Welcome to the most important page in my site. If you are reading this, it's probably because you are at the end of your rope and are ready to "cash in." Please don't do this just yet. If you've gone to the trouble of browsing to this page, at least read it all the way to the bottom. OK? I promise, you'll be glad you did.

Right now, I'm going to promise you this: I will not preach or lie to you. You deserve better than that.

First of all, I've been where you are. It may help for you to read about my experience with depression. But I want you to know this--although you probably feel completely and utterly alone, you are not. Millions of people have depression and you are by no means the first to feel this terrible nor will you be the last.

As I said, I won't preach. I won't tell you that life is sweet, just hang on, and all of that crap. It isn't necessarily true, and even if it were, you aren't buying it. The trouble is that your view of things is distorted. You won't believe that either--so I'm just going to ask you to take my word for it. For now, please just assume this is so and read on.

You are thinking about ending your life for a very simple reason: You can no longer cope with the stresses in your life. That's all there is to it. And you can't cope because the depression won't permit you to look for ways to cope. Rather than deal with problems, you assume you just "deserve" them, or something like that. But the fact is that problems, all problems, can be dealt with, but only if you take off the blinders of depression and look for those solutions.

Understand this, no-one upon no-one in this world "deserves" problems or unpleasantness. Harmful or unpleasant events cannot think. They do not pick you for some inexplicable reason. They simply happen. There is no reason for it. Bad things simply "happen"--period. You are not a factor in why they happen. You just happen to be there when they do.

I know you don't believe it, but your life is not over. It is just beginning, if you want it to. You see, you are in charge of your life. At the moment, you simply have lost direction and see no way out. All you have to do is accept that you are not in control and are not seeing things as they are. Admit this and ask for help.

Your pain is unbearable. You can't imagine living one more day this way. I know. And you probably think that your pain is spilling over onto others. Better to end your life now and spare everyone else this awful pain that you can no longer stand--right? Wrong! If you end your life, all you will do is spread your pain around, not eliminate it. The people who love you (and there are some, even if you don't think so) will mourn you for the rest of their lives. They will wonder why you did it, how they could have helped you, what way they failed you, or even why you chose to do this to them.

You see, you won't spare those who love you a lifetime of pain. You'll be inflicting one on them! Don't do it!

Right now, stop what you are doing, and call for help. Call a friend, clergyman, doctor, crisis line, or even just dial 9-1-1 if you can think of no-one else. Listen to what they say--whoever it is--and allow them to help you. You are in no shape to make decisions right now.

You've lived with the pain long enough. It's time to let someone help you with it. Please do it now, before you make a mistake that someone else will mourn for the rest of their lives.

Please.

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Or for a crisis center in your area, go here.

next: How To Recognize Depression Symptoms
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Once you find out that a family member is mentally ill, what is the next step? How do you cope with mentally illness in the family?

Supporting Someone with Bipolar - For Family and Friends

Introduction

When the movie A Beautiful Mind opened in late December 2001, the mental health community called it a winner. The story of a Nobel Prize-winning mathematician who suffered from schizophrenia and the wife who supported him drew applause from families in similar situations.

"A great leap has been made for consumers who are recovering from this devastating disease," says one couple about the movie on the Web site of the National Alliance for the Mentally Ill. "Our son was diagnosed in 1986."

"I loved this film," says a woman from California. "I am the mother of a 36-year-old son who has schizophrenia and the daughter of a man who also has the disease."

Fifty-four million people have a mental disorder in any given year, according to the Surgeon General's Report on Mental Health. While family caregivers of mentally ill people suffer many of the same stresses as those who take care of family members with, for example, physical disabilities or chronic heart disease - stresses like fatigue, anxiety, frustration, and fear - special problems face mental health caregivers.

Shame and guilt are particularly common, says Nassir Ghaemi, MD, an assistant professor of psychiatry at Harvard and director of the Bipolar Research Program at Cambridge Hospital. Mental illness is more and more being recognized as a biological illness, and therefore carries less stigma than it used to. It's no longer seen as a character defect. But there is a genetic side to it, and that can make many families feel ashamed and guilty.

Julie Totten's father and brother both suffered from clinical depression and she felt isolated from other people as a result. "I wouldn't talk to them about my problems at home because I was too embarrassed," she says, explaining that life at her house was just too different from what she saw at other people's houses.

Mental Illness and Marriage

The strains of mental illness on a marriage may be devastating. "There's a very high divorce rate among people who have depression or bipolar disorder," says Ghaemi. "Some spouses aren't able to take care of the other spouse when they're ill. The illness can interfere with the relationship so that the depressed spouse, for instance, can be irritable...The manic patient can have affairs when they're manic."

Treatment for these diseases may also cause problems. For example, drugs like Prozac can affect a person's sexuality and feelings of desire.

Bill N.'s marriage almost collapsed after his wife Missy was diagnosed with bipolar depression 10 years ago, shortly after their first child was born. He says he felt a little resentful that his wife hadn't told him about problems her family had had with mental illness.

Another problem is that during Missy's bad periods, Bill says, she uses all her reserves to cope with the children. According to Bill, there isn't much left for him - "so you have to kind of get used to the fact that you aren't going to get much love or attention or interest."

Bill actually developed a facial tick as a result of the stress, but he joined a support group and also got some individual counseling. This helped him cope until medication eventually improved his wife's condition and they actually felt confident enough to have another child. "Try and realize that things can get better," he says, "but realize that it's a slow process."

Helping Families Cope

"I strongly urge family members to go to support groups," says Ghaemi. "There is some evidence that being a participant in a support group is associated with doing better - having a better outcome with one's illness. But he adds that most research has focused on family support for patients themselves and very little has been done on how family members cope and how their lives are affected.

Totten chose individual therapy to help her cope with her emotions. "I realized that I lacked control, (that) I was scared and anxious all the time...and I was always trying to take care of everybody." She also founded Families for Depression Awareness, a nonprofit organization outside Boston dedicated to helping families understand and deal with mental illness, particularly depression.

"Family members do need to be educated about the mental health system (and) what services are out there, because they certainly do serve as a good resource," says Cecilia Vergaretti of the National Mental Health Association (NMHA).

But remember, mental illness tends to strike in young adulthood, and family members may have little legal or financial control over their loved one. "We would advocate for whatever the adult with the illness wants," says Vergaretti. "Some adults choose to include their families in their treatment plan to different degrees, and others choose not."

Totten's brother committed suicide at 26 after refusing help. She has come to terms with the powerlessness she felt at the time," she says, and has learned to accept boundaries. "I can't do everything for them."

The National Mental Health Association has some tips to help caregivers cope:

• Accept feelings like fear, worry, and shame. They are normal and common.
• Educate yourself about your loved one's illness.
• Establish a support network.
• Seek counseling, either on an individual basis or in a group.
• Take time out. Schedule time away to keep from becoming frustrated or angry.

next: Mental Illness: Information for Family and Friends
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~ all bipolar disorder articles

A dyslexia research team at Yale University's Center for Learning and Attention lead by Dr. Sally Shaywitz has found a window on the brain through a new imaging technique called functional MRI. These medical scientists have identified parts of the brain used in reading. By observing the flow of oxygen-rich blood to working brain cells, they have found that people who know how to sound out words can rapidly process what they see. This information has shed new light on dyslexia and how to help dyslexics.

When readers are asked to imagine "cat" without the "kah" sound, they readily summon "at." The MRI photographs show their brains lighting up like pinball machines. When the brain gets it, the light bulbs really do go on. However, the brains of people who can't sound out words often look different on MRI pictures. There is less blood flow to the language centers of the brain and, in some cases, not much activity evident at all. Scientist's are not sure why this is or what it means. But simply put, without the ability to sound out words, the brain is stumped.

Basically this research seems to be saying that the brain learns to read the same way it learns to talk, one sound at a time. When babies first learn to talk they may slowly say one sound at a time. Once they get the hang of it, they speed up. Our brain becomes adept at processing and our experience is that of hearing words but actually our brain is processing sounds (phonemes) and putting them together so we hear words. When we read the same process is in operation. Our brain is processing one sound at a time but we perceive it as a whole word. In good readers, the process is so fast it appears that they are reading whole words but in fact they are converting the letters on the written page into sounds. The brain then recognizes groups of sounds as words.

Reading is not automatic but must be learned. The reader must develop a conscious awareness that the letters on the page represent the sounds of the spoken word. To read the word "cat," the reader must parse, or segment, the word into its underlying phonological elements. Once the word is in its phonological form, it can be identified and understood. In dyslexia, an inefficient phonological module produces representations that are less clear and hence more difficult to bring to awareness. (Scientific American, November 1996, page 100). In READING the word (for example, "cat") is first decoded into its phonological form ("kuh, aah, tuh") and identified. Once it is identified, higher-level cognitive functions such as intelligence and vocabulary are applied to understand the word's meaning ("small furry mammal that purrs"). In people who have dyslexia, a phonological deficit impairs decoding, thus preventing the reader from using his or her intelligence and vocabulary to get to the word's meaning. (Scientific American, November 1996, page 101) Neural Architecture for reading has been suggested by functional magnetic resonance imaging. letter identification activates the extrastriate cortex in the occipital lobe; phonological processing activates the inferior frontal gyrus (Broca's area); and accessing meaning activates primarily the superior temporal gyrus and parts of the middle temporal and supramarginal gyri.

According to Dr. Shaywitz, "Over the past two decades, a coherent model of dyslexia has emerged that is based on phonological processing. The phonological model is consistent both with the clinical symptoms of dyslexia and with what neuroscientists know about brain organization and function. Investigators from many laboratories, including my colleagues and I at the Yale Center, have had the opportunity through 10 years of cognitive, and more recently, neurobiological studies."

Dyslexics (or poor readers) are very frustrated by the fact that they can understand what they hear but not what they read. Dyslexics have average or above average intelligence. Once they can properly decode words they can understand the concept. Decoding skills are the key to learning from written material.

Years of educational research has shown that the use of intensive phonics is the only way to teach dyslexics and learning disabled individuals how to read. The new brain research shows why intensive phonics is also the best way for everyone to learn to read.

Unfortunately, 80% of our nation's schools do not teach reading by intensive phonics. Most school use either the whole word method or a mix of whole word and phonics. The pictures above illustrate why the brain is confused by this approach.

For over 20 years, The Phonics Game (a complete learning system) has successfully taught children and adults how to read in as little as 18 hours. Also, research has shown that developing reading skills at an early age is an advantage for children later in their school careers. Because of this a new program has been developed that introduces children as young as 3 or 4 to the magic of letters and sounds and how they go together to make words. Children can become early readers.

For More Reading on This Subject:
Reiben Laurence & Perfetti, Charles, Learning To Read, Lawrence Erlbaum Associates: Hillsdale, NJ 1991

Lyon, G Reid, Toward A Definition of Dyslexia, Annals of Dyslexia, Vol 45 pp3-27

Shaywitz, Sally, Dyslexia, Scientific American, November 1996 pp98-104

next: About Learning Disabilities
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9. Where do 12-step or self-help programs fit into drug addiction treatment?

Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with:

• Alcoholics Anonymous (AA),
• Narcotics Anonymous (NA), and
• Cocaine Anonymous (CA),

all of which are based on the 12-step model, and Smart Recovery®. Most drug addiction treatment programs encourage patients to participate in a self-help group during and after formal treatment.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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I dedicate this book to you,

the wounded angels.

who have courageously

shared with me your stories...

You have touched my life in ways that

I can't possibly express,

and that you cannot imagine...

I have wept in your presence

in spite of the years of training

that cautioned me to be objective,

and to be still,

and to hide myself from you

while at the same time drawing you out...

They taught me that you were damaged

and that I would need to fix you...

I learned from you

that while you might be wounded,

you were still beautiful

and wise, and whole...

possessing healing tools of your own...

You so often believed

that yours was a story of pain,

of despair, and of failure...

Together we discovered that yours

was a story of courage, of survival,

of strength, and of hope...

Taken from the dedication page of "Finding The Forest: Treating Survivors of Trauma Integrating Brief, Holistic, and Narrative Techniques"

next:Essays, Stories: Telling Stories

Stand-up comedian Paul Jones discusses his feelings after being diagnosed with bipolar disorder and how the official bipolar diagnosis changed his life.

Personal Stories on Living with Bipolar Disorder

What were your feelings when you were "officially" diagnosed as having Bipolar I Disorder? How did the "official" diagnosis change your life, good or bad?

I was sitting in my office and was having very heavy thoughts of suicide - so heavy, in fact, that I had made a plan and was ready to carry it out. You see, I was going to come into my office and take an overdose of sleeping pills. I had everything planned out and was convinced that it was the only way to stop all of the pain that I was in. I was unable to write, I was not able to sleep, even though that's all I wanted to do. I was not able to finish any projects that I had going on.

Well, anyway, at some point, I looked up at the picture of my three children sitting on top of my computer table and thought to myself that this was the stupidest thing I would ever think of. What would they think of their father? I picked up the phone and called home and told my wife to get me in to see our family doctor. In a normal situation it would take three to four days to get in to see him. However, when Lisa called, they said that they had a cancellation and that I could get in at 1:30 p.m. I think that it was about 11:00 a.m. when I locked up the office and went home to wait for the appointment. I remember telling my wife that I could no longer take the pain and I wanted to end this whole thing.

When I showed up to the Doctor's office, it took every ounce of energy that I had to sit and wait in the waiting room. It seemed like I was sitting for hours, but in reality it was probably 30 minutes or so. One of the toughest things for me to realize was the fact that I could not handle this whole thing myself. You see, I have always been a person that fixed problems. I was the one that people would come to to make things better and here I was, unable to fix myself. All I could think of was that I was "weak" and nothing more than a big "sissy". Why was it that I could not stop all these thoughts of suicide? Why is it that other people could handle life and I was now unable to handle any part of it?

So, I got to the Doctor's office and Mark walked in. He asked me how I was feeling and then had me fill out a questionnaire for Bipolar Disorder. After answering, "yes" to all of the questions and telling him how I felt and the thoughts that had been going through my head for so many years, he told me that I was "Bipolar I". After he explained what that meant, I think I just sat and stared at him. It felt like I had said nothing for 15 minutes, but I am sure that it was only seconds.

I asked him what my options were and he told me that he wanted to put me on Celexa (citalopram hydrobromide) and see how I reacted to that. Needless to say, when I walked out of his office I felt like a huge weight had been lifted from my shoulders. As I look back now, I think it was something as simple as knowing that I was ill and not that I was "crazy" or "strange". You see, I think that when you know something is wrong with you, yet you don't actually know what it is, your mind can play a lot of tricks on you. It is amazing what thoughts go through your mind and why you are sitting wondering what your problem is. I had, for years, thought that I was manic-depressive, but without a doctor telling me that I was, I would simply go through each day wondering.

As soon as I got home and told my wife what the doctor had said, I went to the pharmacy and got my pills. It was funny - as happy as I was knowing that I was now able to put a name to the problem, getting those pills was very hard for me. Now I had to admit and face the music that I was sick. What would I tell my family? What would I tell people that I worked with, or should I even try to tell them? What was I going to tell my children and would they understand what I was saying to them?

I remember going home with pills in hand and going downstairs and getting on the Internet to read up on my "new found illness".

I can actually say that at times I wish I was never told that I was Bipolar. For some reason, it is now more of an issue to me knowing that I am sick. I know that, at times, when I make a decision, I find myself wondering whether or not I am making it or my illness is making it. At times I get angry at something and find myself wondering yet again if my anger is really from me or is it from the illness.

Like many with this illness, I have shared it with family and friends, and I cannot help but wonder if they look at me differently because of it. All in all, I would have to say that I am glad that I now know what is wrong with me, and only time will tell as to the full effects of knowing. I guess I would say that my life has changed somewhat for the better, but I do, at times, wish that I was still going through life as just "plain old carefree Paul Jones".

Read more about the author, Paul Jones on page 2 of this article.

Paul Jones, a nationally touring stand-up comedian, singer/songwriter, and businessman, was diagnosed with bipolar disorder in August 2000, just a short 3 years ago, although he can trace the illness back to the young age of 11 years old. Coming to grips with his diagnosis has taken many "twists and turns" not only for him, but also for his family and friends.

One of Paul's main focuses now is to educate others as to the effects this illness can have not only on those who suffer from bipolar disorder, but also the effects it has on those around them - the family and friends who love and support them. Stopping the stigma associated with any mental illness is paramount if proper treatment is to be sought by those that may be affected by it.

Paul has spoken at many high schools, universities, and mental health organizations as to what it's like to, "Work, Play, and Live with Bipolar Disorder."

Paul invites you to Walk the Path of Bipolar Disorder with him in his series of articles on Psychjourney. You are also cordially invited to visit his website at www.BipolarBoy.com.

Purchase his book, Dear World: A Suicide Letter

Book Description: In the United States alone, bipolar disorder impacts over 2 million citizens. Bipolar Disorder, Depression, Anxiety Disorders and other mentally-related illnesses affect 12 to 16 million Americans. Mental illness is the second leading cause of disability and premature mortality in the United States. The average length of time between the onset of bipolar symptoms and a correct diagnosis is ten years. There is real danger involved in leaving bipolar disorder undiagnosed, untreated or undertreated- people with bipolar disorder who do not receive proper help have a suicide rate as high as 20 percent.

Stigma and fear of the unknown compound the already complex and difficult problems faced by those who suffer from bipolar disorder and stems from misinformation and simple lack of understanding of this disease.

In a courageous attempt to understand the illness, and in opening his soul in an attempt to educate others, Paul Jones wrote Dear World: A Suicide Letter. Dear World is Paul's "final words to the world"- his own personal "suicide letter"- but it ended up being a tool of hope and healing for all who suffer from "invisible disabilities" such as bipolar disorder. It is a must read for those suffering from this illness, for those who love them and for those professionals who have dedicated their lives to try to help those who suffer from mental illness.

next: Sharing a Diagnosis of Bipolar Disorder with Family And Friends
~ bipolar disorder library
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Comments on recent research by Roy Baumeister.

Is pathological narcissism a blessing or a malediction?

The answer is: it depends. Healthy narcissism is a mature, balanced love of oneself coupled with a stable sense of self-worth and self-esteem. Healthy narcissism implies knowledge of one's boundaries and a proportionate and realistic appraisal of one's achievements and traits.

Pathological narcissism is wrongly described as too much healthy narcissism (or too much self-esteem). These are two absolutely unrelated phenomena which, regrettably, came to bear the same title. Confusing pathological narcissism with self- esteem betrays a fundamental ignorance of both.

Pathological narcissism involves an impaired, dysfunctional, immature (true) self coupled with a compensatory fiction (the False Self). The sick narcissist's sense of self-worth and self-esteem derive entirely from audience feedback. The narcissist has no self-esteem or self-worth of his own (no such ego functions). In the absence of observers, the narcissist shrivels to non-existence and feels dead. Hence the narcissist's preying habits in his constant pursuit of narcissistic supply. Pathological narcissism is an addictive behaviour.

Still, dysfunctions are reactions to abnormal environments and situations (e.g., abuse, trauma, smothering, etc.).

Paradoxically, his dysfunction allows the narcissist to function. It compensates for lacks and deficiencies by exaggerating tendencies and traits. It is like the tactile sense of a blind person. In short: pathological narcissism is a result of over-sensitivity, the repression of overwhelming memories and experiences, and the suppression of inordinately strong negative feelings (e.g., hurt, envy, anger, or humiliation).

That the narcissist functions at all - is because of his pathology and thanks to it. The alternative is complete decompensation and integration.

In time, the narcissist learns how to leverage his pathology, how to use it to his advantage, how to deploy it in order to maximize benefits and utilities - in other words, how to transform his curse into a blessing.

Narcissists are obsessed by delusions of fantastic grandeur and superiority. As a result they are very competitive. They are strongly compelled - where others are merely motivated. They are driven, relentless, tireless, and ruthless. They often make it to the top. But even when they do not - they strive and fight and learn and climb and create and think and devise and design and conspire. Faced with a challenge - they are likely to do better than non-narcissists.

Yet, we often find that narcissists abandon their efforts in mid-stream, give up, vanish, lose interest, devalue former pursuits, or slump. Why is that?

A challenge, or even a guaranteed eventual triumph - are meaningless in the absence of onlookers. The narcissist needs an audience to applaud, affirm, recoil, approve, admire, adore, fear, or even detest him. He craves the attention and depends on the narcissistic supply only others can provide. The narcissist derives sustenance only from the outside - his emotional innards are hollow and moribund.

The narcissist's enhanced performance is predicated on the existence of a challenge (real or imaginary) and of an audience. Baumeister usefully re-affirmed this linkage, known to theoreticians since Freud.

next: The Losses of the Narcissist

• Watch the video on Narcissistic Routines

The behaviour of the narcissist is regulated by a series of routines developed by rote learning and by repetitive patterns of experience. The narcissist finds change extremely distasteful and unsettling. He is a creature of habit. The function of these routines is to reduce his anxiety by transforming a hostile and arbitrary world into a hospitable and manageable one.

Granted, many narcissists are unstable - they often change jobs, apartments, spouses, and vocations. But even these changes are predictable. The narcissistic personality is disorganized - but also rigid. The narcissist finds solace in certainty, in recurrence, in the familiar and the anticipated. It balances his inner precariousness and volatility.

Narcissists often strike their interlocutors as "machine-like", "artificial", "fake", "forced", "insincere", or "spurious". This is because even the narcissist's ostensibly spontaneous behaviours are either planned or automatic. The narcissist is continuously preoccupied with his narcissistic supply - how to secure its sources and the next dose. This preoccupation restricts the narcissist's attention span. As a result, he often appears to be aloof, absent-minded, and uninterested in other people, in events around him, and in abstract ideas - unless, of course, they have a direct bearing on his narcissistic supply.

The narcissist develops some of his routines to compensate for his inability to attend to his environment. Automatic reactions require much less investment of mental resources (think driving).

Narcissists may fake personal warmth and an outgoing personality - this is the routine of the "Narcissistic Mask". But as one gets to know the narcissist better, his mask falls, his "narcissistic make-up" wears off, his muscles relax and he reverts to the "Narcissistic Tonus". The Narcissistic Tonus is a bodacious air of superiority mixed with disdain.

While routines (such as the various Masks) are extraneous and require an (often conscious) investment of energy - the Tonus is the default position: effortless and frequent.

Many narcissists are obsessive-compulsive as well. They conduct daily "rituals", they are overly punctilious, they do things in a certain order, and adhere to numerous "laws", "principles", and "rules". They have rigid and oft-repeated opinions, uncompromising rules of conduct, unalterable views and judgments. These compulsions and obsessions are ossified routines.

Other routines involve paranoid, repetitive, thoughts. Yet others induce shyness and social phobia. The whole range of narcissistic behaviours can be traced to these routines and the various phases of their evolutionary cycles.

It is when these routines break down and are violated - when they become no longer defensible, or when the narcissist can no longer exercise them - that a narcissistic injury occurs. The narcissist expects the outside world to conform to his inner universe. When a conflict between these two realms erupts, thus unsettling the ill-poised mental balance so painstakingly achieved by the narcissist (mainly by exercising his routines) - the narcissist unravels. The narcissist's very defence mechanisms are routines, and so he is left defenceless in a hostile, cold world - the true reflection of his inner landscape.

next: Pathological Narcissism - A Dysfunction or a Blessing?

I cannot confront my life - that dreary, aimless, unpromising stream of days and nights and days. I am past my prime - a pitiable figure, a has been who never was, a loser and a failure (and not only by my inflated standards). These facts are hard enough to face when one is not burdened with a grandiose False Self and a sadistic inner voice (superego). I have both.

So, when asked what do I do for a living, I say that I am a columnist and analyst (I am neither - I am a Senior Business Correspondent for United Press International - UPI. In other words, a glorified hack).

I say that I am a successful author (I am far from one). I say that I was the Economic Advisor to the government. True, I was - but at long last I was fired, having pushed my client to the point of nervous breakdown with my endless tantrums and labile fickleness.

But these lies - both outright and borderline - are known to me as such. I can tell the difference between reality and fantasy. I choose fantasy knowingly and consciously - but it doesn't render me oblivious to my true condition.

There is a different sort of self-deception which runs much deeper. It is more pernicious and all-pervasive. It is better at disguising itself as true and veritable. In the absence of outside help and reflection, I can never tell when (and how) I am self- deluded.

On the whole, I am that rarity, the reification of that oxymoron, the self-aware narcissist. I know that my teeth are rotten, my breath is bad, my flesh is flabby. I recognize my preposterous pomposity, my tortured syntax, my often disordered thinking, my compulsions, my obsessions, my regressions, my intellectual mediocrity, my perverted and melancholy sexuality. I know that my cognition is distorted and my emotions thwarted.

What appears to me to be genuine achievements - are often grandiose fantasies. What I take to be admiration - is mockery. I am not loved - I am exploited. And when I am loved - I exploit. I feel entitled - for no good reason. I feel superior - with no commensurate traits or achievements. I know all this. I have written about it extensively. I have expounded about it a thousand times.

And, yet, I keep getting surprised when confronted with reality. My feelings are hurt, my narcissism injured, my self esteem shaken, my rage provoked.

One becomes aware of one's place in various hierarchies - some implicit, some explicit - through social interactions. One learns that one is not alone in this world, one gets rid of the solipsistic and infantile "I am the (centre of the) world" point of view. The more one meets people - the more one becomes aware of one's relative skills and accomplishment.

In other words, one develops empathy.

But the narcissist's social range and repertoire are often limited. The narcissist alienates people. Many narcissists are schizoids. They interactions with others are stunted, partial, distorted, and misleading.

They learn the wrong lessons from the dearth of their social encounters. They are unable to realistically evaluate themselves, their skills, their achievements, their rights and privileges, and their expectations. They retreat to fantasy, denial, and self-delusion. They become rigid and their personality becomes disordered.

The other day, I said to one of my fiancé girlfriends, full of my usual hubris: "do you think I am a spy?" (i.e., mysterious, romantic, dark, clever). She looked at me disdainfully and responded: "Frankly, you remind me more of a shopkeeper than a spy".

I am a graphomaniac. I write prolifically about every subject, near and far. I post my work on Web sites and discussion lists, I submit it to the media, I publish it in books (that no one buys), I like to believe that I will be remembered by it. But people mostly find my essays lacking - the verbosity, the triteness, the convolutions of argumentation which often lead to a syllogistic dead-end.

It is when I write about the mundane that I excel. My political and economic columns are reasonable, though by no means spectacular and often in need of thorough editing. My few analytic pieces are good. Some of my poems are excellent. Many of my journal entries are praiseworthy. My work about narcissism is helpful, though badly written. The rest - the bulk of my writing - is trash.

Yet, I respond with outrage and shock when people tell me that. I attribute their well meant words to envy. I reject it fiercely. I counter-attack. I draw my bridges and ensconce myself in a shell of indignation. I know better. I am farsighted, a giant among intellectual dwarves, the tortured genius. The alternative is too painful to contemplate.

I like to think of myself as menacing. I like to think that I impress others with my clout and might. The other day someone said to me: "You know, you want to believe that you are frightening, you want to deter, to instill fear. But when you rage - you are merely being hysterical. It has the opposite effect. It is counter-productive".

I nurture my self-image as a machine: efficient, relentless, industrious, emotionless, reliable, and precise. I am always taken aback when people tell me that I am exceptionally emotional, that I am ruled by my feelings, that I am hyper-sensitive, that I have clear borderline traits.

Once, in response to a contemptuous remark I made about someone (call him "Joe"), his friend retorted: "Joe is cleverer than you because he makes more money than you. If you are so clever and efficient - how come you so poor?"

"I am not as corrupt as he" - I responded - "I wouldn't act as criminally and in collusion with the local venal politicians". I felt self-righteous and triumphant. I really BELIEVED in what I said. I felt indignant and infuriated by Joe's nefarious acts (of which I had no knowledge, nor any proof).

Joe's friend looked at me, not comprehending.

"But, in the last two years, you have served as advisor to these very venal politicians. Joe never worked with them as directly as you did." - she said softly - "And you did spend a year in jail for white collar crimes. Joe never did. What gives you the right to cast the first stone at him?"

There was sad amazement in her voice. And pity. A great pity.

next: Narcissistic Routines

4. How long does drug addiction treatment usually last?

Individuals progress through drug addiction treatment at various speeds, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate lengths of drug addiction treatment. Generally, for residential drug treatment or outpatient treatment of drug addiction, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated. For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years.

Good outcomes are contingent on adequate lengths of drug addiction treatment.

Many people who enter drug treatment drop out before receiving all the benefits that treatment can provide. Successful outcomes may require more than one drug treatment experience. Many drug addicts have multiple episodes of treatment, often with a cumulative impact.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

next: FAQ: What Helps People Stay in Drug Treatment?
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