Psychiatry and the Obstacles to Human Growth



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"Self-esteem has two interrelated aspects: a sense of personal efficacy and a sense of personal worth. It is the conviction that one is competent to live and worthy of living.

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The conviction that one is competent to live means: confidence in the functioning of one's mind; confidence in one's ability to understand and judge the facts of reality (within the sphere of one's interests and needs); intellectual self-reliance. The conviction that one is worthy of living means: an affirmative attitude toward one's right to live and to be happy; a self-respect derived from the conviction that one practices the virtues one's life and happiness require.

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Self-esteem is a basic need of man, a cardinal requirement of his mental health and psychological well-being. There is no value judgment more important to man than the estimate he passes on himself.

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This estimate is ordinarily experienced by him, not in the form of a conscious, verbalized judgment, but in the form of a feeling, a feeling that can be hard to isolate and identify because he experiences it constantly: it is a part of every other feeling. It is involved in his every emotional response.

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An emotion is the product of an evaluation. It reflects an appraisal of the beneficial or harmful relationship of some aspect of Reality to oneself. Thus, a man's view of himself is necessarily implicit in all of his value-responses. Any judgment entailing the issue: "Is this for me or against me?" entails the view of the "me" involved. His self-evaluation is an omnipresent factor in man's psychology.

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The nature of his self-evaluation has profound effects on a man's thinking processes, emotions, desires, values and goals. It is the single most eloquent key to his behavior.

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One of the tragedies of human development is that many of a person's most self-destructive acts are prompted by a blind, misguided (and subconscious) attempt to protect his sense of self--to preserve or s.trengthen his self-esteem.
When a person represses certain of his thoughts and memories, because he regards them as immoral or humiliating, he disowns a part of himself--in the name of protecting his self-esteem.

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When a person represses certain of his emotions, because they threaten his sense of control or conflict with his notion of "strength" or "maturity" or "sophistication," he disowns a part of himself--in the name of protecting his self-esteem.

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When a person represses certain of his desires, because he cannot tolerate the anxiety of wondering whether or not he will attain them, an anxiety that makes him feel helpless and ineffectual, he disowns a part of himself--in the name of protecting his self-esteem.

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When a person represses certain aspects of his personality which seem incompatible with the standards of his "significant others," because he has tied his sense of personal worth to the approval of those "others", he disowns a part of himself--in the name of protecting his self-esteem.

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When a person represses certain of his legitimate needs, because their frustration leaves him feeling impotent and defeated, he disowns a part of himself--in the name of protecting his self-esteem.

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When a person represses his capacity for spontaneity and self-assertiveness, because he wants to be certain that his responses always conform to the "moral ideals" laid down by his particular authorities, he disowns a part of himself--in the name of protecting his self-esteem.

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Do such attempts succeed? They do not. Self-esteem cannot be built on a foundation of self-alienation. The consequence of such attempts is the sabotaging of one's ability to enjoy life, the inner sense of some nameless fraudulence and self-betrayal, the anxious need always to be on guard against dark, frightening forces which might erupt from the limbo of one's denied self to threaten the structure of one's existence--and the subversion of one's self-esteem.

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When a young child represses a pain that he experiences as intolerable, he does so not only because pain is intrinsically a dis-value, but also because it threatens his sense of control, it causes him to feel impotent and incapable of functioning; it nullifies his sense of efficacy. In later years, his block against re-confronting the pain serves the same purpose as in childhood; to maintain his equilibrium to protect his sense of efficacy, of control, of self-esteem.

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Men destroy themselves every day--in the name of assuring their survival. Neurosis might almost be defined as the attempt to protect one's self-esteem and assure one's survival by self-destructive (reality avoiding) means.

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[Regaining one's self-esteem in the face of the often overwhelming power of the conditioning we all have been subjected to growing up is] the psychological result of a sustained policy of commitment to awareness, by which is meant:

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  • a will to understand the facts of reality, as they relate to one's life, actions and needs:

  • a respect for facts, and a refusal to seek escape from facts, including the facts of one's inner experience;

  • a policy of being guided by one's awareness of reality when one acts, so that one does not take actions or pursue goals that require or entail the subversion of consciousness, the restriction or evasion of awareness, the betrayal of knowledge, reason or honest conviction

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The "self" one is esteeming is one's mind--one's mind and its characteristic method of functioning, of dealing with reality. All life is a process of interaction between organism and environment, and successful life for man is that which has awareness as the cutting edge of his motion through the world.

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This way of relating to reality produces that sense of efficacy, of power and worth which is the meaning of self-esteem."

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These repressed energies are carried into adulthood, creating suffering because they continue to influence behavior of people in ways they are unaware of.

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The repression of emotions, which begins in childhood with the denial of pain, frustration, fear and rage, extends in later years to more and more areas of one's emotional life, resulting in a progressively deepening sense of self-estrangement.
A person denies his need to find human beings he can respect, admire and love--and then superimposes on himself the unreal personality of a cynic. A person denies his loneliness--and then withdraws from people behind an artificial front of indifferent remoteness. A person denies his need for self-esteem--and then proceeds to seek it in the bodies of an endless procession of women. A person denies his longing for beauty--and then affects a vulgarity aimed at proving his 'practicality' and 'realism.' A person denies his pain--and then losses his sensitivity and buries his perceptiveness beneath a brutal blindness to the pain of others, including those he professes to love. A person denies his anxiety--and then finds himself locked in a self-made tomb of passive rigidity. A person makes himself thoroughly invisible--and then agonizes over the fact that no one sees or understands him. A person extinguishes one part of his personality after another--and then feels horror when he looks inward and finds only a sterile void.

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The crisis, Branden observes, comes as the individual begins to feel like he is falling apart mentally or emotionally, as the pressures of the energies of the repressed parts of his self begin to intrude into his outer life and things begin to fall apart in the form of job losses, break-ups of one's marriage, breaking down of one's relationship to one's children, drug or alcohol addiction, chronic depression episodes, psychotic episodes and so on.

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An individual is often driven into treatment by crisis instead of pre-emptively through an act of choosing to discover why he does not have a sense of himself, why he does not know who he is, why he does not know what he wants, or why he does not know where he is going. In treatment, if asked why he is not able to get his needs met, he may blame the environment or his parents for his 'failures', or refuse to revisit the causes of his childhood frustration and anger, or he may resist ferociously assigning blame and instead take all the blame on himself masochistically. He may take refuge in religion to escape the gray, barrenness of his life. He may be so repressed that he disavows any responsibility for what has happened to him and fully believes it.

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Brandon pointedly argues that in his experience the persons in therapy are no more neurotic or maladjusted that those who never come to therapy.

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Treatment involves helping the patient to recognize that his disorder is a defense mechanism to avoid remembering and re-experiencing the pain he experienced during childhood, and re-experience the repressed thoughts, memories and feelings. Ordinarily, this requires the patient to revisit his youth to re-experience the environment, mistreatment, and trauma initiating his repression.

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Once the patient recalls that feeling originally causing his repression, the therapist can work logically to help the patient to understand how his repression is continuing to affect his view of the world and how he is defending himself from being hurt again. This is often terrifying to the patient, who may refuse to stop avoiding the source of his fear and suffering. This underscores the fact that undertaking this kind of work, or entering therapy, is not only an act of desperation but of courage as well. At this point, the work has the possibility of restoring the sense of self, the self-confidence to change one's beliefs, attitudes and patterns of behavior in the world. The patient begins working towards the time he can take full responsibility for what happens to him in his life.

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Heinz Kohut's Self Psychiatry and the Tragic Man

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More recently, a branch of psychiatry known as 'Self Psychology" has emerged from the work of psychiatrist Heinz Kohut to contradict the Freudian viewpoint. Kohut, initially a Freudian, departed from his support for Freud's biological arguments that man is naturally solitary. He came instead to argue that the maturation process involves a tension between two poles of the 'self.' One 'pole' is that of ambition (Freudian), which drives the individual to achieve in life to meet her needs. The other 'pole' is that of 'the idealizing self', which helps the individual to experience herself as okay even when needs are frustrated because she is supported through intimate emotional support from an idealized 'other'--such as a mother or father figure who is able to share their strength and objectivity. Ideally, the infant and growing child will realize full and unconditional love, understanding and support from both parents as she grows and tests herself against the world.

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In childhood, the infant goes through a healthy 'narcissistic stage' in which she is very exhibitionistic and sees the world as an extension of herself. Attempting to meet her needs in this totally safe playground, she experiences occasions in which her needs become frustrated. As extensions of herself, she sees her parents as parts of herself whose purpose is to satisfy her needs. The parents, however, come to a point that they refuse the child's demands, and the child expresses her frustration and rage through crying.

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Parents witnessing infant anger consider it a tantrum and punish the child whenever this happens. The child experiences shock at first that a part of itself would strike out at it to refuse its demand. It learns from repeated punishment, however, that expressing anger at her need frustration brings punishment from a part of itself it had previously totally trusted: first, the she feels helpless to manifest her needs in a family environment which has suddenly become threatening. Second, she has been told that she is 'bad' for speaking up for herself--even for having these needs in the first place.

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She is now fearful of her self and her environment, not knowing what is safe and what is not. Here, the infant begins to learn that her parents are not a part of herself, and the shock of this separation through punishment reverberates as fear, loneliness, and loss of intimacy for years.

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Several dynamics are now in play that may prove difficult for the growing infant.

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First, the infant begins to see her environment as unresponsive to her needs; the world--and other people--may begin to appear hostile to her and her happiness. Secondly, a dynamic is established that produces guilt in the infant every time she asks others to meet her needs; instead, she should be thinking about the needs of others and putting her own needs second or after those of her significant others. Third, her natural anger at not being able to express or effect her own needs is stifled and turned within. She is angry at others, but because of guilt and the threat of punishment, is not allowed to express this anger. Fourth, she begins to see herself as someone whose needs are not as important as others, as not being loved enough by her parents to help or show her how to meet those needs. She somehow is now not worthy of their love, and she begins to lose respect for herself. She turns his anger inward at herself for being too weak to speak up for herself, too unworthy to receive the love of her parents, too unimportant for society to care whether she gets the things out of life she needs or not.

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This is the beginning of the process described by Heinz Kohut as the 'disintegration of the self.'

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As the child grows, around the age of 6, 7 or 8 years--normal development would have the child develop an idealized view of his or her father or mother, and from this idealization, take on the goals and values they represent to her. These values serve as a rudder in early life to give her resiliency, direction, and emotional support as she encounters the inevitable disappointments to her budding ambitions. Gradually, the emotional support from this 'idealized other' is supposed to be 'internalized', so that the maturing youngster builds an internal structure of emotional support and so that she can sustain the inevitable cyclic frustration of needs and hopes in life. Unfortunately, modern society all too frequently fails to provide those significant 'idealized others' so badly needed during the maturing process. Parents sometimes refuse to be idealized or to provide the unconditional, non-judgmental emotional support so badly needed in growing up.

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Traditional religious beliefs are described by Kohut, Branden, White and Weiner, and many others as 'self-destroying' in that their effect is to create a propensity among believers to judge their selves--or some part of the self--as sinful, evil, or bad. Guilt and fear, alienation from the self, and self-hate follow. Through their religious beliefs, many psychiatrists believe, parents instill in their offspring the guilt and fear they themselves have of the World.

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They react to the demands of their children seeking need satisfaction in exactly the way the world treats their own efforts to satisfy their needs: with indifference, punishment for 'acting out', and lack of empathy. Early psychiatry viewed child raising in this way; attempting to bring the child face to face with hostile reality quickly and not soften the blow. After all, they reasoned, the Real World is a tough place, and the sooner the child accepts that and conforms, the better it will be for the child. Today, psychiatry accepts that, while reality may be harsh, it is easier to bear when one experiences closeness, intimacy, and love from other humans. Through such support, the harshness of life becomes endurable.

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Life itself will test each child; the parents do great harm, however, by bringing the harshness of the world and a lack of empathy and nurturing into their training of their children.

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As the young grow outward away from the parents into the isolation characterizing much of modern life, they continue to encounter traumatic frustration of their needs. Not having the emotional support or stability of idealized values to hold them together, their selves 'fragment' and their behavior grows increasingly self-destructive. Self psychologist Gary Greif, in his book The Tragedy of the Self, expresses this point of view as follows:

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Destructive human behavior reflects people's experience of disintegration from insufficient human support. This proceeds in stages, and is accompanied not only by violent acts, but also by such experiences as anxiety, fury, arrogance, empty depression and hopelessness. At high levels of selfobject frustration (i.e. not being able to find empathetic support from caring individuals), the self experiences the threat of losing all vitality and of totally disintegrating, generating the experience of coming apart at the seams and breaking up into fragments, culminating in losing all will to live, causing terror at the prospect of self annihilation. A self lacking adequate selfobject sustenance will be weak, fragmented and beset by conflicting urges.

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This experience is literally one of terror and of coming apart for some, of an inability to cope with reality. Those afflicted by these symptoms, which include most of us to a greater or lesser degree, Kohut refers to as Tragic Man.

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Once fragmented, the individual's ability to cope with life is impaired, and without psychiatric support, often cannot put himself back together again. Continued suffering without relief will lead to a flight from reality into addictions, religious excess, withdrawal, and depression. Once they reach the point of disintegration characterized by psychotic or borderline behavior, they are beyond the reach of self psychology therapy and often have to be institutionalized or cared for outside the marketplace.

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Therapy for self-fragmentation of those with lesser disorders can repair the damage by reactivating the causes of fragmentation and aiding the sufferer to work through the selfobject needs whose frustration caused the fragmentation in the first place. Most of us cannot afford professional assistance and must do this on our own to repair the damage. Unfortunately, many of those in pain cannot identify what has happened to them and only know that they are 'inadequate' and not able to cope with the harshness of the 'real world.'

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While alive, Kohut was severely critical of the modern social and economic system in the West as being incapable of supporting the realization of the self and blames it for enormous suffering and psychic fragmentation of individuals caught in its web. His student, Gary Greif argued as follows:

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While we value individual fulfillment, and often proclaim it our highest value, out of a fear of being destroyed we readily submit to limits on realizing this value. We adopt the stance that true individual fulfillment consists in independence, fundamentally from one another. The demands of work reinforce our desire to be guarded emotionally, and are in turn reinforced by this desire. Competing against one another to obtain and keep employment, we consider our ability to retain employment a sign that we are independent and individually fulfilled. We are therefore not inclined to rebel against social and economic forces which require that our human self needs take second place. Goods and services provided by the marketplace and work not only do not entice us beyond commitment to this defensive and restricted individuality, they appear to validate it as concrete symbols of success. Our economic world, reflecting and encouraging self deprivation and fragmentation by subordinating self needs to the demands of economic competition, increases our propensity for violence and our consequent need to further subordinate our self needs.

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Buddhist Psychology

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The Indian Prince, Siddhartha Gautauma, born 2500 years ago went on a quest to seek spiritual understanding. Experimenting with many sects and teachings, he reached the point where he wondered whether any of the teachings worked. He finally sat down under a tree in what is now the country of Nepal determined to await 'enlightenment,' and one morning as the planet Venus rose in the early morning sky, he experienced a transcendent awakening. At that moment, he became 'the Buddha'--the One Who Is Awake. For the next 40 years, he taught the psychology of awakening to all who sought him.

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What he taught then is as fresh and true today and it was all those years ago: The Four Noble Truths

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The First Noble Truth: That suffering is a part of life, but that we suffer because we struggle to keep that which can't be kept. Nothing is permanent in this world; pleasure cannot be sought and suffering cannot be avoided. Therefore, detachment from the world of the senses and attunement to the basic goodness of Creation is the path to happiness.

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The Second Noble Truth: Suffering is made worse because of our fear and sense of ego. We believe that we are a permanent, unchanging self living in a separate changing Universe. In fact, we do not exist as a separate being at all and are simply a perspective of the One Life having no permanence.

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The Third Noble Truth: There is a way for us to free ourselves from our suffering and use it to enrich our lives. That way is through the control of attachment to the phenomenal world.

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The Fourth Noble Truth: The path to the cessation of suffering is called, in Buddhism, the 'Middle Way'--avoidance of the extremes of either the indulgence of the senses or self-mortification--is the path to freedom.

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The Middle Way is also called the Eightfold Path. Practice of the Eightfold Way brings the ability to perceive reality as it is--Enlightenment--rather than as we, in our suffering, fear and defensiveness, insist it is or ought to be.

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  • Right Understanding

  • Right Intentions
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