Question:

You mention three different types of victims of the narcissist. What things would cause a narcissist to victimise a significant other sadistically versus just discarding them when no longer useful?

Answer:

The narcissist simply discards people when he becomes convinced that they can no longer provide him with Narcissistic Supply. This conviction, subjective and emotionally charged, does not have to be grounded in reality. Suddenly - because of boredom, disagreement, disillusion, a fight, an act, inaction, or a mood - the narcissist wildly swings from idealisation to devaluation.

The narcissist then detaches immediately. He needs all the energy he can muster to obtain new Sources of Narcissistic Supply and would rather not spend these scarce resources over what he regards as human refuse, the waste left after the extraction of Narcissistic Supply.

A narcissist would tend to display the sadistic aspect of his personality in one of two cases:

1. That the very acts of sadism generate Narcissistic Supply to be consumed by the narcissist ("I inflict pain, therefore I am superior"), or
2. That the victims of his sadism are still his only or major Sources of Narcissistic Supply but are perceived by him to be intentionally frustrating and withholding. Sadistic acts are his way of punishing them for not being docile, obedient, admiring and adoring as he expects them to be in view of his uniqueness, cosmic significance, and special entitlement.

The narcissist is not a full-fledged sadist, masochist, or paranoiac. He does not enjoy hurting his victims. He does not believe firmly that he is the focal point of persecution and the target of conspiracies.

But, he does enjoy punishing himself when it provides him with a sense of relief, exoneration and validation. This is his masochistic streak.

Because of his lack of empathy and his rigid personality, he often inflicts great (physical or mental) pain on meaningful others in his life - and he enjoys their writhing and suffering. In this restricted sense he is a sadist.

To support his sense of uniqueness, greatness and (cosmic) significance, he is often hypervigilant. If he falls from grace - he attributes it to dark forces out to destroy him. If his sense of entitlement is not satisfied and he is ignored by others - he attributes it to the fear and inferiority that he provokes in them. So, to some extent, he is a paranoid.

The narcissist is as much an artist of pain as any sadist. The difference between them lies in their motivation. The narcissist tortures and abuses as means to punish and to reassert superiority, omnipotence, and grandiosity. The sadist does it for pure (usually, sexually-tinged) pleasure. But both are adept at finding the chinks in people's armours. Both are ruthless and venomous in the pursuit of their prey. Both are unable to empathise with their victims, self-centred, and rigid.

The narcissist abuses his victim verbally, mentally, or physically (often, in all three ways). He infiltrates her defences, shatters her self-confidence, confuses and confounds her, demeans and debases her. He invades her territory, abuses her confidence, exhausts her resources, hurts her loved ones, threatens her stability and security, enmeshes her in his paranoid state of mind, frightens her out of her wits, withholds love and sex from her, prevents satisfaction and causes frustration, humiliates and insults her privately and in public, points out her shortcomings, criticises her profusely and in a "scientific and objective" manner - and this is a partial list.

Very often, the narcissist sadistic acts are disguised as an enlightened interest in the welfare of his victim. He plays the psychiatrist to her psychopathology (totally dreamt up by him). He acts the guru, the avuncular or father figure, the teacher, the only true friend, the old and the experienced. All this in order to weaken her defences and to lay siege to her disintegrating nerves. So subtle and poisonous is the narcissistic variant of sadism that it might well be regarded as the most dangerous of all.

Luckily, the narcissist's attention span is short and his resources and energy limited. In constant, effort consuming and attention diverting pursuit of Narcissistic Supply, the narcissist lets his victim go, usually before it had suffered irreversible damage. The victim is then free to rebuild her life from ruins. Not an easy undertaking, this - but far better than the total obliteration which awaits the victims of the "true" sadist.

If one had to distil the quotidian existence of the narcissist in two pithy sentences, one would say:

The narcissist loves to be hated and hates to be loved.

Hate is the complement of fear and narcissists like being feared. It imbues them with an intoxicating sensation of omnipotence.

Many of them are veritably inebriated by the looks of horror or repulsion on people's faces: "They know that I am capable of anything."

The sadistic narcissist perceives himself as Godlike, ruthless and unscrupulous, capricious and unfathomable, devoid of emotions and asexual, omniscient, omnipotent and omnipresent, a plague, a devastation, an inescapable verdict.

He nurtures his ill-repute, stoking it and fanning the flames of gossip. It is an enduring asset. Hate and fear are surefire generators of attention. It is all about Narcissistic Supply, of course - the drug which narcissists consume and which consumes them in return.

Deep inside, it is the horrid future and inescapable punishment that await the narcissist that are irresistibly appealing. Sadists are often also masochists. In sadistic narcissists, there is, actually, a burning desire - nay, need - to be punished. In the grotesque mind of the narcissist, his punishment is equally his vindication.

By being permanently on trial, the narcissist defiantly claims the high moral ground and the position of the martyr: misunderstood, discriminated against, unjustly roughed, outcast due to his very towering genius or other outstanding qualities.

To conform to the cultural stereotype of the "tormented artist", the narcissist provokes his own suffering. He is thus validated. His grandiose fantasies acquire a modicum of substance. "If I were not so special, they surely wouldn't have persecuted me so." The persecution of the narcissist proves his uniqueness. To "deserve" or provoke it, he must be different, for better or for worse.

The narcissist's aforementioned streak of paranoia makes his persecution inevitable. The narcissist is in constant conflict with "lesser beings": his spouse, his shrink, his boss, his colleagues, the police, the courts, his neighbours. Forced to stoop to their intellectual level, the narcissist feels like Gulliver: a giant shackled by Lilliputians. His life is a constant struggle against the self-contented mediocrity of his milieu. This is his fate which he accepts, though never stoically. It is his calling and the mission of his stormy life.

Deeper still, the narcissist has an image of himself as a worthless, bad and dysfunctional extension of others. In constant need of Narcissistic Supply, he feels humiliated by his dependency. The contrast between his grandiose fantasies and the reality of his habit, neediness and, often, failure (the Grandiosity Gap) is an emotionally corroding experience. It is a perpetual background noise of devilish, demeaning scorn. His inner voices "say" to him: "You are a fraud", "You are a zero", "You deserve nothing", "If only they knew how worthless you are".

The narcissist attempts to silence these tormenting voices not by fighting them but by agreeing with them. Unconsciously - sometimes consciously - he "responds" to them: "I do agree with you. I am bad and worthless and deserving of the most severe punishment for my rotten character, bad habits, addiction and the constant fakery that is my life. I will go out and seek my doom. Now that I have complied - will you leave me alone? Will you let me be?"

Of course, they never do.

next: Crime and Punishment: The Never Repenting Narcissist

More about these issues in "Metaphors of the Mind - Part II" and "Metaphors of the Mind - Part III".

Background

This dream was related to me by a male, 46 years old, who believes that he is in the throes of a major personal transformation. Whether he is a narcissist (as he believes himself to be) or not is quite irrelevant. Narcissism is a language. A person can choose to express himself in it, even if he is not possessed by the disorder. The dreamer made this choice.

Henceforth, I will treat him as a narcissist, though insufficient information renders a "real" diagnosis impossible. Moreover, the subject feels that he is confronting his disorder and that this could be a significant turning point on his way to being healed. It is in this context that this dream should be interpreted. Evidently, if he chose to write to me, he is very preoccupied with his internal processes. There is every reason to believe that such conscious content invaded his dream.

The Dream

"I was in a run-down restaurant/bar with two friends sitting at a table in a large open area with a few other tables and a bar. I did not like the music or the smoky atmosphere or other customers or greasy food, but we were travelling and were hungry and it was open and the only place we could find.

There was a woman with other people at a table about 10 feet in front of me that I found attractive, and noticed she was noticing me as well. There was also another woman with other people at a table about 30 feet to my right, old with heavy make-up and poorly dyed hair, loud, obnoxious, drunk who noticed me. She started saying negative things to me, and I tried to ignore her. She just got louder and more derogatory, with horrible rude and jabbing comments. I tried to ignore her, but my other friends looked at me with raised eyebrows, as if to ask: 'How much more are you going to take before you stand up for yourself?' I felt sick to my stomach, and did not want to confront her, but everyone in the place was now noticing her confrontation of me, and she was almost screaming at me. I couldn't believe no one was telling her to stop it, to be civil, to be nice.

I finally looked over at her and raised my voice and told her to shut up. She looked at me and seemed to get even angrier, and then looked at her plate and picked up a piece of food and threw it at me! I couldn't believe it. I told her I wasn't going to take one more thing, and to stop it now or I would call the police. She got up, walked towards me, picking up a plate of popcorn from another table, and upended it flat upon the top of my head. I stood up and said: 'That's it! That's assault! You're going to jail!' and went to the cash register area by the door and called the police.

The police instantly appeared and took her away, with her resisting arrest the whole time. I sat down and someone at the table next to me said: 'Now you can open up the dam gate.' I said: 'What?', and he explained how the woman was actually pretty powerful and owned a dam and had shut the gate down years ago, but that now she was locked up we could go open it up.

We piled into a truck and I was led into a cavernous room and shown a small room with a glass wall in it and a big wheel, a control valve. I was told that I could turn it whenever I wanted. So I started to turn it and the water started flowing. I could easily see it through the glass, and the level on the glass rose higher the more I turned the wheel. Soon there was a torrent, and it was thrilling. I had never seen such an incredible roar of water. It was like the Niagara Falls flowing through the huge room. I got frightened along with being thrilled, but discovered I could lessen the water with the valve if it got to be too much. It went on for a long time, and we whooped and laughed and felt so excited. Finally, the water grew less no matter how wide I opened the valve, and it reached a steady flow.

I noticed the pretty woman from the grill way across the huge area, and she seemed to be looking for someone. I hoped it was me. I opened the door, and went out to go meet her. On the way out, I got grease on my hand, and picked up a rag on the table to wipe it off. The rag had even more grease on it, and so now my hands were completely covered in grease. I picked up another rag on top of a box, and there were wet spark plugs stuck with globs of grease to the underside of the rag, lined up in order as if they used to be in an engine and someone stuck them in this order on purpose, and some of it got on my clothes. The guys with me laughed and I laughed with them, but I left without going to meet the woman, and we went back to the grill.

I found myself in a tiny room with a table in it and a picture window looking out into the area where everyone was sitting and eating. The door was open into a back hallway. I started to go out, but a man was coming into the room. For some reason he frightened me, and I backed up. However, he was robot-like, and walked to the window and looked out to the dining area, making no indication that he even noticed me, and stared blandly at the people having fun. I left and went out into the dining area. I noticed everyone staring at me in an unfriendly way. I started for the exit, but one of the policemen who had arrested the woman from the night before was off-duty in plain clothes and grabbed my arm and twisted me around and shoved me face down on a table. He told me that what I did to the woman was wrong, and that no one liked me because of it. He said that just because I had the law on my side and was in the right didn't mean anyone would like me. He said if I was smart I would leave town. Others were around me and spit on me.

He let me go, and I left. I was driving in a car alone out of town. I didn't know what became of the friends I was with. I felt both elated and ashamed at the same time, crying and laughing at the same time, and had no idea where to go and what I was doing."

The Interpretation

As the dream unfolds, the subject is with two friends. These friends vanish towards the end of the dream and he doesn't seem to find this worrisome. "I didn't know what became of the friends I was with." This is a strange way to treat one's friends. It seems that we are dealing not with three dimensional, full-blown, flesh and blood friends but with FRIENDLY MENTAL FUNCTIONS. Indeed, they are the ones who encourage the subject to react to the old woman's antics. "How much more are you going to take before you stand up for yourself?" - they ask him, cunningly. All the other people present at the bar-restaurant do not even bother to tell the woman "to stop, to be civil, to be nice". This eerie silence contributes to the subject's reaction of disbelief that mushrooms throughout this nightmare. At first, he tries to emulate their behaviour and to ignore the woman himself. She says negative things about him, goes louder and more derogatory, horribly rude and jabbing and he still tries to ignore her. When his friends push him to react: "I felt sick to my stomach and did not want to confront her." He finally does confront her because "everyone was noticing" as she was almost screaming at him.

The subject emerges as the plaything of others. A woman screams at him and debases him, friends prod him to react, and motivated by "everyone" he does react. His actions and reactions are determined by input from the outside. He expects others to do for him the things that he finds unpleasant to do by himself (to tell the woman to stop, for instance). His feeling of entitlement ("I deserve this special treatment, others should take care of my affairs.") and his magical thinking ("If I want something to happen, it surely will.") are so strong - that he is stunned when people do not do his (silent) bidding. This dependence on others is multi-faceted. They mirror the subject to himself. He modifies his behaviour, forms expectations, gets disbelievingly disappointed, punishes and rewards himself and takes behavioural cues from them ("The guys with me laughed and I laughed with them."). When confronted with someone who does not notice him, he describes him as robot-like and is frightened by him. The word "look" disproportionately recurs throughout the text. In one of the main scenes, his confrontation with the rude, ugly woman, both parties do not do anything without first "looking" at each other. He looks at her before he raises his voice and tells her to shut up. She looks at him and gets angrier.

The dream opens in a "run down" restaurant/bar with the wrong kind of music and of customers, a smoky atmosphere and greasy food. The subject and his friends were travelling and hungry and the restaurant was the only open place. The subject takes great pains to justify his (lack of) choice. He does not want us to believe that he is the type of person to willingly patronise such a restaurant. What we think about him is very important to him. Our look still tends to define him. Throughout the text, he goes on to explain, justify, excuse, reason and persuade us. Then, he suddenly stops. This is a crucial turning point.

It is reasonable to assume that the subject is relating to his personal Odyssey. At the end of his dream, he continues his travels, continues his life "ashamed and elated at the same time". We are ashamed when our sense of propriety is offended and we are elated when it is reaffirmed. How can these contradictory feelings coexist? This is what the dream is about: the battle between what the subject has been taught to regard as true and proper, the "shoulds" and the "oughts" of his life, usually the result of overly strict upbringing - and what he feels is good for him. These two do not overlap and they foster in the subject a sense of escalating conflict, enacted before us. The first domain is embedded in his Superego (to borrow Freud's quasi-literary metaphor). Critical voices constantly resound in his mind, an uproarious opprobrium, sadistic criticism, destructive chastising, uneven and unfair comparisons to unattainable ideals and goals. On the other hand, the powers of life are reawakening in him with the ripening and maturation of his personality. He vaguely realises what he missed and misses, he regrets it, and he wants out of his virtual prison. In response, his disorder feels threatened and flexes its tormenting muscles, a giant awakened, Atlas shrugged. The subject wants to be less rigid, more spontaneous, more vivacious, less sad, less defined by the gaze of others, and more hopeful. His disorder dictates rigidity, emotional absence, automatism, fear and loathing, self-flagellation, dependence on Narcissistic Supply, a False Self. The subject does not like his current locus in life: it is dingy, it is downtrodden, it is shabby, and inhabited by vulgar, ugly people, the music is wrong, it is fogged by smoke, polluted. Yet, even while there, he knows that there are alternatives, that there is hope: a young, attractive lady, mutual signalling. And she is closer to him (10 feet) than the old, ugly woman of his past (30 feet). His dream will not bring them together, but he feels no sorrow. He leaves, laughing with the guys, to revisit his previous haunt. He owes this to himself. Then he continues his life.

He finds himself, in the middle of the road of life, in the ugly place that is his soul. The young woman is only a promise. There is another woman "old, with heavy make-up, poorly dyed hair, loud, obnoxious, drunk". This is his mental disorder. It can scarcely sustain the deception. Its make-up is heavy, its hair dyed poorly, its mood a result of intoxication. It could well be the False Self or the Superego, but I rather think it is the whole sick personality. She notices him, she berates him with derogatory remarks, she screams at him. The subject realises that his disorder is not friendly, that it seeks to humiliate him, it is out to degrade and destroy him. It gets violent, it hurls food at him, it buries him under a dish of popcorn (a cinema theatre metaphor?). The war is out in the open. The fake coalition, which glued the shaky structures of the fragile personality together, exists no longer. Notice that the subject does not recall what insults and pejorative remarks were directed at him. He deletes all the expletives because they really do not matter. The enemy is vile and ignoble and will make use and excuse of any weakness, mistake and doubt to crack the defence set up by the subject's budding healthier mental structures (the young woman). The end justifies all means and it is the subject's end that is sought. There is no self-hate more insidious and pernicious than the narcissist's.

But, to fight his illness, the subject still resorts to old solutions, to old habits and to old behaviour patterns. He calls the police because they represent the Law and What Is Right. It is through the rigid, unflinching, framework of a legal system that he hopes to suppress what he regards as the unruly behaviour of his disorder. Only at the end of his dream he comes to realise his mistake: "He said that just because I had the law on my side and I was in the right didn't mean that anyone would like me." The Police (who appear instantly because they were always present) arrest the woman, but their sympathy is with her. His true aides can be found only among the customers of the restaurant/bar, whom he found not to his liking ("I did not like... the other customers..."). It is someone in the next table who tells him about the dam. The way to health is through enemy territory, information about healing can be gotten only from the sickness itself. The subject must leverage his own disorder to disown it.

The dam is a potent symbol in this dream. It represents all the repressed emotions, the now forgotten traumas, the suppressed drives and wishes, fears and hopes. It is a natural element, primordial and powerful. And it is dammed by the disorder (the vulgar, now-imprisoned, lady). It is up to him to open the dam. No one will do it for him: "Now YOU can open the dam gate." The powerful woman is no more, she owned the dam and guarded its gates for many years ago. This is a sad passage about the subject's inability to communicate with himself, to experience his feelings unmediated, to let go. When he does finally encounter the water (his emotions), they are safely contained behind glass, visible but described in a kind of scientific manner ("the level on the glass rose higher the more I turned the wheel") and absolutely controlled by the subject (using a valve). The language chosen is detached and cold, protective. The subject must have been emotionally overwhelmed but his sentences are borrowed from the texts of laboratory reports and travel guides ("Niagara Falls"). The very existence of the dam comes as a surprise to him. "I said: What?, and he explained."

Still, this is nothing short of a revolution. It is the first time that the subject acknowledges that there is something hidden behind a dam in his brain ("cavernous room") and that it is entirely up to him to release it ("I was told that I could turn it whenever I wanted."). Instead of turning around and running in panic, the subject turns the wheel (it is a control valve, he hurries to explain to us, the dream must be seen to obey the rules of logic and of nature). He describes the result of his first encounter with his long repressed emotions as "thrilling", "incredible" "roar(ing)", "torrent(ial)". It did frighten him but he wisely learned to make use of the valve and to regulate the flow of his emotions to accord with his emotional capacity. And what were his reactions? "Whooped", "laughed", "excited". Finally, the flow became steady and independent of the valve. There was no need to regulate the water anymore. There was no threat. The subject learned to live with his emotions. He even diverted his attention to the attractive, young woman, who reappeared and seemed to be looking for someone (he hoped it was for him).

But, the woman belonged to another time, to another place and there was no turning back. The subject had yet to learn this final lesson. His past was dead, the old defence mechanisms unable to provide him with the comfort and illusory protection that he hitherto enjoyed. He had to move on, to another plane of existence. But it is hard to bid farewell to part of you, to metamorphesise, to disappear in one sense and reappear in another. A break in one's consciousness and existence is traumatic no matter how well controlled, well intentioned and beneficial.

So, our hero goes back to visit his former self. He is warned: it is not with clean hands that he proceeds. They get greasier the more he tries to clean them. Even his clothes are affected. Rags, wet (useless) spark plugs, the ephemeral images of a former engine all star in this episode. Those are passages worth quoting (in parentheses my comments):

"I noticed the pretty woman from the grill (from my past) way across the huge area (my brain), and she seemed to be looking for someone. I hoped it was me. I opened the door, and went out to go meet her (back to my past). On the way out, I got grease on my hand (dirt, warning), and picked up a rag on the table to wipe it off. The rag had even more grease on it (no way to disguise the wrong move, the potentially disastrous decision), and so now my hands were completely covered in grease (dire warning). I picked up another rag on top of a box, and there were wet (dead) spark plugs stuck with globs of grease to the underside of the rag, lined up in order as if they used to be in an engine (an image of something long gone) and someone stuck them in this order on purpose, and some of it got on my clothes. The guys with me laughed and I laughed with them (he laughed because of peer pressure, not because he really felt like it), but I left without going to meet the woman, and we went back to the grill (to the scene of his battle with his mental disorder)."

But, he goes on to the grill, where it all started, this undefined and untitled chain of events that changed his life. This time, he is not allowed to enter, only to observe from a tiny room. Actually, he does not exist there anymore. The man that enters his observation post, does not even see him or notice him. There are grounds to believe that the man who thus entered was the previous, sick version of the subject himself. The subject was frightened and backed up. The "robot-like" person (?) "looked through the window, stared blandly at people having fun." The subject then proceeded to commit the error of revisiting his past, the restaurant. Inevitably, the very people that he debunked and deserted (the elements of his mental disorder, the diseased occupants of his mind) were hostile. The policeman, this time "off duty" (not representing the Law) assaults him and advises him to leave. Others spit on him. This is reminiscent of a religious ritual of ex-communication. Spinoza was spat on in a synagogue, judged to have committed in heresy. This reveals the religious (or ideological) dimension of mental disorders. Not unlike religion, they have their own catechism, compulsive rituals, set of rigid beliefs and "adherents" (mental constructs) motivated by fear and prejudice. Mental disorders are churches. They employ institutions of inquisition and punish heretical views with a severity befitting the darkest ages.

But these people, this setting, exert no more power over him. He is free to go. There is no turning back now, all bridges burnt, all doors shut firmly, he is a persona non grata in his former disordered psyche. The traveller resumes his travels, not knowing where to go and what he is doing. But he is"crying and laughing" and "elated and ashamed". In other words, he, finally, after many years, experiences emotions. On his way to the horizon, the dream leaves the subject with a promise, veiled as a threat "If you were smart you would leave town." If you know what is good for you, you will get healthy. And the subject seems to be doing just that.

next:   Persecutory Anxiety

• Watch the video on Dead Parents of the Narcissist

Question:

How do narcissists react to the death of their parents?

Answer:

The narcissist has a complicated relationship with his parents (mainly with his mother, but, at times, with his father). As Primary Objects, the narcissist's parents are often a source of frustration which leads to repressed or to self-directed aggression. They traumatise the narcissist during his infancy and childhood and thwart his healthy development well into his late adolescence.

Often, they are narcissists themselves. Always, they behave capriciously, reward and punish the narcissist arbitrarily, abandon him or smother him with ill-regulated emotions. They instil in him a demanding, rigid, idealistic and sadistic Superego. Their voices continue to echo in him as an adult and to adjudicate, convict and punish him in a myriad ways.

Thus, in most important respects, the narcissist's parents never die. They live on to torment him, to persecute and prosecute him. Their criticism, verbal and other forms of abuse and berating live on long after their physical demise. Their objectification of the narcissist lasts longer than any corporeal reality.

Naturally, the narcissist has a mixed reaction to the passing away of his parents. It is composed of elation and a sense of overwhelming freedom mixed with grief. The narcissist is attached to his parents in much the same way as a hostage gets "attached" to his captors (the Stockholm syndrome), the tormented to his tormentors, the prisoner to his wardens. When the bondage ceases or crumbles, the narcissist feels both lost and released, saddened and euphoric, empowered and drained.

Additionally, the narcissist's parents are Secondary Narcissistic Supply Sources (SNSSs). They fulfil the triple role of "accumulating" the narcissist's past, evidencing the narcissist's grand moments ("live history") and providing him with Narcissistic Supply on a regular and reliable basis (Regulation of Narcissistic Supply). Their death represents the loss of the best available Narcissistic Supply Source and, therefore, constitutes a devastating blow to the narcissist's mental composure.

But beneath these evident losses lies a more disturbing reality. The narcissist has unfinished business with his parents. All of us do - but his is more fundamental. Unresolved conflicts, traumas, fears and hurts seethe and the resulting pressure deforms the narcissist's personality.

The death of his parents denies the narcissist the closure he so craves and needs. It seals his inability to come to terms with the very sources of his invalidity, with the very poisonous roots of his disorder. These are grave and disconcerting news, indeed. Moreover, the death of his parents virtually secures a continuation of the acrimonious debate between the narcissist's Superego and the other structures of his personality.

Unable to contrast the ideal parents in his mind with the real (less than ideal) ones, unable to communicate with them, unable to defend himself, to accuse, even to pity them - the narcissist finds himself trapped in a time capsule, forever reenacting his childhood and its injustice and abandonment.

The narcissist needs his parents alive mostly in order to get back at them, to accuse and punish them for what they have done to him. This attempt at reciprocity ("settling the scores") represents to him justice and order, it introduces sense and logic into an otherwise totally chaotic mental landscape. It is a triumph of right over wrong, weak over strong, law and order over chaos and capriciousness.

The demise of his parents is perceived by him to be a cosmic joke at his expense. He feels "stuck" for the rest of his life with the consequences of events and behaviour not of his own doing or fault. The villains evade responsibility by leaving the stage, ignoring the script and the director's (the narcissist's) orders.

The narcissist goes through a final big cycle of helpless rage when his parents die. He then feels, once again, belittled, ashamed and guilty, worthy of condemnation and punishment (for being angry at his parents as well as elated at their death). It is when his parents pass away that the narcissist becomes a child again. And, like the first time round, it is not a pleasant or savoury experience.

next: The Narcissist's Dead Parent

Chapter 11

At the beginning of life, the dominance of the innate mental equipment is overwhelming and the hegemony of the subsystem of the basic emotions is nearly complete. The brain structures of the basic emotions are repeatedly activated by innate programs of their own. At that stage, the emotional repertory is quite simple and nearly every inconvenience of substantial impact causes the baby to cry.

Combined with the physiological processes of maturing, the accumulated experiences result in the building of new programs. A number of the new emotional programs built are only more flexible versions of innate ones. A number are those the fresh aspect of which is the result of the inclusion of options (and inhibitions) that are based on the maturing of the body and the cognitive ability.

Other supra-programs are based to a large extent on acquired knowledge and skills. They seems to be entirely new, and it is hard, at first, to find which of the more primitive programs were used as their "building materials".

Over the years the relative weight of accumulated experience in the building of programs, increases immensely. Consequently, most of the new programs of adults are based on stored information accumulated during the actual activation of ad hoc programs which were based on previously built supra-programs.

Though all programs are related to survival, and thus to emotion, not all of them are colored so much with emotional factors accessible to awareness of the individual or to those who observe him. Thus it is a common custom to distinguish between the two kinds and call "Emotional" only those which are obvious or which defy simple logic.

As a result of the maturation and the accumulation of supra-programs, the rigid automatic innate mode of operation for the activation of the brain structures of the basic emotions, is abolished. This causes changes to the way each of the various components of each of the basic emotions function. It also changes dramatically the relations and interactions between these components which become very flexible.

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For instance, using a supra-program, the integration processes of basic emotions can be inputted and influenced by other than the innate perceptual patterns. They can be influenced by word, memory, thinking, perception of signs or symbols or other things, that are connected with the specific basic emotion by association.

The most striking example is the ability of colored pieces of paper, (treated as money) or memories and imagery about them, to influence the emotional climate of people. They can change the mood of a person, from the positive pole of the basic emotion happiness v. sorrow to the opposite pole and vice versa. (This power is especially potent when the colored-pieces of paper are inscribed with a number followed by many zeros, which with luck one may receive, or unfortunately, may have to give.)

During maturation and socialization, the reflex like manner in which the primary patterns of stimuli of a basic emotion influence the integration processes and activate their other components, progressively diminishes. The original activity of the basic emotion, internal, external and communicative, also loses its cohesiveness and semi-automatic mode. Even the ability of the processes occurring in the integration component of each basic emotion to create feelings of the subjective experience of that particular emotion is no longer automatic and unconditional.

The building, updating, upgrading, mending, and other changes entered into the activation programs of the emotional system are, in principle, more or less the same as the changes responsible for practical activities. Initially, they are based, like all other activities of the mind and brain system, on innate programs. However, it seems that in this domain, the basic building blocks come less from the senso-motoric repertoire and more from the small number of complex innate programs of the basic emotions.

For instance, most of the older generation still remember the feelings of disgust (and the tendency to vomit) engendered by cod-liver oil given to them in childhood to correct vitamin D deficiencies. This initially automatic activity of the basic emotion of Disgust v. Desire (or Attraction v. Repulsion) was aroused at first by the mere smell. However, after lots of pressure and bribes from mothers and other caring persons, this pattern gradually faded. After a while most of us ceased to spit out or vomit this "medicine" or even stopped feeling revulsion, and a few of us even got used to it.

During life, individuals acquire (learn) new sub-components and patterns that are integrated into the regular activities of each of the basic emotions by means of emotional supra-programs. These new components act as additions, variations or even substitutions to innate patterns and sub-components. The individual acquires supra-programs that culminate in the ability to activate deliberately the basic emotions - as a whole or certain parts of them - in ways that differ widely from the innate patterns.

Sometimes, the acquired changes are expressed whether unconsciously or involuntarily in an instinctive-like fashion, in such a way that it is hard to distinguish from the innate mode.

For example, people can intentionally activate their desire versus disgust basic emotion - the desire pole mainly - by memories of sexual activities or by imaginary ones. The initiation of these "unreal activities" can happen spontaneously during dreams. They can be activated intentionally or spontaneously or even reluctantly during daydreams, by the sight of a passerby, or an association.

The deviation of these patterns from the original ones (of the basic emotions involved) may or may not reach our awareness, and the resulting sensations and images appear with varying degrees of vividness. These may or may not be accompanied by voluntary or spontaneous activity of one kind or another.

Throughout his life, the individual acquires the ability to influence the components of the basic emotions responsible for initiating activities, which were originally under the strict control of the integration components. Usually he also acquires some proficiency in executing them.

This proficiency enables the average person to activate various processes: intra-organismic, behavioral and communicative, even without a previously achieved suitable integration. Not only professional actors can simulate emotions successfully, even young children can do it.

The subjective experiential component is also not immune from the interventions and variations induced by supra-programs. The social environment greatly influences the shaping of this component, mainly by means of modeling, education and socialization.

During, and as a result of these processes, the individual also acquires a proficiency which may be used to divert the emotional experience. This proficiency is constantly expressed, deliberately or automatically, and with various degrees of awareness of the processes that divert the subjective experience from the innate course.

For instance, people learn to halt laughter or crying, by contracting the face muscles involved in the expression of these emotions. For thousands of years, people have been listening to and performing certain melodies to change their whole emotional climate. All of us are aware that we can change our mood just by changing the contents of our thoughts.

People posses a whole range of natural measures capable of inducing change in the emotional climate. Prominent among the behavioral alternatives are those that are included in the innate repertoire or appear automatically when one is sufficiently mature. In addition, there is a huge number of measures acquired from being subject to cultural customs of upbringing, and from divergent individual solutions found to common developmental problems, which were encountered on the way to adulthood.

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The four main branches of this group of measures are:

1. Natural behavior that satisfies different desires and needs like eating when hungry and drinking when thirsty.
2. Behavior corresponding to the basic emotion most active at the given moment, like weeping when suffering and staring when interested.
3. Regarding the specific feelings, emotional experiences of a certain moment, moods and other felt sensations of the body, as announcing the prevailing conditions at the time of their occurrence and as recommending a specific reaction. For instance, the treatment of the feelings of fear in dangerous circumstances as a recommendation to leave rapidly.
4. Treating the feelings and sensations of the emotional process as a "call to arms" directed to brain and mind systems, or at least as an invitation to pay them attention.

The essence of this book and the manual in chapter 5, form a technique for the management of the emotional system and climate, which is based on improving and enhancing this fourth natural behavior pattern. (It seems that this is the best method of enhancing the activity of the internal maintenance processes of the updating, mending, and building of supra-programs of daily use, and especially the more emotional ones.)

next: The Cover-Programs

Thoughtful quotes about wealth and poverty.

Words of Wisdom

"Paying attention to simple little things that most men ignore makes a few men rich." (Henry Ford)

"The real measure of our wealth is our worth if we lost our money." (author unknown)

"It is only by spending ourselves that we become rich." (Sarah Bernhardt)

"The dignity of man depends on creating and not on possessing." (Theo Spoerri)

"The best things in life are free but it costs you a lot of time and money before you find this out." (author unknown)

" There is nothing in the nature of money to produce happiness. The more a man has, the more he wants. Instead of filling a vacuum, it makes one." (Benjamin Franklin)

"Enough money always means more then you have now." (Author unknown)

"The world is full of men making good livings but poor lives." (Author Unknown)

"I want you to know that possessions have made more people unhappy than happy, because they define the limits of your life and keep you from the freedom of choice that comes with traveling light upon the earth." (Ken Nerburn)

"...I have become all the more convinced that the most valuable fortune anyone can amass during a life time is not material wealth but the things he learns." (Eric Sloane)

"Everyone who has ever struggled with poverty knows how extremely expensive it is to be poor." (James Baldwin)

"He profits most who serves best." (A.F. Sheldon)

"Poverty of purpose is worse than poverty of purse." (Author Unknown)

next: Wholeness

Reproduced from page 222 of the book: Uncovering the Mystery of MPD;
Its Shocking Origins... Its Surprising Cure

next:  Inner Faces Of Multiplicity: Contemporary Look at a Classic Mystery

Most people with bipolar disorder suffer relapses, a return of bipolar symptoms. Learn how to keep bipolar relapses at bay.

Bipolar disorder cannot be prevented, but often the mood swings can be controlled with medications, if you take them regularly as prescribed by your doctor.

About 1 in 3 people will remain completely free of symptoms of bipolar disorder by taking mood stabilizer medications, such as carbamazepine (Tegretol) or lithium, for life. (read more about medication compliance here)

Other ways to help prevent a depressive or manic mood episode include:

• Eating a balanced diet.
• Exercising daily.
• Avoiding extensive travel into other time zones.
• Getting approximately the same number of hours of sleep every night.
• Keeping your daily routines similar.
• Avoiding alcohol or drugs.
• Reducing stress at work and at home.
• Seeking treatment as soon as you notice symptoms of a depressive or manic episode coming on.

Changes in your sleep patterns can sometimes trigger a manic or depressive mood episode. If you plan extensive travel into other time zones, you may want to call your doctor before you leave to discuss whether you should make any changes in your medications, and what to do if you have a manic or depressive episode while you are away.

Home Treatment

Home treatment is important in bipolar disorder. In addition to taking your medications every day as prescribed, you can help control mood swings by:

Family members often feel helpless when a loved one is depressed or manic. Family members and friends can help by:

• Encouraging the person to take his or her medications regularly, even when feeling good.
• Learning the warning signs for suicide, which include:
  • Drinking heavily or taking illegal drugs.
  • Talking, writing, or drawing about death, including writing suicide notes.
  • Talking about harmful things, such as pills, guns, or knives.
  • Spending long periods of time alone.
  • Giving away possessions.
  • Aggressive behavior or suddenly appearing calm.
• Recognizing a lapse into a manic or depressive episode, and helping the person cope and get treatment.
• Allowing your loved one to take enough time to feel better and get back into daily activities.
• Learning the difference between hypomania and when he or she is just having a good day. Hypomania is an elevated or irritable mood that is clearly different from a regular nondepressed mood and can last for a week or more.
• Encouraging your loved one to go to counseling and join a support group, and joining one yourself if needed.

Mood stabilizers, especially lithium and divalproex (Depakote), are the cornerstones of prevention or long-term maintenance treatment. About 1 in 3 people with bipolar disorder will remain completely free of symptoms just by taking mood stabilizing medication for life. Most other people experience a great reduction in the frequency and severity of episodes during maintenance treatment.

It is important not to become overly discouraged when episodes do occur and to recognize that the success of treatment can only be evaluated over the long term, by looking at the frequency and severity of episodes. Be sure to report changes in mood to your doctor immediately, because adjustments in your medicine at the first warning signs can often restore normal mood and head off a full-blown episode. Medication adjustments should be viewed as a routine part of treatment (just as insulin doses are changed from time to time in diabetes). Most patients with bipolar disorder do best on a combination or "cocktail" of medications. Often the best response is achieved with 1 or more mood stabilizers, supplemented from time to time with an antidepressant or possibly an antipsychotic medication.

Continuing to take medication correctly and as prescribed (which is called adherence) on a long-term basis is difficult whether you are being treated for a medical condition (such as high blood pressure or diabetes) or for bipolar disorder. Individuals with bipolar disorder are often tempted to stop taking their medication during maintenance treatment for several reasons. They may feel free of symptoms and think they don't need medication any more. They may find the side effects too hard to deal with. Or they may miss the mild euphoria they experience during hypomanic episodes. However, research clearly indicates that stopping maintenance medication almost always results in relapse, usually in weeks to months after stopping. In the case of lithium discontinuation, the rate of suicide rises precipitously after discontinuation. There is some evidence that stopping lithium in an abrupt fashion (rather than slowly tapering off) carries a much greater risk of relapse. Therefore, if you must discontinue medication, it should be done gradually under the close medical supervision of your doctor.

If someone has had only a single episode of mania, consideration may be given to tapering the medication after about a year. However, if the single episode occurs in someone with a strong family history of bipolar disorder or is particularly severe, longer-term maintenance treatment should be considered. If someone has had two or more manic or depressive episodes, experts strongly recommend taking preventive medication indefinitely. The only times to consider stopping a preventive medication that is working well is if a medical condition or severe side effect prevents its safe use, or when a woman is trying to become pregnant. Even these situations may not be absolute reasons to stop, and substitute medications can often be found. You should discuss each of these situations carefully with your doctor.

Sources:

• Sachs GS, et al. (2000). Expert Consensus Guidelines Series: Medication Treatment of Bipolar Disorder.
• Sachs GS, et al. (2000). The treatment of bipolar depression. Bipolar Disorders, 2(3, Part 2): 256-260.
• Glick ID, et al. (2001). Psychopharmacologic treatment strategies for depression, bipolar disorder, and schizophrenia. Annals of Internal Medicine, 134(1): 47-60.
• American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159(4, Suppl):1-50.

next: What Recovery From Bipolar Disorder and Depression Means to Us
~ bipolar disorder library
~ all bipolar disorder articles

The time has come for me to let go of the past. I've carried this realization for a while now. I've grieved over the past long enough. The time to say goodbye, once and for all, has arrived.

Am I rejecting my past? No. Part of letting go is accepting and admitting the past is over, done, finished, and complete. Nothing is left back there for me to do. Nothing is left back there for me to cling to, except some wonderful memories. But life is about making memories. So life is quietly urging me to move on, embrace the future, and create new memories. Life is asking me to look ahead, rather than looking behind. All that I have been and once was is important, but now, it is more important for me to forge onward, to grow, into all I am capable of becoming.

Getting to this point was not necessarily a conscious goal on my part. The process required many months of preparation—working all the way through my pain, false hope, anger, frustration, humiliation, discouragement, and disappointment. My recovery lesson is to learn that letting go cannot be forced. Letting go must come easily, naturally, at just the right time. I cannot let go until I am fully prepared to let go. I cannot let go until hanging on causes more pain than letting go.

Clinging to the past has become far too painful to me. Yesterday's solutions and answers to my life problems no longer work. New solutions, new answers, new situations—a new life awaits me. What's over the next hill? Only God knows. But I'm keeping a prayerful, positive, hopeful, attitude. I'm patiently anticipating the future, rather than obsessively trying to control it. I'm waiting to see what will happen next, moment by moment by moment.

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next: Letting Go of Outcomes

High dropout rates from cognitive-behavioral treatment for bulimia nervosa have been noted in the literature. Zachary Steel and colleagues from the University of New South Wales in Australia sought to identify those characteristics that would predict treatment dropout; their findings have been published in the September 2000 issue of the International Journal of Eating Disorders.

These researchers evaluated 32 consecutive referrals to their mental health service for bulimia nervosa treatment. Most of the individuals studied were female (97%) and averaged 23 years of age. Subjects had experienced bulimia symptoms for an average of five years prior to presentation.

Of this group, 18 individuals (57%) completed the treatment program, attending an average of 15 treatment sessions, while 14 individuals (43%) did not. In this latter group, the average number of treatment sessions attended was seven.

When comparing those who left treatment early with those who did not, there were no differences in core demographics or initial symptom severity. Those who dropped out of treatment did, however, manifest higher levels of pretreatment depression and hopelessness, as well as elevated feelings of ineffectiveness and a greater external locus of control than those who completed treatment. Together, these parameters could predict which individuals would end treatment prematurely with 90% accuracy.

Steel and colleagues suggest that interventions targeting depressed mood and hopelessness may assist in the retention of bulimic clients in treatment and should be administered in advance of standard cognitive-behavioral intervention for bulimia.

Source: Steel, Z., Jones, J., Adcock, S., Clancy, R., Bridgford-West, L., & Austin, J. (2000). Why the high rate of dropout from individualized cognitive-behavior therapy for bulimia nervosa? International Journal of Eating Disorders, 28(2), 209-214

next: Causes of Eating Disorders: Factors Responsible for Cutting Down Eating Habits
~ eating disorders library
~ all articles on eating disorders

Laboratory studies and other medical tests may be helpful in determining the diagnosis of bipolar as well as the extent of any medical problems resulting from the disorder.

Lab Studies:

• Tests for substance and alcohol abuse usually prove necessary initially to exclude drugs and alcohol as causative agents for behavior.
• No specific blood or other laboratory tests are available to aid the mental health professional in diagnosing bipolar disorder.
  • Of interest, serum cortisol levels may be elevated, but this is not of diagnostic or clinical value.
  • Thyroid studies may help assure the clinician that an altered mood is not secondary to a thyroid disorder.
  • The clinician may order serum blood chemistries such as basic metabolic panels and liver function tests to help assess renal and hepatic health before starting or continuing to administer certain medications to help regulate or ameliorate bipolar symptoms.
  • Mania and depression both may involve states of malnutrition secondary to the psychiatrically diminished awareness of or ability to maintain one's health and well-being. Thus, a metabolic panel along with, in extreme cases, levels of thiamine, albumin, and prealbumin may help determine the extent of self-neglect and compromised nutritional state.
  • Once pharmacotherapy has been implemented, periodic laboratory tests may be required to monitor drug levels and to ensure that no adverse response to the medication is harming renal or hepatic function.

Imaging Studies:

• Neuroimaging modalities are currently not helpful in making the diagnosis of bipolar disorder. Rather, the clinical presentation of symptom clusters as defined in the DSM-IV TRplus family and genetic histories guide the mental health clinician when diagnosing psychiatric conditions.
  • Neuroimaging studies of child and adolescent patients with bipolar disorder are few. Magnetic resonance imaging (MRI) studies of children and adolescents with bipolar I disorder have shown enlarged ventricles and an increased number of hyperintensities compared to healthy control subjects. The pathologic and clinical significance of these findings is unknown.
  • MRI studies performed by Dasari et al (1999) found that the area of the thalamus is significantly decreased in youth with either bipolar disorder or schizophrenia compared to healthy control subjects; adult studies revealed similar findings. The diagnosis of either bipolar disorder or schizophrenia cannot be made based on this volume difference as revealed by MRI. Nonetheless, reduced thalamic volume is consistent with clinical symptoms of poor attention, difficulty in filtering simultaneous stimuli, and dysregulation of mood—symptoms found in patients with both of these major mental illnesses. Whether a structural or functional deficit within the thalamus may be causal or contributory to the pathophysiology of these mental disorders remains unknown.

Other Tests:

• A baseline electrocardiogram may be needed before starting a psychotropic medication because some are known to alter QT intervals or other cardiac rhythm features.

Sources:

• AACAP Official Action. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. Jan 1997;36(1):138-57.
• Dasari M, Friedman L, Jesberger J, et al. A magnetic resonance imaging study of thalamic area in adolescent patients with either schizophrenia or bipolar disorder as compared to healthy controls. Psychiatry Res. Oct 11 1999;91(3):155-62.

next: Age of Onset and Gender Issues in Bipolar Disorder
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~ all bipolar disorder articles