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The Myth of Self-EsteemReview - The Myth of Self-Esteem
How Rational Emotive Behavior Therapy Can Change Your Life Forever
by Albert Ellis
Prometheus Books, 2005
Review by Andrea Bellelli, MD
Nov 21st 2006 (Volume 10, Issue 47)

Patients suffering of depression during their crises tend to underrate themselves; and when the crisis ends, either spontaneously or because of therapy, they look at themselves more optimistically. Conversely, maniacal patients tend to overrate themselves during manic episodes. These and similar clinical observations have suggested the term of self-esteem, that in itself is purely descriptive. Unfortunately, the concept seemed appealing and grew by itself, became reified and in the mind of many is causally correlated to performance, well-being and mental health: some psychologists consider low self-esteem as a cause, rather than as a consequence or a symptom, of depression and other psychiatric ailments. This etiological hypothesis has been disproved by several studies, but it has proven hard or impossible to convince its supporters to renounce it. As Paul Mc Hugh once wrote, every now and then psychiatry is plagued by fashionable, yet wrong, ideas, that are both harmful and difficult to abandon.

The book by Albert Ellis comments on the problem of self-esteem and its role in psychiatric pathology from the view point of Rational Emotive Behavior Therapy (REBT), of which he is the founder. Ellis' main points however, are philosophical, rather than empirical. If you want a sound discussion about the hypothesis that self-esteem may be the cause of psychiatric diseases, this is not your book: read The House of Cards by Robyn Dawes instead.

The title of the book is misleading: scientific research in psychology suggests that self-esteem is a myth in the sense that it is less relevant than it is usually hold, at least as a causal factor of behavior and pathology, whereas Ellis' opinion is that self-esteem is a myth in the sense that people are overdependent on it. I suspect that a possible reason of this discrepancy is that low self-esteem may have been overrepresented in Ellis' clinical experience, since depression is so common a psychiatric disease.

 

The myth of self-esteem is quite simplistic, and is meant to be more a self help instrument than a technical exposition of REBT. It is essentially divided in two parts: the first is an exposition of the principles of REBT and their relationships with self-esteem; the second an analysis of the role of self-evaluation and self-esteem in a score of philosophical theories. I enjoyed the latter more than the former. As one might expect from a self help book, both parts are oversimplified, to the point of containing misleading information: e.g. diagnosis is not discussed, so that mild depression or anxiety performance are not discriminated from common stress on the one hand and from major depression on the other, and the very same discussion seems to apply to all these conditions.

REBT is a variant of cognitive and patient-centered psychotherapies, that aims at guiding the patient to a more benign, and less damaging self assessment. Since the correlation between self-esteem, psychopathology and damaging behavior is modest (with the possible exception of major depression), the whole enterprise is built up on more fragile bases than Ellis pretends. This does not imply that REBT is not an effective psychotherapy; indeed it is quite effective, and Ellis deserves the credit of having been a pioneer of cognitive therapy. The apparent paradox of a psychotherapy whose success exceeds the credibility of its theoretical basis is solved by the numerous trials demonstrating that all psychotherapies have more or less the same rate of success, and that inexperienced therapists, or even lay people who lack specific training are often as effective as experienced therapists. Thus, therapeutic success is in no way a proof of the theory on which the therapy is based, and is largely due to other factors (e.g. the empathic human relationship with the therapist): thus, psychological hypotheses are to be tested by carefully conducted studies, usually outside the context of psychotherapy. Self help books, however, occupy a no-man's-land, where sound research in psychology is little prized: they must be convincing, rather than empirically sound, and mood-raising. 

 

Ellis' theory can be stated quite simply: the author believes that low self-esteem and the quest for high self-esteem are both damaging; thus he suggests that people would be much better off if they rate their achievements, rather than their selves. The take home message is: rate your performance and your actions, not yourself as a person, for a person cannot be rated, and should be accepted unconditionally. Moreover, try to accept others unconditionally as well.

I do not doubt that people suffering of minor neuroses may find Ellis' advice rewarding: it suggests a way of using one's intellectual resources to combat everyday difficulties and mild symptoms. Even in major depression, this type of psychotherapy may usefully complement a full therapy with antidepressants. If the idea of convincing people to accept themselves unconditionally may help depressed patients to recruit their intellectual resources against their disease, it is probably not worth 10 mg of paroxetine, and is quite crude a basis for a philosophical or a  psychological theory. Ellis candidly admits that a coherent philosophy is necessary to convince his patients; but, we may add, this philosophy must also be simplistic, otherwise few people would appreciate it and less still could force it to its intended usage. Indeed the lengthy enumeration of the reasons why one should not rate a whole person (either himself or other people) is shallow: essentially it is based on the trivial considerations that a person is not fully reflected in his actions, and that he or she may change as time goes on, so that any judgment is incomplete.

At least two of Ellis' implications are frankly misleading: that this easy-going psychophilosophy may be the basis of a true ethic, and that self-esteem is so central an issue for people not suffering of diagnosable psychiatric diseases. These two issues are correlated with each other since Ellis implies that an ethical philosophy conscious of self-esteem and its pathogenic potential is necessary because the quest of self-esteem poisons the lives and relationships of a large majority of the population. It is hard to believe that self-esteem is such a major problem for the general population and I have the impression that non-depressed people find their way to self-acceptance and self-justification by easier means than those advocated by Ellis.  It is even harder to believe that such a simplistic philosophy may have an appeal for people who do not suffer of some form of psychopathology. Indeed ethic is based on the concept of responsibility, that Ellis' theory aims to weaken, and an important problem of scientific psychology, with extended legal implications, is that of predicting the behavior of people, that Ellis' theory depicts as impossible.

 

The analysis of Ellis' crude moral philosophy leads us to the second part of the book, that is quite stimulating and makes a pleasant reading. It has no pretence of scientificity, and amounts to a simplified analysis of some aspects of famous theories. Ellis' analyzes the ideas of such famous thinkers as  Heidegger and Sartre, or even Jesus, to sort out whether they practiced unconditional self-acceptance or damned themselves by pursuing conditional self-esteem. I shall not try to reproduce all of Ellis' reflections, but shall concentrate only on some, arbitrarily chosen.

Jesus' ethical teaching is puzzling to Ellis: "Back and forth, the pronouncements of Jesus go, so that it is difficult to tell what he really believed." or "How to resolve the contradiction that on the one hand Jesus was unjudgmental and forgiving and, on the other hand, so punishing and damning? I really don't know." Let us try to solve this point. Ellis collects from Matthew's gospel quotations that imply: conditional self-esteem (CSE), unconditional other acceptance (UOA) and its opposite, conditional other acceptance (COA). What he fails to realize is that these are not all assigned to the same beings. Jesus promises that we all shall be judged by our Holy Father, Who will therefore apply COA. Since we are to be judged, and rewarded or punished, we better apply CSE and judge ourselves if this prevents us from wrongdoings. We however shall not be called to judge our peers, thus we should offer to them UOA: if we apply COA we usurp God's role and shall be damned. Jesus teachings amount to a coherent transcendent ethical philosophy, at least as far as a transcendent philosophy may be coherent, and clearly show the limits of Ellis' pretence of drawing ethical conclusion from a (weak) theory of psychopathology. Indeed we may rate our actions rather than our selves, but if our actions are severely wrong punishment will fall upon us, not upon our actions: the laws, be them human or divine, forbid criminal actions and the judges condemn the persons who commit crimes. Ellis' pretence of separating the evaluation of the performance from that of the individual may have some value as a therapeutic means to support mildly depressed people, but does not make up a coherent ethical philosophy; thus, why should we be interested in his comment to philosophy? The answer is that, even if in the end Jesus is a stronger philosopher than Ellis, Ellis' perspective gives us an opportunity to re-focus Jesus' teachings.

Not surprisingly, Ellis enjoys oriental philosophy much more than western philosophy: Lao Tsu, Buddha and Dalai Lama are among his heroes. These great thinkers deserve all our respect, but I cannot fail to notice that their moral precepts, especially their recommendations for unconditional other acceptance, imply a judgment of our actions: are we following the precept or not? And it is hard to judge the action and not the actor, as Ellis pretends we should do, however cautious we want to be about the fact that the actions do not exhaustively reveal the personhood of the actor.

 

The myth of self-esteem, as any self help book, ends with advices and exercises for those readers who want to try the principles of REBT on themselves. It is claimed that in a survey Ellis ranked the second best known psychologist in the USA, beating Freud who came third. This is hardly surprising since self help psychology manuals are often best sellers, and Ellis wrote some seventy five of them in fifty years of psychotherapeutical practice. Unfortunately, this amounts to writing a book every eight months on average, and The Myth of Self-Esteem is the book you may expect to result from such a hurried preparation.

 

© 2006 Andrea Bellelli

 

Andrea Bellelli has an MD and a degree in psychology, and teaches biochemistry in the Medical School of the University of Rome, Italy.


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