Shirah Vollmer MD

The Musings of Dr. Vollmer

Low Self-Esteem or Disorganized: Hard To Tell

Posted by Dr. Vollmer on March 26, 2012

Elisa, thirty, misses appointments, forgets to pay her bills, does not return phone calls, and has trouble completing tasks. She suffers from ADHD, takes stimulants which she reports as “very helpful,” but she remains disorganized and thereby rude to her friends and family. As we explore her behavior, which occurs intermittently with our appointments as well, Elisa comes to the understanding that she runs her life in a “crisis mode.” By that she means that when they are just about to shut off her electricity, then she will pay her bill. Before that, “I just don’t see the need,” she says with a flat affect, seemingly uncaring that her two kids will have to suffer if the electricity gets shut off. “It seems like you need adrenaline to carry out a task?” I ask, noticing that the heat of a crisis bolts her into action. “Yes, absolutely, I have always been that way,” she responds rapidly. “Maybe that the adrenaline has to compensate for your general low sense of yourself and your general sense of unworthiness, such that you do not feel compelled to do the activities of daily living unless there is an immediate consequence which looms large.” I say, noticing that maybe layered over her ADHD is a sense that life is not much fun, that she is not much fun, if she has to be ordinary. “The sense that one has that it is OK to do ordinary things is often derived from a sense that one is OK. If you don’t have a sense that you are OK, maybe then you do not see the value in showing up and being a person of your word. Maybe you don’t think your word means much because you don’t feel that you mean much.” I say, again showcasing that perhaps if she had a larger view of her self-importance, maybe then she would comprehend why it is important to other people that she does what she says she will do. If she thinks low of herself, she may think that her word is not valued and therefore she is not obligated to follow through. I wonder. Elisa looks back at me mystified and unsure as to what I am talking about. “I don’t know what you are saying, but I will sure try to think about it,” she responds. “That is all I ask. Think about it.” I say, expressing hope that maybe through chewing on my idea,  Elisa can come up with her own ideas as to why she has trouble being responsible. She left confused, but also with a look of curiosity and reflection that made me think that we were involved in a deep journey.

11 Responses to “Low Self-Esteem or Disorganized: Hard To Tell”

  1. Shelly said

    Very interesting and timely blog for me, being married tp someone you describe exactly in this blog. He constantly has an excuse for being late or losing papers or being disorganized, etc… But having low self-esteem would be the very last thing on his mind. He does not feel unworthy and his excuses for being late are usually, “Well we are paying the fee so they can wait,” or “Well, there’s traffic, what do you want from me?” (leave a little earlier, maybe?). I feel ADHD is used as a crutch and as an excuse to explain away unacceptable behaviors– even though all 4 of my kids have it and so does my husband.

  2. Hi Shelly,
    Thanks. Yes, the layering of issues is always fascinating since one can fixate on one layer, and although there is truth in that layer, that does not explain the whole story. Organizational skills, like all skills seem to be both innate and learned. One can improve upon one’s nature if one is motivated to do so. This motivation needs to come from a place of self-esteem. Thanks Again.

  3. jo said

    Can hyper-vigilance about the ordinary things of life also point to low self-esteem?

  4. Hi Jo,
    Hyper-vigilance usually suggests anxiety, which can indeed point to low self-esteem.

  5. Shirah, your mention, above, of the “layers of issues” as part of the human condition has always been very fascinating to me. To use an analogy, it seems kind of like peeling an onion..layer after layer after layer…or maybe even an artichoke..leaf after leaf until you reach the best part…the “heart”. I recently heard someone rather appropriately refer to a 5 year old nephew of mine as “a work in progress” and while true, my response was, “aren’t we all” 😉 ….My point was that as we all age hopefully we keep growing mentally and emotionally and spiritually, and continue to better know more about ourselves…our “layers” so to speak.

    • Yes, indeed, we are all a work in progress. Adapt or die, as my colleagues like to say. We need to grow and develop both as we achieve new developmental milestones and as the world changes around us. The quality of adaptability is perhaps the most important of all. Yes, the layers of the mind, the peeling of an onion or an artichoke are all ways in which we struggle to avoid dichotomies and enter into a discussion of multiple truths. Although in good times, most of us can appreciate this notion, under stress, one is inclined to simplify one’s world and create a binary system of good and bad. Therapy is one way to help stay focused on complexit which thereby deepens one’s experience of one’s world. Thank you, as always, for contributing to this discussion.

  6. rebeccaerobbins said

    I work with young adolescents who struggle with executive functioning (Aspie and ADHD, mostly), and it seems their greatest struggle is overcoming learned helplessness. These kids receive an outstanding amount of negative feedback, and often have an understandable fear based response to difficult tasks, and low self esteem even at the age of ten. It’s so much harder to overcome this as an adult.

    • Hi Rebecca,
      Thanks so much for sharing your insights from your important work with these kids. I agree that the low self-esteem starts at a young age and it begins with difficulties in school, which then sets off a negative feedback loop. Sometimes I wish that these kids could see their strengths first, and then go to school so they could develop the perspective that everyone has strengths and weaknesses, rather than the idea that they are inferior because they are not good students. Clearly, kids who work with you have a much better chance of having good self-esteem as adult, and that is one of the many reasons why your work is so important. Thanks again for joining my “community” of people who care about the mental well-being of folks, from cradle to grave. As you alluded to in your comment, so many adult feelings stem from childhood experiences.

  7. eugene_obt said

    That made so much talks directly to me.

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