Hello, Dr. Stanton Peele!

I, as have many Native American people, have been tremendously affected by the consequences of alcohol addiction running rampant through my family, my clan, my tribe, and friends and family in other tribes.

Please tell us: What is the rate of alcohol addiction among women of child-bearing age on our reservations, and what is the rate of F.A.S. amidst the new-borns?

What is available for our child-bearing-aged women, and how can we grandmothers step in to help protect our heritage (the children)?

Can you direct me to more information aimed at statistics for individual reservations? Perhaps we can learn from those experiencing a reprieve as well as those who are not achieving positive results.

Is there a web site that allows us to converse and compare programs and ideas?

Thank You for your time;
Sincerely,
Wendy

Dear Wendy:

I am not an expert on this topic, but many people are very concerned. You need to contact groups working with native American alcoholism — I do know the rate of FAS is many (30!) times as high among native Americans as among Whites.

What my site is about — and I believe it applies doubly to Native Americans — is whether telling people they are born with the disease of alcoholism is helpful. I say not.

Best, Stanton

Dear Dr. Peele:

Thank you for responding to my note. I agree that the disease-model is not positive for my people for a number of reasons.

First, it gives an excuse: "Yes, there's something wrong with us and we can't help ourselves, so let's just go out and fulfill our destiny."

Second, the disease model ignores many of the real issues surrounding Indigenous people in the United States. For example, aside from being coerced from our ancestral lands and needing to adjust to new diets (which results in all varieties of bodily illnesses through several generations), many of our family members, clan members, tribal members died from new diseases, malnutrition, bounties, and so forth.

We wrapped our remaining relatives closely to us, tolerating addictions and other maladaptive behaviors simply to hold on to those few who remained. In 1979, thanks to Jimmy Carter's Freedom of Religion Act, we were finally given permission to pray in our own way without being jailed for doing so, then in the late eighties, the U.S. government finally stopped removing children — for educational purposes (the Carlisle School) — from their reservations at the age of six.

It has been a long holocaust for us, and I'd say my people need treatment for generations of pent up anger, post traumatic stress, horrific depression, and low self-esteem for having been so helpless to prevent what happened. Further, because the children — all but a few who were hidden — were regularly removed over several generations, I'd say we also could use parenting skills!

No, the disease model only serves to prolong our substance abuse difficulties. We as a people fairly collectively believe that our hope and our heritage lie within the children. If this is so, then surely our hope lies within ourselves to model the laying aside of addictions and to begin to demonstrate honor and sober integrity.

Yet as I reach out across the web, I'm finding no statistics, no real research, no positive connections, hence, I must be searching the wrong venues.

Again, thank you for your time, and further, thank you for you.

Sincerely,
Wendy Whitaker

next: Drug, Set or Setting - Which Has the Greatest Impact Upon Drug Use Problems?
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

Jealously. . . it feeds on your insecurity, devours your self-confidence, and gobbles up the trust in your relationship.

Jealousy has been defined as an emotion experienced by one who perceives that another person is giving something that she or he wants (typically attention, love, or affection) to a third party.

Jealousy is an emotion resulting from the resentfully suspicious nature of man. It is a universal emotional trauma caused by things as well as people. Jealousy is a reaction to a perceived threat - real or imagined - to a valued relationship or to its quality. Jealousy has a mind of its own and it is strong enough to make us believe and see things that are not even there or that have not happened yet.

Jealousy is a "complex reaction" because it involves such a wide range of emotions, thoughts and behaviors.

Believe it or not, like other difficult emotional experiences, jealousy can be a trigger for growth, increased self-awareness, and greater understanding of both your partner and your relationship.

While some couples seem to feed off of inciting a playful type of jealousy, many other relationships are laid to waste by uncontrollable and irrational fits of jealous rage.

In small, manageable doses, jealousy can be a positive force in a relationship. Jealousy heightens emotions, making love feel stronger and sex more passionate. But when jealousy is intense or irrational, the story is very different.

Jealousy is almost always a demonstration of our own insecurities and low self-esteem. Unless an unfaithful partner has broken trust, about 90% of jealousy comes from from personal insecurity. When you are feeling unloved, be careful not to focus on your partner when the feelings are really inside you. Jealousy provides an opportunity to come to a fundamental understanding of yourself. You may be being driven by your fears.

Insecurities bring forth jealousy, which, in effect, is a cry for more love. It is within our rights to ask for more affection when self-doubts surface, however, the indirect way that jealousy asks for it is counterproductive. Excessive possessiveness is inappropriate. Jealousy is the surest way to drive away the very person we may fear losing.

One of the biggest mistakes you can make is to try and hide it. Jealousy is usually a signal of something needing fixing, and ignoring that usually only makes things worse.

To keep yourself on the right track of jealousy conquering, just remember these steps:

Acknowledge your jealousy. Ask yourself where it is coming from and why it makes you feel jealous. I suggest asking yourself, "What do I feel insecure about? Do I feel unattractive or uninteresting myself? Do I doubt the other persons love for me? Their physical attraction? Do I doubt that I can have the type of relationship I want?"

Make self-health and lifestyle changes that will assist you in fighting it off. Combine jealousy with a more rational emotion. Have patience and practice!

As long as you keep those steps in mind and follow them, you will learn how to take control of your jealousy instead of it controlling you.

Emma Goldman once said, "All lovers do well to leave the doors of their love wide open. When love can go and come without fear of meeting a watch-dog, jealousy will rarely take root because it will soon learn that where there are no locks and keys, there is no place for suspicion and distrust, two elements upon which jealousy thrives and prospers."

next: Kidding Around With Romance

Despite the importance of nutrition in managing type 1 diabetes, eating disorders and unhealthy weight-control tactics are not uncommon in young women with the disease -- and the combination can lead to serious complications, a new study shows.

UK researchers found that among 87 teenage girls and young women with type 1 diabetes who were followed over roughly a decade, 15 percent had a probable eating disorder, such as anorexia or bulimia, at some point during the study.

In addition, more than one-third reported cutting back on their insulin in an effort to keep their weight in check, while others said they had vomited or abused laxatives for weight control.

Instead of fading with age, these problems became more common in young adulthood compared with adolescence, according to findings published in the journal Diabetes Care.

The study included girls and young women ages 11 to 25 who were patients at a UK diabetes clinic in the late 1980s. They were interviewed about their eating habits, attitudes toward food and eating disorder symptoms at the start of the study, then again when they were between the ages of 20 and 38.

Type 1 diabetes is an autoimmune disease in which the immune system mistakenly destroys the pancreatic cells that produce insulin -- a hormone that helps usher the sugar from foods out of the blood and into body cells to be used for energy.

People with type 1 diabetes must take daily insulin injections in order to live. They also have to be careful about what and when they eat to avoid dangerous blood sugar lows, while also sticking with their insulin regimens to keep blood sugar levels from soaring. Over time, poor blood sugar control can lead to complications such as kidney failure, nerve damage, vision problems and heart disease.

Despite the importance of healthy habits in type 1 diabetes, some patients are able to disguise the fact that they have an eating disorder, according to Dr. Robert C. Peveler of the University of Southampton, the lead author of the new study.

"Surprisingly, some patients do manage it for a time," he told Reuters Health. "The deterioration in their health may be quite slow and therefore hard to spot."

Among women in his team's study, those with a history of eating disorders were five times more likely than their peers to suffer two or more diabetes complications -- such as damage to the eye's blood vessels, kidney dysfunction or nerve damage in the limbs -- over 8 to 12 years of follow-up.

Women who had ever used unhealthy weight-control tactics or misused their insulin faced a similarly elevated risk of complications.

Overall, six women died during the study period, two of whom had bulimia, Peveler and his colleagues found.

Poor blood sugar control likely made a large contribution to the heightened complication risks, Peveler said, but poor nutrition may also have played a direct role. As an example, he noted that non-diabetic women with anorexia can develop diabetes-like nerve damage in the extremities.

It's unclear, according to Peveler, whether there is something about type 1 diabetes that makes women with the disease vulnerable to eating disorders.

"We still can't really be sure, but it looks as if there may be a slight increase in risk," he said.

The fact that insulin injections can promote weight gain may play a role, as well as the stress of managing a chronic disease, according to Peveler. But for now, he noted, that is just speculation.

SOURCE: Diabetes Care.

next: Figuring Out Fat and Calories
~ eating disorders library
~ all articles on eating disorders

Having a successful relationship is like driving a car at night. You can only see as far as your headlights shine up ahead, AND you can make the entire trip that way. When you see a bump in the road or have to take a detour (to avoid a major disagreement), you simply make a mutually beneficial adjustment and keep on going!

Couples need to go through the ups and downs, experience the traumas and revel in the successes of their relationship in order to grow. Commitment to complete the journey, come what may, nurtures the love needed to arrive there together.

When the relationship is strained, it is often difficult to be your own person. Sometimes you may feel that if you don't do what your partner wants you to do, he/she will be upset and become even more distant. This is where agreements are important. Agree to allow each other to make your own choices, first for yourself and then for the relationship. Remember, women usually respond most to a man's action or lack of action. Men generally respond most to a woman's attitude. So. . . now you know what you need to work on. Men - Action. Women - Attitude.

Stay on track. Do what's right. Do unto your partner what you would have them do unto you. Indulge in honoring your combined efforts. Buy your partnership a trophy from a trophy shop. Have it engraved. Present it to each other in your very own private ceremony where you renew your promise to each other to continue to work together.

Let go of having to "be right!" Healthy, full functioning couples find happiness is sharing their differences instead of being indifferent to them. They discover happiness in discussing, in a loving way, areas of mutual concern. It's true! Men and women are truly different, AND there are similarities.

Healthy couples identify problems, talk openly and honestly about their differences and choose workable solutions. Integrate your mutual intentions for a healthy, happy relationship or the relationship will evaporate.

Give each other room to grow. No one can grow in the shade. If you are always hovering over your partner, you are literally smothering the love that could be yours. Partners need time alone. They need space. Give it willingly. Take time to be alone with your thoughts. This is another way to attend to your needs.

Even though it may appear that you are from different planets because you share so little in your communication, it is possible for you to lay down your ray guns, seek peace and choose to travel in the same orbit, working together to celebrate your differences in ways that mutually benefit the relationship. Always remember: If God brings you to it, He will bring you through it!

Have sexual speed bumps slowed you down? Click here!
Has your relationship run out of gas?
Has one partner left the scene of the accident?
Need a relationship tow truck? Click here for help!

Here's your relationship road map! Click here for 52 relationship tips!

May all your "ups and downs" be beneath the sheets!

next: The Keys to Self-Acceptance

Detailed information on the physical and behavioral signs of drug and alcohol abuse.

If you notice unexplained changes in physical appearance or behavior, it may be a sign of drug abuse - or it could be a sign of another problem. You will not know definitively until a professional does a screening.

Physical Signs

• Change in sleeping patterns
• Bloodshot eyes
• Slurred or agitated speech
• Sudden or dramatic weight loss or gain
• Skin abrasions/bruises
• Neglected appearance/poor hygiene
• Sick more frequently
• Accidents or injuries

Behavioral Signs

• Hiding use; lying and covering up
• Sense that the person will "do anything" to use again regardless of consequences
• Loss of control or choice of use (drug-seeking behavior)
• Loss of interest in previously enjoyed activities
• Emotional instability
• Hyperactive or hyper-aggressive Depression
• Missing school or work
• Failure to fulfill responsibilities at school or work
• Complaints from teachers or co-workers
• Reports of intoxication at school or work
• Furtive or secretive behavior
• Avoiding eye contact
• Locked doors
• Going out every night
• Change in friends or peer group
• Change in clothing or appearance
• Unusual smells on clothing or breath
• Heavy use of over-the-counter preparations to reduce eye reddening, nasal irritation, or bad breath
• Hidden stashes of alcohol
• Alcohol missing from your supply
• Prescription medicine missing
• Money missing
• Valuables missing
• Disappearances for long periods of time
• Running away
• Secretive phone calls
• Unusual containers or wrappers

Sources:

• The National Institute on Drug Abuse
• American Institute for Preventive Medicine

next: Support Groups for Alcoholism - Drug Abuse and Addiction
~ addictions library articles
~ all addictions articles

I think a lot about the desultory waste that is my biography. Ask anyone who shared a life with a narcissist, or knew one and they are likely to sigh: "What a waste". Waste of potential, waste of opportunities, waste of emotions, a wasteland of arid addiction and futile pursuit.

Narcissists are as gifted as they come. The problem is to disentangle their tales of fantastic grandiosity from the reality of their talents and skills.

They always tend either to over-estimate or to devalue their potency. They often emphasize the wrong traits and invest in their mediocre or (dare I say) less than average capacities. Concomitantly, they ignore their real potential, squander their advantage and under-rate their gifts.

The narcissist decides which aspects of his self to nurture and which to neglect. He gravitates towards activities commensurate with his pompous auto-portrait. He suppresses these tendencies and aptitudes in him which don't conform to his inflated view of his uniqueness, brilliance, might, sexual prowess, or standing in society. He cultivates these flairs and predilections which he regards as befitting his overweening self-image and ultimate grandeur.

A slave to this pressing need to preserve a fake and demanding self, I dedicated years to commerce. I projected the spectre of a rich man (I never came close) of great power (I never had) and multitudinous connections throughout the world (mostly shallow and ephemeral). I hated every minute of wheeling and dealing, of cutting throats and second guessing, of the nauseatingly boring repetition that is the essence of this world. But I kept on trudging, unable to forsake the fear and adulation and media attention and frivolous gossip that gave me sustenance and constituted my very self-worth.

It took a catastrophic, Job-like, turn of events to wean me from this self-made dependency. Having emerged from prison, with nothing but the proverbial shirt on my back, I finally was able to be me. I finally decided to partake of both the joys and the successes of writing, my true skill and knack. Thus, I became an author.

But, the narcissist, no matter how self-aware and well-meaning is accursed.

His grandiosity, his fantasies, the compelling, overriding urge to feel unique, invested with some cosmic significance, unprecedentedly bestowed - these thwart the best intentions. These structures of obsession and compulsion, these deposits of insecurity and pain, the stalactites and stalagmites of years of abuse and then abandonment - they all conspire to frustrate the gratification, however circumspect, of the narcissist's true nature.

Consider, yet again, my writing. I am at my most effective when I write "from the heart", about my personal experiences and in a thoughtful-reminiscing mode. But, to my mind, such style serves the purpose of showcasing my sparkling intellect and my remarkable brilliance poorly. I need to impress and inspire awe more than I need to communicate with my readers and affect them. I act the academic which my laziness and sense of entitlement and lack of commitment prevented me from being. I am looking, once more, for a short cut.

I am blind to the fact that my prolix and babblative prose inspires more ridicule than awe. I ignore my incomprehensibility and the irritation I provoke with my moribund vocabulary, convoluted syntax and tortured grammar.

I present my half-baked ideas, based on a shaky and fragmented foundation of knowledge haphazardly gleaned, with the certitude of confidence of an authority - or a trickster.

Tis a waste. I have written heart-rending short fiction and powerful poetry.

I have touched the hearts of people. I have made them cry and rage and smile. But I have laid this part of my writing to rest because it does injustice to my grandiose perception of myself. Anyone can write a short story or a poem. Only the few - the unique, the erudite, the brilliant - can comment on the Measurement Problem, analyse Church-Turing machines and use words such as "atrabilious", "sesquipedalian" and "apothegm". I count myself among those few. By doing so, I betray my inner sanctum, my real potential, my gift.

This betrayal and the helpless rage that it provokes in one, if you ask me, is the very essence of narcissism.

next: The Split Narcissist - Unstable and Unpredictable and Deadly

• Routine
• Personality and Conduct
• The results:
• Instincts and Drives
• Object Relations
• Sample sentences of narcissists:
• Functioning and Performance
• Locations and Environment

Routine

I hate routine. When I find myself doing the same things over and over again, I get depressed. I oversleep, overeat, overdrink and, in general, engage in addictive, impulsive and compulsive behaviors. This is my way of re-introducing risk and excitement into what I (emotionally) perceive to be a barren life.

The problem is that even the most exciting and varied existence becomes routine after a while. Living in the same country or apartment, meeting the same people, doing essentially the same things (though with changing content)- all "qualify" as stultifying rote.

I feel entitled to more. I feel it is my right - due to my intellectual superiority - to lead a thrilling, rewarding, kaleidoscopic life. I feel entitled to force life itself, or, at least, people around me - to yield to my wishes and needs, supreme among them the need for stimulating variety.

This rejection of habit is part of a larger pattern of aggressive entitlement. I feel that the very existence of a sublime intellect (such as myself) warrants concessions and allowances. Standing in line is a waste of time best spent pursuing knowledge, inventing and creating. I should avail myself of the best medical treatment proffered by the most prominent medical authorities - lest the asset that is I be lost to Mankind. I should not be bothered with proofreading my articles (or even re-reading them) - these lowly jobs best be assigned to the less gifted. The devil is in paying precious attention to details.

Entitlement is sometimes justified in a Picasso or an Einstein. But I am neither. My achievements are grotesquely incommensurate with my overwhelming sense of entitlement. I am but a mediocre and forgettable scribbler who, at the age of 39, is a colossal under-achiever, if anything.

Of course, the feeling of supremacy often serves to mask a cancerous complex of inferiority. Moreover, I infect others with my projected grandiosity and their feedback constitutes the edifice upon which I construct my self esteem. I regulate my sense of self worth by rigidly insisting that I am above the madding crowd while deriving my narcissistic supply from this very thus despised source.

But there is a second angle to this abhorrence of the predictable. As a narcissist, I employ a host of Emotional Involvement Prevention Mechanisms (EIPM). Despising routine and avoiding it is one of these mechanisms. Their function is to prevent me from getting emotionally involved and, subsequently, hurt. Their application results in an "approach-avoidance repetition complex". The narcissist, fearing and loathing intimacy, stability and security - yet craving them - approaches and then avoids significant others or important tasks in a rapid succession of apparently inconsistent and disconnected behaviours.

Here is a partial (and truncated) list of other EIPMs. In this text - "objects" means "others".

From "Malignant Self Love - Narcissism Revisited":

"Emotional Involvement Preventive Measures

Personality and Conduct

• Lack of enthusiasm, anhedonia, and constant boredom.
• A wish to "vary", to "be free", to hop from one subject matter or object to another.
• Laziness, constantly present fatigue.
• Dysphoria to the point of depression - leads to reclusiveness, detachment, low energies.
• Repression of the affect and uniform emotional tint.
• Self-hatred disables capacity to love or to develop emotional involvement.
• Externalised transformations of aggression:
• Envy, rage, cynicism, vulgar honesty
• (all lead to dis-intimization and distancing and to pathological emotional and sexual communication)...
• Narcissistic compensatory and defence mechanisms: ...
• Grandiosity and grandiose fantasies
• (Feelings of) uniqueness

• Lack of empathy, or the existence of functional empathy, or empathy by proxy
• Demand for adoration and adulation
• A feeling that he deserves everything ("entitlement")
• Exploitation of objects
• Objectification/symbolization (abstraction) and
• Fictionalisation of objects
• Manipulative behaviours
  (Using personal charm, ability to psychologically penetrate the object, ruthlessness, and knowledge and information regarding the object obtained, largely, by interacting with the object)
• Intellectualisation through generalization, differentiation and categorization of objects.
• Feelings of omnipotence and omniscience.
• Perfectionism and performance anxiety (repressed).
• These mechanisms lead to emotional substitution (adulation and adoration instead of love),
• to the distancing and repulsion of objects,
• to dis-intimization (not possible to interact with the "real" Narcissist).

The results:

• Narcissistic vulnerability to narcissistic injury
• (More bearable than emotional vulnerability and can be more easily recovered from)
• "Becoming a child" and infantilism
  (The narcissist's inner dialogue: No one will hurt me, I am a child and I am loved without any reservations, judgement, or interests)
• Such expectations for unconditional love and acceptance do not exist among adults and they constitute a barrier to mature, adult relationships.
  Intensive denial of reality
  (perceived by others as innocence, naiveté, or pseudo-stupidity).
• Constant lack of confidence concerning matters not under full control leads to hostility towards objects and towards emotions.
• Compulsive behaviours intended to neutralize a high level of anxiety and compulsive seeking of love substitutes (money, prestige, power)...

Instincts and Drives

• • Sexual abstinence, low frequency of sexual activity lead to less emotional involvement.
  • Frustration of emotional objects through sex avoidance encourages abandonment by the object.
  • Sexual dis-intimization by preferring autoerotic, anonymous sex with immature or incompatible objects
    (who do not represent an emotional threat or demands).
  • Sporadic sex with long intervals and drastic alterations of sexual behaviour patterns.
  • Dissociation of pleasure centres:
  • Pleasure avoidance (unless "for and on behalf" of the object).
  • Refraining from child rearing or family formation.
  • Using the object as an "alibi" - extreme marital and monogamous faithfulness, to the point of ignoring all other objects leads to object inertia.
  • This mechanism defends the Narcissist from the need to make contact with other objects.
  • Sexual frigidity with significant other and sexual abstinence with others.

Object Relations

• Manipulative attitudes, which in conjunction with feelings of omnipotence and omniscience, create a mystique of immunity.
• Partial reality test.
• Social friction leads to social sanctions (up to imprisonment).
• Refraining from intimacy.
• Absence of emotional investment.
• Reclusive life, avoiding neighbours, family (both nuclear and extended), spouse and friends.
• The narcissist is often a schizoid (see FAQ67)
• Active misogyny with sadistic and anti-social elements.

• Narcissistic dependence serves as substitute for emotional involvement.
• Immature emotional dependence and habit
• Object interchangeability
  (dependence upon AN object - not upon THE object)...
• Limitation of contacts with objects to material and "objective" transactions.
  The Narcissist prefers fear, adulation, admiration and
• Narcissistic accumulation to love.
• To the narcissist, objects have no autonomous existence except as PNSS and
• SNSS (=primary and secondary sources of narcissistic supply).
  Knowledge and intelligence serve as control mechanisms and extractors of adulation and attention (=Narcissistic Supply).
• The Object is used to recreate early life conflicts:
• The Narcissist is bad and asks to be punished anew and to have confirmation that people are angry at him.
• The object is kept emotionally distant through deterrence and is constantly tested by the Narcissist who reveals his negative sides to the object.
• The aim of negative, off putting behaviours is to check whether the Narcissist's uniqueness will override and offset them in the mind of the object.
• The object experiences emotional absence, repulsion, deterrence, and insecurity.
• It is thus encouraged not to develop emotional involvement with the Narcissist
  (emotional involvement requires a positive emotional feedback).
• The erratic and demanding relationship with the Narcissist is experienced as a burden.
• It is punctuated by a series of "eruptions" followed by relief.
• The Narcissist is imposing, intrusive, compulsive, and tyrannical.
• Reality is interpreted cognitively so that negative aspects - real and imagined - of the object will be highlighted.
• This preserves distance, fosters uncertainty, prevents emotional involvement and activates Narcissistic mechanisms (such as grandiosity) which, in turn, increase the repulsion and the aversion of the partner.

Sample sentences of narcissists:

• • "The object is not as (some trait) as the Narcissist is",
  • "She is boring",
  • "She is dangerous because she is.",
  • "A stable relationship cannot be formed because."
  • Another interpretation offered by the narcissist:
  • The Narcissist chose the object because of an error/circumstances/pathology/loss of control/immaturity/partial or false information, etc.

Functioning and Performance

• A grandiosity shift:
• A preference to be emotionally invested in grandiose professional fantasies in which the Narcissist does not have to face a practical, professionally rigorous and constant path.
• The Narcissist avoids success in order to avoid emotional involvement and investment.
• He shuns a success which obliges him to invest and to identify himself with some goal and emphasizes areas of activity in which he is unlikely to succeed.
• The Narcissistic ignores the future and does not plan.
• Thus he is never emotionally committed.
• The Narcissist invests the necessary minimum in his job (emotionally).
• He is not thorough and under-performs, his work is shoddy and defective or partial.
  He evades responsibility and tends to pass it on to others while exercising little control.
• His decision making processes are ossified and rigid
• (He presents himself as a man of "principles" - usually his whimsical moods).
• The Narcissist reacts very slowly to a changing environment (change is painful).
• He is a pessimist, knows that he will lose his job/business - so, he is constantly engaged in seeking alternatives and constructing plausible alibis.
  This yields a feeling of temporariness, which prevents engagement, involvement, commitment, dedication, identification and emotional hurt in case of change or failure.
• The alternative to a spouse:
  Solitary life (with vigorous emphasis on PNSS) or another partner.

• This frequent change of vocations prevents the Narcissist from having a clear career path and annuls the need to persevere.
• All the initiatives adopted by a Narcissist are egocentric, sporadic and discrete.
• They focus on an aspect of the Narcissist, are randomly distributed in space and in time, and do not form a thematic or other continuum - they are not goal or objective oriented).
• Sometimes, as a substitute, the Narcissist engages in performance shifting:
  The construction of imaginary, invented goals with no correlation with the real world - and their attainment.
• To avoid facing performance tests and to maintain grandiosity and uniqueness the Narcissist refrains from acquiring skills and training (driving licence, technical skills, any systematic - academic or non-academic - knowledge).
• The Child in the narcissist is reaffirmed this way - because these are adult activities and attributes that are avoided.
• The gap between the image projected by the Narcissist (charisma, unusual knowledge, grandiosity, fantasies) and his actual achievements - create in him permanent feelings that he is a crook, a hustler, living an unreal life in a movie-like setting.
• This gives rise to ominous sensations of threat and, concurrently, to compensating feelings of immunity.
• The Narcissist is forced to become a manipulator.

Locations and Environment

• • A prevailing feeling of not belonging and of detachment.
  • Bodily discomfiture
    (the body feels as depersonalised, alien and a nuisance, its needs are totally ignored, its signals re-routed and re-interpreted, its maintenance neglected)
  • Distance from the political communities which the Narcissist inhabits (neighbourhood, city, state), his religion, his ethnic background, his friends.
  • He often adopts the stance of the "scientific observer".
  • This is Narcissistic Detachment - the feeling the Narcissist has that he is a director or an actor in a movie about his life.
  • The Narcissist avoids "emotional handles": photographs, music identified with a certain period in his life, places, people, mementoes and emotional situations.
  • The Narcissist lives on borrowed time in a borrowed life.
  • Every place and time period are but transitory (sufficient but not necessary) and lead to the next, unfamiliar environment.
  • The Narcissist feels that the end is near.
  • He lives in rented apartments, is an illegal immigrant in many countries, works without the necessary permits and licenses, is fully mobile on a short notice, does not buy real estate or immovables.
  • He travels light and he likes to travel. He is peripatetic and itinerant.
  • The Narcissist cultivates feelings of incompatibility with his surroundings.
  • He considers himself superior to others and keeps criticizing people, institutions and situations.
  • The above behaviour patterns constitute a denial of reality.
  • The Narcissist defines a rigid, impenetrable, personal territory and is physically revolted when it is breached."

next: Wasted Lives: Spending Time With A Narcissist

• Watch the video on Differences Between Healthy Daydreaming and Grandiosity

Sometimes I find myself bemused (though rarely amused) by my own grandiosity. Not by my fantasies - they are common to many "normal people".

It is healthy to daydream and fantasize. It is the antechamber of life and its circumstances. It is a process of preparing for eventualities, embellished and decorated. No, I am talking about feeling grandiose.

This feeling has four components.

OMNIPOTENCE

I believe that I will live forever. "Believe" in this context is a weak word. I know. It is a cellular certainty, almost biological, it flows with my blood and permeates every niche of my being. I can do anything I choose to do and excel in it. What I do, what I excel at, what I achieve depends only on my volition. There is no other determinant. Hence my rage when confronted with disagreement or opposition - not only because of the audacity of my, evidently inferior, adversary. But because it threatens my world view, it endangers my feeling of omnipotence. I am fatuously daring, adventurous, experimentative and curious precisely due to this hidden assumption of "can-do". I am genuinely surprised and devastated when I fail, when the Universe does not arrange itself, magically, to accommodate my unlimited powers, when it (and people in it) does not comply with my whims and wishes. I often deny such discrepancies, delete them from my memory. As a result, my life is remembered as a patchy quilt of unrelated events.

OMNISCIENCE

Until very recently, I pretended to know everything - I mean EVERYTHING, in every field of human knowledge and endeavour. I lied and invented to avoid proof of my ignorance. I pretended to know and resorted to numerous subterfuges to support my God-like omniscience (reference books hidden in my clothes, frequent visits to the restroom, cryptic notation or sudden illness, if all else failed). Where my knowledge failed me - I feigned authority, faked superiority, quoted from non-existent sources, embedded threads of truth in a canvass of falsehoods. I transformed myself into an artist of intellectual prestidigitation. As I advanced in age, this invidious quality has receded, or, rather, metamorphosed. I now claim more confined expertise. I am not ashamed to admit my ignorance and need to learn outside the fields of my self-proclaimed expertise. But this "improvement" is merely optical. Within my "territory", I am still as fiercely defensive and possessive as I have ever been. And I am still an avowed autodidact, unwilling to subject my knowledge and insights to peer scrutiny, or, for this matter, to any scrutiny. I keep re-inventing myself, adding new fields of knowledge as I go: finance, economics, psychology, philosophy, physics, politics... This crawling intellectual annexation is a round about way of reverting to my old image as the erudite "Renaissance Man".

OMNIPRESENCE

Even I - the master of self-deception - cannot pretend that I am everywhere at once in the PHYSICAL sense. Instead, I feel that I am the centre and the axis of my Universe, that all things and happenstances revolve around me and that disintegration would ensue if I were to disappear or to lose interest in someone or in something. I am convinced, for instance, that I am the main, if not the only, topic of discussion in my absence. I am often surprised and offended to learn that I was not even mentioned. When invited to a meeting with many participants, I assume the position of the sage, the guru, or the teacher / guide whose words survive his physical presence. My books, articles and web sites are extensions of my presence and, in this restricted sense, I do seem to exist everywhere. In other words, I "stamp" my environment. I "leave my mark" upon it. I "stigmatise" it.

NARCISSIST: THE OMNIVORE (PERFECTIONISM and COMPLETENESS)

There is another "omni" component in grandiosity. The narcissist is an omnivore. It devours and digests experiences and people, sights and smells, bodies and words, books and films, sounds and achievements, his work and his leisure, his pleasure and his possessions. The Narcissist is incapable of ENJOYING anything because he is in constant pursuit of the twin attainments of perfection and completeness. Classic narcissists interact with the world as predators would with their prey. They want to do it all, own it all, be everywhere, experience everything. They cannot delay gratification. They do not accept "no" for an answer. And they settle for nothing less than the ideal, the sublime, the perfect, the all-inclusive, the all-encompassing, the engulfing, the all-pervasive, the most beautiful, the cleverest, the richest. The narcissist is shattered by discovering that a collection he possesses is incomplete, that his colleague's wife is more glamorous, that his son is better than he in math, that his neighbour has a new, impressive car, that his roommate got promoted, that the "love of his life" signed a recording contract. It is not plain old jealousy, not even pathological envy (though it is definitely a part of the psychological make-up of the narcissist). It is the discovery that the narcissist is NOT perfect, or ideal, or complete - that does him in.

next: Narcissists and the Entitlement of Routine

In-depth look at what causes ADHD including: deficiency in neurotransmitters, genetics, brain abnormalities, environmental agents plus food additives and sugar.

Although the exact causes of ADHD are unknown, it is most likely caused by an interaction of genetic, environmental, and nutritional factors, with a strong focus on the interaction of multiple genes (genetic loading) that together cause ADHD.

The Role of Neurotransmitters in Attention Deficit Disorder

There is some evidence that people with ADHD do not produce adequate quantities of certain neurotransmitters, among them dopamine, norepinephrine, and serotonin. Some experts theorize that such deficiencies lead to self-stimulatory behaviors that can increase brain levels of these chemicals (Comings DE et al 2000; Mitsis EM et al 2000; Sunohara GA et al 2000).

Epinephrine
Epinephrine activation of receptors on the cranial vagus nerve increases the release of central norepinephrine and has been shown to enhance memory formation. Patients with ADHD have been shown to have a reduced urinary epinephrine level. Contrary findings are seen in patients with anxiety or PTSD. Given the high incidence of anxiety within ADHD patients as well as the increased risk of accident and injury, testing of epinephrine in ADHD patients should consider these other factors in order to have a better understanding of the role of epinephrine in ADHD.

Dopamine
ADHD is believed to be in part the result of a reduced or hypodopaminergic state. In conjunction with this assumption are the needs for stronger and less delayed behavioral reinforcement. Dopamine is involved in the reward cascade and the increased reinforcement threshold may be a manifestation of the hypodopaminergic state. Children with ADHD have displayed normal task performance under conditions of high incentive, but deficient performance under conditions of low incentive. Methylphenidate is believed to be beneficial in ADHD in part due to its ability to enhance dopamine signaling and therefore may enhance a deficient reward system in ADHD patients. Like many parameters that affect cognitive performance, dopamine levels also display an inverted U-shaped curve when plotted against factors like impulsivity.

The development of the dopamine system prior to and during early adolescence is quite rapid, while the development of the serotonin system during this same time remains steady. A relative deficit in dopamine maturity would be concordant with an increased impulsivity and increased reward threshold seen in ADHD.

A delayed rate of brain development in ADHD is also supported by studies that find patients have increased level of delta and theta brain wave activity compared to controls. Delta and theta brain wave activity normally decreases until adulthood. As such, increased delta and theta wave brain activity can be an indicator of slowed brain maturity. Differences in the rate of serotonin and dopamine system development also may explain why significant numbers of children outgrow their ADHD symptoms.

Norepinephrine
Norepinephrine is an excitatory neurotransmitter that is important for attention and focus. Norepinephrine is synthesized from dopamine by means of the enzyme dopamine beta-hydroxylase, with oxygen, copper, and vitamin C as co-factors. Dopamine is synthesized in the cytoplasm, but norepinephrine is synthesized in the neurotransmitter storage vesicles.; Cells that use norepinephrine for formation of epinephrine use SAMe as a methyl group donor. Levels of epinephrine in the CNS are only about 10% of the levels of norepinephrine.

The noradrenergic system is most active when an individual is awake, which is important for focused attention. Elevated norepinephrine activity seems to be a contributor to anxiousness. Also, brain norepinephrine turnover is increased in conditions of stress. Interestingly, benzodiazepines, the primary anxiolytic drugs, decrease firing of norepinephrine neurons.

PEA
PEA (phenylethylamine) is an excitatory neurotransmitter that tends to be lower in patients with ADHD. Studies that tested urine levels of PEA in subjects with ADHD during treatment with stimulants (methylphenidate or dextroamphetamine), found that the levels of PEA were increased. Additionally, studies report that the efficacy of the treatment correlated positively with the degree to which urinary PEA increased.

Serotonin
Many of the effects of serotonin occur due to its ability to modify the actions of other neurotransmitters. Specifically, serotonin regulates dopamine release. This is evident in the observation that antagonists of either the 5-HT2a or the 5-HT2c serotonin receptor will stimulate dopamine outflow while agonists inhibit dopamine outflow. Similarly, dopamine has a regulatory effect on serotonin and neonatal damage to the dopamine system has been shown to cause large increases in serotonin.

Aspects of the interaction between serotonin and dopamine are believed to affect attention. Evidence of this interaction is present in the observation that reduced serotonin synthesis impairs the positive effects of methylphenidate on learning. Meaning some aspects of methylphenidate's therapeutic effects require serotonin. Serotonin levels are significantly affected by stress and coping abilities combined with other environmental factors and the person's genetic make-up to determine serotonin activity.

Brain Structural Differences in Attention Deficit Hyperactivity Disorder

There may also be some structural and functional abnormalities in the brain itself in children who have ADHD (Pliszka SR 2002; Mercugliano M 1999). Evidence suggests that there may be fewer connections between nerve cells. This would further impair neural communication already impeded by decreased neurotransmitter levels (Barkley R 1997). Evidence from functional studies in patients with ADHD demonstrates decreased blood flow to those areas of the brain in which "executive function," including impulse control, is based (Paule MG et al 2000). There may also be a deficit in the amount of myelin (insulating material) produced by brain cells in children with ADHD (Overmeyer S et al 2001).

Some prenatal factors that increase the risk of developing ADHD have been identified. These include complications during pregnancy that limit oxygen supply to the brain such as toxemia and eclampsia. Other factors during pregnancy that have an impact on normal prenatal development and increase the risk of a child developing ADHD include smoking and fetal alcohol syndrome.

Other factors, such as stress, significantly affect the way the brain functions. If the temperament of the individual under stress allows them to cope in a positive manner, stress can actually increase performance and health. If however, the temperament of the individual under stress is such that the individual does not cope with the stress, the adaptive changes that allow the body to enhance its performance and stress may fail to function. This may lead to either an inability of the body to compensate or the inactivation of some neurological systems. Alternatively, neurological systems may become chronically elevated. In either case, the altered functions of these regions may underlie clinical symptoms.

Genetics and ADHD

Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population.⁶ Many studies of twins now show that a strong genetic influence exists in the disorder.

Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.

Environmental Agents

Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Brain Injury

One early theory was that attention disorders were caused by brain injury. Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with ADHD have been found to have suffered a traumatic brain injury.

Food Additives and Sugar

It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.³ A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.⁴

In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.⁵

Source: NIMH ADHD Publication

next: Misdiagnosing ADHD

male sexual problems

You can begin by discussing your impotence with your family doctor. Many primary care physicians are not treating impotence in their practices. If your family doctor does not treat impotence, he or she will probably refer you to a urologist.

The physician who treats your impotence should first determine the cause of your impotence and then help you choose the simplest, safest and most effective treatment option for you.

You should know that difficulties in getting or keeping an erection is a common problem among men. The following treatments for impotence may be considered. Your doctor will be able to discuss these treatments with you in more detail and advise you on the advantages and disadvantages of each.

• Talk to your partner. Impotence won't go away unless you face up to it. If you're in an ongoing sexual relationship, then being open and honest with your partner can help identify any anxieties that might be causing the problem.
• Sex counseling or sex therapy. This can be effective for the small percentage of men who have psychological impotence. Sex counseling or sex therapy is most often successful when you have a cooperative partner willing to attend sessions with you.
• Lifestyle changes.Cutting out alcohol, tobacco and recreational drugs can lead to significant improvements.
• Vacuum device. This technique uses a mechanical device which creates a vacuum around the penis and causes it to enlarge in a way that is similar to a natural erection. In order to maintain the erection, a tension ring (similar to an elastic band) must be pushed onto the base of the penis. This stops the blood escaping from the penis too quickly, and with the tension ring in place, the erection can be maintained for up to 30 minutes.

• Penile injection therapy. Medication is injected into the base of the penis, causing the penis to become hard almost immediately and the erection to last for one to two hours.
• Penile insertion (transurethral) therapy. This involves inserting an applicator containing a tiny pellet of medication into the end of the penis. Once the pellet is released, it causes an erection to develop over the next 10 to 30 minutes.
• Penile implants. This is a surgical procedure which involves the permanent insertion of a cylinder in the penis, which is connected by a tube to a pump in the scrotum. This procedure permanently alters the penis so that a natural erection will never again be possible.
• Drug therapy. Drug therapy for impotence (Viagra) has received a great deal of publicity. The drug works by opening up the blood vessels to the penis, so it may help patients who have trouble achieving erection due to lack of blood supply to the penis. It is not suitable for patients with heart problems.
• Hormone replacement therapy. In the form of testosterone injections can be effective for the 3-5% of men who are impotent due to a low level of male hormone.

New Drugs to Treat Impotence

Every man's worst nightmare is to realize, in the heat of a passionate moment, that he can't get an erection. Lucky for many men, we live in the twenty-first century and all the research in medicine is starting to pay-off. Today if you have erectile dysfunction, you have a variety of treatment options at your disposal, as well as quick fixer-upper drugs that can provide a temporary solution. We've already discussed the causes of impotence, treatment options, and where to find a specialist. But what many men want to know, is if there are treatment options available that don't require any surgery. The answer is "yes".

a gleam of hope

Thanks to modern medicine, a man can soon choose from a variety of new erection drugs. For men who have problems with their Willy, here is an introduction to the new impotence drugs awaiting approval from the FDA.

• Nasal Spray: This one gives new meaning to the expression, getting high from snorting. There is still no name for this product, developed by Nastech Pharmaceuticals. The spray works by delivering a dose of apomorphine into the nose. One snort allegedly gives you an erection in five minutes. One of the known side effects is nausea and because nasal delivery puts a large amount of the drug into the bloodstream at once, side effects worsen. You can expect to find it on the market by Spring 2002.

  • Vasomax: A pill that is supposedly safe for heart patients. This little pill by Zonagen Inc. contains phentolamine mesylate, a drug that dilutes the blood vessels in the penis. It works in about 20 to 30 minutes and it doesn't increase blood pressure. Human trials found that Vasomax caused erections in 40% of users. Some of the known side effects are nasal congestion and dizziness. You can expect to find it on the market by Spring 2001.

  • Alprox-TD: A topical gel made by NexMed Inc. contains alprostadil, a drug used in injectable impotence treatments. The drug works by allowing greater blood flow through the relaxation of the corpus cavernosum muscle. One of the perks to this gel is that most of the drug stays on your penis therefore minimizing side effects. Human trials found that the gel produced erections in 75% of men within 20 minutes. Some of the known side effects are a slight warming sensation in the penis. You can expect this gel on the market by Spring 2001.

  • Uprima: A tablet produced by TAP Pharmaceuticals contains apomorphine, a drug that is used in case of poisoning. It is placed under the tongue and begins working through a chemical reaction within the brain causing blood flow throughout the entire body. The drug is safer for heart patients and men who take anti-depressants. Human tests show that 58% of users had an erection within 20 minutes.

  • IC351: Created by Lilly Icos, the same makers of the famous Viagra pill. Viagra's big brother inhibits the phosphodiesterase type 5 enzyme, which constricts muscles and allows greater blood flow. The pill is still in its initial clinical trials. Some of the known side effects are the same as Viagra - headaches and flushes - but not as strong. It is still not recommended for men with heart conditions. You can expect to find it on the market by 2002.

These are just some of the drugs that are being developed to help men, especially those in their middle ages. But if you don't have an erectile dysfunction (why are you reading this article?), then you can at least use some of this information to make money on the stock market.

It is very important that you consult your doctor or a specialist before tying any of these new miracle drugs. For more information about impotence, check this out.

next: The Truth About Impotence