For the past 25 years, Dr. Richard Grossman has maintained a psychotherapy practice specializing in the treatment of people with relationship problems and general life dissatisfaction. Much of his work has focused on the "voiceless":adult children of narcissistic parents and people with narcissistic or self-absorbed spouses/partners. Prior to entering private practice, he taught and supervised in the internship and postdoctoral psychotherapy programs at Massachusetts General Hospital/ Harvard Medical School where he was on staff.

Dr. Grossman started the Voicelessness and Emotional Survival web site in 1999. The essays on this site--on narcissism, relationship issues, parenting, and therapy--have drawn tens of thousands of readers, and the Voicelessness and Emotional Survival Message Board has over 100,000 posts from people sharing (often for the first time) their personal experience with these topics.

Featured in New England Psychologist, Dr. Grossman's work has also appeared in Boston Magazine, The Boston Globe, Cosmopolitan (UK), The Brookline Tab, and other magazines, books, and web sites.

Best of luck!
Richard Grossman, Ph.D.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

 

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next: Giving Your Child "Voice": The 3 Rules of Parenting

Comprehensive information on alternative remedies, alternative therapies, for psychiatric disorders including depression, anxiety, ADHD, and addictions.

Index of Alternative Therapies and Modalities

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Complementary Therapies for Your Mental Health

A B

• Acupressure
• Alexander Technique
• Applied Kinesiology
• Aromatherapy
• Autogenic Therapy
• Bach Flower Remedies
• Balneotherapy
• Bowen Technique

C D E F

• Chelation Therapy
• Chiropractic
• Colonic Irrigation
• Color Therapy
• Craniosacral Therapy
• Crystal Therapy
• Electrocrystal Therapy
• Feldenkrais Method

G H I J K L

• Guided Imagery
• Hellerwork
• Homeopathy
• Hydrotherapy
• Hypnosis
• Hypnotherapy
• Kinesiology, Applied

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M N O P Q

• Magnet Therapy
• Massage
• Meditation
• Music Therapy
• Osteopathy
• Ozone Therapy
• Polarity
• Prayer
• Qi Gong

R S

• Reflexology
• Reiki
• Relaxation Therapy
• Rolfing® Structural Integration
• Shiatsu
• Spinal Manipulation
• Spinal Manipulative Therapy
• Spiritual Healing

T U V W X Y Z

• Tai Chi
• TENS
• Therapeutic Touch
• Transcutaneous Electrical Nerve Stimulation
• Tuina
• Visualization
• Yoga

next: Acupressure, Shiatsu, Tuina

Question:

Sometimes you say that the narcissist's True Self has relegated its functions to the outside world - and sometimes you say that it is not in touch with the outside world (or that only the False Self is in touch with it). How do you settle this apparent contradiction?

Answer:

The narcissist's True Self is introverted and dysfunctional. In healthy people, Ego functions are generated from the inside, from the Ego. In narcissists, the Ego is dormant, comatose. The narcissist needs the input of the outside world to perform the most basic Ego functions (e.g., "recognition" of the world, setting boundaries, differentiation, self-esteem and regulation of a sense of self-worth). Only the False Self gets in touch with the world. The True Self is isolated, repressed, unconscious, a shadow of its former self.

Forcing the narcissist's False Self to acknowledge and interact with his True Self is not only difficult but may also be counterproductive and dangerously destabilising. The narcissist's disorder is adaptive and functional, though rigid. The alternative to this (mal)adaptation would have been self-destructive (suicidal). This bottled up, self-directed venom is bound to resurface if the narcissist's various personality structures are coerced into making contact.

That a personality structure (such as the True Self) is in the unconscious does not automatically mean that it is conflict-generating, or that it is involved in conflict, or that it has the potential to provoke conflict. As long as the True Self and the False Self remain out of touch, conflict is excluded.

The False Self pretends to be the only self and denies the existence of a True Self. It is also extremely useful (adaptive). Rather than risking constant conflict, the narcissist opts for a solution of "disengagement".

The classical Ego, proposed by Freud, is partly conscious and partly preconscious and unconscious. The narcissist's Ego is completely submerged. The preconscious and conscious parts are detached from it by early traumas and form the False Ego.

The Superego in healthy people constantly compares the Ego to the Ego Ideal. The narcissist has a different psychodynamic. The narcissist's False Self serves as a buffer and as a shock absorber between the True Ego and the narcissist's sadistic, punishing, immature Superego. The narcissist aspires to become pure Ideal Ego.

The narcissist's Ego cannot develop because it is deprived of contact with the outside world and, therefore, endures no growth-inducing conflict. The False Self is rigid. The result is that the narcissist is unable to respond and to adapt to threats, illnesses, and to other life crises and circumstances. He is brittle and prone to be broken rather than bent by life's trials and tribulations.

The Ego remembers, evaluates, plans, responds to the world and acts in it and on it. It is the locus of the "executive functions" of the personality. It integrates the inner world with the outer world, the Id with the Superego. It acts under a "reality principle" rather than a "pleasure principle".

This means that the Ego is in charge of delaying gratification. It postpones pleasurable acts until they can be carried out both safely and successfully. The Ego is, therefore, in an ungrateful position. Unfulfilled desires produce unease and anxiety. Reckless fulfilment of desires is diametrically opposed to self-preservation. The Ego has to mediate these tensions.

In an effort to thwart anxiety, the Ego invents psychological defence mechanisms. On the one hand the Ego channels fundamental drives. It has to "speak their language". It must have a primitive, infantile, component. On the other hand, the Ego is in charge of negotiating with the outside world and of securing a realistic and optimal "bargains" for its "client", the Id. These intellectual and perceptual functions are supervised by the exceptionally strict court of the Superego.

Persons with a strong Ego can objectively comprehend both the world and themselves. In other words, they are possessed of insight. They are able to contemplate longer time spans, plan, forecast and schedule. They choose decisively among alternatives and follow their resolve. They are aware of the existence of their drives, but control them and channel them in socially acceptable ways. They resist pressures - social or otherwise. They choose their course and pursue it.

The weaker the Ego is, the more infantile and impulsive its owner, the more distorted his or her perception of self and reality. A weak Ego is incapable of productive work.

The narcissist is an even more extreme case. His Ego is non-existent. The narcissist has a fake, substitute Ego. This is why his energy is drained. He spends most of it on maintaining, protecting and preserving the warped, unrealistic images of his (False) Self and of his (fake) world. The narcissist is a person exhausted by his own absence.

The healthy Ego preserves some sense of continuity and consistency. It serves as a point of reference. It relates events of the past to actions at present and to plans for the future. It incorporates memory, anticipation, imagination and intellect. It defines where the individual ends and the world begins. Though not coextensive with the body or with the personality, it is a close approximation.

In the narcissistic condition, all these functions are relegated to the False Ego. Its halo of confabulation rubs off on all of them. The narcissist is bound to develop false memories, conjure up false fantasies, anticipate the unrealistic and work his intellect to justify them.

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The falsity of the False Self is dual: not only is it not "the real thing" - it also operates on false premises. It is a false and wrong gauge of the world. It falsely and inefficiently regulates the drives. It fails to thwart anxiety.

The False Self provides a false sense of continuity and of a "personal centre". It weaves an enchanted and grandiose fable as a substitute to reality. The narcissist gravitates out of his self and into a plot, a narrative, a story. He continuously feels that he is a character in a film, a fraudulent invention, or a con artist to be momentarily exposed and summarily socially excluded.

Moreover, The narcissist cannot be consistent or coherent. His False Self is preoccupied with the pursuit of Narcissistic Supply. The narcissist has no boundaries because his Ego is not sufficiently defined or fully differentiated. The only constancy is the narcissist's feelings of diffusion or annulment. This is especially true in life crises, when the False Ego ceases to function.

From the developmental point of view, all this is easily accounted for. The child reacts to stimuli, both internal and external. He cannot, however, control, alter, or anticipate them. Instead, he develops mechanisms to regulate the resulting tensions and anxieties.

The child's pursuit of mastery of his environment is compulsive. He is obsessed with securing gratification. Any postponement of his actions and responses forces him to tolerate added tension and anxiety. It is very surprising that the child ultimately learns to separate stimulus and response and delay the latter. This miracle of expedient self-denial has to do with the development of intellectual skills, on the one hand and with the socialisation process, on the other hand.

The intellect is a representation of the world. Through it, the Ego examines reality vicariously without suffering the consequences of possible errors. The Ego uses the intellect to simulate various courses of action and their consequences and to decide how to achieve its ends and the attendant gratification.

The intellect is what allows the child to anticipate the world and what makes him believe in the accuracy and high probability of his predictions. It is through the intellect that the concepts of the "laws of nature" and "predictability through order" are introduced. Causality and consistency are all mediated through the intellect.

But the intellect is best served with an emotional complement. Our picture of the world and of our place in it emerges from experience, both cognitive and emotional. Socialisation has a verbal-communicative element but, decoupled from a strong emotional component, it remains a dead letter.

An example: the child is likely to learn from his parents and from other adults that the world is a predictable, law abiding place. However, if his Primary Objects (most importantly, his mother) behave in a capricious, discriminating, unpredictable, unlawful, abusive, or indifferent manner - it hurts and the conflict between cognition and emotion is powerful. It is bound to paralyse the Ego functions of the child.

The accumulation and retention of past events is a prerequisite for both thinking and judgement. Both are impaired if one's personal history contradicts the content of the Superego and the lessons of the socialisation process. Narcissists are victims of such a glaring discrepancy: between what adult figures in their lives preached - and their contradictory course of action.

Once victimised, the narcissist swore "no more". He will do the victimizing now. And as a decoy, he presents to the world his False Self. But he falls prey to his own devices. Internally impoverished and undernourished, isolated and cushioned to the point of suffocation - the True Ego degenerates and decays. The narcissist wakes up one day to find that

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he is at the mercy of his False Self as much as his victims are.

next:   The Narcissist's Split Off Ego

Question:

Are narcissists capable of introspection? Can they distinguish their False Self from who they really are? Can this help them in the therapeutic process?

Answer:

A passage by Nathan Salant-Schwartz from "Narcissism and Character Transformation" [pp. 90-91. Inner City Books, 1985]:

"Psychologically, the shadow or reflection carries the image of the self - not the Ego. It is interesting and even psychotherapeutically useful to have persons suffering from NPD study their face in a mirror. Often they will see someone of great power and effectiveness, precisely the qualities they feel a lack of. For even though they may overwhelm others with their energy and personal qualities, they themselves feel ineffective.

Narcissus must possess his idealised image; he cannot allow its otherness for that would be too threatening to his basic design, to be mirrored himself. Hence, the sudden switch: 'Shall I be wooed or woo?'. Narcissus' libido quickly changes from an idealisation into a mirror form, showing how his unredeemed inflation, in psychoanalytic terms, his grandiose-exhibitionistic self, gains control."

Jungian parlance aside, the author seems to be describing - rather poetically - the basic relationship between the True Self and the False Self. No theoretician has ignored this dichotomy, most basic to malignant narcissism.

The True Self is synonymous with the [Freudian] Ego. It is shrivelled, dilapidated, stifled and marginalised by the False Self. The narcissist draws no distinction between his Ego and his Self. He is incapable of doing so. He relegates his Ego functions to the outside world. His False Self is an invention and the reflection of an invention.

Narcissists, therefore, do not "exist". The narcissist is a loose coalition, based on a balance of terror, between a sadistic, idealised Superego and a grandiose and manipulative False Ego. These two interact only mechanically. Narcissists are Narcissistic Supply seeking androids. No robot is capable of introspection, not even with the help of mirroring.

Narcissists often think of themselves as machines (the "automata metaphor"). They say things like "I have an amazing brain" or "I am not functioning today, my efficiency is low." They measure things, constantly compare performance. They are acutely aware of time and its use. There is a meter in the narcissist's head, it ticks and tocks, a metronome of self-reproach and grandiose, unattainable, fantasies.

The narcissist likes to think about himself in terms of automata because he finds them to be aesthetically compelling in their precision, in their impartiality, in their harmonious embodiment of the abstract. Machines are so powerful and so emotionless, not prone to be hurting weaklings.

The narcissist often talks to himself in third person singular. He feels that it lends objectivity to his thoughts, making them appear to be emanating from an external source. The narcissist's self-esteem is so low that, to be trusted, he has to disguise himself, to hide himself from himself. It is the narcissist's pernicious and all-pervasive art of un-being.

Thus, the narcissist carries within him his metal constitution, his robot countenance, his superhuman knowledge, his inner timekeeper, his theory of morality and his very own divinity - himself.

Sometimes the narcissist does gain self-awareness and knowledge of his predicament - typically in the wake of a life crisis (divorce, bankruptcy, incarceration, accident, serious illness, or the death of a loved one). But, in the absence of an emotional correlate, of feelings, such merely cognitive awakening is useless. It does not gel into an insight. The dry facts alone cannot bring about any transformation, let alone healing.

Narcissists often go through "soul searching". But they do so only in order to optimize their performance, to maximize the number of sources of narcissistic supply, and to better manipulate their environment. They regard introspection as an inevitable and intellectually enjoyable maintenance chore.

The introspection of the narcissist is emotionless, akin to an inventory of his "good" and "bad" sides and without any commitment to change. It does not enhance his ability to empathize, nor does it inhibit his propensity to exploit others and discard them when their usefulness is over. It does not tamper his overpowering and raging sense of entitlement, nor does it deflate his grandiose fantasies.

The narcissist's introspection is a futile and arid exercise at bookkeeping, a soulless bureaucracy of the psyche and, in its own way, even more chilling that the alternative: a narcissist blissfully unaware of his own disorder.

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next: The Narcissist's Stripped Ego

• Watch the video on Narcissist False Self

Question:

Why does the narcissist conjure up another Self? Why not simply transform his True Self into a False one?

Answer:

Once formed and functioning, the False Self stifles the growth of the True Self and paralyses it. Henceforth, the True Self is virtually non-existent and plays no role (active or passive) in the conscious life of the narcissist. It is difficult to "resuscitate" it, even with psychotherapy.

This substitution is not only a question of alienation, as Horney observed. She said that because the Idealised (=False) Self sets impossible goals to the narcissist, the results are frustration and self hate which grow with every setback or failure. But the constant sadistic judgement, the self-berating, the suicidal ideation emanate from the narcissist's idealised, sadistic, Superego regardless of the existence or functioning of a False Self.

There is no conflict between the True Self and the False Self.

First, the True Self is much too weak to do battle with the overbearing False. Second, the False Self is adaptive (though maladaptive). It helps the True Self to cope with the world. Without the False Self, the True Self would be subjected to so much hurt that it will disintegrate. This happens to narcissists who go through a life crisis: their False Ego becomes dysfunctional and they experience a harrowing feeling of annulment.

The False Self has many functions. The two most important are:

1. It serves as a decoy, it "attracts the fire". It is a proxy for the True Self. It is tough as nails and can absorb any amount of pain, hurt and negative emotions. By inventing it, the child develops immunity to the indifference, manipulation, sadism, smothering, or exploitation - in short: to the abuse - inflicted on him by his parents (or by other Primary Objects in his life). It is a cloak, protecting him, rendering him invisible and omnipotent at the same time.
2. The False Self is misrepresented by the narcissist as his True Self. The narcissist is saying, in effect: "I am not who you think I am. I am someone else. I am this (False) Self. Therefore, I deserve a better, painless, more considerate treatment." The False Self, thus, is a contraption intended to alter other people's behaviour and attitude towards the narcissist.

These roles are crucial to survival and to the proper psychological functioning of the narcissist. The False Self is by far more important to the narcissist than his dilapidated, dysfunctional, True Self.

 

The two Selves are not part of a continuum, as the neo-Freudians postulated. Healthy people do not have a False Self which differs from its pathological equivalent in that it is more realistic and closer to the True Self.

It is true that even healthy people have a mask [Guffman], or a persona [Jung] which they consciously present to the world. But these are a far cry from the False Self, which is mostly subconscious, depends on outside feedback, and is compulsive.

The False Self is an adaptive reaction to pathological circumstances. But its dynamics make it predominate, devour the psyche and prey upon both the True Self. Thus, it prevents the efficient, flexible functioning of the personality as a whole.

That the narcissist possesses a prominent False Self as well as a suppressed and dilapidated True Self is common knowledge. Yet, how intertwined and inseparable are these two? Do they interact? How do they influence each other? And what behaviours can be attributed squarely to one or the other of these protagonists? Moreover, does the False Self assume traits and attributes of the True Self in order to deceive the world?

Let's start by referring to an oft-occurring question:

Why are narcissists not prone to suicide?

The simple answer is that they died a long time ago. Narcissists are the true zombies of the world.

Many scholars and therapists tried to grapple with the void at the core of the narcissist. The common view is that the remnants of the True Self are so ossified, shredded, cowed into submission and repressed - that, for all practical purposes, the True Self is dysfunctional and useless. In treating the narcissist, the therapist often tries to construct and nurture a completely new healthy self, rather than build upon the distorted wreckage strewn across the narcissist's psyche.

But what of the rare glimpses of True Self oft reported by those who interact with the narcissist?

Pathological narcissism is frequently comorbid with other disorders. The narcissistic spectrum is made up of gradations and shades of narcissism. Narcissistic traits or style or even personality (overlay) often attach to other disorders (co-morbidity). A person may well appear to be a full-fledged narcissist - may well appear to be suffering from the Narcissistic Personality Disorder (NPD) - but is not, in the strict, psychiatric, sense of the word. In such people, the True Self is still there and is sometimes observable.

 

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In a full-fledged narcissist, the False Self imitates the True Self.

To do so artfully, it deploys two mechanisms:

Re-Interpretation

It causes the narcissist to re-interpret certain emotions and reactions in a flattering, socially acceptable, light. The narcissist may, for instance, interpret fear as compassion. If the narcissist hurts someone he fears (e.g., an authority figure), he may feel bad afterwards and interpret his discomfort as empathy and compassion. To be afraid is humiliating - to be compassionate is commendable and earns the narcissist social commendation and understanding (narcissistic supply).

Emulation

The narcissist is possessed of an uncanny ability to psychologically penetrate others. Often, this gift is abused and put at the service of the narcissist's control freakery and sadism. The narcissist uses it liberally to annihilate the natural defences of his victims by faking empathy.

This capacity is coupled with the narcissist's eerie ability to imitate emotions and their attendant behaviours (affect). The narcissist possesses "emotional resonance tables". He keeps records of every action and reaction, every utterance and consequence, every datum provided by others regarding their state of mind and emotional make-up. From these, he then constructs a set of formulas, which often result in impeccably accurate renditions of emotional behaviour. This can be enormously deceiving

 

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next: Narcissists and Introspection

Gotu kola is an herbal remedy used to ease anxiety and treat mental fatigue and insomnia. Learn about the usage, dosage, side-effects of Gotu kola.

Botanical Name:Centella asiatica
Common Names:Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.)

• Overview
• Plant Description
• Medicinal Uses and Indications
• Dosage and Administration
• Precautions
• Interactions and Depletions
• Supporting Research
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Overview

Gotu kola has been used as a medicinal herb for thousands of years in India, China and Indonesia. Its ability to heal wounds, improve mental clarity, and treat skin conditions such as leprosy and psoriasis were important reasons for its extensive use in these countries. It has also been called one of the "miracle elixirs of life" because legend has it that an ancient Chinese herbalist lived for more than 200 years as a result of using the herb.

Historically, gotu kola has also been used to treat mental fatigue, syphilis, hepatitis, stomach ulcers, epilepsy, diarrhea, fever, and asthma. Today, American and European herbalists use gotu kola for disorders that cause connective tissue swelling, such as scleroderma, psoriatic arthritis (arthritis occurring in conjunction with psoriasis), anklylosing spondylitis (arthritis of the spine), and rheumatoid arthritis. Recent studies confirm some of the traditional uses and also suggest possible new applications for gotu kola, such as lowering high blood pressure, treating venous insufficiency (pooling of blood in the veins, usually in the legs, boosting memory and intelligence, easing anxiety, and speeding wound healing.

Gotu kola should not be confused with kola nut (Cola nitida). Kola nut is an active ingredient in Coca Cola and contains caffeine. Gotu kola has no caffeine, and is not a stimulant.

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Plant Description

Gotu kola is a perennial plant native to India, Japan, China, Indonesia, South Africa, Sri Lanka, and the South Pacific. It is a tasteless, odorless plant that thrives in and around water. It has small fan-shaped green leaves with white or light purple-to-pink flowers and it bears small oval fruit. The leaves and stems of the gotu kola plant are used for medicinal purposes.

Medicinal Uses and Indications

Treatment

Wound Healing and Skin Lesions

Gotu kola contains triterpenoids, compounds that have been shown to aid in wound healing. For example, animal studies indicate that triterpenoids strengthen the skin, increase the concentration of antioxidants in wounds, and restore inflamed tissues by increasing blood supply. Because of these properties, gotu kola has been used externally for burns, psoriasis, prevention of scar formation following surgery, recovery from an episiotomy following vaginal delivery of a newborn, and treatment of external fistulas (a tear at or near the anus).

Venous Insufficiency and Varicose Veins

When blood vessels lose their elasticity, blood pools in the legs and fluid leaks out of the blood vessels, causing the legs to swell (venous insufficiency). In a study of 94 people with venous insufficiency, those who took gotu kola reported a significant improvement in symptoms compared to those who took placebo. In another study of people with varicose veins, ultrasound examination revealed improvements in the vascular tone of those who took gotu cola.

High Blood Pressure

In a study of people with heart disease and high blood pressure, those who took abana (an Ayurvedic herbal mixture containing gotu kola) experienced a significant reduction in diastolic blood pressure (pressure on blood vessels when the heart is at rest) compared to those who took placebo. Further studies are needed to determine whether gotu kola alone, some other herb in the Ayurvedic mixture, or the particular combination of all the herbs in the remedy is responsible for the beneficial effect.

Gotu kola for Anxiety

Triterpenoids (active compounds in gotu kola) have been shown to soothe anxiety and boost mental function in mice. A recent study found that people who took gotu kola were less likely to be startled by a novel noise (a potential indicator of anxiety) than those who took placebo. Although the results of this study are somewhat promising, the dose used in this study was extremely high, making it difficult to draw any conclusions about how gotu kola might be used by people with anxiety.

Scleroderma

One study involving 13 females with scleroderma found that gotu kola decreased joint pain, skin hardening, and improved finger movement.

Insomnia

Because of sedative effects demonstrated in animals, gotu kola has been used to help people with insomnia.

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Dosage and Administration

Gotu kola is available in teas, as dried herbs, tinctures, capsules, tablets, and ointments. It should be stored in a cool, dry play and used before the expiration date on the label.

Pediatric

There is currently no information in the scientific literature about the use of gotu kola for children. Therefore, it is not recommended for those under 18 years old.

Adult

The adult dosage of gotu kola may vary depending on the condition being treated. An appropriately trained and certified herbalist, such as a naturopath, can provide the necessary guidance.

The standard dose of gotu kola varies depending on the form:

• Dried herb—to make tea, add ¼ to ½ tsp dried herb to a cup of boiling water (150 mL) for 10 minutes, 3 times a day
• Powdered herb (available in capsules)—1,000 to 4,000 mg, 3 times a day
• Tincture (1:2, 30% alcohol)—30 to 60 drops (equivalent to 1.5 to 3 mL - there are 5 mL in a teaspoon), 3 times a day
• Standardized extract—60 to 120 mg per day; standardized extracts should contain 40% asiaticoside, 29% to 30% asiatic acid, 29% to 30% madecassic acid, and 1% to 2% madecassoside; doses used in studies mentioned in the treatment section range from 20 mg (for scleroderma) up to 180 mg (in one study for venous insufficiency; although, most of the studies for this latter condition were conducted using 90 mg to 120 mg per day).

The recommended dosage for people with insomnia is ½ tsp of dried herb in a cup of water taken for no more than 4 to 6 weeks.

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Precautions

The use of gotu kola for more than 6 weeks is not recommended. People taking the herb for an extended period of time (up to 6 weeks) should take a 2-week break before taking the herb again.

Asiaticoside, a major component of gotu kola, has also been associated with tumor growth in mice. Though more studies are needed, it is wise for anyone with a history of precancerous or cancerous skin lesions—such as squamous cell, basal cell skin cancer, or melanoma—to refrain from taking this herb.

Side Effects

Gotu kola side effects are rare but may include skin allergy and burning sensations (with external use), headache, stomach upset, nausea, dizziness, and extreme drowsiness. These side effects tend to occur with high doses of gotu kola.

Pregnancy and Breastfeeding

Pregnant women should not take gotu kola because it may cause spontaneous abortion. There is little or no information regarding the safety of this herb during breastfeeding, so nursing mothers should refrain from taking this herb.

Pediatric Use

Gotu kola is not recommended for children.

Geriatric Use

People older than 65 years should take gotu kola at a lower than standard dose. The strength of the dosage can be increased slowly over time to reduce symptoms. This is best accomplished under the guidance of an appropriately trained and certified herbalist such as a naturopathic doctor.

Interactions and Depletions

There have been no reports documenting negative interactions between gotu kola and medications to date. Since high doses of gotu kola can cause sedation, individuals should refrain from taking this herb with medications that promote sleep or reduce anxiety.

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Supporting Research

Antani JA, Kulkarni RD, Antani NJ. Effect of abana on ventricular function in ischemic heart disease. Jpn Heart J. Nov 1990: 829-835.

Anonymous. Centella asiatica (Gotu kola). Botanical Monograph. American Journal of Natural Medicine. 1996;3(6):22-26.

Belcaro GV, Rulo A, Grimaldi R. Capillary filtration and ankle edema in patients with venous hypertension treated with TTFCA. Angiology. 1990;41(1):12-18.

Bradwejn J, Zhou Y, Koszycki D, Shlik J. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol. 2000;20(6):680-684.

Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publication; 1998.

Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomed. 2000;7(5):427-448.

Cauffield JS, Forbes HJM. Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. Lippincotts Prim Care Pract. 1999:3(3):290-304.

DerMarderosian A, ed. Gotu Kola. In: Facts and Comparisons The Review of Natural Products. St. Louis, MO: Wolters Kluwer Co.: 1999:1-3.

Fetrow C, Avila J. Professional's Handbook of Complementary & Alternative Medicines. Springhouse, PA: Springhouse Corp.; 1999.

Gruenwald J, Brendler T, Jaenicke C, Fleming T, Deutsch M, Hamid M, eds. et al. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc..; 1998:729-731.

Kuhn M, Winston D. Herbal Therapy and Supplements: A Scientific and Traditional Approach. Philadelphia, Pa: Lippincott; 2001.

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McCaleb R. Anti-Cancer Effects of Gotu Kola. HerbalGram. 1996;36:17.

McGuffin M, Hobbs C, Upton R, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press; 1997.

Miller LG, Murray W J, eds. Herbal Medicinals: A Clinician Guide. New York, NY: Pharmaceutical Products Press; 1998:217.

Peirce A. Practical Guide to Natural Medicines. New York: Stonesong Press Inc.; 1999:317-318.

Pointel JP, Boccalon H, Cloarec M, Ledevehat C, Joubert M. Titrated extract of centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiology 1987;38(1 Pt 1):46-50.

Russo E. Handbook of Psychotropic Herbs. New York, NY: Hawthorn Herbal Press; 2001.

Shukla A, Rasik AM, Dhawan BN. Asiaticoside-induced elevation of antioxidant levels in healing wounds. Phytother Res. 1999;13(1):50-54 [abstract].

Thoughtful quotes about spirituality and God.

Words of Wisdom

 

"We are not born all at once, but by bits. The body first, and the spirit later. Our mothers are racked with the pains of our physical birth; we ourselves suffer the longer pains of our spiritual growth." (Mary Antin, the Promised Land, 1969)

"While spirituality can be discovered in solitude - by retreating to a cell of some kind, by reading, by thinking, meditating, praying - it can be fulfilled only in community." (Earnest Kurtz and Katherine Ketcham)

"True spirituality, however, is about power. It is about developing the powers of creativity, justice, and compassion in all persons. It is about unleashing the divine powers in us all. It is about grounding persons and communities in the powers that will enable them to survive and even flourish in the midst of adversity." (Mathew Fox,)

"Physical strength can never permanently withstand spiritual force." (Franklin Roosevelt)

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"The first peace, which is the most important, is that which comes within the soul of people when they realize their relationship, their oneness, with the universe and all its powers, and when they realize at the center of the universe dwells the Great Spirit, and that this center is really everywhere, it is within each of us." (Black Elk)

"The soul loves and creates." (Sue Monk Kid)

"The body must be nourished, physically, emotionally and spiritually. We're spiritually starved in this culture - not underfed but undernourished." (Carol Horning)

"God has no religion." (Gandhi)

"Soul is what connects you to everyone and everything else. It is the sum of all the choices you make. It is where your beliefs and values reside. Soul is at the center of our relationships to others, and for me it is at the center of the business enterprise." (Tom Chappel)

"With knowledge and no faith, we may well see a world destroyed. With faith and no knowledge, we may still see a world destroyed. With faith and knowledge bound together, we can hope to cherish and protect the lives of the men and the life of the world." (Margaret Mead)

"Every soul is a melody which needs renewing." (unknown)

"Acceptance of what has happened is the first step to overcoming the consequences of any misfortune." (William James)

"I found God in myself and I loved her fiercely." (Ntosake Shange)

"I would rather live in a world where my life is surrounded by mystery than live in a world so small that my mind can comprehend it." (Harry Emerson Fosdick)

"What characterizes our modern humanity, therefore, is not the absence of spiritual values...but rather the fact that these values no longer have any decisive influence upon the destiny of culture." (Paul Tournier)

"Man cannot dispense with the spirit. The attempt is made to deprive him of it; so he invents surrogates for it." (Paul Tournier)

"Consult the spirit within you first." (Oprah Winfrey)

"Science without religion is lame, religion without science is blind." (Einstein)

"We have just enough religion to make us hate, but not enough to make us love one another." (Thoreau)

"You are a soul with a body, rather than a body with a soul." (Wayne W. Dyer)

"The best way to know God is to love many things." (Van Gough)

 

next: Success/Failure

Overview of complementary therapies for treating depression including herbal medicine, nutritional therapy, acupuncture, psychological therapies, light therapy, self-help.

Depression is a psychological state of dejection or melancholy that can also have physical symptoms. It affects almost all of us at some point in varying degrees from feeling 'low' to suicidal.

In this article

• What to look for
• Causes
• Orthodox treatments
• Complementary approaches
• Self-help tips

What to look for

Common signs of depression include negative feelings, self-doubt, misery, tearfulness, feelings of hopelessness and dejection, fatigue, sleep disturbance, loss of appetite, mood swings, headaches, aches and pains, and loss of sex drive. In severe cases, suicidal thoughts are common.

Causes

Depression often stems from anxieties about work, money, health and relationships - or it may be triggered by bereavement. It can also have a physical cause such as nutritional deficiency or hormonal imbalance and may be experienced by women after they've had a baby or as part of the menstrual cycle.

Poor diet and lack of adequate rest, relaxation and exercise can also play a part. Depression may also be triggered by a lack of exposure to sunlight during the winter months. This type of depression is known as seasonal affective disorder (SAD).

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Orthodox treatments

Doctors often prescribe antidepressant medication for moderate to severe depression. In milder cases counselling, psychological therapy or psychotherapy may be recommended along with exercise, lifestyle and dietary changes.

Complementary approaches

• Herbal medicine - St John's wort has been clinically proven to relieve mild or moderate depression. (However, it shouldn't be used by anyone taking the contraceptive pill as it may render it ineffective).

• Nutritional therapy, dietary change - correcting nutritional deficiencies, balancing blood sugar levels and improving diet can significantly help lift depression. The role of certain amino acids may also be significant. Consult a nutritionist for advice.

• Acupuncture - traditional acupuncture treatment or electro-acupuncture can ease depression. Some studies found it was superior to antidepressant drugs and had fewer side effects.

• Homeopathy - various remedies may help: ignatia is often used to ease grief, pulsatilla may relieve tearfulness, sulphur is often indicated for despair and aurum met. is used for suicidal feelings. A qualified homeopath can advise on the most suitable remedy and dosage.

• Psychological therapies - cognitive behavioral therapy and relaxation training can relieve depression. Research has shown that listening to music can also help.

• Reflexology, meditation and yoga - have been used in the treatment of depression but have yet to be tested by research.

• Magnetic and electrical stimulation - transcranial magnetic stimulation can significantly improve depression without side effects. Gentle electrical stimulation, with low-level currents passed through electrodes over several hours, combined with hypnotherapy can relieve sleep disturbance and depression.

• Light therapy - exposure to bright light and the use of lightboxes can help people suffering from SAD.

Self-help tips

• Don't bottle up your feelings and hide away. Find someone to talk to about your problems. Avoid spending long periods alone.

• Eat a healthy diet with plenty of fresh vegetables and wholegrains. Avoid sugar, junk food, alcohol and coffee. Try supplementing with vitamin B complex, magnesium and folic acid.

• Essential oil of clary sage has an uplifting effect and is said to ease depression. A few drops can be added to bathwater, placed on a tissue or pillow, or added to a bowl of steaming water and inhaled.

• Some Bach flower remedies, including sweet chestnut, mustard and Rescue Remedy, are often used for depression. Place four drops in a tumbler of water and sip throughout the day.

• Take regular, moderate exercise. Yoga, meditation and relaxation techniques can also help.

next: Which Alternative Treatments Work Best for Depression

Your Home on the Web For the Best of Self-Help Stuff That Works

Hello. I'm Adam Khan and I'd like to welcome you to a wide-ranging exploration of the field of self-help. Most of the material here will help you feel better more often by changing the way you think or the way you deal with other people. Those two areas have the greatest impact on your level of happiness, your mental health, and your effectiveness in life.

I'm the author of the book, Self-Help Stuff That Works, a published collection of articles I wrote for the newsletter, At Your Best, published by Rodale Press (publishers of Men's Health, Prevention Magazine, etc.).

Here, at HealthyPlace.com, I'm going to share with you the principles for eliminating some of the unhealthy and probably unnecessary frustration, worry, stress, etc., in our lives. The best place for you to begin your exploration is the Immediate Relief Page, where you'll find remedies for any negative feelings you're having at the moment.

Thanks for coming by. Take a look around and let me know what you think. I would love to hear from you.

 

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next: About Me

Some physically active women are at risk for a group of symptoms called the Female Athlete Triad. This often unrecognized disorder is a combination of three conditions:

• Disordered eating
• Amenorrhea (lack of menstrual periods)
• Osteoporosis

disordered eating, whether manifested as restrictive eating behaviors, binging and purging or excessive exercise, can lead to changes in normal body hormones, such as estrogen. Normal estrogen levels are needed to maintain calcium content in bone. Estrogen levels may be lowered when amenorrhea occurs and as a result, calcium content can be lost from bone. The result is osteoporosis, or porous bones.

Who's at risk: are all athletes on this team?

If you are a physically active woman, you are at risk for the Triad. The competitive nature and strong discipline that can help make you a good athlete may also be part of the equation leading to this disorder. Competitive athletes may be at a higher risk than the more casual athlete due to a more rigorous training schedule and the "play-to-win" nature of their sports. You are particularly at risk if you participate in endurance sports, like cross-country running; aesthetic sports, like gymnastics or ballet; and sports which require formfitting uniforms, like swimming. The emphasis on a certain "look" and the perception that carrying less weight will universally improve performance lead to this risk.

How will the Triad affect my performance?

Each part of the Triad can impair health and sport performance.

Disordered eating:

An underfueled athlete is a slowed and weakened athlete. No matter what the sport, if your muscles lack sufficient and proper fuel, performance is impaired. At first there might just be some early fatigue. As the fuel deficit worsens, actual loss of strength and muscle size can occur as the body uses skeletal muscle in order to fuel essential body functions, like heart function and breathing. Lack of fuel can also lead to your inability to concentrate, not a quality befitting an athlete. If you are an athlete with strength losses and poor concentration, you can be more easily injured. Injuries then are slow to heal in a poorly fueled body.

Amenorrhea:

Loss of menstrual periods may signal a change in your body's intricate and complicated hormone system. Hormone imbalance from underfueling your body can result in lowered estrogen production. There are also other causes of lowered estrogen levels. A diminished estrogen level can have many effects; the most immediately apparent one can be bone loss. Amenorrhea can often go unreported to medical providers because of the common belief it is "just part of the training effect." We do know that the bone loss that occurs as a result of this is NOT "just part of the training effect" and can start to occur after just a few months with no period. Click for more information on amenorrhea.

Osteoporosis:

Loss of bone, especially if you are an athlete, can be an unfortunate setup for an injury. Stress fractures can sideline sports activity and be slow to repair if you are underfueled. Repeated stress fractures and unexplained injuries should be a red flag to further evaluate your eating and exercise patterns. Bone loss that occurs because of amenorrhea can be permanent; osteoporosis is not just a disease grandmothers get!

What are the warning signs?

In addition to the clinical information presented, the following could be red flags:

• Frequent or unexplained injuries, stress fractures
• Excessive or compulsive exercise (not being able to skip a day of exercise or reduce time spent exercising)
• Change in performance -- loss of endurance, speed, strength
• Impaired concentration
• Absent or irregular menstrual periods
• Restrictive eating masked as a "performance enhancing" meal plan
• Use of weight loss products or supplements

Prevention of the Female Athlete Triad

Prevention of the Female Athlete Triad is the best way to stay healthy so you can enjoy participating in your sport. Try these tips:

• Choose an activity that complements your natural body strengths and suits you as an individual.
• Realize your health is more important than competitive success. Taking health risks for a perceived competitive edge will make you lose in the long run.
• Be wary of those who value your competitive success over your well being. Frequent weigh-ins, weight comments and punitive consequences for weight gain may increase an athlete's risk for the Triad.
• Appreciate your own healthy, active body. Don't compare yourself to others, especially those portrayed in the media. Optimal weight for health AND performance is different for everyone.
• Realize the thinnest athletes are not necessarily the fastest or the strongest.
• Think of fuel as the ultimate performance enhancer!
• Don't starve your bones. Part of your fuel mix should include several servings a day of good calcium sources like milk, yogurt, cheese, calcium-fortified juices and soy products. I f you are lactose-intolerant, try some of the no-lactose dairy products available. Green leafy vegetables, almonds and beans also have some calcium.
• Be a role model with both your words and actions. Speak up when you hear others making negative comments about weight or body shape. Compliment friends and teammates on their talents and personality, not their looks. Take a positive attitude about fueling yourself and enjoying foods.

next: Eating Disorders: Thin Battle
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