition the child to think a certain way about himself and a certain way about the world. There is some distortion in everybody’s perspective, but some end up feeling incompetent or unappealing. You are right. If you react to the world as if these things are true, you convince others; and they become true. Still, like the shy child who can learn to manage social trials, the child with low self-esteem will respond to some extent to positive events and to being treated properly by others. The real world has an effect.
As I have indicated elsewhere, I think the goal of treatment should be to help the patient get to where he wants to go–given the fact that every person has strengths and weaknesses, and some have overt symptoms. The problem is that patients do not always know exactly where they want to go, and, also, in order to get there they always have to do something they are afraid of–something that makes them feel uncomfortable. Dating is one example. Success in life comes from perseverance, what we sometimes call character–the ability to keep going in the face of rejection, disappointment and failure. The job of the therapist is to help. Some kinds of depression respond to drugs; but the kind that include low self-esteem and go back to childhood are not due to a a physiological defect, they are due to a set of ideas that are learned and have to be un-learned. But such a thing does happen. You should not let your past, how well you may come to know it, prevent you from struggling with the present.
Beyond that I can have little to say, not knowing you personally.
– Dr. Neuman