Networking is. . . using your creative talents to help others achieve their goals as you cultivate a network of people strategically positioned to support you in your goals. . . expecting nothing in return! ~ Larry James

To achieve maximum benefits while attending any function where the opportunity for networking exists, it is important to have a clear understanding of networking. You will notice that my definition of networking has two parts. #1 ~ Helping others, and #2 ~ Helping yourself. In that order.

So. . . what's this about expecting nothing in return? Often we expect people who we help to help us. That would be nice. And it doesn't always work that way. Some people are in better positions to help some than others. Just give. That's the key! Just give. Willingly. It will come back to you. Help people and you get helped! Have no expectations about where your assistance should come from. Just give. And keep on giving. It will come. . . often when you least expect it and when you most need it.

To use networking as an effective business tool; to use it to help you make productive business links, you must first grasp the concept and engage in it relentlessly. Network all the time. Never stop networking.

Many people use business meetings, Chamber "After Hours," conventions, association meetings, trade shows, Junior Chamber of Commerce meetings, civic gatherings, etc., as functions at which to prospect; to look for new customers. That is never my priority.

It has been my experience that a much better way to maximize your networking efforts is to use this time as an opportunity to develop important new business contacts, not necessarily prospects, although often prospects show up where you least expect them. The emphasis must be on developing new business connections.

Find ways you can help others. . . FIRST!

You can always prospect, but good networking opportunities for developing new business contacts are rare. Use the following Top 10 "Hot Ideas" to assist you in making lots of new friends and business contacts at your next function.

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Hot Idea #1 ~ Have a plan! Set a goal to meet no less than 10 new people at the next meeting. Circulate. Don't get bogged down at the bar or with the people you already know. When you set a goal to meet 10 new people, you usually will meet more than you would have if you had no goal.

Hot Idea #2 ~ Develop a good self-introduction! I call this very important self-introduction a "30 second connection!" It must be taken seriously. It is often the first words people hear from you. Practice, drill and rehearse it. After you've been introduced, people should know precisely who you are and what you do. It shouldn't be longer than 30 seconds and it can be shorter.z

It is important for you to be able to introduce yourself quickly without stumbling over your words. This is why I said you must practice, drill and rehearse. My friend and networking expert, Anne Boe once said, "Clarity is power!" Connections that begin with clarity can become long-lasting because they stand out; they will be remembered.

When you clearly communicate who you are, and what you do, people are in a much better position to assist you in your networking efforts. They are more likely to remember you when the opportunity for them to help you shows up.

Grant G. Gard says, "If it's fuzzy in the pulpit, it's cloudy in the pew!" Learning to speak clearly teaches us to say good-bye to confusion. Crystal clear communication allows us to make the connections that enable ideas to flourish and positive actions to occur.

There are four important elements to an effective "30 second connection."

1. Your name.
2. The name of your business.
3. Specifically what you do.
4. What kind of business leads you are looking for.

You need to have the fourth element of a "30 second connection" ready for the right occasion. There are some groups, such as networking groups, where it is totally appropriate for you to tell people what kind of business leads you are looking for. As a matter of fact, it is expected!

Most networking groups offer an opportunity for you to give your "30 second connection" and solicit business leads. There are other places where it is less appropriate. Use your good judgment. Always be looking for the opportunity to tell people what you do when you show up! No time to be shy when you are networking.

Here is an example of a "30 second connection:

• Hi, my name is Larry James with CelebrateLove.com. I present "Relationship Enrichment LoveShops," "Mars and Venus Seminars" and "Networking Seminars" for solo singles, singles with partners and married love partners and business groups both nationally and internationally. I am also on staff with Dr. John Gray, Ph.D., author of "Men Are From Mars, Women Are From Venus." A good business lead for me is anyone who is in a position to make a decision about hiring a speaker for a seminar, workshop, keynote address, convention or association meeting.

Hot Idea #3~ Carry lots of business cards! Never leave home or the office without them. Saying, "I just gave out my last card!" smacks of poor planning. Make a brief note on the back of the other persons card to help you recall the conversation later. Then, follow-up by asking them how YOU can help THEM!

Hot Idea #4~ Have fun! Smile and talk to lots of people! Make good eye contact. Never let anyone catch you looking over their shoulder. It gives the appearance that you are looking for someone more important to talk with. Mix and mingle. If after meeting someone new, you feel they are someone you may want to stay in touch with, exchange business cards. Consider making an appointment to get better acquainted later while you are still face-to-face.

It is a major business irritant to hear someone say, "Call me Monday and we'll make an appointment to get together." Now! Do it now! Carry your pocket calendar with you to assist in that process, then move on. Remember your goal is to meet 10 new people! You can talk to your friends anytime.

Hot Idea #5~ Pay attention! Look for opportunity. It's there waiting to be discovered. . . and you must know what you are looking for. Talk 20% of the time and listen 80% of the time. Listen for ways you can help to make a connection for them with someone else in your network. The way to call attention to yourself is to pay attention to others!

Hot Idea #6~ Be the host! Don't be shy. If you meet someone and know they might be a good connection for someone you just met across the room, help make the introduction! They will remember you!

Hot Idea #7~ Ask for what you want! People can't read your mind. If you are looking for a special contact in a specific business, ask everyone you meet to help you make the connection. That's networking!

Hot Idea #8~ Say, "Thank you!" Express appreciation when someone offers ideas, business leads, information, support or any of the other many wonderful things that are available when networking. Jot them a quick 'thank you' the next day.

Buy a special card; not your typical pre-printed company business 'thank you' card, and in your own handwriting, write them a note they won't soon forget. Instead of using the postage meter, stock a colorful supply of stamps. This all demonstrates your attention to detail. They will know you had to have shifted into 'extra effort' to accomplish this and will appreciate your note even more.

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Hot Idea #9~ Avoid common crutches! Don't arrive too late. Don't leave too early. Don't drink to much. Don't gorge at the buffet table. Remember, you never have a second chance to make a good first impression! Don't stay huddled in groups with people you already know. Expand your horizons. Move past your fears.

Hot Idea #10~ Follow-up! A hot lead or new business connection can cool very rapidly if you don't follow-up. Remember, most sales people fail because they never ask for the order and because they fail to follow-up on what they get started. If you tell someone that you will call, do it. . . quickly! Keep your word. In business, integrity is everything.

Networking works! And you must work it! My professional speaking business is now nationwide because of networking. All three of my relationship books have received endorsements from celebrity authors, therapist, speakers and is now available in all major book stores.

Those who take networking seriously; as an art to be learned; as a skill to be fine-tuned; and who stay connected to those people who count, can generally find out what they want in three to six phone calls to those in their network.

When you understand the concept of networking, create a plan of action, and commit to work that plan, you can experience a new kind of momentum that will put your career and your life on FAST FORWARD!

next: The Secret to Solving ALL Your Problems!

Many parents can't believe their child self-harms. Here are some reasons why people self-injure.

Why people engage in self-harm

It's shocking! Frightening! Who could believe that someone would want to deliberately hurt themselves?

But for people who do injure themselves by cutting, burning, head-banging, skin-picking or other means, self-injury offers a momentary sense of calm and a release of tension. Unfortunately, that's usually quickly followed by guilt and shame and the return of other painful emotions. And with self-injury comes the very real possibility of inflicting serious and even fatal injuries.

According to the Mayo Clinic, self-injury isn't a specific disease or condition. Rather, it's a type of abnormal behavior. It may accompany a variety of mental disorders, such as depression and borderline personality disorder. Because self-injury is often done on impulse, it's sometimes considered an impulse-control behavior problem. Self-injury is also known as self-harm, self-injurious behavior and self-mutilation.

Although it's hard to estimate how many people engage in self-injury because some never seek treatment, it's thought that about 3 - 5 percent of Americans have deliberately hurt themselves at some point in their lives. Self-injury may be more common - and on the rise - in adolescents.

Some reasons why people engage in self-harm:

• To distract themselves from emotional pain by causing physical pain
• To punish themselves
• To relieve tension
• To feel real by feeling pain or seeing evidence of injury
• To feel numb, zoned out, calm, or at peace
• To experience euphoric feelings (associated with the release of endorphins)
• To communicate their pain, anger, or other emotions to others
• To nurture themselves (through the process of healing the wounds)

Some people self-injure to end a dissociated or unreal-feeling state; to ground themselves and come back to reality. Basically, studies have suggested that when people who self-injure get emotionally overwhelmed, an act of self-harm brings their levels of psychological and physiological tension and arousal back to a bearable baseline level almost immediately.

Detailed information on St. John's Wort, an alternative herbal treatment for depression, including dangerous interactions between St. John's Wort and certain medications.

Contents

• Introduction
• Key Points
• Frequently Asked Questions
• For More Information
• Selected Sources

Introduction

The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet on the use of St. John's wort for depression. It is part of a series intended to help consumers make informed decisions about whether to use complementary and alternative medicine (CAM) for a disease or medical condition. NCCAM defines CAM as approaches to health care that are not currently part of conventional medicine as practiced in the United States.^a

Key Points

• St. John's wort is an herb that has been used for centuries for medicinal purposes, including to treat depression.

• The composition of St. John's wort and how it might work are not well understood.

• There is some scientific evidence that St. John's wort is useful for treating mild to moderate depression. However, recent studies suggest that St. John's wort is of no benefit in treating major depression of moderate severity. More research is required to help us know whether St. John's wort has value in treating other forms of depression.

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  St. John's wort interacts with certain drugs, and these interactions can be dangerous.

• It is important to inform all of your health care providers about any therapy that you are currently using or considering, including any dietary supplements. This is to help ensure a safe and coordinated course of care.

^a Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. To find out more, see the NCCAM fact sheet "What Is Complementary and Alternative Medicine?"

Frequently Asked Questions

1. What is St. John's wort?
St. John's wort (Hypericum perforatum in Latin) is a long-living plant with yellow flowers. It contains many chemical compounds. Some are believed to be the active ingredients that produce the herb's effects, including the compounds hypericin and hyperforin.

How these compounds actually work in the body is not yet known, but several theories have been suggested. Preliminary studies suggest that St. John's wort might work by preventing nerve cells in the brain from reabsorbing the chemical messenger serotonin, or by reducing levels of a protein involved in the body's immune system functioning.

2. For what medicinal purposes has St. John's wort been used?
St. John's wort has been used for centuries to treat mental disorders as well as nerve pain. In ancient times, doctors and herbalists (specialists in herbs) wrote about its use as a sedative and treatment for malaria as well as a balm for wounds, burns, and insect bites. Today, St. John's wort is used by some people to treat mild to moderate depression, anxiety, or sleep disorders.

3. What is depression?
Information on depression is available from the National Institute of Mental Health. Here is a brief overview.

Depression is a medical condition that affects nearly 19 million Americans each year. A person's mood, thoughts, physical health, and behavior all may be affected. Symptoms commonly include:

• Ongoing sad mood
• Loss of interest or pleasure in activities that the person once enjoyed
• Significant change in appetite or weight
• Oversleeping or difficulty sleeping
• Agitation or unusual slowness
• Loss of energy
• Feelings of worthlessness or guilt
• Difficulty "thinking," such as concentrating or making decisions
• Recurrent thoughts of death or suicide

Depressive illness comes in different forms. The three major forms are described below. Each can vary from person to person in terms of symptoms experienced and the severity of depression.

• In major depression, people experience a sad mood or loss of interest or pleasure in activities for at least 2 weeks. In addition, they have at least four other symptoms of depression. Major depression can be mild, moderate, or severe. If it is not treated, it can last for 6 months or more.

• In minor depression, people experience the same symptoms as major depression, but they are fewer in number and are less disabling. Symptoms last at least 6 months but less than 2 years continuously.

• In dysthymia, a milder, but more chronic form of depression, people experience a depressed mood for at least 2 years (1 year for children) accompanied by at least two other symptoms of depression.

• In bipolar disorder, also called manic depression, a person has periods of depressive symptoms that alternate with periods of mania. Symptoms of mania include an abnormally high level of excitement and energy, racing thoughts, and behavior that is impulsive and inappropriate.

Some people still hold outdated beliefs about depression--for example, that the emotional symptoms caused by depression are "not real" and that a person can merely "will" himself out of it. Depression is a real medical condition. It can be treated effectively with conventional medicine, including by antidepressant drugs and certain types of psychotherapy (talk therapy).

4. Why is St. John's wort used as an alternative therapy for depression?
Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.

Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).

Finally, cost can be a reason. St. John's wort costs less than many antidepressant medications, and it is sold without a prescription (over the counter).

5. How widely is St. John's wort used for treating depression?
In Europe, St. John's wort is widely prescribed for depression. In the United States, St. John's wort is not a prescription medication, but there is considerable public interest in it. St. John's wort remains among the top-selling herbal products in the United States.

6. How is St. John's wort sold?
St. John's wort products are sold in the following forms:

• Capsules
• Teas--the dried herb is added to boiling water and steeped for a period of time.
• Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.

7. Does St. John's wort work as a treatment for depression?
There has been scientific research to try to answer this question.

In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (here, a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants (Linde et al. British Medical Journal, 1996).

Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression (Shelton et al. JAMA, 2001).

In addition, several components of the National Institutes of Health (NIH)--NCCAM, the Office of Dietary Supplements (ODS), and the National Institute of Mental Health (NIMH)--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This clinical trial (a research study in people) found that St. John's wort was no more effective for treating major depression of moderate severity than placebo (Hypericum Depression Trial Study Group. JAMA, 2002; for further information, view the press release online at nccam.nih.gov/news/2002 or contact the NCCAM Clearinghouse).

8. Are there any risks to taking St. John's wort for depression?
Yes, there are risks in taking St. John's wort for depression.

Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.

Research from NIH has shown that St. John's wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John's wort can interact with chemotherapeutic, or anticancer, drugs (such as irinotecan). The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporine). Using St. John's wort limits these drugs' effectiveness.

Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.

People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, diarrhea, nausea, increased sensitivity to sunlight, and fatigue.

9. What are some other possible problems with using St. John's wort?
Herbal products such as St. John's wort are classified as dietary supplements by the U.S. Food and Drug Administration (FDA), a regulatory agency of the Federal Government. The FDA's requirements for testing and obtaining approval to sell dietary supplements are less strict than its requirements for drugs. Unlike drugs, herbal products can be sold without requiring studies on dosage, safety, or effectiveness. For more information, see the NCCAM fact sheet "What's in the Bottle? An Introduction to Dietary Supplements."

The strength and quality of herbal products are often unpredictable. Products can differ in content not only from brand to brand, but from batch to batch. Information on labels may be misleading or inaccurate. For more information on safety issues, see the NCCAM fact sheet "Herbal Supplements: Consider Safety, Too."

10. Is NCCAM funding research on St. John's wort, including for depression and other mental illnesses?
Yes. For example, recent projects supported by NCCAM include:

• Safety and effectiveness of St. John's wort for the treatment of minor depression

• Safety of St. John's wort for the treatment of social phobia

• Effectiveness of St. John's wort for the treatment of obsessive compulsive disorder

• Effects of St. John's wort on how well birth control pills work

• Possible adverse interactions of St. John's wort and narcotic pain medications

For More Information

NCCAM Clearinghouse
Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
Web site: http://nccam.nih.gov
Address: NCCAM Clearinghouse,
P.O. Box 7923, Gaithersburg, MD 20898-7923

Fax: 1-866-464-3616 Fax-on-Demand service: 1-888-644-6226

The NCCAM Clearinghouse provides information about CAM and about NCCAM. Services include fact sheets, other publications, and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

CAM on PubMed
Web site: www.nlm.nih.gov/nccam/camonpubmed.html

CAM on PubMed, a database on the Internet developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, brief summaries of) articles on CAM in scientifically based, peer-reviewed journals. CAM on PubMed also links to many publisher Web sites, which may offer the full text of articles.

National Institute of Mental Health (NIMH)
Web site: www.nimh.nih.gov
Toll-free: 1-800-421-4211
E-mail: nimhinfo@nih.gov
Address: 6001 Executive Blvd., Rm. 8184,
MSC 9663, Bethesda, MD 20892-9663

NIMH is committed to reducing the burden of mental illness through research on mental disorders and the underlying basic science of brain and behavior. NIMH provides publications on depression and other illnesses.

Office of Dietary Supplements (ODS), NIH
Web site: http://ods.od.nih.gov
Address: 6100 Executive Blvd.,
Bethesda, MD 20892-7517

ODS, whose mission is to explore the potential role of dietary supplements to improve health care, promotes the scientific study of dietary supplements through conducting and coordinating scientific research and compiling and disseminating research results. Its public information is offered via its Web site only.

ClinicalTrials.gov
Web site: http://clinicaltrials.gov

ClinicalTrials.gov provides patients, family members, health care professionals, and members of the public access to information on clinical trials, primarily in the United States and Canada, for a wide range of diseases and conditions. It is sponsored by NIH and the FDA.

Computer Retrieval of Information on Scientific Projects (CRISP)
Web site: http://crisp.cit.nih.gov

CRISP is a searchable database of federally funded (including by NIH) biomedical research projects conducted at universities, hospitals, and other research institutions.

Selected Sources

American Herbal Pharmacopoeia and Therapeutic Compendium. St. John's wort (Hypericum perforatum) Monograph. Herbalgram: The Journal of the American Botanical Council and the Herb Research Foundation. 1997;s (40):1-16.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Washington, DC: American Psychiatric Association, 1994.

National Institute of Mental Health. Fact Sheets on Depression--"The Invisible Disease: Depression," "Depression Research at the National Institute of Mental Health," and "The Numbers Count: Mental Disorders in America," available online at www.nimh.nih.gov or see "For More Information" above.

Hypericum Depression Trial Study Group. "Effect of Hypericum perforatum (St. John's wort) in major depressive disorder: A Randomized, Controlled Trial". Journal of the American Medical Association. 2002; 287:1807-14.

Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John's wort in major depression. Journal of the American Medical Association. 2001; 285:1978-86.

Linde K, et al. St. John's wort for depression--An Overview and Meta-analysis of Randomized Clinical Trials. British Medical Journal. 1996; 313:253-8.

Piscitelli SC, et al. Indinavir concentrations and St. John's wort. The Lancet. 2000; 355:547-8.

Mathijssen RHJ, et al. Effects of St. John's wort on irinotecan metabolism. Journal of the National Cancer Institute. 2002; 94:1247-9.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

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Detailed government report on whether SAMe is effective for the treatment of depression, osteoarthritis and liver disease.

S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease

Summary

Under its Evidence-based Practice Program, the Agency for Healthcare Research and Quality (AHRQ) is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools. Contractor institutions review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities.

• Overview
• Reporting the Evidence
• Methodology
• Findings
• Future Research
• Availability of the Full Report

Overview

The objective of this report was to conduct a search of the published literature on the use of S-adenosyl- L-methionine (SAMe) for the treatment of osteoarthritis, depression, and liver disease; and, on the basis of that search, to evaluate the evidence for the efficacy of SAMe. A broad search revealed sufficient literature to support a detailed review of the use of SAMe for three conditions: depression, osteoarthritis, and cholestasis of pregnancy and intrahepatic cholestasis associated with liver disease.

Depression will affect 10 to 25 percent of women and 5 to 12 percent of men in the United States during their lifetimes. Approximately 10 to 15 million people experience clinical depression in any given year. The annual cost for treatment and lost wages is estimated at $43.7 to $52.9 billion.

Osteoarthritis is the most common form of arthritis. An estimated 15 percent of Americans suffer from arthritis, and the annual cost to society is estimated at $95 billion. It is the second most common cause cited in claims for Social Security disability benefits.

Intrahepatic cholestasis of pregnancy occurs in 1 in 500 to 1000 pregnancies and is associated with an increased risk of premature delivery and fetal death. Intrahepatic cholestasis is a relatively common complication of a number of acute and chronic liver diseases such as viral hepatitis, alcoholic hepatitis, and autoimmune liver diseases. In two series of chronic liver disease patients, 35 percent had intrahepatic cholestasis characterized by elevations of bilirubin and liver enzymes. While an economic cost is difficult to assign to cholestasis, pruritus causes significant morbidity in affected patients.

Empirical evidence of the efficacy of SAMe for the treatment of these three conditions would be helpful to health care providers who manage them and would be useful in identifying areas for future research.

Reporting the Evidence

Searches of the literature yielded 1,624 titles, of which 294 were selected to review; the latter included meta-analyses, clinical trials, and reports that contained supplemental information on SAMe. Ninety-nine articles, representing 102 individual studies, met the screening criteria. They focused on SAMe treatment for depression, osteoarthritis, or liver disease and presented data from clinical trials on humans. Of these 102 studies, 47 focused on depression, 14 focused on osteoarthritis, and 41 focused on liver disease (all conditions).

Methodology

A panel of technical experts representing diverse disciplines was established to advise the researchers throughout the research. In consultation with the funding agencies and taking into account the uses for which SAMe was generally recommended, the use of SAMe to treat depression, osteoarthritis, and liver disease was selected as the focus of the report. The aim was to perform a meta-analysis whenever the literature was appropriate for such an analysis.

Search Strategy

Twenty-five biomedical databases were searched through year 2000: MEDLINE®, HealthSTAR, EMBASE, BIOSIS Previews®, MANTIS™, Allied and Complementary Medicine, Cochrane™ Library, CAB HEALTH, BIOBASE, SciSearch®, PsychINFO, Mental Health Abstracts, Health News Daily, PASCAL, TGG Health & Wellness DB, and several pharmaceutical databases. The researchers searched using the term SAMe and its many pharmacological synonyms, the three focus disease states, study design, and article type. They also searched the bibliographies of review and meta-analysis articles and questioned experts to identify additional citations. An additional 62 articles were identified from these sources, particularly from review articles and from citations suggested by the advisors.

Selection Criteria

Reports were included in the synthesis of evidence if they focused on SAMe for one of the selected diseases and presented the results of randomized clinical trials on human subjects. Language of publication was not a barrier to inclusion. About 25 percent of the selected studies were in foreign languages, mainly Italian.

Data Collection and Analysis

All selected titles, abstracts, and articles, in all languages, were reviewed independently by two reviewers who were fluent in the appropriate language, and all disagreements were resolved by consensus. Information was collected about patient demographics, disease state, intervention, study design, and outcomes. Sufficient numbers of homogeneous studies existed to permit a meta-analysis of the efficacy of SAMe for treatment of four conditions: depression versus placebo and active (pharmacological) therapy, osteoarthritis versus placebo and active (pharmacological) therapy, cholestasis of pregnancy versus placebo and active therapy, and intrahepatic cholestasis associated with liver disease versus placebo. The remainder of the liver disease studies were too heterogeneous for pooled analysis and were assessed qualitatively.

Findings

Researchers identified 102 relevant studies in the three selected areas: 47 studies for depression, 14 studies for osteoarthritis, and 41 studies for liver disease. The majority of the studies enrolled small numbers of patients, and the quality of the studies varied greatly, as judged by the Jadad criteria. Results are summarized in five evidence tables. After removal of duplicate studies, the distribution of studies across the three selected areas was as follows:

Out of 39 unique studies considered, 28 studies were included in a meta-analysis of the efficacy of SAMe to decrease symptoms of depression.

• Compared to placebo, treatment with SAMe was associated with an improvement of approximately 6 points in the score of the Hamilton Rating Scale for Depression measured at 3 weeks (95 percent CI [2.2, 9.0]). This degree of improvement is statistically as well as clinically significant and is equivalent to a partial response to treatment. Too few studies were available for which a risk ratio could be calculated for either a 25 percent or 50 percent improvement in the Hamilton Rating Scale for Depression. Therefore a pooled analysis could not be done, but the results generally favored SAMe compared to placebo.

• Compared to treatment with conventional antidepressant pharmacology, treatment with SAMe was not associated with a statistically significant difference in outcomes (risk ratios for a 25 and for a 50 percent decrease in the Hamilton Rating score for depression were 0.99 and 0.93, respectively; effect size for the Hamilton Rating score for depression measured continuously was 0.08 (95 percent CI [-0.17, -0.32])).

Out of 13 unique studies considered, 10 studies were included in a meta-analysis of the efficacy of SAMe to decrease pain of osteoarthritis.

• One large randomized clinical trial showed an effect size in favor of SAMe of 0.20 (95 percent CI [-0.39, - 0.02]) compared to placebo, thus demonstrating a decrease in the pain of osteoarthritis.

• Compared to treatment with nonsteroidal anti-inflammatory medication, treatment with SAMe was not associated with a statistically significant difference in outcomes (effect size 0.11; 95 percent CI [0.56, 0.35]).

Eight unique studies were included in a meta-analysis of the efficacy of SAMe to relieve pruritus and decrease elevated serum bilirubin levels associated with cholestasis of pregnancy.

• Compared to placebo, treatment with SAMe was associated with an effect size of nearly a full standard deviation (-0.95; 95 percent CI [-1.45, -0.45]) for decrease in pruritus and of over one and one-third standard deviations (-1.32; 95 percent CI [-1.76, -0.88]) for decrease in serum bilirubin levels.

• In two clinical trials that were not pooled, conventional therapy (ursodeoxycholic acid) was favored over SAMe for the treatment of pruritus. One of them was statistically significant. For serum bilirubin, the results of three small trials varied, and no conclusion could be drawn.

Out of 10 unique studies considered, six studies were included in a meta-analysis of the efficacy of SAMe to relieve pruritus and decrease elevated bilirubin levels associated with intrahepatic cholestasis caused by a variety of liver diseases.

• Compared to placebo, treatment with SAMe for pruritus was associated with a risk ratio of 0.45, meaning that patients treated with SAMe were twice as likely as placebo treated patients to have a reduction in pruritus (95 percent CI [0.37, 0.58]).

• Studies that compared SAMe to active therapy were insufficient in number to permit pooled analysis.

Twenty remaining studies were too heterogeneous with respect to both diagnosis (a wide variety of liver conditions) and outcomes to permit pooled analysis. They were assessed qualitatively.

Future Research

The review has identified a number of promising areas for future research. These areas are discussed briefly.

A need exists for additional review studies, studies elucidating the pharmacology of SAMe, and clinical trials. A better understanding of the risk benefit ratio of SAMe compared to conventional therapy, especially for depression and osteoarthritis, is very important. To that end, additional analysis of existing data could be done, but it would likely be more productive to support new definitive clinical studies to address this issue.

Good dose-escalation studies have not been performed using the oral formulation of SAMe for depression, osteoarthritis, or liver disease. Once efficacy of the most effective oral dose of SAMe has been demonstrated, larger clinical trials are indicated for the use of SAMe for depression, osteoarthritis, and cholestasis. Such trials would need to enroll large numbers of patients with homogeneous diagnoses, and focus on significant clinical outcomes. Ideally, they would compare SAMe to both placebo and standard care. Information on side effects and adverse events should be systematically collected in these trials.

For liver conditions other than cholestasis, additional smaller trials should be conducted to ascertain which patient populations would benefit most from SAMe, and what interventions (dose and route of administration) are most effective. Additional smaller clinical trials of an exploratory nature should be conducted to investigate uses of SAMe to decrease the latency of effectiveness of conventional antidepressants and to treat of postpartum depression.

Availability of the Full Report

The full evidence report from which this summary was derived was prepared for AHRQ by the Southern California Evidence-Based Practice Center (EPC) under contract number 290-97-0001. Printed copies may be obtained free of charge from the AHRQ Publications Clearinghouse by calling 1-800-358-9295. Requesters should ask for Evidence Report/Technology Assessment No. 64, S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease.

The Evidence Report is also online on the National Library of Medicine Bookshelf.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

My mother used to love strawberry malts. It was a thrill for me to drop in to see her and surprise her with her favorite refreshment.

In her later years, both my mom and dad lived in a life-care retirement center. Partially due to the stress of my mom's Alzheimer's condition, my dad became ill and was unable to care for her anymore. They lived in separate rooms, yet were together as much as they could be. They loved each other so much. Hand-in-hand, those silver-haired lovers would stroll the halls, visiting their friends; passing out love. They were the 'romantics' of the retirement center.

When I realized that her condition was worsening, I wrote her a letter of acknowledgment. I told her how much I loved her. I apologized for my orneriness when I was growing up. I told her that she was a great mother and I was proud to be her son. I told her things I had wanted to say for a long time and had been too stubborn to say until I realized she may or may not be in a position to comprehend the love behind the words. It was a detailed letter of love and of completion. My dad told me that she often would spend many hours reading and re-reading that letter.

It saddened me to know that my mom no longer knew I was her son. She would often ask, "Now, what was your name?" and I would proudly reply that my name was Larry and I was her son. She would smile and reach for my hand. I wish I could once again experience that special touch.

On one of my visits, I stopped by the local malt shop and bought her and my father a strawberry malt. I stopped by her room first, re-introduced myself to her, chatted for a few minutes and took the other strawberry malt to my dad's room.

By the time I returned, she had almost finished the malt. She had laid down on the bed for a rest. She was awake. We both smiled when she saw me come into the room.

Without a word, I pulled a chair close to the bed and reached over to hold her hand. It was a Divine connection. I silently affirmed thoughts about my love for her. In the quiet I could feel the magic of our unconditional love even though I knew she was quite unaware of who was holding her hand. Or was she holding my hand?

After about 10 minutes, I felt her give my hand a tender squeeze. . . three squeezes. They were brief and instantly I knew what she was saying without having to hear any words.

continue story below

The miracle of unconditional love is nurtured by the power of the Divine and our own imagination.

I couldn't believe it! Even though she could no longer express her innermost thoughts like she used to, no words were necessary. It was as though she came back for a brief moment!

Many years ago when my father and she were dating, she had invented this very special way of telling my dad, "I love you!" while they were sitting in church. He would softly give her hand two squeezes to say, "Me too!"

I gave her hand two soft squeezes. She turned her head and gave me a loving smile I shall never forget. Her countenance radiated love.

I remembered her expressions of unconditional love for my father, our family, and her countless friends. Her love continues to profoundly influence my life.

Another eight to ten minutes went by. No words were spoken.

Suddenly she turned to me and quietly spoke these words. "It's important to have someone who loves you."

I wept. They were tears of joy. I gave her a warm and tender hug, told her how very much I loved her and left.

My mother passed away shortly after that.

Very few words were spoken that day; those she spoke were words of gold. I will always treasure those special moments.

next: Is Your Relationship Stranded at Malfunction Junction?

• Watch the video on Narcissism, Idealization and Devaluation

Question:

What is the mechanism behind the cycles of over-valuation and devaluation in the narcissist's life?

Answer:

Cycles of over-valuation (idealisation) followed by devaluation characterise many personality disorders (they are even more typical of Borderline PD than of NPD, for example). They reflect the need to be secure, protected against the vicious and capricious whims of others, shielded from the hurt that they can inflict. Such protection is constructed from the mercurial twin substances of idealisation and disillusionment.

The ultimate and only emotional need of the narcissist is to be the subject of attention and, thus, to support his volatile self-esteem. In this very important sense, the narcissist is dependent on others for the performance of critical Ego functions. While to healthier people, a disappointment or a disillusionment are nothing but these - to the narcissist they are the difference between Being and Nothingness.

The quality and reliability of Narcissistic Supply are, therefore, of paramount importance. The more the narcissist convinces himself that his sources are perfect, grand, comprehensive, authoritative, omniscient, omnipotent, beautiful, powerful, rich and so on - the better he feels. The narcissist has to idealise his Supply Sources in order to value the supply that he derives from them. This leads to over-valuation and results in the formation of an unrealistic picture of others.

The fall is inevitable. Disillusionment and disappointment ensue. The slightest criticism, disagreement, shades of opinion - are interpreted by the narcissist as an all out assault against his very existence. The previous appraisal is sharply reversed. For example: the same people are judged stupid who were previously deemed to possess genius.

This is the devaluation part of the cycle - and it is very painful both to the narcissist and to the devalued (for very different reasons, of course). The narcissist mourns the loss of a promising "investment opportunity" (=Source of Narcissistic Supply). Conversely, the "investment opportunity" mourns the loss of the narcissist.

But what is the mechanism BEHIND the mechanism? What drives the narcissist to such extremes? Why was no better (more efficient) coping technique developed by narcissists hitherto?

The answer is that the over-valuation-devaluation mechanism IS the most efficient one available. To understand why, one needs to take stock of the narcissist's energy, or, rather, of the lack of it.

The narcissist's personality is a precariously balanced affair and it requires inordinate amounts of energy to maintain and to sustain. So overwhelmingly dependent on the environment for mental sustenance, the narcissist must optimise (rather, maximise) the use of the scarce resources at his disposal.

Not one iota of effort, time and emotion must be wasted lest the narcissist finds his emotional balance severely upset. The narcissist attains this goal by sudden and violent shifts between foci of attention. This is a highly efficacious mechanism of allocation of resources in constant pursuit of the highest available emotional yields.

After emitting a narcissistic signal (see The Narcissistic Mini-Cycle), the narcissist receives a host of narcissistic stimuli. The latter are, simply, messages from people who are willing to provide then narcissist with Narcissistic Supply. But mere readiness is not sufficient.

The narcissist now faces the daunting task of evaluating the potential content, quality, and extent of Narcissistic Supply each and every one of the potential collaborators has to offer. He does so by rating each one of them. The stimulus with the highest rating is, naturally, selected. It represents "the best value for money", the most cost/reward efficient proposition.

The narcissist immediately over-values and idealises this source. It is the narcissistic equivalent of getting emotionally involved. The narcissist "bonds" with the new source. The narcissist feels attracted, interested, curious, magically rewarded, reawakened. Healthier people recognise this phenomenon: it is called infatuation.

To remove doubt: the Source of Narcissistic Supply thus chosen need not be human. The narcissist is equally interested in inanimate objects (for example: as status symbols), in groups of people (the nation, the Church, the army, the police), and even in the abstract ("history", "destiny", "mission").

A process of courting then commences. The narcissist knows how to charm, how to simulate emotions, how to flatter. Many narcissists are gifted actors, having acted the role of their False Self for so long. They wine the targeted Supply Source (whether primary or secondary) and dine it. They compliment and sweet-talk, intensely present, deeply interested.

Their genuine and keen (though selfish) immersion in the other, their overt high regard for him or her (a result of idealisation), their almost submissiveness - are alluring. It is nigh impossible to resist a narcissist on the prowl for Sources of Supply. At this stage, his energies are all focused and dedicated to the task.

During this phase of narcissistic courting or narcissistic pursuit, the narcissist is full of vitality, of dreams and hopes and plans and vision. And his energy is not dissipated: he resembles a laser beam. He attempts (and in many cases, succeeds to achieve) the impossible. If he targeted a publishing house, or a magazine, as his future Source of Supply (by publishing his work) - he produces incredible amounts of material in a short period of time.

If it is a potential mate, he floods her with attention, gifts and inventive gestures. If it is a group of people that he wishes to impress, he identifies with their goals and beliefs to the point of ridicule and discomfort. The narcissist has the frightening capacity to turn himself into a weapon: focused, powerful, and lethal.

He lavishes all his energies, capabilities, talents, charms and emotions on the newly selected Source of Supply. This has a great effect on the intended source and on the narcissist. This also serves to maximise the narcissist's returns in the short run.

Once the Source of Supply is captured, preyed upon and depleted, the reverse process (of devaluation) sets in. The narcissist instantaneously (and startlingly abruptly) loses all interest in his former (and now useless or judged to be so) Source of Narcissistic Supply. He dumps and discards it.

He becomes bored, lazy, slow, devoid of energy, absolutely uninterested. He conserves his energies in preparation for the attack on, and the siege of, the next selected Source of Supply. These tectonic shifts are hard to contemplate, still harder to believe.

The narcissist has no genuine interests, loves, or hobbies. He likes that which yields the most Narcissistic Supply. A narcissist can be a gifted artist for as long as his art rewards him with fame and adulation. Once public interest wanes, or once criticism mounts, the narcissist, in a typical act of cognitive dissonance, immediately ceases to create, loses interest in art, and does not miss his old vocation for a second. He is likely to turn around and criticize his erstwhile career even as he pursues another, totally unrelated one.

The narcissist has no genuine emotions. He can be madly in "love" with a woman (Secondary Narcissistic Supply Source) because she is famous, or wealthy, or a native and can help him obtain legal residence through marriage, or because she comes from the right family, or because she is unique in a manner positively reflecting on the narcissist's perceived uniqueness, or because she had witnessed past successes of the narcissist, or merely because she admires him.

Yet, this "love" dissipates immediately when her usefulness runs its course or when a better "qualified" Source of Supply presents herself.

The over-valuation and devaluation cycles are mere reflections and derivatives of these ups and downs of the narcissist's pools of energy and flows of supply. Efficient (that is, abrupt) energy shifts are more typical of automata than of human beings. But then the narcissist likes to brag of his inhumanity and machine-like qualities.

next: Narcissistic Immunity

• Watch the video on Narcissistic Cycles

Question:

I know a narcissist intimately. Sometimes he is hyperactive, full of ideas, optimism, plans. At other times, he is hypoactive, almost zombie-like.

Answer:

You are witnessing the narcissistic signal-stimulus-hibernation mini-cycle. Narcissists go through euphoric and dysphoric cycles. These are long cycles. They are dilated, all encompassing, all consuming and all-pervasive. They are different from manic-depressive cycles (in the Bipolar Disorder) in that they are reactive, caused by easily identifiable external events or circumstances.

For instance: the narcissist reacts with dysphoria and anhedonia when he loses his Pathological Narcissistic Space, or in a major life crises (financial problems, divorce, imprisonment, loss of social status and peer appreciation, death in the family, crippling illness, etc.).

But the narcissist also goes through much shorter and much weaker cycles. He experiences brief periods of mania. Then he can be entertaining, charming, and charismatic. Then he is "full of ideas and plans", attractive and leader-like. In the manic phase, he is restless (often insomniac), full of pent up energy, explosive, dramatic, creative, an excellent performer and manager.

Suddenly, and often for no apparent reason, he becomes subdued, depressed, devoid of energy, pessimistic, and "zombie-like". He oversleeps, his eating patterns change, he is slow and pays no attention to his external appearance or to the impression that he leaves on others.

The contrast is very sharp and striking. While in the manic phase, the narcissist is talkative and gregarious. In the depressive phase he is passively-aggressively silent and schizoid. He vacillates between being imaginative and being dull, being social and being antisocial, being obsessed with time management and achievement and lying in bed for hours, being a leader and being led.

These mini-cycles, though outwardly manic-depressive (or cyclothymic) - are not. They are the result of subtle fluctuations in the volatile flow of Narcissistic Supply.

The narcissist is addicted to Narcissistic Supply: admiration, adoration, approval, attention and so on. All his activities, thoughts, plans, aspirations, inspiration, and daydreams - in short, all the aspects of his life - are dedicated to regulating the flow of such supply and to rendering it relatively stable and predictable.

The narcissist even resorts to Secondary Narcissistic Supply Sources (a spouse, his colleagues, or his business - SNSS) in order to "accumulate" a reserve of past Narcissistic Supply for times of short supply. The SNSS do this by witnessing the narcissist's accomplishments and moments of grandeur and recounting what they saw when he is down and low. Thus, the SNSS smooth and regulate the vicissitudes of the supply emanating from the Primary Narcissistic Supply Sources (PNSS).

But the very process of obtaining and securing Narcissistic Supply, in the first place, is complex and multi-phased.

First there is a depressive phase. To obtain Narcissistic Supply, the narcissist has to toil. He has to work hard to create Sources of Supply (PNSS, SNSS) and to maintain them. These are demanding tasks. They are often very tiring. Exhaustion plays a major role in the mini-cycles. His energy depleted, his creativity at its end, his resources stretched to the maximum, the narcissist reposes, "plays dead", withdraws from life. This is the phase of "narcissistic hibernation".

The narcissist invariably goes into narcissistic hibernation before the emission of a narcissistic signal (see below). He does so in order to gather the energies that he knows are going to be needed in the later phases. During his hibernation, he surveys the terrain, in an effort to determine the richest and most rewarding sources, veins and venues of Narcissistic Supply. He contemplates the possible structures of various signals, in order to ensure that the most effective one is emitted.

Building up his energy reserves during the hibernation phase is crucial. The narcissist knows that even the manic phase of the mini-cycle, following the receipt of the narcissistic stimulus (see below) is taxing and laborious.

Having thus reposed, the narcissist is ready to go. He jumps start the cycle by emitting a "narcissistic signal". It is a message - written, verbal, or behavioural - intended to foster the generation of Narcissistic Supply. The narcissist may send letters to magazines, offering to write for them (for free, if need be). He may dress, behave, or make statements intended to elicit admiration or opprobrium (in short, attention). He may consistently and continuously describe himself in glamorous and flattering terms (or, conversely, fish for compliments by berating himself and his achievements).

Anything goes in order to become well known and to impress people.

Narcissistic signals are automatically triggered and emitted whenever an important element changes in a narcissist's life: his workplace, his domicile, his position, or his spouse. They are intended to re-establish the equilibrium between the uncertainty which inevitably follows such changes and the narcissist's inner turmoil which is the result of the disruption of the patterns and flows of Narcissistic Supply caused by said changes.

Ideally, the narcissistic signal elicits a "narcissistic stimulus". This is a positive sign or response from the recipients of the signal indicating their willingness to swallow the narcissist's bait and to provide him with Narcissistic Supply. Such a stimulus brings the narcissist back to life. It energises him. Once more, he becomes a fountain of ideas, plans, schedules, visions and dreams.

The narcissistic stimulus pushes the narcissist into the manic phase of the mini-cycle.

Thus, caught between mini-cycles of mania and depression and bigger cycles of euphoria and dysphoria - the narcissist leads his tumultuous life. It is no wonder that he gradually evolves into a paranoid. It is easy to feel persecuted and at the mercy of forces mysterious, capricious and powerful when this, indeed, is the case.

next: Narcissistic Allocation

Question:

Is narcissism "contagious"? Can one "catch" narcissism by being in the presence of a narcissist?

Answer:

The psychiatric profession uses the word: "epidemiology" when it describes the prevalence of psychopathologies. There is some merit in examining the incidence of personality disorders in the general population. Some of them might be genetically induced. Most of them are, probably, influenced by the cultural context of the society in which they occur. But are personality disorders communicable diseases?

The answer is more complex than a simple "yes" or "no". Personality disorders are not contagious in the restricted, rigorous, medical sense. They are not communicated by pathogens from one individual to another. They lack many of the basic features of physical-biological epidemics. Still, they are communicated.

First, there is the direct, interpersonal, influence.

A casual encounter with a narcissist is likely to leave a bad aftertaste, bewilderment, hurt, or anger. But these transient reactions have no lasting effect and they fade with time. Not so with more prolonged interactions: marriage, partnership, co-existence, cohabitation, working or studying together and the like.

Narcissism brushes off. Our reactions to the narcissist, the initial ridicule, the occasional rage, or the frustration - tend to accumulate and form the sediment of deformity. Gradually, the narcissist distorts the personalities of those he is in constant touch with, casts them in his defective mould, limits them, redirects them, and inhibits them. When sufficiently cloned, the narcissist uses the effected personalities as narcissistic proxies, narcissistic vehicles of vicarious narcissism.

The narcissist provokes in us emotions, which are predominantly negative and unpleasant. The initial reaction, as we said, is likely to be ridicule. The narcissist, pompous, incredibly self-centred, falsely grandiose, spoiled and strange (even his manner of speech is likely to be constrained and archaic) - often elicits smirks in lieu of admiration.

But the entertainment value is fast eroded. The narcissist's behaviour becomes tiresome, irksome and cumbersome. Ridicule is supplanted by ire and, then, by anger and by rage. The narcissist's inadequacies are so glaring and his denial and other defence mechanisms so primitive - that we feel like constantly screaming at him, berating, debasing and reproaching him, even to the point of striking at him literally as well as figuratively.

Ashamed at these reactions, we begin to also feel guilty. We find ourselves attached to a mental pendulum, swinging between repulsion and guilt, rage and pity, lack of empathy and remorse. Slowly we acquire the very characteristics of the narcissist that we so deplore. We become as tactless as he is, as devoid of empathy and of consideration, as ignorant of the emotional composition of other people, as one track minded. Bathed in the sick halo of the narcissist - we are "blessed".

The narcissist invades our personality. He makes us react the way he would have liked to, had he dared, or had he known how (a mechanism known as "projective identification"). We are exhausted by his eccentricity, by his extravagance, by his grandiosity, by his constant claims.

The narcissist incessantly, adamantly, even aggressively makes demands upon his environment. He is addicted to his Narcissistic Supply: admiration, adoration, approval, attention. He feels entitled. He forces others to lie to him and over-rate his achievements, his talents, his merits. Living in a narcissistic fantasyland, he imposes on his nearest or dearest to join him there, however incommensurate the exercise, either with their personality, or with reality.

The resulting exhaustion, desperation and weakening of the will - are fully taken advantage of by the narcissist. Through these reduced defences he penetrates, and, like a Trojan horse, spews forth his lethal charge. Imitation and emulation of his personality traits by his surroundings are but two of the weapons in his never dwindling, always creative, arsenal. But he does not recoil from using fear and intimidation.

He coerces people around him by making subtle uses of processes such as reinforcement and conditioning. Seeking to avoid the unpleasant consequences of not succumbing to his wishes - people would rather comply with his demands and be subjected to his whims. Not to confront his rages - they "cut corners", pretend, participate in his charade, lie, and become subsumed in his grandiose fantasies.

Rather than be aggressively nagged, they reduce themselves, minimise their personalities, and place themselves in the shadow cast by the narcissist, however small. By doing all this - they delude themselves that they have escaped the worst consequences.

But the worst is yet to come. The narcissist is confined, constrained, restrained and inhibited by the unique structures of his personality and of his disorder. There are many behaviours which he cannot engage in, many reactions and actions "prohibited", many desires stifled, many fears inhibiting.

The narcissist uses others as an outlet to all these repressed emotions and behaviour patterns. Having invaded their personalities, having altered them by methods of attrition and erosion, having made them compatible with his own disorder, having secured the submission of his victims - he moves on to occupy their shells. Then he makes them do what he always dreamt of doing, what he often desired, what he constantly feared to do.

Using the same compelling methods, he drives his mates, spouse, partners, colleagues, children, or co-workers - into collaborating in the expression of the repressed side of his personality. At the same time, he negates the vague sensation that their personality has been substituted by his when committing these acts.

The narcissist can, thus, derive, vicariously, through the lives of others, the Narcissistic Supply that he so needs. He induces in them criminal, romantic, heroic, impulses. He navigates them to forbidden realms of the intellect. He makes them travel far, travel fast, breach all norms, gamble against all odds, fear not - in short: be what he could never be.

And he thrives on the attention, admiration, fascination, or horrified reactions lavished upon his proxies. He consumes the Narcissistic Supply flowing through the human conduits of his own making. Such a narcissist is likely to use sentences like "I made him", "He was nothing before he met me", "He is my creation", "She learned everything she knows from me and at my expense", and so on.

Sufficiently detached - both emotionally and legally - the narcissist flees the scene when the going gets tough. Often, these behaviours, acts and emotions induced by the proximity to the narcissist - bring about harsh consequences. An emotional crisis can be as calamitous as a physical or material catastrophe.

The narcissist's prey is not equipped to deal with the crises that are the narcissist's daily bread and which, now, he or she are forced to confront as the narcissist's proxy. The behaviour and emotions induced by the narcissist are alien and a cognitive dissonance usually ensues. This only aggravates the situation. But the narcissist is rarely there to watch his invaded victims writhe and suffer.

At the first sign of trouble, he flees and disappears. This act of vanishing need not be physical or geographical. The narcissist is better at disappearing emotionally and at evading his legal obligations (despite constant righteous moralising). It is then and there that the people who surround the narcissist discover his true colours: he uses and discards people in an absentminded manner. To him, people are either "functional" and "useful" in his pursuit of Narcissistic Supply - or not human at all, dimensionless cartoons. Of all the hurts that the narcissist can inflict - this, probably, is the strongest and most enduring one.

When Victims Become Narcissists

Some people adopt the role of a professional victim. In doing so, they become self-centred, devoid of empathy and, abusive and exploitative. In other words, they become narcissists. The role of "professional victims" - ones whose existence and very identity is defined solely and entirely by their victimhood - is well researched in victimology. It doesn't make for a nice reading.

These victim "pros" are often more cruel, vengeful, vitriolic, lacking in compassion and violent than their abusers. They make a career of it. They identify with this role to the exclusion of all else. It is a danger to be avoided. And this is precisely what I called "Narcissistic Contagion" or "Narcissism by Proxy".

These affected entertain the (false) belief they can compartmentalize their narcissistic behavior and direct it only at the narcissist. In other words, they trust in their ability to segregate their behavior patterns: verbally abusive towards the narcissist - civil with others, act with malice where the narcissist is concerned - and with Christian charity towards all others.

They cling to the "faucet theory". They believe that they can turn on and off their negative feelings, their abusive outbursts, their vindictiveness and vengefulness, their blind rage, their non-discriminating judgment. This, of course, is untrue. These behaviors spill over, into daily transactions with innocent others.

One cannot be partly or temporarily vindictive and judgmental any more than one can be partly or temporarily pregnant. To their horror, these victims discover that they have been transmuted and transformed into their worst nightmare: into a narcissist.

Narcissism is contagious and that many victims tend to become narcissists themselves: malevolent, vicious, lacking empathy, egotistical, exploitative, violent and abusive.

next: Narcissistic Signal, Stimulus, and Hibernation Mini-Cycles

Self-Therapy For People Who ENJOY Learning About Themselves

Relationships

SEX OR CUDDLING?

Which is most important, sex or cuddling? If that's the choice, it's cuddling.

But really it is touch - in all its forms - that makes or breaks relationships.

WANTING A NEW PARTNER

In order to find a new partner you must first be certain that you are available!

Many people complain long and loud about how hard it is to find a partner but will admit that they are not absolutely sure ("down deep") that they even want one.

When they finally get to the point that they are sure, they usually find a new partner within months.

So do whatever it takes to make up your mind about this extremely important question.

GUILT OR RESPONSIBILITY

"You hurt my feelings" aims to arouse guilt and leads to more hurt feelings especially for the accuser.

"I'm angry about what you did" aims to assign responsibility and leads to real problem solving for both people.

COMPETITION VS. COOPERATION

"I want to go bowling," says one.
"I want to watch TV," says the other.

In most relationships the communication stops there and both people try to "win" while trying to make the other person "lose."

These are called competitive relationships. They are based on the all-American ideal of winning and losing!

In a healthy relationship it goes like this:
"I want to go bowling."
"I want to watch TV."
"How can we both get what we want tonight?"

These are cooperative relationships. Both people win and nobody loses. (But it might be un-American!)

DO WE NEED A PRIMARY RELATIONSHIP?

It is definitely possible to be happy without a primary, sexual relationship. It just isn't easy.

It takes an immense amount of hard work to get enough attention and love from friends alone.

WHO'S PROBLEM IS IT?

"I feel sad and blue today and I don't know why...." This is a manipulative statement (except in therapy). It begs your partner to help you to solve your problem.

And, since the partner can't possibly know you as well as you know yourself, it usually leads to an argument and mutual feelings of being misunderstood.

"I feel sad and blue today and I don't know why, but I'm working on it...." This is an intimate statement which can bring people together. The responsibility for solving the problem remains where it belongs, on the person who is feeling bad. And your partner can feel free to be supportive and loving without feeling responsible for your problem.

SEX ROLE BIGOTRY

When someone says something about "men" or "women" during a disagreement, they would accomplish more if they'd just stop the discussion completely and focus on their own childhood beliefs.

Our bigoted ideas of men and women are well established by age ten.

Our general beliefs about each sex are irrelevant to any discussion of real-life problems we are having today with this particular man or this particular woman.

HEALTHY ARGUING

If you really want to have a clear, productive argument insist that you and your partner "stick to the video camera"!

This means, talk about what you want and don't want from each other in such a clear way that a video camera would be able to "see" what you are talking about.

EXAMPLE:
Instead of saying "You don't love me" or "I want you to love me" tell your partner the actual behaviors you want to see more of from them.

Don't ask to be "loved" (which is too general) when you can ask for a warm hug with a smile
(which will help you to get the feeling of love that you want).

HAPPINESS FROM A RELATIONSHIP

The most important relationship in your life is the one you have with yourself!

Happiness comes from treating yourself well, not from finding someone else to do it for you.

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Couples Relationships Index

Thoughtful quotes about pleasure, giving pleasure and receiving pleasure.

Words of Wisdom

"Did you know that both the Koran, the sacred book of Islam, and the Jewish Talmud teach that we will be called to account for every permissible pleasure life offered us but which we refused to enjoy while on earth?" (Sara Ban Breathnach)

"That man is the richest whose pleasures are the cheapest." (Thoreau)

"Most men that do thrive in the world do forget to take pleasure during the time that they are getting their estate, but reserve it till they have got one, and then it is too late for them to enjoy it." (Samuel Pepys)

"There are few pleasures in the world so reasonable and so cheap as the pleasure of giving pleasure." (anonymous

"All animals, except man, know that the principle business of life is to enjoy it." (Samuel Butler)

"There is only one question: how to love this world." (Mary Oliver)

next:Priorities