About two decades ago, a woman knocked on the door of Paul Hewitt, a clinical psychologist based in Vancouver, Canada. Outwardly, Anita — the pseudonym given in Hewitt’s new book — had everything meticulously together: she told her therapist of an idyllic childhood, the supportive family she came from, the daughter she felt close to, her broad network of friends. But the loss of her mom, who was her closest friend and confidant, was a big blow to her; it had happened ten years earlier, and was a continued source of hurt and anger. More recently, she’d injured her shoulder, forcing her out of her career in food science. However successful she appeared, she was actually suicidal and depressed.
She had tried many treatments to deal with her depression and thoughts of suicide, but none worked; she used the “runner’s highs” from long distance swimming as a way to cope with her loss, though the shoulder injury ended that. Few people in her life knew the depth of her pain. She had come to Hewitt because he’d heard an interview with the University of British Columbia psychologist where he talked about the links between depression, suicide, and perfectionism.
“She was one of the most suicidal people I’ve ever worked with,” he tells Thrive Global. Anita’s transformation serves as the central case study in the new book Perfectionism: A Relational Approach to Conceptualization, Assessment, and Treatment, co-authored by Hewitt’s frequent collaborator Gordon Flett, of York University, and the private clinical psychologist Samuel F. Mikail.
Over the past three decades, these researchers have found that far from being a quirk of high-achievers, an innocent humblebrag you give to job interviewers when they ask you what your greatest weakness is (“I’m sometimes a perfectionist”)—this way of approaching life creates or amplifies all sorts of mental health issues. It also signals a problematic relationship with the self. “It’s not a way of thinking,” Hewitt says. “It’s a way of being in the world.”
As they understand it, perfectionism isn’t about perfecting things: your job, a specific project, the way you look, or a relationship. At a fundamental level, it’s about perfecting the self, and this urge doesn’t come from a healthy place: “All components and dimensions of perfectionism ultimately involve attempts to perfect an imperfect self,” the authors write.
Perfectionism is an “epidemic,” Flett tells Thrive Global, and one that is growing. In recent studies of both American and Australian adolescents, 3 in 10 high schoolers displayed some sort of unhealthy perfectionism. It is also life endangering: a 2009 paper tracked 450 older Canadians over six and half years, and found that people with higher scores on perfectionism were more likely to die.
Perfectionism is implicated in eating disorders. It appears to make it harder for people to cope with chronic illness, like irritable bowel disease, fibromyalgia, and recovery from heart disease and traumatic brain injury. In cancer patients, perfectionism is related to greater symptoms of anxiety, depression and insomnia. Perfectionists do a lot of “emotional preoccupation coping,” or ruminating about what’s wrong, rehashing what could have been otherwise. The influential Yale psychologist Sidney Blatt found perfectionism to lead to self-critical depression, and multiple studies have found links between perfectionism and attempted or completed suicide.
While perfectionism is popularly thought to drive achievement, anecdotes and research indicate that its problematic forms get in the way of sustainable success. Flett holds up Brian Wilson, the creative genius behind the Beach Boys’ best work, as a prime example. Though Wilson made what is considered one of the greatest albums — if not the greatest — of all time, he drove himself to a nervous breakdown for not being able to top the Beatles as the greatest ever. (Rolling Stone puts Pet Sounds as number two all-time; Sgt. Pepper’s Lonely Hearts Club Band is number one.) That’s part of why the myth that perfectionism drives success is so off: perfectionists are more anxious about their work. In a self-aware 2010 study, Hewitt, Flett and their colleagues found that among 1,2000 psychology professors, those who strive for perfection and hold unrealistic expectations for themselves were “less likely to produce publications, receive citations, and publish in high-impact journals.”
The lesson: if mistakes are unacceptable, it’s going to be hard to get things done. You’ll be more likely to procrastinate, since you can’t do badly on things you haven’t yet started.
It starts early: in Perfectionism, the authors report that they can reliably and meaningfully assess perfectionism in kids as young as seven years-old. They interpret perfectionism to be an outgrowth of a child’s attachment style — which, to put it briefly, is the way kids (and the adults they turn into) are taught to assume relationships work, through their interactions with their mother or primary caregiver. Predictably, perfectionism gets passed down from one generation to another.
“Think about the child as a learning machine,” Hewitt says. “A three year old can learn a second language, no problem whatsoever. They learn everything about everything.” Early on — before they can speak, and before lots of episodic memory takes hold, children are learning if being too close or wandering far away makes their mother anxious, whether people are there to help them with things and soothe them when they’re upset, or if others are dangerous and powerful.
“For some of these kids, they’ll develop a sense that they’re not worthy, that there’s some flaw, defect, or otherwise something wrong with them,” Hewitt says.
An assumption starts taking foot: If I’m perfect, I won’t be rejected, ridiculed, abused — I’ll be loved and accepted. It’s an unconscious negotiation they make with the world: If I’m perfect, all this good stuff will happen, all these needs will be met — and their frequently difficult relationships with parents, siblings, and peers will become easier. His clients will often say that they’ve needed to be perfect for as long as they can remember, that they were never good enough, so they were always striving. “Perfectionism develops as a way to cope with that defective sense of self and a sense of not fitting in with others, not fitting in with the world, not having a place in the world,” Hewitt says.
These themes were certainly present with Anita. Early in her treatment, she recalled a memory from her childhood. At about age five, for reasons that were hazy, she and her sister were sent to away from their mom and dad to live with some relatives for a few months. The anecdote came up several times during therapy, with more details coming out each session. She recalled feeling upset, alone, abandoned, and unable to comprehend why she would be living away from her parents. Then, in another session, another scene emerged: the sight of her mom coming off the plane, and how beautiful she looked as she came to gather her and her sister up. In recalling the memory, it was obvious this was a significant experience for her, but she couldn’t quite tell why.
Over time, it became clear that being separated from mom was a significant experience for Anita. This was the pivotal moment where her perfectionism took root. She realized something about that experience she had as a child: following it, she became committed to never doing anything that might prompt that feeling of separation from her mother again.
As an adult, she arranged her life to be as much like her mother’s as possible: working in the same field when she was still alive, then eventually the same facility. When she and her husband were first married, they rented a room from their parents, then moved down the street. Being over-responsible for others’ welfare was another expression of this, since she’d never want to do anything to make her mother upset with her, and the perfectionism was a way to secure her mother’s ongoing affections.
Though she had organized her life around keeping her mother close to her, death took her mother away. Her swims were a way to deal with this — she’d often fantasize about her mom being alive during euphoric stretches in the water. But with her shoulder injury, that was gone too. The abandonment she’d spent so much of her life staving off came crashing in, along with anxiety, rage, depression, and suicidal impulses. Her commitment to keeping things seemingly perfect patterned her other relationships, too: even in the most extreme places of pain, she never told her friends or family.
This is why, Hewitt says, techniques that just target the way people think — like cognitive behavioral therapy — aren’t a good fit for perfectionism. The way he sees it, the words that compose our mental narratives are expressive of deeper beliefs we have about ourselves. “You can tell the quality of a relationship through the tone of the dialogue,” Hewitt says. “The content of how you’re communicating represents the relationship you have with that person.”
You talk to your boss with a certain style, your partner, your parent, your friends. The tone you use with the listener reflects the relationship you have, and it’s the same deal with the self. Most of our inner dialogue is about taking care of life’s responsibilities — you have to do this, that, and the other thing. That’s like you and your partner getting ready to go work in the morning — who’s going to go to the grocery store, who’s going to take the dog out. But in times of conflict or transition, things can take a deeper, more intimate, and more revealing turn: If you just lost your job or your relationship, what tone do you take with yourself? For people who aren’t perfectionistic, there will be self criticism, but also self soothing. But for perfectionistic people, it can be all scalding censure.
Doing psychotherapy with these people is extremely emotional, Hewitt says — for him and the patient alike. The stories are hard. A main goal is to help people to see that they have a relationship with themselves — a task that in itself is like explaining water to fish — and through that relationship, move to self-acceptance. But this is easier said than done, and you can’t just command someone to have a more agreeable internal life if they’ve spent a lifetime doing otherwise. “These people are hugely hard on themselves, with a hatred that is breathtaking at times,” Hewitt says — perfectionistic people will treat themselves like with a harshness on par with “a nasty adult beating the crap out of a tiny child.”
One key task for Hewitt as a therapist, then, is to find the right moment to help his patients to perceive their own self-regard. When the right teachable moment presents itself, he’ll ask clients to imagine their four-year-old selves, and remember how much pain they were in — how hard they were trying to fit in, how hard they wanted to feel better, to feel loved, how to make their parents or siblings or peers care for them.
If you could leave my office right now, and run into your four year-old self, knowing how much pain that four year old was in, what would you do? Hewitt will asks his patients. Often, the patient will say that they’d put their arms around the kid, and tell them they’re OK the way they are. But what do they actually do to themselves? Curse, swear, kick and scream. “That internal dialogue — ’I should have done this perfectly, I should be doing that, I’m horrible, I’m awful, I’m the most stupid,’ stuff like that — that represents that inner relationship with self,” Hewitt says.
You don’t just tell a perfectionistic person stop being so critical. Like physical pain, this harsh self-dialogue is a symptom of an underlying issue, and taking a painkiller when you have appendicitis isn’t going to be much help. “The symptom is a message to you, saying there’s something wrong in your abdomen,” Hewitt says. That’s why, in his sessions with patients, they don’t really talk about “perfectionism,” they discuss the underlying issues — the attachment, the longing for deeper connections with others, a sense of defectiveness with the self. “We want them to understand the purposes their symptoms serve,” he says. Once you understand the perfectionism’s function— a way of seeking security, love, self worth — then you can understand the deeper emotional machinery underlying a behavior.
The work with Anita focused on two levels: identifying how her perfectionism protected her from abandonment and then getting to a place where she could truly understand that she didn’t lose her mother because she wasn’t good enough — neither as a kid moving away to live with relatives, nor as an adult, with her mother’s death to cancer. That involves, of course, a ton of self-acceptance and self-compassion, two things that perfectionists tend to have a tough time with. For Anita, it worked: her depression and suicide diminished, her relationships got better, with no relapse. To this day, Hewitt gets a Christmas card every year. She thanks him for another year she has with her family.
Originally published at journal.thriveglobal.com