[costello]

Low self-esteem is a huge problem for my son. I think the self-esteem issues preceded the psychosis issues, but obviously being diagnosed with a mental illness and coping with the other problems that go along with it hasn't helped.

I found the following list at wikipedia. My son has every one of these issues:

A person with low self-esteem may show some of the following symptoms:

• Heavy self-criticism, tending to create a habitual state of dissatisfaction with oneself.
• Hypersensitivity to criticism, which makes oneself feel easily attacked and experience obstinate resentment against critics.
• Chronic indecision, not so much because of lack of information, but from an exaggerated fear of making a mistake.
• Excessive will to please: being unwilling to say "no", out of fear of displeasing the petitioner.
• Perfectionism, or self-demand to do everything attempted "perfectly" without a single mistake, which can lead to frustration when perfection is not achieved.
• Neurotic guilt: one is condemned for behaviors which not always are objectively bad, exaggerates the magnitude of mistakes or offenses and complains about them indefinitely, never reaching full forgiveness.
• Floating hostility, irritability out in the open, always on the verge of exploding even for unimportant things; an attitude characteristic of somebody who feels bad about everything, who is disappointed or unsatisfied with everything.
• Defensive tendencies, a general negative (one is pessimistic about everything: life, future, and, above all, oneself) and a general lack of will to enjoy life.

As well, individuals with low self-esteem may have feelings of insignificance.

[costello]

Then I ran across this:

Depression, Low Self-Esteem Worsen Schizophrenia Symptoms

British researchers studying 100 schizophrenic patients who had recently experienced a relapse into psychosis found that depression, low self-esteem and negative views about others contribute to more severe auditory and persecutory hallucinations.

Patients were assessed both for schizophrenic symptoms such as hallucinations and for signs of depression, low self-esteem and negative views of others. Researchers found that individuals with depression and low self-esteem had more severe auditory hallucinations featuring more intensely negative content. Where these symptoms were combined with negative views about others, individuals also experienced more severe and distressing persecutory delusions. Meanwhile, severe grandiose delusions were directly related to higher self-esteem and inversely related to depression.

What do you all think? My son flips back and forth between depression and grandiosity. It doesn't seem to me that his self-image is shifting back and forth between too high and too low. It's more like he can't tolerate the depression and self-disgust, so he pushes himself into the grandiose place where he believes he's very, very important and people admire and envy him and want to be like him. It's more pleasant for him to be in the grandiose place than the depression place, but extremely low self-esteem seems to underlie both IMO.

I'd like to find a way to raise his self-esteem, but I don't want to flip him into the grandiose place. Unfortunately that's exactly what starts to happen when I offer reassurance that he's fine just the way he is. He doesn't think "I can accept myself - warts and all." He thinks "Mom says I'm fine, so I must be perfect." ["Perfect" is one of his favor words. He wants to be perfect and make no mistakes, but he's also afraid he'll be "too perfect."]

Any thoughts?

[unaluna]

it's tough, because how do you raise self-esteem? by little accomplishments, which require daily habits, which we find BORING!!! or disgusting, or procrastinate about, for some reason. I need a creative not painful schedule. if I ever come up with one, i'll let you know.

[costello]

Originally Posted by hankster

it's tough, because how do you raise self-esteem? by little accomplishments, which require daily habits, which we find BORING!!! or disgusting, or procrastinate about, for some reason. I need a creative not painful schedule. if I ever come up with one, i'll let you know.

It is tough. I agree that you can't give someone self-esteem. They have to get it by accomplishing things. And my son doesn't seem to be willing or able to do the things necessary to accomplish anything. He's nearly incapacitated by anxiety over the job hunt. And he doesn't have the kinds of interests that would lead to a hobby, for example, where he'd achieve something.

I found this little article from the Mayo Clinic which recommends a sort of CBT/mindfulness approach - being aware of changing self-talk. (http://www.mayoclinic.com/health/self-esteem/MH00129) My son has been taking this approach somewhat, and it's somewhat helpful, but he does seem to use it as an excuse to stop trying far short of goal. ("I've already achieved a lot and people envy me, so I should quit working on this before I get 'too perfect.'")

Last week he told me he's already tried really hard and achieved a lot - for example, he went out for track in high school and worked so hard at one practice that he nearly vomited. This happened over a decade ago, and my recollection is that he dropped out of track before he competed in any meets. Yet he's going to rest on these particular laurels? He nearly vomited when he was 16? I find that attitude frustrating. I suppose what lies under it is fear. He's afraid if he tries he'll fail. But the statement that he nearly vomited when he was 16 so he's excused from ever making any effort again for the rest of his life is so patently absurd, I just don't know how to respond to him.

[cybermember]

Originally Posted by costello

Then I ran across this:


What do you all think? My son flips back and forth between depression and grandiosity. It doesn't seem to me that his self-image is shifting back and forth between too high and too low. It's more like he can't tolerate the depression and self-disgust, so he pushes himself into the grandiose place where he believes he's very, very important and people admire and envy him and want to be like him. It's more pleasant for him to be in the grandiose place than the depression place, but extremely low self-esteem seems to underlie both IMO.

I'd like to find a way to raise his self-esteem, but I don't want to flip him into the grandiose place. Unfortunately that's exactly what starts to happen when I offer reassurance that he's fine just the way he is. He doesn't think "I can accept myself - warts and all." He thinks "Mom says I'm fine, so I must be perfect." ["Perfect" is one of his favor words. He wants to be perfect and make no mistakes, but he's also afraid he'll be "too perfect."]

Any thoughts?

Sounds to me your son has black or white thinking. My therapist says that is my thinking as well. It's either or with no middle ground. My therapist is trying to help me see that there are grey areas in life not just extremes.

[costello]

Originally Posted by cybermember

Sounds to me your son has black or white thinking. My therapist says that is my thinking as well. It's either or with no middle ground. My therapist is trying to help me see that there are grey areas in life not just extremes.

He does. And he has since childhood. It's so interesting. I taught him to read with he was 6. His school was using a method that wasn't working with him, so I took him to the library and found some old books that took a phonetics approach to teaching reading. I had him read to me. He would insist that he couldn't read - then he'd read. I remember one story which he read from beginning to end with me helping him sound out two words. When he got to the end, he said, "See? I can't read." I was astonished. I told him he'd just read the whole story. He pointed out that I'd helped with two words. So for him, it was all or nothing. All the words he read easily counted for nothing because of the two he struggled with!

He still thinks that way today. I'm working on it. And now that he's aware of it he's working on it too.

[unaluna]

Sounds like me. where are my rewards. when you don't trust you are going to get rewarded, why work for anything? I DID work, all thru grade school and high school only to be laughed at at the end by my parents and denied my dream. it screwed me up. I still worked, but I couldn't keep any rewards, financially, physically, emotionally. I can't even have myself. Does your son even have himself? How can he have a job? I don't mean to be harsh on you, no one works harder than you to help. I just got a feeling of him spinning, and a job and stuff flying off him, where we just need to solidify and establish him first. Does he do chores at home?

[costello]

Originally Posted by hankster

Sounds like me. where are my rewards. when you don't trust you are going to get rewarded, why work for anything?

That's an interesting insight. I suppose he might think that way.

I DID work, all thru grade school and high school only to be laughed at at the end by my parents and denied my dream. it screwed me up.

Well, I never laughed at him.

I still worked, but I couldn't keep any rewards, financially, physically, emotionally.

I guess it feels that way to me too. But I still get up every day and try.

I can't even have myself. Does your son even have himself?

I feels to me like he gives himself away. He does things that set himself up to fail. Even he says he gets to a certain point and he "hits the self-destruct button." He does things knowing they'll lead to something bad for himself. I think the low self-esteem thing plays into that too. He'll say he doesn't "deserve" something or other.

Also I'm convinced he does "stupid" things just to prove to himself that he really is "stupid." If you know before you do something that it's stupid, why do it? There may be several reasons, but one would be to keep your view of yourself intact. And my son is convinced that he's stupid.

How can he have a job? I don't mean to be harsh on you, no one works harder than you to help. I just got a feeling of him spinning, and a job and stuff flying off him, where we just need to solidify and establish him first.

I agree, but that's outside of my control. He's getting pressure from the federal government to get a job - Ticket To Work - and from the state government because they bought him a car through voc rehab. He needs a chance to heal, but I can't stop the world from doing what it does. And right now it's pushing him toward finding a job.

I'm resisting the urge to contact his voc rehab case worker and asking him to back off, because the anxiety is making my son sick. I'm trying to back off and let him handle his own stuff, though. They're pressuring him to make 3 to 4 applications a day! My son needs a very specific kind of job. Half time or less. Contact with only a few very mature non-judgmental people. He needs to be successful at this job. His first biggest fear is that he won't get hired. His second biggest fear is that he'll be hired then fired immediately.

I'm trying to take the pressure off by telling him to reframe the issue. His job isn't to find a job. It's to look for a job. As long as he's actively looking, he's keeping his deal with the state. If they want him out there applying for totally inappropriate jobs, so be it. Doesn't seem to have lessened the stress for him yet.

Does he do chores at home?

No, he won't do chores. I've asked him to, but it always leads to a fight. When I suggest it might help his self-esteem to be contributing even in that small way, he never responds and he doesn't do anything. I do whatever housework gets done and pick up after him too. It's one of those situations where you stop caring for yourself because you're depressed, then you feel more depressed because you're not taking care of yourself.

Unfortunately asking him to help out is a recipe for rage. He punched me in the head once when I asked him to wash the dishes. Another time he flew into a rage and threw the kitchen furniture around when I asked him to pick up a pill bottle he'd dropped on the floor.

And then after these rage episodes he feels a great deal of shame. I feel helpless to change this cycle. I just don't ask him anymore to do anything.

[unaluna]

I don't mean to pry, but 2 questions:
1. when I gave those same qualifications at my disability appeal about the kind of job I could work (non-judgmental), I think that's when they made their decision - no such job
2. re behavior at home chores etc - didn't that show up on the questionnaires about how he functions? does he need another review? I forget, was he kicked out of group housing, is that why he is with you? it would be nice if the voc rehab worker would treat you not as family, but more like a group home, where he had expectations he had to fulfill.

[costello]

Originally Posted by hankster

I don't mean to pry, but 2 questions:
1. when I gave those same qualifications at my disability appeal about the kind of job I could work (non-judgmental), I think that's when they made their decision - no such job

I don't think he was ever asked about that. It would indeed have to be a very unique job. I picture something where he's working in a small office or business with one or two or three very kind people who understand he'll have bad days, but if they don't lean on him too hard, he'll eventually come back to center.

Where do you find that job? Not at the places they're making him apply - big retail stores and restaurants. He won't work fast enough. He'll get confused. He's even had jobs in the past where he would get lost in the store or business because his sense of direction is so bad. And there will inevitably be conflict with coworkers and customers.

2. re behavior at home chores etc - didn't that show up on the questionnaires about how he functions?

When he applied for disability, he wasn't living at home.

does he need another review?

Yes. Because he didn't meet the Ticket To Work goals last year, he has to have medical reviews again.

I forget, was he kicked out of group housing, is that why he is with you?

He was kicked out for being a disruption. He was refusing to take medication (spitting it out), eating other people's food, and wrecking the place (one night he sprayed Coke all over the floor; another night at 2 am he fished an empty pizza carton out of the trash and cooked it in the oven, setting off the fire alarms). The final thing that sealed his fate was the evening at 8 when they were giving out meds, he was in the kitchen right outside the staff office door arguing about taking his meds when he urinated on the kitchen wall.

He was just hell for them to handle. It would help if they weren't so rigid and inflexible, but I guess it's going to be that way in group housing. The first time he lived there he did ok, but eventually he became paranoid and delusional about the staff - even though he was functioning well otherwise. He has a really hard time with anyone telling him what to do, and he always thinks people are judging him harshly.

it would be nice if the voc rehab worker would treat you not as family, but more like a group home, where he had expectations he had to fulfill.

Hmmm... I never thought of that. I didn't realize voc rehab ever did that. The only expectation they seem to have is that he get a job.

[unaluna]

i'm not saying they do. i'm just saying my mom had to fill out forms on me as I was living with her when I filed. I went to a voc rehab information session, but at the time I was in nail school, so it wasn't applicable to me.

I don't suppose they do anger management courses. I mean, resources are being allocated to him, but they are the wrong resources, a bad fit. Who do you tell? How do you arrange for a better fit? He can hardly advocate for himself. But what standing do you have?

[costello]

Originally Posted by hankster

i'm not saying they do. i'm just saying my mom had to fill out forms on me as I was living with her when I filed.

I filled out a form about my son too, but since he hadn't been living with me for several years beforehand, I really couldn't respond to the chore thing. I can say that when he has his own place, he keeps it tidy. There's something about living with your parents that propels you back to childhood. That's one reason he needs to get out on his own as soon as he's able.

I went to a voc rehab information session, but at the time I was in nail school, so it wasn't applicable to me.

Voc rehab here will help him go to school if he wishes, but right now he has two huge barriers to that. First, he owes the school $1800. Second, he doesn't really know what he wants to major in.

I don't suppose they do anger management courses.

He had a brief anger management program the last time he was hospitalized. I looked through the material he brought home with him and was pleasantly surprised.

I mean, resources are being allocated to him, but they are the wrong resources, a bad fit. Who do you tell? How do you arrange for a better fit? He can hardly advocate for himself. But what standing do you have?

Yeah. I've given up on the idea that appropriate resources will be forthcoming.

He has a private pdoc and therapist. The county mental health center sucks. Their "social group" consists of taking a group of clients to WalMart. Yippee! That must be fun.

They had no interest in providing him with any kind of talk therapy or group therapy.

I have tons of ideas of things he can try, but he's not willing to try most of them. And if I push it at all, even very gently, he feels like I'm trying to control him.

He's miserable, but honestly the only solutions he ever comes up with are getting drunk or getting high. Since I won't allow that in my home, we're pretty much at a stand off.

[Shoe]

I remember hearing once that most of our self esteem comes from what we do or our vocation. My comes from my vacation though ;-)
I read this this morning and thought that I would provide the link here. I love Oxytocin.

http://psychcentral.com/news/2012/02...one/35027.html

[costello]

Originally Posted by Shoe

I read this this morning and thought that I would provide the link here. I love Oxytocin.

I've read about oxytocin before. Sounds interesting. According to this article it helps with sz. Never heard that before.

[Shoe]

Originally Posted by costello

I've read about oxytocin before. Sounds interesting. According to this article it helps with sz. Never heard that before.

Oxytocin is suppose to counteract the stress hormone cortisol. I believe I read that at this lady's website.
http://www.self-compassion.org/
I remember her saying that you can release oxytocin in yourself by giving yourself a hug or simply putting a hand over your heart.
Oxytocin is more abundant in females rather than males mammals. Breast feeding releases a lot but also having sex with a partner releases a lot.
There seems to be and inverse relationship between testosterone and oxytocin. Recently I watched a documentary on this male soccer team forming. As the team members were bonding oxytocin would be released. As a team member became self absorb in individual play testosterone would be released. The narrator stated that testosterone could be described as being the selfish hormone while oxytocin could be described as the selfless hormone. Maybe that is how it fits in with being helpful concerning schizophrenia. I have observed that in schizophrenia there seems to be a major focus on the self such as self consciousness, self esteem, and paranoia or an over concern for one's self. Just my theory.
One more piece of trivia, we men become fathers they are shown to then have lower levels of testosterone which probably means there is more oxytocin floating around in their blood stream.

[Shoe]

I came across this article this morning and thought that it sort of relates to this thread.
http://psychcentral.com/blog/archive...think-you-are/
Russel Targ co-authored a book entitled The End of Suffering. In it he writes how people get too identified with their story or business card.

I have low self esteem. It has been a problem for a long time. It has gotten better as I've gotten older.

[costello]

Originally Posted by brookwest

I have low self esteem. It has been a problem for a long time. It has gotten better as I've gotten older.

I've noticed my self-esteem has gone up as I've gotten older too. I wonder why that is?

I think we get wiser with age.

[costello]

Originally Posted by brookwest

I think we get wiser with age.

I think we figure out it's not as serious as we thought it was when we were young. And we figure out other people have as many issues as we do.

Maybe declining hormone levels play a role too.

I don't get paid to think like a MD so I refuse to think using those words. I'm grateful that my self-esteem has become manageable. Life is easier for me now, in part, because of this. You sound like a smart guy, Costello. Your a dad to a special needs child? You come here for personal support? Whatever your reason, thanks for taking the time to help me. I appreciate it.

[costello]

Originally Posted by brookwest

Your a dad to a special needs child? You come here for personal support?

Actually I'm a mom. And my "child" is almost 27.

I do come here for personal support. I wish to God I could understand what my son is going through. I've never experienced what he has, so I have to turn to the experts - people who've travelled this road or are travelling it now.

Whatever your reason, thanks for taking the time to help me. I appreciate it.

I like you, brookwest. You're a good guy.

I'm willing to answer any questions you have costello. If it will help your son, I'd like to do that for you. My diagnosis is major depression w/ psychotic features. I think I've been schizoaffective disorder also. Maybe my experience strength and hope can help? You seem good also.

[costello]

Originally Posted by brookwest

Maybe my experience strength and hope can help?

You've already helped.