When Elliot protests that he can’t just do nothing, he is seeing and judging himself from the perspective of a culture that looks with disdain at anything that smacks of inactivity. Under constant self-scrutiny as to whether he is being sufficiently productive, he feels ashamed when he judges himself to have come up short in this regard. But this leaves him at once too drained to work and unable to rest.

I discuss how two patients came from early childhood to associate their worth and value with their levels of achievement. Under constant pressure from within to “be their best”, they were liable to feel empty and exhausted when, inevitably, they felt they’d failed to live up to this ideal self-image.

This is me.