Stimulant medication isn't the only medical treatment for ADHD. There's non-stimulant medication, Strattera, for ADHD, as well as antidepressants and some blood pressure drugs.

There are many drugs other than psychostimulants that can be used to treat ADHD.

Nonstimulant Therapy for ADHD

Strattera is the first nonstimulant approved for treatment of ADHD. It is also the only drug approved to treat adult ADHD.

Strattera works on the neurotransmitter (chemical in the brain that transmits nerve impulses) called norepinephrine. Like the stimulant drugs, Strattera is effective in treating and controlling ADHD symptoms, but it is not a controlled substance and people are less likely to abuse the drug or become dependant on it.

In addition, Strattera doesn't cause many of the potential side effects linked to psychostimulants, such as sleeplessness. Overall, the drug is well tolerated with minimal side effects.

How Does Strattera Work?

This medication works by increasing the amount of norepinephrine, an important brain chemical, in the brain. Doing this appears to help ADHD by increasing attention span and reducing impulsive behavior and hyperactivity.

What Are the Side Effects of Strattera?

The most common side effects seen with Strattera are:

• Upset stomach
• Decreased appetite, which may cause weight loss
• Nausea
• Dizziness
• Fatigue
• Mood swings

Generally, these side effects are not severe, and only a very small percentage of clinical trial participants stopped Strattera due to side effects.

There have been reports of slightly decreased growth in children and teens. It is recommended that children and adolescents be observed, measured and weighed periodically while on Strattera.

Allergic reactions to Strattera are rare but do occur, usually as swelling or hives. The prescribing doctor or other health care professional should be advised immediately if anyone taking Strattera develops a skin rash, swelling, hives or other allergic symptoms.

On Dec. 17, 2004, Eli Lilly, the makers of Strattera, added a warning to the drug noting Strattera should be stopped in patients with signs of jaundice -- yellowing of the skin or whites of the eyes. Jaundice is a sign of liver damage. If blood tests show evidence of liver damage, the drug should also be stopped.

Who Shouldn't Take Straterra?

There are certain situations in which a person should not take Strattera. If you or your child has any of the following conditions, you should discuss them with your health care provider before taking Strattera:

• Narrow angle glaucoma (a condition causing increased pressure in the eyes and can lead to blindness).
• Treatment with a type of antidepressant called monoamine oxidase inhibitors, such as Nardil or Parnate, within 14 days of starting Strattera.

Straterra: Tips and Precautions

Be sure to tell your doctor:

• If you are nursing, pregnant, or plan to become pregnant
• If you are taking or plan to take any dietary supplements, herbal medicines or nonprescription medications
• If you have any past or present medical problems, including high blood pressure, seizures, heart disease, glaucoma or liver or kidney disease
• If you have a history of drug or alcohol abuse or dependency or if you have had mental health problems, including depression, manic depression, or psychosis.

Strattera should always be taken exactly as prescribed. It is usually taken once or twice a day and may be taken with or without food. No specific laboratory testing is required while taking Strattera and it may be used for extended, or long-term, treatment as long as there are periodic evaluations with your health care provider.

Antidepressant Therapy for ADHD

Several types of antidepressant drugs can be used to treat ADHD. Antidepressant therapy for ADHD is sometimes used as the treatment of choice for children or adults who have ADHD and depression.

Antidepressants, however, are generally not as effective as stimulants or Straterra at improving attention span and concentration.

Antidepressants used for treating ADHD include:

• Tricyclic antidepressants, such as Pamelor, Aventyl, Tofranil, Norpramin, and Pertofrane, have been shown to be helpful in children and adults with ADHD, but they can cause some unpleasant side effects, such as dry mouth, constipation or urinary problems. They are also relatively inexpensive.
• Wellbutrin
• is a different type of antidepressant that is very effective in treating ADHD in adults and children. It is generally well-tolerated but it also has some side effects that may be a problem with some people who have anxiety, headaches or seizures.
• Effexor and Effexor XR are antidepressants that increase the levels of norepinephrine and serotonin in the brain. The drugs are effective at improving mood and concentration in adults as well as children and teens.
• MAO inhibitors are a group of antidepressants that can treat ADHD with some benefit but are rarely used because they have significant and sometimes dangerous side effects and can dangerously interact with foods and other medications. They may be of benefit in people where other medications have failed. Examples include Nardil or Parnate.

Note: In October 2004, The FDA has determined that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider. Learn more

How Do Antidepressants Work to Treat ADHD?

Since most antidepressants work by increasing the levels of brain messenger chemicals (neurotransmitters), such as norepinephrine, serotonin and dopamine, it makes sense that they might have similar effects to other ADHD stimulant and nonstimulant treatments that appear to work by similar mechanisms.

Antidepressant treatment seems to improve attention span as well as impulse control, hyperactivity and aggressiveness. Children and adolescents treated with antidepressants are often more willing to take direction and are less disruptive.

Antidepressants have the advantage of having a low potential for abuse and there is no evidence that they suppress growth or contribute to significant weight loss.

Who Should Not Take Antidepressants?

Antidepressants should not be used

• If you have a history or tendency toward manic behavior or manic depression (bipolar disorder)
• Wellbutrin can't be taken if you have any history of seizures or epilepsy.
• Treatment with antidepressants should not be initiated if you have taken a monoamine oxidase inhibitor antidepressant, such as Nardil or Parnate, within the last 14 days.
• Each type of antidepressant has its own contraindications and usage warnings, and you should discuss these with your doctor.

Side Effects of Antidepressants

The most common side effects experienced with tricyclic antidepressants include:

• Stomach upset
• Constipation
• Dry mouth
• Blurred vision
• Drowsiness
• Low blood pressure
• Weight gain
• Tremor
• Sweating
• Difficulty urinating

Wellbutrin sometimes causes stomach upset, anxiety, headaches and rashes.

Effexor can cause nausea, anxiety, sleep problems, tremor, dry mouth and sexual problems in adults.

MAO inhibitors can cause a wide variety of side effects, including dangerously increased blood pressure when combined with certain foods or medications.

Antidepressants Therapy for ADHD: Tips and Precautions

When taking antidepressants for ADHD, be sure to tell your health care provider:

• If you are nursing, pregnant, or plan to become pregnant
• If you are taking or plan to take any dietary supplements, herbal medicines or nonprescription medications
• If you have any past or present medical problems, including high blood pressure, seizures, heart disease and urinary problems
• If you have a history of drug or alcohol abuse or dependency or if you have had mental health problems, including depression, manic depression or psychosis.

The following are useful guidelines to keep in mind when taking antidepressants or giving them to your child for ADHD:

• Always give the medication exactly as prescribed. If there are any problems or questions, call your doctor.
• Antidepressants usually take 2-4 weeks before the full effects are apparent. Be patient and dont give up before giving them a chance to work!
• Your doctor will probably want to start out at a low dose and increase gradually until symptoms are controlled.
• It is better not to miss doses of antidepressants. Most are given once or twice a day. If you miss a day or two of Effexor, it can cause an unpleasant withdrawal syndrome.
• Tell your doctor if you notice any new or unusual side effects. Taking bulk laxatives (fiber) and drinking lots of water is a good idea with tricyclic antidepressants as they tend to cause constipation and hard stools.
• If you become constipated as a result of taking tricyclic antidepressants, take a bulk laxative (fiber) and drink lots of water.
• Monitor your child, especially when starting antidepressant therapy, for potential suicidal thoughts and behaviors.

Blood Pressure Drugs Used to Treat ADHD

Two drugs, Catapres and guanfacine, normally taken to treat high blood pressure, have been shown to be of some benefit for ADHD when used alone or in combination with stimulant drugs. The drugs can improve mental functioning as well as behavior in ADHD.

How Do Blood Pressure Drugs Treat ADHD?

How these drugs work in treating ADHD is not yet known, but it is clear that they have a calming effect on certain areas of the brain.

Catapres can be applied in a weekly patch form for gradual medication release. This delivery method helps decrease some side effects, such a dry mouth and fatigue. After a few weeks, side effects usually diminish considerably.

Catapres and guanfacine can help reduce some of the side effects of stimulant therapy, especially the sleeplessness and aggressive behavior. However, combining stimulants with one of these drugs is controversial, because there have been some deaths in children taking both stimulants and Catapres.

It is not known whether these deaths were due to the combination of drugs, but caution should be exercised whenever such combinations are used. Careful screening for heart rhythm irregularities and regular monitoring of blood pressure and electrocardiograms help reduce these risks. If your doctor thinks that combining these two treatments offers more benefits than risks, it may be a good option.

Who Should Not Take Blood Pressure Drugs?

Catapres and guanfacine may be contraindicated if there is a history of low blood pressure or other personal or family history of a significant heart problem.

What Are the Side Effects of Blood Pressure Medications?

The most common side effects seen with these drugs include:

• Drowsiness
• Lowered blood pressure
• Headache
• Sinus congestion
• Dizziness
• Stomach upset

These drugs can rarely cause irregular heartbeats.

Blood Pressure Medication for ADHD: Tips and Precautions

When taking one of these drugs for ADHD, be sure to tell your doctor:

• If you are nursing, pregnant, or plan to become pregnant
• If you are taking or plan to take any dietary supplements, herbal medicines or nonprescription medications
• If you have any past or present medical problems, including low blood pressure, seizures, heart rhythm disturbances and urinary problems

The following are useful guidelines to keep in mind when taking Catapres or guanfacine or giving them to your child for ADHD:

• Always take or give the medication exactly as prescribed. If there are any problems or questions, call your doctor. It is best not to miss doses or patches as this may cause the blood pressure to rise quickly, which may cause headaches and other symptoms.
• Your health care provider will probably want to start out at a low dose and increase gradually until symptoms are controlled.
• Catapres patches come in various sizes. Rotate the placement of the patch to avoid skin irritation.
• For very young children, Catapres tablets can be formulated into a liquid by your pharmacist to make giving the medication easier.

next: ADHD Treatment Overview: Psychotherapy
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Excerpts from the Archives of the Narcissism List Part 1

1. Why Does the Narcissist Devalue his Source of Secondary Narcissistic Supply?
2. Narcissistic Mental Health Professionals
3. How to Cope with a Narcissist
4. NPD Treatments - SSRI
5. Epidemiology of Narcissism
6. Rescue Fantasies
7. Loving a Narcissist
8. Hitler and Narcissism
9. Cultural Sensitivity of Therapists
10. NPD, Culture and Normalcy
11. Psychodynamic versus Cognitive-Behavioral Treatments
12. Bill Clinton - a Narcissist?
13. Self-Defeating and Self-Destructive Behaviours
14. Narcissism not Curable?
15. Narcissism and Culture
16. The Vocations of Narcissists
17. Lazy Narcissists

Part 1

1.Why does the narcissist devalue his source of secondary narcissistic supply?

ONE of the reasons is what you mentioned (I wouldn't like to belong to a club which will accept me as a member syndrome). But there are many others. For instance, the narcissist resents his dependence and by devaluing the object of dependence (his spouse, for instance), he gets rid of the dissonance.

Yet another issue:

The narcissist perceives intimacy and sex as a threat to his uniqueness and specialness. EVERYONE needs sex and intimacy - it is the great equalizer. The narcissist resents this equality. He rebels.

Sex and intimacy are usually also connected to past unresolved conflicts with important primary objects (also known as parents). They invoke these conflicts, encourage transference and provoke the onset of an approach-avoidance cycle.

Later in the week, I promise to post selected passages from Jeffrey Satinover who, despite being a Jungian, has a very clear psychodynamic model of these behaviors.

2. Narcissistic Mental Health Professionals

Mental health professionals are human. Many of them suffer from mental disorders. Many of them chose their profession simply to be able to cope with their own deficiencies and problems.

Unfortunately, not many of them are sufficiently conscientious. They engage in the delicate art of therapy long before they overcome their own problems.

They bring their problematic, even sick, selves into the therapeutical setting and, in doing so, they aggravate the mental state of the patient.

Analysts are supposed to work to solve their own problems prior to practicing. Therapists are supposed to work under supervision and to refer and defer to these outsiders. an outside perspective is often very helpful to them. But not all therapists and psychiatrists adopt these professional standards and work methods. This is unfortunate.

Being subjected to therapy administered by a narcissist must be a harrowing experience. It is no different to being married to a narcissist, or being brought up by a narcissist, or to having a narcissistic parent.

Willingly choosing to continue therapy with such a person was not wise. You say as much. But now is the time to derive lessons: stay away from narcissists and even from those whom you suspect of being narcissists. And ask yourself why did you choose to stay on as things got worse. The answer to this question is important.

Don't be discouraged and do continue therapy with someone else. Your growth and personal development are important and pressing needs. You will overcome this unfortunate encounter. All the victims of narcissists do. They emerge scarred but the wiser for it.

3. How to Cope with a Narcissist

Administer a modicum of narcissistic treatment (including verbal abuse) to the narcissist - and he/she is likely to vanish in a puff of indignant smoke. Narcissists shrivel, wither and die without narcissistic supply.

Humiliation, disagreement, criticism, comparison with others, mirroring the narcissist's behavior - are all great ways of getting rid of narcissists.

4. NPD Treatments - SSRI

Narcissistic Personality Disorder (NPD) per se is NOT treated with medication. It is usually subjected to talk therapy. The underlying disorder is treated by long-term psychodynamic therapy. Other personality disorders (NPD rarely comes alone. It usually appears with other PDs) are treated separately and according to their own characteristics.

But phenomena which are often associated with NPD - such as depression or OCD (obsessive compulsive disorder) - ARE treated with medication. Recent research indicates that SSRI's (such as Fluoxetine, known as Prozac) might have adverse effects if the primary disorder is NPD. They sometimes lead to the serotonin syndrome which includes agitation and exacerbates the rage attacks typical of a narcissist. I didn't hear about the exacerbation of grandiosity due to SSRI consumption but I am keen on comparing notes. SSRI do lead at times to delirium and a manic phase and even to psychotic microepisodes, though.

This is not the case with the heterocyclics, MAO and mood stabilizers, such as lithium. Blockers and inhibitors are regularly applied without discernible adverse side-effects (as far as NPD is concerned).

Additional cognitive-behavioral therapies are often applied to OCD and sometimes to depression. To summarize:

Not enough is known about the biochemistry of NPD. There seems to be some vague link to serotonin but no one knows for sure. There isn't a reliable NON-INTRUSIVE method to measure brain and central nervous system serotonin levels anyhow, so it is mostly guesswork at this stage. Thus, as of now, the typical treatment is: Talk therapy (psychodynamic), Cognitive-behavioral therapy for OCD, and depression Antidepressants (with SSRI being currently under critical scrutiny)

5. Epidemiology of Narcissism

The figures seem to indicate that a minimum of 1% (probably 3% and perhaps up to 5%) of the population above the age of 10 are narcissists. Now, factor in the parents, spouses, colleagues, friends, children, the children's families ...

This is the biggest under-diagnosed mental health pathology ever. Many researchers also believe that all Cluster B personality disorders (Histrionic, Antisocial and Borderline) have a common thread of pathological narcissism. This is getting close to 10% of the adult population. Staggering numbers.

6. Rescue Fantasies

"It is true that he is a chauvinistic narcissist with repulsive behaviors. But all he needs is a little love and he will be straightened out. I will rescue him from his misery and misfortune. I will give him the love that he lacked as a kid. Then his narcissism will vanish and we will live happily ever after".

7. Loving a Narcissist

I believe in the possibility of loving narcissists if one accepts them unconditionally, in a disillusioned and expectation-free manner. Narcissists are narcissists. This is what they are. Take them or leave them. Some of them are lovable. Most of them are highly charming and intelligent. The source of the misery of the victims of the narcissist is their disappointment, their disillusionment, their abrupt and tearing and tearful realization that they fell in love with an ideal of their own invention, a phantasm, an illusion, a fata morgana. This "waking up" is traumatic. The narcissist is forever the same. It is the victim who changes.

It is true that narcissists present a facade in order to generate sources of narcissistic supply. But this facade is easy to penetrate because it is inconsistent. The cracks are evident from day one but often ignored. And what about all those who KNOWINGLY and WILLINGLY commit their wings to the burning narcissistic candle?

I, personally, always inform and warn other people that I am a Narcissist. Yet it never seemed to have dissuaded even one fervent lady from pursuing me (or, rather, my False Self). It did not deter one businessman from doing business with me. Frankly, it did not deter you from joining my list. Why is this? Because, having been forewarned, perhaps you stand to benefit without suffering. And, most probably, you do. But perhaps it is the irresistible attraction we all have to the "other", the "different" and, as a result, the "risky".

8. Hitler and Narcissism

I recommend Alan Bullock's book "Hitler and Stalin - Parallel Lives" (both deemed narcissists by Bullock and Hitler was judged to be NPD by Fromm).

Another FASCINATING study, secretly commissioned during the war years depicts Hitler as a severe case of NPD - when NPD was not even recognized as such: http://www1.ca.nizkor.org/hweb/people/h/hitler-adolf/oss-papers/text/profile-index.html

9. Cultural Sensitivity of Therapists

Today, therapists are trained to be culturally-sensitive. A person needs help if he does not feel well AFTER ADJUSTING for his cultural and societal idiosyncracies. In many subcultures, a person would feel very bad if unable to marry many women. If the client is a fundamentalist Moslem, then he should be treated (because he does feel bad) in order to ENABLE him to marry many women in accordance with his religious practice.

Therapists/psychologists are taught today to be culturally sensitive. They are taught to confront culture, race and gender issues as early as the first session with a patient to avoid future tensions or misunderstandings.

10. NPD, Culture and Normalcy

Assumptions of normalcy should always be qualified. "Normal WITHIN a given culture/society". If the "disorder" is congruent with the client's culture and society - then he is well-adapted. But, for example, if an aboriginal woman chooses to live in the West, then according to Western cultural and societal norms she might indeed be a dangerous deviant. Dissidents and conscientious intellectuals in authoritarian regimes were often treated by psychiatrists because they were abnormal - and THEY WERE! Within their cultural and societal contexts - they acted abnormally and needed treatment because they endangered their lives and the lives of others.

An abnormal (person) does not conform to cultural and societal values prevailing in his or her actual context.

The issues of morality and deviance should not be confused, though. In certain societies and cultures a person is normal ONLY if he is immoral. In others, being moral is abnormal. Risking one's life to oppose Hitler was an abnormal behavior. But it was, is, and always will be moral (assuming morality includes a hard nucleus of "core values" like "thou shalt not kill").

11. Psychodynamic versus Cognitive-Behavioral Treatments

This is the seemingly eternal debate between the cognitive-behavioral theories of therapy and the psychodynamic ones.

To grossly oversimplify:

The CBTs (cognitive behavioral therapies) are based on the belief that insight - even a merely verbal and intellectual one - is sufficient to induce an emotional outcome. If properly manipulated, verbal cues, insights, analyses of standard sentences we keep saying to ourselves ("I am ugly", "I am afraid no one would like me"), and repeated behavioral patterns (learned behaviors) coupled with positive (and, rarely, negative) reinforcements - are sufficient to induce a cumulative emotional effect tantamount to healing.

Psychodynamic theories do not believe that cognition can influence emotion. They believe that much deeper strata have to be accessed and studied by both patient and therapist. The very exposure of these strata is considered sufficient to induce a dynamic of healing. The therapist's role is either to interpret the material revealed to the patient (psychoanalysis) by allowing the patient to transfer past experience and superimpose it on the therapist - or to actively engage in providing a safe emotional environment conducive to changes in the patient.

I think the latter approach is the right one. Consider me: there are few narcissists who achieved the level of cognitive insight I have. I know myself and my mental defenses reasonably well. Did it induce any substantial change in me? I don't think so. Unfortunately, my case is a hybrid, because I also sustained a series of severe narcissistic (=emotional) injuries simultaneously with the cognitive insights. Rather, the latter were induced by the former.

The sad fact is that no known therapy is effective with narcissism ITSELF - though a few therapies are reasonably successful with coping with its effects.

12. Bill Clinton - a Narcissist?

I think the question is WHY is he behaving the way he does. Is he doing it compulsively, in an uncontrolled manner? Is he looking to be punished, get caught, avoid getting caught?

Is he constantly bored, feels empty and is looking to illicit sex for constant thrills?

Is he contemptuous of others?

Does he lie pathologically (cannot help it) or expediently (in a premeditated manner)?

Is he oblivious to the pain that he inflicts on others - or simply does not care?

Has any of you interviewed him lately to come up with unequivocal answers to all these VERY CRITICAL questions? Has any psychiatrist/psychologist/therapist interviewed him and tested his personality him? I don't believe so.

So, in the absence of HARD facts - how can we diagnose him?

13. Self-Defeating and Self-Destructive Behaviours

These behaviors can be grouped by the following motivations:

(1) The Self-Punishing, Guilt-Purging Behaviors

These are intended to inflict punishment upon the individual and thus to provide him with relief.

This is very reminiscent of compulsive-ritualistic behavior. The person harbors guilt. It could be an "ancient" guilt, "sexual" guilt (Freud), "social" guilt - but guilt it is. The person internalized and introjected voices of meaningful others that consistently and convincingly and from positions of authority informed him that he is no good, guilty, deserving of punishment or retaliation, corrupt. His life is thus transformed into an on-going trial. The constancy of this trial, the never adjourning tribunal IS the punishment. It is Kafka's "trial": meaningless, undecipherable, never-ending, without a verdict, subject to mysterious laws, and run by arbitrary judges.

(2) The Extracting Behaviors

People with PDs are very afraid of real, mature, intimacy. Intimacy is formed not only within a couple, but in a workplace, in a neighbourhood, with friends, while working in a team on a project. Intimacy is another word for emotional involvement which is the result of interactions in constant and predictable (safe) proximity. PDs interpret intimacy (not DEPENDENCE - but intimacy) as strangulation, the snuffing of freedom, death in installments. They are terrorized by it. Their self destructive and self defeating acts are intended to dismantle the very foundation of a successful relationship, a career, a project, a friendship. NPDs, for instance, feel elated and relieved after they unshackle these "chains". They feel they broke through a siege, that are liberated and free at last.

(3) The Default Behaviors

We are all afraid of new situations, new possibilities, new challenges, new circumstances, and new demands. Being healthy, being successful, getting married, becoming a mother, or a boss - are abrupt breaks with the past. Some self defeating behaviors are intended to preserve the past, to restore it, to protect it from the winds of change, to decimate the draught through the open window of opportunity.

14. Narcissism not Curable?

Narcissism is a structure of the WHOLE personality. It is ALL-pervasive. It is akin to being an alcoholic but MUCH more so. Alcoholism is an impulsive behavior. Narcissists have these reckless behaviours plus hundreds of other problems. Wife beating is a behavior. Narcissists have dozens of impulsive behaviors, some of them uncontrollable (like their rage or behaviors which are the results of their grandiosity). On the other hand to be a (non kleptomanic) thief is to have a vocation - how can one compare something as superficial as a vocation to the structure of one's personality? You CAN compare narcissism to depression or to other disorders. But not to traits or attributes that we can change at will.

My narcissism is no more "curable" than the entirety of my personality is disposable. I AM a narcissist. Narcissism is the colour of my skin, not my choice of subjects at the university.

15. Narcissism and Culture

Karen Horney was amongst the first to point out that NPD is defined within a cultural context. While I know of NO culture which condones NPD - I can CONCEIVE of one. But, I think it should not matter to us. We are living in an increasingly Westernized world, we are Westerners, our problems are here and now and we label them NPD. That one culture's problem can be another's assets is the staff moral and cultural relativism is made of.

What matters is CONFORMITY to norms. We define norms STATISTICALLY. We have no other choice. There is too much disparity of opinion regarding culture, the "right" norms, morality, and "proper" behavior. So, we sample the population, determine what is statistically normal (not DESIRABLE - but normal) and compare behavior patterns to these statistical benchmarks. If someone deviates from our norms - then he is a deviant, a patient, mentally sick, and so on.

Funny that psychology started differently: by holding forth a model of the "healthy" person and comparing it to PATIENTS. In other words: psychologists defined people as patients simply because they came to see them with a complaint and did not fit an idealized model of the healthy, functional person.

Today, the approach is culturally-sensitive. A person needs help if he does not feel well AFTER ADJUSTING for his cultural and societal idiosyncracies.

16. The Vocations of Narcissists

I think we are likely (or liable .. ) to find a concentration of narcissists in the media, in show business, in politics, and in academe. Did you notice how these people - literally and physically - wither away when out of touch with their sources of narcissistic supply, with their audience?

"Narcissistic Supply" - adulation, admiration, approval, applause, attention, fame, celebrity, notoriety ... in short: feedback - positive OR negative - from people. The narcissist thus sees his "False Self" - the image that he projects to others - reflected. This way he feels assured of his very own existence.

17. Lazy Narcissists

Narcissists are lazy because they feel entitled without having commensurate achievements. To be considerate is to invest effort, time, attention, and other resources. Why do that if, anyhow, one is entitled - and expects to cash in on this entitlement? People are sources of narcissistic supply. Narcissists feel so worthy that they pose a "take me as I am or leave me altogether" choice to the world.

Extra effort is considered by the narcissist to be superfluous. I agree that the best way to treat a narcissist is to out-narcissize him/her. Treat it like it treats you and it will vanish in a puff of smoke quicker than a witch. Narcissists are not interested - nor are they sufficiently resilient - to face opposition, disagreement, friction, conflict, in short: negative narcissistic supplies.

next: Excerpts from the Archives of the Narcissism List Part 2

Alternative therapies like acupuncture, herbal remedies, aromatherapy and martial arts relieve anxiety, stress and depression.

Have you noticed that when you are feeling stressed or down, you can get ill more easily? This may be because of a link between your mind and your body's health.

Several treatments can cure the causes of illness but don't always treat the symptoms. Complementary therapies can work for some people with mental health problems, usually at the same time as other medical treatment. Some people use alternative therapies instead of medication, but it's important to discuss any treatment for mental health problems with your GP.

Alternative therapies can include:

• Acupuncture
• Herbal remedies
• Aromatherapy
• T'ai chi, Aikido
• Yoga

These treatments can help some people with stress. But if you're taking medication ask your doctor before seeing a complementary or alternative therapist. If you know anyone who has tried one of the treatments ask them what they thought of it. It's important to decide what kind of therapy appeals to you, as what works for someone else might not work for you.

Acupuncture and Chinese Medicine

Acupuncture is a form of traditional Chinese medicine that has been used for thousands of years. In Chinese medicine, life energy, known as 'qi,'(pronounced 'Chi') flows beneath the skin. When a person's qi is blocked or can't flow, they become ill. For a person to be cured, their qi has to start moving again.

In acupuncture, the acupuncturist talks to the patient to try to identify the problem. Then small needles are put into the skin at certain points and left in for a short time. The needles are used to help the flow of the qi.

"After years of feeling low, I tried acupuncture. I chose a woman and spoke to her first to see if I liked her. The treatment left me feeling much more relaxed...I feel a lot more balanced and in control of my life. I also had trouble sleeping before, and I sleep a lot better now." (Emily, a 23-year-old teacher who has been having acupuncture to treat her depression.)

There are no reported side-effects of acupuncture, but it's essential to make sure the needles are new - no good acupuncturist will re-use needles.

Acupuncture treatment can start at around $50 a session. Doctors can prescribe acupuncture, but it's unusual.

Herbal Remedies

Herbal remedies are also used in Chinese medicine. If you use this treatment, it's important to tell the herbalist if you're pregnant, or about any medication you're already taking as some medicines can react badly with herbs.

Continue reading to find out about how yoga, martial arts and aromatherapy can all help.

Aromatherapy

Aromatherapy uses extracts from plants and trees. These extracts are made into essential oils, which are very strong. They can be used in different ways:

• Dilute the oils with water, put them in a burner and inhale them.
• Sprinkle a few drops onto your pillow to help you sleep.
• Add a few drops of oil to bath water.
• Mix essential oils with vegetable oil and massage the mixture into your skin.

Aromatherapy oils can be used for relaxation and treating stress:

• Lavender helps people to relax and sleep, and can relieve headaches.
• Patchouli oil reduces anxiety and can help lift your mood.
• Ylang Ylang makes you feel happier and helps you to sleep. But don't use too much, as it can cause headaches.

Books on aromatherapy can tell you which oils to use. Oils can be bought at chemists, health food shops and some high street stores. They can cost between £3 - £7. You can also see a qualified aromatherapist, although this can be expensive.

Martial Arts

Martial arts - hand and body movements mostly learned for self-defence - can help relaxation. T'ai chi and Aikido are two of the best martial arts for relieving stress and tension.

T'ai chi originates from China and has been practiced for thousands of years. It uses body movements and breathing to help clear the mind and body. T'ai chi is also used for self-defense.

Aikido originates from Japan. You don't need to be physically strong to practice Aikido - quick reactions and flexibility are what count. None of the movements are violent or aggressive but they can also be used to overcome attackers.

T'ai chi and Aikido classes are becoming more popular. Look for classes at your local sports centre.

Yoga

Yoga exercise helps create a healthy body and mind. Yoga focuses awareness on your body and the space around you. Tension in your muscles is relaxed and you become more flexible. By focusing attention on your body, your mind can begin to work with a different outlook.

In most yoga classes you'll normally spend a few minutes concentrating on your breathing or meditating, then you'll perform stretches which can be performed while lying, standing, or sitting down.

There are several types of yoga including Hatha, Iyengar and Kundalini. Try different styles until you find one that suits you. It's also important to find a teacher that you like.

Sources: National for Complementary and Alternative Medicine, Tai Chi Techniques That Helps With Relaxation And Eases Stress.

next: Complimentary and Alternative Medicine

"If the world is to be healed through human efforts, I am convinced it will be by ordinary people, people whose love for this life is even greater than their fear. People who can open to the web of life that is called us into being, and who can rest in the vitality of that larger body." Joanna Macy

I would like to share some of the wonderful discoveries I've made while surfing the net. Each link offers the visitor valuable information which addresses emotional, physical, spiritual, or environmental well-being. We recommend that you bookmark this page before clicking onto the following links as they will take you outside of this webpage.

Activist links

Awakening Earth (I can not recommend this site enough! Please pay it a visit)

We The People (dedicated to political reform and social justice)

Sustainable Business Network (providing information and connection to accelerate momentum toward a green economy)

Public Information Network (working to hold corporations and governments responsible)

Future Generations (devoted to living in a sustainable and equitable way)

Green Sense (a terrific and huge resource for sustainable living)

Peacecorps (needs no description - just our support)

Greenpeace (also needs no description - just our support)

continue story below

League of Women Voters (to empower citizens to shape better communities world wide)

Non Violence Web (home of many of the nation's most dynamic peace groups)

Counseling and Recovery Links

PsychNET-UK (a major link site suitable for all mental health professions and students)

HealthyPlace.com (comprehensive mental health information covering everything from symptoms to treatments. Wonderful community for people with mental health concerns.)

Mental Health Matters (Information and resource directory)

BMHC (healing Through the Practice of Self-Acceptance)

Self-Therapy (for people who enjoy learning about themselves! Many topics covering a wide range of self-help issues, includes a newsletter for therapists and more.)

Clinical Psychology Resources (contains links to a number of sites offering information for "Clinical and Abnormal Psychology, Behavioral Medicine, and Mental Health)

Crisis, Grief and Healing (designed to be a place where "men and women can browse to understand and honor the many paths to healing.")

The Psychotherapy Center (information, insight, and thought provoking writings on psychotherapy)

Personal Growth Online (self improvement site featuring self-help quizzes, psychology articles, an award winning newsletter, and once a year therapy)

The Couples Place (an interactive site supporting marriage and other relationships - provides information, skills training, and networking services)

Environmental Links

The Earth Council (devoted to supporting and empowering people to build a more secure, equitable, and sustainable future)

Earth Watch (promotes scientific research, experiential learning, and global citizenship)

NatureConnect (where you can walk nature's path to a fulfilling livelihood, self-improvements, and responsible relationships)

EarthKeepers (focused solely on the physical and metaphysical catering of the Earth)

Friends of the Earth (dedicated to the preservation and protection of earth's resources)

Environmental Newsletter (offers the latest news on environmental issues)

The Guardian (a bi-monthly newsletter dedicated to protecting the environment.)

Health and Wellness Links

Mystic Gateway (provides information on Alternative and Complementary medicine, holistic political news, personal healing and growth)

Wellness Interactive Network (wonderful resource with a wide range of offerings)

The Center for Mind-Body Medicine (dedicated to reviving the spirit and transforming the practice of medicine)

Holistic Healing Web Page (Holistic Healing Fundamentals and Resources)

Natural Health For Women (holistic health care for people and animals)

Ask Dr. Weil (information regarding health and wellness)

Mayo Health Oasis (resources for health and wellness)

The Healing Spectrum (offers a range of resources that support healing in all its aspects, with both alternative and Allopathic Medicine being profiled. A bookstore is also included.)

WellSpring (offers tools for a vibrant mind, body and spirit)

Cooking Light (great resource for healthy cooking)

At Health (provides mental health information, resources, a directory of licensed mental health professionals, an online newsletter, and continuing education information)

The Share Guide (articles, links, and more)

Inspirational Links

After hoursInspriational Stories (a wonderful collection of inspirational stories, jokes, poems, and quotes -- a true gift)

Motivating Moments (a huge and ever growing collection of motivational and inspirational quotes)

Chicken Soup for the Soul (needs no further description...)

Follow Your Dreams (Provides inspirational road side assistance for your journey)

A Quiet Place for the Mind (inspiration, support, and reflection)

The Motivational Mecca (a thoughtful directory of inspirational sites online)

Links Advocating Lifestyles Which Promote Well-Being

I was going to develop a section of SagePlace that addressed lifestyles that enhance emotional, physical, spiritual, and environmental well-being, when I came across some really wonderful sites that already address these issues. I encourage you to visit them!

The Pierce Simplicity Study (wonderful resource on simple living)

I love this place (a friendly place where people choose to make choices that respect themselves, others, and nature)

World Transformation (ideas, resources, connections, and information aimed at growing, creating, or discovering a better world)

Earth Friendly Living (advocates lifestyles that focus on spiritual growth, volunteerism, personal and environmental health)

Frugal Living Resources (offers numerous resources for living frugally and responsibly)

Living Lightly (promotes "voluntary simplicity")

Simple Living (a wonderful resource)

Conscious Choice (a bi-monthly magazine that reports on environmental issues and alternative lifestyles)

Natural Life (a wonderful zine and interactive forum)

Links for Women

Women's World (a virtual home for women - filled with resources, support, and much more)

WomenFolk (focuses on issues related to women's creativity)

Voices of Women (women tell their stories, discuss issues, and share their wisdom)

Advancing Women in Leadership(represents the first on-line professional journal for women in leadership. The journal publishes manuscripts that report, synthesize, review, or analyze scholarly inquiry that focuses on women's issues)

Parenting and Family Links

Schools Online (a service for children, teachers and parents at school and at home which provides you with a wealth of resources and information in a fun way)

Natural Child (articles and advice on parenting and education that respects children)

Parent Soup (outstanding parenting resource)

Family (terrific resource for parents and families)

Family Education Network (wonderful resource to help parents help their kids to learn and succeed)

Whole Family (warm and inviting resource for the whole family)

Professional/Personal Development Links

James Harvey Stout (download books of psychology, personal growth, business, etc.--some books are free.)

Transformational, Holistic and Spirituality links

Spirit Voice (contains an interactive live Compassion Line, information on Alternative Healing, Spiritual Education, Humor, Spiritual Art, Gatherings and conventions, Meditation, and contacts for Spiritual Discussions or Readings.)

Holistic Healing and Personal Growth( explore holistic health, healing, personal growth,spirituality, metaphysics, alternative medicine & more.)

Ishmael (this is the official Daniel Quinn website, author of Ishmael.)

Creative Alternatives for a positive future (alternatives In Health, Energy, Education and Agriculture )

Spiritual Sanctuary (a place of inspiration, information, contemplation, and support)

Empowerment Resources (books and links for personal growth, social change, and ecology, a newsletter, and much more)

The Inner Journey (Dedicated to the personal and spiritual journey)

Eye of the Sacred Wind (Lessons from the soul for personal growth)

mysticplanet ("Visit the mystic planet where you are always loved.")

Many Paths (wisdom and spiritual resources of the ages and from the daily lives of others through 400 pages of book excerpts, pivotal events, art, poetry, live topic chats and more)

Project Mind (a sensitive, challenging delve into the furthest realms of human possibilities)

Thoughts Beneath the Trees (collected essays on Creativity & Transpersonal psychology. Intended to inspire and provoke a new view)

Peace Pilgrim (a powerful message about an extraordinary woman)

New Heaven New Earth (news and information for spiritual seekers)

Conscious Living (health, lifestyle and environment magazine)

Interlude (a place to renew the spirit)

Sacred Transformations (personal stories of visions, awakenings, spiritual emergencies and their effects)

Quavajo (to deepen your understanding of your true self, liberate your spirit, and develop your unique gifts, also serves as a watchdog/advocacy platform for defending personal freedoms)

United Communities of Spirit (a tremendous resource for spiritual seekers)

Elsajoy (devoted to metaphysics, mysticism and spiritual healing.)

The Inspirational Center (non-profit inspirational, motivational, and spiritual page)

The Zoo Fence (an inspirational guide to mysticism, religion, and the spiritual life)

The Dreamtime (earth, spirit and health alternatives)

New Renaissance: A Journal For Spiritual Awakening (an international quarterly providing a holistic and progressive outlook on environmental, social, economic, political and cultural concerns)

Spiritual Endeavors (dedicated to expanding spiritual, holistic and environmental awareness)

The Toltec Nagual (a site devoted to personal growth and spiritual evolution)

Wonderfully Diverse Links

One Earth Network ( a well organized directory offering metaconnections to a vast number of resources on the web)

SELF (a wonderful mixture of personal growth topics covering happiness, relationships, self-awareness, acceptance and empowerment with a focus on the individual)

Appleseeds (promotes positive attitudes and development of holistic human dignity)

WOW (an invitation to look at life with the eyes of a child)

next: Quotes and thoughts to Ponder contributed by Rachaelle Schlosser

Find out about Exelon, a medication for treating mild to moderate Alzheimer's disease.

Exelon (rivastigmine tartrate) Full Prescribing Information

Patient Information Overview

Pronounced: ECKS-ell-on
Generic name: Rivastigmine tartrate
Category: _ Medication

Why is this drug prescribed?

Exelon is used in the treatment of mild to moderate Alzheimer's disease. Alzheimer's disease causes physical changes in the brain that disrupt the flow of information and interfere with memory, thinking, and behavior. By boosting levels of the chemical messenger acetylcholine, Exelon can temporarily improve brain function in some Alzheimer's sufferers, though it does not halt the progress of the underlying disease. Exelon may become less effective as the disease progresses.

Most important fact about this drug

Patience is in order when starting this drug. It can take up to 12 weeks before Exelon's full benefits appear.

How should you take this medication?

Exelon should be taken with food in the morning and in the evening.

--If you miss a dose...

Give the forgotten dose as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to the regular schedule. Never double the dose.

--Storage instructions...

Store at room temperature in a tightly closed container.

What side effects may occur?

Side effects from Exelon cannot be anticipated. If any side effects develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe to continue taking Exelon.

• More common side effects may include: Abdominal pain, accidental injury, anxiety, aggression, confusion, constipation, depression, diarrhea, dizziness, drowsiness, fainting, fatigue, flu-like symptoms, gas, hallucinations, headache, high blood pressure, increased sweating, indigestion, inflamed nasal passages, insomnia, loss of appetite, nausea, tremor, unwell feeling, urinary infection, vomiting, weakness, weight loss
• Less common side effects may include: Belching

Why should this drug not be prescribed?

Exelon cannot be used if it causes an allergic reaction.

Special warnings about this medication

Exelon often causes nausea and vomiting, especially at the beginning of treatment. The problem is more likely in women, but it can lead to significant weight loss in both women and men. Tell your doctor immediately if these side effects occur.

The chance of severe vomiting increases when Exelon is given after an interruption of several days. Do not start giving the drug again without first checking with the doctor. Dosage may need to be reduced to the lowest starting level.

Exelon may aggravate asthma and other breathing problems and can increase the risk of seizures. Other drugs of its type are also known to increase the chance of ulcers, stomach bleeding, and urinary obstruction, although these problems have not been noted with Exelon. Drugs in this category can also slow the heartbeat, possibly causing fainting in people who have a heart condition. Contact your doctor if any of these problems occur.

Exelon has not been tested in children.

Possible food and drug interactions when taking this medication

If Exelon is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Exelon with the following:

Bethanechol (Urecholine) Drugs that control spasms, such as Bentyl, Donnatal, and Levsin.

Special information if you are pregnant or breastfeeding

Exelon is not intended for women of child-bearing age, and its effects during pregnancy and breastfeeding have not been studied.

Recommended dosage

ADULTS

The usual starting dose is 1.5 milligrams 2 times a day for at least 2 weeks. At 2 week intervals, the doctor may then increase the dose to 3 milligrams, 4.5 milligrams, and finally 6.0 milligrams 2 times a day. Higher doses tend to be more effective. The maximum dosage is 12 milligrams daily. If side effects such as nausea and vomiting begin to develop, the doctor may recommend skipping a few doses, then starting again at the same or the next lowest dosage.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek emergency medical attention immediately.

• Symptoms of Exelon overdose may include: Collapse, convulsions, breathing difficulty, extreme muscle weakness (possibly ending in death if breathing muscles are affected), low blood pressure, salivation, severe nausea, slow heartbeat, sweating, vomiting

Exelon (rivastigmine tartrate) Full Prescribing Information

back to: Psychiatric Medications Pharmacology Homepage

I was very touched and honored when Theresa and Lisa asked me to speak in their ceremony today. Theresa asked me if I would read from something I had written or maybe write something new - and Lisa who knows me a little better and knows how passionately I feel about my beliefs and how ready I am to share them - let me know very clearly that I had a strict time limit as to how long I could speak.

So, as I was preparing for this, I was torn between some of my published quotes that are meaningful and would communicate what I believe is important about why we are here, and some things that were bubbling up inside of me over the last few weeks in relationship to this topic.

And at about 3 this morning, when I got clear that what was bubbling up was what I wanted to say to Lisa and Theresa. What became very clear to me this morning is that it really doesn't matter if anyone else here today understands what I am saying. I am here now to speak directly to my friends Lisa and Theresa from my heart and soul - out of my beliefs, out of the mystical knowing that has guided my path.

What I know is that you two have been together many times before in other life times. You made a sacred pact to come together in this lifetime to help each other heal the wounds you need to heal - to serve as teachers and guides and support for each other as you go through this school of Spiritual evolution that we are all in.

It doesn't matter what you call that - twin souls, soul mates, whatever - what matters is that you honor the power of the connection that you feel. And that is why you are here today. To stand here in front of the people you care the most about, to stand here in front of God/The Goddess /The Great Spirit/The Universal Source - and make public Acknowledgment and Affirmation of the sacred commitment that already exists between you.

This is kind of your Soul's way of tricking yourself into agreeing to what your Souls already agreed to. In other words, you were powerless in this lifetime to do anything but end up at this moment.

And someplace along the way, I agreed to show up today to remind you, that this is not the ending where the music swells and the romantic couple rides (in this case on the biker chick's motorcycle) off into the sunset to Live Happily Ever After. This is just the beginning.

Because Yes you are "gifts from heaven" to each other - but like all gifts in this multi-leveled paradoxical experience of life - there is good news and bad news. The good news is that you have found your soul mate and you are going to touch ecstasy together - you are on the path to learning about the True meaning of Love. That is great news because LOVE is all there Truly is and the only thing that is important.

The bad news is that you have a lot of stuff to work through. You have lifetimes of history. You have Loved each other intensely and wounded each other grievously. You each have specific wounds from your paths in this lifetime that are reflections of the ways in which you have been wounded in other lifetimes.

You each have emotional "buttons" that trigger old defensive reactions, fears and insecurities - and you are sitting next to the person who was specifically prepared and trained to be a specialist in pushing your buttons. The gift you will give each other by pushing those buttons will help each of you uncover the wounds that need to be healed.

You have come together to teach each other, to help each other heal, to support and encourage each other in your quest to find your True Self.

If you keep healing, working through your stuff - then you do not have to do the dysfunctional cultural dance of toxic romance here. This does not have to be "the 'I can't live without you, can't smile without you' addictive, make the other person your Higher Power, be the victim, lose yourself, power struggle, right and wrong, trapped, taken hostage, poor abused me, Two Step.

What you are doing today is making a conscious commitment in the Light, to support each other on your healing, Spiritual paths. That's paths plural. Your paths are going to run together - hopefully for the rest of your lives - but they are not going to become one path. You are individual, unique, Special, Magnificent, Powerful Beings who are choosing to become allies, to become partners in the journey to each of you being and becoming all you are meant to be.

You are together because you resonate on the same wave lengths, you fit together vibrationally, in such a way that together you form a powerful energy field that helps both of you access the Higher Vibrational Energy of Love, Joy, Light, and Truth - in a way that would be very difficult for either one of you to do by yourself. You are coming together to touch the face of God. You are uniting your energies to help you access the Love of the Holy Mother Source Energy.

You are not the source of each other's Love. You are helping each other to access the LOVE that is the Source.

The Love that you see when you see your soul in the others eyes is a reflection of the LOVE that you are. Of the Unconditional Love that the Great Spirit feels for you.

It is very important to remember that the other person is helping you to access God's LOVE within you - not giving you something that you have never had before.

It is important to remember that so you can remind yourself that the fear, lack and scarcity messages that will come up - the possessiveness, the jealousy, the clinging, the fear of Abandonment and betrayal, the feeling smothered - are coming from the wounded parts of you that got trained and traumatized by this dysfunctional society to view life from fear, lack and scarcity. Those messages are lies - that is the illusion. The True Reality of The Universal Source is Joy Love and Abundance.

The Abundance of Love and Joy that you can help each other to feel by coming together - are vibrational levels that you then each will be able to access within yourself. You are helping each other to remember how to access that Love - helping each other to remember what it feels like and that "Yes!" you do deserve it.

It is very important to remember that so that you can Let Go. Let Go of believing that the other person has to be in your life, has to do things in a certain way, has to feel a certain way at a certain time. As long as you believe that the other person is the source of your happiness you will feel compelled to try to control them so that you can stay happy. You can not control them and be happy.

You will need to Let Go. And Let Go, and let go again. On a daily basis. Let go of believing that the other person has to be in a good mood or has to like the same things or wants to do things at the same time. Let go of expecting that they can be there for you in the way you want all of the time. They can't. They are human. No one can meet all of another person's needs. You each need to have resources/friends outside of your relationship. You each need to have parts of your life that aren't dependent upon the other.

You will hurt each other, scare each other, make each other angry. Which will then give you the gift of being able to work through those issues to a deeper level of emotional intimacy.

You have got some stuff to work through - that is both the bad news and the good news. Because as you reach those deeper levels of emotional intimacy your love will deepen and grow in ways in which you can't even imagine. You are boldly going where neither of you has ever been before. And you have a friend and a partner who is willing to make a sacred commitment here today to go on this adventure with you. Celebrate that!! It is an incredible gift!

Grab each moment you can and be present with it. By being willing to be present to feel the difficult feelings - hurt, sadness, anger, fear; by being willing to walk through the terror of embracing life - the terror that this commitment to intimacy can bring up; by being willing to take the risk of being abandoned and betrayed - to take the risk of completely exposing yourself to another being; you are opening yourself to Joy and Love to depths and on dimensions that you have only had the slightest taste of so far. Be each other's sanctuary. Be patient and kind and gentle whenever you can make that choice. The more you do your healing and follow your Spiritual path the more moments of each day you will have the choice to Truly be present the moment. And in the moment you can make a choice to embrace and feel the Joy fully and completely and with Gusto. In any specific moment you will have the power to make a choice to feel the Love in that moment as if you have never been hurt and as if the Love will never go away. Completely absolutely unconditionally with fearless abandon you can embrace the Love and Joy in the moment Glory in it! Loving is the Grandest, most sublime adventure available to us. Lets your hearts sings together. Let your souls soar to unimagined heights. Wallow in the sensual pleasure of each others bodies. Roar with the Joy of being fully alive. Go for it!!!!

Lisa also asked me to share a version of the Serenity Prayer at this time.

God/Goddess/Great Spirit Please help me to access the serenity and faith to accept the things I cannot change - which includes life, life events, and other people - specifically _____ (each other). The courage and willingness to change the things I can - which is me, my attitudes, and choosing to take responsibility for my own emotional healing. And the wisdom and clarity to know the difference. Come on Wisdom and Courage and Serenity!

next: Jesus & Christ Consciousness

From: Investigations; Institute of Noetic Sciences

"The mind is its own place, and in itself can make a heaven of Hell, a hell of Heaven." John Milton (1608-1674)

The waking rational self is usually quite sure that we are one mind in one body. The self that dreams knows another world, but assumes it belongs in the realm of imagination and fantasy. But can waking minds be divided up in such a way that several streams of life that are quite separate from one another can exist concurrently in one human being? if so, then does the old saying: "The left hand doesn't know what the right hand is doing" become a kind of reality? Is there more to tales like Dr. Jekyll and Mr. Hyde than we ever thought? Well, in some senses, we experienced a "first wave" resurgence of this idea in the 1970's when the studies of splitbrain patients hit both the science journals and eventually the popular press with all the force of a new myth in the culture. Yes, there were clearly some important findings in the area, but they all too rapidly became used as metaphors for all manner of unrelated claims. We may now be about to experience a "second wave" of data on the subject with the recent resurgence of interest and research into the phenomena of Multiple Personality.

One of the interesting aspects of controversies in contemporary science and the study of the mind is the way in which ideas move from center-stage to the periphery during one period, only later to be returned to the center of attention. Sometimes this happens because a phenomenon is simply too complex to be addressed until the methods of science have evolved to deal properly with it. On other occasions it occurs because the strategies of its proponents are not soundly formulated. Or it can occur because science-at-large finds an idea simply too strange or preposterous to deal with. It seems that the scientific fate of the concept of Multiple Personality has been a cross between the latter two of these. As we shall see in the historical sections of this report, Multiple Personality was topic of great fascination at the end of the last century, and up into the early 1900's attempts were being made to explain it in terms of the proposed capacity of the mind to dissociate. These ideas were proposed by the First Dynamic School of Psychiatry, now an almost forgotten school of thought from the turn of the century. But, one might ask; why was it forgotten and why did the subject virtually fade from view? As Dr. John Kihlstrom of the University of Wisconsin recently wrote:

The eventual dominance of psychoanalysis in clinical psychology and scientific personality led investigators to be interested in different syndromes and phenomena, a different model of the mind, and the eventual replacement of dissociation by repression as the hypothetical mechanism for rendering mental contents unconscious. At the same time, the behaviorist revolution in academic psychology removed consciousness (not to mention the unconscious) from the vocabulary of science. At fault were the dissociation theorists themselves, who often made extravagant claims for the centrality of the phenomenon (of dissociation) and whose investigations were often methodologically flawed.

Today, we seem to be witnessing a return to center stage of a number of previously discarded concepts that all seem to connect with each other in curious ways. One might say that one part of the stage was set by the split-brain data, which once again opened up the concept of the divided mind. Then the rise of Cognitive Science in the 1970's also helped to place a concern with mental processes and consciousness back in the center of things. Also during the 1970's, the data on and respectability of hypnosis research grew and led to greater attention being placed on the concept of dissociation, which is at the core of hypnotic phenomena, once again.

In this issue of Investigations, we will present an overview of the contemporary scene regarding the topic of Multiple Personality. There are several events which have occurred of late to cause a growing number of professionals to re-evaluate their point of view on the topic. More frequent diagnosis of the phenomenon is but one aspect of this sudden increase in interest. Another aspect involves the growing body of research data showing that multiples display unusual degrees of variation in physiological, neurological and immune system variables when the switch. Further the amount of professional attention being devoted to the subject in recent years has grown enormously. In May of 1984, the American Psychiatric Association at its Annual Meeting in Los Angeles devoted an unusually large proportion of its program to the topic: 2 whole days of a pre-conference workshop and 2 major symposia at the convention itself. Then in September of 1984, the First International Conference on Multiple Personality Dissociative States was held in Chicago. The meeting was organized by Dr. Bennett Braun of Rush-Presbyterian-St. Luke's hospital, which co-sponsored the event. The Institute of noetic Sciences provided partial financial backing for the event and for next year's proposed Second International Conference. Further, several established medical and psychiatric journals devoted entire issues to the recent research. To produce this issue, Investigations attended these meetings, researched all the recent journals and interviewed in person between 20 and 30 of the leading figures in the field. What follows, therefore, should provide the reader with a comprehensive update - including data from the early history of the field right up to the present.

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Social Scientific Implications of Multiple Personality

The social implications of this sudden surge in interest are quite complex since it seems definitely connected to the recent awareness in the culture of the phenomena of child abuse and incest. The emergence in the media of more and more reports on the incidence of child abuse and incest in the U.S. has reached a degree that almost daily provides yet another set of shocking headlines. Perhaps it is this latter phenomenon that alerted the therapeutic professions because now not one but two phenomena previously seen as rare seem to be seen in unheard-of-numbers all over the U.S.: Child Abuse and Multiple Personality.

As we now know, the two are intimately connected with one another. Virtually everyone who is diagnosed as being multiple has been severely physically and sexually abuse - though not everyone who is abused becomes multiple. But, one might well ask, why are these phenomena being seen with such frequency today? There is clearly a darker side to our culture that we would rather not look at. Unfortunately, the dual phenomenon of abuse and multiplicity leave us with no other choice. The almost daily onslaught of statistics from the courts and the media now leave little doubt that battered children and battered wives are all too common. What is at the root of all this obscene inhumanity? Is there some deeper process at work in the culture that we refuse to face? What aspects of the human psyche have run amok in this supposedly rational and civilized culture? People stretch for answers to these questions and the queues run the gamut from alcoholism to possession and various sicknesses in between. As the story unfolds within these pages, these questions will occur to the reader again and again. There are no easy answers to any of these questions, but it may well be that a deeper understanding of what the phenomenon of Dissociation is, how it works and what can drive it can throw some light on these troubling questions. Perhaps then we won't have to remain at the mercy of the pathologies of dissociation involved not only in abuse and multiplicity, but also in other forms of extreme inhuman behavior, and can learn instead to tap into the productive and positive uses of this part of our minds.

On another level, the legal and criminal justice implications of the data are only beginning to emerge. It is only in recent years that the insanity plea has begun to include multiple personality in a limited number of cases. Two of the most controversial cases recently both involved male multiples, Billy Milligan and Kenneth Bianchi. In both cases there was extensive dispute regarding the genuineness of their multiplicity. In the Bianchi case, the eventual legal opinion was that Bianchi was a fake. However, a larger number of professionals familiar with aspects of the case feel that Bianchi was both a multiple and capable of faking, too. Several of those interviewed for this report suggested that multiples are more likely to end up, undiagnosed, in the criminal justice system, Female multiples, which make up the great majority of presently known cases, are much less likely to end up in the criminal system. These kinds of issues are only beginning to be appreciated and only time will tell the extent to which the legal and criminal justice aspects of the disorder will affect the system as a whole.

It would seem that the scientific implications of the phenomenon will be very much a factor of just how the subject is handled methodologically by scientists and how it is reported by both science journalists and the popular press. If handled in a way that emphasizes the sensational and paradigm-challenging aspects of the phenomenon, then the chances are that major opportunity for an advance in our understanding of the mind and the Mind-Body Problem will be lost. If, on the other hand, the topic is approached with extreme rigor and caution, as well as respect for the subjects themselves, then the benefits could be enormous in terms of our whole understanding of not only how mind and body are in fact linked, but also in terms of psychosomatic medicine as a whole. The subsequent spill-over into issues involving education, therapy for all kinds of trauma and the social and criminal realms could be significant. If this could happen, then not only would we all benefit, but the pain and suffering endured by multiples would at least have been turned into something positive in the world, and help to prevent others from having to endure such a fate. Let us hope that this time around such a rich opportunity will not be lost! - Brendan O'Regan

next:   Reading Room The People Inside

Suggestions for parents of bipolar children in dealing with situations caused by the illness.

At home, as well as at school, providing a sympathetic and low-stress environment and making some adaptations may be helpful to aid a child or adolescent with bipolar disorder.

• Understand the illness. Understanding the nature of bipolar disorder, its unpredictability, and its consequences for the child will help parents sympathize with a child's struggles. Children whose behavioral symptoms make life stressful for the whole family are most likely vulnerable people who wish they could be "normal" like other kids. It is also important to keep in mind that because children with bipolar disorder are frequently quite impulsive, their actions "in the moment" may not reflect behavioral lessons they have already learned.
• Listen to the child's feelings. Daily frustrations and social isolation can foster low self-esteem and depression in these children. The simple experience of being listened to empathically, without receiving advice, may have a powerful and helpful effect. Parents should not let their own worries prevent them from being a strong source of support for their child.
• Distinguish between symptoms, which are frustrating, and the child. "It's the illness talking." Taking a supportive stance in which parents, child and clinicians unite together to fight symptoms is an effective strategy to encourage a child who is doing the best he or she possibly can. Sometimes it is useful to help the child distinguish himself or herself from the illness ("It sounds like your mood is not very happy today, and that must make it extra hard for you to be patient").
• Plan for transitions. Getting to school in the morning or preparing for bed in the evening may be complicated by fears, anxieties, and the child's fluctuating energy and attention level. Anticipating and planning for these transition times may be helpful for family members.
• Adjust expectations until symptoms improve. Helping a child make more attainable goals when symptoms are more severe is important so that the child can have a positive experience of success. This requires reducing stress on the child where possible: taking a break from after-school activities if they become too stressful, allowing a child who is not functioning well to cut back on homework, and supporting the child's decision to stay home from large social or family functions that may feel overwhelming, for example.
• Keep the "small stuff" small. A parent may need to choose which issues are worth having an argument over (such as hitting a sibling) and which issues are not worth an argument (tonight choosing not to brush teeth). These decisions are not easy, and at times everything may appear to be important. Parenting a child with bipolar disorder requires flexibility that will reduce conflicts at home and instill healthy habits in the child. 
• Understand parental limits. Fulfilling a child's extreme wishes related to symptoms (for example, strong and persistent urges to buy things) may be neither possible nor advisable. Such well-intended efforts to support a child may actually delay the development of new coping strategies and reduce the benefits of behavior therapy. Finding the balance between supportive flexibility and appropriate limit setting is frequently challenging for parents and may be aided by the guidance of a trained professional.
• Talk as a family about what to say to people outside of the family. Determine what feels comfortable for the child (for example, "I was sick and got some help, and now I'm better"). Even if the decision is made not to discuss this medical condition with others, having an agreed-on plan will make it easier to handle unexpected questions and minimize family conflicts about this.
• Behavioral plans may be useful to reinforce a child's successful efforts. Children tend to benefit from behavioral plans that reward good behaviors (rather than punish misbehaviors) because they may otherwise feel as though they get feedback only about their mistakes. Please see the table below.

Behavioral Plans

Provide frequent acknowledgments of success. Experts encourage doing this six times per hour at home. This pattern may not be one parents grew up with, but it is an easy and effective means to help a child develop new habits. For example, tell the child, "Great job getting the table cleaned off with no sticky spots at all," rather than, "I've told you twice already to go pick up your clothes once you get the table cleaned off."

Reward the child for making efforts to reduce problem behaviors. Avoiding a tantrum, demonstrating flexibility in a potentially difficult situation, or increasing times without a rageful episode can all improve daily life and warrant reward or acknowledgment.

Develop meaningful incentives with the child. Praise, gold stars on a calendar, or sitting beside a parent in the car can all be effective rewards. Parents will need to determine with their child what the reward is, and will need to be consistent with the plan for it to be effective. Tangible reminders help children learn that they can be responsible for their actions and will be recognized for their good efforts. Parents can look to the school psychologist or guidance counselor or to their child's treatment professionals for help in developing behavioral plans for the home.

A chart system is often effective, in which a certain number of stars per day may be "cashed in" for the reward (an extra story with a parent, a trip for ice cream, etc.). It is essential that these rewards not become the source of additional conflict. If the child doesn't have the required "points" for a reward, rather than saying, "No, you don't get your treat because you didn't pick up all your clothes today like we asked," parents report more success when they say, "You picked up all your clothing for six days so far-just one more day and you'll earn that ice cream we talked about for picking up for a whole week." Parents need to set appropriate limits, such as saying "no" to an extravagant toy as a reward. On the other hand, the reward needs to be something the child enjoys and will be motivated to earn.

Sources:

• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric Association, 1994
• Dulcan, MK and Martini, DR. Concise Guide to Child and Adolescent Psychiatry, 2nd Edition. Washington, DC: American Psychiatric Association, 1999
• Lewis, Melvin, ed. Child and Adolescent Psychiatry: A Comprehensive Textbook, 3rd Edition. Philadelphia: Lippincott Williams and Wilkins, 2002

What is MPD?

MPD is a survival tactic. It is the creative attempt of highly traumatized children to protect themselves from the trauma and abuse (e.g.: "It isn't happening to me.") When these children dissociate (block) trauma, their "compartments" of trauma become "separate personalities/parts within their one self". Only children have sufficient flexibility (and vulnerability) to adapt to trauma by means of creating alter personalities.

I thought MPD and Schizophrenia were the same thing.

MPD is NOT schizophrenia! Most people thing that schizophrenia means "split personality." Actually, this is totally incorrect. "Split Personality" is MPD, not schizophrenia. Schizophrenia is a chronic form of psychosis due to a biochemical/genetic disorder of the brain. SCHIZOPHRENICS DO NOT HAVE OTHER PERSONALITIES. Schizophrenia is not caused by trauma, and does not involve amnesia and flashbacks.

When can a person get MPD?

MPD arises in childhood, mostly ages 3 to 9 years. There is juvenile diabetes and adult onset diabetes, but there is no adult onset MPD. Only children have sufficient flexibility (and vulnerability) to respond to trauma by breaking their "still-coalescing" self into different, dissociated parts. Adults do not have the capacity to adapt to trauma by forming alter personalities. (The exception is that adults who became "multiples" in childhood can continue to make more alters during adulthood.)

Isn't MPD really just a way for people to get attention?

It is often thought that MPD is a sham, a bizarre form of "play-acting" that is perpetrated by manipulative, attention-seeking individuals. It is not. MPD is a "disorder of hiddeness" wherein 80-90% of MPD patients do not have a clue that they are "multiple." Most know that there is something wrong with them; many fear that they are crazy-- but few know that they are multiple.

Isn't MPD just an exaggeration of the different parts of our personality; aren't we all really "multiple"?

This is an enticing question. "Yes," we all have different parts to our personalities. "No," MPD is not "just an exaggeration" of these parts.

Why?

At least 6 reasons:

1. Because we all don't have a dissociative disorder;
2. Because we all don't suffer from severe and chronic child abuse or trauma;
3. Because we all do not have amnesia for what we are doing when a different part of our personality comes to the fore;
4. Because the "raison d'être" of the different sides to our personality is not to hide from ourselves information or feelings about trauma;
5. Because we all do not posses the ability to be "highly" hypnotic; and,
6. Because we all do not develop POST TRAUMATIC STRESS DISORDER when we begin to pay attention to our parts.

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How many parts are there?

The typical female multiple has about 19 alter personalities; male multiples tend to have less than half of that. The number of alters is explained by 3 factors:

1. The severity of the trauma;
2. The chronicity of the trauma; and,
3. The degree of vulnerability of the child. Thus, the male multiple from ages 7 to 10 who was sexually abused a half-dozen times by a distant relative is going to have far fewer alters than a female multiple who was severely physically, sexually, and emotionally abused by both parents from infancy to age 16. The latter patient, in fact, could quite easily wind up with 30 to 50 (+) alters, even in the hundreds.

How could a person have so many different personalities and how would you tell the difference among them?

The answers to these questions require a clarification of several points:

• First, MPD is a misleading term-- DISSOCIATED SELF DISORDER would probably be better. There is but one self that is dissociated into multiple parts. MPD tends to be misunderstood to mean "multiple self disorder." In fact, there is only one self however divided, or dissociated, it may be.
• Secondly, there are usually only 3 to 6 alters who are particularly active (e.g.: assuming full executive control) on any given day. The rest of the alters are relatively quiet (even dormant for long periods of time).
• Finally, THERE IS NO REQUIREMENT THAT DIFFERENT PERSONALITIES BE VISIBLY DIFFERENT TO AN OBSERVER. It is only necessary that each alter fulfill the basic function of an alter personality-- that is, to protect the host personality from the knowledge and experience of the trauma. This task is accomplished by means of dissociative barriers or walls of amnesia. Thus a multiple could conceivably have dozens of alters that look just the same, but who, nevertheless, serve the function of walling off trauma from the host (and dispersing it among many alters). The answers to the above questions can now be more easily understood in light of the basic task of an alter personality. If the "raison d'être" of alters is to sequester trauma from the host so that he/she is able to continue to function without becoming overwhelmed, then additional alters may be produced to help contain the trauma. It is not required that these new alters look different, nor is it necessary that they all be active at one time; it is only necessary that they do their job (of containing the trauma of the abuse).

What types of alters are there?

The typical alters that are found in a person with MPD include: a depressed, depleted host; a strong, angry protector; a scared, hurt child; a helper; and, an embittered internal persecutor who blames (or persecutes) one or more alters for the abuse that has been suffered. While there may be other types of alters in any given MPD individual, most of them will be variations on the theme of these 5 alters.

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How common is MPD?

Although the data is not all in, the best estimate of the prevalence of MPD is that it approximates that of about 1% of the population. This estimate would translate into at least 2,000,000 cases in the U.S. alone.

Why so many?

Because MPD is directly linked to the prevalence of child abuse. And, unfortunately, child abuse is all too common.

How impaired is the person with MPD?

The range of impairment across different persons with MPD is best analogized to that of alcoholism. Impairment due to alcoholism a) ranges from skid row bums to high functioning senators, congressmen, and corporate executives; and, b) varies in any given alcoholic from one period of time to another as a function of binges, patterns of drinking, life stresses, etc. It is much the same as MPD. There are some multiples who are chronic state mental patients, others who undergo recurrent hospitalization due to self-destructive behavior, and many more who raise children, hold jobs, and may even be high-functioning lawyers, physicians, or psychotherapists.

How Does Being A Multiple Help?

If you are a multiple alters have, for the most part, been your good friends. They have come to your rescue, endured pain for you, and they have hidden lots of your feelings when it wasn't safe to have those feelings and when you couldn't find a safe person with whom to share them.

Is It Bad To Be A Multiple?

Certainly not. Being a multiple helps some to stay alive. It allows them to protect themselves and remain sane in the face of severe abuse. It allows them to endure the bad times and to keep their heart and soul safe from their abusers.

Am I Crazy?

Being a multiple does not make you crazy, but being a multiple can make you feel like you're crazy. If you doubt yourself this way, you can become confused or uncertain. You can also feel ashamed, frightened, or want to spend time alone. This self-doubt and confusion can make you feel bad about yourself.

How long will it last? Does it go away on it's own?

A person who is "multiple" will REMAIN "multiple" until successfully treated. About 90% of "multiples" are totally unaware they are MPD. The symptoms of MPD wax and wane. A person who is "multiple" may appear to be fine for years and then suddenly begin to have strong symptoms- usually due to flashbacks of past trauma. MPD/DID IS treatable, but does not just go away on it's own.

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What signs should I look for if I think I and/or a friend/family member may have MPD?

Look for MPD if there is a pattern of:

• History of depression or suicidal behavior
• Childhood history of physical, sexual, emotional, or psychological abuse... reports one parent was very cold and critical; reports of "wonderful" parents by a person who is clearly emotionally troubled
• Abusive relationships in adulthood
• Strong attacks of shame; sees self as bad or undeserving sacrifices self for others feels does not deserve help; is a burden, reluctant to ask for help is sure you do not want to be troubled with seeing him or her
• Reports being able to turn off pain or "put it out of my mind"
• Self-mutilation or self-injuring behavior
• Hears voices
• Flashbacks (visual, auditory, somatic, affective, or behavioral)
• History of unsuccessful therapy
• Multiple past diagnoses (e.g.: major depression, schizophrenia, bipolar disorder, borderline personality disorder, substance abuse)
• Reports of odd changes or variations in physical skills or interests
• Described by significant other as having 2 personalities or being a "Dr. Jekyll Mr. Hyde"
• Family history of dissociation
• Phobia or panic attacks
• Substance abuse
• Daytime enuresis or encopresis
• History of psycho-physiological symptoms
• Seizure-like episodes
• History of nightmare and sleep disorders
• History of sleepwalking
• School problems
• Reports psychic experiences
• Anorexia or Bulimia
• Sexual difficulties
• History of shifting symptom picture (one day symptoms of this...next day symptoms of that)

Two positive items from among 1-15 mandates consideration of a diagnosis of a dissociative disorder (e.g.: Dissociative Disorder NOS=not otherwise specified or possible Post Traumatic Stress Disorder).

Four or more positive items (especially among 1-15) mandates serious consideration of a diagnosis of Multiple Personality Disorder now known as Dissociative Identity Disorder.

For many observers, MPD is a fascinating, exotic, and weird phenomenon. For the patient, it is confusing, unpleasant, sometimes terrifying, and always a source of the unexpected. The treatment of MPD is excruciatingly uncomfortable for the patient. The dissociated trauma and memory must be faced, experienced, metabolized, and integrated into the patient's view of him/herself. Similarly, the nature of one's parents, one's life, and the day-to-day world must be re-thought. As each alter metabolizes his/her trauma, then that alter can yield it's separateness and re-integrate (because that alter is no longer needed to contain undigested trauma).

Recovery from MPD and childhood trauma takes something on the order of five years. It is a long and arduous process of mourning. The important thing to remember is that recovery does and can happen.

Multiple Personality Disorder/Dissociative Identity Disorder IS TREATABLE.

next:  MPD/DID Key Findings Quick Facts

Chapter 113 of the book Self-Help Stuff That Works

by Adam Khan:

EVERYONE NEEDS ACKNOWLEDGMENT. Not that we'll die without it, but it really makes a difference when we know other people know how good a job we're doing.

But not one in ten of us gets enough appreciation. A common reaction to this fact is that bosses and spouses should pay more attention; they should notice and then appreciate us. The problem is, it is hard to notice the absence of a negative condition. When you don't create problems and do your work well, and you allow other people to do their jobs unhindered, what is there to notice? Your good job becomes business as usual.

The juxtaposition of those two facts - everyone needs acknowledgment and it is hard to notice the absence of a negative condition - presents us with but one solution: You must elicit your own acknowledgment. You must point out your efforts to others when they don't notice.

But you can't do that! It's called bragging. And we've all met obnoxious, self-centered, boorish people who had a habit of talking about themselves and what they've accomplished. Bragging is offensive. Isn't it?

Yes it is - when it is done by obnoxious, self-centered people. When it is done by someone who simply wants to do a good job and stay motivated, eliciting acknowledgment can be a positive thing for everyone involved.

It might go something like this: You've been particularly careful about doing a certain thing, and you have been doing it consistently. You know this thing you're doing really helps out. You know things are working a lot better because you're putting in the time and effort to do this thing well. But since it helps everything go well, and since it is so difficult to notice an absence of a negative condition, no one notices you're doing such a good job. So when your spouse or boss is nearby, say to them, "I've been working very hard to make sure this thing goes right, and it's been going right. I just wanted someone to know."

Since we are all in the same boat, the person you're talking to will understand the feeling of simply wanting someone else to know, and you might even open up the possibility for him or her to do the same thing (elicit acknowledgment).

You don't have to force anything. You don't have to brag and swagger and say it over and over all the time until you brighten up the room every time you leave. You don't need to come from deficiency. You aren't desperate for attention. You're just helping yourself feel a little better about your work (and motivating yourself to keep it up) by letting someone know what you're doing.

Don't expect a lot. Some people will think it's strange that you pointed out your own good work. Some people will think you're bragging. Keep paying attention to the kinds of responses you get and keep modifying what you're doing until it is a simple acknowledgment of the facts.

Also, get people to talk about what they are doing that they want someone to know about and then give them some acknowledgment for it. They will not only become more willing to acknowledge you for your accomplishments, but they will also be less likely to feel jealous when you point out something you did.

Elicit your own acknowledgment. It's better than grumbling that no one notices. It's not anyone's fault that no one notices. Because of the way our bodies, brains and the universe is constructed, it is just that way. Not much we can do about it but use it. You can bemoan the fact that gravity keeps you pinned to the Earth or you can accept it and get so good at dealing with it you can dance!

When you want acknowledgment for something, tell someone what you did.

What do you do when your coworkers complain? Do you think it's healthy to vent? Learn about this important topic right here:
Complaint Compunctions

What if your circumstances haven't been very good? What if you've had lots of hard times and think that it's too late for you to start making a difference? Check out this little ditty:
A Slave to His Destiny

Do you feel that you've tried hard to make some kind of difference with your life but have only met hardship and trouble? Check out:
Conversation on Optimism

next: Self-Confidence