Article on saying goodbye to a dying loved one and the opportunities that come from talking with a dying person.

Have you said goodbye to a dying loved one yet? Chances are good that you will. With medical advancements in the diagnosis and treatment of cancer and other degenerative diseases, we can anticipate 'dying time' much more accurately than ever before. A terminal diagnosis is a gift of time and a wake-up call that time is running out. How will you use the time? Will you see the end of life as an opportunity to talk, love, and grow from the experience of talking with the dying person, or will you bring out the crying towel and simply wait for your loved one to die?

The last stage of a loved one's life is a final opportunity to say "I love you" and to say goodbye. It is a chance to carry on a relationship until the very end or beyond; a time for growth; a time to let go of any hurt that may have been caused by a difficult relationship. Our book, Final Conversations: Helping the Living and the Dying Talk to Each Other, is for all who have lost a loved one to a terminal illness; it is for everyone who will lose someone in the future. It is for the surviving partners and for anyone who wants to understand the practical power and importance of communication at the end of life, and to learn how to have a better and more fulfilling final conversation.

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Final conversations, simplified in our book to "FC-talk," include all the moments of talking, touching, and spending time with the Dying. (We decided to capitalize the Living and the Dying when we mean the person or people rather than the process.) These communicative moments potentially begin when you find out that someone you love is dying, and continue until the moment the person dies. FC-talk is not necessarily the "last" conversation that the Dying had with someone, although in some instances it is.

Seventeen years ago, Ellen was losing the love of her life. Her husband, Michael, was dying of a brain tumor. He was in his early forties and he was leaving a young wife and two young children. Ellen revealed that her FC-talk focused on keeping their relationship genuine until the moment of his death and beyond if possible. She wanted to be sure that Michael knew he was loved and that she had completed her relationship with him up until the moment of his death. She repeatedly told him that I loved him, that I would always love him. I really didn't want to live my life without him, but I didn't get to make a choice about it. I would do my very best job to raise our children right. I was just glad that we got to spend the time that we did together. I thought it was a privilege to be able to have shared my life with him. I was grateful for the time that we had and to have had his children.

Ellen emphasized that the message of love had to be clear, leaving no doubts. I think if you're smart enough of a human being, you actually convey to the person that you love them while it has meaning and while it has emotion. This was a conversation [that really mattered]; I mean, we were going to be separated. We knew we were going to be separated. And I just needed to be able to complete with him and to let him know that I've always loved him and that I always would love him. It was a privilege for me to grow up and spend my life with him. I think conversations that you have with people who you know are on borrowed time . . . even though we're all on borrowed time, we don't live like we're on borrowed time . . . I mean, I guess what I'm trying to say is that we should all live as if we all know we're terminal. Because we all are terminal!

I completed my relationship with him. I didn't walk away thinking, Aauugh, I should have said, I didn't say, I could have said, I wanted to say. There wasn't anything that we didn't really say. And in the final analysis, the most important, the absolutely most important things were all said. Because the person who is left doesn't get stuck holding a bunch of untied knots. It's complete. You're not dragging anything along with it. We both completed the relationship.

We both were able to let each other know that we didn't want it to go that way. But since it was going to go that way anyway, we made the most of that final time. After speaking together, we gave Michael the chance to complete his relationship with his family and his friends. We also gave him the opportunity to tell us anybody that he didn't want to come there. And there were some people, just a few, that he said, "I don't want to deal with them. I don't want to see them." So, it was a new level that a lot of people experienced in relationship to him and his death. Some were shocked that they were able to complete their relationship with Michael [through their FC-talk].

Because Ellen was in love with Michael to the end, she remained open to love and was lucky to find love for a second time. Ellen has now been happily married to Wally for many years.

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Ellen isn't the only one who married again following the death of a beloved spouse. Cathy, Sondra, and Victoria all talked about the importance of FC-talk as a critical tool to assist the Living in moving on past the death. All of these young wives talked about the importance of the Dying giving the Living permission, and sometimes motivation, to continue living life. In these cases, the Dying gave the living permission—even encouragement—to marry again someday. Cathy's husband, Don, was thirty-two years older than she, so he knew that she would outlive him. Don began the conversation with Cathy about marrying again long before their FC-talks, and again when he was dying. Because he knew he was that much older than I, he said that I needed to make sure that I move on. Cathy often dismissed his suggestion while he was alive, but would remember it later. She appreciated his ultimate concern for her and their daughter Christina's future happiness.

Part of the completion of the relationship for these four dying husbands was their unselfishness and release of any personal jealousy of the Living. They knew that life is meant to be lived fully, with love, just as each of these marriages had been lived. For these wives, there was not going to be any guilt or looking back with regret. Completing the relationship honored love itself by acknowledging the love that had been, and by embracing the potential for the love that would be. All four of these women married again.

Sondra's husband, Steve, died of acute leukemia. He had just had four heart attacks in a two-week period. Clearly, he didn't have much longer to live. Steve told Sondra: "I don't want you to fear death. I don't want you to mourn if I pass away." The last thing that he wanted was any fear of that. And he said, "Death is part of life." I'll never forget that. "Everybody is going to die." He told me many times that "the worst thing you could ever do is to mourn my death. Don't mourn me; rejoice because I'm in a better place." Then he said, " I want you to remarry." He made me realize that this is not something that you're going to ever become bitter over. I had always thought previously that if somebody marries somebody, that you show your real love to them [after they die] by never marrying again, and you show that devotion to that person for a long time, even past their death. And, he said, "No, you will love." And he told me that "your real love for someone is to want the best for them."

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A similar message was given to Victoria byher young husband, Kerry,whowas dying of cancer. Kerry was Victoria's first love. They had married young, and she was devastated at the thought of his death. Victoria recalled: We had great passion. I had never been with anybody else beyond casual dating. And I remember sitting in the hospital and saying, "I'll never marry again, there's no way." And he said, "I sure hope you will. I hope being married to me was good enough that it'll make you want to marry again."

Victoria elaborated on the importance of this FC-talk as a love message. When he told me I'd be okay without him, that I could live without him, that I should marry again, he was providing for my family. He was attempting to make sure that we had the best we could, that I would take good care of the girls, that I would have a good life. He was just continuing to be the loving husband and father that he had been all along. He was continuing to take care of us. I have known a lot of women that weren't given that kind of permission, that gift, who really felt uncomfortable with that idea [of moving on to love again]. Her words imply that women who do not receive that gift of letting go can remain stuck in uncompleted relationships and the memory of love—sometimes for the rest of their lives.

So, what did the Living teach us about love? Many things, as we describe in our book, but three points are worth mentioning here:

• Tell the people you love that you love them. Tell them often. Tell them now. Tell them before time runs out.
• Death is a great triage nurse for love. The dying process fails to nurture pettiness and triviality, and then only love remains. Love, the highest of human emotions, is nurtured to the end. Count on it.
• When you love someone so much that you think you can't live through their death yourself, that's when you really have to make yourself participate in FC-talk. To be able to say what needs to be said does help the Living cope. FC-talk helps the Living make the transition to a life without the Dying.

About the authors: Keeley and Yingling are communication experts who personally have had final conversations with loved ones, and who interviewed over 80 volunteers who wanted to share their experiences with others. Portions of this article were excerpted from the authors' book Final Conversations: Helping the Living and the Dying Talk to Each Other (VanderWyk & Burnham, 2007).

next: Articles: The Journey Through Cancer and The Seven Levels of Healing®

Walk by any college computer lab or dorm late at night and you will see hundreds of students frantically typing away on their computer terminals - but instead of school research and paper-writing, they're most likely spending several hours every night slaying monsters at gaming sites or chatting aimlessly with Internet pals hundreds of miles or even continents away. College counselors are starting to see those students who can't stop surfing the Internet at the risk of jeopardizing their grades. And administrators fear the rise of attrition rates due to Internet misuse on campus.

Caught in the Net reveals how the combination of unstructured, free, and unlimited Internet use breed college communities of severe addicts, who are just beginning to awaken to the seriousness of plummeting grades and ruined social lives. Case studies, observations, and suggestions for a new outlook on the Internet in our universities serve as a wake-up call to students, faculty, parents, and counselors.

Dr. Young tours nationally on college campuses. Please contact us to arrange a College Lecture that will enlighten students, faculty, administrators, and college counselors. Click here to order Caught in the Net

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Book and Music

From the experience of loss, I was forced to begin a search.
Whatever it was I was looking for,
I ended up finding myself.

This book evolved from a fierce desire to know and understand myself, and the way in which individuals learn, grow and develop, (socially and spiritually), and as an expansion of my previous book, "Pools of Peace". Even though I had more than enough pages completed, I continually found myself thinking of ways to expand its contents as my own personal development and understanding expanded. I decided that "Pools" had the right amount of information within it, and further expansion on my philosopy was best put into a more detailed form.

As my thirst for knowledge of human development increased, the need for this information to be documented became paramount. Not only was there a need to share this knowledge with you, the readers, and with those who are close and dear to me, but a strange feeling of wanting to share it with myself. I believe that this came from the need to purge myself of the feelings and thoughts within. It was almost like giving myself a test on this subject that is so close to my heart; a way of laying out my inner self on paper and saying, "Yes!, this is exactly what I am feeling". Upon completion of such an exercise, the information seems to slip back into my pysche to become silently, but permanently resident within the core of my being. It is now first nature to me, and I am in a position to act without fear or reserve when any situation comes my way where Love and Compassion are the only answers.

Download a FREE book about developing Awarenessto bring about radical positive change.

Index of Chapters Book and Music Introduction to Getting off The Roller Coaster The Struggle of the Ego The Concept of "The Now" Understanding and Working Through Fears The Mirror Action of Life Conditioned Emotions and Choosing. Cultivating a New Discipline. A Good Way to Love. Affirming Your Right to Love The Gratitude Principle. Co-Creating With God. The Peaceful Balance. Appendix I Appendix II Bibliography To My Readers APPENDIX I: A verse to meditate on APPENDIX II: Lyrics to Songs and their stories 12 Chapters and approx 190 pages. Fully formatted and ready to be printed.

This FREE book has an optional Companion CD or Audio Tape You can listen to these songs at www.broadjam.com or BUY IT FROM MY PURCHASE PAGE INDEX OF SONGS Don't let go of your dreams. The Believing Way It's gonna be alright. Miracles Matter. Talk to Me. Breakaway. Don't be afraid.

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Ideas on how to improve social skills in children with ADHD as many ADHD children often lack the social skills necessary to get along with their peers and communicate with others.

How to Improve Social Skills in Children with ADHD

The direct teaching of social rules or conventions which guide interactions and which most children learn without direct input. These might include how to greet somebody, how to initiate a conversation, taking turns in a conversation, and maintaining appropriate eye contact.

Modelling of social skills such as the above for the target child to observe ; or shared viewing and discussing of a video-tape of two people talking or playing, including reference to any non-verbal messages which can be discerned.

Providing specific and structured activities which are to be shared with one or two selected classmate(s). These might range from some jobs to be completed in the school during break or lunch time, games involving turn-taking (board games based on logic or spatial intelligence such as Chess rather than games based on inference-making like Cluedo, simple card games ), tasks or mini-projects to be completed on the computer ( e.g. preparing large print labels for work to be displayed around the classroom or having the major responsibility for printing a class newsletter ).

Identifying particular skills in the target child and inviting him/her to offer some help to another child who is less advanced (e.g. if your child is really good with the computer then maybe they can help another child who may find computers more difficult).

Encouraging his or her participation in school clubs or organised/structured activities during the lunchtime.

Direct advice about when, and for how long, the child may go on about a favourite topic, perhaps with the use of a signal by which to indicate when to stop ( or not to start ! ). Giving notice of something fifteen minutes before the need to go out or change then a reminder every 5 minutes then every minute 2 minutes before the deadline - you must make sure to make it clear each time e.g. in 15 minutes we need to get ready to go to the shop, in 10 minutes we need to get ready to go to the shop, in 5 minutes we need to get ready to go to the shop, 2 minutes to get ready to go to the shop, 1 minute to get ready to go to the shop. Keep things very clear and specific.

Recognising the Viewpoints and Feelings of Other People

In the classroom setting, instructions should be very precise with no opportunity to misunderstand what is expected. It may be necessary to follow up group instructions with individual instructions rather than assuming that the target child has understood what is needed or can learn "incidentally" from watching what other children do.

Direct teaching about social situations such as how to recognise when someone is joking or how to recognise how someone else is feeling. This latter might begin with a series of cartoon faces with clearly drawn expressions indicating anger, amusement, etc., with the target child helped to identify the various feelings and guess what caused them.

Games or role play to focus upon the viewpoint of another person. This might include simply looking at pictures of children or adults interacting or working together or sharing some activity, and asking what is happening or what a given individual is doing, and what he might be thinking.

Direct teaching of what to do ( or what not to do ) in certain situations, such as when the teacher is cross either with the individual child or with the whole group.

Avoiding Social or Communications Breakdown

• Helping the child to recognise his/her own symptoms of stress or distress, with a "script" by which to try relaxation strategies ; or having in place a system where it is acceptable for the child briefly to remove him/herself from the class as necessary.
• The establishment of a "buddy" system or a system where the child in question is encouraged to observe how other children behave in particular situations.
• Having selected peers specifically model social skills. The buddy might also be encouraged to be the partner of the ADHD child in games, showing how to play, and offering or seeking help if the child is teased.
• The use of the "Circles of Friends" approach designed to identify (social) difficulties, and to set targets and strategies by which other children in the class can be helpful and supportive, with the long term aim of increasing social integration and reducing anxiety.
• The availability of a regular time slot for support from an adult in terms of feedback concerning (social) behaviour, discussing what is going well and less well, and why ; and enabling the child to express concerns or versions of events.
• A clarity and explicitness of rules in the classroom to minimise uncertainty, and to provide the basis for tangible rewards.
• Reminders about conversation rules ; and using videos of TV programmes as a basis for observing appropriate interaction.
• In a group setting, adopting the circle time strategy of limiting verbal contributions to whomsoever is in possession of some object (while ensuring that the object circulates fairly among the whole group).
• Using a video of a situation to illustrate behaviour that is inappropriate in, for example, causing irritation to other children, then and discussing why ; making a video of the target child him/herself and discussing where there are incidents of good social behaviours.
• In respect of repetitive questioning or obsessive topics of conversation ......... :
• Provide a visual timetable plus bulletins of any innovations so there is no uncertainty about the day's routine.
• Make it clear that you will only respond to a question when a given task has been completed.
• Agree a later time for responding to the question and allow the child the opportunity to write it down so they don't forget.
• Specify one particular place, such as the playground, where the question will be answered.
• Explain quietly and politely that the child has asked this before and maybe suggest that it might be a good idea to write down the answer so that the next time they want to ask the same question rather than you becoming a bit exasperated with them that they can pick up the card where the answer is written.
• If obsessive talking appears to mask some anxiety, seek to identify its source, or teach general relaxation techniques.
• Specify times when the obsessive topic can be introduced, or allow an opportunity as a reward for finishing a piece of work.
• Provide time and attention, and positive feedback, when the child is not talking about the given topic.
• Agree with the child and his classmates a signal to be used by those classmates when they are tired of the topic.
• Allow some practice of talking at a reasonable volume, with an agreed signal to be given if it is too loud ; or tape-recording speech so that the child can evaluate the volume him/herself.

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Peer Awareness

A common theme in much of the on going research and studies about social skills in the child with ADHD is that the work intended to help the child needs to involve other children to at least some extent. If the focus is upon peer interaction, there is little logic in seeking to improve performance by using only one to one sessions.

It would therefore be desirable for perhaps two or three non-ADHD peers to participate in the activities or video watching so that there could be a shared discussion and an actual possibility to practice some of the skills by the children in various make believe situations and not simply by target child and adult. This latter arrangement risks being somewhat abstract when evidence suggests the value of working on social skills within a social context.

Also, if peers are involved in the training strategies and share the same rules, this may reduce stress upon the ADHD child and increase the rate at which (s)he internalises the targeted behaviours in real situations they can identify with.

The idea that simply placing a child with ADHD in a mainstream class will not actually be the solution for that child to develop socially appropriate behaviours. There needs to be direct teaching or modelling of the behaviours, and it is likely that the number of such behaviours needs to be limited to one or two at a time if true learning and consolidation is to take place.

Learning from peers can take three forms:

Where the target child is placed within a group of peers whose positive social skills will be modelled constantly by others and where it has been made clear to the ADHD child what to observe and imitate. So the need to explain carefully what you want your child to watch the other children doing needs to be fairly specific - e.g. watch how this group take turns to throw the dice in the game.

The training approach involves peers being shown how to prompt some particular response from the child with ADHD and then to offer praise when the child acts appropriately. So the group you are working with need to know exactly what you are wanting your child to learn - e.g. turn taking so they can go round with the dice with the person with the dice passing this to the next child saying it is now your turn to throw the dice all round the group until it comes to your child's turn. Then the child before can hand your child the dice and say clear that it is now their turn to throw the dice and thank them for waiting nicely for everyone else to have their turn. Then once the child has thrown the dice for them to then pass the dice to the next child saying it is now your turn to throw the dice when that child can then say thank you for giving me my turn. Things like this although may sound very strange help our children to learn the idea of turn taking by constant reinforcement as they learn much better by various forms being taken - watching - speaking the instruction and then interaction of praise for getting it right.

The peer-initiated approach involves showing peers how to talk with the ADHD child and how to invite him or her to respond. It enables the other children to learn that this particular child has a problem and that you are trusting them to help the child to learn how to take part correctly, this therefore also helps the other children to work on the skills they need to continue to involve the child in other activities by asking them in the right manor and how to explain the rules in a way your child will understand in the future.

There is evidence that involving all children in the development of social skills has more benefits than working with the targeted child(ren) only ; there is also the point that this approach avoids singling out the child with the ADHD characteristics which might otherwise introduce a further disadvantage before one even begins ! There is a similar risk in a constant pairing of the ADHD child with a support assistant in that a dependency may be established, and any need or motivation to interact with other children is reduced.

A further implication behind all this is that there will be benefits in providing some sensitive awareness-raising among classmates of the nature of ADHD characteristics and behaviours. There is evidence ( e.g. Roeyers 1996) that giving peers this kind of information can improve the frequency and quality of social interaction between the ADHD child and classmates ; and that it can increase empathy towards the ADHD individual whose idiosyncrasies become more understandable and are not seen as provocative or awkward.

The whole point of this being a Social problem leads everyone to realise that the best way to help your child is to involve them in controlled social situations as this helps not only your child but it also allows others to learn how to involve your child in other situations without this causing as many problems as it may have done in the past.

REFERENCES

• Roeyers H. 1996 The influence of non-handicapped peers on the social interaction of children with a pervasive developmental disorder. Journal of Autism and Developmental Disorders 26 307-320
• Novotini M 2000 What Does Everyone Else Know That I Don't
• Connor M 2002 Promoting Social Skills among Children with Asperger Syndrome (ASD)
• Gray C My Social Stories Book
• Searkle Y, Streng I The Social Skills Game (Lifegames)
• Behaviour UK Conduct Files
• Team Asperger Gaining Face, CD Rom Game
• Powell S. and Jordan R. 1997 Autism and Learning. London : Fulton.
  (With particular reference to the chapter by Murray D. on autism and information technology )

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Accompanying with the steady increase in the number of people with eating disorders has been a rise in the number of people with exercise disorders: people who are controlling their bodies, altering their moods, and defining themselves through their overinvolvement in exercise activity, to the point where instead of choosing to participate in their activity, they have become "addicted" to it, continuing to engage in it despite adverse consequences. If dieting taken to the extreme becomes an eating disorder, exercise activity taken to the same extreme may be viewed as an activity disorder, a term used by Alayne Yates in her book Compulsive Exercise and the Eating Disorders (1991).

In our society, exercise is increasingly being sought, less for the pursuit of fitness or pleasure and more for the means to a thinner body or sense of control and accomplishment. Female exercisers are particularly vulnerable to problems arising when restriction of food intake is combined with intense physical activity. A female who loses too much weight or body fat will stop menstruating and ovulating and will become increasingly susceptible to stress fractures and osteoporosis. Yet, similar to individuals with eating disorders, those with an activity disorder are not deterred from their behaviors by medical complications and consequences.

People who continue to overexercise in spite of medical and/or other consequences feel as if they can't stop and that participating in their activity is no longer an option. These people have been referred to as obligatory or compulsive exercisers because they seem unable to "not exercise," even when injured, exhausted, and begged or threatened by others to stop. The terms pathogenic exercise and exercise addiction have been used to describe individuals who are consumed by the need for physical activity to the exclusion of everything else and to the point of damage or danger to their lives.

The term anorexia athletica has been used to describe a subclinical eating disorder for athletes who engage in at least one unhealthy method of weight control, including fasting, vomiting, diet pills, laxatives, or diuretics. For the rest of this chapter, the term activity disorder will be used to describe the overexercising syndrome as this term seems most appropriate for comparison with the more traditional eating disorders.

Signs and Symptoms of Activity Disorder

The signs and symptoms of activity disorder often, but not always, include those seen in anorexia nervosa and bulimia nervosa. Obsessive concerns about being fat, body dissatisfaction, binge eating, and a whole variety of dieting and purging behaviors are often present in activity disordered individuals. Furthermore, it is well established that obsessive exercise is a common feature seen in anorexics and bulimics; in fact, some studies have reported that as many as 75 percent u and se excessive exercise as a method of purging and/or reducing anxiety. Therefore, activity disorder can be found as a component of anorexia nervosa or bulimia nervosa or, although there is yet no DSM diagnosis for it, as a separate disorder altogether.

There are many individuals with the salient features of an activity disorder who do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. The overriding feature of an activity disorder is the presence of excessive, purposeless, physical activity that goes beyond any usual training regimen and ends up being a detriment rather than an asset to the individual's health and well-being.

In her book, Compulsive Exercise and the Eating Disorders, Alayne Yates lists the proposed features of an activity disorder, a summary of which is listed below.

Features of an Activity Disorder

• The person maintains a high level of activity and is uncomfortable with states of rest or relaxation.
• The individual depends on the activity for self-definition and mood stabilization.
• There is an intense, driven quality to the activity that becomes self-perpetuating and resistant to change, compelling the person to continue while feeling the lack of ability to control or stop the behavior.
• Only the overuse of the body can produce the physiologic effects of deprivation (secondary to exposure to the elements, extreme exertion, and rigid dietary restriction) that are an important component perpetuating the disorder.
• Although activity disordered individuals may have coexisting personality disorders, there is no particular personality profile or disorder that underlies an activity disorder. These persons are apt to be physically healthy, high-functioning individuals.
• Activity disordered persons will use rationalizations and other defense mechanisms to protect their involvement in the activity. This may represent a preexisting personality disorder and/or be secondary to the physical deprivation.
• Although there is no particular personality profile or disorder, the activity disordered person's achievement orientation, independence, self-control, perfectionism, persistence, and well- developed mental strategies can foster significant academic and vocational accomplishments in such a way that they appear as healthy, high-functioning individuals.

Activity disorders, like eating disorders, are expressions of and defenses against feelings and emotions and are used to soothe, organize, and maintain self-esteem. Individuals with the eating disorders and those with activity disorders are similar to one another in many respects. Both groups attempt to control the body through exercise and/or diet and are overly conscious of input versus output equations. They are extremely committed individuals and pride themselves on putting mind over matter, valuing self-discipline, self-sacrifice, and the ability to persevere.

They are generally hard-working, task-oriented, high-achieving individuals who have a tendency to be dissatisfied with themselves as if nothing is ever good enough. The emotional investment these individuals place on exercise and/or diet becomes more intense and significant than work, family, relationships, and, ironically, even health. Those with activity disorders lose control over exercise just as those with an eating disorder lose control over eating and dieting, and both experience withdrawal when prevented from engaging in their behaviors.

Individuals with anorexia nervosa and bulimia nervosa and those with activity disorders usually score high on the EDI subscales of perfectionism and asceticism and have similar distortions in their cognitive (thinking) styles. The following list includes examples of the thinking patterns of people with activity disorders that are similar to the mental distortions in those with eating disorders.

Medical Reference from "The Eating Disorders Sourcebook"

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Cognitive Distortions in Activity Disorder

DICHOTOMOUS, BLACK-AND-WHITE THINKING

• If I don't run, I can't eat.
• I either run an hour or it's not worth it to run at all.

OVERGENERALIZATION

• Like my Mom, people who don't exercise are fat.
• Not exercising means you are lazy.

MAGNIFICATION

• If I can't exercise, my life will be over.
• If I don't work out today, I'll gain weight.

SELECTIVE ABSTRACTION

• If I can go to the gym, I am happy.
• I feel great when I exercise, so if I exercise I'll never be depressed.

SUPERSTITIOUS THINKING

• I must run every morning or something bad will happen.
• I must do 205 sit-ups every night.
• I can't stop at 1 hour and 59 minutes, it has to be exactly 2 hours, so when the fire alarm went off I couldn't get off the Stairmaster, I had to keep going, even if the gym was burning down.

PERSONALIZATION

• People are looking at me because I'm out of shape.
• People admire runners.
• I am a runner, it's who I am, I could never give it up.

ARBITRARY INFERENCE

• People who exercise get better jobs, relationships, and so on.
• People who exercise don't get sick as much.

DISCOUNTING

• My doctor tells me not to run, but she is flabby so I don't listen to her.
• No pain, no gain.
• Nobody really knows the effects of not having a period anyway, so why should I worry?

Physical Symptoms of Activity Disorder

• A key in determining if a person is developing an activity disorder is if she has the symptoms of overtraining (listed below) yet persists with exercise anyway. Overtraining syndrome is a state of exhaustion in which individuals will continue to exercise while their performance and health diminish. Overtraining syndrome is caused by a prolonged period of energy output that depletes energy stores without sufficient replenishment.

Symptoms of Over-Training

• Fatigue
• Reduction in performance
• Decreased concentration
• Inhibited lactic acid response
• Loss of emotional vigor
• Increased compulsivity
• Soreness, stiffness
• Decreased maximum oxygen uptake
• Decreased blood lactate
• Adrenal exhaustion
• Decreased heart rate response to exercise
• Hypothalamic dysfunction
• Decreased anabolic (testosterone) response
• Increased catabolic (cortisol) response (muscle wasting)

The only cure for the above symptoms is complete rest, which may take a few weeks to a few months. To a person with activity disorder, resting is like giving up or giving in. This is similar to an anorexic who feels like eating is "giving in." When giving up their exercise behaviors, those with activity disorder will go through psychological and physical withdrawal, often crying, yelling, and making statements like

• I can't stand not exercising, it's driving me crazy, I'd rather die.
• I don't care about the consequences, I have to work out or I'll turn into a fat blob, hate myself, and fall apart.
• This is worse torture than any effects of the exercise, I feel like I'm dying inside.
• I can't even stand being in my own skin, I hate myself and everyone else.

It is important to note that these feelings diminish over time but need to be carefully attended to.

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Approaching an Individual With an Activity Disorder

In January 1986, the Physician and Sports Medicine Journal discussed the subject of pathogenic (negative) exercise in athletes and listed recommendations for approaching athletes practicing one or more pathogenic weight control techniques. The recommendations can be reformulated and extended for use when approaching individuals with activity disorders who are not necessarily considered athletes.

Guidelines for Approaching the Activity Disordered Individual

• A person who has good rapport with the individual, such as a coach, should arrange a private meeting to discuss the problem in a supportive style.
• Without judgment, specific examples should be given regarding the behaviors that have been observed that arouse concern.
• It is important to let the individual respond but do not argue with him or her.
• Reassure the individual that the point is not to take away exercise forever but that participation in exercise will ultimately be curtailed through an injury or by necessity if evidence shows that the problem has compromised the individual's health.
• Try to determine if the person feels that he or she is beyond the point of being able to voluntarily abstain from the problem behavior.
• Do not stop at one meeting; these individuals will be resistant to admitting that they have a problem, and it may take repeated attempts to get them to admit a problem and/or seek help.
• If the individual continues to refuse to admit that a problem exists in the face of compelling evidence, consult a clinician with expertise in treating these disorders and/or find others who may be able to help. Remember that these individuals are very independent and success oriented. Admitting they have a problem they are unable to control will be very difficult for them.
• Be sensitive to the factors that may have played a part in the development of this problem. Activity disordered individuals are often unduly influenced by significant others and/or coaches who suggest that they lose weight or who unwittingly praise them for excessive activity.

Risk Factors

One outstanding difference between the eating disorders and activity disorders seems to be that there are more males who develop activity disorders and more females who develop eating disorders. Exploring the reason for this may provide a better understanding of both. What are the causes that contribute to the development of an activity disorder? Why do only some individuals with eating disorders have this syndrome and others who have this syndrome don't have eating disorders at all? What we do know is that the risk factors for developing an activity disorder are varied, including sociocultural, family, individual, and biological factors, and are not necessarily the same ones that cause the disorder to persist.

Sociocultural

In a society that places a high value on independence and achievement combined with being fit and thin, involvement in exercise provides a perfect means for fitting in or gaining approval. Exercise serves to enhance self-worth, when that self-worth is based on appearance, endurance, strength, and capability.

Family

Child-rearing practices and family values contribute to an individual choosing exercise as a means of self-development and recognition. If parents or other caregivers endorse these sociocultural values and they themselves diet or exercise obsessively, children will adopt these values and expectations at an early age. Children who learn not only from society but also from their parents that to be acceptable is to be fit and thin may be left with a narrow focus for self-development and self-esteem. A child reared with phrases such as "no pain, no gain," may endorse this attitude wholeheartedly without the proper maturity or common sense to balance this notion with proper self- nurturing and self-care.

Individual

Certain individuals seem predisposed to need a high level of activity. Individuals who are perfectionists, achievement oriented, and have the capacity for self-deprivation will be more likely to seek out exercise and become addicted to the feelings or other perceived benefits the exercise provides. Additionally, individuals who develop activity disorder seem outwardly independent, unstable in their view of themselves, and lacking in their ability to have fully satisfying relationships with others.

Biological

Just as with eating disorders, researchers are exploring what biological factors may contribute to activity disorders. We know that certain individuals have a biologically based predisposition to obsessive thoughts, compulsive behaviors, and, in women, amenorrhea. We know that in animals the combination of food restriction and stress causes an increase in activity level and, furthermore, that food restriction with increased activity can cause the activity to become senseless and driven.

Furthermore, parallel changes have been detected in the brain chemicals and hormones of eating disordered females and long-distance runners that may explain how the anorexic tolerates starvation and the runner tolerates pain and exhaustion. In general, activity disordered men and women seem to be different biochemically than nondisordered individuals and are more easily led and trapped into a cycle of activity that is resistant to intervention.

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Treatment for an Activity Disorder

The principles of treatment for individuals with activity disorders are similar to those with eating disorders. Medical issues must be handled, and residential or inpatient treatment may be necessary to curtail the exercise and to deal with depression or suicidality, but most cases should be able to be treated on an outpatient basis unless the activity disorder and an eating disorder coexist. This combination can present a serious situation rather quickly. When lack of nutrition is combined with hours of exercise, the body gets broken down at a rapid pace, and residential or inpatient treatment is often required.

Sometimes hospitalization is encouraged to patients as a way to relieve the vicious cycle of nutrient deprivation combined with exercise before a breakdown occurs. Activity disordered individuals often recognize that they need help to stop and know that they cannot do it with outpatient treatment alone. Eating disorder treatment programs are probably the best choice for hospitalizing those with activity disorder. An eating disorder facility that has a special program for athletes or compulsive exercisers would be ideal. (See the description of The Monte Nido Residential Treatment Facility on pages 251 - 274).

Therapy for an Activity Disorder

It is important to keep in mind that activity disordered people tend to be highly intelligent, internally driven, independent individuals. They will most likely resist any kind of vulnerability such as going for treatment unless they become injured or face some kind of ultimatum. Excessive activity protects these individuals against desiring to get close, to take in something from another, or to depend on anyone.

Therapists will have to maintain a calm, caring stance with the goal of helping the individual define what he or she needs, rather than focusing on taking things away. Another therapeutic task is to help the individual receive and internalize the soothing functions the therapist can provide, thus promoting relationships over activity.

THERAPEUTIC ISSUES TO DISCUSS IN THE TREATMENT OF ACTIVITY DISORDER

• Overactivity of mind or body
• Body image
• Overcontrol of the body
• Disconnection from the body
• Body care and self-care
• Black-and-white thinking
• Unrealistic expectations
• Tension tolerance
• Communicating feelings
• Ruminations
• The meaning of rest
• Intimacy and separateness

The following section discusses a problem that is the polar opposite of too much activity exercise resistance. "Exercise resistance" is a fairly new term used to describe an intense reluctance to exercise, particularly seen in women.

Eating Disorders: Exercise Resistance in Women

by Francie White, M.S., R.D.

Just as binge eating disorder lies at the opposite end of the disordered eating spectrum from anorexia nervosa, exercise resistance is an activity disorder at the opposite end of the spectrum from addictive or compulsive exercise. As a dietitian specializing in eating disorders, I have noticed a common phenomenon in women with emotional overeating patterns, many of whom qualify as having binge eating disorder.

These women often suffer from entrenched inactivity patterns that are resistant to intervention or treatment. Many professionals assume that inactivity is due to factors such as a harried lifestyle, industrialization, laziness, and, in overweight individuals, the discouraging factor of physical difficulty or discomfort in moving. Behavior modification counseling programs, use of specialized personal trainers, and other types of motivational strategies to encourage a physically active lifestyle seem to be ineffective.

Over a three-year period, beginning in 1993, I began exploring what I call "exercise resistance" in a binge eating disordered population of six groups of ten to twenty women each. The following information is what emerged from studying these groups.

For many women with a history of body image problems, moderate to severe overeating histories, and/or a history of repeated attempts at weight loss, exercise resistance is a common syndrome that requires specialized treatment. Remaining inactive or physically passive appears to be an important aspect of the psychological defense system within the eating disorder itself, providing a balance of sorts from the psychological discomfort that accompanies exercising. This psychological discomfort varies from moderate to severe anxiety and is related to a profound sense of physical and emotional vulnerability.

Underactivity or physical passivity appears to offer a sense of control over body and feelings, just as disordered eating and over-exercise do. Exercise resistance may simply be another component in the menu of options from which men and women find themselves suffering in this time of epidemic eating and body image problems. If we are to begin to look at exercise resistance as a separate syndrome worthy of specialized understanding and treatment, here are some factors to consider.

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WHAT DIFFERENTIATES THE EXERCISE RESISTANT INDIVIDUAL FROM SOMEONE WITH SIMPLE LOW MOTIVATION OR POOR EXERCISE HABITS?

• The individual strongly resists any suggestion to become more physically active (barring any physical impairments and given several workable options).
• The individual reacts with anger, resentment, or anxiety to any suggestion to become more physically active.
• The individual describes experiencing moderate to severe anxiety during physical activity.

RISK FACTORS FOR DEVELOPING EXERCISE RESISTANCE

• A history of sexual abuse of any kind at any age.
• A history of three or more weight loss diets.
• Exercise used as a component of a weight loss regimen.
• A larger body size as a boundary or defense against unwanted sexual attention or sexual intimacy (be it conscious or unconscious).
• Parents who forced or overencouraged exercise, especially if the exercise was to compensate for perceived, or actual, overweight in the child.
• Early puberty or development of large breasts and/or early significant weight gain.

THE MEANING OF EXERCISE RESISTANCE

To better understand exercise resistance, we can borrow from our understanding of how weight loss diets have affected eating behavior. We know that weight loss diets are a key aspect in the historical mistreatment of overweight individuals, in many cases actually contributing to binge eating, which increases over time. Responses from the women surveyed support the view that exercise resistance may be an unexpected, unconscious backlash against the current cultural emphasis on slimness and the overfocus on the symptom; for example, the weight, instead of the inner psychodynamic issues.

QUESTIONS TO ASK THE INDIVIDUAL WITH EXERCISE RESISTANCE

• What feelings and associations emerge for you at hearing the term exercise? Why?
• When did being physically active change for you from "playing" as a child to "exercise"? When did it shift from something natural, an activity you did spontaneously (for example, from an internal drive), to something you felt you should do?
• Has physical activity ever been something that you did to control your weight? If so, how was that for you, and how has it affected your motivation to exercise?
• How did your exercise attitudes change during and after puberty?
• Does being physically active relate in any way to your sexuality? If so, how?

A theme ran through the comments of the women studied that echoes the information in chapter 4, "Sociocultural Influences on Eating, Weight, and Shape." Most of the women expressed that they felt extremely degraded and vulnerable by their direct experiences of being encouraged to exercise as a means to achieve an acceptable body. Instead of being encouraged to exercise for fun, exercise for these women was connected to body image, or the pursuit of an acceptable body.

Many of the women's stories included experiences of deep humiliation, public or otherwise, at being overweight and unable to achieve this illusive standard. Other women actually acquired a lean, thinner body and experienced unwanted sexual objectification by peers and adults. In a significant number of the women, rapes and other sexual abuse occurred after weight loss, and, for many, sexual abuse was connected to the onset of exercise resistance and binge eating.

Many women are confused as they experience the desire to be thinner while at the same time feeling anger and resentment at what they have been told they have to do to achieve it, for example, exercise. For some, exercise resistance and weight gain may be symbolic boundaries, expressing a rebellious refusal to patronize a system in which the playing field for women is not about sports, or even achievement, but about sexual attractiveness to men"We'll play, you pose." This system is one in which women and men equally participate and perpetuate. Women objectify one another and themselves right along with men.

The above discussion of exercise resistance by Francie White was written specifically for inclusion in this book. It is important to understand this area as another disorder on the continuum of those being discussed. The understanding and treatment of exercise resistance are similar to that of eating disorders in that the therapist must impart an empathy for the need for the behaviors instead of trying to take them away.

When working with an exercise resistant individual, one must explore and resolve the source of the resistance, such as underlying anxiety, resentment, or anger. The goal of treatment is that the individual will be able to become physically active by choice, not coercion. It is important to begin by validating the resistance and even in some cases prescribing it, making statements such as:

• It is important that you can choose to not exercise.
• Resisting exercise serves a valuable function for you.
• Continuing not to exercise is one way for you to keep saying "no."

By making these comments, the therapist helps validate the need for the resistance and eliminates the obvious conflict.

It is important to clarify that the issue of addressing exercise resistance is to help individuals who are compelled to "not exercise" just as we try to help others who are compelled to do so, both of which leave the behavior out of the realm of choice. Little attention has been paid to exercise resistance, but it is clear that those who have it, like those with exercise obsession or disordered eating, appear to be in a love-hate relationship with their bodies; derive inner psychological or adaptive functions from their behavior; and are involved in a struggle not just with food or exercise but with the self.

For an examination of the struggle with self and other dynamics that result in eating disorders, the next three chapters will deal with the main areas in which the causes of eating disorders are understood, with a chapter devoted to each of the following:

SOCIOCULTURAL

A look at the cultural preference for thinness, and the current epidemic of body dissatisfaction and dieting, with an emphasis not only on weight loss but also on the ability to control one's body as a means of gaining approval, acceptance, and self-esteem.

PSYCHOLOGICAL

The exploration of underlying psychological problems, developmental deficits, and traumatic experiences such as sexual abuse, which contribute to the development of disordered eating or exercise behaviors as coping mechanisms or adaptive functions.

BIOLOGICAL

A review of the current information available on whether or not there is a genetic predisposition or biological status that is at least partly responsible for the development of an eating or activity disorder.

next: Overview of Eating Disorders in Children
~ eating disorders library
~ all articles on eating disorders

Dear Dr. Stanton Peele:

Thank you for providing information on your web site that is thoughtful, provocative and informative.

Mine is a question that deals with personal freedom and MJ use and relationships. I married an inmate who when he came home after being released began to smoke MJ regularly. I was a bit shocked by his smoking since he never mentioned to me during the time we corresponded and visited regularly that he enjoyed MJ and that he planned to resume smoking it upon his release. (He was not placed under probation or parole because the PO wanted to "give him a break.")

However, his smoking MJ has caused me a lot of personal difficulty since I feel he smokes in an irresponsible manner (before going to work as a self-employed handyman, during our hiking in a public park, in his car while driving alone). I smoke neither tobacco nor MJ. I consider myself a light drinker. I don't like my husband's smoking MJ because I think that it creates a division between us and, more important, I think that it stunts his growth as an individual living a meaningful and responsible life.

I will be frank with you about my resentment over learning that he enjoyed smoking MJ after he came home from prison. He says, in his defense, that smoking MJ in California is not a felony (so he won't be facing 3 strike sentencing), that he works to contribute to the household expenses, and that he comes home at night, it relaxes him, and that for these reasons, I should not be concerned or upset.

I am, and that worries me. I would be grateful if you would provide me with some insight on the difficulty I experience over my husband's smoking MJ. I have thought of bartering with him. He would like me to get up earlier in the mornings because he's a morning person and I'm not by nature. However, I would gladly get up earlier if he would curtail his smoking or quit altogether. Please advise. I considered leaving the marriage over this. Thank you.

Sincerely,
A Wife

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Dear Wife:

You married an inmate? I guess you're finding out that even when they are not committing felonies, some people continue to act in consistently antisocial ways. This is important for understanding substance abuse and addiction. That he would not even mention he was a pot head to you — "didn't think it was relevant" — seems to show that he has a different value system than you do — but perhaps his prison time might also have told you that. I mean, littering is not a felony, but could you marry a litterer?

He does have a point — if mj relaxes him at home at night, perhaps it isn't society's business — but it is yours (it isn't illegal to drink alcohol, but you wouldn't want to marry someone who got drunk every night). Yes, I think bartering is worth attempting. What are you going to ask for exactly? No public mj smoking? Not smoking every night? Not smoking at all? I'm interested to know how he reacts.

Yours,
Stanton

next: John Allen of the NIAAA's Response to Stanton Peele's Article on Project MATCH in The Sciences
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

To learn more about this controversy, read Caught in the Net, the first recovery book about on-line behavior and addictive use of the Internet.

While many believe the term addiction should be applied only to cases involving the ingestion of a drug, many researchers have previously applied this same term to high-risk sexual behaviors, excessive television-viewing, compulsive gambling, computer overuse, and overeating without such controversy. Mental health professionals do not agree on what constitutes an "addiction."

The common argument is that we can be addicted only to physical substances to which we have a chemical response in our bodies. If our bodies our hooked, we're hooked. Well, recent scientific evidence suggests that it may be possible to experience habit-forming chemical reactions to behavior as well as substances. Scientists studying the effect of addictions on the brain have focused new attention on dopamine, a substance of the brain associated with pleasure and elation. Scientists believe that levels of dopamine may rise not only from taking alcohol or drugs, but from gambling, eating chocolate, or even from a hug or word of praise. And when something makes our dopamine level rise, we naturally want more of it. Other studies indicate that as our brain reacts to familiar stimuli it can alter our behavior without our ever really knowing it, which may explain our tendency to excessively repeat addictive patterns. Therefore, linking the term "addiction" solely to drugs creates an artificial distinction that strips the usage of the term for a similar condition when drugs are not involved. Ultimately, it is unclear whether physiologic reasons are responsible for all addictive behaviors, rendering the debate between substance-based and behavior-based addictions meaningless.

Another significant issue is that unlike chemical dependency, the Internet offers several direct benefits as a technological advancement in our society and not a device to be criticized as "addictive." The Internet allows a user a range of practical applications such as the ability to conduct research, to perform business transactions, to access international libraries, or to make vacation plans. Furthermore, several books have been written which outline the psychological as well as functional benefits of Internet use in our daily lives such as Howard Rheingold's book, The Virtual Community and Sherry Turkle's book, Life on the Screen. In comparison, substance dependence is not an integral aspect of our professional practice nor does it offer a direct benefit for its routine usage. Therefore, when one juxtaposes a term with such a negative connotation as "addiction" against a positive tool as the Internet, it is easy to understand why people will respond with criticism. However, even positive activities in life such as gambling, food, sex, or the Internet - can be considered an addiction when it causes significant life problems, or when a person loses self-control.

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p>next: Copyright Notice and Disclaimer
~ all center for online addiction articles
~ all articles on addictions

Desiderada is an inspirational prose poem about attaining happiness in life.

"Go placidly amid the noise and the haste,

and remember what peace there may be in silence.

As far as possible, without surrender,

be on good terms with all persons.

Speak your truth quietly and clearly;

and listen to others, even the dull and ignorant;

They too have their story.

Avoid loud and aggressive persons;

they are vexatious to the spirit.

If you compare yourself with others,

you may become vain or bitter,

for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans.

Keep interested in your own career, however humble;

It is a real possession in the changing fortunes of time.

Exercise caution in your business affairs,

for the world is full of trickery.

But let this not blind you to what virtue there is;

Many persons strive for high ideals,

and everywhere life is full of heroism.

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Be yourself. Especially do not feign affection.

Neither be cynical about love;

for in the face of all aridity and disenchantment

it is as perennial as the grass.

Take kindly the council of the years,

Gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune.

But do not distress yourself with dark imaginings.

Many fears are born of fatigue and loneliness.

Beyond a healthy discipline,

Be gentle with yourself.

You are a child of the universe no less than the trees and the stars;

you have a right to be here,

and whether or not it is clear to you,

no doubt the universe is unfolding as it should.

Therefore, be at peace with God,

Whatever you conceive Him to be.

And whatever your labors and aspirations,

in the noisy confusion of life,

keep peace in your soul.

With all its sham, drudgery, and broken dreams,

it is still a beautiful world.

Be cheerful.

Strive to be happy."

The author is Max Ehrmann, a poet and lawyer from Terre Haute, Indiana, who lived from 1872 to 1945.

next: Acoustic Expressions: Music for Relaxation Meditation and Massage

If I had to distil my quotidian existence in two pithy sentences, I would say: I love to be hated and I hate to be loved.

Hate is the complement of fear and I like being feared. It imbues me with an intoxicating sensation of omnipotence. I am veritably inebriated by the looks of horror or repulsion on people's faces. They know that I am capable of anything. Godlike, I am ruthless and devoid of scruples, capricious and unfathomable, emotion-less and asexual, omniscient, omnipotent and omni-present, a plague, a devastation, an inescapable verdict. I nurture my ill-repute, stoking it and fanning the flames of gossip. It is an enduring asset.

Hate and fear are sure generators of attention. It is all about narcissistic supply, of course - the drug which we, the narcissists consume and which consumes us in return. So, attack sadistically authority figures, institutions, my hosts and I make sure they know about my eruptions.

I purvey only the truth and nothing but the truth - but I tell it bluntly told in an orgy of evocative baroque English.

The blind rage that this induces in the targets of my vitriolic diatribes provokes in me a surge of satisfaction and inner tranquillity not obtainable by any other means. I like to think about their pain, of course - but that is the lesser part of the equation

It is my horrid future and inescapable punishment that carries the irresistible appeal. Like some strain of alien virus, it infects my better judgement and I succumb.

In general, my weapon is the truth and human propensity to avoid it. In tactless breaching of every etiquette, I chastise and berate and snub and offer vitriolic opprobrium. A self-proclaimed Jeremiah, I hector and harangue from my many self-made pulpits. I understand the prophets. I understand Torquemada.

I bask in the incomparable pleasure of being RIGHT. I derive my grandiose superiority from the contrast between my righteousness and the humanness of others.

But it is not that simple. It never is with narcissists. Fostering public revolt and the inevitable ensuing social sanctions fulfils two other psychodynamic goals.

The first one I alluded to. It is the burning desire - nay, NEED - to be punished.

In the grotesque mind of the narcissist, his punishment is equally his vindication.

By being permanently on trial, the narcissist claims high moral ground and the position of the martyr: misunderstood, discriminated against, unjustly roughed, outcast by his very towering genius or other outstanding qualities. To conform to the cultural stereotype of the "tormented artist" - the narcissist provokes his own suffering. He is thus validated.

His grandiose fantasies acquire a modicum of substance. "If I were not so special - they wouldn't have persecuted me so".

The persecution of the narcissist IS his uniqueness. He must be different, for better or for worse. The streak of paranoia embedded in him, makes the outcome inevitable. He is in constant conflict with lesser beings: his spouse, his shrink, his boss, his colleagues. Forced to stoop to their intellectual level, the narcissist feels like Gulliver: a giant strapped by Lilliputians. His life is a constant struggle against the self-contented mediocrity of his surroundings. This is his fate which he accepts, though never stoically. It is a calling, a mission and a recurrence in his stormy life.

Deeper still, the narcissist has an image of himself as a worthless, bad and dysfunctional extension of others. In constant need of narcissistic supply, he feels humiliated. The contrast between his cosmic fantasies and the reality of his dependence, neediness and, often, failure (the "Grandiosity Gap") is an emotionally harrowing experience. It is a constant background noise of devilish, demeaning laughter. The voices say: "you are a fraud", "you are a zero", "you deserve nothing", "if only they knew how worthless you are".

The narcissist attempts to silence these tormenting voices not by fighting them but by agreeing with them. Unconsciously - sometimes consciously - he says to them: "I do agree with you. I am bad and worthless and deserving of the most severe punishment for my rotten character, bad habits, addiction and the constant fraud that is my life. I will go out and seek my doom. Now that I have complied - will you leave me be? Will you leave me alone"?

Of course, they never do.

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next: Grandiosity Deconstructed

When deprived of narcissistic supply - primary AND secondary - I feel annulled. It is a strange sensation, I am not sure it can be described.

Words, after all, do exist. But it is very much like being hollowed out, mentally disemboweled or watching oneself die. It is a cosmic evaporation, disintegrating into molecules of terrified anguish, helplessly and inexorably.

I lived through this twice and I would do anything not to go through it again. It is by far the most nightmarish experience I ever had in a rather febrile life.

I want to tell you now what happens to narcissists when deprived of narcissistic supply of any kind (secondary or primary). Perhaps it will make it easier for you to understand why the narcissist pursues narcissistic supply so fervently, so relentlessly and so ruthlessly. Without narcissistic supply - the narcissist crumbles, he disintegrates like the zombies or the vampires in horror movies. It is terrifying and the narcissist will do anything to avoid it. Think about the narcissist as a drug addict. His withdrawal symptoms are identical: delusions, physiological effects, irritability, emotional liability.

I want to tell you now about the two times in my life that I faced an utter absence of narcissistic supply and what happened to me as a result.

The first time was after Nomi abandoned me as I was in jail, deprived of all means of obtaining narcissistic supply and subject to the dehumanizing existence of a brutal penal colony. I reacted by retreating into a life-threatening dysphoria.

The second time was even more frightening.

I found myself in Russia in the throes of its worst economic crisis ever. I was a fugitive, having escaped the displeasure of a nasty regime I dared criticize and attack openly. Gaining access to sources of narcissistic supply was a tedious and narcissistically injurious process and my girlfriend was far away, in Macedonia. I lived in a decrepit apartment, with no hot water, with furniture in wooden death and tried to get accustomed to the brutish nastiness of everyday life there. I had no narcissistic supply of any kind - and this lasted for months. All my frantic efforts to generate supply - failed.

At the beginning it was a mere thought - following an exceedingly stormy night which I spent reading about Jack the Ripper. I imagined a decomposing body of a young woman emerging from the rusty bathroom (its creaking door half-hidden from where I slept). She leaned casually against the doorframe and said: "So, you finally came". Gradually, this gruesome image obsessed me to the point of terror. I was reduced to scribbling crosses on all doors together with special mantras I invented. At last, I could not stay there any longer and I moved to live for a few days with my client, a jolly, young and entrepreneurial Macedonian. His interpretation was that I was simply too lonely.

He couldn't understand why I was so uninterested in the ravishing girls that worked for him. He could not fathom my behaviour - reading and writing 16 hours a day, day in and day out, without a break.

But I knew better. I knew that my decomposing apparition was a manifestation of a psychotic break, the zombie of my disorder, my self-destructiveness embodied and my virulent self-hatred projected. I knew that "she" was as real an enemy as any I have ever come across. Narcissists often experience brief psychotic episodes when they are disassembled - either in therapy or following a life-crisis accompanied by a major narcissistic injury.

Psychotic episodes may be closely allied to another feature of narcissism: magical thinking. Narcissists are like children in this sense. I, for instance, fully believe in two things: that whatever happens - I will prevail and that good things will happen to me. It is not a belief, really.

There is no cognitive component in it. I just KNOW it, the same way I know gravity - in a direct and immediate and secure way.

I believe that, no matter what I do, I will always be forgiven, I will always prevail and triumph, I will always land safely on all my fours. I, therefore, am fearless in a manner perceived by others to be both admirable and insane. I attribute to myself divine and cosmic immunity - I cloak myself in it, it renders me invisible to my enemies and to the powers of evil. It is a childish phantasmagoria - but to me it is very real.

The second thing I know with religious certainty is that good things will happen to me. Good things always have, I was never disproved, on the very contrary - my belief only grows stronger as I grow older. With equal certitude, I know that I will squander my good fortune time and again in a bedeviled effort to defeat myself and to vindicate my mother and her transubstantiations, all other authority figures. She - and other role models that substituted for her in later life - insisted with a vengeance that I was corrupt and vain and empty. My life is a continuous effort to prove them right.

So, no matter what serendipity, what lucky circumstance, what blessing I shall receive - I will always strive with blind fury to deflect them, to deform, to ruin. And being the talented person that I am - I will succeed spectacularly.

I have lived in fairy tales come true all my life. I was adopted by a billionaire, an admiring student of mine became Minister of Finance and summoned me to his side, I was given millions to invest and have been the subject of many other miracles - but I was and am intent on bringing myself to biblical destitution and devastation.

Perhaps in this - in the belief that I have the omnipotence to conspire against a universe that constantly smiles upon me - lies the real magic of my thinking. The day I stop resisting my endowments and my good fortune is the day I die.

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next: The Music of My Emotions