In earlier cultural epochs, many people derived their self-worth from their relationship with God, or from their ability to be a winner in the commercial marketplace. But in a therapeutic culture people’s sense of self-worth depends on their subjective feelings about themselves. Do I feel good about myself? Do I like me?

From the start, many writers noticed that this ethos often turned people into fragile narcissists. It cut them off from moral traditions and the normal sources of meaning and identity. It pushed them in on themselves, made them self-absorbed, craving public affirmation, so they could feel good about themselves. As Christopher Lasch wrote in his 1979 book The Culture of Narcissism, such people are plagued by an insecurity that can be “overcome only by seeing his ‘grandiose self’ reflected in the attentions of others”.