IN A SERIES OF studies at Columbia University, it was found that people who successfully lose weight and keep it off have tried and failed a number of times before they finally succeeded.

When you change the way you eat or exercise, old habits tend to kick in and ruin your progress. To be successful, you first need to learn how to keep the changes and maintain them over time. Each attempt, even though it "failed," teaches you what you need to do to be successful in the future. In fact, the studies also showed that the more times you try to lose weight, the more likely the change will be permanent.

So don't give up on yourself if you've tried and failed. Your very next attempt may be the one that succeeds.

If you'd like to read the full
chapter on this subject, click here:
You CAN Change

Here's six chapters from Self-Help Stuff That Works that may help you keep changes in your life:
Making Changes Stick

Here is a chapter on becoming more energetic with a simple decision:
Be More Energetic

Here's a more negative way to be positive, but when you are feeling angry or bitter or jealous or annoyed, this way is often easier than trying to muster a positive attitude directly:
Argue With Yourself and Win!

Sometimes and for some people, physical action works better than mental action for turning a negative attitude into a positive attitude. If that's you, you're in luck! You can behold the power of positive thinking even without trying to change your thinking! Check it out:
A Simple Way to Change How You Feel

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next: Why Optimism Is a Self-Fulfilling Prophesy

From acupuncture to fish oil to massage therapy and yoga, we look at alternative treatments, natural remedies for depression.

Articles on Complementary and Alternative Treatments for Depression

• Self-Help and Alternate Therapies for Depression
• Complementary Therapies for Depression
• Effectiveness of Alternative Treatments for Depression
• Treating Depression Without Medications
• Exercise PLUS 5 Other Natural Ways to Treat Depression
• Treating Depression and Bipolar Disorder Without Drugs
• Nutritional Therapy for Depression
• Important Information About Herbal Treatments
• Harmful Substances in Herbal Products

Alternative Remedies for Depression

• Acupuncture
• Alcohol Avoidance
• Alcohol Relaxation
• Aromatherapy
• Caffeine Avoidance
• Chocolate
• Color Therapy
• Dance and Movement Therapy
• Exercise
• Fish Oils
• Ginkgo Biloba
• Ginseng
• Glutamine (L-Glutamine)
• Homeopathy
• Inositol
• Lemon Balm
• Light Therapy
• Massage Therapy
• Meditation
• Music
• Natural Progesterone
• Negative Air Ionizatization
• Pets
• Phenylalanine
• Pleasant Activities
• Relaxation Therapy

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• SAMe
• Selenium
• St. John's wort
• Sugar Avoidance
• Tryptophan
• Tyrosine
• Vervain
• Vitamins
• Yoga

next: Acupuncture

(Reprinted from The Brookline TAB, May 13, 1999 and excerpted in Massachusetts Psychologist, June, 1999)

Finally, two angry young adults in Littleton, Colorado who had been screaming bloody murder for months were heard. This time they were so loud they even drowned out the sound of the bombs falling in Serbia and Kosovo. Up until now, parents, school system, and police all had been stone deaf.

No one can say for sure why Eric Harris and Dylan Klebold came to school April 20 and committed the deadliest school shooting rampage in our nation's history. It is likely that there are many factors, all of which have to line up in the right way.

But one factor was, most certainly, deafness.

Two of the tools that psychologists use when evaluating their subjects are inference and backwards extrapolation. If we observe a particular interaction between two people in the present, we assume that similar interactions have occurred in the past, probably repeatedly. This is because peoples' personalities don't tend to change much over time (barring therapy, of course).

If a couple comes into my office and one party is slighted by something the other party said, the odds are extraordinarily high that similar incidents have occurred over and over again in the past.

Consider, then, that Eric Harris' parents were deaf to the rage and hatred that the young man was making obvious to the world at large on his Web site, getting into a scrape with the law, throwing a block of ice at a windshield, making a death threat against another boy, etc. It is most likely that these parents rarely if ever "heard" their son.

I'm not saying that they did not do things for their son. One can attend a son's baseball games and practices and still be deaf. One can buy presents for your son or take him on vacation, and still be deaf. One can be president of the Parent Teacher Organization and still be deaf. One can look to the outside world like a perfect and loving parent and still be deaf.

Hearing requires granting a child a voice equal to yours from the day they are born. This is difficult for parents who are still trying to make their own voice heard due to injuries from their past. But what children have to say about the world is just as important as what you have to say. And if you listen closely to them, you will learn as much as they will from you. I would be willing to bet that this did not happen in the Harris and Klebold families. If it had, the young men would not have reacted violently to the slights they felt from their peers.

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Why were these four parents unable to hear? In order to answer this each would have to look at their own histories with a therapist. Indeed, part of the therapy process involves the exploration of voice. Ours: was it heard, by whom, if not why not? And our children's: are we hearing them, if not why not, how can we hear them more accurately. Children are incredibly perceptive: they know when they are truly being heard and when they are not. And they know when parents are merely trying to look good to the outside world. If they are chronically unheard, they begin to build walls around themselves, act out, or do whatever it takes to protect themselves from the pain and anxiety of being "voiceless."

Of course, it is too late now---for Harris, Klebold, and the innocent people who were executed on April 20th. But the bloody incident should serve as a reminder, a kind of wake up call--that we must not fool ourselves into believing we are doing a good job as parents when we are not, that we are listening when we are not.

In the end, Eric Harris and Dylan Klebold had the last word. They spoke so loudly that for a few days the whole world paused and listened. It needn't have come to this.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: What is a Wookah?

It could be a man or a woman. He or she could be suffering from depression, anxiety, or relationship problems. They could have begun a few weeks ago or have existed for many years. What goes through my head as a psychologist?

Parents, school, friends, lovers, careers, all have the potential to offer both. Inside everyone is a vulnerable self. That self is subjected to both affirming and destructive life experience. If the pain is too severe, the vulnerable self automatically begins to seek protection. There are many, many ways of doing this and in large part the methods used are dependent on inborn temperament and defensive patterns. Sometimes these "defenses" work: when they do, emotional pain is reduced, but the protection itself presents obstacles to intimate contact with people. When the defenses don't work" - the result is depression, anxiety, or both--the vulnerable self is simply overwhelmed.

In my office I am intent on finding the vulnerable self, and almost always I can find it during the first session. Usually it is covered over for protection, sometimes by a huge concrete bunker, hardened to resist penetration. What happened in this person's life, I wonder, that made him or her need to hunker down in a nuclear bomb shelter? People are not crazy - that is not why they come to my office, and I do not see them in that way. They have protected themselves for good reason, and it is my job to understand as quickly as possible why.

People are often not aware of these forces themselves.Usually this is not difficult. Asking the right questions about a person's history, recent and past, exposes the damaging forces that they have been subjected to. Here is where therapists need to be talented" - because they have to be expert in both subtext and extrapolation. They must read between the lines of important relationships and life events, and at the same time understand that what happened at age 8 or 15 or even at age 50, sometimes reflects what happened to the vulnerable self in years past. Here's why: If you are in a bunker hundreds of feet deep, the world may seem like a reasonably safe place. Nothing has hurt for a long, long time (of course, you or your partner may be very disappointed in your relationship). Occasionally, someone knows exactly what happened in their life--parents, relationships, career" - they have simply been devastated by destructive forces and failed attempts to overcome them.

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It is my job to love and nurture the vulnerable self" - and to demonstrate in my relationship with a client that protection, with me, is not necessary. I do this through insight, understanding, but especially warmth. Initially, there is - lives have revolved around the conflict between protection and yearning. To give this struggle up (and the highs and lows associated with it) requires time and effort. Slowly the vulnerable self has no choice but to accept my love, and it can begin to grow and make decisions about life that are productive and healthy. I watch with joy as depression and anxiety finally lift, and people choose better relationships--or work constructively on the ones they decide to keep. It is often a surprise to the people I see that I end up inside of them: they remember a look, a phrase, a gesture - and they pull it out when they are besieged again (for life is often difficult) or just for pleasure. The end of therapy is bittersweet. When people leave my office for the last time, they know I will be with them for the rest of their life. They may or not know: they will be with me.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Psychotherapy in the Internet Age

Studies suggest that vitamin B9 may be associated with depression more than any other nutrient, and may play a role in the high incidence of depression in the elderly. Learn about the usage, dosage, side-effects of Vitamin B9.

Also Known As:folate, folic acid, folacin

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Vitamin B9, also called folic acid or folate, is one of eight water-soluble B vitamins. All B vitamins help the body to convert carbohydrates into glucose (sugar), which is "burned" to produce energy. These B vitamins, often referred to as B complex vitamins, are essential in the breakdown of fats and protein. B complex vitamins also play an important role in maintaining muscle tone along the lining of the digestive tract and promoting the health of the nervous system, skin, hair, eyes, mouth, and liver.

Folic acid is crucial for proper brain function and plays an important role in mental and emotional health. It aids in the production of DNA and RNA, the body's genetic material, and is especially important during periods of high growth, such as infancy, adolescence and pregnancy. Folic acid also works closely together with vitamin B12 to regulate the formation of red blood cells and to help iron function properly in the body.

Vitamin B9 works closely with vitamins B6 and B12 as well as the nutrients betaine and S-adenosylmethionine (SAMe) to control blood levels of the amino acid homocysteine. Elevated levels of this substance appear to be linked to certain chronic conditions such as heart disease and, possibly, depression and Alzheimer's Disease. Some researchers have even speculated that there is a connection between high levels of this amino acid and cervical cancer, but the results of studies regarding this have been inconclusive.

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Folic acid deficiency is the most common B vitamin deficiency. Animal foods, with the exception of liver, are poor sources of folic acid. Plant sources rich in folic acid are frequently not obtained in adequate amounts in the diet. Alcoholism, irritable bowel syndrome, and celiac disease contribute to deficiency of this important nutrient. Folic acid deficiency can cause poor growth, tongue inflammation, gingivitis, loss of appetite, shortness of breath, diarrhea, irritability, forgetfulness, and mental sluggishness.

Pregnancy can put a woman at risk for folic acid deficiency as the fetus easily depletes a mother's nutrient reserves.

Folic acid deficiency during pregnancy increases the risk for neural tube defects including cleft palate, spina bifida, and brain damage. Neural tube defects are birth defects caused by abnormal development of the neural tube, a structure that eventually gives rise to the central nervous system (the brain and spinal cord). In 1996, the U.S. Food and Drug Administration (FDA) authorized the addition of folic acid to many grain foods (such as bread and cereal). Since this time, the prevalence of neural tube defects in the United States has decreased.

 

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Vitamin B9 Uses

Birth Defects: As mentioned, pregnant women who are deficient in folic acid are more likely to have children with birth defects. Many neural tube defects (such as spina bifida) are believed to be preventable if women of childbearing age supplement their diets with folic acid. This is why women planning on becoming pregnant should be taking a multivitamin with plenty of folate, and why all pregnant women receiving prenatal care are put on a prenatal vitamin.

Studies have found that women who take folic acid supplements before conception and during the first trimester may reduce their risk of having children with neural tube defects by 72% to 100%. A recent study found that the prevalence of neural tube defects in the United States has decreased by 19% since the FDA authorized the fortification of grains with folic acid. Even though this connection seems strong, it is not known whether folic acid or factors other than this vitamin that contributed to this substantial decline.

Recent studies in test tubes brings into question whether there is a connection between elevated homocysteine (and, therefore, folate deficiency) in the mother and Down's syndrome in the child. Preliminary information also raises question about the possibility of folate supplements during pregnancy preventing the development of childhood leukemia. More research is needed in both of these areas before any conclusions can be drawn.

Miscarriage: Clinically, many naturopathic and other doctors recommend the use of vitamin B complex 50 mg per day with additional folic acid 800 to 1,000 mcg per day to try to prevent miscarriage (also known as spontaneous abortion). These practices for prevention of spontaneous abortion are supported by some studies suggesting a connection between impaired homocysteine metabolism and recurrent miscarriages. This conclusion is not without debate, however, with some experts arguing that it is difficult to determine from most studies to date whether it is low folate or other factors contributing to an increased incidence of spontaneous abortion. It is important to know that there are many, many reasons for a miscarriage. In fact, most commonly, there is no explanation for why a woman has miscarried.

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Heart Disease: Folate can help protect the heart through several methods. First, there are studies that suggest that folate can help reduce risk factors for heart disease and the harm that they cause, including cholesterol and homocysteine (both of which can damage blood vessels). Secondly, by diminishing this damage, studies suggest that not only can folate help prevent build up of atherosclerosis (plaque), it may also help the blood vessels function better, improve blood flow to the heart, prevent cardiac events such as chest pain (called angina) and heart attack, and reduce the risk of death.

Collectively, many studies indicate that patients with elevated levels of the amino acid homocysteine are roughly 1.7 times more likely to develop coronary artery disease (coronary arteries supply blood to the heart, blockage there can lead to a heart attack) and 2.5 times more likely to suffer from a stroke than those with normal levels. Homocysteine levels can be reduced by taking folate (the general recommendation is at least 400 micrograms [mcg] per day, but some studies suggest that this daily amount must be at least 650 to 800 mcg.) Folate needs vitamins B6 and B12 and betaine to function properly and to fully metabolize homocysteine.

The American Heart Association recommends that, for most people, an adequate amount of folate and these other B vitamins be obtained from the diet, rather than taking extra supplements. Under certain circumstances, however, supplements may be necessary. Such circumstances include elevated homocysteine levels in someone who already has heart disease or who has a strong family history of heart disease that developed at a young age.

Alzheimer's Disease: Folic acid and vitamin B12 are critical to the health of the nervous system and to a process that clears homocysteine from the blood. As stated earlier, homocysteine may contribute to the development of certain illnesses such as heart disease, depression, and Alzheimer's Disease. Elevated levels of homocysteine and decreased levels of both folic acid and vitamin B12 have been found in people with Alzheimer's Disease, but the benefits of supplementation for this or other types of dementia are not yet known.

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Osteoporosis: Keeping bones healthy throughout life depends on getting sufficient amounts of specific vitamins and minerals, including phosphorous, magnesium, boron, manganese, copper, zinc, folic acid, and vitamins C, K, B12, and B6.

In addition, some experts believe that high homocysteine levels may contribute to the development of osteoporosis. If this is the case, then there may prove to be a role for dietary or supplemental vitamins B9, B6, and B12.

Vitamin B9 and depression: Studies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient, and may play a role in the high incidence of depression in the elderly. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Many healthcare providers recommend a B complex multivitamin that contains folate as well as vitamins B6 and B12 to improve symptoms. If the multivitamin with these B vitamins is not enough to bring elevated homocysteine levels down, the physician may then recommend higher amounts of folate along with vitamins B6 and B12. Again, these three nutrients work closely together to bring down high homocysteine levels, which may be related to the development of depression.

Cancer: Folic acid appears to protect against the development of some forms of cancer, particularly cancer of the colon, as well as breast, esophagus, and stomach, although the information regarding stomach cancer is more mixed. It is not clear exactly how folate might help prevent cancer. Some researchers speculate that folic acid keeps DNA (the genetic material in cells) healthy and prevents mutations that can lead to cancer.

Population-based studies have found that colorectal cancer is less common among individuals with very high dietary intakes of folic acid. The reverse appears to be true as well: low folic acid intake increases risk of colorectal tumors. To have a significant effect on reducing the risk of colorectal cancer, it appears that at least 400 mcg of folic acid per day over the course of at least 15 years is required. Similarly, many clinicians recommend folic acid supplementation to people who are at high risk for colon cancer (for example, people with a strong family history of colon cancer).

Similarly, one population-based study also found that cancers of the stomach and esophagus are less common among individuals with high intakes of folic acid. Researchers interviewed 1095 patients with cancer of the esophagus or stomach as well as 687 individuals who were free of cancer in three health centers across the United States. They found that patients who consumed high amounts of fiber, beta-carotene, folic acid, and vitamin C (all found primarily in plant-based foods) were significantly less likely to develop cancer of the esophagus or stomach than those who consumed low amounts of these nutrients. Another important, good-sized study, however, did not find any connection between folic acid intake and stomach cancer. The possibility of some protection from folate against stomach cancer in particular needs clarification and, therefore, more research is warranted.

Low dietary intake of folate may increase the risk of developing breast cancer, particularly for women who drink alcohol. Regular use of alcohol (more than 1 ½ to 2 glasses per day) is associated with increased risk of breast cancer. One extremely large study, involving over 50,000 women who were followed over time, suggests that adequate intake of folate may lessen the risk of breast cancer associated with alcohol.

Cervical Dysplasia: Folate deficiency appears to be linked to cervical dysplasia (changes in the cervix [the first part of the uterus] that are either precancerous or cancerous and generally detected by pap smear). Studies evaluating the use of folate supplementation to lower the risk of developing such changes to the uterus have not been promising, however. For now, experts recommend getting adequate amounts of folate in the diet for all women (see How To Take It), which may be particularly important for those with risk factors for cervical dysplasia such as an abnormal pap smear or genital warts.

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Inflammatory Bowel Disease (IBD): People with ulcerative colitis and Crohn's disease (both inflammatory bowel diseases) often have low levels of folic acid in their blood cells. This may be due, at least in part, to sulfasalazine and/or methotrexate use, two medications that can diminish levels of folate. Other researchers speculate that folate deficiencies in Crohn's disease patients may be due to decreased intake of folate in the diet and poor absorption of this nutrient in the digestive tract.

Some experts suggest that folic acid deficiencies may contribute to the risk of colon cancer in those with IBDs. Although preliminary studies suggest that folic acid supplements may help reduce tumor growths in people with these conditions, further research is needed to determine the precise role of folic acid supplementation in people with IBDs.

Burns: It is especially important for people who have sustained serious burns to obtain adequate amounts of nutrients in their daily diet. When skin is burned, a substantial percentage of micronutrients may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many studies suggest that a multivitamin including the B complex vitamins may aid in the recovery process.

Male Infertility: In a study of 48 men, researchers found that men with low sperm counts also had low levels of folic acid in their semen. It is not clear whether folic acid supplementation would improve sperm count, however.

 

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Vitamin B9 Dietary Sources

Rich sources of folic acid include spinach, dark leafy greens, asparagus, turnip, beet and mustard greens, Brussels sprouts, lima beans, soybeans, beef liver, brewer's yeast, root vegetables, whole grains, wheat germ, bulgur wheat, kidney beans, white beans, lima beans, mung beans oysters, salmon, orange juice, avocado, and milk. In March of 1996, the FDA authorized the addition of folic acid to all enriched grain products and made manufacturers comply to this rule by January of 1998.

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Vitamin B9 Available Forms

Vitamin B9 can be found in multivitamins (including children's chewable and liquid drops), B complex vitamins, or are sold individually. It is a good idea to take folate as part of or along with a multivitamin because other B vitamins are needed for folate activation. It is available in a variety of forms including tablets, softgels, and lozenges. Vitamin B9 is also sold under the names folate, folic acid, and folinic acid. While folic acid is considered the most stable form of vitamin B9, folinic acid is the most efficient form for raising body stores of the nutrient.

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How to Take Vitamin B9

Most people (except pregnant women) get adequate folic acid from their diet. Under certain circumstances, however, a healthcare professional may recommend a therapeutic dose as high as 2,000 mcg per day for an adult.

It is important to check with a knowledgeable healthcare provider before taking supplements and before giving folic acid supplements to a child.

Daily recommendations for dietary folic acid are listed below:

Pediatric

Infants under 6 months: 65 mcg (adequate intake) Infants 7 to 12 months: 80 mcg (adequate intake) Children 1 to 3 years: 150 mcg (RDA) Children 4 to 8 years: 200 mcg (RDA) Children 9 to 13 years: 300 mcg (RDA) Adolescents 14 to 18 years: 400 mcg (RDA) Adult

19 years and older: 400 mcg (RDA) Pregnant women: 600 mcg (RDA) Breastfeeding women: 500 mcg (RDA) Amounts recommended for heart disease range from 400 to 1,200 mcg.

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Side effects from folic acid are rare. Very high doses (above 15,000 mcg) can cause stomach problems, sleep problems, skin reactions, and seizures.

Folic acid supplementation should always include Vitamin B12 supplementation (400 to 1000 mcg daily) because folic acid can mask an underlying vitamin B12 deficiency, which can cause permanent damage to the nervous system. In fact, taking any one of the B complex vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, it is generally important to take a B complex vitamin with any single B vitamin.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use folic acid supplements without first talking to your healthcare provider.

Antibiotics, Tetracycline: Folic acid should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Folic acid either alone or in combination with other B vitamins should be taken at different times from tetracycline. (All vitamin B complex supplements act in this way and should therefore be taken at different times from tetracycline.)

In addition, long-term use of antibiotics can deplete vitamin B levels in the body, particularly B2, B9, B12, and vitamin H (biotin), which is considered part of the B complex.

Aspirin, Ibuprofen, and Acetaminophen: When taken for long periods of time, these medications, as well as other anti-inflammatories can increase the body's need for folic acid.

Birth control medications, anticonvulsants for seizures (namely, phenytoin and carbamazapine), and cholesterol-lowering medications (namely, bile acid sequestrants including cholestyramine, colestipol, and colesevelam) may reduce the levels of folic acid in the blood as well as the body's ability to use this vitamin. Extra folate when taking any of these medications may be recommended by your healthcare provider. When taking bile acid sequestrants for cholesterol, folate should be taken at a different time of day.

Sulfasalazine, a medication used for ulcerative colitis and Crohn's disease, may reduce the absorption of folic acid, leading to lower levels of folic acid in the blood.

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Methotrexate, a medication used to treat cancer and rheumatoid arthritis, increases the body's need for folic acid. Folic acid reduces the side effects of methotrexate without decreasing its effectiveness.

Other Antacids, cimetidine, and ranitidine (used for ulcers, heartburn, and related symptoms) as well as metformin (used for diabetes) may inhibit the absorption of folic acid. It is best, therefore, to take folic acid at a different time from any of these medications.

Barbiturates, such as pentobarbital and phenobarbital, used for seizures, may impair folic acid metabolism.

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Supporting Research

Alpert JE, Fava M. Nutrition and depression: the role of folate. Nutrition Rev. 1997;5(5):145-149.

Alpert JE, Mischoulon D, Nierenberg AA, Fava M. Nutrition and depression: focus on folate. Nutrition. 2000;16:544-581.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Baggott JE, Morgan SL, Ha T, et al. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem J. 1992;282(Pt 1):197-202.

Bailey LB, Gregory JF. Folate metabolism and requirements. J Nutr. 1999;129(4):779-782.

Ballal RS, Jacobsen DW, Robinson K. Homocysteine: update on a new risk factor. Cleve Clin J Med. 1997;64:543-549.

Bendich A, Deckelbaum R, eds. Prevention Nutrition: The Comprehensive Guide for Health Professionals. Totowa, NJ: Humana Press; 1997.

Biasco G, Zannoni U, Paganelli GM, et al. Folic acid supplementation and cell kinetics of rectal mucosa in patients with ulcerative colitis. Cancer Epidemiol Biomarkers Prevent. 1997;6:469-471.

Booth GL, Wang EE. Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events. The Canadian Task Force on Preventive Health Care. CMAJ. 2000;163(1):21-29.

Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutrition Rev. 1996;54(12):382-390.

Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. JAMA. 1995;274:1049-1057.

Bronstrup A, Hages M, Prniz-Langenohl R, Pietrzik K. Effects of folic acid and combinations of folic acid and vitamin B12 on plasma homocysteine concentrations in healthy, young women. Am J Clin Nutr. 1998;68:1104-1110.

Butterworth CE Jr, Hatch KD, Macaluso M, et al. Folate deficiency and cervical dysplasia. JAMA. 1992;267(4):528-533.

Butterworth CE Jr, Hatch KD, Soong SJ, et al. Oral folic acid supplementation for cervical dysplasia: a clinical intervention trial. Am J Obstet Gynecol. 1992;166(3):803-809.

Cancers, Nutrition and Food. Washington, DC: World Cancer Research Fund/American Institute for Cancer Research; 1997.

Childers JM, Chu J, Voigt LF, et al. Chemoprevention of cervical cancer with folic acid: a phase III Southwest Oncology Group Intergroup study. Cancer Epidemiol Biomarkers Prev. 1995;4(2):155-159.

Choi S-W, Mason JB. Folate and carcinogenesis: an integrated scheme. J Nutr. 2000:130:129-132.

Chowers Y, Sela B, Holland R, Fidder H, Simoni FB, Bar-Meir S. Increased levels of homocysteine in patients with Crohn's disease are related to folate levels. Am J Gastroenterol. 2000;95(12):3498-3502.

Clarke R, Smith AD, Jobst KA, Refsum H, Sutton L, Veland PM. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol. 1998;55:1449-1455.

Cravo ML, Albuquerque CM, Salazar de Sousa L, et al. Microsatellite instability in non-neoplastic mucosa of patients with ulcerative colitis: effects of folate supplementation. Am J Gastroenterol. 1998;93:2060-2064.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Ebly EM, Schaefer JP, Campbell NR, Hogan DB. Folate status, vascular disease and cognition in elderly Canadians. Age Ageing. 1998;27:485-491.

Eikelboom JW, Lonn E, Genest J, Hankey G, Yusuf S. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med. 1999;131:363-375.

Endresen GK, Husby G. Methotrexate and folates in rheumatoid arthritis [in Norwegian]. Tidsskr Nor Laegeforen. 1999;119(4):534-537.

Giles WH, Kittner SJ, Croft JB, Anda RF, Casper ML, Ford ES. Serum folate and risk for coronary heart disease: Results from a cohort of US adults. Ann Epidemiol. 1998;8:490-496.

Giovannucci E, Stampfer MJ, Colditz GA, et al. Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study. Ann Intern Med. 1998;129:517-524.

Goggin T, Gough H, Bissessar A, Crowley M, Baker M, Callaghan N. A comparative study of the relative effects of anticonvulsant drugs and dietary folate on the red cell folate status of patients with epilepsy. Q J Med. 1987;65(247):911-919.

Goodman MT, McDuffie K, Hernandez B, Wilkens LR, Selhub J. Case-control study of plasma folate, homocysteine, vitamin B12, and cysteine as markers of cervical dysplasia. Cancer. 2000;89(2):376-382.

Giuliano AR, Gapstur S. Can cervical dysplasia and cancer be prevented with nutrients? Nutr Rev. 1998;56(1):9-16.

Hall J. Folic acid for the prevention of congenital anomalies. Eur J Pediatr. 1998;157(6):445-450.

Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LYC. Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA. 2001;285(23):2981-2236.

Imagawa M. Extra-intestinal complications of ulcerative colitis: hematologic complication [in Japanese]. Nippon Rinsho. 1999;57(11):2556-2561.

Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.

Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996:64-67.

Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102(18):2284-2299.

Kuroki F, Iida M, Tominaga M, et al. Multiple vitamin status in Crohn's disease. Dig Dis Sci. 1993;38(9):1614-1618.

Kwasniewska A, Tukendorf A, Semczuk M. Folate deficiency and cervical intraepithelial neoplasia. Eur J Gynaecol Oncol. 1997;18(6):526-530.

Lewis DP, Van Dyke DC, Stumbo PJ, Berg MJ. Drug and environmental factors associated with adverse pregnancy outcomes. Part II: Improvement with folic acid. Ann Pharmacother. 1998;32:947-961.

Lobo A, Naso A, Arheart K, et al. Reduction of homocysteine levels in coronary artery disease by low-dose folic acid combined with levels of vitamins B6 and B12. Am J Cardiol. 1999;83:821-825.

Malinow MR, Bostom AG, Krauss RM. Homocyst(e)ine, diet, and cardiovascular disease. A statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation. 1999;99:178-182.

Malinow MR, Duell PB, Hess DL, et al. Reduction of plasma homocyst(e)ine levels by breakfast cereal fortified with folic acid in patients with coronary heart disease. N Engl J Med. 1998;338:1009-1015.

Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther. 1982;4(6):423-440.

Mayer EL, Jacobsen DW, Robinson K. Homocysteine and coronary atherosclerosis. J Am Coll Cardiol. 1996;27(3):517-527.

Mayne ST, Risch HA, Dubrow R, et al. Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev. 2001;10:1055-1062.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

Miller AL, Kelly GS. Homocysteine metabolism: nutritional modulation and impact on health and disease. Altern Med Rev. 1997;2(4):234-254.

Miller AL, Kelly GS. Methionine and homocysteine metabolism and the nutritional prevention of certain birth defects and complications of pregnancy. Altern Med Rev. 1996;1(4):220-235.

Morgan SL, Baggott JE, Lee JY, Alarcon GS. Folic acid supplementation prevents deficient blood folic acid levels and hyperhomocysteinemia during long-term, low-dose methotrexate therapy for rheumatoid arthritis: implications for cardiovascular disease prevention. J Rheumatol. 1998;25:441-446.

Morgan S, Baggott J, Vaughn W, et al. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. Ann Intern Med. 1994;121:833-841.

Morselli B, Neuenschwander B, Perrelet R, Lippunter K. Osteoporosis diet [in German]. Ther Umsch. 2000;57(3):152-160.

Moscow JA. Methotrexate transport and resistance. Leuk Lymphoma. 1998;30(3-4):215-224.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.

Omray A. Evaluation of pharmacokinetic parameters of tetracylcine hydrochloride upon oral administration with vitamin C and vitamin B complex. Hindustan Antibiot Bull. 1981;23(VI):33-37.

Ortiz Z, Shea B, Suarez-Almazor ME, et al. The efficacy of folic acid and folinic acid in reducing methotrexate gastrointestinal toxicity in rheumatoid arthritis. A metaanalysis of randomized controlled trials. J Rheumatol. 1998;25:36-43.

Quere I, Bellet H, Hoffet M, Janbon C, Mares P, Gris JC. A woman with five consecutive fetal deaths: case report and retrospective analysis of hyperhomocysteinemia prevalence in 100 consecutive women with recurrent miscarriages. Fertil Steril. 1998;69(1):152-154.

Pogribna M, Melnyk S, Pogribny I, Chango A, Yi P, James SJ. Homocysteine metabolism in children with Down syndrome: in vitro modulation. Am J Genet. 2001;69(1):88-95.

Rimm EB, Willett WC, Hu FB, et al. Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. JAMA. 1998;279:359-364.

Ringer D, ed. Physician's Guide to Nutriceuticals. St. Joseph, Mich: Nutritional Data Resources; 1998.

Rock CL, Michael CW, Reynolds RK, Ruffin MT. Prevention of cervix cancer. Crit Rev Oncol Hematol. 2000;33(3):169-185.

Rohan TE, Jain MG, Howe GR, Miller AB. Dietary folate consumption and breast cancer risk [communication]. J Natl Cancer Inst. 2000;92(3):266-269.

Schnyder G. Decreased rate of coronary restinosis after lowering of plasma homocysteine levels. N Engl J Med. 2001;345(22):1593-1600.

Seligmann H, Potasman I, Weller B, Schwartz M, Prokocimer M. Phenytoin-folic acid interaction: a lesson to be learned. Clin Neuropharmacol. 1999;22(5):268-272.

Sellers TA, Kushi LH, Cerhan JR, et al. Dietary folate intake, alcohol, and risk of breast cancer in a prospective study of postmenopausal women. Epidemiology. 2001;12(4):420-428.

Snowdon DA. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun study. Am J Clin Nutr. 2000;71:993-998.

Steger GG, Mader RM, Vogelsang H, Schöfl R, Lochs H, Ferenci P. Folate absorption in Crohn's disease. Digestion. 1994;55:234-238.

Su LJ, Arab L. Nutritional status of folate and colon cancer risk: evidence from NHANES I epidemiologic follow-up study. Ann Epidemiol. 2001;11(1):65-72.

Temple ME, Luzier AB, Kazierad DJ. Homocysteine as a risk factor for atherosclerosis. Ann Pharmacother. 2000;34(1):57-65.

Thompson JR, Gerald PF, Willoughby ML, Armstrong BK. Maternal folate supplementation in pregnancy and protection against acute lymphoblastic leukemia in childhood: a case-controlled study. Lancet. 2001;358(9297):1935-1940.

Thomson SW, Heimburger DC, Cornwell PE, et al. Correlates of total plasma homocysteine: folic acid, copper, and cervical dysplasia. Nutrition. 2000;16(6):411-416.

Title LM, Cummings PM, Giddens K, Genest JJ, Jr., Nassar BA. Effect of folic acid and antioxidant vitamins on endothelial dysfunction in patients with coronary artery disease. J Am Coll Cardiol. 2000;36(3):758-765.

Torkos S. Drug-nutrient interactions: a focus on cholesterol-lowering agents. Int J Integrative Med. 2000;2(3):9-13.

Tucker KL, Selhub K, Wilson PW, Rosenberg IH. Dietary intake pattern relates to plasma folate and homocysteine concentrations in the Framingham Heart Study. J Nutr. 1996;126:3025-3031.

Verhaar MC, Wever RM, Kastelein JJ, et al. Effects of oral folic acid supplementation on endothelial function in familial hypercholesterolemia. Circulation. 1999;100(4):335-338.

Wald DS. Randomized trial of folic acid supplementation and serum homocysteine levels. Arch Intern Med. 2001;161:695-700.

Wallock LM. Low seminal plasma folate concentrations are associated with low sperm density and count in male smokers and nonsmokers. Fertil Steril. 2001;75(2):252-259.

Wang HX. Vitamin B12 and folate in relation to the development of Alzheimer's Disease. Neurology. 2001;56:1188-1194.

Watkins ML. Efficacy of folic acid prophylaxis for the prevention of neural tube defects. Ment Retard Dev Disab Res Rev. 1998;4:282-290.

Windham GC, Shaw GM, Todoroff K, Swan SH. Miscarriage and use of multi-vitamins or folic acid. Am J Med Genet. 2000;90(3):261-262.

Wolf PA. Prevention of stroke. Lancet. 1998;352 (suppl III):15-18.

Wong WY, Thomas CM, Merkus JM, Zielhuis GA, Steegers-Theunissen RP. Male factor subfertility: possible causes and the impact of nutritional factors. Fertil Steril. 2000;73(3):435-442.

Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. A prospective study on folate, B12, and pyridoxal 5'-phosphate (B6) and breast cancer. Cancer Epidemiol Biomarkers Prev. 1999;8(3):209-217.

Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA. 1999;281:1632-1637.

 

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The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

Self-Therapy For People Who ENJOY Learning About Themselves

Most of us have problems with shame, to one degree or another.

The first article in this series ("About Shame") helped you to learn if you have a big problem with shame.

This second article is for anyone who finds any shame in their life.

YOUR OVERALL GOAL

To overcome shame, you need to learn that it's OK to be who you are!

To get there, you must have and absorb deeply many separate moments of being accepted, loved, or valued.

I'll be giving you some practical ideas about how to do this.

ABOUT THE PEOPLE WHO ARE CLOSEST TO YOU

Stop relying on anyone who treats you as if you are not OK.

Spend more and more of your time with the people who know you are OK the way you are.
And let them know more and more about you.

Choose your relationships based on how you are treated - not just on whether the other person feels "comfortable." [We are "comfortable" with what we are used to - even when it's bad for us!]

Treat people the way you want to be treated. It's contagious.

WHEN PEOPLE TREAT YOU POORLY

Tell them to stop it! If they keep it up, don't tell them over and over. This is like "begging."
It makes you feel weak in their presence. You need to feel strong when you have to be around such people!

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Expect people who treat you badly to keep it up and hold them responsible for how they treat you.

Hold yourself responsible for how much time you spend with them, how you respond to their mistreatment, and whether you take their opinions seriously.

When people imply that you aren't valuable, they are wrong. You must learn how to throw away such comments immediately. (You know how angry you get when you are treated this way. This anger is your guide. It tells you that this person's opinion of you is worthless and can be thrown away without question.)

Know that only a few people are likely to treat you poorly. The rest of us are ready to treat you well!

(If you catch yourself thinking otherwise, at least remind yourself that I am positive you are wrong!)

NEXT...

The suggestions coming up next are even more important than what you've read so far.

WHEN PEOPLE TREAT YOU WELL

Absorb it!

Always take at least a few seconds to FEEL the good feelings you get when you are treated well.

Let your appreciation show. (Your natural smile will do just fine!)

Showing your appreciation reinforces the other person and encourages them to stay around you longer.

Don't talk yourself out of it! Most compliments are honest. Even when someone is trying to manipulate you they say things they mean! Turn down the manipulation but accept the compliment!

For example: "Thanks for noticing how attractive I am, but I still don't want to give you my phone number." and, "Thanks for noticing I have good taste in cars, but I still won't pay what you are asking for this one."

WHEN YOU THINK ABOUT IT LATER

The most important factor in overcoming shame is how you treat yourself when you get home!

When you've been treated poorly how do you treat yourself afterwards?

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The Unhealthy Option:
Focus on yourself and wonder if they were right about the bad things they said!
"Maybe they are right and I am a jerk!"
"Maybe I am stupid!"

The Healthy Option:
Focus on your anger at the mistreatment!
"What a jerk he was!"
"What's wrong with someone like that!?"
"Who asked for her opinion?!"

When you've been treated well how do you treat yourself afterwards?

• Do you relax and think about the good things?

• Do you mentally recycle the best parts?

• Do you notice how much you agree about your good qualities?

• Do you take the time to ENJOY feeling good?

ANSWERS TO THE USUAL OBJECTIONS

Q: "What about all the horrible mistakes I made in my life?"
A: "You needed to make them, to learn. Now that you know they were mistakes, you have learned!"

Q: "What about all the people I've hurt?"
A: "And what about all the people they've hurt? Hurting each other is awful, but it's part of life."

Q: "Won't I keep screwing up if I don't feel ashamed?"
A: "It never stopped you in the past! Shame doesn't control you. YOU control you."

Q: "This is all B.S.! I'm bad, and I know it, and I need to feel this way."
A: "Your pain is only a warning. You've got your warning. Feeling more of it won't help anything."

Q: "We all need to suffer or else terrible things will happen in this world!"
A: "If you ever meet the mean people who taught you that, tell them I said they were full of it!"

Enjoy Your Changes!

Everything here is designed to help you do just that!

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next: How Much Change Is Possible?

"Malignant Self Love - Narcissism Revisited"
The Introduction: The Habitual Identity

In a famous experiment, students were asked to take a lemon home and to get used to it. Three days later, they were able to single out "their" lemon from a pile of rather similar ones. They seemed to have bonded. Is this the true meaning of love, bonding, coupling? Do we simply get used to other human beings, pets, or objects?

Habit forming in humans is reflexive. We change ourselves and our environment in order to attain maximum comfort and well being. It is the effort that goes into these adaptive processes that forms a habit. The habit is intended to prevent us from constant experimenting and risk taking. The greater our well being, the better we function and the longer we survive.

Actually, when we get used to something or to someone - we get used to ourselves. In the object of the habit we see a part of our history, all the time and effort that we put into it. It is an encapsulated version of our acts, intentions, emotions and reactions. It is a mirror reflecting back at us that part in us, which formed the habit. Hence, the feeling of comfort : we really feel comfortable with our own selves through the agency of the object of our habit.

Because of this, we tend to confuse habits with identity. If asked WHO they are, most people will resort to describing their habits. They will relate to their work, their loved ones, their pets, their hobbies, or their material possessions. Yet, all of these cannot constitute part of an identity because their removal does not change the identity that we are seeking to establish when we enquire WHO someone is. They are habits and they make the respondent comfortable and relaxed. But they are not part of his identity in the truest, deepest sense.

Still, it is this simple mechanism of deception that binds people together. A mother feels that her off spring are part of her identity because she is so used to them that her well being depends on their existence and availability. Thus, any threat to her children is interpreted to mean a threat on her Self. Her reaction is, therefore, strong and enduring and can be recurrently elicited.

The truth, of course, is that her children ARE a part of her identity in a superficial manner. Removing her will make her a different person, but only in the shallow, phenomenological sense f the word. Her deep-set, true identity will not change as a result. Children do die at times and their mother does go on living, essentially unchanged.

But what is this kernel of identity that I am referring to? This immutable entity which is the definition of who we are and what we are and which, ostensibly, is not influenced by the death of our loved ones ? What is so strong as to resist the breaking of habits that die hard?

It is our personality. This elusive, loosely interconnected, interacting, pattern of reactions to our changing environment. Like the Brain, it is difficult to define or to capture. Like the Soul, many believe that it does not exist, that it is a fictitious convention. Yet, we know that we do have a personality. We feel it, we experience it. It sometimes encourages us to do things - at other times, as much as prevents us from doing them. It can be supple or rigid, benign or malignant, open or closed. Its power lies in its looseness. It is able to combine, recombine and permutate in hundreds of unforeseeable ways. It metamorphesizes and the constancy of its rate and kind of change is what gives us a sense of identity.

Actually, when the personality is rigid to the point of being unable to change in reaction to changing circumstances - we say that it is disordered. A personality Disorder is the ultimate misidentification. The individual mistakes his habits for his identity. He identifies himself with his environment, taking behavioral, emotional, and cognitive cues exclusively from it. His inner world is, so to speak, vacated, inhabited, as it were, by the apparition of his True Self.

Such a person is incapable of loving and of living. He is incapable of loving because to love (at least according to our model) is to equate and collate two distinct entities : one's Self and one's habits. The personality disordered sees no distinction. He IS his habits and, therefore, by definition, can only rarely and with an incredible amount of exertion, change them. And, in the long term, he is incapable of living because life is a struggle TOWARDS, a striving, a drive AT something. In other words : life is change. He who cannot change cannot live.

"Malignant Self Love" was written under extreme conditions of duress. It was composed in jail as I was trying to understand what had hit me. My nine year old marriage dissolved, my finances were in a shocking condition, my family estranged, my reputation ruined, my personal freedom severely curtailed. Slowly, the realization that it was all my fault, that I was sick and needed help penetrated the decades old defenses that I erected around me. This book is the documentation of a road of self discovery. It was a painful process, which led to nowhere. I am no different - and no healthier - today than when I wrote this book. My disorder is here to stay, the prognosis is poor and alarming.

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The narcissist is an actor in a monodrama, yet forced to remain behind the scenes. The scenes take centre stage, instead. The narcissist does not cater at all to his own needs. Contrary to his reputation, the narcissist does not "love" himself in any true sense of this loaded word.

He feeds off other people, who hurl back at him an image that he projects to them. This is their sole function in his world: to reflect, to admire, to applaud, to detest - in a word, to assure him that he exists.

Otherwise, they have no right to tax his time, energy, or emotions - so he feels 

To borrow Freud's trilateral model, the narcissist's Ego is weak, disorganized and lacks clear boundaries. Many of the Ego functions are projected. The Superego is sadistic and punishing. The Id is unrestrained.

Primary Objects in the narcissist's childhood were badly idealised and internalised.

His object relations are distraught and destroyed.

The Essay, "Malignant Self Love - Narcissism Revisited" offers a detailed, first hand account of what it is like to have a Narcissistic Personality Disorder. It contains new insights and an organised methodological framework using a new psychodynamic language. It is intended for professionals.

The first part of the book comprises 102 Frequently Asked Questions (FAQs) regarding narcissism and personality disorders. The posting of "Malignant Self Love - Narcissism Revisited" on the Web has elicited a flood of excited, sad and heart rending responses, mostly from victims of narcissists but also from people suffering from the NPD. This is a true picture of the resulting correspondence with them.

This book is not intended to please or to entertain. NPD is a pernicious, vile and tortuous disease, which affects not only the narcissist. It infects and forever changes people who are in daily contact with the narcissist. In other words: it is contagious. It is my contention that narcissism is the mental epidemic of the twentieth century, a plague to be fought by all means.

This book is my contribution to minimising the damages of this disorder.

Sam Vaknin

purchase: "Malignant Self Love - Narcissism Revisited"

Read excerpts from the book

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next: Discussion and Reading Group Guide

Malignant Self Love - Narcissism Revisited and other books by Sam Vaknin about narcissists, psychopaths, and abuse in relationships

Tenth, Revised Printing (January 2015)

By: Sam Vaknin, Ph.D.

Narcissism, Pathological Narcissism, The Narcissistic Personality Disorder (NPD), the Narcissist, and Relationships with Abusive Narcissists and Psychopaths

Barnes & Noble.com link: "Malignant Self Love - Narcissism Revisited"

Amazon.com link: "Malignant Self Love - Narcissism Revisited"

(ISBN 80-238-3384-7 - New ISBN 978-80-238-3384-3)

Read excerpts from the book

The Eighth Print Edition includes:

• The full text of "Malignant Self Love - Narcissism Revisited"
• The full text of 102 Frequently Asked Questions and Answers
• Covering all the dimensions of Pathological Narcissism and Abuse in Relationships
• An Essay - The Narcissist's point of view
• Bibliography
• 730 printed pages in a quality paper book

Are YOU Abused? Stalked? Harassed? Victimized? Confused and Frightened?

• Had a Narcissistic or Psychopathic Parent?
• Married to a Narcissist or a Psychopath - or Divorcing One?
• Afraid your children will turn out to be the same?
• Want to cope with this pernicious, baffling condition?

OR 

Are You a Narcissist or a Psychopath - or suspect that You are one ...

This book will teach you how to...

• Cope, Survive, and Protect Your Loved Ones!

"Malignant Self Love - Narcissism Revisited" is based on correspondence since 1996 with hundreds of people suffering from the Narcissistic Personality Disorder (narcissists) and with thousands of their suffering family members, friends, therapists, and colleagues.

Click to buy the Narcissism and Abuse Series of SIXTEEN e-Books (more than 5,500 pages) for less than the price of the print edition! (PLEASE NOTE: The Series includes the full text of "Malignant Self Love- Narcissism Revisited" plus FIFTEEN other books about narcissists, psychopaths, and abusive relationships) You can also purchase nine of these ebooks separately - click here!

Testimonials

 

What the Media have to say

 

“Few people can claim to have increased the public awareness of NPD to such a degree.”

 

Adrian Tampany, Financial Times Weekend Magazine, September 4-5, 2010

 

“Malignant Self-love (is a) ... magnum opus”

 

Yvonne Roberts, Sunday Times, September 16, 2007

 

"Sam Vaknin is the world’s leading expert on narcissism."

 

Tim Hall, New York Press, Volume 16, Issue 7 - February 12, 2003

Interviews (New-York Times, New-York Post, Washington Post and other major media) United Press International  Part I Part II

 

"Vaknin’s a respected expert on malignant narcissists ... He set about to know everything there is about the psychopathic narcissist."

 

Ian Walker, ABC Radio National Background Briefing, July 18, 2004

 

What Mental Health Professionals and Authors have to say

 

“Among many books published on the topic of pathological narcissism, this is by far the best.

It is highly recommended not only for the general public but also for professional therapists.”

 

(Akira Otani, Ed.D.,ABPH, University of Maryland)

 

"Sam is doing a great work on pathological narcissism. His book "Malignant self love" is our first guideline in handling malignant types of patients in the forensic setting."

 

(Dr. Sanja Radeljak, MD, PhD, psychiatrist and forensic expert, Neuropsychiatric hospital "Dr. Ivan Barbot" Popovaca, Croatia)

 

“Sam Vaknin is the number one author in guiding this understanding - technically rich - and serious in details of specific dynamics other authors don't get ... This is the one book to support professionals and people coming out of dysregulated families and dysfunctional relations.”

 

(Dr. Claudia Riecken, clinician and neuroscientist, Brazil)

 

“The book penetrates deeply into the narcissist's mind and is filled with myriad gripping novel insights. It gives the reader a great insight into the fears, desires, defenses, and motives of the narcissist, as well as those in a relationship with the narcissist.”

 

(Alison Poulsen, Ph.D.)

 

“Brilliant, insightful, extremely relevant, not only clinically, but practically, on a day to day basis. This work can be immediately applied and be of assistance to our society at large.”

 

(Dr. Cyndie Spanier, Ph.D., Deputy Director at Pittsburgh Behavioral Medicine, LLC)

 

“Sam is a genius his work most inspiring not only to myself but to my colleagues as well.”

 

(Joan Jutta Lachkar, Ph.D., Affiliate Member of the New Center for Psychoanalysis and Author of: How to Talk to a Narcissist; How to Talk to a Borderline; Narcissistic/Borderline Couples)

 

“Sam Vaknin is extremely impressive and the author of Malignant Self-Love: Narcissism Revisited, which is a seminal work on narcissism. Buy Vaknin’s book because it will teach you every single thing in the world about narcissists. This guy invented how we think about narcissism.”

 

(Dr. Samantha Rodman, DrPsychMom.com)

 

"Sam Vaknin is an expert on this field and presents his work clearly and with ease. I recommend this book most highly as awareness of NPD is crucial in this world today and Sam Vaknin gives his exclusive comprehensive understandings of this topic. This book will help you with human interactions in dealing with families, friends and co-workers. This is a most valuable investment for you in reading and re-reading, to have in your library. This read is worth several therapy sessions I believe and more so in fact."

 

(Audrey Epstein, M.S. Ed., MPA)

 

“Clinicians, researchers and narcissistic abuse victims alike have benefited from this one-of-a-kind book about narcissistic personality disorder. As a psychologist who specializes in narcissistic abuse recovery, psychopathy, and narcissistic personality disorder (NPD), I endorse this book as an empowering clinical tool. This resource has helped me to form a clearer diagnostic impression of malignant narcissists who seek my help during episodes of desperation and withdrawal due to narcissistic supply depletion. Armed with a more comprehensive understanding of NPD, I feel calm and in control when ambushed by narcissistic rage during diagnostic interviews and psychotherapy sessions. Vaknin's familiar descriptions of psychological theory and clinical terminology are quite helpful in managing transference and countertransference issues in order to maintain healthy therapeutic boundaries. This book is an invaluable resource to mental health professionals to combat compassion fatigue and psychological abuse when working with cluster b personality pathology. I highly encourage clinicians to both read and reference Malignant Self-love to improve treatment outcomes for victims of narcissistic abuse.”

 

(Dr. April Jones, Licensed Psychologist in Chicago, Illinois, USA)

 

"Sam Vaknin's book is THE bible on Narcissism!"

 

(Mary Jo Fay, author of 'When Your Perfect Partner Goes Perfectly Wrong - Loving or Leaving the Narcissist in Your Life')

 

"I consider this book to be the compass for Narcissistic Personality Disorder education"

 

(Jen Emmerich, LMSW, ACSW)

 

"There is no more important work than this one on the subject ... You may very well discover yourself."

 

(Heyward Bruce Ewart, III, Ph.D., author of 'Am I Bad')

 

"Read Malignant Self Love so you will understand that you are NOT crazy, you are just embedded in a crazy-making relationship."

 

(Liane J. Leedom, M.D., author of 'Just Like His Father?')

 

"Vaknin's depth and breadth are unmatched anywhere else and by anyone else. He knows everything there is to know about narcissistic and psychopathic abusers and how to cope with them effectively."

 

(Yomtov Barak, family therapist)

 

"I was stimulated just as I was challenged and enlightened."

 

(Robert L. Mueller, author of 'Bullying Bosses')

 

"The only source of such vast, serious, elaborated and thorough first-hand information about Narcissism available.

Useful for victims as well as therapists."

 

(Dr. Nili Raam, author)

 

'Provides the partners, family and friends of NPD sufferers, and the sufferers themselves,

with deep insight into the numerous expressions of this devastating and often insidious disorder."

 

(Esther Veltheim, author of 'Beyond Concepts')

 

"One powerful healing tool in our therapy with these people is Dr. Vaknin's book.

The most accurate portrayal of the 'typical' cult leader we have ever seen."

 

(Robert Pardon, Director of MeadowHaven)

 

"A must read for psychologists, social workers, and all individuals who want to learn how to deal with the narcissists in their lives."

 

(Laurie Anthony, teacher and author)

 

"Required reading for any codependent - to understand how the other side works."

 

(Dr. Irene, psychologist and Webmistress of drirene.com)

 

"If you wish to get under the skin of a Narcissist, if you wish to get to know how he thinks and feels and why he behaves as he does, then this is the book for you."

 

(Dr. Anthony Benis, Mount Sinai Hospital, New York, and author "Towards Self and Sanity - On the Genetic Origins of the Human Character")

 

"Sam Vaknin is a leading authority on the topic of narcissism."

 

(Lisa Angelettie M.S.W., former editor of BellaOnline's Mental Health, "What is Narcissistic Personality Disorder")

 

"I cannot recommend this book enough to those of you who have this disorder, to families and friends who are trying to understand."

 

(Patty Pheil, MSW, Mental Health Today )

 

"(T)his book is a must read and will give you insight into the emotionally destructive people in your workplace, your family and among your friends. Sam Vaknin clears up the questions, confusion, and effects of dealing with narcissists: the book is well written, informative, and therapeutic. “

 

(Carolyn Reilly, MSW San Jose, Costa Rica)

 

Other Testimonials

 

"...This book has an important purpose. I am sure it will be appreciated in a library, classroom or among the mental health profession."

 

(Katherine Theriault, Inscriptions Magazine, Vol. 2, Issue 20)

 

“I challenge anyone to get this book, pick any page at random and not be impressed by the depth and quality of the unique insight into NPD that is provided there. A truly excellent and thorough piece of work that solidifies Sam's position as the global authority on the subject of Narcissistic Personality Disorder.”

 

(Richard Grannon, Spartan Life Coach)

 

"Now, for the first time, a much-needed first-hand account of what Narcissistic Personality Disorder is like. Offers insight and clarity."

 

(Howard Brown, 4Therapy )

 

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Sam has plugged all the loopholes, exposed all the plots, and introduced a new language to confront the Narcissist. A 'hands-on' tool that can immediately bring relief. If you want to breathe again, if you are at your wits end, if everything has been tried and failed,  if you NEED a change, then Malignant Self Love can give you your life back.  This book is a lifesaver!

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next: Book Introduction

1. Overview
2. Personality Disorders
3. The Biochemistry and Genetics of Mental Health
4. The Variance of Mental Disease
5. Mental Disorders and the Social Order
6. Mental Ailment as a Useful Metaphor
7. The Insanity Defense
8. Adaptation and Insanity - (correspondence with Paul Shirley, MSW)

"You can know the name of a bird in all the languages of the world, but when you're finished, you'll know absolutely nothing whatever about the bird... So let's look at the bird and see what it's doing - that's what counts. I learned very early the difference between knowing the name of something and knowing something."

Richard Feynman, Physicist and 1965 Nobel Prize laureate (1918-1988)

"You have all I dare say heard of the animal spirits and how they are transfused from father to son etcetera etcetera - well you may take my word that nine parts in ten of a man's sense or his nonsense, his successes and miscarriages in this world depend on their motions and activities, and the different tracks and trains you put them into, so that when they are once set a-going, whether right or wrong, away they go cluttering like hey-go-mad."

Lawrence Sterne (1713-1758), "The Life and Opinions of Tristram Shandy, Gentleman" (1759)

1. Overview

Someone is considered mentally "ill" if:

1. His conduct rigidly and consistently deviates from the typical, average behaviour of all other people in his culture and society that fit his profile (whether this conventional behaviour is moral or rational is immaterial), or
2. His judgment and grasp of objective, physical reality is impaired, and
3. His conduct is not a matter of choice but is innate and irresistible, and
4. His behavior causes him or others discomfort, and is
5. Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.

Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated - is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) - or brought on by abusive or wrong nurturance?

These questions are the domain of the "medical" school of mental health.

Others cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium - the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.

The members of the functional school regard mental health disorders as perturbations in the proper, statistically "normal", behaviours and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual - ill at ease with himself (ego-dystonic) or making others unhappy (deviant) - is "mended" when rendered functional again by the prevailing standards of his social and cultural frame of reference.

In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter - but, to a counter intuitively large degree, a faulty methodology.

As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his article "The Lying Truths of Psychiatry", mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.

This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" - even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) - are usually none of these things.

The outcome is a bewildering array of ever-shifting mental health "diagnoses" expressly centred around Western civilisation and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a "personality disorder", almost seven decades after it was first described by Freud.

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2. Personality Disorders

Indeed, personality disorders are an excellent example of the kaleidoscopic landscape of "objective" psychiatry.

The classification of Axis II personality disorders - deeply ingrained, maladaptive, lifelong behavior patterns - in the Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] - or the DSM-IV-TR for short - has come under sustained and serious criticism from its inception in 1952, in the first edition of the DSM.

The DSM IV-TR adopts a categorical approach, postulating that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). This is widely doubted. Even the distinction made between "normal" and "disordered" personalities is increasingly being rejected. The "diagnostic thresholds" between normal and abnormal are either absent or weakly supported.

The polythetic form of the DSM's Diagnostic Criteria - only a subset of the criteria is adequate grounds for a diagnosis - generates unacceptable diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none. The DSM fails to clarify the exact relationship between Axis II and Axis I disorders and the way chronic childhood and developmental problems interact with personality disorders.

The differential diagnoses are vague and the personality disorders are insufficiently demarcated. The result is excessive co-morbidity (multiple Axis II diagnoses). The DSM contains little discussion of what distinguishes normal character (personality), personality traits, or personality style (Millon) - from personality disorders.

A dearth of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities. Numerous personality disorders are "not otherwise specified" - a catchall, basket "category".

Cultural bias is evident in certain disorders (such as the Antisocial and the Schizotypal). The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSM-IV-TR itself:

"An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another" (p.689)

The following issues - long neglected in the DSM - are likely to be tackled in future editions as well as in current research. But their omission from official discourse hitherto is both startling and telling:

• The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
• The genetic and biological underpinnings of personality disorder(s);
• The development of personality psychopathology during childhood and its emergence in adolescence;
• The interactions between physical health and disease and personality disorders;
• The effectiveness of various treatments - talk therapies as well as psychopharmacology.

3. The Biochemistry and Genetics of Mental Health

Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain - or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.

To designate a pattern of behaviour as a mental health disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist - but are they truly the roots of mental perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness - or the other way around?

That psychoactive medication alters behaviour and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable - is debatable and involves tautological thinking. If a certain pattern of behaviour is described as (socially) "dysfunctional" or (psychologically) "sick" - clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".

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The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behaviour patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.

Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also affect the brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines - as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) - treat symptoms, not the underlying processes that yield them.

4. The Variance of Mental Disease

If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, the case. Psychological diseases are not context dependent - but the pathologizing of certain behaviours is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures - and utterly normative or advantageous in others.

This was to be expected. The human mind and its dysfunctions are alike around the world. But values differ from time to time and from one place to another. Hence, disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.

As long as the pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms - i.e., mostly on observed or reported behaviours - they remain vulnerable to such discord and devoid of much-sought universality and rigor.

5. Mental Disorders and the Social Order

The mentally sick receive the same treatment as carriers of AIDS or SARS or the Ebola virus or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in the name of the greater good, largely as a preventive policy.

Conspiracy theories notwithstanding, it is impossible to ignore the enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, on the propagation of the concept of "mental illness" and its corollaries: treatment and research.

6. Mental Ailment as a Useful Metaphor

Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited the unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.

"Mental health disorders" are no different. They are shorthand for capturing the unsettling quiddity of "the Other". Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both the dangerous and the idiosyncratic to the collective fringes is a vital technique of social engineering.

The aim is progress through social cohesion and the regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is often the case with human endeavour, it is a noble cause, unscrupulously and dogmatically pursued.

7. The Insanity Defense

"It is an ill thing to knock against a deaf-mute, an imbecile, or a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)

If mental illness is culture-dependent and mostly serves as an organizing social principle - what should we make of the insanity defense (NGRI- Not Guilty by Reason of Insanity)?

A person is held not responsible for his criminal actions if s/he cannot tell right from wrong ("lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct" - diminished capacity), did not intend to act the way he did (absent "mens rea") and/or could not control his behavior ("irresistible impulse"). These handicaps are often associated with "mental disease or defect" or "mental retardation".

Mental health professionals prefer to talk about an impairment of a "person's perception or understanding of reality". They hold a "guilty but mentally ill" verdict to be contradiction in terms. All "mentally-ill" people operate within a (usually coherent) worldview, with consistent internal logic, and rules of right and wrong (ethics). Yet, these rarely conform to the way most people perceive the world. The mentally-ill, therefore, cannot be guilty because s/he has a tenuous grasp on reality.

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Yet, experience teaches us that a criminal maybe mentally ill even as s/he maintains a perfect reality test and thus is held criminally responsible (Jeffrey Dahmer comes to mind). The "perception and understanding of reality", in other words, can and does co-exist even with the severest forms of mental illness.

This makes it even more difficult to comprehend what is meant by "mental disease". If some mentally ill maintain a grasp on reality, know right from wrong, can anticipate the outcomes of their actions, are not subject to irresistible impulses (the official position of the American Psychiatric Association) - in what way do they differ from us, "normal" folks?

This is why the insanity defense often sits ill with mental health pathologies deemed socially "acceptable" and "normal" - such as religion or love.

Consider the following case:

A mother bashes the skulls of her three sons. Two of them die. She claims to have acted on instructions she had received from God. She is found not guilty by reason of insanity. The jury determined that she "did not know right from wrong during the killings."

But why exactly was she judged insane?

Her belief in the existence of God - a being with inordinate and inhuman attributes - may be irrational.

But it does not constitute insanity in the strictest sense because it conforms to social and cultural creeds and codes of conduct in her milieu. Billions of people faithfully subscribe to the same ideas, adhere to the same transcendental rules, observe the same mystical rituals, and claim to go through the same experiences. This shared psychosis is so widespread that it can no longer be deemed pathological, statistically speaking.

She claimed that God has spoken to her.

As do numerous other people. Behavior that is considered psychotic (paranoid-schizophrenic) in other contexts is lauded and admired in religious circles. Hearing voices and seeing visions - auditory and visual delusions - are considered rank manifestations of righteousness and sanctity.

Perhaps it was the content of her hallucinations that proved her insane?

She claimed that God had instructed her to kill her boys. Surely, God would not ordain such evil?

Alas, the Old and New Testaments both contain examples of God's appetite for human sacrifice. Abraham was ordered by God to sacrifice Isaac, his beloved son (though this savage command was rescinded at the last moment). Jesus, the son of God himself, was crucified to atone for the sins of humanity.

A divine injunction to slay one's offspring would sit well with the Holy Scriptures and the Apocrypha as well as with millennia-old Judeo-Christian traditions of martyrdom and sacrifice.

Her actions were wrong and incommensurate with both human and divine (or natural) laws.

Yes, but they were perfectly in accord with a literal interpretation of certain divinely-inspired texts, millennial scriptures, apocalyptic thought systems, and fundamentalist religious ideologies (such as the ones espousing the imminence of "rupture"). Unless one declares these doctrines and writings insane, her actions are not.

we are forced to the conclusion that the murderous mother is perfectly sane. Her frame of reference is different to ours. Hence, her definitions of right and wrong are idiosyncratic. To her, killing her babies was the right thing to do and in conformity with valued teachings and her own epiphany. Her grasp of reality - the immediate and later consequences of her actions - was never impaired.

It would seem that sanity and insanity are relative terms, dependent on frames of cultural and social reference, and statistically defined. There isn't - and, in principle, can never emerge - an "objective", medical, scientific test to determine mental health or disease unequivocally.

8. Adaptation and Insanity - (correspondence with Paul Shirley, MSW)

"Normal" people adapt to their environment - both human and natural.

"Abnormal" ones try to adapt their environment - both human and natural - to their idiosyncratic needs/profile.

If they succeed, their environment, both human (society) and natural is pathologized.

Note on the Medicalization of Sin and Wrongdoing

With Freud and his disciples started the medicalization of what was hitherto known as "sin", or wrongdoing. As the vocabulary of public discourse shifted from religious terms to scientific ones, offensive behaviors that constituted transgressions against the divine or social orders have been relabelled. Self-centredness and dysempathic egocentricity have now come to be known as "pathological narcissism"; criminals have been transformed into psychopaths, their behavior, though still described as anti-social, the almost deterministic outcome of a deprived childhood or a genetic predisposition to a brain biochemistry gone awry - casting in doubt the very existence of free will and free choice between good and evil. The contemporary "science" of psychopathology now amounts to a godless variant of Calvinism, a kind of predestination by nature or by nurture.

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next: Do's and Don'ts to Keep or Avoid a Narcissist

• Watch the video on Narcissist and Serial Killers

Countess Erszebet Bathory was a breathtakingly beautiful, unusually well-educated woman, married to a descendant of Vlad Dracula of Bram Stoker fame. In 1611, she was tried - though, being a noblewoman, not convicted - in Hungary for slaughtering 612 young girls. The true figure may have been 40-100, though the Countess recorded in her diary more than 610 girls and 50 bodies were found in her estate when it was raided.

The Countess was notorious as an inhuman sadist long before her hygienic fixation. She once ordered the mouth of a talkative servant sewn. It is rumoured that in her childhood she witnessed a gypsy being sewn into a horse's stomach and left to die.

The girls were not killed outright. They were kept in a dungeon and repeatedly pierced, prodded, pricked, and cut. The Countess may have bitten chunks of flesh off their bodies while alive. She is said to have bathed and showered in their blood in the mistaken belief that she could thus slow down the aging process.

Her servants were executed, their bodies burnt and their ashes scattered. Being royalty, she was merely confined to her bedroom until she died in 1614. For a hundred years after her death, by royal decree, mentioning her name in Hungary was a crime.

Cases like Bathory's give the lie to the assumption that serial killers are a modern - or even post-modern - phenomenon, a cultural-societal construct, a by-product of urban alienation, Althusserian interpellation, and media glamorization. Serial killers are, indeed, largely made, not born. But they are spawned by every culture and society, molded by the idiosyncrasies of every period as well as by their personal circumstances and genetic makeup.

Still, every crop of serial killers mirrors and reifies the pathologies of the milieu, the depravity of the Zeitgeist, and the malignancies of the Leitkultur. The choice of weapons, the identity and range of the victims, the methodology of murder, the disposal of the bodies, the geography, the sexual perversions and paraphilias - are all informed and inspired by the slayer's environment, upbringing, community, socialization, education, peer group, sexual orientation, religious convictions, and personal narrative. Movies like "Born Killers", "Man Bites Dog", "Copycat", and the Hannibal Lecter series captured this truth.

 

Serial killers are the quiddity and quintessence of malignant narcissism.

Yet, to some degree, we all are narcissists. Primary narcissism is a universal and inescapable developmental phase. Narcissistic traits are common and often culturally condoned. To this extent, serial killers are merely our reflection through a glass darkly.

In their book "Personality Disorders in Modern Life", Theodore Millon and Roger Davis attribute pathological narcissism to "a society that stresses individualism and self-gratification at the expense of community ... In an individualistic culture, the narcissist is 'God's gift to the world'. In a collectivist society, the narcissist is 'God's gift to the collective'". Lasch described the narcissistic landscape thus (in "The Culture of Narcissism: American Life in an age of Diminishing Expectations", 1979):

"The new narcissist is haunted not by guilt but by anxiety. He seeks not to inflict his own certainties on others but to find a meaning in life. Liberated from the superstitions of the past, he doubts even the reality of his own existence ... His sexual attitudes are permissive rather than puritanical, even though his emancipation from ancient taboos brings him no sexual peace.

Fiercely competitive in his demand for approval and acclaim, he distrusts competition because he associates it unconsciously with an unbridled urge to destroy ... He (harbours) deeply antisocial impulses. He praises respect for rules and regulations in the secret belief that they do not apply to himself. Acquisitive in the sense that his cravings have no limits, he ... demands immediate gratification and lives in a state of restless, perpetually unsatisfied desire."

The narcissist's pronounced lack of empathy, off-handed exploitativeness, grandiose fantasies and uncompromising sense of entitlement make him treat all people as though they were objects (he "objectifies" people). The narcissist regards others as either useful conduits for and sources of narcissistic supply (attention, adulation, etc.) - or as extensions of himself.

Similarly, serial killers often mutilate their victims and abscond with trophies - usually, body parts. Some of them have been known to eat the organs they have ripped - an act of merging with the dead and assimilating them through digestion. They treat their victims as some children do their rag dolls.

Killing the victim - often capturing him or her on film before the murder - is a form of exerting unmitigated, absolute, and irreversible control over it. The serial killer aspires to "freeze time" in the still perfection that he has choreographed. The victim is motionless and defenseless. The killer attains long sought "object permanence". The victim is unlikely to run on the serial assassin, or vanish as earlier objects in the killer's life (e.g., his parents) have done.

In malignant narcissism, the true self of the narcissist is replaced by a false construct, imbued with omnipotence, omniscience, and omnipresence. The narcissist's thinking is magical and infantile. He feels immune to the consequences of his own actions. Yet, this very source of apparently superhuman fortitude is also the narcissist's Achilles heel.

The narcissist's personality is chaotic. His defense mechanisms are primitive. The whole edifice is precariously balanced on pillars of denial, splitting, projection, rationalization, and projective identification. Narcissistic injuries - life crises, such as abandonment, divorce, financial difficulties, incarceration, public opprobrium - can bring the whole thing tumbling down. The narcissist cannot afford to be rejected, spurned, insulted, hurt, resisted, criticized, or disagreed with.

 

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Likewise, the serial killer is trying desperately to avoid a painful relationship with his object of desire. He is terrified of being abandoned or humiliated, exposed for what he is and then discarded. Many killers often have sex - the ultimate form of intimacy - with the corpses of their victims. Objectification and mutilation allow for unchallenged possession.

Devoid of the ability to empathize, permeated by haughty feelings of superiority and uniqueness, the narcissist cannot put himself in someone else's shoes, or even imagine what it means. The very experience of being human is alien to the narcissist whose invented False Self is always to the fore, cutting him off from the rich panoply of human emotions.

Thus, the narcissist believes that all people are narcissists. Many serial killers believe that killing is the way of the world. Everyone would kill if they could or were given the chance to do so. Such killers are convinced that they are more honest and open about their desires and, thus, morally superior. They hold others in contempt for being conforming hypocrites, cowed into submission by an overweening establishment or society.

The narcissist seeks to adapt society in general - and meaningful others in particular - to his needs. He regards himself as the epitome of perfection, a yardstick against which he measures everyone, a benchmark of excellence to be emulated. He acts the guru, the sage, the "psychotherapist", the "expert", the objective observer of human affairs. He diagnoses the "faults" and "pathologies" of people around him and "helps" them "improve", "change", "evolve", and "succeed" - i.e., conform to the narcissist's vision and wishes.

Serial killers also "improve" their victims - slain, intimate objects - by "purifying" them, removing "imperfections", depersonalizing and dehumanizing them. This type of killer saves its victims from degeneration and degradation, from evil and from sin, in short: from a fate worse than death.

The killer's megalomania manifests at this stage. He claims to possess, or have access to, higher knowledge and morality. The killer is a special being and the victim is "chosen" and should be grateful for it. The killer often finds the victim's ingratitude irritating, though sadly predictable.

In his seminal work, "Aberrations of Sexual Life" (originally: "Psychopathia Sexualis"), quoted in the book "Jack the Ripper" by Donald Rumbelow, Kraft-Ebbing offers this observation:

"The perverse urge in murders for pleasure does not solely aim at causing the victim pain and - most acute injury of all - death, but that the real meaning of the action consists in, to a certain extent, imitating, though perverted into a monstrous and ghastly form, the act of defloration. It is for this reason that an essential component ... is the employment of a sharp cutting weapon; the victim has to be pierced, slit, even chopped up ... The chief wounds are inflicted in the stomach region and, in many cases, the fatal cuts run from the vagina into the abdomen. In boys an artificial vagina is even made ... One can connect a fetishistic element too with this process of hacking ... inasmuch as parts of the body are removed and ... made into a collection."

Yet, the sexuality of the serial, psychopathic, killer is self-directed. His victims are props, extensions, aides, objects, and symbols. He interacts with them ritually and, either before or after the act, transforms his diseased inner dialog into a self-consistent extraneous catechism. The narcissist is equally auto-erotic. In the sexual act, he merely masturbates with other - living - people's bodies.

The narcissist's life is a giant repetition complex. In a doomed attempt to resolve early conflicts with significant others, the narcissist resorts to a restricted repertoire of coping strategies, defense mechanisms, and behaviors. He seeks to recreate his past in each and every new relationship and interaction. Inevitably, the narcissist is invariably confronted with the same outcomes. This recurrence only reinforces the narcissist's rigid reactive patterns and deep-set beliefs. It is a vicious, intractable, cycle.

Correspondingly, in some cases of serial killers, the murder ritual seemed to have recreated earlier conflicts with meaningful objects, such as parents, authority figures, or peers. The outcome of the replay is different to the original, though. This time, the killer dominates the situation.

The killings allow him to inflict abuse and trauma on others rather than be abused and traumatized. He outwits and taunts figures of authority - the police, for instance. As far as the killer is concerned, he is merely "getting back" at society for what it did to him. It is a form of poetic justice, a balancing of the books, and, therefore, a "good" thing. The murder is cathartic and allows the killer to release hitherto repressed and pathologically transformed aggression - in the form of hate, rage, and envy.

But repeated acts of escalating gore fail to alleviate the killer's overwhelming anxiety and depression. He seeks to vindicate his negative introjects and sadistic superego by being caught and punished. The serial killer tightens the proverbial noose around his neck by interacting with law enforcement agencies and the media and thus providing them with clues as to his identity and whereabouts. When apprehended, most serial assassins experience a great sense of relief.

Serial killers are not the only objectifiers - people who treat others as objects. To some extent, leaders of all sorts - political, military, or corporate - do the same. In a range of demanding professions - surgeons, medical doctors, judges, law enforcement agents - objectification efficiently fends off attendant horror and anxiety.

Yet, serial killers are different. They represent a dual failure - of their own development as full-fledged, productive individuals - and of the culture and society they grow in. In a pathologically narcissistic civilization - social anomies proliferate. Such societies breed malignant objectifiers - people devoid of empathy - also known as "narcissists".

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Interview (High School Project of Brandon Abear)

1 - Are most serial killers pathological narcissists? Is there a strong connection? Is the pathological narcissist more at risk of becoming a serial killer than a person not suffering from the disorder?

A. Scholarly literature, biographical studies of serial killers, as well as anecdotal evidence suggest that serial and mass killers suffer from personality disorders and some of them are also psychotic. Cluster B personality disorders, such as the Antisocial Personality Disorder (psychopaths and sociopaths), the Borderline Personality Disorder, and the Narcissistic Personality Disorder seem to prevail although other personality disorders - notably the Paranoid, the Schizotypal, and even the Schizoid - are also represented.

2 - Wishing harm upon others, intense sexual thoughts, and similarly inappropriate ideas do appear in the minds of most people. What is it that allows the serial killer to let go of those inhibitions? Do you believe that pathological narcissism and objectification are heavily involved, rather than these serial killers just being naturally "evil?" If so, please explain.

A. Wishing harm unto others and intense sexual thoughts are not inherently inappropriate. It all depends on the context. For instance: wishing to harm someone who abused or victimized you is a healthy reaction. Some professions are founded on such desires to injure other people (for instance, the army and the police).

The difference between serial killers and the rest of us is that they lack impulse control and, therefore, express these drives and urges in socially-unacceptable settings and ways. You rightly point out that serial killers also objectify their victims and treat them as mere instruments of gratification. This may have to do with the fact that serial and mass killers lack empathy and cannot understand their victims' "point of view". Lack of empathy is an important feature of the Narcissistic and the Antisocial personality disorders.

"Evil" is not a mental health construct and is not part of the language used in the mental health professions. It is a culture-bound value judgment. What is "evil" in one society is considered the right thing to do in another.

In his bestselling tome, "People of the Lie", Scott Peck claims that narcissists are evil. Are they?

The concept of "evil" in this age of moral relativism is slippery and ambiguous. The "Oxford Companion to Philosophy" (Oxford University Press, 1995) defines it thus: "The suffering which results from morally wrong human choices."

To qualify as evil a person (Moral Agent) must meet these requirements:

1. That he can and does consciously choose between the (morally) right and wrong and constantly and consistently prefers the latter;
2. That he acts on his choice irrespective of the consequences to himself and to others.

Clearly, evil must be premeditated. Francis Hutcheson and Joseph Butler argued that evil is a by-product of the pursuit of one's interest or cause at the expense of other people's interests or causes. But this ignores the critical element of conscious choice among equally efficacious alternatives. Moreover, people often pursue evil even when it jeopardizes their well-being and obstructs their interests. Sadomasochists even relish this orgy of mutual assured destruction.

Narcissists satisfy both conditions only partly. Their evil is utilitarian. They are evil only when being malevolent secures a certain outcome. Sometimes, they consciously choose the morally wrong - but not invariably so. They act on their choice even if it inflicts misery and pain on others. But they never opt for evil if they are to bear the consequences. They act maliciously because it is expedient to do so - not because it is "in their nature".

The narcissist is able to tell right from wrong and to distinguish between good and evil. In the pursuit of his interests and causes, he sometimes chooses to act wickedly. Lacking empathy, the narcissist is rarely remorseful. Because he feels entitled, exploiting others is second nature. The narcissist abuses others absent-mindedly, off-handedly, as a matter of fact.

The narcissist objectifies people and treats them as expendable commodities to be discarded after use. Admittedly, that, in itself, is evil. Yet, it is the mechanical, thoughtless, heartless face of narcissistic abuse - devoid of human passions and of familiar emotions - that renders it so alien, so frightful and so repellent.

We are often shocked less by the actions of narcissist than by the way he acts. In the absence of a vocabulary rich enough to capture the subtle hues and gradations of the spectrum of narcissistic depravity, we default to habitual adjectives such as "good" and "evil". Such intellectual laziness does this pernicious phenomenon and its victims little justice.

Note - Why are we Fascinated by Evil and Evildoers?

The common explanation is that one is fascinated with evil and evildoers because, through them, one vicariously expresses the repressed, dark, and evil parts of one's own personality. Evildoers, according to this theory, represent the "shadow" nether lands of our selves and, thus, they constitute our antisocial alter egos. Being drawn to wickedness is an act of rebellion against social strictures and the crippling bondage that is modern life. It is a mock synthesis of our Dr. Jekyll with our Mr. Hyde. It is a cathartic exorcism of our inner demons.

Yet, even a cursory examination of this account reveals its flaws.

Far from being taken as a familiar, though suppressed, element of our psyche, evil is mysterious. Though preponderant, villains are often labeled "monsters" - abnormal, even supernatural aberrations. It took Hanna Arendt two thickset tomes to remind us that evil is banal and bureaucratic, not fiendish and omnipotent.

In our minds, evil and magic are intertwined. Sinners seem to be in contact with some alternative reality where the laws of Man are suspended. Sadism, however deplorable, is also admirable because it is the reserve of Nietzsche's Supermen, an indicator of personal strength and resilience. A heart of stone lasts longer than its carnal counterpart.

Throughout human history, ferocity, mercilessness, and lack of empathy were extolled as virtues and enshrined in social institutions such as the army and the courts. The doctrine of Social Darwinism and the advent of moral relativism and deconstruction did away with ethical absolutism. The thick line between right and wrong thinned and blurred and, sometimes, vanished.

Evil nowadays is merely another form of entertainment, a species of pornography, a sanguineous art. Evildoers enliven our gossip, color our drab routines and extract us from dreary existence and its depressive correlates. It is a little like collective self-injury. Self-mutilators report that parting their flesh with razor blades makes them feel alive and reawakened. In this synthetic universe of ours, evil and gore permit us to get in touch with real, raw, painful life.

The higher our desensitized threshold of arousal, the more profound the evil that fascinates us. Like the stimuli-addicts that we are, we increase the dosage and consume added tales of malevolence and sinfulness and immorality. Thus, in the role of spectators, we safely maintain our sense of moral supremacy and self-righteousness even as we wallow in the minutest details of the vilest crimes.

3 - Pathological narcissism can seemingly "decay" with age, as stated in your article. Do you feel this applies to serial killers urges as well?

A. Actually, I state in my article that in RARE CASES, pathological narcissism as expressed in antisocial conduct recedes with age. Statistics show that the propensity to act criminally decreases in older felons. However, this doesn't seem to apply to mass and serial killers. Age distribution in this group is skewed by the fact that most of them are caught early on but there are many cases of midlife and even old perpetrators.

4 - Are serial killers (and pathological narcissism) created by their environments, genetics, or a combination of both?

A. No one knows.

Are personality disorders the outcomes of inherited traits? Are they brought on by abusive and traumatizing upbringing? Or, maybe they are the sad results of the confluence of both?

To identify the role of heredity, researchers have resorted to a few tactics: they studied the occurrence of similar psychopathologies in identical twins separated at birth, in twins and siblings who grew up in the same environment, and in relatives of patients (usually across a few generations of an extended family).

Tellingly, twins - both those raised apart and together - show the same correlation of personality traits, 0.5 (Bouchard, Lykken, McGue, Segal, and Tellegan, 1990). Even attitudes, values, and interests have been shown to be highly affected by genetic factors (Waller, Kojetin, Bouchard, Lykken, et al., 1990).

A review of the literature demonstrates that the genetic component in certain personality disorders (mainly the Antisocial and Schizotypal) is strong (Thapar and McGuffin, 1993). Nigg and Goldsmith found a connection in 1993 between the Schizoid and Paranoid personality disorders and schizophrenia.

The three authors of the Dimensional Assessment of Personality Pathology (Livesley, Jackson, and Schroeder) joined forces with Jang in 1993 to study whether 18 of the personality dimensions were heritable. They found that 40 to 60% of the recurrence of certain personality traits across generations can be explained by heredity: anxiousness, callousness, cognitive distortion, compulsivity, identity problems, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, and suspiciousness. Each and every one of these qualities is associated with a personality disorder. In a roundabout way, therefore, this study supports the hypothesis that personality disorders are hereditary.

This would go a long way towards explaining why in the same family, with the same set of parents and an identical emotional environment, some siblings grow to have personality disorders, while others are perfectly "normal". Surely, this indicates a genetic predisposition of some people to developing personality disorders.

Still, this oft-touted distinction between nature and nurture may be merely a question of semantics.

As I wrote in my book, "Malignant Self Love - Narcissism Revisited":

"When we are born, we are not much more than the sum of our genes and their manifestations. Our brain - a physical object - is the residence of mental health and its disorders. Mental illness cannot be explained without resorting to the body and, especially, to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neurophysiology is lacking. Such lacking theories are nothing but literary narratives. Psychoanalysis, for instance, is often accused of being divorced from corporeal reality.

Our genetic baggage makes us resemble a personal computer. We are an all-purpose, universal, machine. Subject to the right programming (conditioning, socialization, education, upbringing) - we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set - it is constructed and expected to do one, and only one, thing. It has a single purpose and a unitary function. We, humans, are more like computers than like television sets.

True, single genes rarely account for any behavior or trait. An array of coordinated genes is required to explain even the minutest human phenomenon. "Discoveries" of a "gambling gene" here and an "aggression gene" there are derided by the more serious and less publicity-prone scholars. Yet, it would seem that even complex behaviors such as risk taking, reckless driving, and compulsive shopping have genetic underpinnings."

5 - Man or Monster?

A. Man, of course. There are no monsters, except in fantasy. Serial and mass killers are merely specks in the infinite spectrum of "being human". It is this familiarity - the fact that they are only infinitesimally different from me and you - that makes them so fascinating. Somewhere inside each and every one of us there is a killer, kept under the tight leash of socialization. When circumstances change and allow its expression, the drive to kill inevitably and invariably erupts.

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next: The Myth of Mental Illness