My mother was a perfectionist and, while I was  never predisposed to shame and perfectionism, certainly life has happened to me  and I’ve walked a long path with other issues I’ve had to deal with.   So, this story does not in any way imply that I have no issues or  problems or that life has been perfect, because that most certainly is not the case. That said, my mother’s birthday was the 23rd of this month.  She died many years ago.  I remember and honor her now for two special things she did for me.  I have shared them with many clients who then cried, because they had not had these gifts.  I want to share them now, these two examples of outstanding parenting.  While I think shame and other issues take a combination of predisposition and environment, I hope parents will read this and take it to heart.

I think shame and a feeling of being bad or unacceptable come after learning we are separate.  We all have to learn this, like it or not. Then, if we are accepted in our separateness, we have a chance to not be filled with shame and a longing to be better in some vague way.  People who had miserable, abusive childhoods were obviously not given this and in fact are given multiple messages that they are bad.  That is the essence of shame, that we are somehow bad in a core kind of way. Yet, there are non-abusive homes in which the parents do not know how to let their children know that they are okay in their being different from them.  But some special parents do not need their children to be identical to them, to mirror how they wish they were.  My mother was such a person.  She never studied psychology but knew in her heart in a truly wise way.

I have early, preschool memories.  I always have.  I might have trouble remembering dates of everything important to me, or
times, or names, but I remember some early things and I remember issues.  When I was very young, my mother didn’t work or drive and we would walk everywhere.  One day we walked to get ice cream cones, as was our custom.  My mother, ordering for us, asked for two vanilla cones.  I was very young.  I was gripped in an intense anxiety and asked her why she always got vanilla, as I burst out crying.  My heart was pounding and this was a significant development for me.  My mother, knowing what I was feeling, said, “Oh! I should have asked you.  Do you want something else?  Do you want chocolate?”  Crying, I said I  did.  My mother went on and said that we loved each other and that it was okay to not like the same things, that people can love each other a lot and like different things and that this had nothing to do with love.  She said she did not need me to like what she liked to know I loved her or to love me.  The anxiety started to leave me.  My mother then went on to say I was growing older and that she should have realized it was time to change the habit of just ordering for me.  She went on to say people were not good or bad because of a food preference.  

A short time later we took a walk to the drugstore, back in the day when you could eat lunch there and have a fountain drink.  We lived in Jacksonville, Florida, at the time.  My mother ordered two hot dogs, and added "No mayonnaise."  I asked her what mayonnaise was, and she said it was "the white stuff I use when I make tuna fish."  I said I loved that, and she asked if I wanted it on mine.  At this place, they used to put everything on hot dogs – mustard, ketchup, mayonnaise, and relish.  I told her I did want it, and it was fantastic!  I asked her if this was like the ice cream, and she laughed and said it was.  She said to always remind her of what I wanted, because she got used to my not knowing things and might forget and just order for me.  I was so happy because chocolate and mayonnaise entered my world, and more importantly, I was okay, and good, and free to explore my feelings and preferences without guilt or shame.  I have remembered this all my life and I am sixty now.

Several years ago I complimented my client Cindi’s hair.  It was short and spiky with a purplish streak, and she looked great and I loved it.  She burst out crying, and when I asked why, she said her mother never approved of her hair and she finally thought she may as well do it the way she wanted and have some fun with it, since she never liked it anyway.  But the act of freedom and trying to have some fun with her style was not what she had hoped.  She admitted to feeling bad and ugly and also guilty, and avoided seeing her mother.  I could give you hundreds of examples of people even in their 30s who had a hairstyle or other thing the mother didn’t like.  People oppose their parents and then think they are horrible people.  They go into therapy because they are in their 30s and can’t find what they want to do in life.  It’s no wonder!  They were not allowed to even be, let alone be someone with some self-expression. It is amazing the kinds of details that make people feel filled with shame and badness.  
 
When I told Cindi what my mother had told me, she began to sob, and I told her my mother could share this with her as well.  Of course, we had more  work, but the goal of this work was to help her internalize what was so freely given to me at the time it needed to be.  Some people really feel they are bad people because they didn’t clean their apartment, wash their dishes, do laundry on schedule, watched television instead of learning something that evening. I could go on forever.  I finally came up with the phrase “morally neutral” for my clients, to refer to these things that are neither good nor bad.  

As I have said, I have had my own path to walk and sometimes it has been very long, but that is not the purpose of this blog.  I have never doubted my essential goodness and decency as a person.  I have never measured myself or others by achievements. I have always known that I am not my achievements, my things, my likes and dislikes.  I had never thought about this until I met so very many people who did not get the gift I was given, and I have had the honor of working with so many with these issues.  
 
For my mother’s birthday, I want to thank her, to let her know that this gift, in the context of ice cream and a hot dog, was one of the greatest gifts a parent can give a child. I want her to know how her wisdom is freely given to those in need.  Until I worked with people therapeutically and saw how a majority had these painful issues of shame and not being good enough, I never knew I was rich.  I am sixty now and I put things together better than before, and when my mind tends to worry about different things or to feel bad about aspects of life that hurt, I remember that pearl sitting in my heart that my mother gave me – all the more valuable because she responded quickly and without intellectually knowing, just knowing.  I pray that my mother is with the
angels in a wonderful place, soothing, healing, making people laugh, as she did in this life, and I thank her with all my heart.  I will always care about shame and related issues and reach out to help people, and I will never forget my brush  with those feelings.

Psychologists and other mental health professionals talk a lot about labels.  There are reasons, of course:  We all know what it means when someone is depressed, for example.  We can understand it as a state of mind aside from it being a diagnostic label.  We know that if someone is schizophrenic, it is a very sad situation.  Labels exist so people can communicate without needing a long explanation each time.  I get that, of course.  In my profession, we also say that to provide the right treatment, we need the right diagnosis; while there is leeway in the treatments that may be provided, there is truth also in the belief that the right diagnosis shapes the treatment options we consider.  To continue with the same example, you would not treat someone depressed in the same way you would someone with a psychosis; however, I would hope that many things would be the same—the caring, the respect, and the remembering that both are human beings with feelings.  It is this last point that I have been thinking about for a long time—for years really.

Those of us who believe that childhood influences who we are can be called psychoanalytic, psychodynamic, at times humanistic or existential.  We also call ourselves holistic, because we are not treating symptoms but trying to help people with the reasons for their unhappiness.  People who have had bad childhoods are well aware of the influence childhood events had and already understand this all too well.  Yet, mental health professionals sometimes forget about the person, his or her issues, and the life experience that brought the person to the point of having a label.  

For example, we all know what depression is and I have had numerous clients come in, self-diagnosed–correctly—with depression.  But what did it mean for these people?  And who was the person who was depressed?  I have had clients who have been through a painful experience, and one that would not end quickly, who were sad all the time and had trouble facing each new day; they were not self-blamers.  But I've also had clients who were depressed because they had very strong, shame-based personalities, and when something happened in life that triggered that shame or perfectionism, they fell into a deep depression.  Both types of client are depressed and need and deserve help, but they are not the same.  I have treated many people who suffered for years with depression who even had the chronic nature of it addressed, but not the issues that lie underneath. They could never measure up to their own beliefs of what they should be and therefore disliked themselves, and one painful symptom perpetuated the other. 

Others would come in and say that they suddenly developed panic attacks and had never had them, and that there was no reason they could think of.  The reason always lay in an aspect of their personality that was now triggered by life circumstances.  I cannot tell you how many young adults I have seen who faced a career choice that was not what the parents favored, and to them, it brought back all the shame and feeling of being disappointing they had when younger.  When this was simply clarified, the relief was significant.  Sometimes people had had their symptoms treated elsewhere and their stories had never been addressed.  We had to go back in time to determine what the trigger was and what came before, who the person was whom the life circumstance happened to.  When these issues are addressed with true compassion and empathy, and the person gains insight, not only the label can go away but more painful traits that make the person so vulnerable.

I remember a woman with agoraphobia, who had suffered from it for several years before coming in.  (I must stress that this example is a composite of many people, as all too many women had a similar story.)  I received a letter from her psychiatrist saying she needed behavioral therapy.  The woman said she was hopeless.  No one had ever asked her why, in her adult years, she developed a fear of leaving her home, or what had happened to cause this.  What was being treated was the agoraphobia, not this whole person with a whole life story.  As it turned out, she had been in an abusive relationship and, like so very many others, had been abused as a child.  She felt extreme shame because of the abuse she suffered, and it was underscored by her abusive husband.  She no longer lived with the abuser, but he still supported her and came around; this, too, is unfortunately very common.  By the time she developed agoraphobia, she felt like everyone could look at her and see that she was no good and was filled with shame.  As a secondary gain, she did not want to go out with her husband and deal with his advances and his insults.  When she gained insight, she was not only not agoraphobic but got a career, became independent, and had a very active social life.  .

What was so sad and frustrating to me was that issues of shame and perfectionism and the many other issues that go with them had been left unaddressed.  People were left thinking they had anxiety disorders, panic disorders, chronic depression, and agoraphobia, for example, without having had their issues addressed.  I cannot tell you how many women I have seen who fit the above description or how many cases of depression caused by people beating themselves up with shame, thinking they are filled with badness, and having panic attacks because they could not stand up for themselves.  After all, they already thought they were selfish and unworthy people.  Those of us who are holistic believe that the whole person matters more than the symptom, even though one does need to cope and get through things.  Those of us with this orientation like to look at and treat the whole person.  But I think all too often well-intentioned people do lose the person behind the label.  They treat the depression, the agoraphobia, the anxiety, the panic and almost forget the person.  What does this symptom or problem mean for this person?  I think sometimes we forget that the person has a life experience and a very important narrative.

So many women have these issues, along with gay people, cultural-ethnic minorities, those who were abused—and the list goes on.  I can’t tell you how many women I alone have treated who had agoraphobia who had been in abusive marriages, and before those relationships, ones with abusive parents; likewise, the number of people suffering depression and anxiety because of shame-based feelings that have become traits in their personalities.  There are tools for coping with depression and anxiety—and those are important to get through the day or night—but when it is time to facilitate healing, we really must remember the whole person sitting across from us who is in pain.  We don’t want to add to the pain by failing to see them or understand.  A know of a man diagnosed with a bipolar illness who wanted to tell his therapist about a dream he had been having, and he dismissed the client by telling him, “That’s just your bipolar illness.”  What was “just” the illness?  The dream?  This man felt erased by treatment and by his label.

While I understand the ways and occasions when labels can be appropriate and what they can convey, I do not have to like them, even though they have their place.  Truthfully, a schizophrenic does not have the same chances as a depressed person, but can we still not remember that some schizophrenics have a sense of humor and some don’t; some are considerate and some are not, and that they are people after all.  No matter how serious a label is, we can remember that the label is not the person.  The label is something the person has, not what the person is, and having and being are not the same.  A label can imply a long, tough course, a hard path; but still, we don’t have to discount it if the person has a pet peeve, gets angry like everyone else, or has certain issues.  I think at all times we need to remember that we treat people, not cases or labels.  We treat people, for certain issues, problems, and maybe sometimes labels, but we treat people.  The person’s problems are not the person, just what a person has.

In my book Fear of the Abyss: Healing the Wounds of Shame and Perfectionism, I discuss issues.  I chose these particular issues because in just under eighteen years of practice these are the issues I usually see, regardless of the diagnostic label.  People fell into groups that seemed artificial, and I think those who share issues have much more in common.  Everyone has issues, and many are the same; regardless of the level of severity, people share certain ones.  I hope we can remember how very important it is to treat whole people with respect and empathy, rather than getting stuck on labels. 

I will end with a memory from when I was in graduate school doing a placement in a psychiatric hospital.  Some halfway houses had come to interview several patients who were about to be discharged, and one young man had not been accepted at the halfway house he interviewed for.  He was crying and felt humiliated and rejected.  I mentioned this to the psychiatrist, who laughed, saying that a neurotic, like any of us, would feel ashamed and rejected, but this man was after all psychotic and did not have those feelings.  I was a student and there wasn’t much I could do.  But the patient told me he felt rejected and stupid.  He told me he felt that way, and it is the kind of thinking displayed by the psychiatrist, dismissing what a person is or says because of a label, that makes me dislike them. 

Parents are the major influence on the self-esteem of  their children, and yet sometimes get so wrapped up in wanting them to do well  or to be the “best” at something, they forget the effect they are having.  I think it is helpful to look at what not to do.  When my daughter was five and a half, we adopted her from South America.  She went to preschool for a time and then Kindergarten.  I speak Spanish but she learned English very quickly.

When she was in Kindergarten, she took a standardized test and scored in the 97th percentile in language skills.  When I picked her up from school and we were walking to the car, I said it was amazing that she did so well, especially as she was still learning English.  We got to the car, and seconds afterwards a classmate and his mother were getting to their car.  The mother was screaming at this child, whom I will call Chuck.  She yelled, “You just did AVERAGE!  AVERAGE!  How do you think that makes me feel?” and she went on to berate him as he got into the car with his head down.  I didn’t say  anything to her, because this kind of emotional abuse is not illegal and I feared making things worse for the little boy.  My daughter said to me, “I guess  Chuck’s mom isn’t so happy with him.”  She asked me why the mother was so angry, and I tried my best to answer her.

The narcissism of this mother was  blatant.  She said outright that it was her own feelings she was concerned about with her child’s scores, as if his very existence had nothing to do with anything outside of making her feel good about herself.  I do not think it was well-intentioned, but she might not have meant to be as devastating as she was.  My daughter is 26 now and this happened in Kindergarten, but I have never forgotten this little boy.  I wondered if one of my colleagues sees him as a client now.  This was one incident, but it is hard to imagine he was ever given the message that he was good enough the way he was.

This is a strong example, but many teachers who have been clients have told me about parents coming to them and wanting – demanding really – that their children come out at the very top on standardized testing.  Teachers have told me they feel pressured to teach to the test.  Parents everywhere push their children to get straight As, to be perfect.  I have known children who were not gifted who were pushed into gifted classes, but were nervous wrecks.

 I think to raise a child with good self-esteem the parent needs to understand that we are not meant to be perfect and are very imperfect.  People have different gifts, and what they do with them is what counts.  What about character?  Have we forgotten about people who are kind and helpful?  What message are children being given when they have to be better than everyone else?  What does this teach them about themselves in relation to others?  I remember explaining to my daughter how having a gift makes certain things easier and provides opportunities, just as we would sometimes laugh together about how she hated math, telling her none of us had that as our strongest point, although her father was respectable in it.  Why are people proud of gifts given by nature instead of making good, decent choices?  Maybe pride is not the way to go, and there is too much of it
already. 

Yes, we are concerned about children having choices in the future, and they have to study and ideally should do their best, but we have gone far beyond that. Do we praise or even respect effort and diligence, or helping others?  Overly-pressured children do not have good self-esteem and I have seen many of them as adults, all the more confused because as they struggled with
sometimes crippling anxiety related to perfectionism and shame, they would say their parents wanted the best for them and they were never abused.  It is not the function of children to live out the fantasy of the parent.  I can’t tell you how many adult clients felt depressed and anxious because they did not want to choose the career their parents wanted.  That is not their function, but many have been raised to think it is.  I knew a young woman who was an artist, born into a family of doctors; she told me she was the family idiot.  This happens more often than we want to admit, and people who would never abuse and are horrified by it, are making children extremely depressed and anxious – children who later don’t even know why they are struggling.

I think parents who do not feel good enough themselves need to work on themselves instead of making their children accomplish what they themselves could not. Children are not dreams; their function is not to live out the fantasy life of the parent.  I understand that there is sometimes a tension between confidence and competence, but I think we are seeing a lot of cases in which the parents thought for some reason that their child would somehow live up to the impossible standard they themselves
never could.  I think we need to remember to respond to our children in ways that show we value their positive traits, which may or may not be the most prestigious ones. I think children need to be loved for themselves and not for how much they make the parent feel raised up.  In order to teach children self-love and love for others, we need to be  able to experience it ourselves.

She was about 80 and didn't consider herself old.  She lived in a nursing home with her husband, who usually didn't know who she was.  She couldn't hear, so doing therapy with her meant you had to write her notes, and very quickly.  She was also extremely intelligent, probably gifted, but then in her era most people didn't care if a woman was gifted, and she was pushed to get married and have children.  She got dialysis a few times a week, and I hadn't known how brutal a process this is, involving sitting up for hours and having huge bruises to show for it.  She had one leg as her diabetes necessitated an amputation.

I never knew anyone as grateful for life as she was.  She once told me that she knew I would cry for her when she died, but that she would be living in glory, happy as can be in a better place.  Yet she was human.  A doctor once talked down to her and she was understandably very angry.  She was very religious and said that people with their egos made her sick.  In mid-session she started to laugh and said, "Look at me!  I'm not much better than he is or I wouldn't be so upset!"  We talked about how it is easier to not involve the ego so much when not challenged by someone who is really stuck there and how quickly we can fall.  She often said she loved me, and told me I was not a pompous ass.  I would tell her sometimes in my field you end up being therapist to someone superior to you and you keep learning from them.  She smiled.