Jake came to see me for therapy after a suicide attempt. Brilliant, attractive, athletic, and professionally accomplished, most of us would look at this man in his late 30s as a high-achieving role model. Popular with friends and colleagues, he had a prestigious job and made a high salary. His wife loved him, and they owned a beautiful home. All the external trappings of success were there, and most would assume he had every reason to be happy and proud of himself.
So what drove Jake to the intentional overdose that nearly cost him his life?
Despite his many talents and successes, Jake was never satisfied. The fear of failure tormented him. He had lived his entire life under the burden of perfectionism and viewed the world through a distorted lens where everything about him was being perpetually measured, judged, and graded.
Nothing is ever good enough for the perfectionist, and external validation is fleeting and unsatisfying. Jake could never rest in his accomplishments and relax.
Everyone loves a high achiever. We reward it in our families, schools, and workplaces. However, there’s a difference between high standards and impossible, unrealistic standards, and the perfectionist is trapped in the unrealistic.
Like all perfectionists, Jake lived in fear of being judged by others and was driven by a brutal and relentless inner critic. This inner critic created the following problems for Jake:
Excessive work
Jake worked from home, and even though his workday was scheduled to end at 4:30 pm, he routinely continued to work through the evening hours and often on the weekends. Obsessive attention to every minor aspect of his work left him burned out, irritable, and exhausted.
Unrealistically high standards
Jake was constantly unhappy with his own work and that of those around him. These high standards permeated all areas of his life and included the standards he kept for his physical fitness and body weight. Despite an athletic build and normal weight, he obsessed over his body fat and musculature.
Relationship problems
Jake could not be emotionally available to his wife since work always came first. Even when he attempted to spend time with her, his mind was focused on work projects. He failed to recognize her needs or bond with her on any sort of deep level. He made no time for friendships with other guys outside of superficial connections in competitive sporting events.
Procrastination
Like many perfectionists, procrastination was an ineffective coping mechanism that Jake used at times to avoid the anxiety he felt about an impending stressful task. If he wasn’t confident that he could do something perfectly, he became intensely anxious and failed to start the project. Avoidance only led to trouble down the road.
Jake had always experienced life as a difficult, stressful challenge, but he suffered through it with gritted teeth and clenched fists, giving it his all. Most of the time, he succeeded expectations, but it was inevitable that from time to time, something in the workplace wouldn’t go well. What would have been a minor work setback to most of us was the final straw that caused Jake to spiral into such deep despair he tried to take his life.
Perfectionism is a component of several associated mental health conditions, particularly depression, anxiety, and obsessive-compulsive disorders. It’s also associated with eating disorders and body dysmorphic disorder. Jake met the diagnostic criteria for each of these intertwining conditions.
Jake was beset with self-hatred, panic attacks, and insomnia. He’d never known a day of feeling comfortable in his skin. But there was no way to effectively treat any single one of the symptoms he was experiencing without working at the thread of perfectionism that permeated Jake’s way of being in the world.
This is complicated work. Jake’s brain was wired to view the world in a distorted way. It’s not as simple as “just stop thinking like that.” Even when he became clear that his thinking patterns were causing harm, he couldn’t keep his mind from falling into habitual patterns.
Like all aspects of personality, perfectionism results from a combination of inherited personality traits and environmental influences. Jake’s parents were both perfectionists and had similar personality styles, so since we know that personality is 50% heritable, genetic factors were involved.
In some families, perfectionistic parents mold their children from early childhood by constantly measuring and rewarding achievement and punishing or withdrawing affection whenever a mark is missed. Thus, a perfectionistic cognitive style becomes wired into the neurobiological system early on, and it’s hard to change, even when a person wants it to be different. It’s more than how they think — it’s how they perceive the world. It’s a style of perceiving that causes one to see all the tiny things that don’t line up perfectly rather than the beauty of the big picture.
One of the first things I asked Jake to do was to personify his relentless inner critic. He needed to become more aware of what was happening in his thoughts. Jake came to refer to the inner voice as “the drill sergeant.” The constant refrain in his head told him that he needed to do more, work harder, and be better. Before therapy, Jake didn’t realize that the way he went through the world was different than most.
Jake wanted to develop self-compassion and flexibility, quiet the inner drill sergeant and allow more playful parts of himself to thrive. This is no easy task for a person like Jake. Over the three-year time when I knew him, he made big progress.
Many specific therapy interventions were used to treat depression, anxiety, and insomnia, including mindfulness, cognitive tools, and values clarification. Jake needed lots of support in developing awareness of his deeper emotions and learning a vocabulary of feelings. Ego-state work, also known as “parts work,” was useful in helping Jake develop aspects of his personality that helped him enjoy life and build a more balanced lifestyle. Jake discovered the healing power of nature as he intentionally began to spend time outdoors just being rather than doing. Over time, couples therapy helped Jake reconnect with his wife on a deeper level.
Perfectionism exists on a continuum; a little bit may work well for a person, but too much can be deadly. Though Jake’s drill sergeant may still live in his head, the volume has been lowered. Jake is alive and well with a richer life. He has a lot to be proud of, and he knows that now.
Of course, he did the hard work of personal growth. Hard work is what Jake does, and it’s very hard for some people to be imperfect.
My friend from Hungary assures me that in her language, there is no word for “perfectionism” since it’s understood it is simply impossible. Instead, they use the word “maximalism” to express doing the best each person can. The rest of us can apparently learn something very useful from the Hungarians.