The New Food Anxiety

Food shapes our identity and influences how we see the world.

Our food is better than ever. So why do we worry so much about what we eat? An emerging psychology of food reveals that when we swap sit-down for take-out, we cut our emotional ties to the table and food ends up fueling our worst fears. Call it spiritual anorexia.

Early in the 1900s, as America struggled to digest yet another wave of immigrants, a social worker paid a visit to an Italian family recently settled in Boston. In most ways, the newcomers seemed to have taken to their new home, language, and culture. There was, however, one troubling sign. "Still eating spaghetti," the social worker noted. "Not yet assimilated." Absurd as that conclusion seems now--especially in this era of pasta--it aptly illustrates our long-standing faith in a link between eating and identity. Anxious to Americanize immigrants quickly, U.S. officials saw food as a critical psychological bridge between newcomers and their old culture and as a barrier to assimilation.

Many immigrants, for example, did not share Americans' faith in large, hearty breakfasts, preferring bread and coffee. Worse, they used garlic and other spices, and mixed their foods, often preparing an entire meal in a single pot. Break these habits, get them to eat like Americans--to partake in the meat heavy, superabundant U.S. diet--and, the theory confidently held, you'd have them thinking, acting, and feeling like Americans in no time.

A century later, the link between what we eat and who we are is not nearly so simple. Gone is the notion of a correct American cuisine. Ethnic is permanently in, and the national taste runs from the red-hot spices of South America to the piquancy of Asia. U.S. eaters are in fact inundated by choice--in cuisines, cookbooks, gourmet magazines, restaurants, and, of course, in food itself. Visitors are still struck dumb by the abundance of our supermarkets: the myriad meats, year-round bonanza of fresh fruits and vegetables, and, above all, the variety--dozens of kinds of apples, lettuces, pastas, soups, sauces, breads, gourmet meats, soft-drinks, desserts, condiments. Salad dressings alone can take up several yards of shelf space. All told, our national supermarket boasts some 40,000 food items, and, on average, adds 43 new ones a day--everything from fresh pastas to microwavable fish-sticks.

Yet if the idea of a correct American cuisine is fading, so, too, is much of that earlier confidence we had in our food. For all our abundance, for all the time we spend talking and thinking about food (we now have a cooking channel and the TV Food Network, with celebrity interviews and a game show), our feelings for this necessity of necessities are oddly mixed. The fact is, Americans worry about food--not whether we can get enough, but whether we are eating too much. Or whether what we eat is safe. Or whether it causes diseases, promotes brain longevity, has antioxidants, or too much fat, or not enough of the right fat. Or contributes to some environmental injustice. Or is a breeding ground for lethal microbes. "We are a society obsessed with the harmful effects of eating," grouses Paul Rozin, Ph.D., professor of psychology at the University of Pennsylvania and a pioneer in the study of why we eat the things we eat. "We've managed to turn our feelings about making and eating food--one of our most basic, important, and meaningful pleasures--into ambivalence."

Rozin and his colleagues aren't just talking here about our frighteningly high rates of eating disorders and obesity. These days, even normal American eaters are often culinary Sybils, by turns approaching and avoiding food, obsessing over and negotiating (with themselves) what they can and can't have--generally carrying on in ways that would have flabbergasted our ancestors. It's the gastronomic equivalent of too much time on our hands.

Liberated from the "nutritional imperative," we've become free to write our own culinary agendas--to eat for health, fashion, politics, or many other objectives--in effect, to use our food in ways that often have nothing to do with physiology or nutrition. "We love with it, reward and punish ourselves with it, use it as a religion," says Chris Wolf, of Noble & Associates, a Chicago-based food marketing consultancy. "In the movie Steel Magnolias, somebody says that what separates us from the animals is our ability to accessorize. Well, we accessorize with food."

One of the ironies regarding what we eat--our psychology of food--is that the more we use food, the less we seem to understand it. Inundated by competing scientific claims, buffeted by conflicting agendas and desires, many of us simply wander from trend to trend, or fear to fear, with little idea of what we're seeking, and almost no certainty that it will make us happier or healthier. Our entire culture "has an eating disorder," argues Joan Gussow, Ed.D., professor emeritus of nutrition and education at Teachers College, Columbia University. "We are more detached from our food than at any time in history."

Beyond clinical eating disorders, the study of why people eat what they eat remains so uncommon that Rozin can count his peers on two hands. Yet for most of us, the idea of an emotional link between eating and being is as familiar as, well, food itself. For eating is the most basic interaction we have with the outside world, and the most intimate. Food itself is almost the physical embodiment of emotional and social forces: the object of our strongest desire; the basis of our oldest memories and earliest relationships.

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Lessons from Lunch

As children, eating and mealtimes figure hugely in our psychic theater. It's through eating that we first learn about desire and satisfaction, control and discipline, reward and punishment. I probably learned more about who I was, what I wanted, and how to get it at my family dinner table than anywhere else. It was there that I perfected the art of haggling--and had my first major test of will with my parents: an hours-long, almost silent struggle over a cold slab of liver. Food also gave me one of my first insights into social and generational distinctions. My friends ate differently than we did--their moms cut the crusts off, kept Tang in the house, served Twinkies as snacks; mine wouldn't even buy Wonder bread. And my parents could not do Thanksgiving dinner like my grandmother.

The dinner table, according to Leon Kass, Ph.D., a culture critic at the University of Chicago, is a classroom, a microcosm of society, with its own laws and expectations: "One learns self-restraint, sharing, consideration, taking turns, and the art of conversation." We learn manners, Kass says, not only to smooth our table transactions, but to create a "veil of invisibility," helping us avoid the disgusting aspects of eating and the often violent necessities of food production. Manners create a "psychic distance" between food and its source.

As we reach adulthood, food takes on extraordinary and complex meanings. It can reflect our notions of pleasure and relaxation, anxiety and guilt. It can embody our ideals and taboos, our politics and ethics. Food can be a measure of our domestic competence (the rise of our souffle, the juiciness of our barbecue). It can also be a measure of our love--the basis of a romantic evening, an expression of appreciation for a spouse--or the seeds of a divorce. How many marriages begin to unravel over food-related criticisms, or the inequities of cooking and cleaning?

Nor is food simply a family matter. It connects us to the outside world, and is central to how we see and understand that world. Our language is rife with food metaphors: life is "sweet," disappointments are "bitter," a lover is "sugar" or "honey." Truth can be easy to "digest" or "hard to swallow." Ambition is a "hunger." We are "gnawed" by guilt, "chew" over ideas. Enthusiasms are "appetites," a surplus, "gravy."

In fact, for all its physiological aspects, our relationship with food seems more a cultural thing. Sure, there are biological preferences. Humans are generalist eaters--we sample everything--and our ancestors clearly were too, leaving us with a few genetic signposts. We're predisposed to sweetness, for example, presumably because, in nature, sweet meant fruit and other important starches, as well as breast milk. Our aversion to bitterness helped us avoid thousands of environmental toxins.

A Matter of Taste

But beyond these and a few other basic preferences, learning, not biology, seems to dictate taste. Think of those foreign delicacies that turn our own stomachs: candied grasshoppers from Mexico; termite-cakes from Liberia; raw fish from Japan (before it became sushi and chic, that is). Or consider our capacity to not only tolerate but cherish such inherently off tastes as beer, coffee, or one of Rozin's favorite examples, hot chilies. Children don't like chilies. Even youngsters in traditional chili cultures like Mexico require several years of watching adults consume chilies before assuming the habit themselves. Chilies do spice up the otherwise monotonous diet--rice, beans, corn--many chili cultures must endure. By rendering starchy staples more interesting and palatable, chilies and other spices, sauces, and concoctions made it more likely that humans would eat enough of their culture's particular staple to survive.

In fact, for most of our history, individual preferences were not only probably learned, but dictated (or even subsumed entirely) by the traditions, customs, or rituals a particular culture had developed to ensure survival. We learned to revere staples; we developed diets that included the right mix of nutrients; we erected complex social structures to cope with hunting, gathering, preparation, and distribution. This isn't to say we had no emotional connection with our food; quite the contrary.

The earliest cultures recognized that food was power. How tribal hunters divided their kill, and with whom, constituted some of our earliest social relations. Foods were believed to bestow different powers. Certain tastes, such as tea, could become so central to a culture that a nation might go to war over it. Yet such meanings were socially determined; scarcity required hard and fast rules about food--and left little room for differing interpretations. How one felt about food was irrelevant.

Today, in the superabundance that characterizes more and more of the industrialized world, the situation is almost entirely reversed: food is less a social matter, and more about the individual--especially in America. Food is available here in all places at all times, and at such low relative cost that even the poorest of us can usually afford to eat too much--and worry about it.

Not surprisingly, the very idea of abundance plays a large role in American attitudes toward food, and has since colonial times. Unlike most developed nations of the time, colonial America began without a peasant diet reliant on grains or starches. Faced with the New World's astonishing natural abundance, especially of fish and game, the European diets many colonists brought over were quickly modified to embrace the new cornucopia.

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Food Anxiety and the Yankee Doodle Diet

Gluttony in the early days wasn't a concern; our early Protestantism allowed no such excesses. But by the 19th century, abundance was a hallmark of American culture. The portly, well-fed figure was positive proof of material success, a sign of health. At the table, the ideal meal featured a large portion of meat--mutton, pork, but preferably beef, long a symbol of success--served separately from, and unsullied by, other dishes.

By the 20th century, this now-classic format, which English anthropologist Mary Douglas has dubbed "1A-plus-2B"--one serving of meat plus two smaller servings of starch or vegetables--symbolized not only American cuisine but citizenship. It was a lesson all immigrants had to learn, and which some found harder than others. Italian families were constantly lectured by Americanizers against mixing their foods, as were the rural Polish, according Harvey Levenstein, Ph.D., author of Revolution at the Table. "Not only did [Poles] eat the same dish for one meal," Levenstein notes, "they also ate it from the same bowl. They therefore had to be taught to serve food on separate plates, as well as to separate the ingredients." Getting immigrants from these stew-cultures, which extended meat via sauces and soups, to adopt the 1A-plus-2B format was regarded a major success for assimilation, adds Amy Bentley, Ph.D., professor of food studies at New York University.

The emerging American cuisine, with its proud protein emphasis, effectively reversed eating habits developed over thousands of years. In 1908, Americans consumed 163 pounds of meat per person; by 1991, according to government figures, this had climbed to 210 pounds. According to food historian Elisabeth author of The Universal Kitchen, our tendency to top one protein with another--a slab of cheese on a beef patty, for example--is a habit many other cultures still regard as wretched excess, and is only our latest declaration of abundance.

There was more to America's culinary cockiness than mere patriotism; our way of eating was healthier--at least according to the scientists of the day. Spicy foods were overstimulating and a tax on digestion. Stews were non-nutritious because, according to the theories of the time, mixed foods couldn't efficiently release nutrients.

Both theories were wrong, but they exemplify how central science had become to the American psychology of food. The early settlers' need for experimentation--with food, animals, processes--had helped feed a progressive ideology that, in turn, whetted a national appetite for innovation and novelty. When it came to food, newer nearly always meant better. Some food reformers, like John Kellogg (inventor of corn flakes) and C. W. Post (Grape-Nuts), focused on increasing vitality through newly discovered vitamins or special scientific diets--trends that show no signs of fading. Other reformers lambasted the poor hygiene of the American kitchen.

Twinkies Time

In short order, the very concept of homemade, which had sustained colonial America--and is so prized today--was found unsafe, obsolete, and low class. Far better, reformers argued, were heavily processed foods from centralized, hygienic factories. Industry was quick to comply. In 1876, Campbell's introduced its first tomato soup; in 1920, we got Wonder bread and in 1930, Twinkies; 1937 brought the quintessential factory food: Spam.

Some of these early health concerns were valid--poorly canned goods are deadly--but many were pure quackery. More to the point, the new obsessions with nutrition or hygiene marked a great step in the depersonalization of food: the average person was no longer deemed competent to know enough about his or her food to get along. Eating "right" required outside expertise and technology, which American consumers increasingly embraced. "We just didn't have the food traditions to hold us back from the helter-skelter of modernity," says Gussow. "When processing came along, when the food industry came along, we didn't put up any resistance."

By the end of the second World War, which brought major advances in food processing (Cheerios arrived in 1942), consumers were increasingly relying on experts--food writers, magazines, government officials, and, in ever-greater proportions, advertisements--for advice on not only nutrition but cooking techniques, recipes, and menu planning. More and more, our attitudes were being shaped by those selling the food. By the early 60s, the ideal menu featured plenty of meat, but also concocted from the growing pantry of heavily-processed foods: Jello, canned or frozen vegetables, green-bean casserole made with cream of mushroom soup and topped with canned french-fried onions. It sounds silly, but then so are our own food obsessions.

Nor could any self-respecting cook (read: mother) serve a given meal more than once a week. Leftovers were now a blight. The new American cuisine demanded variety--different main courses and side-dishes every night. The food industry was happy to supply a seemingly endless line of instant products: instant puddings, instant rice, instant potatoes, gravies, fondues, cocktail mixers, cake mixes, and the ultimate space-age product, Tang. The growth in food products was staggering. During the late 1920s, consumers could choose among only a few hundred food products, only a portion of them branded. By 1965, according to Lynn Dornblaser, editorial director at the Chicago based New Product News, nearly 800 products were being introduced every year. And even that number would soon seem small. In 1975, there were 1,300 new products: in 1985 there were 5,617; and, in 1995, a whopping 16,863 new items.

In fact, in addition to abundance and variety, convenience was rapidly becoming the center of American food attitudes. As far back as Victorian times, feminists had eyed central food processing as a way to lighten the homemakers' burdens.

While the meal-in-a-pill ideal never quite arrived, the notion of high-tech convenience was all the rage by the 1950s. Grocery stores now had freezer cases with fruits, vegetables, and--joy of joys--pre-cut french fries. In 1954, Swanson made culinary history with the first TV dinner--turkey, cornbread stuffing, and whipped sweet potatoes, configured in a compartmentalized aluminum tray and packaged in a box that looked like the TV set. Although the initial price--98 cents--was high, the meal and its half-hour cooking time were hailed as a space-age marvel, perfectly in synch with the quickening pace of modern life. It paved the way for products ranging from instant soup to frozen burritos and, as importantly, for an entirely new mind-set about food. According to Noble & Associates, convenience is the first priority in food decisions for 30 percent of all American households.

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Granted, convenience was, and is, liberating. "The number-one attraction is spending time with the family instead of being in the kitchen all day," explains Wenatchee, Washington, restaurant manager Michael Wood, of the popularity of take-out home-cooked meals. These are called "home meal replacement" in industry parlance. But convenience's allure wasn't limited to the tangible benefits of time and saved labor.

Anthropologist Conrad Kottak has even suggested that fast-food restaurants serve as a kind of church, whose decor, menu, and even conversation between counter-clerk and customer are so unvaried and dependable as to have become a kind of comforting ritual.

Yet such benefits aren't without considerable psychic cost. By diminishing the wide variety of social meanings and pleasures once associated with food--for example, by eliminating the family sit-down dinner--convenience diminishes the richness of the act of eating and further isolates us.

New research shows that while the average upper-middle class consumer has some 20 contacts with food a day (the grazing phenomenon), the amount of time spent eating with others is actually falling. That's true even within families: three-quarters of Americans don't breakfast together, and sit-down dinners have fallen to just three a week.

Nor is convenience's impact simply social. By replacing the notion of three square meals with the possibility of 24-hour grazing, convenience has fundamentally altered the rhythm food once bestowed upon each day. Less and less are we expected to wait for dinner, or avoid spoiling our appetites. Instead, we eat when and where we want, alone, with strangers, on the street, on a plane. Our increasingly utilitarian approach to food creates what the University of Chicago's Kass calls "spiritual anorexia." In his book The Hungry Soul, Kass notes that, "Like the one-eyed Cyclops, we, too, still eat when hungry, but no longer know what it means."

Worse, our increasing reliance on prepared foods coincides with a diminished inclination or capacity to cook, which in turn, only further separates us--physically and emotionally--from what we eat and where it comes from. Convenience completes the decades long depersonalization of food. What is the meaning--psychological, social, or spiritual--of a meal prepared by a machine in a factory on the other side of the country? "We're almost to the point where boiling water is a lost art," says Warren J. Belasco, head of American studies at the University of Maryland and author of Appetite for Change.

Add Your Own... Water

Not everyone was satisfied with our culinary progress. Consumers found Swanson's whipped sweet-potatoes too watery, forcing the company to switch to white potatoes. Some found the pace of change too quick and intrusive. Many parents were offended by the pre-sweetened cereals in the 1950s, preferring, apparently, to spoon the sugar on themselves. And, in one of the true ironies in the Age of Convenience, lagging sales of the new just-add-water cake mixes have forced Pillsbury to un-simplify its recipes, excluding powdered eggs and oil from the mix so that homemakers could add their own ingredients and feel they were still actively participating in cooking.

Other complaints weren't easily assuaged. The post-WWII rise of factory food sparked rebellions by those who feared we were becoming alienated from our food, our land, our nature. Organic farmers protested the rising reliance on agri-chemicals. Vegetarians and radical nutritionists repudiated our meat passion. By the 1960s, a culinary counterculture was underway, and today, there are protests not just against meat and chemicals, but fats, caffeine, sugar, sugar substitutes, as well as foods that are not free-range, that contain no fiber, that are produced in an environmentally destructive way, or by repressive regimes, or socially unenlightened companies, to name but a few. As columnist Ellen Goodman has noted, "Pleasing our palates has become a secret vice, while fiber-fueling our colons has become an almost public virtue." It has fueled an industry. Two of the most successful brands ever are Lean Cuisine and Healthy Choice.

Clearly, such fads often have a scientific basis--the research on fat and heart disease is hard to dispute. Yet just as often, evidence for a particular dietary restriction is modified or eliminated by the next study, or turns out to have been exaggerated. More to the point, the psychological appeal of such diets has almost nothing to do with their nutritional benefits; eating the right foods is for many of us very satisfying--even if what's right may change with the next day's newspapers.

In truth, humans have been assigning moral values to foods and food practices forever. Yet Americans seem to have taken those practices to new extremes. Numerous studies have found that eating bad foods--those prohibited for nutritional, social, or even political reasons--can cause far more guilt than any measurable ill-effects might warrant, and not just for those with eating disorders. For example, many dieters believe they have blown their diets simply by eating a single bad food--irrespective of how many calories were ingested.

The morality of foods also plays a huge role in how we judge others. In a study by Arizona State University psychologists Richard Stein. Ph.D., and Carol Nemeroff, Ph.D., fictitious students who were said to eat a good diet--fruit, homemade wheat bread, chicken, potatoes--were rated by test subjects as more moral, likable, attractive, and in shape than identical students who ate a bad diet--steak, hamburgers, fries, doughnuts, and double-fudge sundaes.

Moral strictures on food tend to be heavily dependent on gender, with taboos against fatty foods strongest for women. Researchers have found that how much one eats can determine perceptions of attractiveness, masculinity, and femininity. In one study, women who ate small portions were judged more feminine and attractive than those who ate larger portions; how much men ate had no such effect. Similar findings turned up in a 1993 study in which subjects watched videos of the same average-weight woman eating one of four different meals. When the woman ate a small salad, she was judged most feminine; when she ate a big meatball sandwich, she was rated least attractive.

Given the power that food has over our attitudes and feelings for ourselves and others, it's hardly surprising that food should be such a confusing and even painful subject for so many, or that a single meal or a trip to the grocery store can involve such a blizzard of contradictory meanings and impulses. According to Noble & Associates, while just 12 percent of American households demonstrate some consistency in modifying their diets along health or philosophical lines, 33 percent exhibit what Noble's Chris Wolf calls "dietary schizophrenia": trying to balance their indulgences with bouts of healthy eating. "You'll see someone eat three slices of chocolate cake one day and just fiber the next," Wolf says.

With our modern traditions of abundance, convenience, nutrition science, and culinary moralizing, we want food to do so many different things that just enjoying food as food has come to seem impossible.

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Food Anxiety: Is Food the New Pornography?

In this context, the welter of contradictory and bizarre food behaviors seem almost logical. We're bingeing on cookbooks, food magazines, and fancy kitchenware--yet cooking far less. We chase the latest cuisines, accord celebrity status to chefs, yet consume more calories from fast food. We love cooking shows, even though, Wolf says, most move too fast for us to actually make the recipe at home. Food has become a voyeuristic pursuit. Instead of simply eating it, says Wolf, "we drool over pictures of food. It's food pornography."

There is evidence, however, that our obsession with variety and novelty may be on the wane or at least slowing down. Studies by Mark Clemens Research show that the percentage of consumers who say they're "very likely" to try new foods has dropped from 27 percent in 1987 to just 14 percent in 1995--perhaps in response to the overwhelming variety of offerings. And for all that magazines like Martha Stewart Living lend to culinary voyeurism, they may also reflect a yearning for traditional forms of eating and the simpler meanings that go with them.

Where can these impulses lead us? Wolf has gone so far as to rework psychologist Abraham Maslow's "hierarchy of needs" to reflect our culinary evolution. At the bottom is survival where food is simply calories and nutrients. But as our knowledge and income grow, we ascend to indulgence--a time of abundance, 16-ounce steaks, and the portly ideal. The third level is sacrifice, where we begin removing items from our diet. (America, says Wolf, is firmly on the fence between indulgence and sacrifice.) The final level is self-actualization: everything is in balance and nothing is dogmatically consumed or avoided. "As Maslow says, nobody ever really gets to be completely self-actualized--just in fits and starts."

Rozin, too, urges a balanced approach, particularly in our obsession with health. "The fact is, you can eat almost anything and grow and feel good," Rozin argues. "And no matter what you eat, you will eventually face deterioration and death." Rozin believes that to resign enjoyment to health, we've lost far more than we know: "The French have no ambivalence about food: it's almost purely a source of pleasure."

Columbia's Gussow wonders whether we simply think too much about our food. Tastes, she says, have become far too complex for what she calls "instinctive eating"--choosing foods we really need. In ancient times, for example, a sweet taste alerted us to calories. Today, it may indicate calories, or artificial sweetener; it may be used to hide fat or other flavors; it may become a kind of background flavor in nearly all processed foods. Sweet, salty, tart, spicy--processed foods are now flavored with incredible sophistication. One national brand of tomato soup is sold with five different flavor formulations for regional taste differences. A national spaghetti sauce comes in 26 formulations. With such complexities at work, "our taste buds are constantly being fooled," Gussow says. "And that forces us to eat intellectually, to consciously assess what we eat. And once you try to do that, you're trapped, because there's no way to sort through all these ingredients."

And how, exactly, are we to eat with more pleasure and instinct, less anxiety and less ambivalence, to regard our food less intellectually and more sensually? How can we re-connect with our food, and all the facets of life that food once touched, without simply falling prey to the next fad?

We can't--at least, not all at once. But there are ways of beginning. Kass, for example, has argued that even small gestures, such as consciously halting work or play to fully focus on your meal, can help recover an "awareness of the deeper meaning of what we're doing" and help mitigate the trend toward culinary thoughtlessness.

University of Maryland's Belasco has another strategy that begins with the simplest of tactics. "Learn to cook. If there is one thing you can do that is very radical and subversive," he says, "it is either starting to cook, or picking it up again." To create a meal from something other than a box or can requires reconnecting--with your cupboards and refrigerator, your kitchen utensils, with recipes and traditions, with stores, produce, and deli counters. It means taking time--to plan menus, to shop, and, above all, to sit and enjoy the fruits of your labors, and even invite others to share. "Cooking touches a lot of aspects of life," says Belasco, "and if you are really going to cook, then you're really going to have rearrange a lot of the rest of how you live."

next: Genes That Predispose Some People to Anorexia and Bulimia
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EEG Biofeedback or Neurofeedback

This drug free approach is becoming very popular in the USA and is also available in the UK (see below).
The EEG Spectrum website at http://www.eegspectrum.com/ explains it best......

EEG Biofeedback is a learning strategy that enables persons to alter their brain waves. When information about a person's own brain wave characteristics is made available to him, he can learn to change them. You can think of it as exercise for the brain.

What is it used for?
EEG Biofeedback is used for many conditions and disabilities in which the brain is not working as well as it might. These include Attention Deficit Hyperactivity Disorder and more severe conduct problems, specific learning disabilities, and related issues such as sleep problems in children, teeth grinding, and chronic pain such as frequent headaches or stomach pain, or pediatric migraines.

The training is also helpful with the control of mood disorders such as anxiety and depression, as well as for more severe conditions such as medically uncontrolled seizures, minor traumatic brain injury, or cerebral palsy."

Bal Singh from the UK writes:

"EEG Biofeedback or Neurofeedback pioneered in the USA has been available in the UK since 1996 from EEG Neurofeedback Services. This is the UK's only full-time comprehensive neurofeedback practice offering treatment as a NHS service provider or by private referral. As well as treating ADD/ADHD they have also dealt with a variety of other conditions such as Tics, Dyspraxia, Dyslexia, Learning Disabilities, Asthma, Epilepsy, etc. This leads to the elimination of medications such as Ritalin, Pemoline, Respiridone, Becotide, Epilim as the brain learns to take control. Actual write-ups from people who have received the treatment can be found at http://www.eegneurofeedback.net as well as local press/radio articles featuring the work of the practice. The work of the practice has also been featured nationally, in the Sunday Times, since 1998."

Alex Elsaesser, PARNET Assistant, Cerebra-For Brain Injured Children and Young People writes:

"The Imperial College School of Medicine is to start testing a remarkable NEW THERAPY for attention problems from the USA. This comes after two years of negotiations and a transatlantic trip for Professor Gruzelier instigated and funded by The Rescue Foundation - (now Cerebra-For Brain Injured Children and Young People).

The therapy requires no drugs, surgery or other invasive procedures, just training of the child to regulate their own brain!

It has been known for many years that children with attention, hyperactivity and learning problems often have abnormal brain waves (EEG) and that they can be trained to alter them. Professor Lubar of Tennessee has demonstrated repeatedly that when these children self-regulate their brain waves the symptoms of inattention and hyperactivity diminish or disappear altogether! But .... the first children that will have the opportunity to try this remarkable therapy in the UK will be those enrolled on the research program that is validating the therapy for the UK. The intention is to train appropriate professionals to make the therapy more widely available hopefully through the NHS."

Alex Elsaesser
PARNET Assistant, Cerebra-For Brain Injured Children and Young People, 13 Guildhall Square, 

Note: Please remember, we do not endorse any treatments and strongly advise you to check with your doctor before using, stopping or changing any treatment.

It's not unusual for Alzheimer's patients to need help choosing clothes and remembering to change clothes. Here are some suggestions.

The person with Alzheimer's disease may be reluctant to undress even when they go to bed, or they may refuse to change their clothes. It's important to make sure the person changes their clothes frequently without getting upset. Here are a few strategies you could use to persuade them:

• Remove the dirty clothing and put clean clothing in its place when they're in the bath or shower.
• Persuade them to change because someone is visiting.
• Say how much you'd love to see them wearing something new.

Unusual clothing and Alzheimer's

As long as it does no harm, it's probably better to accept the person dressing in an unusual way, or wearing clothing that is out of place, than to have a confrontation. If they're determined to wear a hat in bed, for example, or a heavy coat in summer, try to respect their choice.

Other aspects of grooming and Alzheimer's

When the person is dressed, help them with their hair. A woman may like to wear makeup or perfume. If she likes wearing jewelry, this is another opportunity for her to have a say in her appearance. If she enjoys having her nails painted, you might like to do this for her. A man may like to have his hair dressed with Brylcreme or to wear cuff links.

Boosting confidence with Alzheimer's Patients

Helping a person to look good is an important way to maintain their confidence. Regularly compliment the person on the way they look, and encourage them to take pride in their appearance.

What to wear and Alzheimer's

Look for clothes that are easy for the person to put on and take off, particularly if they live on their own, such as clothes with larger neck openings and front fastenings or no fastenings.

If you or the person you're caring for are struggling with getting dressed or undressed, make sure they have the right clothing, or make some adaptations:

• Use Velcro fastenings rather than buttons, or hooks and eyes.
• Shoes with laces may be difficult for someone with Alzheimer's to manage. Try well fitting slip-on shoes or shoes with Velcro fastenings, or replace shoelaces with elastic.
• Try to make sure the person doesn't wear slippers for more than a few hours as they may not offer enough support to the feet.
• If you're caring for a woman, front opening bras will be easier for you both to manage. Try to avoid self-supporting stockings as they can cause circulation problems.
• For men, boxer shorts may be easier to manage than Y-fronts.

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continue story below

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Sources:

• NIH Senior Health, Caring for Someone with Alzheimer's, March 19, 2002.
• Alzheimer's Society - UK, Information Sheet 510, June 2005.

next: Treatment Options for Alzheimer's Diseas

Excerpts from the Archives of the Narcissism List Part 43

1. Closure
2. The Narcissist's Body
3. Narcissists and Age
4. An Object Relations Approach to Understanding Unusual Behaviors and Disturbances

1. Closure

Everyone learns from experience. The question is what is learned.

The narcissist has alloplastic defenses. In other words, he tends to blame the world for failures, mishaps, problems, and defeats.

Because he has a preconceived notion of a hostile, menacing Universe - his experience only serves to fortify his prejudices. The narcissist learns nothing, forgets nothing, and forgives nothing.

A post-mortem of a relationship conducted with a narcissist is very frustrating because it never achieves closure. The narcissist is interested exclusively in allocating blame and generating guilt - not in progressing, developing, atoning, soothing, or concluding anything.

Such exercises in futility are best avoided.

2. The Narcissist's Body

Lowen in his 1983 book "Narcissism: Denial of the True Self" wrote: "Narcissists lack a sense of self derived from bodily feelings ... (T)hey deny feelings that contradict the image they seek."

The Self first coalesces around physical sensations confined to one's body, excretions, and contact with other physical entities (mainly, the mother). Freud believed that narcissists fail to learn how to shift their attentions and, later, emotions, onto external "objects" (people). Instead, their "Libido" (life and sex drive) is directed at their own body, both sexually (auto-eroticism, masturbation) and emotionally. This failure at "Object Relations" also leads to difficulties in recognizing and accepting the separateness of other people, their boundaries, and their independent emotions and needs.

I think that both Lowen and Freud are right.

However, to my mind, Freud is referring to the somatic narcissist - while Lowen deals with the cerebral one. Cerebral narcissists indeed loathe their body as a source of decay, decrepitude, disease, uncontrollable urges, and death.

3. Narcissists and Age

The Narcissistic and Antisocial personality disorders are so similar that many scholars and, more so, clinicians, suggested to abolish the distinction altogether. Yet, in some respects, there are differences.

Age is one of them.

The DSM IV-TR (2000) has this to say (page 704):

"By definition, Antisocial Personality Disorder cannot be diagnosed before age 18 years ... (It) has a chronic course but may become less evident or remit as the individual grows older, particularly by the fourth decade of life. Although this remission tends to be particularly evident with respect to engaging in criminal behavior, there is likely to be a decrease in the full spectrum of antisocial behaviors and substance use."

And about the Narcissistic Personality Disorder (p. 716):

"Narcissistic traits may be particularly common in adolescents and do not necessarily indicate that the individual will go on to have Narcissistic Personality Disorder (NPD). Individuals with NPD may have special difficulties adjusting to the onset of physical and occupational limitations that are inherent in the aging process."

The antisocial personality ameliorates with age and, very often, vanishes completely in midlife. Not so pathological narcissism. Many narcissists do get better as they mature, battered by life crises and faced with new responsibilities and new, sometimes painful, lessons.

But other narcissists only get worse. Age seems to accentuate the worst in them. I wrote about this deterioration here.

4. An Object Relations Approach to Understanding Unusual Behaviors and Disturbances

An essay by Kathyi Stringer surveys Object relations theory (mainly Mahler's work). I fully agree with her that this branch of psychodynamics possesses the strongest explanatory powers as far as childhood development and the emergence of psychopathology go.

The main problems with the limited versions of object relations are the neglect of all early infancy influences, bar the mother's - and the proliferation of postulated psychic structures, none of them directly observable. There isn't an agreement even as to basic terminology. Klein's "bad object" is "out thee" - Winnicott's is internalized.

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Additionally, the various phases and transitions - such as Separation-Individuation - are "smooth" and do not "leave psychological traces". Melanie Klein's work with its life-long "positions" (paranoid-schizoid and, later, depressive) partly saw to that - but, even so, some scholars (Daniel Stern) dispute the entire edifice based on clinical research.

It is not even agreed that the awareness of separate objects is not an innate, born, ability. Klein - a pillar of Object Relations Theory - thought that infants are born with an ego and the immediate ability to split the world into bad and good objects. Kohut suggested that narcissism and object-love co-exist throughout life and are born - not learned - qualities. And, as many a mother would attest, most children are aware of outside object long before they are 30 days old, the end of the Autistic Phase, according to Mahler.

Classic Object Relations theory also fails to explain the Rapprochement sub-phase of the Separation-Individuation phase. What brings about the separation anxiety that drives the child back into his mother's arms and provokes in it an acute sense of object inconstancy? How does the child transit from the symbiotic omnipotent dyad, in which the mother is a mere extension - into a state of quivering hysteria? Where does the realization of separateness emanate from? The development of language skills reflect this mysterious process - they do not induce it.

Aware of these weaknesses in Mahler's work, Object Relations theorists suggested that primary narcissism has numerous roots. The omnipotence attributed to the mother-extension in the symbiotic phase is only one of them. More about this in my Primer on Narcissism.

 

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next:   Excerpts from the Archives of the Narcissism List Part 44

Excerpts from the Archives of the Narcissism List Part 42

1. Decompensation
2. Introspection
3. Why does He Keep Coming Back?
4. Acting Civil, Saying Goodbye
5. Avoiding Pain
6. Prevalence of NPD
7. Long-term Planning
8. Love and Being Loved

1. Decompensation

Narcissism is a primitive (early life) defense mechanism. It is one of many deployed by the narcissist to prevent his personality from disintegrating (a state known as psychosis). The others are splitting, projection, projective identification, intellectualization, rationalization, denial and so on.

Under severe stress and duress, these defense mechanisms crumble. This is called decompensation.

At first, decompensation leads to acting out - outbursts, childish behavior, criminal activities, atypical substance abuse or reckless behavior, violence.

But if the stressful situation is prolonged and with no end in sight, psychotic micro-episodes are common and they may last from a few minutes up to 4 days each.

2. Introspection

Narcissists are incapable of introspection. This inability to "watch themselves from the outside" is what often gets them into trouble.

Only when the narcissist goes through a massive life crisis (divorce, death in the family, near death experience, bankruptcy, incarceration, abuse, humiliation, exile, etc.) - only then does he begin to reflect on his life and on himself.

But, even then, narcissists are interested in getting things "back to how they were" - not in changing.

Moreover, KNOWING something is not transformative. You've got to feel it, too (to have an "emotional correlate" amounting to an "insight").

3. Why does He Keep Coming Back?

Narcissists act (or refrain from acting) based solely on the availability of narcissistic supply (or lack thereof). If the narcissist keeps coming back - he does so because he is convinced that there is narcissistic supply to be obtained - or because he has yet to secure an alternative source of supply.

Narcissistic supply is about attention, however thwarted and depraved. Adversity, intrigue, fighting, notoriety, infamy, quarrelling, active rebuffing - all constitute narcissistic supply. If ignored consistently for a sufficiently long time, though, the narcissist is likely to let go, if he is not vindictive.

All past sources "qualify" for "re-activation" once the narcissist's supply has been depleted and no other sources are in sight.

Only past sources who made it unequivocally clear that they will allow no further contact are "exempt". But this is very rare. Even a divorce is not the end of the relationship with the narcissist. There is common property, common children, the occasional phone conversation, mail to be forwarded, etc.

Sources of PRIMARY supply are ranked by social status, fame/celebrity, wealth, power/influence, etc. Narcissistic supply emanating from a top politician or the CEO of a large company far outweighs anything offered by the neighborhood grocer.

Spouses or girlfriends provide secondary supply and, as sources, they are utterly interchangeable. Their role is to "accumulate" information about past supply and release it to the narcissist when supplies are low ("remember how famous you were in 1985?", "remember how you won the tournament?"). This is called "regulation" of narcissistic supply.

Thus, to recap, reversion to old sources of secondary supply is automatically triggered when the narcissist's supply has been depleted and no other sources are in sight.

4. Acting Civil, Saying Goodbye

The narcissist acts civil only towards potential sources of narcissistic supply. If your narcissist believes that you may supply him in the future - he will not devalue and discard you and will make the separation as courteous as possible. If he judges you to be "useless" as far as future narcissistic supply goes - he will likely dump you, discard, devalue and even purposefully hurt you in the process.

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That's all there is to it. Narcissists regard other people as you might regard a faucet. As long as it spews forth water - you maintain it. Once it stops - you ignore it without giving it a second thought.

But narcissists sometimes fail to say goodbye because they find it difficult to confront their own failure. It is too painful and threatening. The narcissist is a confabulation of omnipotence and perfection built on shaky, fallacious foundations. Failure means exposure and exposure might lead to the disintegration of the entire edifice. The narcissist thus prefers to simply abandon the scene of his defeat even as he declares victory unilaterally and counterfactually.

5. Avoiding Pain

Narcissists are terrified of pain. The False Self - the essence of pathological narcissism- is an elaborate, multilayered reaction to past traumas and their attendant anguish. The narcissist is conditioned by his torturous past to avoid grief at any cost - even at the cost of self-annihilation and re-invention as a narrative, a piece of fiction.

6. Prevalence of NPD

The incidence of the Narcissistic Personality Disorder (NPD) may be MUCHhigher than the reported figures (up to around 5% of the adult population). The reason NPD is under-reported is because narcissists rarely go to therapy, tend to charm and deceive the therapists once they do , and never admit that something is wrong with them even then.

7. Long-term Planning

The typical narcissist has a short attention span and believes that the world is a random, menacing place. Catch as catch can. Carpe Diem (seize the day). The narcissist lurches at any potential source with a "charm attack" that often, alas, proves irresistible.

Very few narcissists are sufficiently cold and calculated to cultivate long-term Sources of Supply.

Pathological narcissism - the addiction to and pursuit of Narcissistic Supply to regulate a labile sense of self-worth - is not a conscious choice, or a lifestyle, or a profession. It is the quiddity (the essence) of the narcissist. Do bees plan to sting? Do tigers analyze their hunting patterns? Do mothers love their children by design?

It just comes to the narcissist naturally.

I see a beautiful woman, who is also reasonably clever - and I want to "convert" her, to make her admire me, to cause her to spread news and views about me and "proselytize" to ever expanding circles of family and friends.

This wish is the psychological equivalent of hunger or thirst (or sex drive). It is a craving gradually translated into a plan of action.

But first comes the insatiable addiction to narcissistic supply - and only then a cognitive "blueprint" of hunting, conversion and conquest.

8. Love and Being Loved

Fear of commitment ("commitmentophobia") and intimacy is one thing. Inability to love and be loved is another.

All narcissists share the first. And, surprisingly, all narcissists share the second also!

The word "love" is understood by the narcissist to mean "dependence", "neediness", "ability to provide narcissistic supply", "becoming the narcissist's extension and property".

In these - distorted and sick - senses of the word, all narcissists love to be loved...

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next:   Excerpts from the Archives of the Narcissism List Part 43

Excerpts from the Archives of the Narcissism List Part 41

1. Interview with Tim Hall, published by New York Press
2. Interview granted to The Modern Author

1. Interview with Tim Hall, published by New York Press, February 12, 2003

The edited interview appeared here - http://www.nypress.com/16/7/news&columns/feature.cfm

Q: I'm very interested in the concept of corporate narcissism. Many companies are successful without also engaging in criminal behaviour. In your opinion, how much of the recent wave of business scandals in the U.S. is attributable to a corporate "culture of narcissism," and how much to a number of very misguided - and possibly narcissistic - individuals?

A: The "few rotten apples" theory ignores the fact that affairs like Enron and World.com were not isolated incidents - nor were they conducted conspiratorially and surreptitiously. What is now conveniently labeled "misconduct" was an open secret. Information - albeit often relegated to footnotes - was available. The charismatic malignant narcissists who headed these corporation were cheered on by investors, small and institutional alike. Their grandiose fantasies were construed as visionary. Their sense of entitlement - never commensurate with their actual achievements - was tolerated forgivingly. Their blatant exploitation of co-workers and stakeholders was part of the ethos of the virile Anglo-Saxon, natural selection, can-do, dare-do, version of capitalism. Everyone colluded in this mass psychosis. There are no victims here - only scapegoats.

Q: This relates to my first question. In the late 1990s you couldn't swing a dead cat on lower Broadway without hitting a dozen Internet "visionaries," touting companies which then went bankrupt. These individuals seemed to literally come out of nowhere--suddenly everybody was a Genius with a Big Idea. Again, I'm wondering if you have any thoughts on whether certain business cycles (like the Internet boom) actually create Narcissists, or simply attract numbers of pre-existing Narcissists, looking for quick and easy wealth.

A: The latter. Pathological (or malignant) narcissism is the outcome of a confluence of an appropriate genetic predisposition and early childhood abuse by role models, caretakers, or peers. It is ubiquitous because every human being - regardless of the nature of his society and culture - develops healthy narcissism early in life. Healthy narcissism is rendered pathological by abuse - and abuse, alas, is a universal human behaviour. By "abuse" I mean any refusal to acknowledge the emerging boundaries of the individual. Thus, smothering, doting, and excessive expectations are as abusive as beating and incest.

Pathological narcissism, though, can be latent and induced to emerge (to out) by what I call "collective narcissism". The WAY pathological narcissism manifests and is experienced is dependent on the particulars of societies and cultures. In some cultures, it is encouraged, in others suppressed. In collectivist societies, it may be projected onto the collective, in individualistic societies, it is an individual's trait. Families, businesses, industries, organizations, ethnic groups, churches, and even whole nations can be safely described as "narcissistic" or "pathologically self-absorbed".

The longer the association, or affiliation of the members - the more cohesive and conformist the inner dynamics of the group, the more shared are its grandiose fantasies ("the vision thing"), the more persecutory, or numerous its enemies, the more misunderstood and exclusionary it feels, the more intensive the physical and emotional experiences of its members. The stronger the bonding myth - the more rigorous the common pathology.

Such an all-pervasive and extensive malaise manifests itself in the behavior of each and every member. It is a defining - though often implicit or underlying - mental structure. It has explanatory and predictive powers. It is recurrent and invariable - a pattern of conduct melded with distorted cognition and stunted emotions. And it is often vehemently denied.

Q: What steps might a corporation take to protect it from being ruined by this kind of narcissistic contagion?

A: The first - and most obvious - step is screening. Mental health management is often considered a low organizational priority - frequently with calamitous outcomes. Employees on all levels - especially the upper echelons - should be tested periodically and regularly by professional diagnosticians for personality disorders. Those who test positive should be sacked. There is no way of containing narcissism. It is contagious - weaker people tend to emulate narcissists, stronger ones tend to adopt narcissistic behaviors in order to fend off the narcissist's unwelcome attentions and overweening demands.

Narcissistic behaviour - bullying, stalking, harassment, criminal predilections - should be proscribed and punished severely. Management should be attuned to warning signs - such as a persistent and recurrent inability to get along with all co-workers, a domineering sense of entitlement, unrealistic and grandiose fantasies, requiring excessive attention, responding with rage to criticism, or disagreement, excessive and destructive envy, exploitativeness, lack of empathy. Pathological narcissism rarely manifests in a first encounter - but is invariably revealed later on.

Q: The latest web craze is blogging. Some of these sites are focused on external subjects, like politics or technology, but the majority of them are online diaries wherein the owners attempt to self-mythologize the most mundane aspects of their existence. Are weblogs becoming the latest form of collective narcissism?

A: It depends on the blogger and the content of the blog. Not every act of self-centredness is narcissistic. A modicum of self-love, self-esteem and a sense of self-worth are all healthy. Pathological narcissism is rigorously defined. The narcissist feels grandiose and self-important (e.g., exaggerates achievements and
talents to the point of lying, demands to be recognized as superior without commensurate achievements). He (most narcissists are men) is obsessed with fantasies of unlimited success, fame, fearsome power, or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion.

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The narcissist is firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions). He requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (narcissistic supply).

The narcissist feels entitled. He expects unreasonable, or special and favorable priority treatment. He demands automatic and full compliance with his expectations, is "interpersonally exploitative", i.e., uses others to achieve his or her own ends, is devoid of empathy. The narcissist is unable or unwilling to identify with or acknowledge the feelings and needs of others. He is constantly envious of others and believes that they feel the same about him or her. He exhibits arrogant, haughty behaviors, or attitudes coupled with rage when frustrated, contradicted, or confronted.

Q: Would you say the Catholic Church is suffering from a kind of collective narcissism, given its history of protecting child molesters?

A: No, I would say that it is showing the same sense of self-preservation and Mob-like clubbiness that has characterized its history. The doctrine of the infallibility of the Pope, the Church's claim to possess privileged knowledge and unique access to the Creator, its pronounced lack of empathy for the victims of its misconduct, its self-righteous conviction, its belief that it is above human laws, its rigidity and so on - are all narcissistic traits and behavior patterns. But, to my mind, as an organization, it has crossed the line between pathological narcissism and psychopathy long ago. But then, I am a Jew and, therefore, somewhat biased.

Q: In an interview on healthyplace.com, in response to a question about how to reason and negotiate with a narcissist, you said, "That's a tough one. The narcissist is autistic." That interested me because I had just been reading about Asperger's Disorder, which is considered to be a form of high-functioning autism, and in some ways the symptoms are similar to NPD. Can you explain in some more detail about what you meant? Are you aware of any research linking AS with NPD?

A: People suffering from Asperger's Disorder lack empathy, are sensitive to the point of paranoid ideation, and are rigid with some obsessive-compulsive behaviours - all features of the Narcissistic Personality Disorder. As a result, their social skills are impaired and their social interactions thwarted. The presenting symptoms of both disorders are very similar. It is easy to misinterpret the Asperger's body language as haughtiness, for instance. Still, scholars today regard Asperger as part of a "schizoid spectrum" in common with the Schizoid Personality Disorder rather than the Narcissistic one.

Q: On your site, you say that a Narcissist can change his behaviour, but usually only after his world is in shambles. Further, even if he does change his behaviour, he cannot heal. This reminded me of the "bottoming-out" process that many drug addicts and alcoholics must go through before they will seek help. Likewise, 12-step movements assert that no addict is ever "cured." Can the philosophies of AA be successfully applied to the narcissist, or help in understanding narcissism?

A: The narcissist is addicted to a drug - his "narcissistic supply". He craves and relentlessly and ruthlessly pursues attention. In the absence of positive attention - adulation, admiration, affirmation, applause, fame, or celebrity - the narcissist makes do with the negative kind (notoriety, infamy). The dynamics of the narcissistic disorder, therefore, closely resemble the psychological dimensions of drug addiction, including the "bottoming-out" that you mentioned. I believe that the treatment modalities preferred by AA, Weight Watchers and 12 step programs should prove applicable to the Narcissistic Personality Disorder. Perhaps it is time to establish Narcissists Anonymous.

Q: Is the narcissist unwilling to change, or unable to change?

A: The narcissist is unwilling to change because pathological narcissism has been an adaptive and efficient reaction to the narcissist's life circumstances. Wilhelm Reich called the amalgam of such defence mechanisms an "armor". It restricts one's freedom of movement - but keeps out hurt and threat. The narcissist overcomes adversity by pretending it is isn't there or by reinterpreting events and circumstances to conform to his grandiose and fantastic internal landscape of perfection, omnipotence and omniscience. his narcissism. All narcissists are dimly aware that something has gone awry early on in their lives. But none of them sees why he should replace an existence of splendor - albeit mostly imaginary - with the drabness of the quotidian. The precarious balance of his chaotic and primitive personality vitally depends on the maintenance and furtherance of

Q: What is your advice to somebody who might read this and think that they live or work with a narcissist? What's the first thing they should do?

A: The first and the last thing they should do is disengage. Run, abandon, vanish. Make no excuses. Narcissism is dangerous to your health.

Q: Do you still live in Skopje, Macedonia? Can you tell me a little about where you live, what it's like?

A: I am an Israeli by birth. Upon my release from prison at the end of 1996, I moved to live in Macedonia. With the exception of 1998-9, when I had to flee Macedonia due to political agitation against the incumbent government's corruption, I have lived in Skopje ever since.

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Frozen at an early morning hour, the stony hands of the giant, cracked clock commemorate the horror. The earthquake that struck Skopje in 1963 has shattered not only its Byzantine decor, has demolished not merely the narrow passageways of its Ottoman past, has transformed not only its Habsburgian waterfront with its baroque National Theatre. The disastrous reconstruction, supervised by a Japanese architect, has robbed it of its soul. It has become a drab and sprawling socialist metropolis replete with monumentally vainglorious buildings, now falling into decrepitude and disrepair. The influx of destitute and simpleton villagers (which more than quintupled Skopje's population) was crammed by central planners with good intentions and avaricious nature into low-quality, hi-rise slums in newly constructed "settlements".

Skopje is a city of extremes. Its winter is harsh in shades of white and grey. Its summer is naked and steamy and effulgent. It pulses throughout the year in smoke-filled, foudroyant bars and dingy coffee-houses. Polydipsic youths in migratory skeins, eager to be noted by their peers, young women on the hunt, ageing man keen to be preyed upon, suburbanites in search of recognition, gold chained mobsters surrounded by flaxen voluptuousness - the cast of the watering holes of this potholed eruption of a city.

The trash seems never to be collected here, the streets are perilously punctured, policemen often substitute for dysfunctional traffic lights. The Macedonians drive like the Italians, gesture like the Jews, dream like the Russians, are obstinate like the Serbs, desirous like the French and hospitable like the Bedouins. It is a magical concoction, coated in the subversive patience and the aggressive passivity of the long oppressed. There is the wisdom of fear itself in the eyes of the 600,000 inhabitants of this landlocked, mountain-surrounded habitat. Never certain of their future, still grappling with their identity, an air of "carpe diem" with the most solemn religiosity of the devout.

The past lives on and flows into the present seamlessly. People recount the history of every stone, recite the antecedents of every man. They grieve together, rejoice in common and envy en masse. A single organism with many heads, it offers the comforts of assimilation and solidarity and the horrors of violated privacy and bigotry. The people of this conurbation may have left the village - but it never let them go. They are the opsimaths of urbanism. Their rural roots are everywhere: in the the division of the city into tight-knit, local-patriotic "settlements". In the traditional marriages and funerals. In the scarcity of divorces despite the desperate shortage in accommodation. In the asphyxiating but oddly reassuring familiarity of faces, places, behaviour and beliefs, superstitions, dreams and nightmares. Life in a distended tempo of birth and death and in between.

Skopje has it all - wide avenues with roaring traffic, the incommodious alleys of the Old Town, the proper castle ruins (the Kale). It has a Turkish Bridge, recently renovated out of its quaintness. It has a square with Art Nouveau building in sepia hues. An incongruent digital clock atop a regal edifice displayed the minutes to the millennium - and beyond. It has been violated by American commerce in the form of three McDonald restaurants which the locals proceeded cheerfully to transform into snug affairs. Stolid Greek supermarkets do not seem to disrupt the inveterate tranquility of neighbourhood small grocers and their coruscant congeries of variegated fruits and vegetables, spilling to the pavement.

In winter, the light in Skopje is diaphanous and lambent. In summer, tis strong and all-pervasive. Like some coquettish woman, the city changes mantles of orange autumn leaves and the green foliage of summer. Its pure white heart of snow often is hardened into grey and traitorous sleet. It is a fickle mistress, now pouring rain, now drizzle, now simmering sun. The snowy mountain caps watch patiently her vicissitudes. Her inhabitants drive out to ski on slopes, to bathe in lakes, to climb to sacred sites. It gives them nothing but congestion and foul atmosphere and yet they love her dearly. The Macedonian is the peripatetic patriot - forever shuttling between his residence abroad and his true and only home. Between him and his land is an incestuous relationship, a love affair unbroken, a covenant handed down the generations. Landscapes of infancy imprinted that provoke an almost Pavolvian reaction of return.

Skopje has known many molesters. It has been traversed by every major army in European history and then by some. Occupying a vital crossroad, it is a layer cake of cultures and ethnicities. To the Macedonians, the future is always portentous, ringing with the ominousness of the past. The tension is great and palpable, a pressure cooker close to bursting. The river Vardar divides increasingly Albanian neighbourhoods (Butel, Cair, Shuto Orizari) from Macedonian (non-Muslim) ones. Albanians have also moved from the villages in the periphery encircling Skopje into hitherto "Macedonian" neighbourhoods (like Karpos and the Centre). The Romas have their own ghetto called "Shutka" (in Shuto Orizari), rumoured to be the biggest such community in Europe. The city has been also "invaded" (as its Macedonian citizens experience it) by Bosnian Muslims. Gradually, as friction mounts, segregation increases. Macedonians move out of apartment blocks and neighbourhoods populated by Albanians. This inner migration bodes ill for future integration. There is no inter-marriage to speak of, educational facilities are ethnically-pure and the conflict in Kosovo with its attendant "Great Albania" rumblings has only exacerbated a stressed and anxious history.

It is here, above ground, that the next earthquake awaits, along the inter-ethnic fault lines. Strained to the point of snapping by a KFOR-induced culture shock, by the vituperative animosity between the coalition and opposition parties, by European-record unemployment and poverty (Albania is the poorest, by official measures) - the scene is set for an eruption. Peaceful by long and harsh conditioning, the Macedonians withdraw and nurture a siege mentality. The city is boisterous, its natives felicitously facetious, its commerce flourishing. It is transmogrified by Greek and Bulgarian investors into a Balkan business hub. But under this shimmering facade, a great furnace of resentment and frustration spews out the venom of intolerance. One impolitic move, one unkind remark, one wrong motion - and it will boil over to the detriment of one and all.

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Dame Rebecca West was here, in Skopje (Skoplje, as she spells it) about 60 years ago. She wrote:

"This (Macedonian) woman (in the Orthodox church) had suffered more than most other human beings, she and her forebears. A competent observer of this countryside has said that every single person born in it before the Great War (and quite a number who were born after it) has faced the prospect of violent death at least once in his or her life. She had been born during the calamitous end of Turkish maladministration, with its cycles of insurrection and massacre and its social chaos. If her own village had not been murdered, she had, certainly, heard of many that had and had never had any guarantee that hers would not some day share the same fate... and there was always extreme poverty. She had had far less of anything, of personal possessions, of security, of care in childbirth than any Western woman can imagine. But she had two possessions that any Western woman might envy. She had strength, the terrible stony strength of Macedonia; she was begotten and born of stocks who could mock all bullets save those which went through the heart, who could outlive the winters when they were driven into the mountains, who could survive malaria and plague, who could reach old age on a diet of bread and paprika. And cupped in her destitution as in the hollow of a boulder there are the last drops of the Byzantine tradition."

Q: Your book, "Malignant Self-Love - Narcissism Revisited" is a consistent high-seller on the Barnes & Noble website. Do you know how many copies are currently in print?

A: Yes, I do but it is a commercial secret, I am afraid.

Q: Is the book being used in any colleges or coursework to your knowledge?

A: None whatsoever. No self-respecting - and, more often than not, narcissistic - academic would admit to learning anything from a self-confessed narcissist and ex-con with no institutional affiliation. Academe's resistance to field work is coupled with a patronizing, navel-gazing, self-satisfied and autistic attitude. There are precious few mental health professionals who possess a real and profound grasp of narcissism - or who peruse the archives of my discussion lists - the record of interactions among thousands of narcissists and their victims and an invaluable, unique, resource. would readily admit to such deficiency. Very few bother to visit and

Q: Do you have any plans to come to the U.S. for any lectures or readings?

A: I would love to - but was never invited by anyone.

Q: What I found most fascinating about the book was not only the subject matter, but the style of writing and the intensely personal twist you bring to a subject that is usually treated in dry, impenetrable academic/psychiatric jargon. To me, your book is not only an essential primer on Narcissism, but it ranks as one of the great works of confessional literature. Have others noted the purely literary qualities of the book, apart from the clinical/psychological aspect?

A: I am flattered but beg to disagree. The book's literary qualities are, at best, questionable. My best writing is political (see, for instance, my articles in Central Europe Review) and economic (my articles published by United Press International-UPI). My poetry, I believe, is good as is my online journal. But my other work is verbose and convoluted. Luckily for my publisher, there is nothing that comes remotely close to it in scope and - this being a first hand account and a distillation of six years of correspondence with thousands of people - in penetration and accuracy.

Q: In the wake of these business scandals, the concept of narcissism seems to be appearing in the media more and more. Have you seen increased interest in your work in the past year or so?

A: Interest in narcissism has exploded after the bursting of the dot.com bubble in early 2000. My Web sites have hitherto garnered more than 4 million page views and are currently running at 15,000 page views per day. There are 4000 members in my various mailing lists. It is impossible to avoid my work when one queries a search engine, such as Google, or a human-edited directory such as the Open Directory Today, seven of every ten Web sites which deal with the issue mirror my content - including all the major ones. Phrases I have either coined or helped disseminate widely are routinely used by the profession and in the media, both print and electronic. My book, as you yourself have noted, is a bestseller in Barnesandnoble.com

Yet, hard to believe as this may sound, in six years of activity which touched the lives of hundreds of thousands, frequently in transforming ways, I have been interviewed only once by the major media (the New York Times last year). It is as if I did not exist. I am embittered and feel disenfranchised.

The amazing thing is that thousands of journalists and media people all over the world have been exposed to my work. Barely three or four of them - yourself included - have offered to write about it.

Q: Going back to the concept of 12-step programs and NPD, there's a saying in AA that "self-esteem is built by doing esteemable acts." Through your work and writing you have helped a great many people. Do you ever have moments where you feel genuinely good about yourself for helping others?

A: Yes, but the way a narcissist would. I enjoy my power to affect other people's lives, the narcissistic supply they provide me with and the attention this brings. Hence my consternation at the scant media attention I am getting.

Q: Regarding your own experience with NPD: with such a poor prognosis for sufferers, aren't you at least beating the odds when it comes to NPD? Would you say you are winning the battle, if not the war?

A: Undoubtedly, I have succeeded to harness the usually destructive power of narcissism and apply it productively for the common benefit of everyone involved. But it is still narcissism. I am still - exclusively - after narcissistic supply. I am as grandiose, as exploitative, as lacking empathy as I ever was. I feel as entitled as I ever did. I fly into rages, idealize and devalue and, in general, exhibit the full spectrum of narcissistic behaviors. Narcissism is a dynamic. Its outcomes can be either socially acceptable or condemnable - but the underlying corrosive phenomenon is the same. One cannot heal merely by cognitively accepting that one is diseased. The assimilation of such an insight requires an emotional complement, an investment of feelings and humility. I lack these.

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I once wrote in "The Malignant Optimism of the Abused":

"I often come across sad examples of the powers of self-delusion that the narcissist provokes in his victims. It is what I call "malignant optimism". People refuse to believe that some questions are unsolvable, some diseases incurable, some disasters inevitable. They see a sign of hope in every fluctuation. They read meaning and patterns into every random occurrence, utterance, or slip. They are deceived by their own pressing need to believe in the ultimate victory of good over evil, health over sickness, order over disorder. Life appears otherwise so meaningless, so unjust and so arbitrary... So, they impose upon it a design, progress, aims, and paths. This is magical thinking."

2. Interview granted to The Modern Author

The edited interview appeared here -

Q: Is this the only genre you write and if so have you ever been tempted to write something else (and what)?

A: I resist temptations poorly. Hence my varied portfolio: poetry, short fiction, nonfiction, political and economic articles, opinion columns and even mystery.

Q: What are the names/genres of your books? Where can they be found?

A: All my recent books - there are too many to enumerate here - can be found here: http://samvak.tripod.com/freebooks.html

Some of them can be freely downloaded - others must be purchased, I am afraid...

My Hebrew short fiction is available through here: http://samvak.tripod.com/sipurim.html

My poetry is here (warning: not for the squeamish!): http://samvak.tripod.com/contents.html

Older titles can be found or accessed through my biography page:

My United Press International (UPI) archive:http://vakninupi.cjb.net

Author archive of political columns in "Central Europe Review"

http://www.ce-review.org/authorarchives/vaknin_archive/vaknin_main.html

Q: Who/what influenced your writing?

A: In my youth I was swayed by authors such as Poe, Conan Doyle and other weavers of mystery and intrigue. I liked their baroque, Victorian style - penumbral and ponderous with a pathology lurking just beneath the surface.

My fiction, though, is post-modern: lean, amoral, documentary. My columns attempt to imitate the erudition and crispiness of The Economist - a tall order, admittedly.

Q: What is your favourite book?

A: By far, Alice in Wonderland. A prophetic tome which foretold the gathering storm of the 20th century: moral relativism, social disintegration, lethal authoritarianism, the absurd. A dark, haunting and disturbing masterpiece masterfully disguised as a nursery tale.

Q: Who is your favourite author?

A: A low-brow answer: Agatha Christie. The unwitting and morbidly fascinating chronicler of her own demise - the gradual fading of her milieu, her period, its mores and values, beliefs and superstitions, dreams and aspirations. The mirror of pre-Hitler Europe crack'd and then there were none. She was there, an indefatigable and uncannily observant documentarist of a dying era.

Q: Which book that you have written is your favourite?

A: My first book of short fiction - "Requesting my Loved One" (http://samvak.tripod.com/sipurim.html) - records the simultaneous processes of disintegration and self-revelation I experienced in jail. It is such an intensely intimate document that I dare not delve into now, years after it was published and won critical acclaim and awards.

But my favorite work is "After the Rain - How the West Lost the East" (http://samvak.tripod.com/after.html). It is an anthology of political jeremiads of biblical fury and imagery. I didn't know I had it in me.

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Q: When did you start writing?

A: My parents bought me a blackboard and chalk when I was three. I could read a daily paper by the age of six. I never stopped since. I prefer reading and writing to absolutely any other experience, bar films.

Q: How long does it take you to write a book?

A: I write c. 4-6 pages daily. I produce a typical 240 pages book of political and economic commentary and researched articles every 3 months.

Q: What would you like to ask another author (and which author)?

A: I would like to ask the great Austrian and German novelists - Musil, Werfel, Mann, Kafka (and the quasi-Frenchman Proust) - how they sustained the effort? I could never compose a work of fiction longer than 10 pages. How does one avoid plodding and the inexorable waning of the characters? How is the reader kept riveted to the last page?

Q: What advice would you give for aspiring authors?

A: It's all about marketing. Network, self-promote, spread the word, give free copies and free copy, collaborate with fellow authors, be generous, be ubiquitous, put the Internet to good use.

Q: What would you like to get out of being an author and your work?

A: Above all, I would like to make a difference. "Malignant Self Love - Narcissism Revisited" has touched the lives of many and changed them for the better. This is the only thing that counts, to my mind.

Q: What message (if any) would you like readers to take from your writing?

A: It is all in your hands. What happens to you and the fate of others in entirely in your hands. You have the power to make a difference and to change things. Do it now.

 

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next:   Excerpts from the Archives of the Narcissism List Part 42

Overview of tryptophan as a natural remedy for depression and whether tryptophan works in treating depression.

What is Tryptophan for Depression?

Tryptophan is an amino acid which is naturally present in the diet. It can also be taken as a dietary supplement either in the form of tryptophan or 5-hydroxytryptophan (5-HTP).

How does Tryptophan work?

Tryptophan in food is converted by the body into 5-hydroxytryptophan and then into serotonin. Serotonin is a chemical messenger in the brain which is in short supply in people who are depressed. By taking more tryptophan, the supply of serotonin in the brain will be increased.

Is Tryptophan effective for depression?

There have been a large number of studies on tryptophan, but most of these have been poor quality. There have been only two good quality studies. These studies found that tryptophan was more effective than placebo (dummy pills).

Are there any disadvantages?

The side-effects of Tryptophan include producing nausea and digestive problems. In 1989 there were over 30 deaths from Eosinophilia-Myalgia Syndrome in people taking tryptophan. It is not known whether these deaths were due to the tryptophan itself or some impurity when it was manufactured.

Where do you get Tryptophan?

Due to its possible risks, tryptophan is restricted in availability in a number of countries.

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Recommendation

Tryptophan may help depression. However, because of safety concerns, it cannot be recommended.

Key references Shaw K, Turner J, Del Mar C. Tryptophan and 5-hydroxytryptophan for depression (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd.

back to: Alternative Treatments for Depression

It's bothered me at times that as a male, I've been accused of thinking about sex often. I hear phrases by the females of my species that would suggest that thinking about sex often throughout the day is a negative activity. Many derogatory remarks surround the male thinking in regards to sex and how the activity of sex for men is not in line with what might be considered in our society as caring, nurturing, or respectful. So, why do men think about sex? Have we been trained from young boys to do so? Have we been trained to have sex and then leave the scene with very few words? Are we uncaring and disrespectful in our approach to sex? Maybe we do care a great deal and have an enormous respect for it, but in a way that nature intended and not as defined by the females of our species.

It appears to me that the male mammals on our planet have been engineered by nature to do something very important. This something ensures the continuance of each of our species of mammal so they do not fall into the throws of extinction. This something is the very essence of our existence.

Mammals reproduce.

Male mammals reproduce as often as possible. It is the core of their being. They eat and reproduce and they are engineered by nature to do so. It is a characteristic that is miraculous and should be celebrated by each species. If males had not been engineered to have this characteristic, we would parish. Our species would cease to exist. We did not choose this attribute; we were given it as a special gift by nature just as females were given the special gift of baring the life that, male and female create. We celebrate the miracle of growing children and the baring of them in the female of our species. I believe it to be important to also celebrate the miracle of reproductive desires by the male of our species and not judge nature's decision to engineer males in her way. . . as a negative.

It is one of the miracles of being a man. It is a celebrated process. It is life.

What nature has engineered males to care about, whether they want to or not, is the continuance of our species. This is a very noble purpose in the cycle of life on our planet. We have tremendous respect for this process and its important not to speak negatively about it to our children or to each other. Saying it is derogatory for men to want to have sex many times throughout the day is similar to saying it is derogatory for women to want to have babies. Both are important. Both are noble.

Shaming men for having been engineered by nature to want to reproduce is as destructive as shaming women for having been engineered by nature to want to have children.

next: About Me, Clinton Clark
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The sound of the Big Hole, lapping, moving slowly, October-like. I could sit here and breathe in the sage til I filled up with the fragrance so big, so strong, that I explode. Little pieces of me would fling for a mile across the river, into the cottonwoods, over the prickly pear and the juniper, till they finally reach the golden eagle rookery.

And a young eagle will say to its mother, "What's all these little pieces of stuff falling from Heaven; looks like aspen leaves, but it's not." And his mother would answer, "Oh, that's just pieces of that woman who loves sage. I've seen her here before. I've seen her pick sage twigs and juniper twigs and put them in her pocket. I've seen her looking up at us when we're in the sky, craning her neck back till she fell over. I've seen her sitting on the ground, holding sage against her nose, breathing it in. I knew something like this would happen to her if she kept doing that. She probably knew it too.

She loves this place. She loves our sky, our river, the willow, the juniper, the greasewood, the rocks, the old bones, the wild flowers; everything of the earth and sky she loves. She even loves every high-tailed little chipmunk that scurries around. You know, the ones we like to eat for dessert? I know all this because I've watched from the sky---with my eagle eye!

I've seen her on her back staring at our sky, watching the clouds roll across; the dolphin clouds, the shark clouds, the lace clouds, the long finger clouds. I've seen her face down on the ground, kissing it! Can you imagine? And that's where she wanted to be---a part of the earth---and that's what she is now. She breathed in so much sage power she just exploded. Sage Ecstasy.

I've heard her pray for rain, a healing rain, and it would come. Whatever she asked for, it would come. She asked to be a part of mother earth, and now you see these tiny pieces floating through the air like dry aspen leaves. They are sage woman, and she has come home. She has come home.

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continue story below

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More of Marg's wonderful work:

Restore Us

May the great waters
of the Creator
wash down
and cleanse us of
OUR HISTORY.

Wash the blood from
our hands,
our hearts.
Restore us, Creator,
all of us,
every one.

Restore the earth
OUR MOTHER,
and all her children.
Restore us to
Harm-less-ness.

Let no harm
be in us
ever again.

Let us, Creator,
remember LOVE,
which will
bring us home
again.

(©Marg Garner, Dillon, Montana - February 4, 1997)

Cluster Picking

I don't remember why they made us do it,
pick those beans, three cents a pound.
Maybe I was 13...now it seems like a life
somebody else lived...like I died
and was resurrected later down the line.
People at the factory said
don't cluster pick, hold with the left,

pick with the right...leave the baby beans.
But God, it was hot, awful hot,
and the rows went on all day long.
A bean-at-a-time took forever
while we drug those burlap bags
up and down...up and down...
the only shade made by those

awful green vines where spiders
clung to leaves, to beans.
I don't know who told us we had to do it.
Maybe for pocket money
Dad was always drunk.

We were a truck-load of kids in
The black dark at 5 a.m.
I hated leaving the covers
My refuge in that other life
The life that's gone.

And there's nothing
Left of the 'me' that was then.
Well, maybe the part that hates spiders, and
green beans, and getting up in the morning
and the part that would cluster pick
if I thought I could get away with it.

(© Marg Garner, Dillon, Montana. Reprinted with permission. Marg Garner is a writer of short stories, essays and poetry.)

next:Gifts from the Web

It was about a month after starting my new job, that I started having crying fits and felt out-of-sorts all the time. There was this burning ache in my chest that wouldn't go away. Even though my duties at work were light, everything seemed impossible to do, and just walking through the door was intimidating. I began confiding in a couple of friends that something was terribly wrong, and they just listened--which for awhile was very comforting, but it began to ring hollow within a couple of months.

By September, I was depressed nearly all the time, and didn't want to talk to anyone for any reason--mostly because I didn't want to sadden them. I was withdrawn, even at work. At some point, the notion that I'd be like that for the rest of my life became unbearable. The natural result of that was that I started thinking about suicide. I imagined all sorts of neat and clean ways to do myself in. After a week of intermittent suicidal thoughts, it finally occurred to me that this wasn't right. I recalled signs listing the symptoms of depression that used to be up in my college dorm hallway and I knew that I fit just about all of them.

By this point, I knew I needed help. Still, I put it off. The embarrassment of telling my doctor, and the fear that I wouldn't get better, nearly paralyzed me. But one day, I collapsed in a crying fit, at work and literally bawled for a half-hour straight. No one was around, thankfully, but the chance that someone might have seen me, was enough. The embarrassment of asking for help, couldn't be worse than having co-workers come across me like that. So I made a call and saw my doctor. (To show you how seriously he took it, when I asked for an appointment, his secretary initially set one for about 3-weeks away. She asked what was wrong. When I told her I thought I was depressed, she made it for the next day.) The doctor started me on Prozac.

Just this, was enough to cheer me a little. My doctor had been helpful and supportive and assured me that I'd be well. However, even though he suggested therapy as an option, I didn't pursue it. I didn't want to have to explain my past to a stranger. Moreover, I had been trying to forget it about my past for 20 years. The last thing I wanted was to dig it all up again!

I found out the hard way that this doesn't work. The Prozac helped for a little while, but I worsened again. This time, I was sure that nothing would help. If I was getting depressed while on medication, then ... well, that was it. There was no hope of a cure. So I kept going downhill, eventually getting even worse than before.

In early January 1997, I took a day off from work. I was just too depressed to go. The day grew worse until, in the afternoon, I put together a suicide plan. Before I could follow through though, my wife came home from her job a couple hours early and found me crying in bed. She called my doctor who asked to talk with me. And then came the golden question: "Have you thought about hurting yourself?"

That, I think, was a defining moment. I could've denied that I'd been planning suicide, but that would get me nowhere (except dead). So I broke down and admitted I'd made a plan and was a few minutes away from it, before I "got caught." My doctor sent me to the emergency room and I was admitted to the hospital psych ward, that night.

I was in the hospital well over a week. There were group therapy sessions and the nurses and counselors all spent time with me trying to find the cause(s) of my depression. It took several days, but I finally started talking about things that had happened 20-to-30 years ago. I remembered things that happened that I'd long forgotten. Such as the time some kids threw me down a flight of stairs at school, in sight of a teacher, who just laughed. There were many other things which I will not go into here. Suffice it to say that I arrived at the hospital in terrible shape, and actually got worse as these things were revealed. However, by about a week after admission, I started to see that none of it was my fault and that I was no longer that bothersome little knee-biter that noone wanted to deal with. Reality was not what I'd believed it to be.

Since then it's been a long, long uphill climb. Since that first hospital admission, I've been back there three times. These setbacks aside, I've slowly gotten better. But I have a long way to go yet, and probably will have a few more breakdowns.

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