For emotional reasons, some people cannot go out and look for a job. Or they cannot keep a job. They cannot bear criticism, can't get along with others, or don't know why but just can't work, period. Or they work well enough, sometimes as if driven by demons, but cannot manage relationships. They remain not just unmarried but friendless. Many overeat, gamble too much, drink too much, buy things they cannot afford—they sincerely try to stop their addiction
Some have chronic physical illnesses that elude diagnosis and flare up whenever they make fresh plans. Some compulsively put the needs others first. They are burned out, yet must go on. They forget doctor appointments and medications, eat badly, and sleep far too little or too much.
They are always chronically depressed, anxious, or both, or perhaps diagnosed with ADD, but even on medication, not much changes. If medications do help, they have serious side effects. So they are diagnosed with a personality disorder. They are avoidant, narcissistic, borderline, dependent, obsessive compulsive—whatever. In an age of genetics, their disorder is usually thought to be innate.
Of course they despise themselves, slipping even deeper into their undervalued self. It becomes much worse with age, as peers pass them by. What do you say when someone asks, "What do you do?" You can't answer with "Oh, try to get up in the morning." If asked if you're in a relationship, you don't say, "Nope, thirty and still a virgin."
Those around them try to coach them. "Why don't you try..." "But why don't you just..." "You've got to make more of an effort." "There's no excuse for someone your age not to..." Finally, "I don't know what's the matter with you." Sadly, therapists say these things too, even after it is obvious that the patient cannot act.
Is this an illness? Are people born with it? While genes may increase vulnerability, in my experience, the cause is always that something truly horrible happened in childhood, usually with their mother and in the first two years of life. She left or died, or was depressed, physically incapacitated, stressed to an extreme degree, narcissistic, an addict or alcoholic, or abused in her own childhood—the bottom line was that she was unresponsive. Study after study with humans as well as other primates shows the same disastrous effects when caregiving fails.
This happens to children all around us, and they grow up and are still all around us. If their bodies were badly contorted at birth, so that at some point they would have to go through surgery and rehabilitation to live even close to normal lives, we would want it done and admire their endurance. We would look for a cure. Groups would organize and see it was done. But this is the wound that cannot be seen and, worse, is not even named.
Quick fixes do not work when the damage is this deep. Brief therapy can ease symptoms, but in the long run does little. People with such backgrounds have developed a primitive protector-persecutor defense (I describe it in The Undervalued Self). Its purpose is "never again." No growth or change, no closeness with others—it might mean encountering again the unbearable rejection and pain of childhood. Still, research finds that some can heal substantially with long-term therapy, or at least find meaning in their destiny, but this requires a skilled and loving clinician whom they can afford to see.
Next time you meet such a person, even if it is in the mirror, have compassion. Support whatever they do to heal. And if they are fortunate enough to have a therapist, don't be one of those who asks, "Why are you still in therapy after all these years?"