I was born in the seaside city of Port Elizabeth in South Africa. Life for middle class white South Africans in the 60’s and 70’s was privileged, and I enjoyed all the social and educational opportunities this offered. Following in my father’s footsteps, I became a doctor after graduating from the University of Cape Town in 1978. After trying different branches of medicine I began specialty training in psychiatry and completed it at Johannesburg’s University of Witwatersrand in 1987. I have worked as a psychiatrist ever since. I am remarried and live with my wife in Vancouver, Canada. Between us we are blessed with 5 children and a grandson.

At the time I started my training I was particularly drawn to the allure of psychoanalysis and psychotherapy. In the 1980s this was still in vogue in psychiatry, but starting to fade in popularity. The new age of biological psychiatry was dawning, and my training coincided with the advent of psychopharmacology as the new kid on psychiatry’s block. My training incorporated both the medication and psychotherapy approaches, and I have always utilized both in my clinical practice.

The real world of practice differed from training, and I soon discovered the limitations of both treatment modes. Colleagues seemed more readily impressed with clever psychoanalytic interpretations than patients were. Frank evaluation of my practice of psychotherapy was that it seemed more like a way to maintain the status quo than to bring about meaningful personal change and growth. Drug treatments for anxiety and depressive disorders also fell short of therapeutic aspirations, despite ever more sophisticated drugs and drug combinations. Safely ensconced in the university’s specialized mood disorder unit where patients’ failure to benefit from and respond to treatment could be put down to “treatment refractory depression”, I became increasingly dissatisfied with high rates of “treatment resistance”. Too many patients treated with the best treatments remained miserable and despondent. Something was missing, something that neither the drugs nor the therapy was targeting. I became increasingly uneasy and disillusioned facing patients who had every right to expect improvement and relief but who remained desperate and sometimes frantic or at their wit’s end in the face of their persistent distress.

I tried to identify what it was that was so resistant to treatment, what it was beyond the word “refractory” that accounted for their being so stuck in their unhappiness. I asked questions. I probed them for their perspectives on their backgrounds. I wrestled with the discrepancy between the apparently happy and successful outer appearance of their lives and their inner experience of emptiness and futility. I reflected on my own personal experiences of difficulties, as well as those of people close to me, both family and friends. Where results fell short of the expectations my education and experience predicted, I tried to think less of how things ought to be and more about how they actually were. As I listened and thought about these things, something became clearer and clearer to me. What it boiled down to was that most of the refractory patients felt terrible about themselves. The missing piece was that they thought of themselves as worthless, as failures, as people whose outer pretence of competence was about to be stripped away at any moment and they would be revealed to be the worthless, ignorant and undeserving frauds they felt themselves to be. This seemed to be the key to their “refractoriness”, something that I came to understand as self-esteem failure. Since this morbid self-perception seemed most often to precede the onset of anxiety and depression symptoms, it occurred to me that self-esteem failure was the cause, not the symptom of their distress, their misery and the despair that I and my profession was labelling a mental illness or a depressive or anxiety disorder.

There was no pill that could fix this self-esteem failure, and therapy, especially cognitive behaviour therapy or CBT, seemed, from the feedback I heard, to have similarly disappointing results.

This insight led to me to a new examination of self-esteem. With time, more attentive listening and deeper and more varied study that included another round of self-examination, I came to a fresh understanding of the nature, origins and purpose of self-esteem, how it affects us and what we can do about it when it fails us and leaves us at a loss at the bottom of a pit.

The manuscript I have written is all about this.

I am launching this website to raise awareness about these issues and to generate interest and discussion with the hope that it will create the momentum to see the manuscript become a published book that will appeal to and help the many who suffer from self-esteem failures, the many who I have come to see now as being stuck with self-esteem failure rather than sick with mental illness.

Another quote

“If adulthood means reaching that state where you become emotionally responsible for your self, and thereby responsible for your self-esteem, then it is something we all need to consciously learn, because the learning of this is neither instinctive, intuitive nor automatic. We are not specifically taught this in any of our cultural institutions, be they the family, schools, religious institutions or the media. In fact, we are taught just the opposite. Our institutions tell us we should please others and teach us how to fit in and how to feel worthwhile precisely on the basis of earning approval from others.”