Depression frequently goes hand-in-hand with physical illness. Particularly noteworthy are thyroid or other hormonal disorders, which appear to affect brain chemistry and bring about depression. For newly diagnosed patients, most doctors will order blood tests to rule out thyroid problems, simply because this is so common.

Another known cause of depressive symptoms is chemotherapy (depression in cancer patients). The reasons for this aren't clear. It's possible that the chemotherapy medications themselves bring them about (either by directly affecting brain chemistry, or indirectly by disturbing hormone balance, or causing fatigue and generally draining the body), but just as likely is that the length and severity of treatment create feelings of despair and anguish, which become depression.

Similarly, depression often accompanies chronic pain, because of long, exhaustive and ultimately ineffective treatments. And quite understandably, many of the terminally ill experience depression, for reasons which are obvious.

Finally, it's worth noting that anyone who already has clinical depression, may have this condition aggravated by the onset of a physical illness. Even something as minor as a cold or the flu can make a depressed person feel worse about themselves and worsen their depression.

next: Effects Of Depression On Family and Friends
~ back to Living with Depression homepage
~ depression library articles
~ all articles on depression

When you have a psychological disorder such as depression or anxiety, a healthy lifestyle should be part of your treatment program.

It's just as important to take positive measures to stay well as it is to seek treatment when you're unwell.

Below we list some things that are important for general mental well-being - and many are also important for physical well-being.

If you have other suggestions on ways of staying well, please feel free to share them with us and we'll add them to our list.

• Exercise
• Diet
• Stress management and relaxation
• Meditation
• Reading

Exercise

Apart from its physical benefits, exercise has been shown to have very positive effects upon mental well-being. Exercise not only releases endorphins (the 'feel good' chemicals that also alleviate pain) into our bloodstream, but also increases serotonin, which has a number of benefits including lifting our mood and helping to counteract insomnia.

The good news about exercise is that it doesn't have to be strenuous for us to feel some of these benefits. Experts say that even 30 minutes of walking at least 3 times a week is a good start.

It can help to find someone else to exercise with. This makes it sociable, as well as more likely to be regularly maintained.

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Looking after your diet

Most people know that having a healthy diet is vital to good health. We tend to generally feel better when we eat well.

To summarize the key dietary guidelines for adults:

• Eat plenty of vegetables, legumes and fruits
• Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain
• Include lean meat, fish, poultry and/or alternatives
• Include milks, yoghurts, cheeses and/or alternatives. Reduced-fat varieties should be chosen, where possible
• Drink plenty of water
• Limit saturated fat and moderate total fat intake
• Choose foods low in salt
• Limit your alcohol intake if you choose to drink
• Consume only moderate amounts of sugars and foods containing added sugars.

A number of studies have shown that, in addition to looking after your diet and general nutrition, there are some specific dietary approaches that may help depression and mood disorders. They are:

• avoiding alcohol if you're a heavy drinker
• avoiding caffeine if you're sensitive to caffeine (however further research is necessary)
• increasing the amount of Omega 3 oils in your diet
• avoiding sugar (however further research is necessary).

Stress management and relaxation

Minimizing harmful stress is a vital component of mental well-being. We have shown elsewhere the key links between stress and mood disorders.

Ways of coping with stress are many and varied. Stress reduction and relaxation courses are offered by many organizations including local councils, community health centers and evening colleges. Your doctor may be able to suggest such courses. Relaxation can be as simple as taking your dog (black or any other color will do) for a leisurely stroll in a park, having a warm bath, or listening to some nice music. It can also involve more structured techniques to voluntarily control and relax the muscles. The idea is that practicing such techniques enables someone to use them whenever they begin to feel anxiety or stress developing. They include:

• 'Ten Hints to Avoid Harmful Stress' [PDF, 55KB]
• Better Health Channel, Stress in Everyday Life
• Effects of stress on the immune system: ABC Radio National, the Health Report, 27/4/98
• 'Quick Relaxation Techniques' [PDF, 65KB]
• Cognitive Therapy - 'Thinking Your Way Out of Depression' [PDF, 81KB]
• Getting adequate sleep.

Reading

Reading can be a good way of staying positive and helping to keep yourself on track, mentally. There are many titles that provide practical approaches and strategies for living with illnesses, and many of a more inspirational nature. Your local library is likely to stock some of these.

Meditation

Many people find meditation a vital part of their recovery from mental illness as well as their day-to-day routine when they are well. Meditation is believed to be very helpful for people with depression.

Meditation as a practice is found in many religious and spiritual traditions but is also used by people of no particular religious denomination as a way of experiencing calmness, and heightened awareness. Alpha waves are generated when a person meditates and they result in a relaxing of the entire nervous system.

Meditation essentially involves clearing one's mind of thoughts and being mentally quiet for a period of time. There are a number of different techniques that are used to achieve this, including:

• Focusing on your breathing
• Focusing on an object, such as a candle, or something from nature such as a tree
• Using a mantra - a word or phrase that is repeated usually internally to focus the attention
• Forms of movement that focus the mind, such as yoga or tai chi.

There are many places where you can learn meditation. Your local community centre or local library may have listings of such places. You could also look up your Yellow Pages for organizations that teach meditation.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

Excerpts from the Archives of the Narcissism List Part 7

1. Can Narcissists be Cured?
2. My Shame
3. Luring a Narcissist
4. The Enemy
5. Victim or Survivor?
6. Narcissists as Drug Addicts
7. Alexander Lowen
8. NPDs and other PDs
9. Incest without Sex?
10. NPD and DID
11. Plasticity
12. A Core of Values?
13. Licensing Parents (continued)
14. Nations as Patients
15. Narcissistic Myths

1. Can Narcissists be Cured?

Narcissists can rarely be cured. A fact. In the early 1980's therapists thought otherwise (Lowen, 1983). They were wrong. Now we have epidemiology and statistics. Therapists have been fooled by smart narcissists and most narcissists are smart and chameleon- or Zelig- like, so they learn how to deceive the therapist. You can see it very often in prison.

Why fight windmills? As in Judo, I use my weaknesses and the enemy's strengths against it.

I am saying: "I have tendencies that hurt people. Very bad. I will find ways to use these very tendencies to help people. Very good".

2. My Shame

I envy you for being able to identify the exact sources and realms of your shame.

My shame was all-pervasive. I virtually drowned in it, suffocating, suffused by it. I was not only ashamed at my incompetence (athletic, social). I was ashamed at my body, deficiencies, lack of social skills. I was ashamed at my parents, my neighbourhood, my ethnic background, my socio-economic status, the quality of my possessions. I was pathologically envious as a result and I started on my way to full blown NPD because of this shame (and abuse/trauma).

I remember the exact moments and dynamics of overcoming my shame. I consciously developed my personality disorder, it seems to me in retrospect. My grandiose fantasies were first elaborated cognitively and then assimilated (emotionally?). I invested a great effort at mimicking others to the point of becoming indistinguishable from them. Like a Trojan horse my aim was first to penetrate the walls of shame, so that later I would be able to feed my entitlement, my grandiosity and to impose my idiosyncrasies on others from the inside.

I still am a believer in the transforming power of shame and in its central role in the formation of personality disorders. I think it is not only an integral but a crucial part of any childhood abuse.

I can't discuss the sociological dimensions much. But from corresponding with literally thousands of self-designated and expertly-diagnosed narcissists and with their victims I can safely identify the role of shame in the psychodynamics of pathological narcissism.

3. Luring a Narcissist

Narcissists are drug addicts and the name of the drug is narcissistic supply (NS). Give a narcissist NS and he will do ANYTHING for it. Now, you must be creative and think HOW and WHAT can you offer to him. Also, can you fake, WILL you fake? You can tell him you need him, for instance. This is very pure NS, it is gratifying. In the personal, fantastic mythology of the narcissist, this is olympic victory over the bad, humiliating guy (you). You can make him a collaborator in a "conspiracy". There is any number of ways to make a deal with a narcissist. Your currency in the transaction is his NS.

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4. The Enemy

Narcissism is partly a reactive formation, a complex of intertwined defense mechanisms, a network of survival tactics. One develops narcissism because the alternative is death (slow or fast). Death from emotional starvation, pain, abuse, and trauma. These negative emotions coupled with the negative events that fostered them sink and accumulate in one's spiritual veins, a sediment leading to the emotional infarct called "narcissism".

Without my narcissism, I am not only naked - I am a fetus. I am exposed to bursts of hurt that stand an excellent chance of eliminating me altogether, emotionally, perhaps physically. My narcissism is functional, it is adaptive, it helps me breathe. By denying and repressing my SELF, I deny and suppress my biggest enemy.

I have seen the enemy - and it is I.

5. Victim or Survivor?

Although the prognosis is encouraging, the appropriate term is "victim" and not anything else. Or maybe "surviving victim". Living with a narcissist is the equivalent of enduring a natural catastrophe (like a hurricane). Leaving him is surviving a natural catastrophe. But the narcissist has a mind, a consciousness, intentions. He can control many of his behaviors. So, he victimizes and the survivors are also victims. The narcissist victimizes by contempt, humiliates by indifference, subjugates by fear, and conditions by alternating between idealization and devaluation.

Did you see "Good Will Hunting"? Robin Williams, the therapist, clasps Will's shoulders, looks him in the eyes, and repeats a mantra of healing, ever softly but firmly: "You are not guilty" (until Will breaks into tears).

6. Narcissists as Drug Addicts

Narcissists are drug addicts. Their drug is called "narcissistic supply". They will do ANYTHING to obtain it, both morally acceptable and morally reprehensible. Give him his supply and he will read about narcissism enthusiastically and incessantly. Be creative. For instance: tell him that you NEED him to EXPLAIN to you about narcissism. You have been trying to understand this complex concept by yourself and failed. Think of other ways to boost his supply. Believe me, with the proper inducement he will become a world expert on pathological narcissism and I will be out of a job ... :o((

7. Alexander Lowen

I do distinguish between cerebral and somatic narcissists and in my FAQ 40 "Narcissism - The Psychopathological Default" I use a typology very close to Lowen's. Let me state that I regard Lowen's book as superb but not my cup of tea for a few reasons:

1. I am much less interested in the narcissist - and much more in his victims. My book is chiefly and primarily intended to assist those who have been inadvertently exposed to this hurricane known as the narcissist.

1. I think the fad of classifying (DSM style) is fast dying all over the world. It started in order to assist mental health professionals in their dealings with insurance companies. Psychiatry tried to resemble Medicine in which everything has a name and there are clear syndromes, signs and symptoms. I think it has been a wrong, reductionist, approach in medicine and led to an impasse. But it was doubly and triply wrong in psychiatry. The result of this alien imposition was "multiple diagnoses (co-morbidity)" and absolute confusion in new fields of knowledge (such as personality disorders).

I believe that there is a continuum between families of mental health disorders. I believe that HPD is a form of NPD where the narcissistic supply is sex or physique. I think that BPD is another form of NPD. I think that all AsPD are NPDs with a twist. I think that pathological narcissism underlies all these - wrongly distinguished - disorders. This is why my book is entitled NARCISSISM revisited and not NPD.

Lowen is a magnificent taxonomist of narcissism but I think his fine tuning is much too fine. I think that people are much less precise than Lowen would have us believe.

I think Lowen is wrong in implying that not all narcissists are pathological liars. He simply does not attribute too much importance to this fact. Virtually all the big names in PD research regard pathological lying as a trait of narcissists. Even the DSM defines NPD using words such as "fantasy", "grandiose" and "exploit" which imply the usage of half truths, inaccuracies and lies on a regular basis. Kernberg and others coined the term "False Self" not in vain.

Of course narcissists love to have an audience. But they love an audience only because and while it provides them with narcissistic supply. Otherwise, they are not interested in human beings (they lack empathy which makes other humans much less fascinating than they are to empathic people).

Narcissists are terrified of introspection. Not of intellectualization or rationalization or simple application of their intelligence - this would not constitute introspection. Proper introspection must include an emotional element, an insight and the ability to emotionally integrate the insight so that it affects behavior. Some psychologists are narcissists and they KNOW it (cognitively). They even think about it from time to time - is this introspection? Not in my book. Narcissists do engage in real introspection following a life crisis, though. They attend therapy at such time.

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8. NPDs and other PDs

NPDs are afraid of abandonment and do everything they can to bring it about (and thus "control" it). BPDs are terrified of abandonment and they do everything they can either to avoid relationships in the first place - or to prevent abandonment (cling to the partner or emotionally extort him) once in a relationship.

But I think that these distinctions are pretty artificial and this is why we always have multiple diagnoses.

I think that the differential diagnoses between the Cluster B disorders are pretty artificial. It is true that some traits are much more pronounced (or even qualitatively different) in any given disorder. For example: the grandiose fantasies typical to a narcissist (their pervasiveness, their influence on the most minute behavior, their tendency to inflate and so on) - are rather unique in both severity and character to NPD.

But I think that all Cluster B disorders lie on a continuum. HPD, to me, is an NPD whose source of narcissistic supply is bodily/sexual. There is a mild variant of this in NPD: the somatic narcissist. The diagnostic criteria seem to overlap.

It used to be thought that NPDs are ego-syntonic ALL the time. That they do not have reactive psychoses and do not suffer from psychotic microepisodes under stress. Recent research has disproved these "differential diagnoses criteria". NPDs are so much like BPDs in so many respects that the likes of Kernberg suggested to abolish the distinction. All Cluster B PDs seem to arise from pathological narcissism.

NPD rarely comes in its "pure" form. It joins forces with other disorders (OCD, BPD, HPD, AsPD).

9. Incest without Sex?

Not in the legal sense but surely in the theological and philosophical ones. Incest can be a product of the mind or the spirit as well as of the flesh. We still attribute magical qualities to words and letters. A thought can be as destructive (and often more) as an act. The Church (mainly the Catholic but also others) always maintained that such "intellectual" sins (heresy, for instance) should be dealt with with no less severity than acts.

More pragmatically:

The main problem with incest in today's world is not genetically defective progeny or problems with the rules of inheritance. These were the original (pretty good) reasons to prohibit incest. A good quality condom can take care of that. The problem is the ensuing disruption to the relationships among the family members and the dysfunction of the whole family unit which follows. The prevention of this disruption is a good enough justification for observing the incest taboo (to my mind).

10. NPD and DID

I say that the narcissist vanishes and is replaced by a False Self. There is NO True Self in there. It's gone. The Narcissist is a hall of mirrors - but the hall itself is an optical illusion created by the mirrors ... This is a little like the paintings of Escher.

MPD(Multiple Personality Disorder or DID - Dissociative Identity Disorder) is more common than believed. In DID, the emotions are segregated. The notion of "unique separate multiple whole personalities" is primitive and untrue. DID is a continuum. The inner language breaks down into a polyglottal chaos. Emotions cannot communicate with each other for fear of the resulting pain (and its fatal outcomes). So, they are kept apart by various mechanisms (a host or birth personality, a facilitator, a moderator, and so on).

All PDs - except NPD - suffer from a modicum of DID, or incorporate it. Only narcissists don't. This is because the narcissistic solution is to emotionally disappear so thoroughly that not one personality/emotion is left. Hence, the tremendous, insatiable need of the narcissist for external approval. He exists ONLY as a reflection. Since he is forbidden from loving his self - he chooses to have no self at all. It is not dissociation - it is a vanishing act.

This is why I regard pathological narcissism as THE source of all PDs. The total, "pure" solution is NPD: self extinguishing, self abolishing, totally fake. Then come variations on the self hate and perpetuated self abuse theme: HPD (NPD with sex/body as the source of the narcissistic supply), BPD (lability, movement between poles of life wish and death wish), and so on.

Why are narcissists not prone to suicide? Simple: they died a long time ago. They are the true zombies of the world. Read vampire and zombie legends and you will see how narcissistic these creatures are.

11. Plasticity

You are assuming that brains are rigid. But recent research shows that brains are more plastic than we imagined. So, genetic predisposition, abuse, trauma, and neglect mould the brain at an early stage. But some of it seems to be reversible. I was subjected to abuse. I did turn out to be a monster. Then I had a life crisis of all-pervasive proportions. And now, I am the same BUT I channel my propensities positively. I am looking for narcissistic supply by helping others. I am empathizing through my overpowering (malignant) intellect. PDs are VESSELS, bottles and pots - you can fill them with any wine or food you want.

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Take a psychopath: he can put his disorder at the service of a higher cause (military, secret service, fighting the bad guys). Take a narcissist: he can obtain narcissistic supply by helping others and thus securing their praise.

12. A Core of Values?

I, for one, DO share the BELIEF that there is a core of values, inalienable and universal, culture independent, period independent, and society independent.

This is a highly disputable contention in modern moral philosophy.

But even if we accept it, the problem, of course, is to AGREE what values belong to this core. I think "Thou shalt not kill" belongs to it. I believe almost everyone will agree with me. Admittedly, the "almost" is there but it is very negligible.

I don't think one can claim the same universal status for Incest. There have been many cultures in which it has been the norm (within certain classes). There is a substantial minority who believe that, in this day and age, with contraceptives, if two consenting adults who happen to share 50% of their genetic material, wish to engage in sex, they should not be condemned, or at least not stopped. I think otherwise (for very pragmatic reasons) - but there ARE those who think differently.

13. Licensing Parents (continued)

I once suggested half-jokingly that parents should not be allowed to become parents unless and until they are:

1. Educated by professionals to become parents

2. Tested and get some "on the job" training under supervision (an internship)

3. Tested for medical (and mental health) eligibility

4. Licensed with the licence renewed periodically

We licence people to drive lorries and sell groceries. Presumably there is nothing more important (socially and morally) than child rearing, yet this field of human life and endeavour is wide open to anyone, regardless of the consequences to the off-spring.

Of course this opens up a can of moral, ethical and philosophical worms (in whom or what shall the authority to licence parents be vested? What moral criteria should be applied? Is the right to breed inalienable? and so on). But the idea is intriguing and not entirely without merit. After all, it is society that bears the cost of parental incompetence.

I wholeheartedly agree that ONLY parents are to BLAME for abuse and neglect. I take back my unfortunate use of the words "genetic propensity" or disposition of the infant not to attach. This would be a highly unlikely event (counter-survival, as it were). I modify this and now talk about "warm" or "detached or cold" babies (or social and asocial ones).

But I never intended to apportion blame. I wanted to discuss TRIGGERS, not who is guilty, WHY - not WHO. I offered an OBSERVATION that some babies do not attach, not an idea that they are to be blamed for their own abuse. Mothers consistently and insistently claim that their babies have a "character" almost immediately after being born. They probably are projecting (this has never been proven, to the best of my limited knowledge, though). OR, they might be on to something. Whatever it is - it might trigger abuse and neglect if there is incompatibility between mother and child.

I was NOT referring to innate differences in children, or even to the perception of such differences (if they do exist and are not merely projective in nature). I was talking about the perception of these differences as a TRIGGER to abuse and neglect. And I was not talking about theorizing but about research, experimentation, "hard" "facts".

14. Nations as Patients

Sometimes I think that a new branch of psychology should be created: "geopsychology". I believe that nations and ethnic groups react as individuals do. Having been subjected to abuse/trauma, a nation or an ethnic group is likely to develop a personality disorder. This is NOT stereotypizing. To stereotypize is to believe that you know everything about an individual from his/her national, or racial, or ethnic, or social, or cultural affiliation. I reject this. Each of us is a universe unto itself. Only some of us have black holes in our midst, or a nebula. I believe that the application of individual-orientated psychological theories and treatment methods to nations and ethnic groups should not be ruled out.

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15. Narcissistic Myths

I have to dispel two hidden assumptions. The first is that there is such thing as a typical narcissist. Well, there is, but one must specify whether we are dealing with a cerebral narcissist or a somatic one.

A cerebral narcissist uses his intelligence to obtain narcissistic supply. A somatic narcissist uses his body, his looks and his sexuality to do likewise. Inevitably, each type is likely to react very differently to a narcissistic injury brought about by an accident.

Somatic narcissists are a variation upon the HPD theme. They are seductive, provocative and obsessive - compulsive when it comes to their bodies, their sexual activities, their health (they are likely to be hypochondriacs as well).

The second "myth" is that narcissism is an isolated phenomenon that can be distilled and dealt with in purity in the laboratories of the mind. This is not the case. Actually, due to the fuzziness of the whole field, diagnosticians are both forced AND encouraged to render multiple diagnoses ("co-morbidity"). NPD usually appears in tandem with some other Cluster B disorder (such as AsPD, HPD or, most often, BPD).

Narcissists VERY rarely commit suicide. It runs against the grain. They have suicidal ideation and reactive psychoses under severe stress - but to commit suicide runs against the grain of narcissism. This is more a BPD trait. A differential diagnosis of NPD actually almost rests on the absence of attempted suicide and self-mutilation.

In response to a life crisis (divorce, disgrace, imprisonment, accident, and severe narcissistic injuries) the narcissist is likely to adopt either of two reactions:

EITHER

• To finally refer himself to therapy, realizing that something is very wrong or dangerously wrong with him. Statistics show that all types of therapies are very ineffective when it comes to narcissists. Soon enough, the therapist is bored, fed up or actively repelled by the grandiose fantasies and open contempt of the narcissist. The therapeutic alliance crumbles and the narcissist emerges "triumphant" having depleted the therapist's energy.

OR

• To frantically grope for alternative sources of narcissistic supply.

Narcissists are very creative. If all else fails, they exhibitionistically make use of their own misery (as I do). Or they lie, create a fantasy, invent stories, harp on other people's emotions, forge a medical condition, pull a stunt, fall in ideal love with the chief nurse, make a provocative move or a crime. The narcissist is bound to come up with a surprising angle.

Experience shows that most narcissists go through (a) and then through (b).

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next: Excerpts from the Archives of the Narcissism List Part 8

"Having it all" isn't the be all and end all. This essay, directed towards women, speaks about balance, cultural myths, happiness and well-being.

Life Letters

How many times have you received the message either inferred or directly that, "You can have it ALL!" What an offer, what a dream, what a promise, what a lie...

For years, most people who knew me believed that I "had it ALL." And I might have even agreed with them not so long ago. I had a successful private practice, a loving marriage that now spans two decades, a healthy blond haired, blue eyed daughter, a Ph.D., wonderful friends, a close extended family, a cottage on the water to escape to, mutual funds, stocks, an IRA, and plenty of money in the bank.

So how come I wasn't living "happily ever after?" I had more than my young girl fantasies had ever promised. Why wasn't I satisfied? What was wrong with me? Was I just another "spoiled baby boomer?" Did I expect too much? Demand too much?

Or, was it that I had too much? Too many appointments, too many obligations, too many goals, too many roles, too many deadlines, too many plans, too much to maintain, too much to loose...

Most parents want their children to have better lives. Ours wanted more money, more opportunities, more security, and more choices for us. We wanted more too, and that's exactly what many of us got - more. More materials, more opportunities, more education, more technology, more stress related disorders, more failed marriages, more latch key children, and more demands. We got, I believe, a whole lot more than most of us bargained for.

We wanted the "good life." I wanted the "good life." I was told in countless ways that it was possible for me to achieve it - if I was smart enough, motivated enough, disciplined enough, willing to work hard enough. If I was "good" enough, it could be mine. And so I did my very best to be and do all of those things. I wanted MINE.

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As I struggled to achieve, I began to succeed in obtaining and accumulating all of the trappings of the "good life" I had fought so hard for. But along with the college degrees came student loans, the house came with a significant mortgage, the private practice came with significant demands, the cottage required upkeep, the marriage called for compromises, the child came with no instructions but with numerous responsibilities, and each friend offered his or her own unique gifts as well as obligations. Along with my 'good life' came more and more and more...

I had a full life. It was so full, that all too often it felt that I would explode. I was becoming a woman of means too. I had the means to do and buy a number of things, and I did them, and bought them, until one day I was surrounded - by THINGS - to have and to hold. I had so much of it ALL that all I needed now was time. I wanted just a little more time please, so that I could do it ALL - with the ALL that I had. It seemed ironic that with the ALL that I'd gained, I couldn't have more of such a small thing. Just a wee thing that didn't take up physical space, didn't require maintenance or a mortgage, just a tiny request really - Just a little more time...

One day, in the midst of my plenty, I recognized that I was starving - craving a few totally pointless moments, a period of doing nothing, to just "be" and not "do." How difficult that was to accomplish in spite of ALL that I'd achieved and accumulated. I was surrounded by it ALL.

I had so many CHOICES. Where were they? They were looking me right in the eye and smirking.

"Should I close my practice?" I considered. "And what will become of your clients? How will you get by on just one income? What about those degrees you're still paying on? What will happen to those dreams of yours? How will you pay for your daughter's gymnastic classes, her college, family vacations, and be certain that your financially secure in old age?" the voice demanded.

"Should I stay working?" I wondered. "And how will you give your daughter the quality time she deserves? How will you find time to contribute to your community? When will you ever write your book? How will you manage to stay involved in your daughter's school, connected to your family and friends, keep a journal, and read all of the books that you keep saying you're going to read that aren't work related? Who will tend your garden, keep your bird feeders filled, see that your family's diet is healthy, make dental appointments, see to your daughter's homework, and that your dog has his shots? How will you do all of that and still manage to live a life that doesn't exhaust you?" the voice taunted. "I'll manage. I have so far" I replied. "And is this the life you want for your daughter?" queried the voice. "Absolutely not! I want more for her," I quickly replied. "Maybe you should want less for her," the voice retorted.

Want less? I wanted her to have every opportunity that I had and more. And then it hit me. The more had become my problem. I had bought into one of the most popular myths of my generation - that I could have it ALL.

No-one can have it all. We each must make choices, it's a fundamental law that not one of us escapes. When we choose one path, we forsake another, at least for the time being. We can't do it ALL without making sacrifices.

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If a woman chooses to work and parent at the same time, it doesn't necessarily mean that she'll compromise the well-being of her child. But she will give up something. In many cases it means giving up time for herself - time to nurture her other relationships, and to develop significant aspects of her inner life. It may not be fair, but it's true.

If a woman chooses not to bare children, it doesn't mean that she's robbing herself of her biological right or forsaking her duty. It does mean that she'll miss certain experiences that many women hold sacred. She can't simply replace them with additional adventures and opportunities, but she can be fulfilled and complete without them.

If a woman chooses to stay at home with her children, it doesn't mean that she'll automatically be a better parent than her working peers, or that she'll stop growing. It does mean in most cases that she and her children won't be able to spend money as freely as those families who possess two incomes, but she'll have more choices regarding how she spends her time.

If a man decides to abandon the fast track in order to pursue another calling, it doesn't automatically follow that he'll die poor, any more than it guarantees that he'll live happily ever after. It does mean that he's not as likely to possess the financial and material options of his corporate brothers, but he will most likely possess a sense of freedom that most of those he left behind can only hope for in retirement - if they live that long.

There are no simple answers. No perfect path to follow. There is no way to obtain "everything" and give up "nothing." We all understand that intellectually, and yet somehow many of us are still trying to figure out how to get around this fundamental truth.

Lilly Tomlin, the comedian perhaps best known for her portrayal of the precocious little "Edith Ann," quipped, "If I'd known what it would be like to have it all, I might have settled for less."

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But I wasn't raised to "settle." My generation which has been touted the largest, most educated, and most advantaged group in the history of the United States, has been born and bred to expect the riches and opportunities we were promised. And we struggle to claim them long after Bob Welch reported in More to Life Than Having it All, that according to two separate studies published in Psychology Today, we are five times more likely to be divorced as our parents, and ten times more likely than our elders to be depressed. We keep scrambling for more, and more is what we have ultimately gotten, I guess...

We want the 'good life' we've heard so much about. Interestingly, while the notion of the 'good life' seems to be deeply implanted in our generation's psyche's, it's origin stems from the dreams of those who came before us, and meant something entirely different from what so many of us have come to yearn for. The world was introduced to the concept of the 'good life' by such long gone seekers as William Penn, Thomas Jefferson, Henry David Thoreau and Wendell Barry. And it appears that their vision was very different than our own turned out to be. To them, the 'good life' represented a lifestyle based on simplicity; not materialism, on personal freedom; not acquisition, on spiritual, emotional, and interpersonal development; not net-worth. We lament that we too value those things even as we scramble to put large screen televisions with stereo sound, and computers on our tables.

Do I sound harsh? Judgmental? Forgive me please. You see, more than anything else, I'm conducting an argument with myself in your presence. I'm attempting to set myself straight, which typically involves great vigor and drama. It's never been easy for me to change, and that's what I'm trying to do these days. Change my attitude, my perspective, my lifestyle, and my direction... I never did like to walk alone, and so here I am once again attempting to get you to walk along with me. Never mind that I've gotten lost on more than one occasion. Just keep me company.

I've altered my path significantly in the last few years, and I won't tell you that the rewards have been tremendous, (although they often have) or that I don't look longingly at my neighbors life from time to time (is that a new car they have in the garage again? I ask, as we attempt to keep our 1985 model running). One day I'm sitting in my rocker gazing at the crepe Myrtle trees we just planted, feeling a sense of satisfaction and gratitude. The next morning I'm dreaming that my book has been published and has been well received, leaving me free of the financial concerns that periodically plague me. I'm feeling good that I'm more available to my daughter one minute, and shooing her away while I attempt to pump out more words on my computer screen the next. You see, I'm far, far from finished and settled into this new life plan of mine. And I still want more, but now I'm settling for less, and striving for different things.

Who ever it was that said, "You get what you settle for" got my attention, and those words still touch me today. I got plenty in my old life, and I settled for more. More stress, and less time; more responsibilities, and less peace of mind; more materials, and less satisfaction; more money for play, and fewer opportunities to enjoy what I had; larger Christmas presents for my daughter, and smaller portions of my energy.

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And now, over two years after I made significant changes in my life, I'm still struggling with the trade-offs. There have been far more sacrifices than I would have chosen to make if I were queen of the world. But I'm by no means royalty, so I've learned to barter. And I generally manage to feel that I'm gaining far more than I lost in the deal.

Djohariah Toor informs us in, "The Road by the River," that the Hopi's have a word, Koyaanisqatsi, which means, "a life out of balance." What specifically does it mean to live such a life? Well, I'm not sure I can adequately explain it, but I know with all of my heart that I lived it, and still do. The good news however, is that I've succeeded (I believe) in swinging the pendulum closer to the center. I'm able to invest more in my inner life, my spirit, my relationships, and to live a life that reflects my personal values to a far greater extent than ever before. There's much in my life which still requires fine-tuning, and my professional life has certainly absorbed formidable blows, but my garden is beginning to bloom, my heart feels lighter, and I'm once again discovering anticipation in the mornings.

Charles Spezzano wrote in, What to do Between Birth and Death, that, "You don't really pay for things with Money. You pay for them with time." I tell myself today (and now believe it), that my time is more valuable than my money. I don't want to spend as much of it as I used to on things that really don't matter much. I have no idea how much of it remains available to me, and I'd rather run out of money in the bank at this point, than out of what ever time I have left. I can't have it ALL, and so I'm negotiating.

My husband, Kevin continues to struggle with his own choices. He's chosen to provide our family with it's only significant source of income. Sometimes I feel saddened when I think of him. One of his best friends, who opted not to have children, enjoys so many more choices than Kevin does. He has a partner that shares the financial burden that Kevin carries alone. His friend goes off on adventures, purchases newer and bigger toys, and relaxes on the weekend, while my sweet husband mows the lawn, attempts to fix a broken appliance (that in his old life he would have had repaired), while contemplating which bill he should pay this week. In our old life, he never would have had to think twice about who to pay when. The money was always there. Still, today, there's no checking with me to see if he can work late, no wondering what he'll make for dinner tonight after working ten hours, or rushing to pick up our daughter before day care closes. He doesn't need to rush around getting himself and our daughter ready in the morning, and he no longer faces a second shift when he leaves the office for the day. He still misses the financial freedom our previous life-style allowed, how could he not? And he still wonders what it's all for on a bad day. But he's able to focus more closely on his own life, go to bed early if he chooses, and his best friend is waiting for him after a long day who's not as preoccupied as she used to be. One who eagerly awaits him and feels far greater appreciation for him that she ever did before.

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Our life is far, far, from perfect. We still catch ourselves longing for that elusive future when we're able to experience greater freedom and more choices. We have less than we used to for sure - less money, less security, and far fewer investments to brighten up our "golden years." But we also have fewer regrets, less guilt, and less tension.

Our larger dreams still all too often overshadow our day to day enjoyment of what we have - our child, our health, our families, our love... But we're more apt to catch ourselves now, rather than getting lost far down that road of tomorrow, the one we used to travel on an almost daily basis.

Marilyn Ferguson observed in, The Aquarian Conspiracy, that, "our problems are often the natural side effects of our success." Kevin and I are clearly experiencing fewer benefits of the conventional "success" that we used to take for granted. Yet, while our shift in life style has presented new challenges, it has also offered solutions to issues that used to weigh heavily on our shoulders each and every day. We have ceased our exhausting struggle to have it ALL, in order to experience and appreciate more fully what we havetoday, for who knows if it will be there tomorrow.

I sometimes recall my yesterdays when I become discouraged with my today's. Then my mantra was, "hurry, hurry, hurry!" My little girl learned from her parents to move quickly, while reaching out to grab hold as we went speeding by. I recently watched a video of a beautiful, curly haired child playing ballerina, a toddler that used to be mine. As the camera zeroed in on her golden eyes, I realized how often back then her little face was out of focus, as I raced to catch up with my life.

I'm slowing down now. Go ahead and pass me. I'll get out of your way, although I may be tempted to speed up as you go sailing by. I'm hoping though my resolve will hold - that I'll take the time that I truly understand now is precious. Because no matter what we do, become, or accomplish - the one thing that awaits us all in the end - is the finish line."

next: Life Letters: On the Love, Pain, Hopes and Fears of Parenting Table of Contents

Excerpts from the Archives of the Narcissism List Part 6

1. Narcissists and Ego Dystony
2. VoNPD (Victims of NPD)
3. Surrounded by Inferiors
4. Narcissists Hurting Others
5. Narcissists and Art
6. Narcissists are Misogynists
7. Narcissists and Group Therapy
8. Degrees of Narcissism
9. Narcissism and Evil (2)
10. Why do Narcissists Exist?
11. I am Very Sad
12. The Narcissistic Hunt
13. WHY?
14. Unified Dysfunction Theory
15. Humbling Oneself
16. The Time before Narcissism

1. Narcissists and Ego Dystony

Recent, very surprising, research, shows that narcissists sometimes are ego dystonic. Mostly they don't care about it, they consider it part of their uniqueness. But many narcissists do develop permanent "ego-dystony" (in humanspeak: they constantly feel bad about themselves and their behavior). But the narcissist feels that people are simply not worth the effort. The narcissist's time is of cosmic significance and should not be wasted on such trivia. Also, his narcissism is part of what makes him unique and he will not give it up easily. The narcissist brags of his insensitivity, lack of empathy, lack of emotions, "resilience", "character strength". He deplores "whining" and over-emoting ("histrionics"). This is part of his self definition.

2. VoNPD (Victims of NPD)

Victims of NPD experience shame and anger for their past helplessness and submissiveness.

They are hurt and sensitized by the harrowing experience of sharing a simulated existence with a simulated person, the narcissist.

They are scarred.

Some of them lash at others, offsetting their frustration with aggression (a classic mechanism).

Like his disorder, the narcissist is all-pervasive. Being the victim of a narcissist is a condition no less pernicious than being a narcissist. Great efforts are required to leave a narcissist and physical separation is only the first step. One can abandon a narcissist -but the narcissist is slow to abandon its victims. It is there, lurking, rendering existence unreal, twisting and distorting with no respite, an inner, remorseless voice, lacking in compassion and empathy for its victim. And the narcissist is there spiritually long after it has vanished physically.

This is the real danger that the victims of the narcissist face: that they will become like him, bitter, self-centered, lacking in empathy. This is the last bow of the narcissist, his curtain call, by proxy, as it were.

Stay away from the narcissist inside you - it is far more dangerous than the ones from without.

3. Surrounded by Inferiors

The narcissist does tend to surround himself and interact with his inferiors. This is the safest and fastest way to sustaining his grandiose fantasies of superiority, omnipotence and omniscience, brilliance, ideal traits, perfection and so on.

Humans are interchangeable and the narcissist anyhow does not distinguish one individual from another. To him they are all inanimate parts of "his audience" whose job is to reflect his false self. This generates a perpetual and permanent cognitive dissonance:

The narcissist despises the very people who sustain his ego boundaries and functions. He cannot respect people so expressly and clearly inferior to him - yet he can never associate with people evidently on his level or superior to him, the risk to his self esteem being too high. Equipped with a fragile ego, precariously teetering on the brink of narcissistic injury - the narcissist prefers the safe route of associating with his inferiors. But he feels contempt to himself and to others for having preferred it.

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4. Narcissists Hurting Others

Some NPDs are ALSO antisocial PDs (AsPDs) and / or sadists and so enjoy hurting others (mostly during sex but also without it).

Antisocials (psychopaths) don't really ENJOY hurting others - they simply don't care one way or the other. But sadists do enjoy it.

"Pure" NPDs do not enjoy hurting others - but they do enjoy the sensation of omnipotence, unlimited power, and the validation of their grandiose fantasies when they hurt others or are in the position to do so. It is more the POTENTIAL to hurt others than the actual act that turns them on.

5. Narcissists and Art

A narcissist would find it difficult to enjoy the emotional content, message and context of a work of art. This is because narcissists lack empathy. They are unable to put themselves in other people's "shoes". They are like islands with all lines of communications cut, with giant mirrors in which the islanders are reflected.

BUT

The narcissist will very likely appreciate a work of art in terms of its influence, technical mastery, monetary value, rarity, and other external aspects.

A narcissist will NOT accept criticism good-humoredly. A narcissistic artist will expect only praise and if criticised, he will belittle and devalue the critics, feel misunderstood, a giant in a land of Lilliputians, wronged and abused. He will react violently and aggressively and maybe stop creating altogether.

Producing a work of art IS working to the benefit of mankind. Does a narcissistic artist INTEND to benefit mankind with his work? To this the answer is an unequivocal NO. The narcissist is interested ONLY in ONE thing: narcissistic supply. If he can obtain it by creating art - he will. It's simply another way of obtaining his drug. In most cases, he is not even emotionally involved in what he does.

6. Narcissists are Misogynists

Narcissists are misogynists. To them women as mere sources of SNS (secondary narcissistic supply). The feminine chores are to accumulate past NS and release it in an orderly manner, so as to regulate the fluctuating flow of primary supply. Otherwise, cerebral narcissists are not interested in women. Most of them (myself included) are a-sexual (engage in sexual acts very rarely, if at all). They hold women in contempt and abhor the thought of being really intimate with them. Usually, they choose submissive women, well below their level, to perform these functions. This leads to a vicious cycle of neediness, self contempt (how come I need this inferior woman), and abuse directed at the woman. When primary NS is available - the woman is hardly tolerated, as one would reluctantly pay the premium of an insurance policy in good times.

Now, this would hardly constitute an attraction to a "sexy, smart and powerful woman" would it?

7. Narcissists and Group Therapy

Narcissists are notoriously unsuitable for group activities of ANY kind, let alone group therapy. They immediately size up others as potential sources of narcissistic supply - or potential competitors for such. They idealize the first (suppliers) and devalue the latter (competitors). This, obviously, is not very conducive to group therapy.

Moreover, the dynamic of the group is bound to reflect the combined dynamics of its members. Narcissists are individualists. They regard coalitions with disdain and contempt. The need to resort to coalitions is perceived by them to be humiliating and degrading (a contemptible weakness). Thus, the group is likely to fluctuate between short term, very small size, coalitions (undermined by "superiority" and contempt) and outbreaks (acting outs) of rage and coercion.

8. Degrees of Narcissism

Pathological narcissism occurs in varying degrees and its culmination is "full criteria NPD" - a narcissist who responds to all the criteria in the DSM IV.

There is a story about Buddha. He was walking with his disciples and saw a butterfly. "Are we the butterfly's dream" - he asked his disciples. Put differently by others, the question became: "are we dreaming that we are awake?". My life is like a long dream (or nightmare) interrupted by short awakenings (only one or two hitherto). I am not sure whether I am the subject of my dream or whether my dream is dreamt by me. This is an existential fog which is difficult to penetrate.

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Recent research discovered that NPDs are less ego-syntonic than thought before. In other words, they don't feel that great most of the time and even have something like a conscience. The way to make a narcissist respond to your wish is to present it either as an intellectual challenge (no cerebral narcissist can resist that) - or as a plea for help. YOU are in need of help and you ask your omnipotent, omniscient narcissist to help you. Make it that something is wrong with YOU (you feel bad, you want to understand him or, better still, yourself) and you need his help and collaboration (for instance, in going to marital therapy). Narcissists are very easy to dupe because they constantly try to dupe others. The most gullible and suggestible people on earth are con-artists. Living in a world of lie is bi-directional, the liar loses his grip on reality at least as much as the person being lied to.

Narcissists of ALL shades can usually control their behavior and actions. They simply don't want to, they regard it as a waste of their precious time, a degradation. The narcissist feels both superior and entitled - regardless of his real gifts or achievements. To narcissists, all others are their inferiors, their slaves, there to cater to their needs and make their existence seamless, flowing and smooth. The narcissist feels cosmically significant and he must be accorded the conditions needed for him to realize his talents and to successfully complete his mission (which changes fluidly and of which he has no clue except that it has to do with brilliance and ideal something).

What narcissists CANNOT control is the void in their midst, the emotional black hole, the fact that they don't know what it is like to be human (they lack empathy). As a result, they are awkward, tactless, painful, taciturn, and abrasive.

9. Narcissism and Evil (2)

Narcissists are "evil" in an absent-minded, indifferent manner. It is not that they occupy Transylvanian castles, or plot to gorge on the blood of the innocent. They wound and hurt as a by-product of their firm belief that they are unique, that they deserve more and better, that they should not be subjected to other people's laws and should no be consumed by the mundane. Others to them are mere pawns, tools in the cosmically significant chessboard of their lives. In other words: dispensable. Narcissists are addicted to the narcissistic supply provided by crowds and by exerting authority. Narcissism drives the narcissistically afflicted to achievements. In their pursuit of narcissistic supply, narcissists will do anything - even benefit humanity.

10. Why do Narcissists Exist?

No one knows if there is a genetic propensity or predisposition to becoming a narcissist. But one asks "why do they exist at all".

There are two possibilities:

1. That narcissists are mutations, "wrong" results in the on-going experiment of evolution. But this is unlikely because if this were the case - according to the laws of evolution - they would have disappeared a long time ago (being as maladapted as they appear to be).

1. That narcissists are a required ingredient in the brew of humanity's survival. That they fulfill some function. For instance: maybe ambition is a derivative of a narcissistic urge to be famous and to impact humanity and history.

To some extent narcissism thrives more easily and is accepted more readily in societies with a specific profile. This is Lasch's main thesis regarding the American society (see: The Cultural Narcissist: Lasch in an Age of Diminishing Expectations).

My solution is different and more humane: educate people to beware of narcissists. Safe sex prevents AIDS or minimizes its prevalence. A Safe Emotions Regime (if you fall in love perhaps you love to fall - that is if you fall in love too fast and too indiscriminately). Teach people how to identify narcissists, how to cope with them, how to avoid them, how to divorce them. This is also a more practical approach.

11. I am Very Sad

I am very sad most of the time if I am not busy. It is not the superficial sadness of satiated people after a good meal. It is not the existential threat of depression. It is a foggy haze, a curtain behind which everything looks yellow and aged, liked crumpled, liver-stained photos. When my ex-wife left me (I was in jail), all my defenses fell apart and I FELT - for the first time in my life I felt in color. I wanted to die, the pain was so consuming, so all-pervasive. But instead of dying, I wrote dozens of very emotional short stories which won prizes and praises. It spilled over into another book and then I felt the walls closing in again, like living through a film scrolled backwards. I ossified in stages: first a hand, a leg, my neck. Like a perverse Galathea, I went from life to stone, a speechless Pygmalion. I was emotionless again, my world in shades of gray as before, with only dim memories of colour. In those last minutes of emotional sanity, I wrote "Malignant Self Love", engulfed by the harrowing realization that I am dying once more.

Did you see the play "The White Mouse"? A retarded person is transformed into a genius under the influence of a miraculous substance. When the influence wanes, he reverts to idiocy but with the added cruelty of KNOWING it. In "Awakenings" by Sachs, patients are awakened after decades of disease- induced lethargy only to discover that they are receding again into the same sculpture-like state. I felt that way and I wanted to leave a testimonial behind. This testimony is my book.

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12. The Narcissistic Hunt

Your friend didn't "go" from any phase to any other phase. He didn't change at all. He was simply pretending, lying, putting on his best face to get you hooked. For some reason, you represented narcissistic supply to him. It was crucial for him to get his supply from you - so he set out to do it. Narcissists are relentless exterminators when it comes to obtaining supply. Deep inside they are misanthropes and, if men, mostly misogynists. They hate the fact that they are dependent on others for sustenance, that they stand to crumble if not supplied properly, that they are mere reflections. They resent it. So, they are critical, contemptuous, insulting, and lack any empathy. BUT when they are out to get you, they can be the MOST charming, stunning, captivating, wonderfully-sensitive things. It is THE great deception. And you are not the first person to fall prey to it - nor, I am afraid, the last one. OF COURSE he lost all interest to you. Why should he invest his scarce and cosmically significant resources in a has- been source of supply?

And THIS is the victimization process. This sudden loss of interest, respect, "love", sensitivity and compassion. The transparentization of the "meaningful" other. The dawning and shocking realization that you have been used and ab-used and mis-used, that you were no better than any domestic appliance to him. Becoming an object is what drives the victims to near insanity.

13. WHY?

To avoid a proliferation of "he/she", I will use "it" to denote a unisex narcissist.

Didn't you feel something was wrong from the very first minute when it couldn't stop talking about itself, bragging, outlining grandiose schemes, and ignoring you altogether?

Couldn't you penetrate the torrential charm, the incisive intelligence, the baby face, the "need to be protected", the "no one understands me" facade?

Didn't you ask yourself "is this for real" with growing intensity?

Weren't you repelled and upset by its haughtiness, venomous diatribes, constant criticism, self pity and "ne'er do wrong" attitude?

Didn't you sense that it was vacuous despite its academic degrees, vain despite its professed modesty, vicious despite its exhibitionistic altruism?

Ever wonder why it humiliates and then melts into a saccharinic show of unbearable sentimentality?

Had you no suspicion that something was awfully wrong when it exhibited abnormal attachment to Mommy/Daddy?

Did you feel that you had to compete and do battle to gain minimal acknowledgement, a modicum of attention, a fleeting (insincere, absent-minded) smile?

Then WHY, on earth, WHY did you stay?

WHAT were you looking for and how can you be convinced that you did not get it?

14. Unified Dysfunction Theory

Ever since Freud and Bleuler there has been an overt effort to "scientify"psychology. Freud - a medical doctor (neuorology, as it was known then) tried to invent a "physics of the mind" with structures and drives in lieu of molecules and forces in Newtonian mechanics (a.k.a. "Psychodynamics"). He used "scientific" language and believed that he was "objectifying" the subjective (=analysis).

Psychology and psychologists are beset by an inferiority complex given to them by physicists. They also want to be considered "an accurate science" with predictions, falsifications, repeatable experiments, the whole smorgasbord of respectability (not to mention budgets and prestige). Just compare the status of physicists and psychologists in courts of law ...

So, when quantum mechanics developed - there was a movement of "quantum and the mind" or the mind as a physical field. Now, in physics, physicists are self-importantly discussing the next illusion of grandeur (=narcissistic grandiose fantasy): TOE. A Theory of Everything (formerly known as a Unified Field Theory). Immediately the ugly, statistical, stepdaughter, psychology, also wants to have a TOE. What life does a discipline have without a TOE of its own? In comes the "Unified Dysfunction Theory" (which - on pure philosophical grounds - is impossible as long as the psychophysical problem has not been solved).

Humans are not atoms. The brain is more complex than any cluster of galaxies. The processes of energy conversion in the body far outweigh in complexity anything happening in the stars, to mention but one basic issue. We know very little about the brain (contrary to scientific claims. There are texts from 1900 which claimed as confidently that we know everything there is to know about the brain). We know even less about mental processes. Psychology is made up of one third fairy tales (psychoanalysis), one third educated guesses (object relations, behaviorism), one third prejudices and superstitions and some primitive ability to manipulate moods (psychopharmacology). Psychology today is where physics was when Plato was roaming the Earth. One should not succumb so lightly to the proposition of a unified theory pertaining to such a little understood phenomena and based on such fragmented knowledge.

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15. Humbling Oneself

I recommend to you to HUMBLE yourselves. This way, you will not only be offering NS (which WILL be rejected if the source is "wrong") - but also vindication and validation of the PERSONAL MYTHOLOGY of the narcissist as a giant, misunderstood and wronged by the Lilliputians. The combination is irresistible and the narcissist will easily fall into this double trap.

16. The Time before Narcissism

That a condition has a beginning does not necessarily mean that it has an end. That its roots can be traced does not imply that it can be uprooted. Not only do I remember a time without narcissism (up to the age of 4, I believe) - but I remember INVENTING the d**n thing. I remember creating narratives of omnipotence, of brilliance and ideal heroism in which I was either the main character or able to manipulate the main character.

How was the time before narcissism? Terrorizing, unpredictable, arbitrary, violent, capricious, unjust. I hated it. I still do.

I would be surprised to learn that a complex, interacting set of behavior and reaction patterns (known as personality) can be the result of a single biochemical or genetic cause, though.

 

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next: Excerpts from the Archives of the Narcissism List Part 7

Excerpts from the Archives of the Narcissism List Part 5

1. Jeffrey Satinover on the Myth of Narcissus
2. Pathological Envy
3. Narcissism as Self-Definition
4. Narcissistic Ups and Downs
5. Narcissists and the Order of the World
6. Devaluing the Significant Other
7. Should the Narcissist be Held Accountable for his Actions?
8. Narcissists Getting Tired of their Sources of Supply
9. Narcissists Put on a Show Regarding their "Emotions"?
10. Narcissists Facing their Diagnosis
11. Narcissists and Happy Marriages
12. Male Narcissists and Women
13. The Internalized Voice of the Narcissist
14. My Role in the List
15. This Paradoxical List...
16. The Narcissist as Body Snatcher 
17. Watch the video on Narcissism Myths

1. Jeffrey Satinover on the Myth of Narcissus

This second version of the Narcissus legend was first told by Pausanias. Jeffrey Satinover in his excellent essay "Puer Aeternus - The Narcissistic Relation to the Self" (he is a Jungian) elaborates:

"The core of Puer (=eternal adolescent - SV) relationships is this: the puer seeks relationships that provide him the kind of reflection he is unable to perform for himself. What appears as extroversion in the puer is not that at all. In effect, the puer does not relate to objects (in the analytic sense); he relates instead to a missing part of himself which he either sees in another or makes another perform. Objects function for the puer primarily as an indirect means of introversion.
(Here Satinover quotes Pausanias and proceeds:)
If we take this myth simply as a reflection of the puer's anima problem, we see right away that he seeks not so much his mother as, through the anima, himself."

 

2. Pathological Envy

Pathological envy is a strong motive in narcissism. Additionally, to cast themselves in the role of "master" (Jeffrey Satinover's term), narcissists cast others in the roles of disciples. They transform others into patients, assigning to themselves the role of psychiatrist. And so on. Actually, they firmly and fully believe that they are working towards the improvement and personal betterment and welfare of the other (I call it: the "mobilization" of their motives and behaviour). This is why they are shocked when these others "ungratefully" rebel, release themselves from the straight jacket of their assigned "roles" and confront them. They are narcissistically injured to the core when this happens and react with rage and paranoia. It only serves to enforce their belief in an unjust world, far inferior and oblivious to their talents and contributions.

3. Narcissism as Self-Definition

"Victim of a narcissist" is a label that does NOT capture the entirety of the person being thus labeled. But this does not apply to narcissism and by extension to other personality disorders (my view). Being a narcissist DOES capture my ENTIRE existence and being. It permeates every one of my cells. As the DSM so aptly puts it, it is "all pervasive". I experience my illusions of grandeur, for instance, on a second by second basis. I don't have a personality - I have a personality disorder. My very personality is disordered. Every aspect, nook and cranny of my personality is disordered. Can we separate the crookedness of a tree from the tree? No, it is a crooked tree. A personality is not like having a tumor, it is like being a tumor. There are developmental reasons why I say this

(see: FAQ 64 ).

4. Narcissistic Ups and Downs

Narcissists do have highs reminiscent of those induced by drugs and associated with the obtaining of narcissistic supply. Recent research shows that narcissists do experience periods of "ego dystony" (feeling bad about themselves, their behavior and what they do to others). But their defense mechanisms are so trained, their personality so rigid - that they revert immediately to their previous existence. I write a lot about narcissistic dysphorias (dysphoria is like a less pervasive depression) in my book and in my websites.

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5. Narcissists and the Order of the World

We are conditioned to believe in law, order, justice, cause and effect, and a host of other principles which make our mental world inhabitable. The narcissist replicates the treatment that he received earlier in life. He is unduly and destructively critical, arbitrary, capricious, sadistic and fluctuates between TOTAL idealization and TOTAL devaluation with no apparent cause.

Sometimes we try to decipher the patterns even in a natural catastrophe. We ask who is to blame, why, who is responsible. We address God, Nature, Science, the Government. A narcissist is a natural catastrophe brought about by a human being. We have an identifiable person, entity to blame. And we demand to know why. Until we are satisfied that the world is a safe, predictable place - how can we continue to live in it? This is the "achievement" of the narcissist: to demonstrate to us that there is no justice, or order, that there are no laws, it's all an arbitrary and cruel game. We have to cope with this (his) worldview, not only with him.

6. Devaluing the Significant Other

Regarding women with whom the narcissist is "intimate" (as he defines intimacy): a woman CAN be a source of PRIMARY NS - IF and only as long as no intimacy is involved. The moment intimacy - however thwarted and distorted - sets in, the woman is transformed into a source of secondary supply and, thereby, devalued.

Just a reminder:

Primary Narcissistic Supply (NS) - adulation, adoration, attention, affirmation, approbation derived by the narcissist from others (narcissistic supply sources). I wrote dozens of pages on the mechanisms of identification of sources and the derivation of NS thereof.

Secondary Narcissistic Supply - the retention, accumulation, amplification and reflection of PAST primary NS. This helps the narcissist to regulate his narcissistic supply and its ebbs and flows. The source is considered inferior and is often devalued. It is devalued REGARDLESS of objective reality. Even a strong, sexy and highly intelligent woman will be devalued because of her function in the narcissist's universe: a secondary, devaluing function. One cannot hold an instrument in high regard.

7. Should the Narcissist be Held Accountable for his Actions?

I think that the narcissist should be held accountable for most of his actions. The list of what he should NOT be held accountable to is shorter: his rage and his grandiose fantasies. These are two exceptions which could allow us to make the rule clearer.

The narcissist CANNOT control his rage and, therefore, should not be held accountable for it. BUT, if he attacks someone physically, he should be held accountable because:

1. He can tell right from wrong.
2. He simply didn't care about the other person sufficiently to refrain from action.

Similarly, the Narcissist cannot "control" his grandiose fantasies. He firmly believes that they constitute an accurate representation of reality. BUT, if he lies about his education, he should be held accountable because:

1. He knows that lying is wrong and should not be done.
2. He simply didn't care enough about society and others to refrain from doing so.

Narcissists should be held accountable for most of what they do because they can tell wrong from right AND they can refrain from taking the actions they do take. They simply don't care enough about others to put to good use these twin abilities. A narcissist can be held responsible for some of his actions because he can tell right from wrong and can control most of his actions. He simply doesn't care to do so. Others are not important enough to him.

8. Narcissists Getting Tired of their Sources of Supply

There is no mathematical formula which governs this. It depends on numerous variables. Usually, the narcissist persists in the relationship until he "gets used" to the source and the its stimulating effects wear off OR until a better source of supply becomes available.

9. Narcissists Put on a Show Regarding their "Emotions"?

Well, yes, except some basic, primitive emotional modalities, transformations of aggression: rage, pathological envy, hate, sadistic pleasure, masochistic pleasure, fear.

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10. Narcissists Facing their Diagnosis

The narcissist's reaction depends on WHO does the diagnosis. If an unqualified person does it, the narcissist will go into a rage attack, berate the "diagnostician" and devalue him, doubt his qualification, personality, integrity, past and so on. He will become cold and aloof and disconnect from the diagnostician, the former having lost its supply source status by daring to make such a diagnosis. The reaction would be no different to a verbal confrontation unless intimidation is involved. If intimidated, the narcissist will recoil and become submissive, overly sentimental, dependent and idealizing.

11. Narcissists and Happy Marriages

All generalizations are false. I discuss the narcissistic couple in one of my FAQs. This is one example of such a happy marriage (when the narcissist teams up with another narcissist of a different kind). Narcissists can be happily married to submissive, subservient, self-deprecating, echoing, mirroring and indiscriminately supportive spouses. They will also do well with masochists. But I find it difficult to imagine that a healthy, normal person would be happy in such a follies-a-deux ("madness in twosome"). Read about "Inverted Narcissists" .

Narcissists are rarely influenced by psychotherapy, so I also find it difficult to imagine a benign and sustained influenced of a stable, healthy mate / spouse / partner. One of my FAQs is dedicated to this issue ("The Narcissist's Spouse / Mate / Partner").

BUT

Many a spouse / friend / Mate / Partner like to BELIEVE that - given sufficient time and patience - they will be the ones to release the narcissist from his wrenching bondage. They think that they can "rescue" the narcissist, shield him from his (distorted) self, as it were. The Narcissist makes use of this naivete and exploits it to his benefit. The natural protective mechanisms which are provoked in normal people by love - are cold bloodedly used by the narcissist to extract yet more narcissistic supply from his writhing victim.

12. Male Narcissists and Women

Narcissists abhor and dread getting emotionally intimate and they regard sex as a maintenance chore, something they have to do in order to keep their source of secondary supply content.

Moreover, many narcissists tend to engage in FRUSTRATING behaviours towards women. They will refrain from having sex with them, tease them and then leave them, resist flirtatious and seductive behaviours and so on. Often, they will invoke the existence of a girlfriend/fiancee/spouse (or boyfriend/etc. - male and female are interchangeable in my texts) as the "reason" why they cannot have sex/develop a relationship. But this is not out of loyalty and fidelity in the empathic and loving sense. This is because they wish (and often succeed) to sadistically frustrate the potential partner.

BUT

This pertains ONLY to cerebral narcissists. NOT to somatic narcissists and HPDs who use their BODY, sex and seduction/flirtation to extract narcissistic supply from others.

13. The Internalized Voice of the Narcissist

We all run constant dialogues inside our heads. We argue and try to convince and apologize and soothe ourselves. All you have to do is identify that OTHER voice. Who are you talking to right now: your parents? your boss? or maybe your narcissist ex? Write down in which circumstances you are having dialogues with her, the contents of the dialogues, their dynamics.

Slowly and gradually, you will discover patterns. Patterns of evasion and self justification and outright lies. Try to avoid these patterns, to invert them, to convert them. After all, these are YOUR dialogues now. Win every argument, mock your ex, and ridicule her positions, expose her narcissistic traits and her preposterous grandiosity. Deprived of narcissistic supply, she will vanish in your head as she has done in your life.

14. My Role in the List

My aim is to provide the victims of narcissism with an available figure of transference, with a substitute-narcissist, someone to take it out on. I am happy that you do. BUT this does not mean that I should be mute, deaf and blind. I intend to fight back if I feel that the attacks are uncalled for. By doing so, I hope to restore to you the sense of three-dimensionality of other humans (even narcissists). The narcissists in your lives deprived you of it (or tried to do so).

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15. This Paradoxical List...

Narcissists use EVERYTHING at their disposal (logic included) to further their narcissistic causes.

Narcissists are halls of mirrors. No sense applying logic to them. No sense applying empathy, emotions, straight thinking. It's all useless.

This list is the embodiment of the most ancient logical paradox: a liar who reveals himself as such: "I always lie" is an impossible sentence. It is also the premise of this list.

It is through this crude mechanism that I am trying to help you all, victims of narcissism, cope with your past. I allow you to get close to a narcissist - without being harmed. You re-enact your conflicts and resolve them with a real life narcissist - but without the usual risks. I am burning fire - but behind a glass, safely.

16. The Narcissist as Body Snatcher

The narcissist affects his victims by infiltrating their psyche, by penetrating their defenses. Like a virus, it establishes a new strain within his/her victims. It echoes through them, it talks through them, it walks through them. It is like the invasion of the body snatchers. You should be careful to separate your selves from the narcissist inside you, this alien growth, this spiritual cancer that is the result of living with a narcissist. You should be able to tell apart your real you and the YOU assigned to you by the narcissist. To cope with him/her, the narcissist forces you to "walk on eggshells" and develop a false self of your own. It is nothing as elaborate as his False Self - but it is there, in you, as a result of the trauma and abuse inflicted upon you by the narcissist.

 

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next: Excerpts from the Archives of the Narcissism List Part 6

Self-injury is a type of abnormal behavior and usually accompanies a variety of mental health disorders, such as depression or borderline personality disorder.

• General Information About Self-Injury
• Conditions in Which Self-injurious Behavior is Seen
• Borderline Personality Disorder
• Mood Disorders
• Eating Disorders
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Dissociative Disorders
  • Depersonalization Disorder
  • DDNOS
  • Dissociative Identity Disorder
• Anxiety and/or Panic
• Impulse-control Disorder Not Otherwise Specified
• Self-injury as a psychiatric diagnosis

General Information About Self-Injury

In the DSM-IV, the only diagnoses that mention self-injury as a symptom or criterion for diagnosis are borderline personality disorder, stereotypic movement disorder (associated with autism and mental retardation), and fictitious (faked) disorders in which an attempt to fake physical illness is present (APA, 1995; Fauman, 1994). It also seems to be generally accepted that extreme forms of self-mutilation (amputations, castrations, etc) are possible in psychotic or delusional patients. Reading the DSM, one can easily get the impression that people who self-injure are doing it willfully, in order to fake illness or be dramatic. Another indication of how the therapeutic community views those who harm themselves is seen in the opening sentence of Malon and Berardi's 1987 paper "Hypnosis and Self-Cutters":

Since self-cutters were first reported on in 1960, they have continued to be a prevalent mental health problem. (emphasis added)

To these researchers, self-cutting is not the problem, the self-cutters are.

However, self-injurious behavior is seen in patients with many more diagnoses than the DSM suggests. In interviews, people who engage in repetitive self-injury have reported being diagnosed with depression, bipolar disorder, anorexia nervosa, bulimia nervosa, obsessive-compulsive disorder, posttraumatic stress disorder, many of the dissociative disorders (including depersonalization disorder, dissociative disorder not otherwise specified, and dissociative identity disorder), anxiety and panic disorders, and impulse-control disorder not otherwise specified. In addition, the call for a separate diagnosis for self-injurers is being taken up by many practitioners.

It is beyond the scope of this page to provide definitive information about all of these conditions. I will try, instead, to give a basic description of the disorder, explain when I can how self-injury might fit into the pattern of the disease, and give references to pages where much more information is available. In the case of borderline personality disorder (BPD), I devote considerable space to discussion simply because the label BPD is sometimes automatically applied in cases where self-injury is present, and the negative effects of a BPD misdiagnosis can be extreme.

Conditions in which self-injurious behavior is seen

• Borderline Personality Disorder
• Mood Disorders
• Eating Disorders
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Dissociative Disorders
• Anxiety Disorders and/or Panic Disorder
• Impulse-control Disorder Not Otherwise Specified
• Self-injury as a diagnosis

As mentioned, self-injury is often seen in those with autism or mental retardation; you can find a good discussion of self-harm behaviors in this group of disorders at the website of The Center for the Study of Autism.

Borderline Personality Disorder

"Every time I say something they find hard to hear, they chalk it up to my anger, and never to their own fear."
--Ani DiFranco

Unfortunately, the most popular diagnosis assigned to anyone who self-injures is borderline personality disorder. Patients with this diagnosis are frequently treated as outcasts by psychiatrists; Herman (1992) tells of a psychiatric resident who asked his supervising therapist how to treat borderlines was told, "You refer them." Miller (1994) notes that those diagnosed as borderline are often seen as being responsible for their own pain, more so than patients in any other diagnostic category. BPD diagnoses are sometimes used as a way to "flag" certain patients, to indicate to future caregivers that someone is difficult or a troublemaker. I sometimes used to think of BPD as standing for "Bitch Pissed Doc."

This is not to say that BPD is a fictional illness; I have encountered people who meet the DSM criteria for BPD. They tend to be people in great pain who are struggling to survive however they can, and they often unintentionally cause great pain for those who love them. But I have met many more people who don't meet the criteria but have been given the label because of their self-injury.

Consider, however, the DSM-IV Handbook of Differential Diagnosis (First et al. 1995). In its decision tree for the symptom "self-mutilation," the first decision point is "Motivation is to decrease dysphoria, vent angry feelings, or to reduce feelings of numbness... in association with a pattern of impulsivity and identity disturbance." If this is true, then a practitioner following this manual would have to diagnose someone as BPD purely because they cope with overwhelming feelings by self-injuring.

This is particularly disturbing in light of recent findings (Herpertz, et al., 1997) that only 48% of their sample of self-injurers met the DSM criteria for BPD. When self-injury was excluded as a factor, only 28% of the sample met the criteria.

Similar results were seen in a 1992 study by Rusch, Guastello, and Mason. They examined 89 psychiatric inpatients who had been diagnosed as BPD, and summarized their results statistically.

Different raters examined the patients and the hospital records and indicated the degree to which each of the eight defining BPD symptoms were present. One fascinating note: only 36 of the 89 patients actually met the DSM-IIIR criteria (five of eight symptoms present) for being diagnosed with the disorder. Rusch and colleagues ran a statistical procedure called factor analysis in an effort to discover which symptoms tend to co-occur.

The results are interesting. They found three symptom complexes: the "volatility" factor, which consisted of inappropriate anger, unstable relationships, and impulsive behavior; the "self-destructive/unpredictable" factor, which consisted of self-harm and emotional instability; and the "identity disturbance" factor.

The SDU (self-destructive) factor was present in 82 of the patients, while the volatility was seen in only 25 and the identity disturbance in 21. The authors suggest that either self-mutilation is at the core of BPD or clinicians tend to use self-harm as a sufficient criterion to label a patient BPD. The latter seems more likely, given that fewer than half of the patients studied met the DSM criteria for BPD.

One of the foremost researchers into Borderline Personality Disorder, Marsha Linehan, does believe that it is a valid diagnosis, but in a 1995 article notes: "No diagnosis should be made unless the DSM-IV criteria are strictly applied. . . . the diagnosis of a personality disorder requires the understanding of a person's long-term pattern of functioning." (Linehan, et al. 1995, emphasis added.) That this does not happen is evident in the increasing numbers of teenagers being diagnosed as borderline. Given that the DSM-IV refers to personality disorders as longstanding patterns of behavior usually beginning in early adulthood, one wonders what justification is used for giving a 14-year-old a negative psychiatric label that will stay with her all of her life? Reading Linehan's work has caused some therapists to wonder if perhaps the label "BPD" is too stigmatized and too over-used, and if it might be better to call it what it really is: a disorder of emotional regulation.

If a care giver diagnoses you as BPD and you're fairly certain the label is inaccurate and counterproductive, find another doctor. Wakefield and Underwager (1994) point out that mental health professionals are no less likely to err and no less prone to the cognitive shortcuts we all take than anyone else is:

When many psychotherapists reach a conclusion about a person, not only do they ignore anything that questions or contradicts their conclusions, they actively fabricate and conjure up false statements or erroneous observations to support their conclusion [note that this process can be unconscious] (Arkes and Harkness 1980). When given information by a patient, therapists attend only to that which supports the conclusion they have already reached (Strohmer et al. 1990). . . . The frightening fact about conclusions reached by therapists with respect to patients is that they are made within 30 seconds to two or three minutes of the first contact (Ganton and Dickinson 1969; Meehl 1959; Weber et al. 1993). Once the conclusion is reached, mental health professionals are often impervious to any new information and persist in the label assigned very early in the process on the basis of minimal information, usually an idiosyncratic single cue (Rosenhan 1973) (emphasis added).

[NOTE: My inclusion of a quote from these authors does not constitute a full endorsement of their entire body of work.]

Mood Disorders

Self-injury is seen in patients who suffer from major depressive disorder and from bipolar disorder. It is not exactly clear why this is so, although all three problems have been linked to deficiencies in the amount of serotonin available to the brain. It is important to separate the self-injury from the mood disorder; people who self-injure frequently come to learn that it is a quick and easy way of defusing great physical or psychological tension, and it is possible for the behavior to continue after the depression is resolved. Care should be taken to teach patients alternative ways to cope with distressing feelings and over-stimulation.

Both major depression and bipolar disorder are enormously complex diseases; for a thorough education on depression, go to The Depression Resources List or Depression.com. Another good source of information about depression is the newsgroup alt.support.depression, its FAQ, and the associated web page, Diane Wilson's ASD Resources page.

To find out more about bipolar disorder, try The Pendulum Resource Page, presented by members of one of the first mailing lists created for bipolar people.

Eating Disorders

Self-inflicted violence is often seen in women and girls with anorexia nervosa (a disease in which a person has an obsession with losing weight, dieting, or fasting, and as a distorted body image -- seeing his/her skeletal body as "fat") or bulimia nervosa (an eating disorder marked by binges where large amounts of food are eaten followed by purges, during which the person attempts to remove the food from her/his body by forced vomiting, abuse of laxatives, excessive exercise, etc).

There are many theories as to why SI and eating disorders co-occur so frequently. Cross is quoted in n Favazza (1996) as saying that the two sorts of behavior are attempts to own the body, to perceive it as self (not other), known (not uncharted and unpredictable), and impenetrable (not invaded or controlled from the outside. . . . [T]he metaphorical destruction between body and self collapses [ie, is no longer metaphorical]: thinness is self-sufficiency, bleeding emotional catharsis, bingeing is the assuaging of loneliness, and purging is the moral purification of self. (p.51)

Favazza himself favors the theory that young children identify with food, and thus during the early stages of life, eating could be seen as a consuming of something that is self and thus make the idea of self-mutilation easier to accept. He also notes that children can anger their parents by refusing to eat; this could be a prototype of self-mutilation done to retaliate against abusive adults. In addition, children can please their parents by eating what they are given, and in this Favazza sees the prototype for SI as manipulation.

He does note, though, that self-injury brings about a rapid release from tension, anxiety, racing thoughts, etc. This could be a motivation for an eating-disordered person to hurt him/herself -- shame or frustration at the eating behavior leads to increased tension and arousal and the person cuts or burns or hits to obtain quick relief from these uncomfortable feelings. Also, from having spoken to several people who both have an eating disorder and self-injure, I think it's quite possible that self-injury offers some an alternative to the disordered eating. Instead of fasting or purging, they cut.

There haven't been many laboratory studies probing the link between SI and eating disorders, so all of the above is speculation and conjecture.

Obsessive-Compulsive Disorder

Self-injury among those diagnosed with OCD is considered by many to be limited to compulsive hair-pulling (known as trichotillomania and usually involving eyebrows, eyelashes, and other body hair in addition to head hair) and/or compulsive skin picking/scratching/excoriation. In the DSM-IV, though, trichotillomania is classified as an impulse-control disorder and OCD as an anxiety disorder. Unless the self-injury is part of a compulsive ritual designed to ward off some bad thing that would otherwise happen, it should not be considered a symptom of OCD. The DSM-IV diagnosis of OCD requires:

1. the presence of obsessions (recurrent and persistent thoughts that are not simply worries about everyday matters) and/or compulsions (repetitive behaviors that a person feels a need to perform (counting, checking, washing, ordering, etc) in order to stave off anxiety or disaster);
2. recognition at some point that the obsessions or compulsions are unreasonable;
3. excessive time spent on obsessions or compulsions, reduction of quality of life due to them, or marked distress due to them;
4. the content of the behaviors/thoughts is not confined to that associated with any other Axis I disorder currently present;
5. the behavior/thoughts not being a direct result of medication or other drug use.

The current consensus seems to be that OCD is due to a serotonin imbalance in the brain; SSRI's are the drug of choice for this condition. A 1995 study of self-injury among female OCD patients (Yaryura-Tobias et al.) showed that clomipramine (a tricyclic antidepressant known as Anafranil) reduced the frequency of both compulsive behaviors and of SIB. It is possible that this reduction came about simply because the self-injury was a compulsive behavior with different roots than SIB in non-OCD patients, but the study subjects had much in common with them -- 70 percent of them had been sexually abused as children, they showed the presence of eating disorders, etc. The study strongly suggests, again, that self-injury and the serotonergic system are somehow related.

Posttraumatic Stress Disorder

Posttraumatic stress disorder refers to a collection of symptoms that may occur as a delayed response to a serious trauma (or series of traumas). More information on the concept is available in my quick Trauma/PTSD FAQ. It's not meant to be comprehensive, but just to give an idea of what trauma is and what PTSD is about. Herman (1992) suggests an expansion of the PTSD diagnosis for those who have been continually traumatized over a period of months or years. Based on patterns of history and symptomology in her clients, she created the concept of Complex Post-Traumatic Stress Disorder. CPTSD includes self-injury as a symptom of the disordered affect regulation severely traumatized patients often have (interestingly enough, one of the main reasons people who hurt themselves do so is in order to control seemingly uncontrollable and frightening emotions). This diagnosis, unlike BPD, centers on why patients who self-harm do so, referring to definite traumatic events in the client's past. Although CPTSD is not a one-size-fits-all diagnosis for self-injury any more than BPD is, Herman's book does help those who have a history of repeated severe trauma understand why they have so much trouble regulating and expressing emotion. Cauwels (1992) calls PTSD "BPD's identical cousin." Herman seems to favor a view in which PTSD has been fragmented into three separate diagnoses:

For an incredible amount of information on trauma and its effects, including posttrauma stress syndromes, definitely visit David Baldwin's Trauma Information Pages.

Dissociative Disorders

The dissociative disorders involve problems of consciousness -- amnesia, fragmented consciousness (as seen in DID), and deformation or alteration of consciousness (as in Depersonalization Disorder or Dissociative Disorder Not Otherwise Specified ).

Dissociation refers to a sort of turning off of consciousness. Even psychologically normal people do it all the time -- a classic example is a person who drives to a destination while "zoning out" and arrives not remembering much at all about the drive. Fauman (1994) defines it as "the splitting off of a group of mental processes from conscious awareness." In the dissociative disorders, this splitting off has become extreme and often beyond the patient's control.

Depersonalization Disorder

Depersonalization is a variety of dissociation in which one suddenly feels detached from one's own body, sometimes as if they were observing events from outside themselves. It can be a frightening feeling, and it may be accompanied by a lessening of sensory input -- sounds may be muffled, things may look strange, etc. It feels as if the body is not part of the self, although reality testing remains intact. Some describe depersonalization as feeling dreamlike or mechanical. A diagnosis of depersonalization disorder is made when a client suffers from frequent and severe episodes of depersonalization. Some people react to depersonalization episodes by inflicting physical harm on themselves in an attempt to stop the unreal feelings, hoping that pain will bring them back to awareness. This is a common reason for SI in people who dissociate frequently in other ways.

DDNOS

DDNOS is a diagnosis given to people who show some of the symptoms of other dissociative disorders but do not meet the diagnostic criteria for any of them. A person who felt she had alternate personalities but in whom those personalities were not fully developed or autonomous or who was always the personality in control might be diagnosed DDNOS, as might someone who suffered depersonalization episodes but not of the length and severity required for diagnosis. It can also be a diagnosis given to someone who dissociates frequently without feeling unreal or having alternate personalities. It's basically a way of saying "You have a problem with dissociation that affects your life negatively, but we don't have a name for exactly the sort of dissociation you do." Again, people who have DDNOS often self-injure in an attempt to cause themselves pain and thus end the dissociative episode.

Dissociative Identity Disorder

In DID, a person has at least two personalities who alternate taking full conscious control of the patients behavior, speech, etc. The DSM specifies that the two (or more) personalities must have distinctly different and relatively enduring ways of perceiving, thinking about, and relating to the outside world and to the self, and that at least two of these personalities must alternate control of the patient's actions. DID is somewhat controversial, and some people claim that it is over-diagnosed. Therapists must be extremely careful in diagnosing DID, probing without suggesting and taking care not to mistake undeveloped personality facets for fully-developed separate personalities. Also, some people who feel as if they have "bits" of them that sometimes take over but always while they're consciously aware and able to affect their own actions may run a risk of being misdiagnosed as DID if they also dissociate.

When someone has DID, they may self-injure for any of the reasons other people do. They may have an angry alter who attempts to punish the group by damaging the body or who chooses self-injury as a way of venting his/her anger.

It's extremely important that diagnoses of DID be made only by qualified professionals after lengthy interviews and examinations. For more information on DID, check out Divided Hearts. For reliable information on all aspects of dissociation including DID, the International Society for the Study of Dissociation web site and The Sidran Foundation are good sources.

Kirsti's essay on "bits" and "The Wonderful World of the Midcontinuum" provide reassuring and valuable information about DDNOS, the space between normal daydreaming and being DID.

Anxiety and/or Panic

The DSM groups many disorders under the heading of "Anxiety Disorders." The symptoms and diagnoses of these vary greatly, and sometimes people with them use self-injury as a self-soothing coping mechanism. They've found that it brings fast temporary relief from the incredible tension and arousal that build up as they grow progressively more anxious. For a good selection of writings and links about anxiety, try tAPir (the Anxiety-Panic internet resource).

Impulse-control Disorder

Not Otherwise Specified I include this diagnosis simply because it is becoming a preferred diagnosis for self-injurers among some clinicians. This makes excellent sense when you consider that the defining criteria of any impulse-control disorder are (APA, 1995):

• Failure to resist an impulse, drive, or temptation to perform some act that is harmful to the person or others. There may or may not be conscious resistance to the impulse. The act may or may not be planned.
• An increasing sense of tension or [physiological or psychological] arousal before committing the act.
• An experience of either pleasure, gratification, or release at the time of committing the act. The act . . . is consistent with the immediate conscious wish of the individual. Immediately following the act there may or may not be genuine regret, self-reproach, or guilt.

This describes the cycle of self-injury for many of the people I've talked to.

Self-injury As A Psychiatric Diagnosis

Favazza and Rosenthal, in a 1993 article in Hospital and Community Psychiatry, suggest defining self-injury as a disease and not merely a symptom. They created a diagnostic category called Repetitive Self-Harm Syndrome. This would be an Axis I impulse-control syndrome (similar to OCD), not an Axis II personality disorder. Favazza (1996) pursues this idea further in Bodies Under Siege. Given that it often occurs without any apparent disease and sometimes persists after other symptoms of a particular psychological disorder have subsided, it makes sense to finally recognize that self-injury can and does become a disorder in its own right. Alderman (1997) also advocates recognizing self-inflicted violence as a disease rather than a symptom.

Miller (1994) suggests that many self-harmers suffer from what she calls Trauma Reenactment Syndrome. Miller proposes that women who've been traumatized suffer a sort of internal split of consciousness; when they go into a self-harming episode, their conscious and subconscious minds take on three roles: the abuser (the one who harms), the victim, and the non-protecting bystander. Favazza, Alderman, Herman (1992) and Miller suggest that, contrary to popular therapeutic opinion, there is hope for those who self-injure. Whether self-injury occurs in concert with another disorder or alone, there are effective ways of treating those who harm themselves and helping them find more productive ways of coping.

About the author: Deb Martinson has a B.S. in Psychology, has compiled extension information on self-injury and co-authored a book on self-harm entitled "Because I Hurt." Martinson is the creator of the "Secret Shame" self-injury website.

Source: Secret Shame website

Interview with Bruce Elkin

Bruce Elkin, 55, is a simple living coach and a consultant to individuals, organizations and communities trying to live simple, yet rich lives in harmony with the systems of life that sustain us all. He is the author of the booklet, "Co-Creating Our Common Future" and the forthcoming book, "Living Well, Living Deeply." He is also Director of The Earthways Institute.

Tammie: What drew you to the Environmental movement?

Bruce: In 1973, I was hired by the Calgary Y to develop an environmental Ed curriculum for their new outdoor center. I did a survey of available programs, was disappointed by the either/or approach I found prevalent among those who thought hard science based conceptual understanding was the key and those who thought sensory appreciation and feelings for nature were the key. Then someone gave me a copy of Steve Van Matre's "Acclimatization: A Sensory and Conceptual Approach to Ecological Involvement." I read all SVM's stuff, joined the Institute for Earth Education, eventually became the senior trainer and, that was the start. Later, I developed my own approach incorporating Van Matre's ideas and ideas about personal empowerment, growth and transformation. Over the years, this led me to set up the EW Inst.

Tammie: In examining your own experiences with 'simple living,' what have you found the most significant challenges and rewards to be?

Bruce: The most challenging aspect is how to make a living. I've been living simply most of the time since 1973, trying to keep my income at a "just enough" level. But, figuring out what "just enough" is, is tough. Sometimes I make enough, sometimes I don't. The most troublesome challenge is walking the fine line between voluntary simplicity and involuntary poverty.

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The other challenge is not giving in to the opportunities to make the big bucks. A couple of times, I've headed off to teach myself new skills (coaching, consulting, etc) and did so well I was tempted to just keep at it to bring in the big bucks, sock them away in an FI fund (a la Your Money or Your Life?), but I found that when I did that kind of work, my expenses went way up (marketing, promotion, new clothes, nice car, air fare for travel, hotels in the city, all the things you need to do to appear a successful consultant). In the end, I didn't take home much more money than I did when I lived close to the bone, so I bagged most of that stuff. Now I only do work for groups I like and only occasionally.

The thing I like best about living simply is the time and freedom it gives me to create (write, relationships,) and to be in the natural world appreciating where I live.

Tammie: In your article, "Living Well, Living Deeply," you assert that lasting change requires "more than mere surface changes in behavior..." but re-arranging "the deeper elements underlying our actions." If you were to explain what you mean by this to an adolescent, what would you say?

Bruce: There are some things that adolescents can't or are not ready to hear, especially those under 15 years. There is a brain growth spurt at +/-14. Before that growth happens, they are still very concretely focused. Some of the structural stuff I work with just goes over their heads. When I do talk to older adolescents about this stuff, I talk about the difference between long-term goals/desires that really matter and short-term demands and how to organize your response to short-term demands so it both gives you what you want now and supports your long term desires. They usually get that.

Tammie: What are the "basic processes underlying the ability to create?"

Bruce: The basic processes underlying the ability to create are:

1. Knowing what you want, being able to envision a completed result in enough detail that you would recognize it if you created it.

2. Knowing what you have, being able to ground yourself in an objective and accurate description (not judgment!) of current reality, i.e. where you are starting from, what you have working for you, against you, what skills, resources, talents, experience etc you have or do not have.

3. The capacity to hold Vision and Current Reality together in your mind at the same time and to live/work comfortably in the gap between Vision and Reality as you craft your creation/desired result step by step.

4. A hierarchical set of choices wherein day to day choices support strategic goals and objectives and strategic goals support long-term purposes and your life mission.

5. The capacity to learn from doing, to try, note results, learn, make adjustments and try again.

6. Momentum: through consistent action, even wrong actions, you keep the momentum flowing. Over time it becomes a force which helps you move toward completion. The key is to always know your next steps, where you're going after you've done the step you're on now.

7. Completion: finishing fully, adding touches and details, making the creation fit the vision in your mind of what it looks like done.

8. Receiving: becoming a non-attached observer/critic of your creation. Being willing to live with its greatness and its faults without seeing either as reflective on you.

9. Using the energy of completion to begin your next creation.

Tammie: Has there been a particular transformative experience in your own life?

Bruce: I'm not a fan of cataclysmic theories of change. I don't think in terms of breakthroughs to higher levels (except in terms of chaos theory's bifurcations, but those are beyond my full understanding), I don't think in terms of quick fixes. I think more in terms of how nature usually works, slowly, consistently, patiently building things up over time. That's also how most art, literature, music, etc is created, step by step, poco a poco. My life has worked that way. No big quakes or shifts, just slow, incrementally building, growing learning over time. Eventually I've found myself miles from where I began.

Tammie: Do you believe that it's possible that we may be experiencing a global 'quake?'

Bruce: It is possible that the earth system is becoming so chaotic that we're about to experience a chaotic bifurcation, but I don't think anyone really knows if this is true or not. I think it is more likely that we're gonna continue muddling on, new things will emerge out of the mix, some will take, some will fall away and we'll gradually move closer to what we all really want. Wendell Berry said about learning to live where you are - Love the neighbors you have, not the ones you wish you had.) I think the key thing for all of us to do is not put our faith in big, sudden shifts but to settle in to our selves, our communities and our world for the long haul. We need to learn to be happy with and to want what we have! We need to love the world we have and work hard to bring into being the things we want in that world. And ourselves!

Tammie: What concerns you the most about our 'collective future,' what gives you the most hope?

Bruce: Not much concerns me about our future, because all the world is way out of my control. I am hopeful that the human spirit, which is part of nature's grand, intelligent complexity, will soar high enough to help our species realize that we are, indeed, just plain citizens of the biotic community and to begin to re-invent our lives, business and communities to fit into that biotic community in harmony with the systems that sustain all life. We may have to do some more real dumb stuff, screw up big time here and there, before everyone "gets it". But, I think we will, eventually. By we I mean humanity, our kids and their kids and their kids kids. In the meantime, I'm trying very much to enjoy what I have, the only life I'm likely to get.

next: On the Death of a Child

Family members, friends are often shocked when learning of the self-injurious activities of a loved one. Dr. Tracy Alderman, the author of "The Scarred Soul," discusses how to help the person who self-injures.

After having an awful day at work and an even worse time fighting the traffic to come home, Joan wanted nothing more than to sit down on her couch, turn on the television, order out for pizza and relax for the rest of the evening. But when Joan walked into the kitchen, what she saw indicated that this would not be the evening of her dreams. Standing in front of the sink was her fourteen-year-old daughter, Maggie. Maggie's arms were covered with blood, long slashes on her forearms dripping fresh blood into the running water of the kitchen sink. A single-edged razor blade sat on the counter along with several once-white towels, now stained crimson by Maggie's own blood. Joan dropped her briefcase and stood before her daughter in silent shock, unable to believe what she saw.

It is likely that many of you have had a similar experience and reaction to learning of the self-injurious activities of a loved one. This article is intended to provide some support, advice, and education to those of you who have friends and family who engage in activities of self-inflicted violence.

Self-Inflicted Violence: The Basics

Self-Inflicted Violence (SIV) is best described as the intentional harm of one's own body without conscious suicidal intent. Most types of SIV involve cutting of one's own flesh (usually the arms, hands, or legs), burning one's self, interfering with the healing of wounds, excessive nail biting, pulling out one's own hair, hitting or bruising one's self, and intentionally breaking one's own bones. SIV is more common than you might think with roughly 1% of the general population engaging in these behaviors (and this is likely to be greatly underestimated). The explanations for why people intentionally injure themselves are numerous and diverse. However, most of these explanations indicate that SIV is used as a method of coping and tends to make life more tolerable (at least temporarily).

How Can I Help Those Who Are Hurting Themselves?

Unfortunately, there is no magic cure for self-inflicted violence. However, there are some things which you can do (and some things you shouldn't do) which can help those individuals who are hurting themselves. Keep in mind though, that unless someone wants your help, there is nothing in the world that you can do to assist that individual.

Talk About Self-Inflicted Violence

SIV exists whether you talk about it or not. As you know, ignoring anything does not make it disappear. The same is true with self-inflicted violence: it will not go away because you are pretending it doesn't exist.

Talking about self-inflicted violence is essential. Only through open discussions of SIV will you be able to help those who are hurting themselves. By addressing the issues of self-injury you are removing the secrecy which surrounds these actions. You are reducing the shame attached to self-inflicted violence. You are encouraging a connection between you and your self-injuring friends. You are helping to create change just by the mere fact that you are willing to discuss SIV with the person who performs those behaviors.

You may not know what to say to the individual who is performing acts of SIV. Fortunately, you don't have to know what to say. Even by acknowledging that you want to talk, but you're not sure how to proceed, you are opening the channels of communication.

Be Supportive

Talking is one way to provide support, however, there are numerous other ways to show your support to another. One of the most helpful ways by which to determine how you could offer support is to directly ask how you might be helpful. In doing so, you might find that your idea of what is helpful is vastly different from how others view what is helpful. Knowing what kind of assistance to offer and when to offer it is necessary in order to be helpful.

Although it may be difficult for you, it is really important that in being supportive you keep your negative reactions to yourself. Because judgments and negative responses contrast with support, you will need to put these feelings aside for the time being. You can only be supportive when you act in supportive ways. This is not to say that you should not or will not have judgments or negative reactions to SIV. However, conceal these beliefs and feelings while you are performing helpful behaviors. Later, when you are not assisting your friend, go ahead and release these thoughts and emotions.

Be Available

Most individuals who injure themselves, will not do so in the presence of others. Therefore, the more you are with those individuals who hurt themselves, the less opportunity they will have to inflict self-harm. By offering your company and your support, you are actively decreasing the likelihood of SIV.

Many people who hurt themselves have difficulty recognizing or stating their own needs. Therefore, it is helpful for you to offer the ways in which you are willing to help. This will allow your friends to know when and in what ways they are able to rely on you.

You will need to set and maintain clear and consistent limits with your self-injuring friends. Thus, if you are not willing to take crisis calls after nine in the evening, then indicate this to your friends. If you can only offer support over the telephone, rather than in person, be clear about that. When individuals need support around issues of SIV, they need to know who is available to help them and in what manner they can offer help. While what you do for your friends is important, establishing and maintaining appropriate boundaries is equally necessary for the relationship (and your own sanity).

Don't Discourage Self-Injury

Although this may seem difficult and irrational, it is important for you to not discourage your friends or family from engaging in acts of self-inflicted violence. Rules, shoulds, shouldn'ts, dos and don'ts all limit us and place restrictions on our freedom. When we maintain the right to choose, our choices are much more powerful and effective.

Telling an individual to not injure herself is both aversive and condescending. Because SIV is used as a method of coping and is often used as an attempt to relieve emotional distress when other methods have failed, it is essential for the person to have this option. Most individuals would choose to not hurt themselves if they could. Although SIV produces feelings of shame, secrecy, guilt and isolation, it continues to be utilized as a method of coping. That individuals will engage in self-injurious behaviors despite the many negative effects is a clear indication of the necessity of this action to their survival.

Although it may be incredibly difficult to witness a loved one's fresh wounds, it is really important that you offer support, and not limits, to that individual.

Recognize the Severity of the Person's Distress

Most people don't self-injure because they're curious and wonder what it would be like to hurt themselves. Instead, most SIV is the result of high levels of emotional distress with few available means to cope. Although it may be difficult for you to recognize and tolerate, it is important that you realize the extreme level of emotional pain individuals experience surrounding SIV activities.

Open wounds are a fairly direct expression of emotional pain. One of the reasons why individuals injure themselves is so that they transform internal pain into something more tangible, external and treatable. The wound becomes a symbol of both intense suffering and of survival. It is important to acknowledge the messages sent by these scars and injuries.

Your ability to understand the severity of your friend's distress and empathize appropriately will enhance your communication and connection. Don't be afraid to raise the subject of emotional pain. Allow your friends to speak about their inner turmoil rather than express this turmoil through self-damaging methods.

Get Help For Your Own Reactions

Most of us have had the experience at some point in our lives of feeling distressed by our reactions to someone else's behavior. Al-Anon and similar self-help groups were created to help the friends and families of individuals dealing with problems of addiction and similar behaviors. At this point in time, no such organizations exist for those coping with a loved one's SIV behaviors. However, the basic premise upon which these groups were designed clearly applies to the issue of self-inflicted violence. Sometimes the behavior of others affects us in such a profound manner that we need help in dealing with our reactions. Entering psychotherapy to deal with your responses to SIV is one such way to handle the reactions which you may find to be overwhelming or disturbing.

You may find it strange to seek help for someone else's problem. However, the behaviors of others can have profound effects on us. This effect is further strengthened by the mysteriousness, secrecy, and misconceptions about self-inflicted violence. Thus, entering psychotherapy (with a knowledgeable clinician) can educate you about SIV as well as assist you in understanding and altering your own reactions. When you learn that a friend or family member is injuring herself, you are likely to have an intense emotional reaction and psychotherapy will help you deal with these reactions.

Sometimes asking for help is really difficult. The individuals who have come to you telling you of their SIV and asking for your help are highly aware of this. Follow in their path. If you need (or want) help, get it. Seek a trained professional. Ask some friends for support. Speak with a religious counsel if that's helpful. Whatever you need to do in order to take care of yourself, do it. You have to take care of yourself before you can assist another. When trying to help friends and family members who are injuring themselves, this point is critical. We cannot be of much use to anyone else if we, ourselves are in a state of need.

Tracy Alderman, Ph.D., is a licensed clinical psychologist and author of a well-known book on self-injury, "The Scarred Soul".

Tips for parents and teens on getting help for dealing with and stopping self-injury.

Parents are encouraged to talk with their children about respecting and valuing their bodies. Parents should also serve as role models for their teenagers by not engaging in acts of self-harm. Some helpful ways for adolescents to avoid hurting themselves include learning to:

• accept reality and find ways to make the present moment more tolerable.
• identify feelings and talk them out rather than acting on them.
• distract themselves from feelings of self-harm (for example, counting to ten, waiting 15 minutes, saying "NO!" or "STOP!," practicing breathing exercises, journaling, drawing, thinking about positive images, using ice and rubber bands)
• stop, think, and evaluate the pros and cons of self-injury.
• soothe themselves in a positive, non-injurious, way.
• practice positive stress management.
• develop better social skills.

Evaluation by a mental health professional may assist in identifying and treating the underlying causes of self-injury. Feelings of wanting to die or kill themselves are reasons for adolescents to seek professional care right away. A child and adolescent psychiatrist can also diagnose and treat the serious psychiatric disorders that may accompany self-injurious behavior.

See also "Self-Help for Self-Injury"

Source:

• The American Academy of Child and Adolescent Psychiatry (AACAP)