Bipolar 2 From Inside and Out

Posts tagged ‘children’

The Self-Esteem Dilemma

I’ve heard that narcissists (and multiple murderers) have too-high self-esteem. I’ve also heard that they have low self-esteem. Which assertion is right? Surely they can’t both be!

Self-esteem became a big topic of conversation in the 1980s. That’s when self-esteem programs for children were beginning to be taught in schools and preschools. There were many questions about them, some of which I asked when assigning a writer to a story about them. (I was an editor for a publication for childcare workers and daycare owners at the time.) Why do children need self-esteem programs? Doesn’t daily living foster self-esteem? What can self-esteem programs do that parents and teachers can’t or don’t? The writer seemed taken aback, but bravely tackled all those questions and wrote a fine article on the subject.

Later, the self-esteem movement came into disrepute and was the subject of much mocking and more authentic criticism. Chief among the things detractors made fun of were “participation trophies” given to every participant in a game or sport, spelling bee, or whatever other sort of competition. Complaints included that this negated the idea of competition altogether, falsely inflated children’s sense of accomplishment, shortchanged children who had truly excelled, and was a touchy-feely practice that had no place in the realm of sports or other competitive areas.

It was also thought that self-esteem programs were teaching the wrong lesson. Instead of learning that effort doesn’t always achieve the desired results, children were learning that everyone was as good as everyone else, which seemed like a mistake to some. Self-esteem programs were also said to lead children to the idea that the world was a kindly place where they would be rewarded just for existing. Instead, they should “toughen up” and learn that the world would deal them harsh blows at times and that they needed to be ready to cope with them. Debate continued about when and where such a lesson should be taught and even if it should be taught at all.

How does this relate to the aforementioned narcissists and toxic people? The two theories about their level of self-esteem seem contradictory and counterintuitive. Do they have low self-esteem? It doesn’t seem like it, the way they take control over others’ lives and manipulate them. Do they have high self-esteem? This sounds a little more plausible.

Reconciling the two theories is problematic. On the one hand, these people’s self-esteem seems to be too great, so they feel they are special and entitled to control other people who aren’t up to the same standard. On the other, their self-esteem might be too low, driving them to overcompensate for their lack by acting powerful and controlling others.

It seems unlikely that both of these mechanisms could apply to a single person. How could they feel genuinely powerful and compensate for being less powerful at the same time?

But, at its heart, true, healthy self-esteem isn’t about power. It’s about loving, accepting, and appreciating yourself for the good qualities that you do have. It’s about recognizing that your place in life is to be neither a doormat nor an idol. It’s about having confidence in yourself that you can face obstacles – though not conquering every obstacle – but knowing your limitations.

Does life teach self-esteem? It can, certainly, if a child is raised in a supportive, encouraging environment; if the child learns that both effort and accomplishment are possible; if the child has role models for self-esteem; and if good lessons about self-worth are taught in the home and at school.

Of course, we know that not all children are raised in such an ideal environment. Probably far too few are. Or children receive mixed messages about self-esteem from parents, schools, religion, and other places where they get training for life events: not to be unrealistically proud but to be proud of achievements; to be humble or to be confident; to be assertive or to obey authority; to share with others or to know what’s theirs and defend it; to cooperate or to take the lead.

Self-esteem is particularly difficult for those of us with brain illnesses or psychological disorders. We may feel broken, unsure of ourselves, and clueless about where we fit into society. In the grip of mania, we can feel ten feet tall and bulletproof. When we are depressed, we can feel worthless. In bipolar disorder, in particular, the two states can be encompassed in a single individual at different times.

But this is not to say that people with psychological challenges are all narcissists. Far from it. I would say that in every person, there are varying degrees of longing to have control and desire to relinquish control. It’s achieving a healthy balance of these two things that’s the real trick.

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Mental Health in Ukraine Before, During, and After the War

We already know that in war, disenfranchised people suffer the most – dependent women and children, disabled persons, and the mentally ill included. The war in Ukraine is no different.

During World War II, mental patients and disabled persons were among the “subhumans” that Hitler sought to annihilate. He felt they were a drain on society. (In fact, there are still people who feel this way.) Nowadays, the impact on the mentally ill is somewhat less direct. Reuters has reported that “Russian forces have taken control of a psychiatric hospital in the town of Borodyanka in Ukraine’s Kyiv region, with 670 people inside.” They quote a Ukrainian official as saying, “Today we do not understand how to evacuate these people, how to help them….These are people with certain special needs, they need constant help. They are running out of water and medicines.”

Not that mental health care in Ukraine was all that great to begin with. General healthcare in Ukraine developed from the old Soviet system, which emphasized preventive care rather than treatment of existing disease. Psychiatric Times also notes that “In comparison to other countries, Ukraine carries a high burden of mental illness and a particularly high prevalence of depression, alcohol use disorder, and suicide….Major barriers to mental health care in Ukraine include lack of trust in the psychiatry system, stigma, and lack of awareness and understanding.”

In the Soviet era, psychiatry was used “as a tool of repression” and “those who opposed the Soviet regime being deemed ‘mentally ill’ and imprisoned in psychiatric hospitals. As a result, Ukrainian older generations are more reluctant to seek mental health care than their youth, remembering the dark history of psychiatry,” reports Not Even Past.

Challenges in the Ukrainian system have included “a large institutionalized psychiatric system associated with human rights violations, alongside public stigma and low awareness of mental health,” says the World Health Organization. They add, “Social services for people with mental disorders are limited or absent in the community. The health information system has mental health data but lacks organization and is not always useful for decision making.”

The COVID pandemic had already taken a toll on mental health in Ukraine, but increasing conflict in the eastern regions caused still more suffering, long before the Russians invaded. In October, 2021, Relief Web reported on the toll-free emotional support hotline that helped more than 3,400 Ukrainians during its first year of operation. The four operators, seven psychologists, and one psychiatrist offered support primarily to women, who made 70% of the calls to the hotline.

Even before the pandemic and the conflict, Ukrainian citizens suffered from a variety of mental health problems. Estimates are that one in three Ukrainians face a mental health challenge at least once during their lives. This is notable, particularly in comparison to countries in Western Europe. Much stigma was also reported, involving problems of “knowledge (ignorance), problems of attitude (prejudice), and problems of behaviour (discrimination).”

Then there are the mental health difficulties directly related to the Russian invasion. Naturally, anxiety and depression are problems in both adults and children. As Relief Web noted, “People fleeing conflict often experience highly distressing situations, loss and trauma, which may impact their mental health and ability to cope. Psychosocial support will be needed in the days, weeks, and months to come.”

ABC News reported on the mental health problems that are arising in Ukrainian children especially. As of March 19, 114 children had reportedly been killed in airstrikes and other acts of war. Children as well as adults no longer have a sense of stability in their lives. Experts recommend supplying structure for the affected children, but this is difficult to impossible in a war zone.

ABC quoted Dr. Jack Shonkoff, director for the Center on the Developing Child at Harvard University, who noted, “Some children in these circumstances tend to be more withdrawn, they’re not crying as much, they’re not demanding much attention.”

He continued, “Sometimes people might look at that and say, ‘This child is managing pretty well.’ Sometimes that’s a sign of the things to worry about the most because these children are withdrawing, they’re internalizing a lot of what’s going on.”

Shonkoff also said that “a good outcome for children in a war zone is … making sure the adults are being taken care of too.” As he put it, “The most important factor that determines how children are going to basically survive and go forward after a war experience is the nature of the adults who are caring for them,” he said. “If the parents and the caregivers are significantly traumatized, they can’t provide that sense of support. The adults’ needs become critically important to protect the children.”

Shonkoff likened it to when adults are advised to put on their own oxygen masks first in case of an airline emergency, before assisting children with theirs. “That’s not a way of saying you’re more important than your child. It’s a way of saying if you pass out, your child won’t be OK,” he said.

What’s the point of all this information? It’s crucial to realize that, in war, not all wounds are physical. We know this from the vast number of veterans who suffer from PTSD. That will no doubt be true of soldiers in Ukraine too. Psychological distress is real – and increasing – and will affect people in Ukraine in both the present and the future. When we talk about sending relief to Ukraine, let’s not forget those with mental health challenges.

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