Quite often I have been faced with people who were praised and admired for their talents and their achievements, who were toilet-trained in the first year of their lives, and who may even, at the age of one and a half to five, have capably helped to take care of their younger siblings. According to prevailing attitudes, these people—the pride of their parents—should have had a strong and stable sense of self-assurance. But the case is exactly the opposite. They do well, even excellently, in everything they undertake; they are admired and envied; they are successful whenever they care to be—but behind all this lurks depression, a feeling of emptiness and self-alienation, and a sense that their life has no meaning. These dark feelings will come to the fore as soon as the drug of grandiosity fails, as soon as they are not "on top," not definitely the "superstar," or whenever they suddenly get the feeling they have failed to live up to some ideal image or have not measured up to some standard. Then they are plagued by anxiety or deep feelings of guilt and shame. What are the reasons for such disturbances in these competent, accomplished people?
In the very first interview they will let the listener know that they have had understanding parents, or at least one such, and if they are aware of having been misunderstood as children, they feel that the fault lay with them and with their inability to express themselves appropriately. They recount their earliest memories without any sympathy for the child they once were, and this is the more striking as these patients not only have a pronounced introspective ability but seem, to some degree, to be able to empathize with other people. Their access to the emotional world of their own childhood, however, is impaired—characterized by a lack of respect, a compulsion to control and manipulate, and a demand for achievement. Very often they show disdain and irony, even derision and cynicism, for the child they were. In general, there is a complete absence of real emotional understanding or serious appreciation of their own childhood vicissitudes, and no conception of their true needs—beyond the desire for achievement. The repression of their real history has been so complete that their illusion of a good childhood can be maintained with ease.