By Philip Chanin, Ed.D., ABPP, CGP
Board Certified Clinical Psychologist
Assistant Clinical Professor, Department of Psychiatry
Vanderbilt University Medical Center
www.drphilchanin.com
philchanin@gmail.com

“Like Narcissus’s obsession, covert depression is at its core a disorder of self-esteem.  Healthy self-esteem is essentially internal.  It is the capacity to cherish oneself in the face of one’s own imperfections, not because of what one has or what one can do.”  (I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, by Terrence Real, p. 44)

“Healthy self-esteem is an inherent, nonfluctuating sense of oneself as essentially worthwhile…Healthy self-esteem is the capacity—rarely taught to either sex in our culture—to hold oneself in warm regard even when colliding with one’s human shortcomings.  Our capacity to stay rooted in a compassionate understanding of one another’s flaws keeps us humane.  When we lose touch with our own frailties we become judgmental and dangerous to others.  Psychoanalysts and developmental psychologists have been clear that the capacity to esteem the self arises from a history of unconditional regard from one’s caregivers.”  (pp.  181-182)

“What we offer boys in our culture is highly conditional, performance-based esteem, not an essential sense of worth that comes from within.  One cannot earn healthy self-esteem.  One has it.  Performance-based esteem augments an insufficient, internal sense of worth by the measuring of one’s accomplishments against those of others and coming out on top.” (p. 182)

In all four of his books, beginning with I Don’t Want to Talk About It, Terrence Real returns again and again to this theme of performance-based self-esteem versus real self-esteem.  He believes that men, especially, are prone to base their self-esteem on achievements and conquests, rather than having a good internal sense of self-worth.  I encounter this every day in my office, as I work with patients who grew up in dysfunctional families and with harsh parenting, resulting often in a deep sense of shame and inadequacy.  This may take years of therapy to heal.  Real writes:

“Healthy self-esteem presupposes that all men and women are created equal; that one’s inherent worth can be neither greater nor lesser than another’s.  Such a vision of intrinsic worth does not require us to lose our capacity for nuanced discrimination.  We can still recognize our gifts and limitations, as well as those of others.  But our basic sense of self as valuable and important neither rises nor falls based on external attributes.” (p. 44)

“Contrary to conventional ideas that link self-worth and self-reliance, in fact it is more accurate to link self-worth and relational connection.  Unlike traditional mythic images of the lone, utterly self-sufficient hero, real boys and men need social connections just as much as do girls and women.  A sense of self-worth always implies a secure sense of membership—a sense of mattering to someone, of being worthy of intimacy.  In a healthy relationship to performance, achievement is a labor of love that exists within a context of secure connection, not an act of grandiosity that takes the place of connection.” (p. 191)

Real returns to this theme in his 2^nd book, How Can I Get Through to You?: Reconnecting Men and Women.  Chapter 13 is entitled “Relational Esteem.”  He begins the chapter by defining relational esteem: “Self-esteem is one’s capacity to hold oneself in warm regard in the face of one’s own imperfections and limitations, one’s capacity to cherish oneself as a flawed, flesh-and-blood, human being.  Relational esteem is the capacity to hold the relationship in warm regard in the face of its imperfections and limitations, to cherish the relationship as the union of two flawed human beings.  I have referred to this capacity throughout as an aspect of repair, as embracing the whole dance, as connection in the face of disconnection.”  (p. 207)

Real has a rebuttal to the idea that good relationships make us happy: “The truth is that relationships do not make us happy.  Relationships are the crucible in which we get to work on ourselves, in which we have the opportunity to stretch, grow, and, if we are fortunate, thrive…

Perfect intimacy, just like distant love, is an oxymoron.  Just as healthy self-esteem evolves not from fleeing one’s humanity but by cherishing oneself in the face of our flaws, so, too, real intimacy is not an escape into unbroken harmony; it grows precisely in the difficult and yet endlessly creative clash of your imperfections with mine.” (p. 109)

Real’s 3^rd book is entitled The New Rules of Marriage:  What You Need to Know to Make Love Work.  He returns to his ideas about healthy self-esteem: “Self-esteem is your capacity to recognize your worth and value, despite your human flaws and weaknesses.  Your value as a person isn’t earned; it isn’t conditional; it can’t be added to or subtracted from.  Your essential worth is neither greater nor lesser than that of any other human being.  It can’t be.  Self-esteem is about being, not doing.  You have worth simply because you’re alive.”  (p. 135)

Real believes that “Self-esteem comes from the inside out…It is the central principle of democracy itself: ‘All men are created equal.’  We understand the essential equality of all human beings in times of crisis…Instead of a spiritual clarity assuring us that no one is fundamentally better or worse than anyone else, our lives are ruled—day by day, hour by hour, even minute by minute—by the confusion of believing that we must justify our existence, that we must earn our worth every day, and, even worse, that our value or its lack will be coolly judged against a backdrop of unending competition.”  (pp. 133-134)

Real brings in the cultural context: “It is more accurate to say that our culture runs on unhealthy self-esteem.  The feeling of inadequacy, and the dream of its cure through acquisition, is the fuel that drives our economy.  We are constantly barraged with the message that simply as ourselves, we are not enough.  We’re too fat; we’re too dumb; our sex lives could be better; our dishes could shine more; and, to be frank, we could smell a lot fresher…Instead of the inner strength that arises naturally from healthy self-regard, our society feeds on three types of unhealthy self-regard: 1) performance-based esteem; 2) other-based esteem; 3) attribute-based esteem.”  (pp. 134-135)

Real continues, “Performance-based esteem is a favorite among men.  Its message is ‘I have worth because of what I can do.’  I can hit a home run, close a tough deal, earn a fat paycheck, make my partner happy.  The great problem with performance-based esteem—as any honest man will admit—is that you’re only as good as your last game.  You can never rest…The question is, ‘What have you done for us lately?’…For some people, everything become a performance.  Their self-worth is always on the line.  How well they cook breakfast, how well they drive, and, of course, their prowess in the sack determine their sense of value.”  (p. 135)

Real writes, “Other-based esteem has been favored among women.  It is the belief that ‘I have worth because you think I do.’  The ‘you’ in that sentence could be family, friends, or colleagues, but, of course, it most often means ‘you, the man I care about.’  Pushed to the extreme, other-based esteem becomes love dependency, in which someone’s lack of the ability to cherish herself is supplemented by her partner’s warm regards for her.  His esteem of her becomes a drug on which she is dependent in order to feel good about herself.  The vulnerability inherent in basing your sense of value on another person’s opinion is obvious.  The lengths that people will go to in order to hold on to someone else’s regard can be truly sad, even frightening.”  (pp. 135-136)

Real next defines attribute-based esteem: “…attribute-based esteem is used equally by both (sexes).  Its message is ‘I have worth because of what I have’—a big car, big muscles, a rich husband, a child at an Ivy League school…Behaving generously is laudable and behaving criminally is reprehensible; we can even call one person morally superior to the other, but neither is essentially superior.  Understanding this brings a great sense of internal stability, one might even say peace.  Not that you check your brain at the door.  Of course, you feel great when things go well and poorly when they don’t.  But there is a firewall between such ups and downs—your unchanging birthright to remain a dignified human being.”  (pp. 137-138)

Real sees grandiosity as another self-esteem disorder.  He writes, “Healthy self-esteem requires an appropriate amount of shame.  Too much shame pulls you into a ‘one-down’ position, engendering feelings of inferiority.  But too little shame pulls you into a ‘one-up’ position, engendering feelings of superiority.  Both states are unhealthy, and both need correction before effective work on your relationship can take hold…If we want to move into true and abiding intimacy, we must deal with both self-esteem issues, going one-down and one-up.  Because every single one of us does both.”  (pp. 139-140)

In describing grandiosity, Real states, “While toxic shame and grandiosity are both self-esteem disorders, there are two key differences that you should appreciate:  Grandiosity feels good.  Grandiosity impairs judgment…In your attempts to deal in a healthy way with a grandiose partner, and in your attempts to deal in a healthy way with your own grandiosity, virtually all of the techniques that help with shame are completely ineffective.”  (p. 141)

Real’s 4^th and most recent book is entitled Us:  Getting Past You and Me to Build a More Loving Relationship.  He returns to his ideas about shame, grandiosity, and self-esteem.  Chapter 6 is entitled “You Cannot Love from Above or Below.”  He says of grandiosity: “Here’s a few things to know about grandiosity and, in particular, about the difference between grandiosity and shame.  First of all, they are both lies; they are purely delusional.  One human being cannot be fundamentally superior or inferior to another.  Not fundamentally.  Whether you’re a serial killer or a saint, Mahatma Ghandi or a homeless alcoholic, all people have equal essential value, worth, and dignity.  Your essential worth comes from the inside out; it can’t be earned or unearned.  It is yours at birth, and it’s yours unto death.”  (pp. 143-144)

Often I talk with patients who describe their harsh “inner critic” voices, and their struggles with self-esteem.  Real writes, “We tend to hold ourselves the way we were held.  If you were treated harshly, odds are your self-talk will be harsh…To me, healthy self-esteem means exactly what it says: it is our capacity to esteem ourselves—to hold ourselves warmly, tenderly—in the face of our screw-ups and imperfections.  You are perfectly imperfect, as Pia Mellody would say.”  (p. 157)

In summary, Terrence Real is a remarkable observer of our culture’s obsession with performance-based self-esteem.  He believes it will never be a substitute for real self-esteem, which cannot be earned.  I tell my patients that performance-based self-esteem is not all bad.  In therapy we work on making the transition from performance-based to real self-esteem.  This is rarely easy.  It can take years of good therapy to develop a secure, internal belief in one’s worth and value.