Question:

Am I to blame for my husband's/child's/parent's mental state and behaviour? Is there anything that I can or should do to help him/reach him?

Answer:

Self-flagellation is a characteristic of those who choose to live with a narcissist (and a choice it is). Constant guilt feelings, self-reproach, self-recrimination and, thus - self-punishment typify the relationships formed between the sadist-narcissist and the masochistic-dependent mate or partner.

The narcissist is sadistic because he was forced into expressing his own guilt and self-reproach in this manner. It is his Superego, which is unpredictable, capricious, arbitrary, judgemental, cruel, and self-annihilating (suicidal). Externalising these internal traits is a way of alleviating internal conflicts and fears generated by this inner turmoil. The narcissist projects his civil war and drags everyone around him into a swirl of bitterness, suspiciousness, meanness, aggression and pettiness. His life is a reflection of his psychological landscape: barren, paranoiac, tormented, guilt ridden. He feels compelled to do unto others what he perpetrates unto himself. He gradually transforms all around him into replicas of his conflictive, punishing personality structures.

Some narcissists are more subtle than others. They disguise their sadism. For instance, they "educate" their nearest and dearest (for their sake, as they present it). This "education" is compulsive, obsessive, incessantly, harshly and unduly critical. Its effect is to erode the subject, to humiliate, to create dependence, to intimidate, to restrain, to control, to paralyse. The victim internalises the endless preaching and criticism and makes them his own. She begins to see justice where there is only twisted logic based on crooked assumptions. She begins to self-punish, to withhold, to request approval prior to any action, to forgo her preferences and priorities, to erase her own identity - hoping to thus avoid the excruciating pains of the narcissist's destructive analyses.

Other narcissists are less sophisticated and they use all manner of abuse to domesticate their kin and partners in life. This spans physical violence, verbal violence (during intensive rage attacks), psychological abuse, brutal "honesty", sick or offending humour, and so on.

But both categories of narcissists employ very simple deceptive mechanisms to achieve their goals. One thing must be made clear: this is not a well thought out, previously planned campaign by the average narcissist. His behaviour is dictated by forces that he cannot master. Most of the time he is not even conscious of why he is doing what he is doing. When he is - he can't tell the outcomes. Even when he can - he feels powerless to behave otherwise. The narcissist is a pawn in the chess game played between the structures of his fragmented, fluid personality. So, in a classical - juridical sense, the narcissist is not to blame, he is not fully responsible or aware of what he is doing to others.

This seems to contradict my answer to FAQ 13 where I write:

"The narcissist knows to tell right from wrong. He is perfectly capable of anticipating the results of his actions and their influence on his human environment. The narcissist is very perceptive and sensitive to the subtlest nuances. He has to be: the very integrity of his personality depends upon input from others... A person suffering from NPD must be subjected to the same moral treatment and judgement as the rest of us, the less privileged, are. The courts do not recognise NPD to be a mitigating circumstance - why should we?"

But, the contradiction is only apparent. The narcissist is perfectly capable of both distinguishing right from wrong - and of foreseeing the outcomes of his actions. In this sense, the narcissist should be held liable for his misdeeds and exploits. If he so chooses, the narcissist can fight his compulsive inclination to behave the way he does.

This would come at a great personal psychological price, though. Avoidance or suppression of a compulsive act result in increased anxiety. The narcissist prefers his own well-being to that of others. Even when confronted with the great misery that he fosters, he hardly feels responsible (for instance, he rarely attends psychotherapy).

To put it more plainly, the (average) narcissist is unable to answer the question: "Why did you do what you did?" or "Why did you choose this mode of action over others available to you under the same circumstances?" These decisions are taken unconsciously.

But once the course of action is (unconsciously) chosen, the narcissist has a perfect grasp of what he is doing, whether it is right or wrong and what will be the price others are likely to pay for his actions and choices. And he can then decide to reverse course (for instance, to refrain from doing anything). On the one hand, therefore, the narcissist is not to blame - on the other hand, he is very guilty.

The narcissist deliberately confuses responsibility with guilt. The concepts are so close that the distinctions often get blurred. By provoking guilt in responsibility-laden situations, the narcissist transforms life with him into a constant trial. Actually, the continuous trial itself is the punishment.

Failures, for instance, induce guilt. The narcissist always labels someone else's efforts as "failures" and then proceeds to shift the responsibility for said failures to his victim so as to maximise the opportunity to chastise and castigate her.

The logic is two-phased. First, every responsibility imputed to the victim is bound to lead to failure, which, in turn, induces in the victim guilt feelings, self-recrimination and self-punishment. Secondly, more and more responsibilities are shifted away from the narcissist and onto his mate - so that, as time goes by, an asymmetry of failures is established. Burdened with less and less responsibilities and tasks - the narcissist fails less. It preserves the narcissist's sense of superiority, on the one hand - and legitimises his sadistic attacks on his victim, on the other hand.

The narcissist's partner is is often a willing participant in this shared psychosis. Such folie a deux can never take place without the full collaboration of a voluntarily subordinated victim. Such partners have a wish to be punished, to be eroded through constant, biting criticisms, unfavourable comparisons, veiled and not so veiled threats, acting out, betrayals and humiliations. It makes them feel cleansed, "holy", whole, and sacrificial.

Many of these partners, when they realise their situation (it is very difficult to discern it from the inside) - abandon the narcissist and dismantle the relationship. Others prefer to believe in the healing power of love or some such other nonsense. It is nonsense not because love has no therapeutic power - it is by far the most powerful weapon in the healing arsenal. It is nonsense because it is wasted on a human shell, incapable of feeling anything but negative emotions, which vaguely filter through his dreamlike existence. The narcissist is unable to love, his emotional apparatus ruined by years of deprivation, abuse, misuse and disuse.

Granted, the narcissist is a consummate manipulator of human emotions and their attendant behaviours. He is convincing, he is deviously successful and sweeps everyone around him into the turbulent delusion which he consists of. He uses anything and anyone to secure his dose of Narcissistic Supply and discards, without hesitation those he deems "useless".

The narcissist-victim dyad is a conspiracy, a collusion of victim and mental tormentor, a collaboration of two needy people who find solace and supply in each other's deviations. Only by breaking loose, by aborting the game, by ignoring the rules - can the victim be transformed (and by the way, acquire the newly found appreciation of the narcissist).

The narcissist also stands to benefit from such a move. But both the narcissist and his partner do not really think about each other. Gripped in the arms of an all-consuming dance macabre, they follow the motions morbidly, semiconscious, desensitised, exhausted, concerned only with survival. Living with a narcissist is very much like being in a maximum security prison.

The narcissist's partner should not feel guilty or responsible and should not seek to change what only time (not even therapy) and (difficult) circumstances may change. She should not strive to please and to appease, to be and not to be, to barely survive as a superposition of pain and fear. Releasing herself from the chains of guilt and from the throes of a debilitating relationship is the best help that a loving mate can provide to her ailing narcissistic partner.

next: The Narcissist and His Family

The narcissistic condition emanates from a seismic breach of trust, a tectonic shift of what should have been a healthy relationship between the narcissist and his Primary Objects (parents or caregivers). Some of these bad feelings are the result of deeply entrenched misunderstandings regarding the nature of trust and the continuous act of trusting.

For millions of years nature embedded in us the notion that the past can teach us a lot about the future. This is very useful for survival. And it is also mostly true with inanimate objects. With humans the story is less straightforward: it is reasonable to project someone's future behaviour from his past conduct (even though this proves erroneous some of the time).

But it is mistaken to project someone's behaviour onto other people's. Actually, psychotherapy amounts to an attempt to disentangle past from present, to teach the patient that the past is no more and has no reign over him, unless the patient lets it.

Our natural tendency is to trust, because we trust our parents. It feels good to really trust. It is also an essential component of love and an important test thereof. Love without trust is dependence masquerading as love.

We must trust, it is almost biological. Most of the time, we do trust. We trust the universe to behave according to the laws of physics, soldiers not to go mad and shoot at us, our nearest and dearest not to betray us. When trust is broken, we feel as though a part of us dies, is hollowed out.

Not to trust is abnormal and is the outcome of bitter or even traumatic life experiences. Mistrust or distrust are induced not by our own thoughts, nor by some device or machination of ours but by life's sad circumstances. To continue not to trust is to reward the people who wronged us and made us distrustful in the first place. Those people have long abandoned us and yet they still have a great, malignant, influence on our lives. This is the irony of the lack of trust.

So, some of us prefer not to experience this sinking feeling of trust violated. They choose not to trust and not to be disappointed. This is both a fallacy and a folly. Trusting releases enormous amounts of mental energy, which is better invested elsewhere. But trust like knives can be dangerous to your health if used improperly.

You have to know WHO to trust, you have to learn HOW to trust and you have to know HOW to CONFIRM the existence of mutual, functional trust.

People often disappoint and are not worthy of trust. Some people act arbitrarily, treacherously and viciously, or, worse, offhandedly. You have to select the targets of your trust carefully. He who has the most common interests with you, who is invested in you for the long haul, who is incapable of breaching trust ("a good person"), who doesn't have much to gain from betraying you is not likely to mislead you. These people you can trust.

You should not trust indiscriminately. No one is completely trustworthy in all fields. Most often our disappointments stem from our inability to separate one area of life from another. A person could be sexually loyal but utterly dangerous when it comes to money (for instance, a gambler). Or a good, reliable father but a womaniser.

You can trust someone to carry out some types of activities but not others, because they are more complicated, more boring, or do not conform to his values. We should not trust with reservations - this is the kind of "trust" that is common in business and among criminals and its source is rational. Game Theory in mathematics deals with questions of calculated trust. We should trust wholeheartedly but know who to entrust with what. Then we will be rarely disappointed.

As opposed to popular opinion, trust must be put to the test, lest it goes stale and staid. We are all somewhat paranoid. The world around us is so complex, so inexplicable, so overwhelming - that we find refuge in the invention of superior forces. Some forces are benign (God) - some arbitrarily conspiratorial in nature. There must be an explanation, we feel, to all these amazing coincidences, to our existence, to events around us.

This tendency to introduce external powers and ulterior motives into our reality permeates human relations, as well. We gradually grow suspicious, inadvertently hunt for clues of infidelity or worse, masochistically relieved, even happy when we find some.

The more often we successfully test the trust we had established, the stronger our pattern-prone brain embraces it. Constantly in a precarious balance, our brain needs and devours reinforcements. Such testing should not be explicit but circumstantial.

Your husband could easily have had a mistress or your partner could easily have stolen your money - and, behold, they haven't. They passed the test. They resisted the temptation offered to them by circumtance.

Trust is based on the ability to predict the future. It is not so much the act of betrayal that we react to - as it is the feeling that the very foundations of our world are crumbling, that it is no longer safe because it is no longer predictable. We are in the throes of death of one theory - and the birth of another, as yet untested.

Here is another important lesson: whatever the act of betrayal (with the exception of grave criminal corporeal acts) - it is frequently limited, confined, and negligible. Naturally, we tend to exaggerate the importance of the event. This serves a double purpose: indirectly it aggrandises us. If we are "worthy" of such an unprecedented, unheard of, major betrayal - we must be worthwhile and unique. The magnitude of the betrayal reflects on us and re-establishes the fragile balance of powers between us and the universe.

The second purpose of exaggerating the act of perfidy is simply to gain sympathy and empathy - mainly from ourselves, but also from others. Catastrophes are a dozen a dime and in today's world it is difficult to provoke anyone to regard your personal disaster as anything exceptional.

Amplifying the event has, therefore, some very utilitarian purposes. But, finally, the emotional lie poisons the mental circulation of the liar. Putting the event in perspective goes a long way towards the commencement of a healing process. No betrayal stamps the world irreversibly or eliminates other possibilities, opportunities, chances and people. Time goes by, people meet and part, lovers quarrel and make love, dear ones live and die. It is the very essence of time that it reduces us all to the finest dust. Our only weapon - however crude and naive - against this unstoppable process is to trust each other.

next: Narcissism and Other People's Gift

Thoughtful quotes about faith and having faith in yourself.

Words of Wisdom

"Faith is, above all, open-ness - an act of trust in the unknown." (Alan Watts)

"Faith is to believe what you do not yet see; the reward for this faith is to see what you believe." (Saint Augustine)

"If you want faith, you have to work for it." (Flannery O'Connor)

"Human misery is too great for men to do without faith." (author unknown)

"To have faith requires courage, the ability to take a risk, the readiness to accept pain and disappointment." (Erich Fromm)

next:Giving

Depression and Spiritual Growth

E. LOVE and MAJOR DEPRESSION

"Love" is a topic that may well have the largest single literature in the history of mankind. And yet few people actually have an understanding of love; that may partly be because the term is used in so many different ways and with so many different meanings. One of the first things that one learns about love is that it is a gift. It cannot be earned, or bought; both of those strategies lead to failure and disappointment. I know that for a fact, because as a child I tried, ever so hard, to earn my parents' love by being a "good boy" and an outstanding student. It did no good whatsoever. And no one is owed love (the only exception being that responsible parents do owe love to their children). In the case of romantic love, one cannot seek it and hope to find it; usually one meets ones beloved by pure accident. Yet love has the ability to excite the most powerful and enduring emotions experienced by most normal people during their lifetime. And it can be one of the most powerful healing forces known. It is important to all humans.

The most incisive picture of love that I have ever encountered comes from Scott Peck's The Road Less Traveled. On p. 25 of this masterpiece, Peck defines love as "The will to extend one's self for the purpose of nurturing ones own, or another's, spiritual growth". [Emphasis added.] I usually subconsciously expand his definition by replacing the word "spiritual" with "spiritual/emotional". Note here that it is important that one has a will, not a "hope" or "desire" or "wish" or ..., to accomplish the act, and that will requires discipline (the topic of the first chapter of his book).

When I first read this definition fifteen years ago, I was baffled. Where are the "warm fuzzies": the delight in being with another, the touch, the kiss, sexuality? What he said sounded very abstract and obscure, and did not speak to my own then-current, or my culture's, conception of "love". But over the years, as I gained experience and thought more deeply on what he wrote, I became convinced that his definition is the very best I have ever found. Of what he speaks is a different kind of love; not mere romantic "love", but the real thing. It is, for example, the love of a parent for her/his child: the innumerable careful, tender acts of encouragement and teaching, to facilitate a child's emotional and spiritual growth, and awareness of, and comfort in, the world. This is a love of great power. In its purest form, it is perhaps God's love for all people; a love that is crystallized in the Quaker view by Her/His (make a choice) will to facilitate the spiritual growth of all of us through His/Her Light.

The topic of love and its power is so important that I will quote from Peck at some length:

The time and the quality of the time that their parents devote to them indicate to children the degree to which they are valued by their parents. ... The feeling of being valuable --- "I am a valuable person" --- is essential to mental health and is the cornerstone of self-discipline. It is a direct product of parental love. Such a conviction must be gained in childhood; it is extremely difficult to acquire it during adulthood. Conversely, when children have learned through the love of their parents to feel valuable, it is almost impossible for the vicissitudes of adulthood to destroy their spirit. ... As a result of the experience of consistent parental love and caring throughout childhood, such fortunate children will enter adulthood not only with a deep internal sense of their own value but also with a deep internal sense of security. All children are terrified of abandonment, and with good reason. ... To the child, abandonment by its parents is the equivalent of death. ... A substantial number of children actually are abandoned by their parents during childhood, by death, by desertion, by sheer negligence, or ... by simple lack of caring. ... these children, abandoned either psychologically or in actuality, enter adulthood lacking any deep sense that the world is a safe and protective place. To the contrary, they perceive the world as dangerous and frightening ... for them the future is dubious indeed. ... In summary, ... it is necessary for them [children] to have self-disciplined role models, a sense of self-worth, and a degree of trust in the safety of their existence. These "possessions" are ideally acquired through the self-discipline and consistent genuine caring of their parents; they are the most precious gifts of themselves that mothers and father can bequeath. When these gifts have not been proffered by ones parents, it is possible to acquire them from other sources, but in that case the process of their acquisition is invariably an uphill struggle, often of lifelong duration and often unsuccessful. [Emphasis added by me.]

These remarks are not directed just at people with CMI, but at all of us. But a person who is in profound depression may not be able to express or receive this kind of love at all. They often think they "need" something more directive, supportive, and overtly comforting. One of the first problems a person, having emerged from depression, will face in healing, is learning to "love ones self". Such people may have such low esteem from a lifetime of pain and failure that they must practically start over as children. Likewise a person who is manic may not even view other people as "real", but only "constructs" of his/her own mind: almost like automatons playing a script that he/she has written. Both types will have much to learn about love in the process of healing.

When I first read the statements by Peck quoted above, given my own history, I felt doomed: I had been abandoned; I had not received "consistent genuine caring" from my parents; I did indeed lack a sense that "the world is a safe and protective place"; and the prospect of facing "an uphill struggle, often of lifelong duration and often unsuccessful" was extremely discouraging, nay, daunting! Fortunately, I had not gotten to the end of his analysis yet. Because there is another source from which this kind of love and its concomitant benefits can be acquired. And like romantic love, it is a gift; but this gift comes from a higher power, God, and is far more powerful than even the strongest human love.

next: Mental Illness and Public Policy
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Self-Therapy For People Who ENJOY Learning About Themselves

Basics #1: Your Needs and Wants

What every eight-year-old should know and most adults have never been taught about the emotions that run our lives.

INTRODUCTION

This topic explains what your feelings are, how to use them to help yourself, and how to overcome the ones that get in your way.

This information applies to every second of your life and every decision you will ever make. Learning to apply the concepts in these few short pages can go a long way toward improving your life!

If you are in therapy, read these pages regularly, perhaps before or after each meeting with your therapist. Apply these concepts to what you learn in therapy.

If you are working on your changes alone, keep these pages close at hand and use them regularly. I'd like very much to hear your thoughts and experiences as you apply the information provided here.

YOUR ENERGY AND YOUR FEELINGS

We get our physical energy from taking care of our bodies well - not perfectly, and not obsessively.

We only need to eat, sleep, and exercise well enough in order for our feelings to give us all of the information we require about our needs and wants, and all the energy we'll need to address them.

Feelings are actually energy surges which tell us, very specifically, what we want or need. When our feelings are strong enough to grab our attention, we can be certain that we'll have sufficient energy to handle things.

YOUR NEEDS

Needs are about survival. We would die if we didn't get what we need.

An adult needs the same things an infant needs. We need: food, air, space, exercise, temperature control (avoiding being too hot or too cold), and to eliminate waste efficiently.

We also need attention or "strokes" from each other. We don't need anything else!

YOUR NEED FOR ATTENTION OR "STROKES"

A "stroke" is a unit of recognition. When we receive a stroke we are being noticed by someone.

Infants need strokes to survive. Adults want strokes so much that getting attention (just being recognized) is the strongest want we will ever experience in our lives.

FOUR KINDS OF STROKES

Get good at getting and deeply absorbing the first three. And be sure to powerfully turn down and throw away all the "Unconditional Negative Strokes" you ever receive!

THE FIRST SIGN OF DISCOMFORT

Some people ignore their needs. They live in pain and may die from it.

Most of us don't ignore our needs. We notice our need but then we wait while the discomfort turns to pain. Don't wait!

Get good at noticing the very first feeling of discomfort!

Avoid emotional problems by taking care of your physical needs at the first sign of discomfort!

TRIGGERS FOR FEELINGS

Feelings are triggered by reality or fantasy. (It's always one or the other, never both.)

REALITY comes to us through our senses. If we can see it, hear it, taste it, smell it, or feel it on our skin, then it is real.

FANTASY is all mental activity - including thoughts, memories, dreams, ideas, etc.

Fantasy doesn't come TO us, it comes FROM us - from our own brains.

If we only think it, it might be true or it might be false - but it is not real!

FEELINGS WE CREATE

Feelings that start in our brains rather than in our senses are unnecessary and optional, because they are not real.

If we create painful feelings we will need to change how we think in order to feel better.

If we create pleasurable feelings, that's great - as long as we remember we are only imagining.

Sometimes we create feelings which are so strong that they hide our real feelings from our senses. When we do this we are out of touch with reality, and in real danger of making serious mistakes.

Enjoy Your Changes!

Everything here is designed to help you do just that!

Basics #2: Your Natural Feelings

What every eight-year-old should know and most adults have never been taught about the emotions that run our lives.

THE NATURAL, REAL FEELINGS

Feelings that start in our senses are natural responses to the real world.

When we notice real anger, or sadness, or scare, we notice that something is wrong in our lives.

When we notice real joy or excitement we notice that something is right in our lives.

Natural feelings are always trustable. Learn what they are saying to you. Use them well.

TYPES OF FEELINGS

There are five natural and necessary feelings: Sad, Mad, Glad, Scared and Excited.

There are many other unnatural and unnecessary feelings - and all of them cause problems. Guilt, shame, and imagined fear are by far the most common and troublesome of these. ("The Basics #3" is about these.)

THREE HUGE QUESTIONS THAT AFFECT OUR FEELINGS

When any feeling starts we are immediately faced with three huge questions - and we tend to automatically answer them in less than a second:

1) Will you admit to yourself what you are feeling? If you don't, you'll feel "out of touch" or "crazy" or uncentered.

2) Will you express the feeling either alone or with someone else? If you don't, you are giving up the chance for relief.

3) Will you take action to improve things? If you don't, you are giving up the chance to improve your future.

When we are having problems, we need to slow down this automatic process so that it takes longer than a second or two. This will allow us to think through each step instead of relying on old habits.

THE FIVE NATURAL FEELINGS

Use this information so you will always know what you want and feel.

HOW TO FIND EACH FEELING IN YOUR BODY

You will need this information to know who you are and what you want and to make every decision you will ever make.

Enjoy Your Changes!

Everything here is designed to help you do just that!

Basics #3: Unnatural Feelings

What every eight-year-old should know and most adults have never been taught about the emotions that run our lives.

ABOUT GUILT

Since guilt is not a natural, necessary emotion, it blocks and wastes our energy.

GUILT IS A COVER-UP FOR ANGER WHICH LEAVES US FEELING SAD.

We wonder: "Why am I so sluggish and irritable?"

On the surface we feel: SAD or DEPRESSED

We've been telling ourselves things like:
"I shouldn't be angry. I should be understanding."
"That person didn't mean to hurt me."
"I'm too sensitive."
"I should just take the mistreatment."
"I don't deserve better."

Down deep we feel: ANGRY

Make A Conscious Choice: Will I admit to myself that I'm angry or will I keep feeling guilty and be depressed?

BE PROUD OF YOUR ANGER!
It's there to protect you. Let it do its job!

ABOUT SHAME

Since shame is not a natural, necessary emotion, it blocks and wastes our energy.

SHAME IS A DEEP BELIEF IN OUR OWN WORTHLESSNESS. IT COMES DIRECTLY FROM BEING SHAMED AS A CHILD.

We wonder: "Why don't I seem to care what happens to me like other people do?"

On the surface we feel: VERY SAD and "HOPELESS."

We've been telling ourselves things like:
"I'm no good. I just don't feel worthwhile."
"I wonder what's wrong with me, but most of the time I just don't care."
"I might as well have a drink (or a drug, or take a big risk)."

Down deep we feel: MOSTLY SAD, BUT FEARFUL AND ANGRY TOO.

Make A Conscious Choice:
Will I keep believing those people who shamed me or will I treat myself well and be happier?

KNOW THAT ANYONE WHO SHAMED YOU WAS WRONG!

ABOUT IMAGINED FEAR

Since imagined fear is not a natural, necessary emotion, it blocks and wastes our energy.

IMAGINED FEAR IS A FEELING WE CREATE TO COVER DEEPER FEELINGS WHICH BOTHER US MORE.

We wonder:
"Why am I so afraid?"
" Why do I always ask: 'What if?'"
"Why don't I stop scaring myself?"

On the surface we feel: FEAR

We've been telling ourselves:
"I hate being afraid."
"I wish I could do what other people do, and not be afraid."
"I wish I'd stop thinking about every single bad thing that could happen."

Down deep we feel: USUALLY SAD. SOMETIMES SHAME (See "Shame.")

Make A Conscious Choice:
Will I always feel scared or will I face and overcome my deeper bad feelings?

FACE WHAT YOU FEEL THAT BOTHERS YOU MORE!
You will get past the deeper feelings. But creating fear can last forever!

ALL OTHER CREATED FEELINGS THAT FEEL BAD

It is possible to create any feeling - and any created feeling that feels bad will block and waste our energy.

All imagined feelings are habitual feelings we create to cover deeper, real feelings that bother us more.

We wonder:
"Why do I keep feeling this same feeling all the time, even when I know it's not necessary?"

On the surface we feel: THE CREATED FEELING.

We've been telling ourselves:
"I hate feeling this all the time."
"I wish I'd feel and do a wider range of things like other people do."
"Why can't I stop making myself feel this way."

Down deep we feel:
REAL FEELINGS THAT SEEM TOO MUCH TO HANDLE.

Make A Conscious Choice:
Will I keep feeling this way or will I face and overcome the deeper bad feelings?

YOU CAN OVERCOME THE DEEPER FEELINGS ALONE OR WITH HELP BUT THE HABITUAL FEELING YOU ARE CREATING COULD GO ON FOREVER!

Face the feelings that bother you more! Stop covering them with your "favorite" bad feeling!

These three topics ("The Basics") contain the most important information I have for you.

I originally wrote "The Basics" around 1985 in a different format and I have given it to everyone in my family, all my clients, and many of my friends.

I refer to these concepts many times every day in my work with others and in dealing with my own dilemmas.

I sincerely hope you will keep this information readily available and use it frequently. Use it whenever you feel stuck in bad feelings, when you want to feel more joy and excitement, and when you feel the healthy urge to look inward.

I WISH YOU THE RICHEST, HEALTHIEST, HAPPIEST LIFE YOU CAN ARRANGE

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Topics everyone should eventually read.

Self-Therapy For People Who ENJOY Learning About Themselves

THE CURSE OF EXPECTATIONS

We pick on ourselves when we don't meet our own expectations. We feel sad and angry when others don't meet the expectations we put on them. And even when our expectations are met we don't feel very good about it. We just say: "I expected it anyway."

If we would just stop expecting things we could save ourselves a lot of unhappiness!

WHAT IS REASONABLE TO EXPECT FROM OTHERS?

It is only reasonable to expect that people will do what they say they will do. This is all we can reasonably expect - that people will keep their word.

Sometimes even expecting people to keep their word is unreasonable. People who break their word regularly aren't trustable. We'd be wise to have no expectations at all about them.

WHAT IS REASONABLE TO EXPECT FROM OURSELVES?

The only reasonable expectations are those that come from agreements or contracts. And since contracts are always between at least two people, making a contract with ourselves is impossible! When we refer to "agreeing with ourselves" about something, we are actually agreeing with the air!

When people make an agreement with themselves they are talking about something that they are trying to change and that they are only hoping will work.

EXAMPLE:
We can say "I'm going to lose ten pounds this year." We say this because we feel a need to set a goal to overcome our consistent pattern of eating and exercising.

It would be more honest to say:
"I'm expecting to eat and exercise the way I always do, so I'm going to TRY to pay attention to these things during the next year and I only HOPE that I will lose 10 pounds."

It's only reasonable to expect consistency from yourself. Everything else is just something you are HOPING for and TRYING to accomplish.

The person who wanted to lose 10 pounds would be wise to:

1) Admit that they really want to continue to eat and exercise the way they always did.

2) Know that they are totally acceptable this way.

3) Experiment to find new ways of eating and exercising that they actually like to do.

4) Keep doing the new things they like to do until they no longer even have to think about it.

SUMMARY:

FIRST - Know what you really want.

SECOND - Accept yourself as you are. (Picking on yourself only reinforces worse behavior!)

THIRD - Try new behaviors to see if you might actually want to do them.

LAST - Repeat the new behaviors until they are habits. (This takes six months to a year.)

THE CURE FOR EXPECTATIONS ABOUT OTHERS

Directly ask people for what you want. If they don't give a clear answer, ask again. When they say a clear "yes" or a clear "no," accept it

BUT WHAT IF I DON'T KNOW WHAT I WANT?

Then you can't expect anyone else to know what you want either. Nobody can guess what you want.

We learn what we want by reading our feelings well. If you need help noticing your feelings and finding out what you want, that's a therapist's job.

WHAT TO DO ABOUT EXPECTATIONS YOU HAVE ABOUT OTHERS

1) Decide what the other person would have to actually do for you to be satisfied.

2) Ask for these specific behaviors from them. (This usually includes teaching and giving concrete examples.)

3) Examine your standards: (Can you change your standards to make them better for you?)

4) Accept that things are what they are (after you've done a good job of #1 and #2).

5) Be responsible: (For either staying in this situation or for finding a better one.)

COMMON EXPECTATIONS
Which of these common expectations do you have?

___ "I expect fair treatment at work."

___ "I expect equal work around the house."

___ "I expect help from family and friends."

___ "I expect to enjoy being with my friends."

___ "I expect to be loved."

___ "I expect good sex."

___ "I expect enough cuddling and hugs."

___ "I expect people to be honest ."

___ "I expect people to like me."

___ "I expect people to want to be with me."

___ "I expect people to leave me alone."

___ "I expect children to obey."

___ "I expect my therapist to help me."

___ "I expect children to listen."

___ "I expect children to learn."

___ "I expect my cat to use the litter box!"

Now think about each item you checked and decide how to use # 1 through #5 in the last paragraph to work toward actually getting what you want (instead of wasting any more of your time waiting, hoping, and expecting).

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Can You Make Someone Change?

Comprehensive information on women and bipolar disorder, how bipolar disorder affects women and managing bipolar disorder during pregnancy and breastfeeding.

About as many men as women get bipolar disorder, but women may experience it differently and, of course, there are are special concerns about managing bipolar disorder during pregnancy, postpartum, and while breastfeeding.

Research shows that women tend to experience more depressive episodes than men and are more likely to develop bipolar II (no severe mania, but instead have milder episodes of hypomania that alternate with depression). If you are a woman with bipolar disorder, manic or depressive episodes may be more likely right before your monthly period or after the birth of a child. Sixty-six percent of women with bipolar I (Bipolar I disorder is the most severe form of the illness marked by extreme manic episodes) had regular mood changes during either their menstrual or premenstrual phase of their cycle. They were more irritable and experienced increased outbursts of anger (Blehar et al., 1998).

Women with bipolar disorder are also more susceptible to rapid-cycling. Rapid cycling, according to the American Psychiatric Association's Diagnostic and Statistical Manual IV, occurs when a person experiences four or more mood swings or episodes in a twelve-month period. An episode can consist of depression, mania, hypomania or even a mixed state. Researchers aren't sure why women are targets for rapid-cycling but suspect it may have something to do with changes in hormone levels and thyroid activity.   In addition, women tend to receive antidepressant therapy which can trigger mania (people with bipolar usually should not be treated with an antidepressant alone. It should be accompanied by a mood stabilizer to prevent a switch into mania).

Polycystic Ovarian Syndrome and Depakote

Depakote is a mood stabilizer with a very good track record for smoothing out mood symptoms. Unfortunately, it also carries with it an increased risk for women to develop POS (Polycystic Ovarian Syndrome). PCOS is characterized by changes to the ovaries such that multiple follicles accumulate in the ovaries without ovulation. The ovary secretes higher levels of testosterone and estrogens. This results in irregular or no menses, excess body hair growth, occasionally baldness, and often obesity, diabetes, hypertension, infertility due to anovulation. Because of the anovulation, women with polycystic ovarian syndrome are at risk for irregular and heavy menstrual bleeding problems, endometrial hyperplasia and even endometrial cancer.

Up until recently, there had been a lot of debate about the connection between Depakote and POS, but a 2006 Harvard study (Joffe et al 2006) may have put a nail in the coffin. The study looked at women starting valproate (Depakene),   versus those starting some other mood stabilizer in the "anticonvulsant" category (lamotrigine, topiramate, carbamazepine, gabapentin , oxcarbazepine), or lithium.   Ten percent of the group starting valproate showed signs of PCOS within a year, versus 1% of the women taking any of those others. Some psychiatrists feel this finding means that Depakote  may not be the best choice in young women, teenagers and girls, particularly since there are other treatments available.

Women with Bipolar Disorder and Pregnancy

There are more detailed articles below, but in general women should not take lithium and other bipolar medications before or during pregnancy as they may result in birth defects and other problems. For pregnant women with bipolar disorder who are having problems with serious mania or depression and cannot be placed on an adequate dose of medication, ECT (electroconvulsive therapy) is a safe and very effective alternative (Kasar et al 2007, Miller 1994, Repke and Berger 1984, according to HealthyPlace.com Medical Director and psychiatrist, Harry Croft, MD. It is very important for pregnant women who undergo ECT to stay nourished and hydrated to help prevent premature contractions. Intubation or antacids may also be used to decrease the risk of gastric regurgitation or lung inflammation during anesthesia for ECT. If you are planning on getting pregnant, talk to your doctor first. Do not discontinue your bipolar medications on your own.

Sources:

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
• Joffe H, Cohen LS, Suppes T, McLaughlin WL, Lavori P, Adams JM, Hwang CH, Hall JE, Sachs GS. Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder. Biol Psychiatry. 2006 Jun 1;59(11):1078-86.
• Kasar M, Saatcioglu O, Kutlar T. Electroconvulsive therapy use in pregnancy. J ECT. 2007 Sep;23(3):183-4.
• Miller LJ. Use of electroconvulsive therapy during pregnancy. Hosp Community Psychiatry. 1994 May;45(5):444-50.

next: Concerns for Our Bipolar Children
~ bipolar disorder library
~ all bipolar disorder articles

Chapter 14

Paying Attention

All people pay some attention to the feelings and sensations created continually by the emotional system and the ad hoc activation programs. It does not have to be an unbearable headache or internal intestinal agony which draw our attention to the feelings and sensations of the moment. But, most people are not consciously aware of the fact that they have bodily felt sensations and feelings all the time, and that they attend to them within the margin of their awareness.

Most of them increase and decrease their level of awareness to this stream of inputs instinctively or as a reflex, with only a vague notion of the fact (except when the feelings are very intense). Usually, they hardly remember afterwards that they paid so much attention to those targets.

Only people who are in extraordinary circumstances, or those who are extremely exceptional themselves, remember in detail their paying attention to a target. Only a very few people who are not specifically trained to do so are wise enough to activate this behavior deliberately and voluntarily.

The general sensate focusing technique, and many other effective measures, which succeed in improving supra-programs of individuals significantly, activate the same system in basically the same manner - even when the persons involved are not aware of this fact.

Those who use these approaches do so by systematically influencing the way the people they work with allocate attentional resources. Intentionally or as a by-product, the reallocated attention is focused on felt sensations which result from the control components of ad hoc programs. (Sometimes, when people are unaware of the real way the emotional system works, it is done only "by accident" as the treatment involves activities which create hard to ignore sensations).

The following are a few pages intended to make the focusing of attention and other tactics of the technique more meaningful.

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Biofeedback or how the head works

During my first year of formal studies in the field of psychology, I enrolled in a course of laboratory workshops. One of the sessions involved the demonstration of the ever-changing electrical conductivity (and resistance to it) of the skin. Each of us experimented with an instrument which measures the changes that occur in the resistance of the skin to a weak electrical current (called by the name of "Galvanic-Skin-Resistance" or G.S.R.). The changes in the measured resistance are mainly due to changes in the sweating intensities.

The slow changes in the secretion of the sweat glands are mainly due to general changes in the body temperature, fast ones are the result of the minute changes that occur in the activity of the "autonomic nervous system". A fast rise in the activity of this system and an increase in the secretion of sweat are physiological expressions of high arousal and fear.

Thus, in spite of its innocent name, this instrument is intended to measure emotional changes and not those of electrical conductivity. For this reason, it is included in the police polygraph (called by some "the lie-detector").

During the exercise, I had one of the instruments attached to my fingers and I started to play with it: first I only followed the minute changes in the position of the needle of the watch-like monitor; then I found that these changes were related to the content of my thoughts; after a short while I even succeeded in controlling the movement of the needle by systematically changing the contents of my thoughts, sexy thoughts moved it to the right and boring ones to the left.

A bit later I found that one need not use thoughts in order to influence the needle, as the intention alone, accompanied with concentration of attention, achieved the same results. Not much later I learned that I was not the first to discover this phenomenon, and that this physiological function is the easiest to measure and influence. The sensations of the body which are related to these functions are hard to discern in normal circumstances and a few of them are never noticed by untrained individuals.

A whole branch of research is dedicated to the task of training people to take partial control of functions of the body with the aid of measuring devices. This activity is usually called "Biofeedback Training". This name sums up the processes behind this phenomenon which consists of:

• A sub-system of the brain and mind system which supervises a physiological function and supplies (feed) it with an input, thus influences its intensity.
• Faint feedback from a part or a region or a site of the body (or brain) about the activation of that function (influenced by the input of the sub-system), supplied (back or in return) to the sub-system of the brain and mind supervising it, via natural channels.
• Substantial feedback about the activation of the same function, supplied to the same sub-system of the brain and mind, from the same site of the body or brain, via the visual or the auditory channel, by the instrument that measures this function.

The initial "Bio" is added to "Feedback" to create the term "Biofeedback" in order to distinguish it from the feedback processes of a purely technological environment.

Many processes of our body are evolving under the supervision of other processes of the organism. Processes are initiated, curtailed or change their level according to the input they get from their supervising processes, which in their turn do it according to inputs from other processes, including feedback from the supervised ones.

For instance, whenever the temperature of the body rises too much, the process which supervises the secretion of the sweat glands get an elevated "signal" from the heat receptors of the skin, and rises the level of secretion. Afterwards, as the temperature subsides, the suitable feedback supplied by the receptors causes the supervising process to reduce the sweat secretion.

Huge quantities of input and feedback are transferred in the body and the brain via the nervous system. Part of it is the new information about the world, most of it is internal - from one subsystem to all the other relevant ones. Sometimes the distances are very small, sometimes they are greater, but very few are easy to measure by instruments.

Though the study of the feedback processes by means of "biofeedback" training has existed for more than thirty years, there is still no detailed explanation in the public pool of knowledge. The usual explanations are an elegant evasion of the problem, embedded in the vague terms of "learning processes".

The Lost Paradox

It is still a common habit to divide the various activities and processes of our body and mind into voluntary and involuntary processes, as a residual of past ignorance:

Included in the first are such activities as talking, moving, swallowing, thinking - and others we can activate as we wish.

In the second kind, are included those we are not clearly aware of and all these we cannot influence by sheer will-power - previously thought to be immune to voluntary influences. As for instance, the level of sugar in the blood, "brain waves", blood-pressure, the temperature of specific regions of the body, etc. We know now that we can influence all of them, but only using indirect means, and by attending to the various sensations of the body.

However, as it was found that man can influence via biofeedback training even the most subtle processes, the dichotomy and all the conceptualization around it were found to be not valid. The wonder, now, at the way one succeeds in changing one's brain waves through biofeedback training is neither more nor less than that aroused by the act of learning to ride a bicycle.

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In spite of the philosophical and psychological difficulties, the dream-like experience of biofeedback training is worth while. Only the one who has experienced the change induced in measuring instrument by the intense concentration of one's attention and will - observed in the monitor of the instrument or in the auditory or visual signal it emits - can appreciate this in full. Only the experience of deliberately causing an unpleasant feeling to dissolve, solely by means of focusing the attention on it, can surpass that experience.

The incomplete story of the emotions and their management comes here to an end. The "theoretical" chapters were introduced in order to help you get a meaningful picture of the self-maintenance system of the operating programs of the mind. This picture may help you recruit your resources in order to treat your emotional system more wisely.

Doing it as recommended in the self training chapter 5, will improve your whole life so much that not only those around will find it hard to comprehend, but you yourself will be amazed. It is a pity no one can yet supply, the final piece of the puzzle which is the mechanism of the brain that writes new information on the new protein chains in the brain cells, and its complementary one - that reads the information already there.

next: Selected Bibliography

"The reason that we have not been Loving our neighbor as ourselves is because we have been doing it backwards. We were taught to judge and feel ashamed of ourselves. We were taught to hate ourselves for being human."

"If I am feeling like a "failure" and giving power to the "critical parent" voice within that is telling me that I am a failure - then I can get stuck in a very painful place where I am shaming myself for being me. In this dynamic I am being the victim of myself and also being my own perpetrator - and the next step is to rescue myself by using one of the old tools to go unconscious (food, alcohol, sex, etc.) Thus the disease has me running around in a squirrel cage of suffering and shame, a dance of pain, blame, and self-abuse."

Codependence: The Dance of Wounded Souls

Codependence is insidious because it is so pervasive. The core emotional belief that there is something wrong with who we are as beings affects all of the relationships in our life and keeps us from learning how to Truly Love. In a Codependent society value is assigned in comparison (richer than, prettier than, more spiritual than, healthier than, etc.) so that the only way to feel good about self is the judge and look down on others. Comparison serves the belief in separation which makes violence, homelessness, pollution, and billionaires possible. Love is about feeling connected in the scheme of things not separate.

Codependence is vicious because it causes us to hate and abuse ourselves. We were taught to judge and shame ourselves for being human. At the core of our relationship with ourselves is the feeling that we are somehow not worthy and not lovable.

My father was trained that he was supposed to be perfect and that anger was the only permissible male emotion. As a result, that little boy that made mistakes and got yelled at felt like he was flawed and unlovable.

My mother told me how much she loved me, how important and valuable I was, and how I could be anything that I wanted to be. But my mother had no self-esteem and no boundaries so she emotionally incested me. I felt responsible for her emotional well-being and felt great shame that I couldn't protect her from father's raging or the pain of life. This was proof that I was so flawed that, though a woman might think I was lovable, eventually the truth of my unworthiness would be exposed by my inability to protect her and insure her happiness.

The church I was raised in taught me that I was born sinful and unworthy, and that I should be grateful and adoring because God loved me in spite of my unworthiness. And, even though God loved me, if I allowed my unworthiness to surface by acting on (or even thinking about) the shameful human weaknesses that I was born with - then God would be forced, with great sadness and reluctance, to cast me into hell to burn forever.

Is it any wonder that at my core I felt unworthy and unlovable? Is it any wonder that as an adult I got trapped in a continual cycle of shame, blame, and self-abuse?

The pain of being unworthy and shameful was so great that I had to learn ways to go unconscious and disconnect from my feelings. The ways in which I learned to protect myself from that pain and nurture myself when I was hurting so badly were with things like drugs and alcohol, food and cigarettes, relationships and work, obsession and rumination.

The way it works in practice is like this: I am feeling fat; I judge myself for being fat; I shame myself for being fat; I beat myself for being fat; then I am hurting so badly that I have to relieve some of the pain; so to nurture myself I eat a pizza; then I judge myself for eating the pizza, etc. etc.

To the disease, this is a functional cycle. The shame begets the self-abuse which begets the shame which serves the purpose of the disease which is to keep us separate so the we don't set ourselves up to fail by believing that we are worthy and lovable.

Obviously, this is a dysfunctional cycle if our purpose is to be happy and enjoy being alive. The way to stop this cycle is two-fold and simple in theory but extremely hard to implement on a moment-to-moment, day-to day basis in our lives. The first part has to do with removing the shame from our inner process. This is a complicated and multi-leveled process that involves changing the belief systems that are dictating our reactions to life (this include everything from positive affirmations to grief/emotional energy release work, to support groups, to meditation and prayer, to inner child work, etc.) so that we can change our relationship with ourselves at the core and start treating ourselves in healthier ways.

The second part is simpler and usually harder. It involves taking 'the action.' ('the action' refers to the specific behavior. We have to take action to do all of the things listed in the first part as well.) Changing the behavior that is giving us a reason for the shame. Just saying 'no' - or 'yes' if the behavior in question is something like not eating or isolating or not exercising. And even though it may sometime work in the short run to use shame and judgment to get ourselves to change a behavior, in the long term - in alignment with our goal of having a more Loving relationship with ourselves so that we can be happy - it is much more powerful to take that action in a Loving way.

This involves setting a boundary for the little child inside of us, who wants instant gratification and instant relief, out of the Loving adult in us who understands the concept of delayed gratification. (If I exercise every day I will feel much better in the long run.) True pride comes from action taken. It is false pride to feel good about ourselves in comparison because of looks, talent, intelligence or for being forced to become spiritual, healthy, or sober. Those are gifts. True pride is taking credit for the action we have taken to foster, nurture, and maintain those gifts.

The way to break the self-destructive cycle, to stop the dance of shame, suffering, and self-abuse, is to set Loving boundaries for ourselves in the moment of that desperate need for immediate gratification and to know that - though it is not shameful if we can't do it perfectly or all the time - we need to 'just do it.' We need to stand up for our True Self to our wounded self in order to Love ourselves.

next: The Codependency Recovery Process, Mental, Emotional, Spiritual

Learn about the different types of alternative medicine including Chinese medicine, Ayurvedic medicine, naturopathy, homeopathy.

On this page

• Introduction
• Traditional Chinese Medicine
• Ayurvedic Medicine
• Naturopathy
• Homeopathy
• Summary
• For More Information
• References

Introduction

Whole medical systems involve complete systems of theory and practice that have evolved independently from or parallel to allopathic (conventional) medicine. Many are traditional systems of medicine that are practiced by individual cultures throughout the world. Major Eastern whole medical systems include traditional Chinese medicine (TCM) and Ayurvedic medicine, one of India's traditional systems of medicine. Major Western whole medical systems include homeopathy and naturopathy. Other systems have been developed by Native American, African, Middle Eastern, Tibetan, and Central and South American cultures.

Traditional Chinese Medicine

TCM is a complete system of healing that dates back to 200 B.C. in written form. Korea, Japan, and Vietnam have all developed their own unique versions of traditional medicine based on practices originating in China. In the TCM view, the body is a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. Among the major assumptions in TCM are that health is achieved by maintaining the body in a "balanced state" and that disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (or vital energy) and of blood along pathways known as meridians. TCM practitioners typically use herbs, acupuncture, and massage to help unblock qi and blood in patients in an attempt to bring the body back into harmony and wellness.

Treatments in TCM are typically tailored to the subtle patterns of disharmony in each patient and are based on an individualized diagnosis. The diagnostic tools differ from those of conventional medicine. There are three main therapeutic modalities:

1. Acupuncture and moxibustion (moxibustion is the application of heat from the burning of the herb moxa at the acupuncture point)
2. Chinese Materia Medica (the catalogue of natural products used in TCM)
3. Massage and manipulation

Although TCM proposes that natural products catalogued in Chinese Materia Medica or acupuncture can be used alone to treat virtually any illness, quite often they are used together and sometimes in combination with other modalities (e.g., massage, moxibustion, diet changes, or exercise).

The scientific evidence on selected modalities from TCM is discussed below.

Acupuncture: The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 states that acupuncture is being "widely" practiced--by thousands of acupuncturists, physicians, dentists, and other practitioners--for relief or prevention of pain and for various other health conditions.¹ In terms of the evidence at that time, acupuncture was considered to have potential clinical value for nausea/vomiting and dental pain, and limited evidence suggested its potential in the treatment of other pain disorders, paralysis and numbness, movement disorders, depression, insomnia, breathlessness, and asthma.

Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine.

It is proposed that acupuncture produces its effects by the conduction of electromagnetic signals at a greater-than-normal rate, thus aiding the activity of pain-killing biochemicals, such as endorphins and immune system cells at specific sites in the body. In addition, studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones and affecting the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person's blood pressure, blood flow, and body temperature are regulated.^2,3

References

Chinese Materia Medica
Chinese Materia Medica is a standard reference book of information on medicinal substances that are used in Chinese herbal medicine.4 Herbs or botanicals usually contain dozens of bioactive compounds. Many factors--such as geographic location, harvest season, post-harvest processing, and storage--could have a significant impact on the concentration of bioactive compounds. In many cases, it is not clear which of these compounds underlie an herb's medical use. Moreover, multiple herbs are usually used in combinations called formulas in TCM, which makes the standardization of herbal preparations very difficult. Further complicating research on TCM herbs, herbal compositions and the quantity of individual herbs in a classic formula are usually adjusted in TCM practice according to individualized diagnoses.

In the past decades, major efforts have been made to study the effects and effectiveness of single herbs and of combinations of herbs used in classic TCM formulas. The following are examples of such work:

• Artemisia annua. Ancient Chinese physicians identified that this herb controls fevers. In the 1970s, scientists extracted the chemical artemisinin from Artemisia annua. Artemisinin is the starting material for the semi-synthetic artemisinins that are proven to treat malaria and are widely used.⁵

• Tripterygium wilfordii Hook F (Chinese Thunder God vine). Thunder God vine has been used in TCM for the treatment of autoimmune and inflammatory diseases. The first small randomized, placebo-controlled trial of a Thunder God vine extract in the United States showed a significant dose-dependent response in patients with rheumatoid arthritis.6 In larger, uncontrolled studies, however, renal, cardiac, hematopoietic, and reproductive toxicities of Thunder God vine extracts have been observed.

Ayurvedic Medicine

Ayurveda, which literally means "the science of life," is a natural healing system developed in India. Ayurvedic texts claim that the sages who developed India's original systems of meditation and yoga developed the foundations of this medical system. It is a comprehensive system of medicine that places equal emphasis on the body, mind, and spirit, and strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. In India, Ayurvedic treatments have been developed for various diseases (e.g., diabetes, cardiovascular conditions, and neurological disorders). However, a survey of the Indian medical literature indicates that the quality of the published clinical trials generally falls short of contemporary methodological standards with regard to criteria for randomization, sample size, and adequate controls.⁷

Naturopathy

Naturopathy is a system of healing, originating from Europe, that views disease as a manifestation of alterations in the processes by which the body naturally heals itself. It emphasizes health restoration as well as disease treatment. The term "naturopathy" literally translates as "nature disease." Today naturopathy, or naturopathic medicine, is practiced throughout Europe, Australia, New Zealand, Canada, and the United States. There are six principles that form the basis of naturopathic practice in North America (not all are unique to naturopathy):

1. The healing power of nature
2. Identification and treatment of the cause of disease
3. The concept of "first do no harm"
4. The doctor as teacher
5. Treatment of the whole person
6. Prevention

The core modalities supporting these principles include diet modification and nutritional supplements, herbal medicine, acupuncture and Chinese medicine, hydrotherapy, massage and joint manipulation, and lifestyle counseling. Treatment protocols combine what the practitioner deems to be the most suitable therapies for the individual patient.⁸

As of this writing, virtually no research studies on naturopathy as a complete system of medicine have been published. A limited number of studies on botanicals in the context of use as naturopathic treatments have been published. For example, in a study of 524 children, echinacea did not prove effective in treating colds.⁹ In contrast, a smaller, double-blind trial of an herbal extract solution containing echinacea, propolis (a resinous product collected from beehives), and vitamin C for ear pain in 171 children concluded that the extract may be beneficial for ear pain associated with acute otitis media.¹⁰ A naturopathic extract known as Otikon Otic Solution (containing Allium sativum, Verbascum thapsus, Calendula flores, and Hypericum perforatum in olive oil) was found as effective as anesthetic ear drops and was proven appropriate for the management of acute otitis media-associated ear pain.¹¹ Another study looked at the clinical effectiveness and cost-effectiveness of naturopathic cranberry tablets--versus cranberry juice and versus a placebo--as prophylaxis against urinary tract infections (UTIs). Compared with the placebo, both cranberry juice and cranberry tablets decreased the number of UTIs. Cranberry tablets proved to be the most cost-effective prevention for UTIs.¹²

References

Homeopathy

Homeopathy is a complete system of medical theory and practice. Its founder, German physician Samuel Christian Hahnemann (1755-1843), hypothesized that one can select therapies on the basis of how closely symptoms produced by a remedy match the symptoms of the patient's disease. He called this the "principle of similars." Hahnemann proceeded to give repeated doses of many common remedies to healthy volunteers and carefully record the symptoms they produced. This procedure is called a "proving" or, in modern homeopathy, a "human pathogenic trial." As a result of this experience, Hahnemann developed his treatments for sick patients by matching the symptoms produced by a drug to symptoms in sick patients.¹³ Hahnemann emphasized from the beginning carefully examining all aspects of a person's health status, including emotional and mental states, and tiny idiosyncratic characteristics.

Since homeopathy is administered in minute or potentially nonexistent material dosages, there is an a priori skepticism in the scientific community about its efficacy. Nonetheless, the medical literature provides evidence of ongoing research in the field. Studies of homeopathy's effectiveness involve three areas of research:

1. Comparisons of homeopathic remedies and placebos
2. Studies of homeopathy's effectiveness for particular clinical conditions
3. Studies of the biological effects of potencies, especially ultra-high dilutions

Five systematic reviews and meta-analyses evaluated clinical trials of the effectiveness of homeopathic remedies as compared with placebo. The reviews found that, overall, the quality of clinical research in homeopathy is low. But when high-quality studies were selected for analysis, a surprising number showed positive results.^13-17

Overall, clinical trial results are contradictory, and systematic reviews and meta-analyses have not found homeopathy to be a definitively proven treatment for any medical condition.

Summary

While whole medical systems differ in their philosophical approaches to the prevention and treatment of disease, they share a number of common elements. These systems are based on the belief that one's body has the power to heal itself. Healing often involves marshalling multiple techniques that involve the mind, body, and spirit. Treatment is often individualized and dependent on the presenting symptoms. To date, NCCAM's research efforts have focused on individual therapies with adequate experimental rationale and not on evaluating whole systems of medicine as they are commonly practiced.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and on NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

NCCAM Clearinghouse

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

E-mail: info@nccam.nih.gov
Web site: www.nccam.nih.gov

About This Series

"Biologically Based Practices: An Overview" is one of five background reports on the major areas of complementary and alternative medicine (CAM).

• Biologically Based Practices: An Overview

• Energy Medicine: An Overview

• Manipulative and Body-Based Practices: An Overview

• Mind-Body Medicine: An Overview

• Whole Medical Systems: An Overview

The series was prepared as part of the National Center for Complementary and Alternative Medicine's (NCCAM's) strategic planning efforts for the years 2005 to 2009. These brief reports should not be viewed as comprehensive or definitive reviews. Rather, they are intended to provide a sense of the overarching research challenges and opportunities in particular CAM approaches. For further information on any of the therapies in this report, contact the NCCAM Clearinghouse.

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.

next: Alternative Approaches to Mental Health Care

References

1. National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Statement. National Center for Complementary and Alternative Medicine Web site. Accessed at odp.od.nih.gov/consensus/cons/107/107_statement.htm on April 30, 2004.
2. Takeshige C. Mechanism of acupuncture analgesia based on animal experiments. In: Scientific Bases of Acupuncture. Berlin, Germany: Springer-Verlag; 1989.
3. Lee BY, LaRiccia PJ, Newberg AB. Acupuncture in theory and practice. Hospital Physician. 2004;40:11-18.
4. Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Rev ed. Seattle, WA: Eastland Press; 1993.
5. Klayman DL. Qinghaosu (artemisinin): an antimalarial drug from China. Science. 1985;228(4703):1049-1055.
6. Tao X, Younger J, Fan FZ, et al. Benefit of an extract of Tripterygium Wilfordii Hook F in patients with rheumatoid arthritis: a double-blind, placebo-controlled study. Arthritis and Rheumatism. 2002;46(7):1735-1743.
7. Hardy ML. Research in Ayurveda: where do we go from here? Alternative Therapies in Health and Medicine. 2001;7(2):34-35.
8. Smith MJ, Logan AC. Naturopathy. Medical Clinics of North America. 2002;86(1):173-184.
9. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. Journal of the American Medical Association. 2003;290(21):2824-2830.
10. Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics. 2003;111(5):e574-e579.
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