Excerpts from the Archives of the Narcissism List Part 10

1. The Exposure of the Narcissist
2. Could Negative Input be Narcissistic Supply?
3. Narcissists, Disagreements and Criticism
4. Unresolved Conflicts
5. The Narcissist Wants to be Liked?
6. Old Sources of Narcissistic Supply (NS)
7. Hurting Others
8. Narcissists and Intimacy
9. Personality Disorders are Culture-Dependent?
10. Fortress Narcissism
11. Inverted Narcissists

 

1. The Exposure of the Narcissist

The exposure of the False Self for what it is - False - is a major narcissistic injury. The narcissist is likely to react with severe self-deprecation and self-flagellation even to the point of suicidal ideation. This - on the inside. On the outside, he is likely to react aggressively. This is his way of channeling life-threatening aggression.

Rather than endure its assault and its frightening outcomes - he redirects the aggression, transforms it and hurls it at others.

What form his aggression assumes is nigh impossible to predict without knowing the narcissist in question intimately. It could be anything from cynical humour, through cruel honesty, verbal abuse, passive aggressive behaviours (frustrating others), and to actual physical violence. I would consider it unwise to leave a child alone with him in such a condition.

2. Could Negative Input be Narcissistic Supply?

Yes, it could. I make clear that NS includes attention, fame, notoriety, adulation, fear, applause, approval - a mixed bag. If the narcissist gets attention - positive or negative - it constitutes NS. If he succeeds to manipulate people or influence them - positively or negatively - it qualifies as NS.

The ability to influence other people, to induce feelings in them, to manipulate them emotionally, to make them do something or refrain from doing it is what counts.

The receipt of NS releases libido (=increases the sexual drive).

3. Narcissists, Disagreements and Criticism

The narcissist perceives every disagreement - let alone criticism - as nothing short of a THREAT. He reacts defensively. He becomes indignant, aggressive and cold. He detaches emotionally for fear of yet another (narcissistic) injury. He devalues the person who made the disparaging remark. By holding the critic in contempt, by diminishing the stature of the discordant conversant - he minimizes the impact on himself of the disagreement or criticism. Like a trapped animal, the narcissist is forever on the lookout: was this remark meant to demean him? was this sentence a deliberate attack? Gradually, his mind turns into a chaotic battlefield of paranoia and ideas of reference until he loses touch with reality as we know it and retreats to his own world of fantasized grandiosity.

The cerebral narcissist is competitive and intolerant of criticism or disagreement. To him, subjugation and subordination establish his undisputed intellectual superiority or professional authority over others. Lowen has an excellent exposition of this "hidden or tacit competition" in his books. The cerebral narcissist aspires to perfection. Thus, even the slightest and most inconsequential challenge to his authority is inflated by him to cosmic proportion. Hence, the disproprtion of his reactions.

4. Unresolved Conflicts

The narcissist is forever entrapped in the unresolved conflicts of his childhood (including the famous Oedipus Complex). This compels him to seek resolution by re-enacting these conflicts with significant others in his life. But he is likely to return to the Primary Objects in his life (=his parents, other caregivers in the absence of parents, peers) to do either of two:

1. "Re-charge" the conflict "battery", or

2. When unable to do (a) - enact the old conflict with another person

The narcissist relates to his human environment through his unresolved conflicts. It is the energy of the tension thus created that sustains him.

He is a person driven by the imminent danger of eruption, by the unsettling prospect of losing his precarious balance. It is a tightrope act. The narcissist must remain alert and on-edge. Only if the conflict is fresh in his mind can he attain such levels of mental arousal.

Periodically interacting with the objects of his conflicts, sustains the inner turmoil, keeps the narcissist on his toes, endows him with the feeling that he is alive.

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5. The Narcissist Wants to be Liked?

Would you wish to be liked by your television set? To the narcissist, people are instruments, sources of supply. If he has to be liked by them in order to secure this supply - he will strive to ensure their liking. If he has to be feared - he will make sure they fear him. He does not really care either way as long as he is being attended to. Attention - whether in the form of fame or infamy - is what it's all about. His world revolves around his constant mirroring. I am seen therefore I exist, sayeth the narcissist.

But the classic narcissist is also looking to get punished. His actions are aimed to elicit social or other sanctions from his environment. His life is a Kafkaesque ongoing trial and the open-endedness of the trial is itself the punishment. A punishment (a reprimand, an imprisonment, an abandonment) serves to vindicate and validate the internal damning voices of his sadistic, ideal and immature superego (really, the voices of his parents or other caregivers). They confirm his worthlessness. They relieve him from the burden of the inner conflict he endures when successful: the conflict between the gnawing sense of guilt and shame for having invalidated his parents' judgement - and the need to secure narcissistic supply.

Thus, free of his past "chains" - his world in ruins - the narcissist embarks on a new voyage, to conquer a new land, to keep new promises, riding into the horizon of a continent of boundless new narcissistic supply, unadulterated by the quotidian and the routine and by his past.

6. Old Sources of Narcissistic Supply (NS)

One should not romanticize the narcissist. His regrets are forever linked to his fears of losing his sources. His loneliness vanishes when he is awash with narcissistic supply.

Narcissists have no enemies. They have only sources of narcissistic supply. An enemy means attention means supply. One holds sway over one's enemy. If the narcissist has the power to provoke emotions in you - you are still a source of supply, regardless of WHICH emotions these are.

He seeks you out probably because he has absolutely no other NS sources at this stage. Narcissists frantically try to recycle their old and wasted sources in such a situation. But he would NOT have done even this had he not felt that he could still successfully extract a modicum of NS from you (even to attack someone is to recognize his existence and to attend to him!!!).

So, what should you do?

First, get over the excitement of seeing him again. To be courted is flattering, perhaps sexually arousing. Try to overcome these feelings.

Then, simply ignore him. Don't bother to respond in any way to his offer to get together. If he talks to you - keep quiet, don't answer. If he calls you - listen politely and then say goodbye and hang up. Indifference is what the narcissist cannot stand. It indicates a lack of attention and interest that constitutes the kernel of negative NS.

7. Hurting Others

Narcissists do feel bad about hurting others and about the unsavoury course their lives tend to assume. Their ego-dystony (=feeling bad about themselves) was only recently discovered and described. But my suspicion is that a narcissist feels bad only when his supply sources are threatened because of his behaviour, or following a narcissistic injury (such as a major life crisis: divorce, bankruptcy, etc.)

The Narcissist equate emotions with weakness. He regards the sentimental and the emotional with contempt. He looks down on the sensitive and the vulnerable. He derides and despises the dependent and the loving. He mocks expressions of compassion and passion. He is devoid of empathy. He is so afraid of his True Self that he would rather demean it all than admit to his own faults and "soft spots". He likes to talk about himself in mechanical terms ("machine", "efficient", "punctual", "output", "computer").

He slaughters his human side diligently and with a dedication derived from his drive to survive. To him, to be human and to survive are mutually exclusive. He must choose and his choice is clear. The narcissist never looks back, unless and until forced to by life itself.

8. Narcissists and Intimacy

ALL narcissists fear intimacy. But the cerebral narcissist deploys excellent defences: "scientific detachment" (the narcissist as the eternal observer), intellectualizing and rationalizing his emotions away, intellectual cruelty (see my FAQ 41 regarding inappropriate affect), intellectual "annexation" (regarding the other person as his extension, or territory), objectifying the other and so on. Even emotions which are expressed (pathological envy, neurotic or other rage, etc.) have the not totally unintended effect of alienating.

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9. Personality Disorders are Culture-Dependent?

There is a debate in psychology ever since Freud whether mental disorders are culture dependent. Could some "personality disorders" be the norm in a different, non-Western, culture?

Could some behaviours be mandatory in one culture while derided in another? I was born in a culture which regarded the ABSENCE of physical abuse as parental neglect and indifference, for instance. Michele Foucault and Louis Althusser (the Marxist philosophers) said that mental health is used as a tool by the prevailing power structures in an effort to perpetuate their power and to propagate it. Lasch claimed that Western society in general is narcissistic. Peck suggested that modern day narcissists are "possessed" by inner demons. Many theoreticians dispute the very theoretical construct known as "personality". They say that there is no such thing.

10. Fortress Narcissism

It is not the maintenance of a double life that is at stake. It is the maintenance of LIFE itself. The personality of the narcissist is a precariously balanced house of cards, symbiotically attached to its sources of narcissistic supply. Any negative input (indifference, disagreement, criticism) - however minute - shatters it, shakes it to its lacking foundations and casts an ominous pall over the narcissist's very existence. This is enormously energy consuming, so the narcissist has no energy left for others.

When it all comes crushing down (a life crisis which results in a major narcissistic injury) - a tiny and passing window of opportunity opens. The narcissist - no longer defended by his crumbling defences, finally experiences the seething abyss of his negative emotions. Many narcissists then entertain suicidal ideas. Some resort to therapy. But the window closes and the opportunity passes and the narcissist reverts to his old, time proven methods. A precious few benefit from the upheaval in their lives.

Others just keep plodding on in the grey world that is fortress narcissism.

11. Inverted Narcissists

The inverted narcissist is not "milder" than the other forms of narcissism.

Like them, it has degrees and shades. But I would agree that it is much more rare and that the DSM IV variety is the more prevalent.

The Inverted narcissist is liable to react with rage whenever threatened (as all of us do)....

• When envious of other people's achievements, ability to feel, wholeness, happiness, rewards and successes.

• When his sense of self-worthlessness is enhanced by a behaviour, a comment, an event.

• When his lack of self-worth and void of self-esteem is THREATENED (so this narcissist might surprisingly react violently or with rage to GOOD things: a kind remark, a mission accomplished, a reward, a compliment, a proposition, a sexual advance).

• When thinking about the past, when emotions and memories are evoked (usually negative ones) by certain music, a given smell, a sight.

• When his pathological envy leads to an all-pervasive sense of injustice and being discriminate against by a spiteful world.

• When he encounters stupidity, avarice, dishonesty, bigotry - it is these qualities in him that the narcissist really fears and rejects so vehemently in others.

• When he believes that he failed (and he always entertains this belief), that he is imperfect and useless and worthless, a good for nothing half-baked creature.

• When he realizes to what extent his inner demons possess him, constrain his life, torment him, deform him and the hopelessness of it all.

Then even the inverted narcissist rebels. He becomes verbally and emotionally abusive. He raises unfairly things told to him in confidence. He uncannily pierces the soft spots of his target, and mercilessly drives home the poisoned dagger of despair and self loathing until it infects his adversary.

The calm after such a storm is even eerier, a thundering silence, indeed.

The narcissist regrets his behaviour but would rarely admit his feelings. He simply nurtures them in him as yet another weapon of self destruction and self defeat. It is from this very suppressed self contempt, from the very repressed and introverted judgement, from this missing atonement, that the narcissistic rage springs forth. Thus the vicious cycle is established.

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next: Excerpts from the Archives of the Narcissism List Part 11

Excerpts from the Archives of the Narcissism List Part 9

1. Love and Sex
2. Schizotypal Personality Disorder
3. Inverted Narcissism
4. Narcissists and Women
5. Narcissists and their Ex's
6. Narcissists Victimize

1. Love and Sex

There is nothing wrong in showing love with our bodies. Love can and should be expressed in many ways, the physical one never to be excluded.

Love can and should be poured into many vessels: in words, in tender gestures, in empathy and consideration, suffused with the right kind of silence or bursting with the joy of momentary unity. Love is the art of merging the distinct and still maintaining the distinction. What better way of applying this principle than sex? What is the orgasm of a loving couple if not a moment of fusion, individually experienced?

So, love and sex do go together.

It is when sex is mistaken for love that pathology sets in. Sex can be had without love. Loveless sex is the emotional equivalent of eating. It can be a gratifying experience. But sex without love is NOT love. To provoke our physiological reactions in isolation is NOT to know and to be known, to love and to be loved. To acquire a sense of self worth and a modicum of self esteem by penetrating or being penetrated, by seducing or by letting go is a poor, illusory substitute for the Real Thing. It is also demeaning. The Other is objectified. It is to USE men (or women) to obtain a supply of sorts: narcissistic or hedonistic. When we become the slaves of sex, its minions, pawns on the gaming board of our compulsion, our ego an extension of our genitals - then love becomes impossible. For one cannot really love an object and one cannot respect that upon which one is dependent and one cannot cherish one's self because of such dependency. How can we love others if we despise our subjugated, compulsion-torn, selves? How can we act compassionately, as love demands, if constantly enraged in our diminishment?

Loveless sex is not love. Is sexless love - love?

No, it isn't. A love devoid of sex to me is lacking. The love of God, the love of a mother, the supposedly platonic - all are painted with the thick brush of sex. Not to crave for someone's body, to single out his soul - and only his soul - for intercourse is not to love. Thus incomplete, it is deformed attachment, enmeshment, dependence - but not love. We love with all our senses, with all our being, with body and with soul. When we love - we ARE. If lacking one dimension - the whole edifice crumbles. A love without sex withers, shrivels in the glaring sun of discord and ruptured intimacy. It is not in vain that the Bible says "to know" when it really means to merge in the ultimate, most sublime, most profound act of loving - in sex.

I am not sure we will all find true love. I am not sure we are not conditioned to confuse love with sex. But I am sure of one thing: the way is as important as the destination. Searching for true love is an act of love in itself. As long as we pursue the path to self betterment, to healing through the power of love - we are in love: with life, with our emerging selves and, gradually and hesitantly with others. This is the triumph of the human personality, however disordered.

I think that the narcissist unconsciously selects a mate that can help him recreate old conflicts with his Primary Objects / caregivers (parents, in humanspeak). This repetition complex stems from the unconscious belief that repeating is resolving or that resolution will emerge somehow in one of the repetition cycles.

There is much more about this in my book and in my FAQs.

Don't be so eager, so competitive, so transparent, so matter-of-fact, so dependent. It scares men away. Men are looking for pure sex or pure romance. Pure sex should be something casual, light-hearted, no strings attached, no egos intertwined, no identities involved, no baggage brought, no competitions won or lost. It is a tension free thing, devoid of anxiety and compulsion. Pure romance is like snowflakes: tender, beautiful, soft spoken, misty, engulfing, soothing.

Romance is also hard to reconcile with the tintinnabulation of the bells of competition or with the high strung eagerness of narcissistic supply. As you are, you don't stand a chance with either type: the purely sexual or the purely romantic. Take it easy, cool off, relax, pursue no goals, enter no contests, keep no notes, spread your sheets and spare your spreadsheets.

2. Schizotypal Personality Disorder

A-propos culture and society determined mental health disorders - did you know that a belief in telepathy (which I do NOT confess to, personally) constitutes one of the criteria in the Schizotypal PD?

Schizotypal Personality Disorder is to my humble mind, perhaps THE most culture-dependent PD of all.

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I will start by saying that it is NOT clearly demarcated from BPD. In most cases there is co-morbidity with another disorder. STs suffer from anxiety, depression and other dysphoric mood states. A very typical feature is strange convictions and sometimes reactive psychoses. Most STs believe in the supernatural, confess to magical thinking and are very superstitious (in the sense that superstition dictates their behaviors to the point of making it "dysfunctional"). STs construct their sentences idiosyncratically and communication with them might be stilted and difficult.

STPD seems to have some genetic component. There are many first and second degree schizophrenic relatives in the families of STPDs.

The treatment includes both antipsychotic medicines when required plus VERY tactful exploration of the eccentric belief systems of the STPD in talk therapy.

Of course the determination of eccentricity and idiosyncrasy is rather dependent on the predominant cultural and societal values, lore, and narratives of the time.

The DSM IV has this to say:

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior beginning by early adulthood and present in a variety of contexts as indicated by five (or more) of the following:

• Ideas of reference (excluding delusions of reference)
• Odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
• Unusual perceptual experiences, including bodily illusions
• Odd thinking and speech (e.g., vague, circumstantial, metaphorical, over-elaborate, or stereotyped)
• Suspiciousness or paranoid ideation
• Inappropriate and constricted affect
• Behaviour, or appearance that is odd, eccentric, or peculiar
• Lack of close friends or confidants other than first degree relatives
• Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self.

Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic disorder, or a pervasive developmental disorder.

3. Inverted Narcissism

The DSM IV defines the NPD using nine criteria. It is sufficient to possess five of them to "qualify". Thus, theoretically, it is possible to be NPD WITHOUT having grandiosity. Many researchers (Alexander Lowen, Jeffrey Satinover, Theodore Millon) suggested a "taxonomy" of pathological narcissism. They divided narcissists to sub-groups (very much as I did with my somatic versus cerebral narcissist dichotomy). Lowen, for instance, talks about the "phallic" narcissist versus others. Satinover makes a very important distinction between narcissists who were raised by abusive parents - and those who were raised by doting mothers or domineering mothers. I expanded upon the Satinover classification in FAQ 64.

I wrote "Malignant Self Love" exactly five years ago (1996). I corresponded with thousands (including dozens of mental health professionals) since then. It is clear to me from this correspondence that there is, indeed, a type of narcissist, hitherto rather neglected and obscure. It is the "self-effacing" or "introverted" narcissist. I call it the "Inverted Narcissist" and others on this list preferred to use "Mirror Narcissist", "NMagnet", or "NCodependent (NCo for short)". Alice Ratzlaff compiled an excellent "DSM" type "list of criteria".

Methodologically she erroneously insisted upon calling it a narcissist in the classical sense but finally we compromised on "Inverted Narcissist".

This is a narcissist who, in many respects, is the mirror image of the "classical" narcissist. The psychodynamics of such a narcissist are not clear, nor are his developmental roots. Perhaps he is the product of a doting or domineering primary object/caregiver. Perhaps excessive abuse leads to the repression of the narcissistic and other defence mechanisms themselves. I mean to say that perhaps the parents suppressed every manifestation of grandiosity (very common in early childhood) and of narcissism - so that the defence mechanism that narcissism is was "inverted" and internalized in this unusual form.

These narcissists are self-effacing, sensitive, emotionally fragile, sometimes socially phobic. They import all their self-esteem and sense of self-worth from the outside (others), are pathologically envious (a transformation of aggression), are likely to intermittently engage in aggressive/violent behaviours, are more emotionally labile that the classic narcissist, etc.

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We can, therefore talk about three "basic" types of narcissists:

1. The offspring of neglecting parents
   They resort to narcissism as the predominant object relation (with themselves as the exclusive object).

1. The offspring of doting or domineering parents (often narcissists themselves)
   They internalized these voices in the form of a sadistic, ideal, immature superego, and spend their lives trying to be perfect, omnipotent, omniscient, and to be judged "a worthy success" by these parent-images.

1. The offspring of abusive parents
   They internalize the abusing, demeaning and contemptuous voices and spend their lives in an effort to elicit "counter-voices" from their human environment and thus to extract a modicum of self esteem and to regulate their sense of self worth.

All three types are doomed to eternal, recursive, Sisyphean failure.

Shielded by their protective shells (defence mechanisms) they constantly gauge reality wrongly, their actions and reactions become more and more rigid and ossified and the damage inflicted by them on themselves and on others ever greater. This damage is what my book is all about.

4. Narcissists and Women

The narcissist does regard the "subjugation" of an attractive woman to be a source of narcissistic supply.

It is a status symbol, proof of virility and masculinity and it allows him to engage in "vicarious" narcissistic behaviours (=being a narcissist through others, transforming others into tools at the service of his narcissism, into his extensions). This is done by employing defence mechanisms such as projective identification. Many of my FAQs and the essay are dedicated to these issues.

Primary NS is ANY kind of NS provided by others who are not "meaningful" or "significant" others. Adulation, attention, affirmation, fame, notoriety, sexual conquests - are all forms of NS.

Secondary NS is afforded by people who are in CONSTANT, repetitive or continuous touch with the narcissist. It includes the important roles of narcissistic accumulation and narcissistic regulation, among others.

The narcissist believes that being in love IS going through the motions and pretending to some degree. To him, emotions are mimicry and pretence.

5. Narcissists and their Ex's

There are two possible reactions:

The Ex "belongs" to the narcissist. She is an inseparable part of his Pathological Narcissistic Space. This possessive streak is not terminated with the official, physical, separation. Thus, the narcissist is likely to respond with rage, seething envy, a sense of humiliation and invasion and violent-aggressive urges to separation, especially since it implies a "failure" on his part and, thus negates his grandiosity.

But there is a second possibility:

If the narcissist were to firmly believe (which is very rare) that the ex does not and will never represent any amount, however marginal and residual, of any kind (primary or secondary) of narcissistic supply - he will remain utterly unmoved by anything she does and anyone she may choose to be with.

If you don't supply - you don't exist.

There is a lot more on these issues here.

6. Narcissists Victimize

"Classical, full fledged" narcissists victimize. Nothing evil here, nothing premeditated, no sinister grins. Simply an absentminded, offhanded, kind of indifference and lack of empathy. And a lot of hurt people.

On balance I (a narcissist) prefer to help the victims. They are far numerous and far more hurting. And I have done far too much to add to their numbers. This is my way of trying to make amends, I guess.

To me, women are either holy or whole. If holy, how could I dare contaminate them with sex, impinge upon their purity and saintliness with my bestial passions and infringe upon their perceived "aloofness" and "above the (sexual) fray status" with my demands.

If whore, sex with them must be impersonal, mildly sado-maso, somewhat autoerotic and devoid of every emotion.

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next: Excerpts from the Archives of the Narcissism List Part 10

Excerpts from the Archives of the Narcissism List Part 8

1. Do Infants Trigger their Own Abuse?
2. Narcissism, Wife Beating and Alcoholism
3. Disinterested Narcissists
4. Superego
5. Emotional Daltonism
6. Atheism
7. The Human Machine
8. Conscience
9. BPD and NPD
10. The Personality Disordered
11. Robert Hare
12. Accusing the Victims
13. Multiple Diagnoses and NPD

1. Do Infants Trigger their Own Abuse?

It is conceivable that certain infants are born with a genetic propensity NOT to attach to the mother (I won't use "caregiver" or "primary object"). Could it be that this PROVOKES abuse/neglect by the mother?

Other infants are born DIFFERENT. For instance, how would a mother cope emotionally with an exceptionally gifted or handicapped child? What about physical defects? These children are "alien", threatening - especially to teen mothers or inexperienced ones (or culturally conditioned ones).

Perhaps children TRIGGER the treatment that they receive in certain cases?

This sounds a lot like shifting the blame to the victim (a classic with rape victims).

I am NOT trying to justify abuse or neglect. There is no justification or mitigating circumstances for abuse, even in the case of the abuser's mental illness.

But we are very far from deciphering the delicate and intricate mechanisms that bind infants to objects and later, to meaningful others. Attachment is still mysterious.

Over the years I had the chance to hear from HUNDREDS of mothers the following:

1. Children are BORN with distinct "characters" (they mostly used the term "personalities" which is going too far, of course). Many mothers insist that - from the third or fourth postnatal day - they could tell if a child is obstinate, temperamental, mentally alert or intelligent, possessive and envious (and many other traits).

1. As a result, these mothers concluded that children are IMMEDIATELY distinguishable from one another.

1. This leads to different treatment and emotional investment accorded to each child, even in the same family and by the same mother and under similar social, cultural and economic circumstances.

There are two possibilities to relate to this common claim:

1. (Cultural, societal, or personal) prejudice and bias (of the mothers), or

1. Part truth. In which case, it is interesting why this very important observation by mothers has been largely ignored hitherto.

2. Narcissism, Wife Beating and Alcoholism

Issue number one: is narcissism equivalent to alcoholism, wife beating and stealing?

Absolutely not. Narcissism is a personality structure. Wife beating and stealing are specific behaviors. "Personality" is a MUCH wider concept.

Issue number two: does this absolve the narcissist of responsibility?

The narcissist is responsible for most of his actions because he can tell right from wrong. He simply doesn't care enough about other people to restrain or modify his behaviour. There's more in the archives and in my FAQs.

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It is true that the narcissist intellectualizes and rationalizes his actions. But he does so to justify the specific action, not its overall nature. For instance: a narcissist berates and demeans his wife in public. He knows that GENERALLY speaking it is wrong to berate and demean anyone, let alone one's spouse. But he has an excellent explanation why the WRONG, unfortunate, and usually regrettable act had, IN THIS CASE, to be done. He would say:

Demeaning one's spouse in public is wrong

BUT

In this case, the circumstances were such that I was left with no choice but to demean and berate her in public.

3. Disinterested Narcissists

Narcissists are like all other humans. BUT, there is a difference. They do not COMPARE.... He is both incapable AND disinterested in your predicament, personality, emotions, in YOU.

They cannot fathom love. But they can definitely fathom anger, indignation, or envy.

Meta language means a language common to us both. Thus, there isn't your meta language or mine, only ours. You can never KNOW if I am hurt. You can assume, guess, deduce, learn that I am hurt from what I tell you, from a similarity of circumstances, from some safe assumptions you are making.

If you call me "idiot" I can PRETEND to be hurt and you would think that I am hurt - irrespective of whether I am truly hurt or not. We cannot KNOW the internal states of anything but ourselves (cogito, ergo sum). We can only INFER them.

4. Superego

The Ego Ideal is not "subsumed by the Superego". It is simply the earlier name given to the Superego in Freud's writings. He then changed it to Superego.

The Superego IS the conscience (in psychodynamic theories). There is no separate conscience. BUT it is true that if the primary caregivers were not "good enough" (Winnicott) the Superego turns out to be idealistic, sadistic, makes unrealistic demands on the Ego, etc.

A conscience can, therefore, be realistic and impose a realistic test of right and wrong - or ideal and sadistic and torment the Ego with its taunting, unrealistic demands. If one grew up in a restrictive, religious environment, chances are that one has a conscience - only "too much" of it, making impossible demands upon one and torturing one with moral self-flagellation and doubts.

5. Emotional Daltonism

By philosophical and logical definition I CANNOT know how is it to be you. You can describe it to me. You can say to me: "this hurts". Then I remember MY pain and I ASSUME that you are having the same thing. Can we PROVE that your pain=my pain, your love=my love? Never. Ours are PRIVATE languages. We are limited to our META-language: we can talk ABOUT our selves, our emotions, our thoughts. We can never be SURE that we share the same experiences or emotions - because there is no WAY to objectively measure, test, evaluate, analyze or compare them.

Narcissists, in this sense, are like all other humans. BUT, there is a difference. They do not COMPARE. When you say: "it hurts (emotionally)", the narcissist has nothing to compare it to. He is an emotional Daltonist. He, therefore, stares at you blankly. You say: "it hurts" (physically) - and to him it is simply a superfluous and rather boring bit of information. He is both incapable AND disinterested in your predicament, personality, emotions, in YOU.

Unless, of course, you represent a potential source of narcissistic supply.

You can never "know" a person. We are all locked within impenetrable walls, speaking incomprehensible private languages, communicating through distant echoes, often misinterpreted by others. We can KNOW only actions. We can GUESS or ASSUME that what is happening inside another human being is SIMILAR/IDENTICAL to what is happening inside us (this is empathy). Tastes and preferences unless expressed remain unknown. If expressed - they are no different to actions. We are all blind to each other. Hence our existential pain.

If a computer were programmed to behave in strict accordance with all ten commandments + Asimov's three laws of robotics + all the legal codex of the USA - would it have possessed a conscience?

Don't people engage in moral activities on strictly utilitarian grounds?

See my "Philosophical Musings": http://musings.cjb.net

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6. Atheism

I am NOT an atheist. No one can make any logically rigorous statement about God. We can only state our beliefs concerning Him. No statement about God can have a truth value (=can be assigned a value of "true" or "false", logically speaking).

This is because we can devise no test to falsify the predictions emanating from such a statement (see Karl Popper and the concept of Falsification).

Thus, an atheist cannot say that God does not exist (this is a statement which MUST be substantiated by yielding a falsifiable prediction concerning the non-existence of God).

An atheist is, therefore, limited to saying that he BELIEVES that God does not exist.

So, an atheist is a BELIEVING person and his RELIGION is atheism.

I am an AGNOSTIC. I say that I DON'T KNOW if God exists or not because I cannot say anything logically-rigorous about his existence (or non-existence).

I presume that "The written word of God" is the assemblage of ancient texts known as the scriptures. Religion is a powerful "outer conscience", a substitute for an inner conscience (also known as Superego in psychoanalysis).

Like any state of suspension of disbelief (example: drug addiction) it provides an agenda (goal), a daily routine (outer skeleton when an inner one is missing), a sublimation and assimilation of obsessions and compulsions (through prayer and compulsive acts). It is no different, nor inferior, in my view, to psychotherapy. It is a narrative with rules of conduct. For further treatment, see Metaphors of the Mind, Part 2 Psychology and Psychotherapy

 

7. The Human Machine

Never declare a victory over a narcissist. Like that legendary phoenix, they keep springing from the ashes of their immolated arguments, strengthened and reinvigorated.

To know what is an NPD - does not take an NPD, only an erudite psychotherapist. Or the right computer software. Humans are pretty basic machines. Feed the right texts to any intelligent agent, he will be able to predict human behaviour pretty well. This is ESPECIALLY true of PDs. They are even more basic than normal people. Their personalities are on a lower level of organization. Their reactions are rigid, boringly predictable. Normal people are much more varied, unpredictable and interesting.

8. Conscience

Narcissists can - and have - discussed conscience. Same way as a blind man can discuss colour, I guess ... Freud seems to have been a narcissist. In any case, there can be no "authority" about conscience because it is a figment of our private language. We can judge only derivative behaviors, not underlying emotions. We cannot communicate our inner world. We can only discuss, analyze and dissect only the language that we use to discuss our inner world.

I grant you that maybe you behave morally. That does not make you a conscientious person. I can decide to behave morally for the rest of my life - and not have an ounce of conscience. As, in this group, I am empathic and helpful (to the best of my ability), patient and accepting - but I am devoid of empathy.

Behavior can be simulated. We cannot infer about inner truths from outer ones. This is why "mens rea" (a criminal motive) is so difficult to establish and the courts prefer to go by one's actions and circumstances.

9. BPD and NPD

The DSM thinks that BPD is not that different than NPD. Borderlines are as manipulative and don't have a conscience. I think each PD has its own narcissistic supply:

HPD - Sex, seduction, flirtation, romance, body
NPD - Adulation, admiration, attention, fame, celebrity
BPD - Presence (they are terrified of abandonment)
AsPD - Money, power, control, fun

BPDs seem to me to be NPDs who are scared of being abandoned. They know that if they hurt people, they might abandon them. So, they are very careful. They DO care deeply not to hurt others - but this is selfish: they don't want to lose those others, they are dependent on them. If you are a drug addict, you are not likely to pick up a fight with your pusher.

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10. The Personality Disordered

They are mortified by the increasing probability of abandonment following their behavior.

Each PD has its own "story", a "narrative". The way to healing is replete with the residues of these narratives. To heal, a PD MUST break through his or her narrative and OUT into the world while assuming personal responsibility.

All PDs engage in scapegoating and bag-punching. To the personality disordered, their parents, abusers, the world, God, or history are responsible for what they are and for what they do DECADES after the original abuse. Research shows that the brain is more plastic than many thought. I can CHOOSE to heal. If I don't - it is because I gain from my infirmity. The same is true for BPDs, AsPDs and every other PD.

11. Robert Hare

Robert Hare is considered to be a heretic in DSM IV terms. His PCL-R was severely criticized by the compilers of DSM IV (especially after he insisted that they muddled up the definition of AsPD ...)

In this case, I think the DSM may be right. The overlap between AsPD and psychopath is too great to justify a separate clinical category. In any case, Hare is absolutely NOT the orthodoxy. The DSM is clear: AsPD in, psychopaths out.

A distinction exists between NPDs and AsPDs.

The differences between PDs and neuroses have been more sharply defined. In a nutshell, PDs have ALLOPLASTIC defenses (react to stress by attempting to change the external environment or by shifting blame to it) while neurotics have AUTOPLASTIC defenses (react to stress by attempting to change their internal processes). The second important difference is that PDs TEND to be ego-syntonic (perceived by the patient to be acceptable, unobjectionable and part of the self) while neurotics tend to be ego-dystonic (the opposite).

This is exactly why "PD Clusters" were invented in 1987. I believe that there is a continuum BPD-HPD-NPD-AsPD.

Grandiosity in its typical narcissistic form is UNIQUE to narcissists. It cannot be found in ANY OTHER PD. A sense of entitlement is common to ALL Cluster B disorders, though. Narcissists almost never act on their suicidal ideation - BPDs do so incessantly (cutting - Self Injury - or mutilation).

And so it goes. The differential diagnosis is nowhere near where it should be ideally but is sufficient and developing by the day. At this stage, as long as they don't have DSM-V (actually DSM IV-TR was published), diagnosticians are in the habit of diagnosing multiple PDs. It is extremely rare to diagnose a single pure PD. This is called, as you know, "co-morbidity". I have textbooks at home which URGE diagnosticians NEVER to render a single diagnosis.

NPDs can suffer from brief reactive psychoses exactly as BPDs suffer from psychotic microepisodes. Actually, there is a whole sub-field in psychodynamic theories of narcissism which tries to explain the dynamics of reactive psychoses in pathological narcissism.

NPDs are different from BPDs in these areas:

1. Less impulsive behaviors (FAR less)
2. Less self-destructiveness, almost no self-mutilation, practically no suicide attempts
3. Less instability (emotional lability, in interpersonal relationships, and so on)

Psychopaths, or Sociopaths, are the old names for the antisocial PD. They are no longer in use, generally. But, the line between NPD and AsPD is very thin. I, personally, believe that AsPD is simply an exaggerated form of NPD and that having two diagnoses in such cases is superfluous.

12. Accusing the Victims

I would never DREAM to accuse the victim!

I just meant to distinguish between those victims who don't know better and get burnt - and those who KNOWINGLY, WILLINGLY, sometimes for the fun of it (risk/adventure), sometimes due to vanity (I will be the one to break him or to save him) - go near narcissists.

The first class of victims are real victims. But I refuse to accept victimology. I think it is degrading and scientifically wrong to assume - as a working hypothesis - that victims WANT to be victimized.

13. Multiple Diagnoses and NPD

NPD rarely appears in isolation. It is not in vain that BPD, NPD, HPD and AsPD constitute members of a Cluster (B) of disorders in the DSM.

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Pathological Narcissism is what the DSM says it is simply because the DSM (and the ICD) define our terminology. It would have been very difficult to communicate meaningfully otherwise. We can stretch the definition of narcissism somewhat but we cannot include in it traits which are the absolute opposite of narcissism. A new title would then be called for (Maybe "Inverted Narcissism"?).

Narcissists do try to merge with an idealized but badly internalized object. They do so by "digesting" the meaningful others in their lives and transforming them into extensions of their selves. They employ various techniques to achieve this. To the "digested" this is the crux of the harrowing experience called "living with a narcissist".

The narcissist has a badly regulated sense of self-worth. However this is not conscious. He goes through cycles of self-devaluation (and experiences them as dysphorias).

Narcissism MUST include a component of active and conscious grandiose self-image. Some narcissists punish themselves by self-defeating and self-destructive behaviors - but if they actively avoid narcissistic supply, they are not narcissists. There is a host of other PDs which incorporate this criterion (social phobia, schizoid PD and many others), though.

The narcissistic dissonance exists on two levels:

1. Between the UNCONSCIOUS feeling of lack of stable self worth and the grandiose fantasies
   AND
2. Between the grandiose fantasies and reality (the Grandiosity Gap).

If someone thinks that he is not unique - then he can never be defined as a narcissist. The word "narcissist" is taken - a new word must be found. But a sense of worthlessness is typical of many other PDs (AND the feeling that no one could ever understand them).

Narcissists are never empathic. They are attuned to others in order to optimize the extraction of narcissistic supply from them.

Because narcissists are unwilling to change - they are take it or leave it propositions. There is little point in trying to "convert" them through the application of love, compassion, or empathy.

Those who are attracted to narcissists must suffer from an underlying mental problem (though I do not think that two narcissists are likely to get along well together).

But there is no denying that some people do get attracted to narcissists - even if they are warned IN GREAT DETAIL as to what is a narcissist and what it is to share a life with one.

 

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next: Excerpts from the Archives of the Narcissism List Part 9

Disability Living Allowance (DLA) is a tax-free social security benefit intended for adults and children with a long-term illness or a disability like ADHD. Here's how it works.

Disability Living Allowance

If you live in the U.K. with a child who suffers from ADHD and you have to take more care of them than you would have to for a non-sufferer, or an adult who has major problems with employment: they or you may qualify for Disability Living Allowance (DLA) - this is, however, dependant on various criteria including mainly the question of how much extra care does the child need compared to others of the same mental age. This includes supervision/safety issues as well as personal care. (E.G. if a child is 10 and has ADD/ADHD, they may be compared to another child with the mental age of 7, as it is generally regarded that children with ADHD are approximately 3 years behind in their emotional development than their peers of the same chronological age. This means that if a child of 10 cannot be allowed to go out without supervision, they would, in fact, be compared to a child of 7 who may not actually be allowed to go out without supervision.)

Therefore when applying for DLA, you must be aware that although other children of the same chronological age may have no problems in a certain area in which your child does, this does not mean they will qualify for DLA unless they have more difficulty than another child of the same mental age group. The best thing to keep in mind is to compare the things your child has difficulty with to another child of approximately 3 years younger than your own child and then, if this younger child would still have no problem with the task, then this may well qualify your child for DLA.

It's basically divided into two areas, mobility allowance and care allowance. Each one has it's own levels which you have to qualify for. For example, our Richard is quite mobile but needs constant supervision in crossing roads etc., so he currently qualifies for the lowest mobility rate. In terms of the care allowance, he needs to be watched over virtually 24 hours a day, even with medication. He needs constant supervision (more about this later) with dressing, washing, going to the loo etc. etc. He therefore qualifies for the higher rate care allowance.

The forms for DLA are long and quite daunting. It could be said that they appear to have been designed solely for physical handicaps rather that mental ones, as the questions don't appear to lend themselves to easy answering when considering the latter. Take time to complete the forms. Try to break it up and complete sections over several evenings. Don't skip any questions because you think they don't apply. Read them again and again just to make sure you can't put something. I was a Claims Manager before leaving my career to look after Richard and believe me these forms are similar, in that the Benefit Authorities like all questions to have an answer, even if it's 'Not Applicable', rather than leave them blank or, worse still, put a line through them.

Look at your child as though you were filling in the form for a stranger and complete the questions accordingly. Really ask yourself, how does this apply rather than does this apply? For example, Richard can go to the toilet unaided, so why do I say he needs constant supervision. Because, if you sometimes don't remind him he looks as though he needs to go, he'd quite happily stand there and let it run down his leg. If he has a bath, apart from the normal struggle of getting a teenager to actually take a bath, I need to make sure he washes under his arms etc., etc., or he'd just get part way into the water, get straight out and make a half-hearted attempt at drying himself. In other words, if I wasn't there, he wouldn't think to bother. This goes for dressing and many other activities. He can cross the road, but many is the time he's suddenly strode away from me and quite oblivious to the danger, darted across the road, with cars swerving to avoid him. I think you get the picture.

If after filling the form in you get rejected, try, try, try again. Don't give up if you think you qualify. It really is an extra boost, especially if you're on income support or similar benefit. You can be working to claim it as well, as it is for the child and not for you.

There has also recently been some research carried out into DLA and ADHD, the abstract of which is below:

The Role of Disability Living Allowance in the Management of ADHD

Abstract:

Objective To explore the use of Disability Living Allowance (DLA) by families of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD), and to discuss the implications for clinicians involved in their treatment.

Study design Opportunistic survey of patients attending ADHD clinic.

Setting Urban area in the north-east of England. Subjects A total of 32 carers of children being treated for ADHD with methylphenidate.

Intervention Semi-structured telephone interviews about receipt and use of DLA.
This involved open and closed questions and a multiple-choice section.

Results In total, 19 out of the 32 families were receiving DLA.
They chose to use it mainly to replace clothes and furniture and to provide diversions and activities for the children concerned.
Some families were unaware of potential eligibility for DLA, whereas a few had chosen not to apply.
OOnly one family's application for DLA had been unsuccessful.
Carers were unanimously positive about the extra income.

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Conclusions Families view DLA as an important means to replace damaged items and to fund recreational activities to contain over-activity.
Families receive little formal guidance on ways of using DLA money to support children with ADHD.
Virtually no specific training in benefits awareness is provided to general practitioners and child health specialists, who are often asked to judge the child's level of impairment or incapacity. Applying for DLA may affect the therapeutic relationship for good or ill.
There is a need for professionals in contact with children with ADHD to inform families of the possibility of receiving DLA and support them in applications. As diagnosis and treatment of ADHD becomes more commonplace, more families are likely to be entitled to claim DLA. This has definite implications for the social security budget.

B J Steyn, J Schneider and P McArdle
Child: Care, Health and Development, vol. 28, 2002, p.523-528br> Document Type: Research article ISSN: 0305-1862

Some Adults with ADHD May Also Qualify for DLA or Incapacity Benefit

This is also dependent on a number of things including generally a medical by the Benefit Agency Doctors - Consideration is also considered for things like the ability to attend and achieve daily tasks and the ability to hold down employment. Some people with ADD/ADHD have difficulty in holding down a job due to the problems they have with attention, focus and general time keeping and things like this. Check with the local Benefit Agency Office for details or you can find more information and criteria for both these Benefits on the Benefit Agency Website at www.dss.gov.uk/lifeevent/benefits/ where there are also application forms, which can be downloaded.

Speaking to the Disability Officer at the local Job Centre is certainly worthwhile as they will be able to help with employment issues including speaking to potential employers and seeking to sort out certain accommodations with the employer before starting the job so that the employer knows about the condition and how it can impact on the work and with colleagues. The Disability Officer has a lot of experience in working with employers and helping to secure various accommodations, which can help to enable the person with ADHD, succeed in the employment stakes.

To get the forms contact your local benefits office. The Benefits Agency have web pages at www.dss.gov.uk/lifeevent/benefits/ that are well worth a look at.

There is also a great site full of really helpful information about all benefits at http://www.benefitsandwork.co.uk/ this is very well worth checking out as they have far more than general information but also do training and look at implications of various appeals cases.

Another helpful site is at http://www.disabilitysecrets.com/adhd-attention-deficit-social-security-disability.html; this is very well worth checking out as they have specific information for ADHD and children as well as other general information.

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Some alternative therapies for treatment of anxiety may be more effective than anti-anxiety medications.

Alternative therapies win plaudits

A two-year study has found many complementary therapies work in treating anxiety and may even be more effective than conventional medicines.

The study, by the Australian National University's Centre for Mental Health, took two years to review all medical literature on the usefulness of 34 complementary therapies. It will be published in The Medical Journal of Australia today.

Included in the review were herbal remedies, such physical treatments as acupuncture and aromatherapy, lifestyle treatments such as humor and prayer, and dietary changes.

Anxiety disorders affect 7 per cent of men and 12 per cent of women and are said to be a problem when anxiety disrupts normal life. It is estimated 20 per cent of people with anxiety disorders seek professional help - many others choose self-help or complementary therapies.

Study co-author Anthony Jorm said the best evidence for alternative therapies treating anxiety disorders came from the herbal remedy kava, physical exercise, relaxation therapy and anxiety self-help books.

"Some of these might be as good as or better than current medicines," Professor Jorm said.

But he warned that kava may cause liver damage and taking it was not advised.

There was also evidence a range of other treatments, including acupuncture, meditation and listening to music, had some effectiveness. But the team found no convincing evidence that popular herbal remedies could alleviate anxiety.

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back to: Alternative Medicine Home ~ Alternative Medicine Treatments

Coping tools for people who have family members with bipolar disorder or another mental illness.

Supporting Someone with Bipolar - For Family and Friends

Although there are different types of mental illness and symptoms, family members and friends of those affected share many similar experiences. There is a lot you can do to help your friend or relative. However, you need to look after yourself, too.

Get Help Early

Don't ignore warning signs of mental illness in a family member or friend. The sooner the person receives treatment, the better the outcome is likely to be. It will help if you:

• Encourage the person to see a general practitioner (GP) or other doctor for an assessment
• Make an appointment with the GP yourself to discuss your concerns and what can be done (if the person refuses to see a doctor.)

Common Reactions
The distress associated with having a family member with a mental illness may lead to feelings of guilt, anger or shame. Acknowledging these feelings is the first step towards resolving them. It is important to understand that neither you nor the person with the mental illness are to blame for it.

A positive attitude helps
Developing a positive attitude will help you to provide better support for a friend or family member with a mental illness. It will help if you:

• Find out as much as you can about mental illness, treatment and what services are available in your area.
• Find out if there are any education and training courses for carers that you can attend.
• Recognize and accept that symptoms may come and go, and may vary in severity. Varying levels of support will be required at different times.
• Develop a sense of balance between your own needs and the needs of the person you care for.
• Contact a support group for carers or relatives and friends of people with a mental illness.

Recognize Your Limits

You should decide what level of support and care you are realistically able to provide. Explain this to the friend or relative with the mental illness as well as the health professionals involved in their care (for example, the psychiatrist or case manager.) This will ensure that the type of support you are unable to provide can be arranged in another way. You should also discuss options for future care with health professionals and other family members and friends. This will ensure continuity of care when you are unable to fulfill your role as a carer.

Develop Plans

Plans to cope on a day-to-day basis
It is important to encourage a sense of structure in the life of a person with a mental illness. You can:

• Develop predictable routines - for example, regular times to get up and eat. Introduce gradual changes to prevent boredom.
• Break tasks into small steps - for example, encourage someone to shower more by helping them put out towels and choose clean clothes.
• Try to overcome a lack of motivation - for example, encourage and include the person in activities.
• Allow the person to make decisions - even though it can sometimes be difficult for them to do this and they may keep changing their mind. Try to resist the temptation to make the decision for them.

Plans to deal with disturbed behavior
Try and discuss strategies with the person and health professionals to deal with:

• Suicidal thoughts - talk about the thoughts with the person and discuss why they are having them. Suggest things to distract the person from the suicidal thoughts. If the thoughts persist, especially if the person experiences hallucinatory voices that suggest suicide, inform their doctor.
• "Manipulative" behavior - for example, where the person with the illness tells one person untrue stories about mistreatment by the others who care for them. Establish whether the behavior is being used to get extra help and support. Try and involve the person in activities, which will make them feel less resentful towards others. Check out the stories before you react.
• Aggressive or violent behavior - this may be associated with psychotic symptoms or alcohol or drug abuse. Involve health professionals promptly. For aggressive behavior associated with extreme stress, try to develop an atmosphere that is open and relaxed.

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Report aggressive behavior
If someone is persistently aggressive, you should report actual or threatened violence to the treating health professionals (and the police, if necessary) immediately. If you live with someone who is persistently aggressive, seriously consider ways you can live apart. It is very likely that living apart will work out better for both of you.

The Effects of Mental Illness on Brothers and Sisters

Mental illness can lead to a variety of emotional effects for brothers and sisters of the affected person. For example, they may feel:

• Confusion about their sibling's changed behavior
• Embarrassment about being in the affected person's company
• Jealous of their parent's attention
• Resentment about not being like their peers
• Fear of developing the mental illness

What brothers and sisters can and can't do

What you can do
If your sibling has a mental illness, you can:

• Talk honestly about your feelings and encourage others in the family to do the same
• Be active in improving mental health services - for example, through local mental health support groups
• Avoid making the ill person the axis around which the family revolves
• Maintain your focus on living and enjoying your own life

What you can't do
If your sibling has a mental illness, you can't:

• Be totally responsible for their welfare
• Make your sibling behave in a certain way - for example, force them to take their medication
• Solve all their problems or feel you ought to
• Lessen the impact of the illness by pretending that it is not there

Things to Remember

• Neither you nor the person affected by the mental illness are responsible for their condition
• It may help to contact a support group for family, friends or carers of people with mental illness

next: A Guide to Balanced Bipolar Living For Patients and Caregivers
~ bipolar disorder library
~ all bipolar disorder articles

Learn all you can about anorexia nervosa, bulimia nervosa, and compulsive overeating. Genuine awareness undermines judgmental or mistaken attitudes about food, body shape, and eating disorders.

Discourage the idea that a particular diet, weight, or body size will automatically lead to happiness and fulfillment.

If you think someone has an eating disorder, express your concerns in a forthright, caring manner. Gently but firmly encourage the person to seek trained professional help.

Basic Principles for the Prevention of Eating Disorders

Every family, group, and community is different in terms of what might contribute to effective primary prevention. Thus, before we offer some specific suggestions for the prevention of eating disorders, we encourage you to consider adopting four principles which are generally applicable to doing prevention work in your family, your community, and your own life.

1. Eating disorders are serious and complex problems. Their expression, causes, and treatment typically have physical, personal, and social(i.e., familial) dimensions. Consequently, one should avoid thinking of them in simplistic terms like "anorexia is just a plea for attention" or "bulimia is just an addiction to food."
2. Prevention programs are not "just a women's problem" or "something for the girls." Males who are preoccupied with shape and weight can also develop disordered eating patterns as well as dangerous shape control practices such as steroid use. Moreover, objectification and other forms of mistreatment of women by men contribute directly to two underlying features of an eating disorder: obsession with appearance and shame about one's body.
3. Prevention efforts will fail, or worse, inadvertently encourage disordered eating, if they concentrate solely on warning parents and children about the signs, symptoms, and dangers of eating disorders. Therefore, any attempt to prevent eating disorders must also address:
   • Our cultural obsession with slenderness as a physical, psychological, and moral issue,
   • The distorted meaning of both femininity and masculinity in today's society, and
   • The development of people's self-esteem and self-respect.
4. If at all possible, prevention "programs" for schools, churches, and athletics should be coordinated with opportunities for individuals in the audience to speak confidentially with a trained professional and, where appropriate, to receive referrals to sources of competent, specialized care.

What does Prevention Really Mean

Prevention is any systematic attempt to change the circumstances that promote, sustain, or intensify problems such as eating disorders.

Primary prevention refers to programs that are designed to prevent the occurrence of the target disorder before it begins, in other words, to promote and sustain healthy development. Primary prevention of eating disorders programs are often incorporated into the ongoing work of parents, teachers, clergy, and coaches.

Secondary prevention is designed to facilitate identification and correction of a disorder in its early stages when it is less likely to be a "lifestyle" and less likely to be associated with other significant problems like depression. Secondary prevention involves education about (a) "warning signs," (b) effective ways to reach out to people in distress, and (c) referral to appropriate sources of treatment.

Why Preventing Eating Disorders is Important

Approximately 5-10% of postpubertal girls and women suffer from an eating disorder or borderline condition. A great many more girls and women and a significant minority of men find their lives restricted by a negative body image and unhealthy weight management practices.

Consider that, at any given time, approximately 20% of our population suffers from a mental disorder or emotional problem. This means that mental health professionals will never be able to adequately respond to the 4-5 million girls and women who are suffering from full-blown eating disorders or borderline variations, let alone those who are unhealthy and unhappy chronic dieters.

Primary prevention is the only solution. Moreover, we truly believe that identifying and changing the conditions which promote eating disorders will improve the psychological and physical health of virtually everyone in our society, male and female alike.

next: Desire to Be Perfect Makes Treating Anorexia Difficult
~ eating disorders library
~ all articles on eating disorders

My name is...

That shouldn't be a tough question, should it? I could reply with the name "we" ALWAYS use in public - BJ.

That's it, I'm BJ. I am a 39 year-old wife, mother of 3 and grandmother of 1. I am also Chipper, a full-time college student (again), a part-time internet design technician, an EMT, a health and safety instructor and other things. And then, I am Kate, an artist. Celeine, a writer, and the list goes on.

I can remember a single incident at the age of 12 when I clearly saw the formation of one of the other "me's". I was laying in my small bed, in my tiny closet-sized bedroom. I was enduring yet another middle-of-the-night visit from someone who terrorized me for all my childhood and much of the rest of my life. I was praying for him to finish and leave.

I was lying in my bed against the wall, staring out the window that was inches from me. I spent many nights staring out that window and wishing I could fly away; be with the stars and the moon. As I lay beneath him, pretending to be asleep, I was wishing I could escape through the window. Get away.

Suddenly, my wish was answered. I was outside the window. I felt no pain, no weight, no fear. I was disembodied, outside, looking back through. Seeing my body on the bed, as if it wasn't me. I felt sadness for the little girl on the bed, but I felt removed from me. It became a skill I honed and perfected for many years to come.

I have since learned that night was not the first, nor would it be the last time that I broke away from the child that suffered. I also discovered there were "multiple children" within me that suffered various pieces of the abuses that overwhelmed me.

For most of my adult life, I lived in happy denial. I pretended to myself, and to the world, that I was a well-adjusted, happy, content woman. I convinced myself that the things that happened to me, that were completely baffling and unexplainable, happened to everyone. Didn't everyone lose track of time, belongings, people? Didn't everyone find things in their possession they couldn't recall buying, or money spent they couldn't recall spending? Didn't everyone have such drastic extremes in desire and goals? Didn't everyone regularly run into people whose names and faces couldn't be placed?

"Victims of multiple personality disorder (MPD) are persons who perceive themselves, or who are perceived by others, as having two or more distinct and complex personalities. The person's behavior is determined by the personality that is dominant at a given time."

That definition describes me. Unfortunately, however, the fact that my behavior might have been determined by various, distinctly different, personalities was only clear to others...Not to me.

"Multiple personality disorder is not always incapacitating. Some MPD victims maintain responsible positions, complete graduate degrees, and are successful spouses and parents prior to diagnosis and while in treatment."

I was the picture of success, responsibility and over achievement. I was also the picture of denial and someone running fast and furious from facing the pain, confusion and internal conflict brought about by a childhood of mistreatment, conditioning and escaping by breaking off and compartmentalizing ME.`

For me though, what started in childhood as a creative, imaginative mechanism of survival, turned into dysfunctionality in adulthood. The ability to compartmentalize and ignore the pain, and the parts of me that carried the pain, broke down. Functioning "normally" became an exercise in futility.

Life became a series of crisis's, hospitalizations, self- destructiveness, suicide attempts, a lost career and a life of utter chaos.

In 1990, I entered treatment. I did the merry-go-round of misdiagnosis for a long time; until 1995, when I was officially diagnosed with MPD/DID and entered an even more difficult phase of self-exploration and healing.

During my treatment I came to the internet searching for support and information. While finding some great things in the way of resources, I also found that some of my needs didn't fit into any of the existing support outlets. I decided to create my own support system.

What began as purely a selfish venture, to find a bit of peer support from people struggling with the same issues, grew into something that became so much bigger than me. WeRMany was officially born on September 3, 1997 and has grown in the last 2 years to a peer group support organization providing real time chat support 24 hours a day, extensive online resources, message forums, an email support group and outlets for people dealing with MPD to share creative writing and drawing.

I hope you find your visit to our site helpful, supportive, and healing. For those who have experienced life's misadventures, I want you to know your life can be better with the proper treatment, support, and friends.

As it says on our homepage: Welcome to WeRMany.

reading room |  thoughts on suicide |

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next: Reading Room Homepage

Chapter 109 of the book Self-Help Stuff That Works

by Adam Khan:

IF JOE AND PETE ARE FRIENDS, they must have something in common: they went to the same school, work in the same place, etc. There are lots of possible things to have in common, but there is one that really makes a difference one factor which, if it is held in common by Joe and Pete, can make them close friends.

That factor is purpose (aim, intention). If Joe and Pete are both strongly interested in the same purpose, they can be close friends.

So in order to have a close friend, you have to know what your own strongest interest is. What fires you up with passion for the subject? What do you love to talk about? What do you love to read about? What do you love to do? What do you strongly desire? When you know the answers to these questions, and when the answers are not a big list of things, but one major one, you've found your purpose.

Now that you know what your main intention or interest is, you can look at your friends and see which one or ones share that interest. Then, to get closer, you simply make the friendship center around that interest. Do things together along the lines of that interest; learn things about it and share what you've learned with your friend; empower each other and encourage each other to persist along those lines when the going gets tough. Do this and if you're honest with your friend, you can have a very close, warm friendship...a lifetime friendship.

If you look at your friends and none of them share your purpose, join clubs and associations that specialize in your interest area. Go to classes and meetings that center around your interest. Your chances are pretty good that you'll find a friend who can become a close fried. And a close friend is the best thing in the world for your health and happiness.

Find and cultivate a friendship that centers around your strongest interest.

Is it necessary to criticize people? Is there a way to avoid the pain involved?
Take the Sting Out

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Would you like to improve your ability to connect with people? Would you like to be a more complete listener? Check this out.
To Zip or Not to Zip

If you are a manager or a parent, here's how to prevent people from misunderstanding you. Here's how to make sure things get done the way you want.
Is That Clear?

Most the people in the world are strangers to you. Here's how to increase your feeling of connectedness to those strangers.
We're Family

How to be here now. This is mindfulness from the East applied to reality in the West.
E-Squared

Expressing anger has a good reputation. Too bad. Anger is one of the most destructive emotions we experience, and its expression is dangerous to our relationships.
Danger

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An analysis of the largest-ever ADHD treatment study of children with ADHD.

Do ADHD treatment effects persist?

The Multimodal Treatment Study of ADHD (MTA Study) is the largest ADHD treatment study ever conducted. A total of 597 children with ADHD-Combined Type (i.e., they had both inattentive and hyperactive-impulsive symptoms) were randomly assigned to 1 of 4 treatments: medication management, behavior modification for ADHD, medication management + behavior modification (i.e., combined treatment), or community care (CC). ADHD medication treatment and behavior therapy were selected because they had the most extensive evidence-base to support their efficacy, and alternative and/or less well-established ADHD treatments were not investigated.

The ADHD medication and behavioral treatment provided in the MTA study were far more rigorous than what children typically receive in community settings. Medication treatment began with an extensive double-blind trial to determine the optimum dose and medication for each child, and the ongoing effectiveness of children's treatment was carefully monitored so that adjustments could be made when necessary. The behavioral intervention included over 25 parent training sessions, an intensive summer camp treatment program, and extensive support provided by paraprofessionals in children's classrooms. In contrast, children in the community care condition (CC) received whatever treatments parents opted to pursue for their child in the community. Although this included medication treatment for the majority of children, it appeared that this treatment was not conducted with the same rigor as with children who received medication treatment from the MTA researchers.

The initial results from this landmark study examined children's outcomes 14 months after treatment began. Although results from this complex study do not lend themselves to a brief summary, the overall pattern suggested that children who received intensive medication management - either alone or in combination with behavior treatment - had more positive outcomes than children who receive behavior therapy alone or community care. Although this was not true for all the different outcome measures considered (e.g., ADHD symptoms, parent-child relations, oppositional behavior, reading, social skills, etc.), it was the case for primary ADHD symptoms as well as for a composite outcome measure that included measures from a broad array of different domains. There was also modest evidence that children who received combined treatment were doing better overall than children who received medication treatment alone.

In terms of the percentage of children within each group who were no longer showing clinically elevated levels of ADHD symptoms and symptoms of oppositional defiant disorder, results indicated that 68% of the combined group, 56% of the medication only group, 33% of the behavior therapy group, and only 25% of the community care group had levels of these symptoms that fell in the normal range. These figures highlight that intensive medication treatment was more likely to result in a normalized level of core ADHD and ODD symptoms than either behavior therapy or community care, and that combined treatment was associated with the highest rate of "normalization".

As noted above, the results previously reported for the MTA Study cover the period out to 14 months after children's treatment began. An important, but as yet unanswered question, is the extent to which treatment benefits persisted after children were no longer receiving the intensive treatments provided in the study. For example, did the benefits associated with carefully conducted medication treatment persist once children's treatment was no longer being monitored through the study? And, was there persistent evidence that the combination of careful medication treatment and intensive behavior therapy was superior overall to medication treatment alone?

The persistent effects of MTA treatments were examined in a study published recently in Pediatrics (MTA Cooperative Group, 2004. National Institute of Mental Health Multimodal Treatment Study of ADHD: 24-Month Outcomes of Treatment Strategies for ADHD, 113, 754-760.). In this report, the MTA researchers examined how children were faring 10 months after all study-related treatments had ended. During these 10 months, children were no longer receiving any treatment services from the researchers; instead, they received whatever interventions their parents selected for them from providers in their community.

Thus, children who had received ADHD medication treatment through the study may or may not have continued on medication. And, if their parents chose to continue medication treatment, they were no longer carefully monitored by MTA researchers so that treatment adjustments could be made when indicated. Similarly, children who received intensive behavior therapy for ADHD symptoms were no longer be receiving such treatment through the study. Parents of these children could thus continue with behavioral intervention in whatever way they were able to. Or, they may have opted to begin treating their child with medication.

To examine whether treatment benefits persisted, the MTA researchers examined 24-month follow-up data on children in 4 different domains: core ADHD symptoms, symptoms of Oppositional Defiant Disorder, social skills, and reading. They also examined whether parents' use of negative ineffective discipline strategies differed according to children's initial treatment assignment.

Results

In general, results from the 24-month outcome analyses were similar to those found at 14 months. For core symptoms of ADHD and ODD, children who had received intensive medication treatment - either alone or in combination with behavior therapy - had superior outcomes to those who received intensive behavior therapy only or community care. Some, but not all of the persistent benefit of having received intensive medication treatment depended on whether children received medication for some portion of the 10-month interval since study treatment services had ended.

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Compared to the magnitude of the differences that were evident at 14 months the superior outcomes for children who had received medication treatment from the researchers was reduced by about 50%. Children who had received combined treatment were not doing significantly better than those who received intensive medication treatment alone. And, those who received intensive behavioral treatment were not doing better than children who had received routine community care.

In order to better understand the clinical significance of these findings, the researchers examined the percentage of children in each group who had levels of ADHD and ODD symptoms at 24 months that fell within the normal range. These percentages were 48%, 37%, 32%, and 28% for the combined, medication only, behavior therapy, and community care groups respectively. Thus, as was found at the 14-month outcome assessment, normalization rates of ADHD and ODD symptoms was highest among children whose treatment included the intensive MTA medication component. It is noteworthy, however, that while the percentages of children with normalized symptom levels were essentially unchanged for the behavior therapy and community care groups, they had declined substantially for the combined (i.e., from 68% to 47%) and medication only (i.e., from 56% to 37%) groups.

For the other domains examined - social skills, reading achievement, and parents use of negative/ineffective discipline strategies there was no evidence of significant treatment group differences in 24-month outcomes. In the social skills domain, however, children who received combined treatment tended to be doing better than children who received intensive medication treatment alone. Similar results were found for parents' use of negative/ineffective discipline. Thus, there continued to be some indication that combined treatment may have been more effective in some domains that medication management only.

As a final analysis, the researchers examined the use of ADHD medication treatment for children in each group at the 24-month outcome period. Seventy percent of children in the combined group and 72% of children in the medication only group were still taking medication. In contrast, 38% of children in the behavior therapy group had been started on medication and 62% of children who received community care were on medication. The doses being received by children who had received medication treatment from MTA researchers were higher than for other children.

Summary and Implications

Results from this study indicate the persistent superiority of the intensive MTA medication treatment for ADHD and ODD symptoms, even after families were left to pursue whatever treatments they preferred and the intensive study-related treatments were replaced with care provided by community physicians. Although these persistent benefits are encouraging, it must be noted that they were less robust than they had been at the 14-month outcome assessment. In addition, there was no evidence that intensive medication treatment was associated with better 24-month outcomes in the other domains examined. Overall, therefore, it appears that the persistent benefits associated with carefully conducted medication treatment were relatively modest.

One likely reason for the dimunition in benefits associated with MTA medication treatment is that a number of children ended medication treatment completely after study-delivered services ended. In addition, it is unlikely that children who continued on medication received the same level of treatment monitoring as had been provided by MTA physicians. Had this careful monitoring of ongoing medication treatment effectiveness continued, it is possible that these children would have continued to do ever better than was found to be the case.

Although children who had received intensive behavior therapy alone were not faring quite as well, a substantial percentage, i.e., 32%, continued to show normalized levels of ADHD and ODD symptoms. Thus, this is additional evidence for the utility of behavior therapy for ADHD. It should be noted, however, that many parents whose child had received behavior therapy chose to begin medication treatment for their child.

In conclusion, results from this study indicate that the benefits of high quality medication treatment persist to some extent even when this treatment is no longer being provided. Although the persistent benefits were modest at best, the MTA authors note that even these modest effects may have important public health benefits. The results also suggest that even intensive multimodal treatment conducted over an extended period does not eliminate the adverse impact of ADHD for most children, and that high quality treatment services provided over many years is likely to be required to help most children reach their full potential.

Finally, these results highlight the pressing need to develop new interventions for ADHD whose efficacy is established through carefully conducted research. Even when provided in the most rigorous way possible, medication and behavior therapy were not successful in normalizing levels of ADHD and ODD symptoms for a large percentage of children. Thus, it seems very important for researchers to focus attention on developing alternative ADHD interventions, and perhaps to strategies for preventing the development of ADHD in the first place.

About the author: Dr. Rabiner is a Senior Research Scientist at Duke University, an expert in childhood ADHD and author of the email newsletter "Attention Research Update."

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