Carolynn Hillman appeared to have it all -- an Ivy League degree, a fulfilling psychotherapy practice in Manhattan, a supportive husband, two terrific kids, a nice house in the suburbs and a cat she adored.
Why then, she wondered, did she feel so rotten about herself? Why did she berate herself for the least imperfection -- real or imagined?
"When a couple I was treating walked out of my office more angry than when they came in, I felt like a terrible therapist," says Ms. Hillman.
Ms. Hillman, 50, concluded she suffered from a lack of self-esteem.
So, it seems, do plenty of other Americans -- from children who fall behind in school to adults who fail to get ahead at work.
Self-esteem -- typically defined as a favorable impression of oneself -- is the buzzword of the '90s.
Schools are instituting multi-cultural programs that feature the historic achievements of ethnic and racial minorities, in part, to boost self-esteem. Major corporations are hiring consultants to elevate worker morale and productivity via self-esteem enhancement techniques. Companies are forming to teach people how to feel better about themselves.
"Self-esteem will be to the '90s what stress management was to the '80s," predicts Don Powell, president of the Michigan-based American Institute for Preventive Medicine, which offers a 12-hour, on-site self-esteem program to corporations and hospitals.
Lots of benefits
Foster self-respect, insist some experts, and society as a whole will benefit -- with decreases in teen-age pregnancy, crime, welfare dependency, eating disorders, substance abuse, employee absenteeism and professional and academic failure.
The self-esteem movement kicked off in the late '80s, with the California Task Force to Promote Self-Esteem, Personal and Social Responsibility. It instituted classroom discussions about the importance of self-esteem and had students keep notebooks on what makes them feel empowered or powerful.
The effect was measurable, according to Gloria Steinem's best seller, "Revolution From Within, A Book of Self-Esteem" (Little, Brown. $11.95). In a high school that examined the link between unwanted pregnancy and self-esteem, such pregnancies dropped from 147 to 20 over three years, Ms. Steinem writes.
To some, low self-esteem is the root of all evil.
"Whether it is the failure to quit smoking or lose weight, alcohol or drug abuse, the inability to get along with co-workers or family members or poor job performance, you have to look at how these people feel about themselves," says Mr. Powell.
"American business loses more than $80 billion in alcohol and substance abuse. A lot of job-related stress -- and resultant absenteeism -- stems from low self-esteem."
The effects of a poor self-image can be even more subtle, say Matthew McKay and Patrick Flanning, authors of "Self-Esteem, A Proven Program of Cognitive Techniques for Assessing, Improving and Maintaining Your Self-Esteem" (New Harbinger. $12.95).
People who judge and reject themselves "take fewer social, academic or career risks," the authors say. They avoid meeting new people, opening up to others, expressing their sexuality, hearing criticism, asking for help and solving problems.
Not everyone buys these notions. Skeptics note a paucity of scientific data, and critics fear that focus on self-esteem draws attention from difficult social problems that demand complex solutions.
Getting an early start
Most psychologists believe self-respect is fostered early in life by nurturing parents. "I would say it begins in the first year, and by the time a child is 6 or 7 years old we can determine if he or she has a high, moderate or low level of self-esteem based on their behavior," says Mr. Powell.
Hillman concluded women generally have less self-esteem than men, after observing women in her practice. Thus, she penned "Recovery of Your Self-Esteem, a Guide for Women" (Simon & Schuster. $11).
"Society doesn't respect women as much as men," she argues. "Women in the media are depicted as not smart, not capable, superfluous beings. On TV and in movies, they're often raped or killed. They're told if they're not physically beautiful, then they don't count. But even very beautiful women lack self-esteem."
Many say minorities victimized by racism and people who lack money and power are more likely to lack self-confidence.
But a 1992 study by the American Association of University Women Educational Foundation, which surveyed 3,000 children nationwide in grades four through 10, found that by middle school the self-esteem level of "European-American" girls was 29 percent, while the level for African-American girls and Hispanic girls was 59 percent and 54 percent, respectively. The Ms. Foundation for Women is sponsoring research to explore this difference.