Intially I copy and pasted into google's search bar the title of this blog. I modified it to "Are the Autism Numbers Accurate?" The responses led me to Kristina Chew. If the name sounds familar to you think neuro-diversity, think the Autism Vox blog. She has many excellent links in this blog entry and one that intrigued me greatly was the CDC's ADDM (Autism and Developmental Disabilities Monitoring Network). This is a network of ten states: Alabama, Arizona, Colorado, Florida, Georgia, Maryland, Missouri, North Carolina, Pennsylvania, South Carolina and Wisconsin. Now of these ten states only 3 (Maryland, North Carolina and  Pennsylvania) has "updated accurate" information. My first red flag. Another red flag is the wording about these centers of excellence. This is how it reads: "The Children’s Health Act of 2000 directed the Centers for Disease Control and Prevention (CDC) to establish regional centers of excellence for autism spectrum disorders (ASDs) and other developmental disabilities." I am wondering if these centers for excellence are the criteria for the national average of 1 in 150 then how can this be an accurate average when other developmental disabilities are tracked within the autism average?

Kristina's blog posting on this subject can be found HERE. Her piece was supporting the position that the current diagnosis rate of 1 in 150 is inaccurate. But she is supporting a position the the numbers are higher than the 1 in 150.

I take the opposite position while using the same material. To begin with according to Kristina schools have the capacity of diagnosing autism. Again another red flag. Historically, schools are not the best to diagnosis anything more than head colds and head lice. Evidence of my opinion can be found HERE. Also Kristinia makes note of there being discrepancies from one school district to another. Which also supports my position of over diagnosis. Also one must keep in mind that for every child receiving special education services within the district, the district gets substanially more money for that child's services. A financial incentive perhaps to pad the numbers? Makes me wonder I can tell you.

As to the "professional" diagnosis via a neurological peditrician, psychologist and the like, I remember what Michael Savage said as a means to justify his statement of "99% of autistic kids are brats". What was said to him by Dr. Peter Breggin was: "that though there are real cases of autism, those involved in the broadening of its diagnosis are in the pay of pharmaceutical companies. Breggin says Savage is correct that autism is over diagnosed." Based on this information I did my own informal unscientific survey of questioning those professionals who diagnosis and teach. The results are the same. The diagnosis of "true" autism is not on the rise. The broadening of the criteria is artificially inflating the numbers.

The reasons for these actions are obvious if you know how the drug cartels operate and why they would be interested in getting more children with autism in their product claws. It is also obvious if you know what the CDC is trying to get out of over inflating the numbers. My reasoning can be found on a previous blog I wrote. That entry can be found HERE.

 JR was diagnosed in 2000 and all though he fits the technical criteria for autism as much now as he did then, he does not fit the mold of autism. Let me explain, JR has always been, since birth a very loving and social human being, he has always enjoyed being around people (albeit, adults mostly ), he has always loved being cuddled and loved on. Now after 8 years of living "on spectrum" with six of those eight years being spent in the educational, behavioral and communicational care of the VISTA school there are many areas of the DSM where JR does not fit the mold anymore of autism. The primary category that keeps JR with an autism diagnosis is lack of speech. However, JR communicates excellently with his dynavox. The DSM criteria is way too narrow focusing excluisvely on "speech" as the only form of communication. One can communicate without ever uttering a word.

Another area of the autism diagnosis that has always been a pet peeve to me is the cognitive level and receptive (understanding what is being said) language issues. Early in JR's days after his diagnosis I would often see on his IEP's that he was cogninitively and receptive language delayed. In the beginning not knowing exactly what these terms meant I would let the team slide continuing to allow them to use these terms where my son was concerned. After a while and through self education I came to learn that in JR's case these issues simply did not exist with him. When a child can figure out a way to get something that he understands he is not allowed to have by distracting you to go elsewhere and then do what I termed an end run around you to get what he intitally wanted to begin with; tells me cognitively he is not only on age mark but is probably very much beyond that level. The same for the receptive delays. That boy understands everything you say to him, if he did't he wouldn't be able to respond appropriately.

So is autism being artifically inflated? Well, Kristina Chew says no and the diagnosis rate currently being spewed by the CDC is under the actual average. I say it's over inflated. Time will tell which of us is right. However, based on the past practices of the drug cartels and the CDC, I would be willing to hedge my bet that I am right.

Admittedly I've never really been a hand person (other than sometimes scanning left rings fingers (which we all know mean relatively little anyway)) but its interesting to read Delany describing his infatuation with different nail-biters and watch the description approach nearer and nearer to an actual fetishistic sexual inclination.  According to the lovely psychiatric doctors charged with delineating health standards in the DSM the "real" (read: clinical and reifying) word for fetish is paraphilia.  The awkward part of this disorder (which falls under a larger umbrella of related sexual disorders) is that the clinical description falls widely outside of what most people would consider fetishistic inclination or behavior.  Delany is describing a characteristic, that to him, is a key component of sexual attraction and one that most certainly helps instigate sex.  Just like some people (ah...) can't stand it when someone wears boxers or only enjoy sex when power play is used to disrupt the unspoken dynamics of a relationship, Delany is expressing what is technically (according to the DSM) healthy sexual behavior that in most circles would be considered a fetish, freakish or both.  But how is it that the DSM is actually past this mark and doesn't absorb him as a deviant?  Because the definition of paraphilia requires a dependancy on the behalf of someone on a certain object, interaction or some such other sexual system for it to be pathological.  To fall within pathological behavior a particular fetish has to interfere with a persons ability to interact with the world around them, inhibiting the development of a healthy, adjusted and truly fabulous life.    

In an incredibly round about way what I was trying to get at (and then lost sight of and just kept going) is that most people (yes...I know that "most people" is sketchy but I'm a little hungover and not nearly smart enough to argue the point anyway) experience sexual attraction and/or arousal to key signifiers that connote sexual compatibility.  From bitten nail beds to muscles and beyond sexually "normal" people exercise the same benchmarks that the kinkiest of fetishist's do, often at a scale and intensity that is very different but none-the-less distributes their sexual drive across certain points of interest...or what you could call fetishes.  

Haha...oh man.  Does any of that make sense?  Onward and Upward!

En lo personal les recomiendo que consigan el cd, porque es mucho mas practico a la hora de navegarlo, pero para aquellos que no puedan o no quieran, en este formato tienen acceso al texto completo.

More lying in bed, sprawled out like a starfish or a beached whale, wrestling with the boa constrictor duvet set from Marks and Sparks. Tossing and turning and growling before I have even begun the painful process of appearing before the judge, jury and executioner. It probably won’t be like that, but I’ve had some interesting experiences with the Psychiatric world. I’ve been labelled so many times, I feel like I’ve been festering on the “reduced for quick sale” shelf at the Tesco’s. One label stuck over the next, desperate for someone to pick me up and take me home before I go mouldy and get thrown in the bin. That’s the thing about labels, isn’t it? They aren’t really removable, like cruel nicknames or rumours, they are rarely erasable, never go away completely. A careless diagnosis is a medical fly poster, one layered over the next, peel enough away and every single one is still visible, albeit frayed and aged.
I’m sure somewhere inside my doorstep of a file there is a note written in block capitals:

DO NOT COPY PATIENT INTO REFERRALS OR OFFICIAL DOCUMENTATION.

Don’t blame them though. Last time I was privy to the cc of a referral, I ended up in the Critical Decision Unit at A&E. I’m not proud of it. It wasn’t so much of an overdose as a cry for help, more like a desperate need to end what I had become. Something so far from who I wanted to be, that there was no way out, and after two days of staring at the letter, I just couldn’t bear it. I was lucky, a friend interrupted me. God knows if I would have taken myself to hospital, I would probably have died rather than face up to my actions. It’s something I don’t normally talk about now. I’m too ashamed. It’s just when I got that letter, I felt judged. There is nothing so hard to take, for me anyway, as seeing the bare bones of your life, reduced to text. A piece of headed paper from one doctor to another, sterilising your experiences, hurt, and personal battles, into various criteria from the DSM-IV. It brings home to you the significance of your life, and the mess which you have made of it, all neatly dissected and compartmentalised, into phrases and labels, from one doctor to another. Every time I see that red A4 folder, overstuffed with bits of my life, it reminds me that I am just another statistic, on another NHS to do list.

And what if the label is wrong? What if you have never behaved like this before, these symptoms are new to you? What if Ockham’s razor is correct, and the way you are behaving is due to the medication which you are taking? What if you know this is wrong, but no one is listening to you?

“Please, I don’t have a problem with anxiety or a problem with anger,” you plead, “Please help me, I’m scared I’m going to hurt someone, I can’t sleep, I can’t stop all this stuff in my head,”
“Punch a pillow,” They say, “Go for a fast walk, count to ten” What if you are labelled as Another Number With A Personality Disorder? After all, you are a female, and you self harm. Nothing screams Personality Disorder to a Mental Health Professional, better than arms carved up like a Christmas Ham. Especially if they can’t quite work you out.

You see labels have always struck me as a dangerous thing. A stereotype, a pigeon hole to jam you in.  The danger comes from the next stage, the assumption.  Here, hang this label around your neck, tag it on your toe, this is you, and because this is you, this is how you will behave, and this is how we will respond. I am assuming that you are feeling what you are feeling, because that is what the handbook says.  You are a theory, typecast and branded, and we know you. We can read you like a book, because we have read the book, and you are a recipe. This is when people stop listening to what you are saying, and start hearing the sentences which make their label correct.

This is why I am reluctant to stand up and be noticed again. In case that label is still kicking around somewhere. Lest someone attempt to tell me that something inside me, something in my character is flawed beyond repair*. This is why I screen my answers to their questions, attempting a neutral stance, refusing to add any ingredients to their recipe, of me. Even I'll admit that I've problems trusting people, but now I am even more of a closed book with a secret ingredient.

*NB: This appears to be the stigma attached to personality disorders.

by THOMAS A. WIDIGER

Every person has a characteristic manner of thinking, feeling, and relating to others. Some of these personality traits can be so dysfunctional as to warrant a diagnosis of personality disorder. The World Health Organization’s International Classification of Diseases (ICD-10) includes ten personality disorder diagnoses. Three issues of particular importance for the diagnosis of personality disorders are their differentiation from other mental disorders, from general personality functioning, and from each other. Each of these issues is discussed in turn, and it is suggested that personality disorders are more accurately and effectively diagnosed as maladaptive variants of common personality traits.

Full article here, from World Psychiatry October 2003

by Emil F. Coccaro and Larry J. Siever

The inclusion for the first time of a chapter on the neuropsychopharmacology of the personality disorders in the "ACNP Generation of Progress" series reflects the increasing appreciation of underlying neurobiologic substraits for these disorders and the value of targeted psychopharmacologic treatment. The personality disorders, located on Axis II in DSM-III-R and DSM-IV, consist of constellations of enduring or persistent maladaptive traits and/or symptoms that are characteristic of the way an individual experiences and interacts with his/her environment. In contrast with the Axis I disorders, which are primarily symptom-oriented and wax and wane in severity (often in episodic fashion), the Axis II personality disorders are conceived to be characteristic of an individual throughout his lifetime. This conceptual distinction between the Axis I and II disorders, while heuristically useful, is becoming increasingly blurred because studies into the neuropsychopharmacology of personality disorder suggest that enduring traits reflect underlying biologic variations that may be amenable to alteration with psychopharmacologic treatment. While some have argued that these considerations argue for the abolition of Axis II, the separation of these disorders on Axis II has highlighted the fact that traits considered to be part of an individual's stable personality can be substantially impacted by psychopharmacologic treatment.

While the DSM-III and III-R represented a significant advance over DSM-II in the identification of specific categories of personality disorder, many of these categories were found to be overlapping and have yet to be validated by external validators. By the advent of DSM-IV, validating antecedents and correlates in both biologic and psychosocial arenas have been found for some of the personality disorders, particularly schizotypal and borderline personality disorder.

Full article here, from 2000.

ICD-10 criteria:

F21 Schizotypal Disorder

A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, thought no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:

(a) inappropriate or constricted affect (the individual appears cold and aloof);
(b) behaviour or appearance that is odd, eccentric, or peculiar;
(c) poor rapport with others and a tendency to social withdrawal;
(d) odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms;
(e) suspiciousness or paranoid ideas;
(f) obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
(g) unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
(h) vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
(i) occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation.

The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to schizophrenics and is believed to be part of the genetic "spectrum" of schizophrenia.

DSM-IV criteria:

Schizotypal Personality Disorder

A: A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. ideas of reference (excluding delusions of reference)
2. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
3. unusual perceptual experiences, including bodily illusions
4. odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
5. suspiciousness or paranoid ideation
6. inappropriate or constricted affect
7. behavior or appearance that is odd, eccentric, or peculiar
8. lack of close friends or confidants other than first-degree relatives
9. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
B: Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizotypal Personality Disorder (Premorbid)."

Why does the narcissist conjure up another Self? Why not simply transform his True Self into a False one?

Answer:

We often marvel at the discrepancy between the private and public lives of our idols: celebrities, statesmen, stars, writers, and other accomplished figures. It is as though they have two personalities, two selves: the "true" one which they reserve for their nearest and dearest and the "fake" or "false" or "concocted" one which they flaunt in public.

In contrast, the narcissist has no private life, no true self, no domain reserved exclusively for his nearest and dearest. His life is a spectacle, with free access to all, constantly on display, garnering narcissistic supply from his audience. In the theatre that is the narcissist's life, the actor is irrelevant. Only the show goes on.

Once formed and functioning, the False Self stifles the growth of the True Self and paralyses it. Henceforth, the True Self is virtually non-existent and plays no role (active or passive) in the conscious life of the narcissist. It is difficult to "resuscitate" it, even with psychotherapy.

This substitution is not only a question of alienation, as Horney observed. She said that because the Idealised (=False) Self sets impossible goals to the narcissist, the results are frustration and self hate which grow with every setback or failure. But the constant sadistic judgement, the self-berating, the suicidal ideation emanate from the narcissist's idealised, sadistic, Superego regardless of the existence or functioning of a False Self.

There is no conflict between the True Self and the False Self.

First, the True Self is much too weak to do battle with the overbearing False. Second, the False Self is adaptive (though maladaptive). It helps the True Self to cope with the world. Without the False Self, the True Self would be subjected to so much hurt that it will disintegrate. This happens to narcissists who go through a life crisis: their False Ego becomes dysfunctional and they experience a harrowing feeling of annulment.

The False Self has many functions. The two most important are:

1. It serves as a decoy, it "attracts the fire". It is a proxy for the True Self. It is tough as nails and can absorb any amount of pain, hurt and negative emotions. By inventing it, the child develops immunity to the indifference, manipulation, sadism, smothering, or exploitation – in short: to the abuse – inflicted on him by his parents (or by other Primary Objects in his life). It is a cloak, protecting him, rendering him invisible and omnipotent at the same time.

1. The False Self is misrepresented by the narcissist as his True Self. The narcissist is saying, in effect: "I am not who you think I am. I am someone else. I am this (False) Self. Therefore, I deserve a better, painless, more considerate treatment." The False Self, thus, is a contraption intended to alter other people's behaviour and attitude towards the narcissist.

These roles are crucial to survival and to the proper psychological functioning of the narcissist. The False Self is by far more important to the narcissist than his dilapidated, dysfunctional, True Self.

The two Selves are not part of a continuum, as the neo-Freudians postulated. Healthy people do not have a False Self which differs from its pathological equivalent in that it is more realistic and closer to the True Self.

It is true that even healthy people have a mask [Guffman], or a persona [Jung] which they consciously present to the world. But these are a far cry from the False Self, which is mostly subconscious, depends on outside feedback, and is compulsive.

The False Self is an adaptive reaction to pathological circumstances. But its dynamics make it predominate, devour the psyche and prey upon both the True Self. Thus, it prevents the efficient, flexible functioning of the personality as a whole.

That the narcissist possesses a prominent False Self as well as a suppressed and dilapidated True Self is common knowledge. Yet, how intertwined and inseparable are these two? Do they interact? How do they influence each other? And what behaviours can be attributed squarely to one or the other of these protagonists? Moreover, does the False Self assume traits and attributes of the True Self in order to deceive the world?

Let's start by referring to an oft-occurring question:

Why are narcissists not prone to suicide?

The simple answer is that they died a long time ago. Narcissists are the true zombies of the world.

Many scholars and therapists tried to grapple with the void at the core of the narcissist. The common view is that the remnants of the True Self are so ossified, shredded, cowed into submission and repressed – that, for all practical purposes, the True Self is dysfunctional and useless. In treating the narcissist, the therapist often tries to construct and nurture a completely new healthy self, rather than build upon the distorted wreckage strewn across the narcissist's psyche.

But what of the rare glimpses of True Self oft reported by those who interact with the narcissist?

Pathological narcissism is frequently comorbid with other disorders. The narcissistic spectrum is made up of gradations and shades of narcissism. Narcissistic traits or style or even personality (overlay) often attach to other disorders (co-morbidity). A person may well appear to be a full-fledged narcissist – may well appear to be suffering from the Narcissistic Personality Disorder (NPD) - but is not, in the strict, psychiatric, sense of the word. In such people, the True Self is still there and is sometimes observable.

In a full-fledged narcissist, the False Self imitates the True Self.

To do so artfully, it deploys two mechanisms:

Re-Interpretation

It causes the narcissist to re-interpret certain emotions and reactions in a flattering, socially acceptable, light. The narcissist may, for instance, interpret fear as compassion. If the narcissist hurts someone he fears (e.g., an authority figure), he may feel bad afterwards and interpret his discomfort as empathy and compassion. To be afraid is humiliating – to be compassionate is commendable and earns the narcissist social commendation and understanding (narcissistic supply).

Emulation

The narcissist is possessed of an uncanny ability to psychologically penetrate others. Often, this gift is abused and put at the service of the narcissist's control freakery and sadism. The narcissist uses it liberally to annihilate the natural defences of his victims by faking empathy.

This capacity is coupled with the narcissist's eerie ability to imitate emotions and their attendant behaviours (affect). The narcissist possesses "emotional resonance tables". He keeps records of every action and reaction, every utterance and consequence, every datum provided by others regarding their state of mind and emotional make-up. From these, he then constructs a set of formulas, which often result in impeccably accurate renditions of emotional behaviour. This can be enormously deceiving.

Also Read

 The Stripped Ego

The Split Off Ego

Narcissists are driven by the need to uphold and maintain a false self - a concocted, grandiose, and demanding psychological construct typical of the narcissistic personality disorder. The false self is projected to the world in order to garner "narcissistic supply" - adulation, admiration, or even notoriety and infamy. Any kind of attention is usually deemed by narcissists to be preferable to obscurity.

The false self is suffused with fantasies of perfection, grandeur, brilliance, infallibility, immunity, significance, omnipotence, omnipresence, and omniscience. To be a narcissist is to be convinced of a great, inevitable personal destiny. The narcissist is preoccupied with ideal love, the construction of brilliant, revolutionary scientific theories, the composition or authoring or painting of the greatest work of art, the founding of a new school of thought, the attainment of fabulous wealth, the reshaping of a nation or a conglomerate, and so on. The narcissist never sets realistic goals to himself. He is forever preoccupied with fantasies of uniqueness, record breaking, or breathtaking achievements. His verbosity reflects this propensity.

Reality is, naturally, quite different and this gives rise to a "grandiosity gap". The demands of the false self are never satisfied by the narcissist's accomplishments, standing, wealth, clout, sexual prowess, or knowledge. The narcissist's grandiosity and sense of entitlement are equally incommensurate with his achievements.

To bridge the grandiosity gap, the malignant (pathological) narcissist resorts to shortcuts. These very often lead to fraud.

The narcissist cares only about appearances. What matters to him are the facade of wealth and its attendant social status and narcissistic supply. Witness the travestied extravagance of Tyco's Denis Kozlowski. Media attention only exacerbates the narcissist's addiction and makes it incumbent on him to go to ever-wilder extremes to secure uninterrupted supply from this source.

The narcissist lacks empathy - the ability to put himself in other people's shoes. He does not recognize boundaries - personal, corporate, or legal. Everything and everyone are to him mere instruments, extensions, objects unconditionally and uncomplainingly available in his pursuit of narcissistic gratification.

This makes the narcissist perniciously exploitative. He uses, abuses, devalues, and discards even his nearest and dearest in the most chilling manner. The narcissist is utility- driven, obsessed with his overwhelming need to reduce his anxiety and regulate his labile sense of self-worth by securing a constant supply of his drug - attention. American executives acted without compunction when they raided their employees' pension funds - as did Robert Maxwell a generation earlier in Britain.

The narcissist is convinced of his superiority - cerebral or physical. To his mind, he is a Gulliver hamstrung by a horde of narrow-minded and envious Lilliputians. The dotcom "new economy" was infested with "visionaries" with a contemptuous attitude towards the mundane: profits, business cycles, conservative economists, doubtful journalists, and cautious analysts.

Yet, deep inside, the narcissist is painfully aware of his addiction to others - their attention, admiration, applause, and affirmation. He despises himself for being thus dependent. He hates people the same way a drug addict hates his pusher. He wishes to "put them in their place", humiliate them, demonstrate to them how inadequate and imperfect they are in comparison to his regal self and how little he craves or needs them.

The narcissist regards himself as one would an expensive present, a gift to his company, to his family, to his neighbours, to his colleagues, to his country. This firm conviction of his inflated importance makes him feel entitled to special treatment, special favors, special outcomes, concessions, subservience, immediate gratification, obsequiousness, and lenience. It also makes him feel immune to mortal laws and somehow divinely protected and insulated from the inevitable consequences of his deeds and misdeeds.

The self-destructive narcissist plays the role of the "bad guy" (or "bad girl"). But even this is within the traditional social roles cartoonishly exaggerated by the narcissist to attract attention. Men are likely to emphasise intellect, power, aggression, money, or social status. Narcissistic women are likely to emphasise body, looks, charm, sexuality, feminine "traits", homemaking, children and childrearing.

Punishing the wayward narcissist is a veritable catch-22.

A jail term is useless as a deterrent if it only serves to focus attention on the narcissist. Being infamous is second best to being famous - and far preferable to being ignored. The only way to effectively punish a narcissist is to withhold narcissistic supply from him and thus to prevent him from becoming a notorious celebrity.

Given a sufficient amount of media exposure, book contracts, talk shows, lectures, and public attention - the narcissist may even consider the whole grisly affair to be emotionally rewarding. To the narcissist, freedom, wealth, social status, family, vocation - are all means to an end. And the end is attention. If he can secure attention by being the big bad wolf - the narcissist unhesitatingly transforms himself into one. Lord Archer, for instance, seems to be positively basking in the media circus provoked by his prison diaries.

The narcissist does not victimise, plunder, terrorise and abuse others in a cold, calculating manner. He does so offhandedly, as a manifestation of his genuine character. To be truly "guilty" one needs to intend, to deliberate, to contemplate one's choices and then to choose one's acts. The narcissist does none of these.

Thus, punishment breeds in him surprise, hurt and seething anger. The narcissist is stunned by society's insistence that he should be held accountable for his deeds and penalized accordingly. He feels wronged, baffled, injured, the victim of bias, discrimination and injustice. He rebels and rages.

Depending upon the pervasiveness of his magical thinking, the narcissist may feel besieged by overwhelming powers, forces cosmic and intrinsically ominous. He may develop compulsive rites to fend off this "bad", unwarranted, persecutory influences.

The narcissist, very much the infantile outcome of stunted personal development, engages in magical thinking. He feels omnipotent, that there is nothing he couldn't do or achieve if only he sets his mind to it. He feels omniscient - he rarely admits to ignorance and regards his intuitions and intellect as founts of objective data.

Thus, narcissists are haughtily convinced that introspection is a more important and more efficient (not to mention easier to accomplish) method of obtaining knowledge than the systematic study of outside sources of information in accordance with strict and tedious curricula. Narcissists are "inspired" and they despise hamstrung technocrats.

To some extent, they feel omnipresent because they are either famous or about to become famous or because their product is selling or is being manufactured globally. Deeply immersed in their delusions of grandeur, they firmly believe that their acts have - or will have - a great influence not only on their firm, but on their country, or even on Mankind. Having mastered the manipulation of their human environment - they are convinced that they will always "get away with it". They develop hubris and a false sense of immunity.

Narcissistic immunity is the (erroneous) feeling, harboured by the narcissist, that he is impervious to the consequences of his actions, that he will never be effected by the results of his own decisions, opinions, beliefs, deeds and misdeeds, acts, inaction, or membership of certain groups, that he is above reproach and punishment, that, magically, he is protected and will miraculously be saved at the last moment. Hence the audacity, simplicity, and transparency of some of the fraud and corporate looting in the 1990's. Narcissists rarely bother to cover their traces, so great is their disdain and conviction that they are above mortal laws and wherewithal.

What are the sources of this unrealistic appraisal of situations and events?

The false self is a childish response to abuse and trauma. Abuse is not limited to sexual molestation or beatings. Smothering, doting, pampering, over-indulgence, treating the child as an extension of the parent, not respecting the child's boundaries, and burdening the child with excessive expectations are also forms of abuse.

The child reacts by constructing false self that is possessed of everything it needs in order to prevail: unlimited and instantaneously available Harry Potter-like powers and wisdom. The false self, this Superman, is indifferent to abuse and punishment. This way, the child's true self is shielded from the toddler's harsh reality.

This artificial, maladaptive separation between a vulnerable (but not punishable) true self and a punishable (but invulnerable) false self is an effective mechanism. It isolates the child from the unjust, capricious, emotionally dangerous world that he occupies. But, at the same time, it fosters in him a false sense of "nothing can happen to me, because I am not here, I am not available to be punished, hence I am immune to punishment".

The comfort of false immunity is also yielded by the narcissist's sense of entitlement. In his grandiose delusions, the narcissist is sui generis, a gift to humanity, a precious, fragile, object. Moreover, the narcissist is convinced both that this uniqueness is immediately discernible - and that it gives him special rights. The narcissist feels that he is protected by some cosmological law pertaining to "endangered species".

He is convinced that his future contribution to others - his firm, his country, humanity - should and does exempt him from the mundane: daily chores, boring jobs, recurrent tasks, personal exertion, orderly investment of resources and efforts, laws and regulations, social conventions, and so on.

The narcissist is entitled to a "special treatment": high living standards, constant and immediate catering to his needs, the eradication of any friction with the humdrum and the routine, an all-engulfing absolution of his sins, fast track privileges (to higher education, or in his encounters with bureaucracies, for instance). Punishment, trusts the narcissist, is for ordinary people, where no great loss to humanity is involved.

Narcissists are possessed of inordinate abilities to charm, to convince, to seduce, and to persuade. Many of them are gifted orators and intellectually endowed. Many of them work in in politics, the media, fashion, show business, the arts, medicine, or business, and serve as religious leaders.

By virtue of their standing in the community, their charisma, or their ability to find the willing scapegoats, they do get exempted many times. Having recurrently "got away with it" - they develop a theory of personal immunity, founded upon some kind of societal and even cosmic "order" in which certain people are above punishment.

But there is a fourth, simpler, explanation. The narcissist lacks self-awareness. Divorced from his true self, unable to empathise (to understand what it is like to be someone else), unwilling to constrain his actions to cater to the feelings and needs of others - the narcissist is in a constant dreamlike state.

To the narcissist, his life is unreal, like watching an autonomously unfolding movie. The narcissist is a mere spectator, mildly interested, greatly entertained at times. He does not "own" his actions. He, therefore, cannot understand why he should be punished and when he is, he feels grossly wronged.

So convinced is the narcissist that he is destined to great things - that he refuses to accept setbacks, failures and punishments. He regards them as temporary, as the outcomes of someone else's errors, as part of the future mythology of his rise to power/brilliance/wealth/ideal love, etc. Being punished is a diversion of his precious energy and resources from the all-important task of fulfilling his mission in life.

The narcissist is pathologically envious of people and believes that they are equally envious of him. He is paranoid, on guard, ready to fend off an imminent attack. A punishment to the narcissist is a major surprise and a nuisance but it also validates his suspicion that he is being persecuted. It proves to him that strong forces are arrayed against him.

He tells himself that people, envious of his achievements and humiliated by them, are out to get him. He constitutes a threat to the accepted order. When required to pay for his misdeeds, the narcissist is always disdainful and bitter and feels misunderstood by his inferiors.

Cooked books, corporate fraud, bending the (GAAP or other) rules, sweeping problems under the carpet, over-promising, making grandiose claims (the "vision thing") - are hallmarks of a narcissist in action. When social cues and norms encourage such behaviour rather than inhibit it - in other words, when such behaviour elicits abundant narcissistic supply - the pattern is reinforced and become entrenched and rigid. Even when circumstances change, the narcissist finds it difficult to adapt, shed his routines, and replace them with new ones. He is trapped in his past success. He becomes a swindler.

But pathological narcissism is not an isolated phenomenon. It is embedded in our contemporary culture. The West's is a narcissistic civilization. It upholds narcissistic values and penalizes alternative value-systems. From an early age, children are taught to avoid self-criticism, to deceive themselves regarding their capacities and attainments, to feel entitled, and to exploit others.

As Lilian Katz observed in her important paper, "Distinctions between Self-Esteem and Narcissism: Implications for Practice", published by the Educational Resources Information Center, the line between enhancing self-esteem and fostering narcissism is often blurred by educators and parents.

Both Christopher Lasch in "The Culture of Narcissism" and Theodore Millon in his books about personality disorders, singled out American society as narcissistic. Litigiousness may be the flip side of an inane sense of entitlement. Consumerism is built on this common and communal lie of "I can do anything I want and possess everything I desire if I only apply myself to it" and on the pathological envy it fosters.

Not surprisingly, narcissistic disorders are more common among men than among women. This may be because narcissism conforms to masculine social mores and to the prevailing ethos of capitalism. Ambition, achievements, hierarchy, ruthlessness, drive - are both social values and narcissistic male traits. Social thinkers like the aforementioned Lasch speculated that modern American culture - a self-centred one - increases the rate of incidence of the narcissistic personality disorder.

Otto Kernberg, a notable scholar of personality disorders, confirmed Lasch's intuition: "Society can make serious psychological abnormalities, which already exist in some percentage of the population, seem to be at least superficially appropriate."

In their book "Personality Disorders in Modern Life", Theodore Millon and Roger Davis state, as a matter of fact, that pathological narcissism was once the preserve of "the royal and the wealthy" and that it "seems to have gained prominence only in the late twentieth century". Narcissism, according to them, may be associated with "higher levels of Maslow's hierarchy of needs ... Individuals in less advantaged nations .. are too busy trying (to survive) ... to be arrogant and grandiose".

They - like Lasch before them - attribute pathological narcissism to "a society that stresses individualism and self-gratification at the expense of community, namely the United States." They assert that the disorder is more prevalent among certain professions with "star power" or respect. "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."

Millon quotes Warren and Caponi's "The Role of Culture in the Development of Narcissistic Personality Disorders in America, Japan and Denmark":

"Individualistic narcissistic structures of self-regard (in individualistic societies) ... are rather self-contained and independent ... (In collectivist cultures) narcissistic configurations of the we-self ... denote self-esteem derived from strong identification with the reputation and honor of the family, groups, and others in hierarchical relationships."

Still, there are malignant narcissists among subsistence farmers in Africa, nomads in the Sinai desert, day laborers in east Europe, and intellectuals and socialites in Manhattan. Malignant narcissism is all-pervasive and independent of culture and society. It is true, though, that the way pathological narcissism manifests and is experienced is dependent on the particulars of societies and cultures.

In some cultures, it is encouraged, in others suppressed. In some societies it is channeled against minorities - in others it is tainted with paranoia. In collectivist societies, it may be projected onto the collective, in individualistic societies, it is an individual's trait.

Yet, can families, organizations, ethnic groups, churches, and even whole nations be safely described as "narcissistic" or "pathologically self-absorbed"? Can we talk about a "corporate culture of narcissism"?

Human collectives - states, firms, households, institutions, political parties, cliques, bands - acquire a life and a character all their own. The longer the association or affiliation of the members, the more cohesive and conformist the inner dynamics of the group, the more persecutory or numerous its enemies, competitors, or adversaries, the more intensive the physical and emotional experiences of the individuals it is comprised of, the stronger the bonds of locale, language, and history - the more rigorous might an assertion of a common pathology be.

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

Also Read

National Post Interview

The Labours of the Narcissist

The Narcissist in the Workplace

The Professions of the Narcissist

Narcissists in Positions of Authority

Narcissists in the Workplace Chat Transcript

Bully at Work - Interview with Tim Field

Open Site Workplace Violence

Narcissistic Leaders

The Psychology of Corporations and Corporate Officers

Pathological Narcissism - A Dysfunction or a Blessing?

The Narcissist's Confabulated Life

The Entitlement of Routine

Interviews and Articles in the Media

Narcissistic Confinement

Psychopaths in Suits

Workplace Bullying

New Narc City

Bully Online

Question: What is workplace bullying?

Answer: Workplace bullying is persistent, unwelcome, intrusive behaviour of one or more individuals whose actions prevent others from fulfilling their duties.

Question: How is it different to adopting disciplinarian measures, maintaining strict supervision, or oversight?

Answer: The purpose of bullying is to hide the inadequacy of the bully and has nothing to do with "management" or the achievement of tasks. Bullies project their inadequacies onto others to distract and divert attention away from the inadequacies. In most cases of workplace bullying reported to the UK National Workplace Bullying Advice Line, the bully is a serial bully who has a history of conflict with staff. The bullying that one sees is often also the tip of an iceberg of wrongdoing which may include misappropriation of budgets, harassment, discrimination, as well as breaches of rules, regulations, professional codes of conduct and health and safety practices.

Question: Should it be distinguished from harassment (including sexual harassment), or stalking?

Answer: Bullying is, I believe, the underlying behavior and thus the common denominator of harassment, discrimination, stalking and abuse. What varies is the focus for expression of the behavior. For instance, a harasser or discriminator focuses on race or gender or disability.

Bullies focus on competence and popularity which at present are not covered by employment legislation.

Bullies seethe with resentment and anger and the conduits for release of this inner anger are jealousy and envy which explains why bullies pick on employees who are good at their job and popular with people. Being emotionally immature, bullies crave attention and become resentful when others get more attention for their competence and achievements than themselves.

Question: What is the profile of the typical bully?

Answer: Over 90% of the cases reported to the UK National Workplace Bullying Advice Line involve a serial bully who can be recognised by their behaviour profile which includes compulsive lying, a Jekyll and Hyde nature, an unusually high verbal facility, charm and a considerable capacity to deceive, an arrested level of emotional development, and a compulsive need to control. The serial bully rarely commits a physical assault or an arrestable offence, preferring instead to remain within the realms of psychological violence and non-arrestable offences.

Question: What are bullying's typical outcomes?

Answer: In the majority of cases, the target of bullying is eliminated through forced resignation, unfair dismissal, or early or ill- health retirement whilst the bully is promoted. After a short interval of between 2-14 days, the bully selects another target and the cycle restarts. Sometimes another target is selected before the current target is eliminated.

Question: Can you provide us with some statistics? How often does bullying occur? How many people are affected?

Answer: Surveys of bullying in the UK indicate that between 12-50% of the workforce experience bullying. Statistics from the UK National Workplace Bullying Advice Line reveal that around 20% of cases are from the education sector, 12% are from healthcare, 10% are from social services, and around 6% from the voluntary / charity / not-for-profit sector.

After that, calls come from all sectors both public and private, with finance, media, police, postal workers and other government employees featuring prominently. Enquiries from outside the UK (notably USA, Canada, Australia and Ireland) show similar patterns with the caring professions topping the list of bullied workers.

Question: Could you estimate the economic effects of workplace bullying - costs to employers (firms), employees, law enforcement agencies, the courts, the government, etc.?

Answer: Bullying is one of the major causes of stress, and the cost of stress to UK plc is thought to be between £5-12 billion (US$7-17 billion). When all the direct, indirect and consequential costs of bullying are taken into account, the cost to UK plc (taxpayers and shareholders) could be in excess of £30 billion (US$44 billion), equivalent to around £1,000 hidden tax per working adult per year. Employers do not account for the cost of bullying and its consequences, therefore the figures never appear on balance sheets.

Employees have to work twice as hard to overcome the serial bully's inefficiency and dysfunction which can spread through an organisation like a cancer.

Because of its subtle nature, bullying can be difficult to recognise, but the consequences are easy to spot: excessive workloads, lack of support, a climate of fear, and high levels of insecurity.

The effects on health include, amongst other things, chronic fatigue, damage to the immune system, reactive depression, and suicide.

The indirect costs of bullying include higher-than average staff turnover and sickness absence. Each of these incur consequential costs of staff cover, administration, loss of production and reduced productivity which are rarely recognised and even more rarely attributed to their cause. Absenteeism alone costs UK plc over £10 billion a year and stress is now officially the number one cause of sickness absence having taken over from the common cold. However, surveys suggest that at least 20% of employers still do not regard stress as a health and safety issue, instead preferring to see it as skiving and malingering.

The Bristol Stress and Health at Work Study published by the HSE in June 2000 revealed that 1 in 5 UK workers (around 5.5m) reported feeling extremely stressed at work. The main stress factors were having too much work and not being supported by managers. In November 2001 a study by Proudfoot Consulting revealed the cost of bad management, low employee morale and poorly-trained staff to British business at 117 lost working days a year. At 65%, bad management (often a euphemism for bullying) accounted for the biggest slice of unproductive days with low morale accounting for 17%. The study also suggested that in the UK 52% of all working time is spent unproductively compared to the European average of 43%.

The results of a three-year survey of British workers by the Gallup Organization published in October 2001 revealed that many employers are not getting the best from their employees. The most common response to questions such as "how engaged are your employees?" and "how effective is your leadership and management style?" and "how well are you capitalising on the talents, skills and knowledge of your people?" was an overwhelming "not very much". The survey also found that the longer an employee stayed, the less engaged they became. The cost to UK plc of lost work days due to lack of engagement was estimated to be between £39-48 billion a year.

Question: What can be done to reduce workplace bullying? Are firms, the government, law enforcement agencies, the courts - aware of the problem and its magnitude? Are educational campaign effective? Did anti-bullying laws prove effective?

Answer: Most bullying is hierarchical and can be traced to the top or near the top. As bullying is often the visible tip of an iceberg of wrongdoing, denial is the most common strategy employed by toxic managements. Only Sweden has a law which specifically addresses bullying. Where no law exists, bullies feel free to bully. Whilst the law is not a solution, the presence of a law is an indication that society has made a judgement that the behaviour is no longer acceptable.

Awareness of bullying, and especially its seriousness, is still low throughout society. Bullying is not just "something children do in the playground", it's a lifetime behaviour on the same level as domestic violence, sexual harassment, and rape.

Bullying is a form of psychological and emotional rape because of its intrusive and violational nature.

Also Read

Narcissism in the Boardroom

The Labours of the Narcissist

The Narcissist in the Workplace

The Professions of the Narcissist

Narcissists in Positions of Authority

Narcissists in the Workplace Chat Transcript

Open Site Workplace Violence

Narcissistic Leaders

The Psychology of Corporations and Corporate Officers

Pathological Narcissism - A Dysfunction or a Blessing?

The Narcissist's Confabulated Life

The Entitlement of Routine

Interviews and Articles in the Media

Narcissistic Confinement

Psychopaths in Suits

Workplace Bullying

New Narc City

Bully Online

Borderline-Verdacht.

Ihr Ergebnis im Detail:

Erfüllte Borderline-Indikatoren gemäß DSM IV*: 8
Festgestellte Nebenmerkmale gemäß DSM IV*: 2
Festgestellte Borderline-Zusatzindikatoren*: 3

Auf Basis der laut DSM-Manual genannten Indikatoren für eine Borderline-Persönlichkeitsstörung weisen Ihre gegebenen Antworten auf das Vorhandensein einer solchen Störung hin. Das zusätzliche Vorhandensein von Nebenmerkmalen, die mit Borderline assoziert werden, bestärkt dieses Testergebnis zusätzlich.

Bestimmte Aspekte Ihres Verhaltens, aber auch die Art, wie Sie Ihre Umwelt und sich selbst wahrnehmen, sind somit, das zeigt dieses Testergebnis, der Art, wie dies Borderline-Persönlichkeiten tun, auffallend ähnlich.

Was können Sie tun?

In Ihrer Lebensführung sind Ihnen offenbar durch verschiedene Aspekte Ihrer Persönlichkeit massive Grenzen und Widerstände gesetzt, aus denen Sie sich bisher wohl noch nie dauerhaft befreien konnten - die allerdings heutzutage mittels bewährter therapeutischer Methoden an sich eigentlich gut bearbeitbar und auflösbar wären. Sollten Sie tatsächlich an einer Borderline-Störung leiden, wäre mit therapeutischen Maßnahmen sogar umgehend zu beginnen, um eine Chronifizierung oder gar Verschlechterung der Symptomatik (die wahrscheinlich wäre) zu verhindern. Nehmen Sie also nach einer detaillierten Diagnostik ggf. baldmöglichst Kontakt mit einem(r) Psychiater(in) oder Psychotherapeuten(in) auf, um eine Therapie zu beginnen, die in den allermeisten Fällen auch ambulant möglich sein wird. Es mag sein, daß eine Psychotherapie nicht sofort Erleichterung verschafft oder alle Probleme löst. Mit Sicherheit wird es auch manche schwierige Phase zu überwinden gelten. Langfristig jedoch werden Sie bemerken, daß eine Therapie bei einem(r) Therapeuten(in), dem(der) Sie vertrauen, Ihre Lebensqualität merkbar verbessert und vor allem auch Ihre Beziehungen zu anderen Menschen entspannen und sogar vertiefen kann.

Sollten Sie sich bereits in Psychotherapie befinden, dann war dies sicherlich eine gute Entscheidung, die Ihnen hoffentlich geholfen hat, Ihre Schwierigkeiten in Teilbereichen bereits in den Griff zu bekommen. Weiterhin viel Erfolg dabei!

Danke für Ihre Teilnahme am Selbsttest und der Umfrage.

Depression in China has been suggested to be different from depression in the west in that there is supposed to be a greater expression of bodily complaints, which in psychiatry we refer to as somatising. Some research also showed that there was a much lower prevalence of depression in China than in other western countries - indeed up to several hundred times lower. This raised a very important question. Why is the prevalence of depression much lower - is it a real difference or is depression culturally different and not picked up by western instruments for detecting depression?

This question was asked in a 2001 study by Parker and colleagues in the American Journal of Psychiatry when they reviewed various research on this topic. This is a fascinating paper and got me to reflect on many issues about diagnosis as I read through it, and its well worth a close study. In the paper, they identify many reasons why there may be such a difference. The first point to note however is that there is no single chinese ethnicity. In the paper, the authors refer to at least 55 different ethnic groups in China. Lower prevalence rates of major depression have been found in chinese people living in western countries but here the authors caution about the possible influences of their native culture. The suggested cultural influences on illness behaviour are profound and include the role of family and community, wider cultural events in China, the meaning of depression and fatalism. What was really interesting was that the concept of neurasthenia which was popular in the UK in the early 20th century resonated in Chinese culture when it was introduced there because of the ease with which it could fit with the understanding of an imbalance of Qi. From the author's discussion, there is evidence of a debate between the use of the term neurasthenia which is considered to be a neurological illness and depression which is considered a psychiatric illness. In the UK a similar debate has existed between Chronic Fatigue Syndrome and Neurasthenia. The authors also discuss the role of stigma. The article ends with a question about western psychiatry - do we underdiagnose neurasthenia or is depression underdiagnosed in China?

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor.

Se méfier d'un changement d'habitude, d'accord, ça peut être raisonnable. La journaliste relève aussi, à raison, que le taux de suicide diminue chez les adolescents, et elle pousse la rigueur jusqu'à mettre en doute le lien entre cette baisse et la montée du traitement pharmacologique. Jusque là, je pourrais fermer les yeux sur son ton qui me semble vaguement hostile aux médicaments, et me dire que son approche demeure raisonnable. Un scientifique doute de tout, jusqu'à preuve du contraire, non ?

Mais ensuite la journaliste décompense, et elle écrit: "Bien sûr, il y a des cas de dépressions sévères qu’il faut absolument combattre avec des moyens chimiques, mais ce n’est pas le cas de tous les états dépressifs. L’antidépresseur est également un moyen rapide de régler un dossier qui exigerait un investissement en temps et en argent qui n’est tout simplement pas envisageable dans notre système de santé actuel."

Pardon ?! Où ça, des états dépressifs qu'il ne faut pas combattre avec des moyens chimiques ? Je n'en connais aucun. Est-ce qu'on parle de la même maladie, elle et moi ? Mme Collard doit certainement parler de la dépression, ou "épisode dépressif majeur", telle que décrite dans le DSM-IV et reconnue comme un diagnostic valide (et fréquent) en psychiatrie. Hé bien je ne sais pas quelle connaissance elle a dans ce domaine; peut-être s'imagine-t-elle que le traitement de première intention est la psychothérapie ? Le voyage dans le Sud ? Le chocolat peut-être ? Quand même pas le livre Le Secret ?

Mettons les choses au clair. Voici d'abord la définition reconnue de l'état dépressif:

A. Au moins 5 des symptômes suivants pendant deux semaines minimum, incluant obligatoirement le symptôme 1 et/ou 2

1. Humeur dépressive presque toute la journée, presque tous les jours, ET/OU irritabilité chez l'enfant et l'adolescent
2. Diminution de l'intérêt et du plaisir pour toute activité
3. Perte ou gain de poids (ou d'appétit)
4. Insomnie ou hypersomnie
5. Agitation ou ralentissement psychomoteur suffisant pour être remarqué par autrui
6. Fatigue
7. Dévalorisation ou culpabilité excessive
8. Baisse de concentration
9. Pensées de mort récurrentes

B. Absence des critères d'épisode maniaque

C. Les symptômes causent une souffrance au patient ou l'empêchent de fonctionner (au plan social, professionnel, scolaire, etc.)

D. Les symptômes ne sont pas causés par une substance (drogue...) ou une maladie physique (hypothyroïdie...)

E. Les symptômes ne sont pas causés par un deuil (aucun être cher n'est décédé dans les 2 mois précédents).

Voilà ce que c'est, une dépression.

Maintenant, pourfendons dans l'oeuf le réflexe d'attribuer tout ça à la psychologie, à des déceptions, à la solitude ou au "mal de vivre". La dépression, au même titre qu'un banal ulcère d'estomac, est une maladie physico-bio-chimique, qui atteint un organe, dans un corps humain. Ai-je mis assez de mots concrets et palpables ? Selon l'état actuel de la médecine, la dépression consiste principalement en une baisse des taux de sérotonine dans le cerveau. Cela peut survenir chez n'importe qui, n'importe quand. Pas besoin de vivre un événement triste ou un traumatisme déclencheur; la dépression peut frapper apparemment au hasard, quoique des prédispositions génétiques existent. Le traitement vise à faire augmenter le taux de sérotonine, ce qui se fait avec des molécules qui augmentent la libération de sérotonine, ou en diminuent le racaptage, ou ont d'autres mécanismes connexes.

Bref, contrairement à ce que je viens de lire dans La Presse, les antidépresseurs ne sont pas à réserver au compte-goutte pour les dépressions les plus sévères. Toute dépression assez marquée pour qu'on parvienne à la diagnostiquer mérite automatiquement un traitement pharmacologique. Il ne s'agit pas, comme dit Mme Collard, de "régler un dossier qui exigerait un investissement en temps et en argent" avec une solution rapide; il s'agit d'employer la meilleure solution disponible dans l'état actuel de la science.

Peu importe "l'investissement", il n'y a présentement pas d'autre traitement qui soit préférable aux antidépresseurs dans le traitement de première ligne de la dépression. Et la deuxième ligne ? Des changements et/ou des combinaisons d'antidépresseurs ! Notons que les électrochocs sont disponibles en dernière ligne, quand aucun médicament ne suffit, et que malgré leur réputation démoniaque ils sont indolores (et très efficaces).

L'idée qu'il faut d'abord faire de la psychothérapie, prendre des vacances, se reposer, et parler de ses problèmes avant d'en venir aux méchantes pilules, c'est un mythe aussi infondé que dommageable. Ces solutions qui plaisent à l'esprit, parfois sérieuses, parfois gnan-gnan selon la façon dont elles sont appliquées, ne sont que des adjuvants, et la clé de voûte du traitement reste médicamenteuse.

Baooon. On répète en choeur: la dépression, ça se traite avec des pilules. Compris, là ?

In a way, the torture victim's own body is rendered his worse enemy. It is corporeal agony that compels the sufferer to mutate, his identity to fragment, his ideals and principles to crumble. The body becomes an accomplice of the tormentor, an uninterruptible channel of communication, a treasonous, poisoned territory.

It fosters a humiliating dependency of the abused on the perpetrator. Bodily needs denied – sleep, toilet, food, water – are wrongly perceived by the victim as the direct causes of his degradation and dehumanization. As he sees it, he is rendered bestial not by the sadistic bullies around him but by his own flesh.

The concept of "body" can easily be extended to "family", or "home". Torture is often applied to kin and kith, compatriots, or colleagues. This intends to disrupt the continuity of "surroundings, habits, appearance, relations with others", as the CIA put it in one of its manuals. A sense of cohesive self-identity depends crucially on the familiar and the continuous. By attacking both one's biological body and one's "social body", the victim's psyche is strained to the point of dissociation.

Beatrice Patsalides describes this transmogrification thus in "Ethics of the Unspeakable: Torture Survivors in Psychoanalytic Treatment":

"As the gap between the 'I' and the 'me' deepens, dissociation and alienation increase. The subject that, under torture, was forced into the position of pure object has lost his or her sense of interiority, intimacy, and privacy. Time is experienced now, in the present only, and perspective – that which allows for a sense of relativity – is foreclosed. Thoughts and dreams attack the mind and invade the body as if the protective skin that normally contains our thoughts, gives us space to breathe in between the thought and the thing being thought about, and separates between inside and outside, past and present, me and you, was lost."

Torture robs the victim of the most basic modes of relating to reality and, thus, is the equivalent of cognitive death. Space and time are warped by sleep deprivation. The self ("I") is shattered. The tortured have nothing familiar to hold on to: family, home, personal belongings, loved ones, language, name. Gradually, they lose their mental resilience and sense of freedom. They feel alien – unable to communicate, relate, attach, or empathize with others.

Torture splinters early childhood grandiose narcissistic fantasies of uniqueness, omnipotence, invulnerability, and impenetrability. But it enhances the fantasy of merger with an idealized and omnipotent (though not benign) other – the inflicter of agony. The twin processes of individuation and separation are reversed.

Torture is the ultimate act of perverted intimacy. The torturer invades the victim's body, pervades his psyche, and possesses his mind. Deprived of contact with others and starved for human interactions, the prey bonds with the predator. "Traumatic bonding", akin to the Stockholm Syndrome, is about hope and the search for meaning in the brutal and indifferent and nightmarish universe of the torture cell.

The abuser becomes the black hole at the center of the victim's surrealistic galaxy, sucking in the sufferer's universal need for solace. The victim tries to "control" his tormentor by becoming one with him (introjecting him) and by appealing to the monster's presumably dormant humanity and empathy.

This bonding is especially strong when the torturer and the tortured form a dyad and "collaborate" in the rituals and acts of torture (for instance, when the victim is coerced into selecting the torture implements and the types of torment to be inflicted, or to choose between two evils).

The psychologist Shirley Spitz offers this powerful overview of the contradictory nature of torture in a seminar titled "The Psychology of Torture" (1989):

"Torture is an obscenity in that it joins what is most private with what is most public. Torture entails all the isolation and extreme solitude of privacy with none of the usual security embodied therein... Torture entails at the same time all the self-exposure of the utterly public with none of its possibilities for camaraderie or shared experience. (The presence of an all powerful other with whom to merge, without the security of the other's benign intentions.)

A further obscenity of torture is the inversion it makes of intimate human relationships. The interrogation is a form of social encounter in which the normal rules of communicating, of relating, of intimacy are manipulated. Dependency needs are elicited by the interrogator, but not so they may be met as in close relationships, but to weaken and confuse. Independence that is offered in return for 'betrayal' is a lie. Silence is intentionally misinterpreted either as confirmation of information or as guilt for 'complicity'.

Torture combines complete humiliating exposure with utter devastating isolation. The final products and outcome of torture are a scarred and often shattered victim and an empty display of the fiction of power."

Obsessed by endless ruminations, demented by pain and a continuum of sleeplessness – the victim regresses, shedding all but the most primitive defense mechanisms: splitting, narcissism, dissociation, Projective Identification, introjection, and cognitive dissonance. The victim constructs an alternative world, often suffering from depersonalization and derealization, hallucinations, ideas of reference, delusions, and psychotic episodes.

Sometimes the victim comes to crave pain – very much as self-mutilators do – because it is a proof and a reminder of his individuated existence otherwise blurred by the incessant torture. Pain shields the sufferer from disintegration and capitulation. It preserves the veracity of his unthinkable and unspeakable experiences.

This dual process of the victim's alienation and addiction to anguish complements the perpetrator's view of his quarry as "inhuman", or "subhuman". The torturer assumes the position of the sole authority, the exclusive fount of meaning and interpretation, the source of both evil and good.

Torture is about reprogramming the victim to succumb to an alternative exegesis of the world, proffered by the abuser. It is an act of deep, indelible, traumatic indoctrination. The abused also swallows whole and assimilates the torturer's negative view of him and often, as a result, is rendered suicidal, self-destructive, or self-defeating.

Thus, torture has no cut-off date. The sounds, the voices, the smells, the sensations reverberate long after the episode has ended – both in nightmares and in waking moments. The victim's ability to trust other people – i.e., to assume that their motives are at least rational, if not necessarily benign – has been irrevocably undermined. Social institutions are perceived as precariously poised on the verge of an ominous, Kafkaesque mutation. Nothing is either safe, or credible anymore.

Victims typically react by undulating between emotional numbing and increased arousal: insomnia, irritability, restlessness, and attention deficits. Recollections of the traumatic events intrude in the form of dreams, night terrors, flashbacks, and distressing associations.

The tortured develop compulsive rituals to fend off obsessive thoughts. Other psychological sequelae reported include cognitive impairment, reduced capacity to learn, memory disorders, sexual dysfunction, social withdrawal, inability to maintain long-term relationships, or even mere intimacy, phobias, ideas of reference and superstitions, delusions, hallucinations, psychotic microepisodes, and emotional flatness.

Depression and anxiety are very common. These are forms and manifestations of self-directed aggression. The sufferer rages at his own victimhood and resulting multiple dysfunction. He feels shamed by his new disabilities and responsible, or even guilty, somehow, for his predicament and the dire consequences borne by his nearest and dearest. His sense of self-worth and self-esteem are crippled.

In a nutshell, torture victims suffer from a Post-Traumatic Stress Disorder (PTSD). Their strong feelings of anxiety, guilt, and shame are also typical of victims of childhood abuse, domestic violence, and rape. They feel anxious because the perpetrator's behavior is seemingly arbitrary and unpredictable – or mechanically and inhumanly regular.

They feel guilty and disgraced because, to restore a semblance of order to their shattered world and a modicum of dominion over their chaotic life, they need to transform themselves into the cause of their own degradation and the accomplices of their tormentors.

The CIA, in its "Human Resource Exploitation Training Manual – 1983" (reprinted in the April 1997 issue of Harper's Magazine), summed up the theory of coercion thus:

"The purpose of all coercive techniques is to induce psychological regression in the subject by bringing a superior outside force to bear on his will to resist. Regression is basically a loss of autonomy, a reversion to an earlier behavioral level. As the subject regresses, his learned personality traits fall away in reverse chronological order. He begins to lose the capacity to carry out the highest creative activities, to deal with complex situations, or to cope with stressful interpersonal relationships or repeated frustrations."

Inevitably, in the aftermath of torture, its victims feel helpless and powerless. This loss of control over one's life and body is manifested physically in impotence, attention deficits, and insomnia. This is often exacerbated by the disbelief many torture victims encounter, especially if they are unable to produce scars, or other "objective" proof of their ordeal. Language cannot communicate such an intensely private experience as pain.

Spitz makes the following observation:

"Pain is also unsharable in that it is resistant to language... All our interior states of consciousness: emotional, perceptual, cognitive and somatic can be described as having an object in the external world... This affirms our capacity to move beyond the boundaries of our body into the external, sharable world. This is the space in which we interact and communicate with our environment. But when we explore the interior state of physical pain we find that there is no object 'out there' – no external, referential content. Pain is not of, or for, anything. Pain is. And it draws us away from the space of interaction, the sharable world, inwards. It draws us into the boundaries of our body."

Bystanders resent the tortured because they make them feel guilty and ashamed for having done nothing to prevent the atrocity. The victims threaten their sense of security and their much-needed belief in predictability, justice, and rule of law. The victims, on their part, do not believe that it is possible to effectively communicate to "outsiders" what they have been through. The torture chambers are "another galaxy". This is how Auschwitz was described by the author K. Zetnik in his testimony in the Eichmann trial in Jerusalem in 1961.

Kenneth Pope in "Torture", a chapter he wrote for the "Encyclopedia of Women and Gender: Sex Similarities and Differences and the Impact of Society on Gender", quotes Harvard psychiatrist Judith Herman:

"It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim, on the contrary, asks the bystander to share the burden of pain. The victim demands action, engagement, and remembering."

But, more often, continued attempts to repress fearful memories result in psychosomatic illnesses (conversion). The victim wishes to forget the torture, to avoid re-experiencing the often life threatening abuse and to shield his human environment from the horrors. In conjunction with the victim's pervasive distrust, this is frequently interpreted as hypervigilance, or even paranoia. It seems that the victims can't win. Torture is forever.

Note – Why Do People Torture?

We should distinguish functional torture from the sadistic variety. The former is calculated to extract information from the tortured or to punish them. It is measured, impersonal, efficient, and disinterested.

The latter – the sadistic variety – fulfils the emotional needs of the perpetrator.

People who find themselves caught up in anomic states – for instance, soldiers in war or incarcerated inmates – tend to feel helpless and alienated. They experience a partial or total loss of control. They have been rendered vulnerable, powerless, and defenseless by events and circumstances beyond their influence.

Torture amounts to exerting an absolute and all-pervasive domination of the victim's existence. It is a coping strategy employed by torturers who wish to reassert control over their lives and, thus, to re-establish their mastery and superiority. By subjugating the tortured – they regain their self-confidence and regulate their sense of self-worth.

Other tormentors channel their negative emotions – pent up aggression, humiliation, rage, envy, diffuse hatred – and displace them. The victim becomes a symbol of everything that's wrong in the torturer's life and the situation he finds himself caught in. The act of torture amounts to misplaced and violent venting.

Many perpetrate heinous acts out of a wish to conform. Torturing others is their way of demonstrating obsequious obeisance to authority, group affiliation, colleagueship, and adherence to the same ethical code of conduct and common values. They bask in the praise that is heaped on them by their superiors, fellow workers, associates, team mates, or collaborators. Their need to belong is so strong that it overpowers ethical, moral, or legal considerations.

Many offenders derive pleasure and satisfaction from sadistic acts of humiliation. To these, inflicting pain is fun. They lack empathy and so their victim's agonized reactions are merely cause for much hilarity.

Moreover, sadism is rooted in deviant sexuality. The torture inflicted by sadists is bound to involve perverted sex (rape, homosexual rape, voyeurism, exhibitionism, pedophilia, fetishism, and other paraphilias). Aberrant sex, unlimited power, excruciating pain – these are the intoxicating ingredients of the sadistic variant of torture.

Still, torture rarely occurs where it does not have the sanction and blessing of the authorities, whether local or national. A permissive environment is sine qua non. The more abnormal the circumstances, the less normative the milieu, the further the scene of the crime is from public scrutiny – the more is egregious torture likely to occur. This is especially true in totalitarian societies where the use of physical force to discipline or eliminate dissent is an acceptable practice.

Also Read:

The Business of Torture

The Argument for Torture

How Victims are Affected by Abuse

Post-Traumatic Stress Disorder (PTSD)