The Links Between Depression And Self-Esteem
Depression is a complex experience that affects millions of people worldwide, often persisting for long periods or recurring throughout a person's life. Depression, especially the ongoing experience that can feel embedded in life itself, is very complex. It is not merely the result of a “chemical imbalance,” but emerges from the interaction of biological, psychological, and social factors.
Importantly, depression is like a fever, a symptom that tells us that something else is going on underneath. Some of these underlying processes involve the interactions between depression and self-esteem, the evaluation we make of ourselves and our worth. This relationship is often rooted in unconscious conflicts, unresolved grief, early life experiences, and the internalization of negative feelings towards the self. In this post, I will discuss some of the ways in which depression and self-esteem are linked, even outside of our awareness.
In the early 20th century, Sigmund Freud conceptualized depression (known at the time as “melancholia”) as a form of "mourning gone awry." He suggested that depression can occur when a person has lost an important “object” (this can be a person, relationship, or even an ideal) and instead of properly grieving the loss, they internalize the lost object and their feelings toward them become directed at themselves. Any feelings of anger, disappointment, or frustration with the lost object are aimed inward, attacking the self.
Over time, these unconscious processes manifest as a persistent sense of worthlessness, self-criticism, and guilt, which are hallmark features of some forms of depression that impact our sense of self and our self-esteem. The reason why we do this, Freud suggested, is to unconsciously keep the attachment with the lost object; better to keep them internalized, even if the price to pay is self-devaluation, than to mourn and accept the loss.
Freud’s understanding can be extended to appreciate the ways in which our early relationships, particularly when marked by loss, can be the foundation for how we perceive ourselves and our worth. By “loss,” I mean not only an actual physical loss (due to death or abandonment, for example), but also the loss of a sense of trust, safety, consistency, attunement, and other conditions that are necessary for the development of our sense of self.
Our early experiences with caregivers shape our internal world, particularly our sense of self and relationships with others. When early relationships are characterized by criticism, neglect, rejection, inconsistency, or abuse from our caregivers, or by their failure to see our individuality, we may still internalize those negative feelings as a way to preserve the relationship with those we need in order to survive. Depression can thus be understood as a continuation of these internalized conflicts, where the self is continually devalued and subjected to harsh, internal criticism.
These disturbed internalized relationships and self-representations can undermine our sense of worth, leading us to feelings of worthlessness, hopelessness, and “unlovability,” which become experiences underlying depression. Chronic depression, in this context, is not just an emotional state but a reflection of deeply entrenched, unconscious, negative self-representations resulting from our identification with rejecting or disappointing others. As a result, depression and low self-esteem reinforce one another, creating a cycle of emotional suffering that can persist for a long time.
When the early interactions with our caregivers are shaped by criticism, harshness, abuse, or by the threat of withholding love, we might develop a very harsh, strict, and punitive relationship with ourselves (what classic psychoanalysis called a harsh superego). These notions of who we “should” be can lead to chronic shame and self-criticism. This internal voice may constantly berate us for perceived failures, mistakes, or inadequacies, further lowering self-esteem and deepening depression. This self-attack is, at times, an internalization of disappointment, anger, or hatred turned inward against the self, instead of being directed towards external sources, such as a rejecting or narcissistic parent. At times, our impatience, judgment, or rage is directed at others towards whom we transfer or project the internalized emotions.
The self-deprecation is often coupled with a fragile sense of self, since we learned that our worth is based on whether we meet very high or impossible expectations and desires from others. This leaves us more vulnerable to what’s called “narcissistic injuries,” wounds that deeply impact our sense of self and our self-esteem based on disappointment, rejection, or betrayal from others. We may internalize those experiences as confirming our inadequacy to be who we “should” be, as an indictment on who we are as a person. We may also disguise the hurt with anger and hostility. Both cases can lead to a deepening of our depression and a bruise in our self-perception.
How can psychodynamic psychotherapy help?
Whether we initiate therapy for depression or in recognition of our self-esteem struggles, psychodynamic psychotherapy can help people become aware of the unconscious ways they may have internalized and identified with the patterns of rejection, criticism, or neglect they experienced in their early relationships. More importantly, therapy can also help people uncover and understand the ways in which those experiences stayed with them in the present, how they became part of how people feel about themselves and how they relate to others.
By bringing these dynamics into awareness, people can start understanding how depression is linked to these early experiences, gradually allowing for the loosening of the negative self-representations that are at the core of their depression, allowing for a more realistic and compassionate view of the self. This would likely entail going through the process of mourning unresolved and unacknowledged losses, recognizing the feelings associated with them and the ways in which we may hold on to old attachments.
Working through these unconscious losses, which may require us to recognize challenging feeling within ourselves, can allow us, over time, to let go of unrealistic or damaging expectations imposed by others. Instead, we would be able to redefine a sense of who we are in our own terms, leading to a life that feels more authentic and grounded. If you are interested in working with our therapists to better understand and work through experiences of depression, please feel free to contact us today.
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Photo credit: Kristina Tripkovic