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The Myth of Self-Esteem

You can't outrun your mind.

While the definition of self-esteem appears harmless enough on its surface, “Confidence in one’s own worth or abilities,” the ideas surrounding self-esteem are some of the most damaging concepts ever propagated. “Self-esteem” implies that if I have enough of “X,” (“X” meaning a material object, an experience, a relationship, etc.), then I will be less anxious, less frustrated, and happier.

However, you’re never going to get rid of your feelings of anxiety or anger. They are a necessary part of life. It has been demonstrated that avoiding these emotions will just increase their frequency. In the famous "White Bears" study, Dr. Daniel Wegner demonstrated that when you to try not to think about something, you will inevitably think about it more. (1) Ignoring your anxiety and frustration will not get rid of those feelings, and the concept of self-esteem won’t help for a variety of reasons.

Source: kwadrat70/AdobeStock

First, self-esteem involves endless judgments of yourself versus those around you. You are either “better than” or “worse than” everyone you encounter. This line of reasoning creates labels; you cannot really see who other people are, what their needs might be, and how you might help. You lose awareness. This is the antithesis of what is necessary for the world to become a better place—the acceptance and celebration of differences.

Second, attempting to build self-esteem uses rational methods to deal with irrational neurological circuits. The emotional unconscious brain is much more powerful than the intellect; it’s a huge mismatch.

Third, when your sense of self-worth is at the mercy of other's opinions (including your own), you are beholden to them. It is particularly problematic in that their self-esteem improves if they can feel better than you. This scenario is in contrast to centuries of ancient wisdom, that a core aspect of enjoying life is to first connect to who you are, even if you are not always that happy about it.

Finally, what happens after you’ve attained the things that you thought would have alleviated your anxiety, and it doesn’t work? You will become more frustrated because there’s nowhere left to go. Think of all the high-profile people who have self-destructed. They usually had every imaginable comfort life has to offer but found it impossible to outrun their feelings of anxiety.

Achievement Doesn’t Work

Burnout has a terrible impact on patient care, as well as greatly affecting physicians' families. Physician burnout is at an epidemic level with one of the indicators being the high rate of suicide. (2) It keeps rising. How can that be? Most of them were “living the dream.” They were highly educated, wealthy, with good reputations, beautiful families—the list is endless. They possessed more than enough to have self-esteem.

These aren’t just numbers to me. I personally know of 19 medical colleagues who took their own lives, and four out of my 80 medical school classmates are dead from suicide. One was a friend who was an excellent spine surgeon and one of those guys you could count on for anything. He had spent the day in surgery with me, assisting with a difficult operation. At two o’clock he shook my hand and said, “Nice case, I have an appointment I can’t miss.” He walked out, and three hours later, shot himself.

I was close to being number 20. (3) There are problems with overwork, loss of independence, and less time to talk to our patients. However, the root cause of suppressed anxiety and frustration is not readily acknowledged or addressed. When you suggest that anxiety is an issue, physicians usually quickly change the subject. Yet, as I have personally helped colleagues navigate their way out of this hole, it is always around anxiety. It is particularly toxic in medicine in that perfect is held up as the standard when it actually compromises performance. The anxious, perfectionistic drive that pushed them to the top is what destroyed them, in the end.


Although “perfect” sounds reasonable when applied to surgery, it’s actually deadly. It creates an intense, chronic anxiety of “never being good enough,” and then frustration from being unable to achieve impossible goals. These emotions are distracting and actually compromise performance. Perfectionism fosters anger-driven anxiety; eventually, the anxiety becomes intolerable.

The "genealogy" of anger and frustration is:

  • Circumstance
  • Blame
  • Victim
  • Anger

With perfectionism, you will blame the situation or yourself for being less than perfect. You are now in victim mode. Since there is no such situation that is perfect, there is no endpoint. It is one of the reasons that physicians achieve so much and it works—until it doesn't. People don’t necessarily kill themselves because they are depressed. It is often an angry act. Anger is destructive and the ultimate act of destruction is to destroy yourself.

I am using the medical profession as an example, as it is my world. However, the concepts apply to any high-performance situation. Another common scenario is in the performance world.

Nick and Holt

My son, Nick, and his friend Holt, are both world-class mogul skiers. I learned many of the concepts I know today from watching them deal with the adversities of competing under intense pressure while being at the mercy of judges. They were also obsessed with winning as the ultimate goal. One of my best friends and athletic performance coach, David Elaimy, as well as myself, worked with them to learn to enjoy the journey, regardless of the outcome. They slowly came around although the ski racing culture is focused on winning.

In 2007, Holt won the national championship in mogul skiing. He felt that significant contributing factors to his victory were the awareness and visualization techniques he had learned through our discussions. By connecting with his best effort instead of the outcome, he was able to let go and perform with freedom.

The day after his victory, he turned to me and said, “You were right. Winning changed my life for about 12 hours. Life goes on.”

If you are creating a life only to fill a void inside you, to define you, it becomes a major problem. The key is to become aware, understand who you are (including your "flaws") and move forward with your best effort. It’s rewarding to strive for excellence; it just has nothing to do with decreasing anxiety and frustration. There is a major difference in having self-confidence versus "self-esteem." No matter what your livelihood—if you are connected with who you are, then you can create the life you want.


1. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 - 13.

2. Kalmoe, M, et al. Physician Suicide: A Call to Action. Mo Med (2019); 116(3): 211–216.

3. Hanscom, D. SpineLine (2011);12(6):42-44. © 2011 North American Spine Society.

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