Most adults who live in the U.S. seem to link their self-worth with their careers. Many also identify with their body image, irrespective of gender. Some pin their self-esteem on high intelligence. People seek advanced college degrees in the expectation that it will allow them to earn more money, and for the purpose of self-worth. Thus, we have Americans who exercise and watch their diet, and who educate themselves and increase their earnings. Many Americans value the accomplishments of their offspring, as extensions of themselves.
Mentally ill people, if we went into a bar and someone approached us to ask, "What do you do?" We might not have a good answer. It would be an awkward moment. And, because psych medications adversely affect metabolism and make it a lot harder to exercise, we may not have a fit physique. Regarding the accomplishments of family, we may have parents or siblings who've done well for themselves, but very few mentally ill people are raising their kids, if they have produced them. Thus, again, when we are approached in a bar or at almost any gathering, when asked about ourselves, we might not have much to say, and this is awkward.
Under these circumstances, it is difficult to have much self-esteem. If we are subject to outpatient institutionalization, and if we don't have a professional job, we may be subject to implied messages telling us that we're subnormal.
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