sex and intimacy

What is the value of sex to a marriage? Although men and women may answer this question differently, most agree that sex is a critical element of a good marriage. However is it the quality of the sex rather than frequency alone that matters? And how does our early learning about sex contribute to the quality and pattern of sexual relating we develop in our marriage?

There are many obstacles that can act as potential roadblocks to rewarding sexual intimacy in a marital relationship. One primary theme is the cultural current most of us experienced from childhood which clearly makes all sex "nasty." Regardless of our participation in the "sexual revolution," early associations can haunt us, particularly when we marry. I remember the first time I found out about sex and the fact that my parents had "it" with each other. I was appalled that they would do such things to one another with such private parts of their bodies (heretofore used only in the bathroom as far as I knew). I was 10 years old and took the first opportunity to tell my younger 9 year old cousin. She immediately revoked such illicit behavior from her own parents' bedroom with the declaration "My father would never do that to my mother!" That stopped our discussions on the topic for some time.

Desensitization, then, is the first order of business for many of us before we can even begin to explore our sexuality. How we relate to our own sensuality is oftentimes through unacceptable fantasies which although conflictual to our morality, match the cultural messages we absorb growing up. During the course of marriage therapy with a couple in my practice in their sixties, the husband shared his experience of growing up male which included that when women said "no" they meant "yes." To be a successful male in his teenage years meant to "score" with a woman sexually. However this put him in great moral conflict. His wife of 41 years shared that she learned being a "good" girl meant always saying "no" to her sexual feelings. This put her in conflict with her developing sexuality.

Throughout their marriage, which included growing both of their careers and raising their three children, sex became conflicted territory between them. She felt oppressed by his sexual overtures and he felt rejected by her. By sharing their experiences of growing up male and female, they discovered they had been set up by their cultural upbringing to be at war with each other sexually. They had never worked out a way for her to say "no" to sex without his experience being one of major rejection. Nor had she taken responsibility for initiating sex in the marriage. Talking about their adolescent years helped him take her refusals less personally and helped her to begin relating to her own sexual desires, causing her to become increasingly proactive in their sexual relationship.

They were also able to identify what contributed to her being turned on sexually and ways to accommodate one another when one was turned on and the other was not. Each sympathized with the formative conditioning their partner endured, that had been placed between them in their marital bed. They were able to find new approaches to one another in the bedroom that allowed for renewed romance, and greater freedom of expression to respond and not to respond sexually to one another. Sharing their adolescent experiences was one step towards desensitizing their early gender conditioning.

Suggestion

Schedule some private time with your partner to share your sexual experiences and feelings growing up. How did you first learn about sex? What were your initial feelings when you did? When and how did you first experience orgasm? What are your sexual fantasies? Have they changed over the years? Are you comfortable with them or not? Take turns sharing. Listen with compassion to your partner's experiences and stories. Explore stereotypes, whether each partner can say "yes" and "no" to sex without serious repercussions to the relationship, and how each takes responsibility for initiating conditions which promote and encourage sexual satisfaction in the marriage.

Shedding light on sexual thoughts, feelings and fantasies helps you take charge of defining your own sexual relationship. Sharing responsibility for clarifying and developing conditions that promote romance and sexual satisfaction can strengthen your marriage. Simply taking time together to share in this way creates a space in time that says your relationship is meaningful. Attention to your marriage in this way helps give it priority in the midst of busy lives and schedules that can otherwise obscure the nourishment that a couple needs from one another. Your relationship is the foundation of your family. It is well worth the time and energy!

next: Why Men Pay For Sex

"We need to become clear internally on what messages are coming from the disease, from the old tapes, and which ones are coming from the True Self - what some people call "the small quiet voice".

"We need to turn down the volume on those loud, yammering voices that shame and judge us and turn up the volume on the quiet Loving voice. As long as we are judging and shaming ourselves we are feeding back into the disease, we are feeding the dragon within that is eating the life out of us. Codependence is a disease that feeds on itself - it is self-perpetuating.

"This healing is a long gradual process - the goal is progress, not perfection. What we are learning about is unconditional Love. Unconditional Love means no judgment, no shame".

The holidays were always a very hard time for me emotionally. Being alone on Christmas and New Years Eve was very painful. So painful that sometimes I would arrange to be with someone or with a group of people just so I wouldn't be alone. That often was more painful than being alone. And on those occasions when I was in a relationship during the holidays it was also painful because there was something missing, somehow I was failing the other person or she was failing me because even though there were moments of Joy and Love, it never felt quite like it "should" feel.

After I had been in recovery a few years - in the course of trying to figure out how I set myself up to be a victim with my expectations - I had a very important insight about holidays. I realized that holidays - not just Christmas and New Years Eve but Thanksgiving, Valentines Day, etc. - along with days like anniversaries and my birthday were the times which I judged myself the most. My expectations of what a holiday "should" be, of where I "should" be at a certain age, of how my life "should" look at this particular time, were causing me to unmercifully beat myself up. I was buying into the disease voice which was telling me that I was a loser and a failure (or going to the other extreme and blaming someone else for my feelings.) I was giving power to the toxic shame that told me that I was unworthy and unlovable.

I realized that I was judging myself against standards that weren't real, against expectations that were a fantasy, a fairy tale. The fairy tale that everyone should be happy and cheerful during the Christmas holidays is ridiculous just like the myth of happily-ever-after is a false belief that doesn't apply to this level of existence. The holidays are just like every other day of the year only magnified. That means there will be moments of happiness and Joy but there will also be moments of sadness and hurt.

Christmas is about Love and birth - rebirth. The Winter Solstice is the time of the longest darkness and marks the point of increasing light, the new beginning. Hanukkah is a celebration of, and time of, rededication. Kwanzaa is a time of recommitment. These are all times of both celebration and introspection. Of assessing the past and focusing on what we want to create in the future (New Years resolutions.) Any new beginning, any birth or rebirth is a also an ending. With every ending there is sadness, feelings of loss and grief. Loss because of Loved ones who are no longer in our life, grief because Loved ones who are still in our life cannot see us or understand us, sadness because of things that ended and people we have had to let go of during the past year.

What is so important, what has changed my experience of these Holidays completely is allowing myself to accept the reality of my life (looking at both the half of the glass that is full as well as the empty part) and be wherever I need to be emotionally - that is, allowing myself to be emotionally honest with myself. That does not mean that I have to be emotionally honest with other people. If I am feeling grief because I am alone on the Holiday it does not serve me to share that with someone who is not being emotionally honest - someone who will shame me for not being cheerful. If I am feeling hurt or scared or angry I will only share that with someone who is a safe person to share with emotionally - that is, they won't discount and invalidate my feelings or try to fix me.

I don't have to live up to some false expectations about how I "should" be feeling today. It was trying to deny the pain and sadness, the anger and fear, while judging myself as shameful for not feeling what I "should" feel or being who I "should" be, that caused me to get depressed and suicidal. When I am in my feeling process I actually am a lot happier and feel more Joy than I ever did before I learned how to be emotionally honest. It was on Christmas about 10 years ago that I got real clear that I could feel more than one feeling at once. I was sad that it was Christmas and I was alone, and I was grieving for all of the Christmases that I had been sad and alone - which were very valid and legitimate feelings. But as I went around to various clubhouses and friend's homes that were having open houses, I could feel happy to see people I cared about. I could feel Joy and gratitude that I was in recovery and feeling my feelings at the same time I was owning the sadness of that day and the grief of all the lonely holidays that I had experienced.

It is so very important to stop judging ourselves against someone else's standards and shaming ourselves due to a fantasy of where we "should be". We are exactly where we are supposed to be. We are Spiritual Beings having a human experience. We are perfect in our Spiritual Essence, we are perfectly where we are supposed to be on our Spiritual path and from a human perspective we will never do human perfectly.

A natural normal part of our human experience is feeling the feelings - we need to accept that. No one who is being emotionally honest with themselves can go through the holidays without feeling sadness and hurt, anger and fear. The good news is that the more we are able to own those emotions the more moments of peace, Joy, and happiness we can have.

So, have a happy, merry, sad, Joyous, painful, peaceful, scary, cheerful in the moment Holiday season experiencing what it feels like to be alive in human body. Whatever your celebration: Christmas, Hanukkah, Winter Solstice, Kwanzaa, New Years, etc. let it be about the new beginning; the rededication to: the recommitment to: the rebirth of; life. But most of all, let it be about Love by first of all Loving yourself enough to tell the critical parent voice in your head to shut up with all the comparisons and shame and judgment.

next: Behavioral Defenses

Read this excerpt from "Coming to Our Senses" about the importance of mindfulness and living in the moment.

Why Even Bother with Mindfulness?

If, from the meditative perspective, everything you are seeking is already here, even if it is difficult to wrap your thinking mind around that concept, if there really is no need to acquire anything or attain anything or improve yourself, if you are already whole and complete and by that same virtue so is the world, then why on earth bother meditating? Why would we want to cultivate mindfulness in the first place? And why use particular methods and techniques, if they are all in the service of not getting anywhere anyway, and when, moreover, I've just finished saying that methods and techniques are not the whole of it anyway?

The answer is that as long as the meaning of "everything you are seeking is already here" is only a concept, it is only a concept, just another nice thought. Being merely a thought, it is extremely limited in its capacity for transforming you, for manifesting the truth the statement is pointing to, and ultimately changing the way you carry yourself and act in the world.

More than anything else, I have come to see meditation as an act of love, an inward gesture of benevolence and kindness toward ourselves and toward others, a gesture of the heart that recognizes our perfection even in our obvious imperfection, with all our shortcomings, our wounds, our attachments, our vexations, and our persistent habits of unawareness. It is a very brave gesture: to take one's seat for a time and drop in on the present moment without adornment. In stopping, looking, and listening, in giving ourselves over to all our senses, including mind, in any moment, we are in that moment embodying what we hold most sacred in life. Making the gesture, which might include assuming a specific posture for formal meditation, but could also involve simply becoming more mindful or more forgiving of ourselves, immediately re-minds us and re-bodies us. In a sense, you could say that it refreshes us, makes this moment fresh, timeless, freed up, wide open. In such moments, we transcend who we think we are. We go beyond our stories and all our incessant thinking, however deep and important it sometimes is, and reside in the seeing of what is here to be seen and the direct, non-conceptual knowing of what is here to be known, which we don't have to seek because it is already and always here. We rest in awareness, in the knowing itself which includes, of course, not knowing as well. We become the knowing and the not knowing, as we shall see over and over again. And since we are completely embedded in the warp and woof of the universe, there is really no boundary this benevolent gesture of awareness, no separation from other beings, no limit to either heart or mind, no limit to our being or our awareness, or to our openhearted presence. In words, it may sound like an idealization. Experienced, it is merely what it is, life expressing itself, sentience quivering within infinity, with things just as they are.

Resting in awareness in any moment involves giving ourselves over to all our senses, in touch with inner and outer landscapes as one seamless whole, and thus in touch with all of life unfolding in its fullness in any moment and in every place we might possibly find ourselves, inwardly or outwardly.

Thich Nhat Hanh, the Vietnamese Zen master, mindfulness teacher, poet, and peace activist, aptly points out that one reason we might want to practice mindfulness is that most of the time we are unwittingly practicing its opposite. Every time we get angry we get better at being angry and reinforce the anger habit. When it is really bad, we say we see red, which means we don't see accurately what is happening at all, and so, in that moment, you could say we have "lost" our mind. Every time we become self-absorbed, we get better at becoming self-absorbed and going unconscious. Every time we get anxious, we get better at being anxious. Practice does make perfect. Without awareness of anger or of self-absorption, or ennui, or any other mind state that can take us over when it arises, we reinforce those synaptic networks within the nervous system that underlie our conditioned behaviors and mindless habits, and from which it becomes increasingly difficult to disentangle ourselves, if we are even aware of what is happening at all. Every moment in which we are caught, by desire, by an emotion, by an unexamined impulse, idea, or opinion, in a very real way we are instantly imprisoned by the contraction within the habitual way we react, whether it is a habit of withdrawal and distancing ourselves, as in depression and sadness, or erupting and getting emotionally "hijacked" by our feelings when we fall headlong into anxiety or anger. Such moments are always accompanied by a contraction in both the mind and the body.

But, and this is a huge "but," there is simultaneously a potential opening available here as well, a chance not to fall into the contraction -- or to recover more quickly from it -- if we can bring awareness to it. For we are locked up in the automaticity of our reaction and caught in its downstream consequences (i.e., what happens in the very next moment, in the world and in ourselves) only by our blindness in that moment. Dispel the blindness, and we see that the cage we thought we were caught in is already open.

Every time we are able to know a desire as desire, anger as anger, a habit as habit, an opinion as an opinion, a thought as a thought, a mind-spasm as a mind-spasm, or an intense sensation in the body as an intense sensation, we are correspondingly liberated. Nothing else has to happen. We don't even have to give up the desire or whatever it is. To see it and know it as desire, as whatever it is, is enough. In any given moment, we are either practicing mindfulness or, de facto, we are practicing mindlessness. When framed this way, we might want to take more responsibility for how we meet the world, inwardly and outwardly in any and every moment -- especially given that there just aren't any "in-between moments" in our lives.

So meditation is both nothing at all -- because there is no place to go and nothing to do -- and simultaneously the hardest work in the world -- because our mindlessness habit is so strongly developed and resistant to being seen and dismantled through our awareness. And it does require method and technique and effort to develop and refine our capacity for awareness so that it can tame the unruly qualities of the mind that make it at times so opaque and insensate.

These features of meditation, both as nothing at all and as the hardest work in the world, necessitate a high degree of motivation to practice being utterly present without attachment or identification. But who wants to do the hardest work in the world when you are already overwhelmed with more things to do than you can possibly get done -- important things, necessary things, things you may be very attached to so you can build whatever it is that you may be trying to build, or get wherever it is that you are trying to get to, or even sometimes, just so you can get things over with and check them off your to-do list? And why meditate when it doesn't involve doing anyway, and when the result of all the non-doing is never to get anywhere but to be where you already are? What would I have to show for all my non-efforts, which nevertheless take so much time and energy and attention?

All I can say in response is that everybody I have ever met who has gotten into the practice of mindfulness and has found some way or other to sustain it in their lives for a period of time has expressed the feeling to me at one point or another, usually when things are at their absolute worst, that they couldn't imagine what they would have done without the practice. It is that simple really. And that deep. Once you practice, you know what they mean. If you don't practice, there is no way to know.

And of course, probably most people are first drawn to the practice of mindfulness because of stress or pain of one kind or another and their dissatisfaction with elements of their lives that they somehow sense might be set right through the gentle ministrations of direct observation, and self-compassion. Stress and pain thus become potentially valuable portals and motivators through which to enter the practice.

And one more thing. When I say that meditation is the hardest work in the world, that is not quite accurate, unless you understand that I don't just mean "work" in the usual sense, but also as play. Meditation is playful too. It is hilarious to watch the workings of our own mind, for one thing. And it is much too serious to take too seriously. Humor and playfulness, and undermining any hint of a pious attitude, are critical to right mindfulness. And besides, maybe parenting is the hardest work in the world. But, if you are a parent, are they two different things?

I recently got a call from a physician colleague in his late forties who had undergone hip replacement surgery, surprising for his age, for which he needed an MRI before the operation took place. He recounted how useful the breath wound up being when he was swallowed by the machine. He said he couldn't even imagine what it would be like for a patient who didn't know about mindfulness and using the breath to stay grounded in such a difficult situation, although it happens every single day.

He also said that he was astonished by the degree of mindlessness that characterized many aspects of his hospital stay. He felt successively stripped of his status as a physician, and a rather prominent one at that, and then of his personhood and identity. He had been a recipient of "medical care," but on the whole, that care had hardly been caring. Caring requires empathy and mindfulness, and openhearted presence, often surprisingly lacking where one would think it would be most in evidence. After all, we do call it health care. It is staggering, shocking, and saddening that such stories are even now all too common, and that they come even from doctors themselves when they become patients and need care themselves.

Beyond the ubiquity of stress and pain operating in my own life, my motivation to practice mindfulness is fairly simple: Each moment missed is a moment unlived. Each moment missed makes it more likely I will miss the next moment, and live through it cloaked in mindless habits of automaticity of thinking, feeling, and doing rather than living in, out of, and through awareness. I see it happen over and over again. Thinking in the service of awareness is heaven. Thinking in the absence of awareness can be hell. For mindlessness is not simply innocent or insensitive, quaint or clueless. Much of the time it is actively harmful, wittingly or unwittingly, both to oneself and to the others with whom we come in contact or share our lives. Besides, life is overwhelmingly interesting, revealing, and awe-provoking when we show up for it wholeheartedly and pay attention to the particulars.

If we sum up all the missed moments, inattention can actually consume our whole life and color virtually everything we do and every choice we make or fail to make. Is this what we are living for, to miss and therefore misconstrue our very lives? I prefer going into the adventure every day with my eyes open, paying attention to what is most important, even if I keep getting confronted, at times, with the feebleness of my efforts (when I think they are "mine") and the tenacity of my most deeply ingrained and robotic habits (when I think they are "mine"). I find it useful to meet each moment freshly, as a new beginning, to keep returning to an awareness of now over and over again, and let a gentle but firm perseverance stemming from the discipline of the practice keep me at least somewhat open to whatever is arising and behold it, apprehend it, look deeply into it, and learn whatever it might be possible to learn as the nature of the situation is revealed in the attending.

When you come right down to it, what else is there to do? If we are not grounded in our being, if we are not grounded in wakefulness, are we not actually missing out on the gift of our very lives and the opportunity to be of any real benefit to others?

It does help if I remind myself to ask my heart from time to time what is most important right now, in this moment, and listen very carefully for the response.

As Thoreau put it at the end of Walden, "Only that day dawns to which we are awake."

Copyright © 2005 Jon Kabat-Zinn, Ph.D.

Excerpted from the book: Coming to Our Senses: Healing Ourselves and the World Through Mindfulness by Jon Kabat-Zinn. Copyright © 2005 Jon Kabat-Zinn, Ph.D. (Published by Hyperion; January 2005; $24.95US/$34.95CAN; 0-7868-6756-6)

About the author: Jon Kabat-Zinn, Ph.D., is the founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, as well as Professor of Medicine emeritus. He leads workshops on stress reduction and mindfulness for doctors and other health professionals and for lay audiences worldwide. He is the bestselling author of Wherever You Go, There You Are and Full Catastrophe Living, and, with his wife, Myla Kabat-Zinn, of a book on mindful parenting, Everyday Blessings. He was featured in the PBS series Healing and the Mind with Bill Moyers, as well as on Oprah. He lives in Massachusetts.

For more information, please visit www.writtenvoices.com.

next: Articles: A Day in the Heart of Pain

"We have come to understand that both the passive and the aggressive behavioral defense systems are reactions to the same kinds of childhood trauma, to the same kinds of emotional wounds. The Family Systems Dynamics research shows that within the family system, children adopt certain roles according to their family dynamics. Some of these roles are more passive, some are more aggressive, because in the competition for attention and validation within a family system the children must adopt different types of behaviors in order to feel like an individual"

There are four basic roles that children adopt in order to survive growing up in emotionally dishonest, shame-based, dysfunctional family systems. Some children maintain one role into adulthood while others switch from one role to another as the family dynamic changes (i.e. when the oldest leaves home, etc.)

"Responsible Child" -"Family Hero"

This is the child who is"9 going on 40". This child takes over the parent role at a very young age, becoming very responsible and self-sufficient. They give the family self-worth because they look good on the outside. They are the good students, the sports stars, the prom queens. The parents look to this child to prove that they are good parents and good people.

As an adult the Family Hero is rigid, controlling, and extremely judgmental of others and secretly of themselves. They achieve "success" on the outside and get lots of positive attention but are cut off from their inner emotional life, from their True Self. They are compulsive and driven as adults because deep inside they feel inadequate and insecure.

"Acting out child" - "Scapegoat"

This is the child that the family feels ashamed of - and the most emotionally honest child in the family. He/she acts out the tension and anger the family ignores. This child provides distraction from the real issues in the family. The scapegoat usually has trouble in school because they get attention the only way they know how - which is negatively. They often become pregnant or addicted as teenagers.

These children are usually the most sensitive and caring which is why they feel such tremendous hurt. They are romantics who become very cynical and distrustful. They have a lot of self-hatred and can be very self-destructive.

"Placater" - "Mascot"

This child takes responsibility for the emotional well-being of the family. They become the families "social director" and clown, diverting the family's attention from the pain and anger.

This child becomes an adult who is valued for their kind heart, generosity, and ability to listen to others. Their whole self-definition is centered on others and they don't know how to get their own needs met. They become adults who cannot receive love, only give it. They often get involved in abusive relationships in an attempt to "save" the other person. They go into the helping professions and become nurses, and social workers, and therapists. They have very low self-worth and feel a lot of guilt.

"Adjuster" - "Lost Child"

This child escapes by attempting to be invisible. They daydream, fantasize, read a lot of books or watch a lot of TV. They deal with reality by withdrawing from it. They deny that they have any feelings and don't bother getting upset!

These children grow up to be adults who find themselves unable to feel and suffer very low self-esteem. They are terrified of intimacy and often have relationship phobia. They are very withdrawn and shy and become socially isolated because that is the only way they know to be safe from being hurt. A lot of actors and writers are lost children who have found a way to express emotions while hiding behind their characters.

It is important to note that we adapt the roles that are best suited to our personalities. We are, of course, born with a certain personality. What happens with the roles we adapt in our family dynamic is that we get a twisted, distorted view of who we are as a result of our personality melding with the roles. This is dysfunctional because it causes us to not be able to see ourselves clearly. The false self that we develop to survive is never totally false - there is always some Truth in it. For example, people who go into the helping professions do truly care and are not doing what they do simply out of Codependence. Nothing is black and white. Recovery is about getting honest with ourselves and finding some balance in our life.

next: The Emotional Frontier Within

How To Help Someone Who's Depressed

I've gotten lots of questions from  friends and family of depression patients, as to how to handle it. This page assumes that the depressed person has been diagnosed and is in treatment. 

Main Problems for Friends and Family

Let me start by saying that I, for one, appreciate your wishing to understand someone else's depression. I commend you for taking an interest in a very difficult subject and for wishing to help. In an indirect way, you're a victim of depression too because this illness impinges on everyone around the people who have it.

Pardon my bluntness, but there are a few things you really need to know, before you get too far into this subject.

1. You cannot cure someone else's clinical depression. It is not just sadness which can be waved off with a few kind words. It goes far deeper than that. If you are going into this with the heroic notion that you can somehow "fix" it for your friend, spouse or relative, then you need to disavow it immediately. Operating on this assumption will only frustrate you and does no one any good.

2. There are ups and downs in depression recovery. It is neither swift, nor steady. Your friend or relative is going to go on the decline, now and then. Don't think it's because you are failing them or they are not trying hard enough. The "roller-coaster" effect is just a part and parcel of depression.

3. Please don't tell a depression patient that "you understand." Unless you, yourself, have experienced clinical depression, you don't. And your friend, spouse or relative knows it. It's not a bad thing; since understanding depression means having it. I'd rather that no one, anywhere, understood it. The point here is to be honest with your friend or relative and don't profess things that aren't so. Sincerity will help him or her a great deal; it will engender trust, which every depression patient has a problem with, at one time or another.

4. No one wants to make your life miserable by being depressed. Try not to view someone else's depression as your own affliction. Rather, be grateful that you don't have clinical depression and try to realize what the other person is going through. Don't take the things your friend, spouse or relative says/does, personally. They aren't meant that way.

5. Recovery from depression is not just a matter of taking anti-depressant medication and going to therapy. Both the depression and recovery from it can totally change a person's life. Treatment involves a lot of fundamental changes in a person. At times, you'll wonder if it's the same person you've known for so long. Believe me, it is--the depression probably hid the "real person" from your view, up to the point that he or she was diagnosed and began treatment.

6. At times, it may seem that the person is actually pushing you away. This is very likely true. Most depression patients believe that they unduly affect those around them and will do anything to prevent that from happening. Thus, they isolate themselves from others. This kind of self-sabotage is actually a symptom of the illness itself. Don't let it overcome your relationship. Try to understand that this is often involuntary and irrational, and act accordingly.

How To Help Someone Who's Depressed

For Family and Friends of Depression Patients

What To Say or Do

I cannot tell you precisely what is best for your friend, spouse or relative. I can only give you some guidelines. The rest is up to you.

1. Don't ask very general questions; you won't get a meaningful answer. As an example: Rather than asking "How are you?" ask "How are you today compared to yesterday?" or something of this kind. Make the question open-ended, so the person can say what he or she wants, but provide something specific for them to talk about.

2. Try to get the person out. He or she will want to isolate themselves--hibernate, even--but this is exactly what should not happen. Take walks, go shopping, go to a movie, whatever you have to, to get the person out of the environment they are trying to take shelter in. You may get some resistance, and even complaints; be persistent but not unreasonable.

3. Don't be afraid to let your spouse, relative or friend talk about whatever they want to. Even if they mention self-injury, or they are suicidal, you are not endangering them by listening. Actually, you are helping to protect them from those things; talking helps them deal with these feelings.

4. Keep an eye out for any changes in behavior. These can include appetite, sleep habits, drinking or drug abuse, anything at all. Any major changes may be a sign of trouble.

5. Little things go a long way for someone with clinical depression. Small gifts and favors seem much bigger to them than to you. Don't be afraid to (for example) leave the person a short note with a smiley face on it. Even if it seems silly or hokey, small considerations will help.

6. There are a couple of web pages which speak to this issue better than I can. You can click the links below.

What Depression Is Not

Understanding Depression

Non-depressed people have a difficult time understanding depression; which is completely understandable. I've discussed these things elsewhere, but I think this bears repeating here. Depression is not a weakness, character flaw, personality trait, or anything of that kind. It's not God's punishment for past sins. It's not karma catching up with something the person did in a past life. It's not someone just being too sensitive. It's not laziness or immaturity. No one does anything to deserve it. And you did nothing to cause someone in your life to become clinically depressed.

Depression is also not just the emotion of sadness. In fact, many depression patients experience numbness, or no emotion, rather than sadness. It is called a "mood disorder," but this is a misnomer, in that it can go way beyond someone's mood. Depression can totally disrupt someone's thinking, in every way.

Depression is also not an excuse. Having this illness doesn't absolve anyone of responsibility for themselves. Don't make the mistake of letting a depression patient "off the hook" because of his or her illness. Point out any transgressions and explain what went wrong, and make sure the person understands it. However, getting angry or vindictive do no good, either. Keep criticism constructive. And stick by your friend or relative; you will find that it pays off in the end.

Go here for a more in-depth look at depression and supporting a depressed person.

Accepting Depression In Someone Else

Just as any depression patient must learn to accept his or her illness, and work on overcoming it, so you must accept that they have a mood disorder. Since recovering is really a matter of work on the patient's part, it's impossible to start doing this work until one accepts that one must do it. By the same token, you will find it impossible to deal with someone else's depression, unless you accept that he or she has an illness--a very real one.

From what I've seen, this is one of the hardest things for friends and family to do. I will not kid you into thinking that this is easy. It's not. Accepting an illness in someone else, that you don't understand and never will (hopefully), is not a simple or trivial matter. Above all, don't blame yourself for it. No one can "make" another person depressed, so don't fall into the trap of thinking that you caused it.

For Caregivers of Depression Patients

This is just as important as anything else! You offer nothing to someone else if you're stressed out. If you need to, take some time away from the depressed person. It will give you a better perspective on things and unravel frustrations and tensions. Just make sure that your friend or relative knows that you're still committed to him or her, anyway. You can even tell him/her that you're taking "time out" for yourself, so you can better help. (It's true.)

next: Medications And Depression
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~ all articles on depression

• Watch the video on Grandiosity Hangover and Narcissistic Baiting

The grandiose fantasies of the narcissist inevitably and invariably clash with his drab, routine, and mundane reality. We call this constant dissonance the "grandiosity gap". Sometimes the gap is so yawning that even the narcissist - however dimly - recognizes its existence. Still, this insight into his real situation fails to alter his behaviour. The narcissist knows that his grandiose fantasies are incommensurate with his accomplishments, knowledge, status, actual wealth (or lack thereof), physical constitution, or sex appeal - yet, he keeps behaving as though this were untrue.

The situation is further exacerbated by periods of relative success in the narcissist's past. Has-been and also-ran narcissists suffer from a "grandiosity hangover". They may have once been rich, famous, powerful, brilliant, or sexually irresistible - but they no longer are. Still, they continue to behave as though little has changed.

The balding, potbellied, narcissist still courts women aggressively. The impoverished tycoon sinks deeper into debts, trying to maintain an unsustainable and lavish lifestyle. The one-novel author or one-discovery scholar still demands professional deference and expects attention by media and superiors. The once-potent politician maintains regal airs and holds court in great pomp. The wizened actress demands special treatment and throws temper tantrums when rebuffed. The ageing beauty wears her daughter's clothes and regresses emotionally as she progresses chronologically.

Human collectives - firms, nations, clubs - develop grandiosity hangovers as easily and as frequently as do individuals. It is not uncommon to come across a group of people who still live in a bygone buy glorious past. This mass pathology is self- reinforcing. Members feed on each other's delusions, pretensions, and lies. Ostrich-like, they bury their collective head in the sand of time, harking back to happier moments of omnipotence, omniscience, and omnipresence.

The grandiosity hangover and the grandiosity gap are the two major vulnerabilities of the narcissist. By exploiting them, the narcissist can be effortlessly manipulated. This is especially true when the narcissist is confronted with authority, finds himself in an inferior position, or when his narcissistic supply is deficient or uncertain.

From "The Narcissist in Court"

Here are a few of the things the narcissist finds devastating:

Any statement or fact, which seems to contradict his inflated perception of his grandiose self. Any criticism, disagreement, exposure of fake achievements, belittling of "talents and skills" which the narcissist fantasizes that he possesses, any hint that he is subordinated, subjugated, controlled, owned or dependent upon a third party. Any description of the narcissist as average and common, indistinguishable from many others. Any hint that the narcissist is weak, needy, dependent, deficient, slow, not intelligent, naive, gullible, susceptible, not in the know, manipulated, a victim.

The narcissist is likely to react with rage to all these and, in an effort to re-establish his fantastic grandiosity, he is likely to expose facts and stratagems he had no conscious intention of exposing.

The narcissist reacts with narcissistic rage, hatred, aggression, or violence to an infringement of what he perceives to be his entitlement.

Narcissists believe that they are so unique and that their lives are so cosmically significant that others should defer to their needs and cater to their every whim without ado. The narcissist feels entitled to special treatment by unique individuals, over and above the regular person.

Any insinuation, hint, intimation, or direct declaration that the narcissist is not special at all, that he is average, common, not even sufficiently idiosyncratic to warrant a fleeting interest will inflame the narcissist.

Add to this a negation of the narcissist's sense of entitlement - and the combustion is inevitable. Tell the narcissist that he does not deserve the best treatment, that his needs are not everyone's priority, that he is boring, that his needs can be catered to by an average practitioner (medical doctor, accountant, lawyer, psychiatrist), that he and his motives are transparent and can be easily gauged, that he will do what he is told, that his temper tantrums will not be tolerated, that no special concessions will be made to accommodate his inflated sense of self, that he is subject to court procedures, etc. - and the narcissist will lose control.

The narcissist believes that he is the cleverest, far above the madding crowd. If contradicted, exposed, humiliated, berated ("You are not as intelligent as you think you are", "Who is really behind all this? It takes sophistication which you don't seem to have", "So, you have no formal education", "you are (mistake his age, make him much older) ... sorry, you are ... old", "What did you do in your life? Did you study? Do you have a degree? Did you ever establish or run a business? Would you define yourself as a success?", "Would your children share your view that you are a good father?", "You were last seen with a Ms. ... who is (suppressed grin) a DOMESTIC (in demeaning disbelief)".

I know that many of these questions cannot be asked outright in a court of law. But you can hurl these sentences at him during the breaks, inadvertently during the examination or deposition phase, etc.

next: The Energy of Self

Since the 1960s, the number of cases of eating disorders has doubled in the United States, according to the Eating Disorders Coalition, a non-profit advocacy organization. About 0.5 percent of teenage girls suffer from anorexia. Up to 5 percent have bulimia nervosa, in which they binge on food and then purge by vomiting or using laxatives, according to the Chicago-based American Academy of Pediatrics.

The statistics suggest that eating disorders have moved beyond the stereotype. It used to be considered primarily a health issue for young, white, affluent teenage girls. Now, the problem has crossed socioeconomic, ethnic and gender boundaries.

Up to 10 percent of all cases now affect boys, and boys and girls are being diagnosed with eating disorders at earlier ages, according to the academy and eating-disorder experts. advertisement

Recent studies have shown that 42 percent of first-, second- and third-grade girls want to be thinner; that 40 percent of almost 500 fourth-graders surveyed said they diet "very often" or "sometimes"; and that 46 percent of 9-year-olds and 81 percent of 10-year-olds admit to dieting, binge eating or fear of getting fat, according to the Harvard Eating Disorders Center in Boston.

The boom in eating disorders is fueled by a number of factors, experts say. Children see parents diet, sometimes obsessively and unnecessarily, and learn by example.

Pressure to look good probably never has been greater, and "good" often translates to "thin," says Dr. Ellen Rome, head of the section of adolescent medicine at the Cleveland Clinic in Ohio. Today's youngsters "are bombarded with messages that thin is in," she says.

Experts hope to get a handle on the problem, partly through earlier diagnosis so patients can get the treatment they need. The American Academy of Pediatrics recently issued a policy statement urging its members to be alert to the possibility of eating disorders in their patients and advising them on how to screen for problems.

Among the recommendations: Pediatricians should be aware of signs and symptoms of eating disorders, such as dizziness, weakness, constipation or "cold intolerance." They also should calculate patients' weight and height to see if they are at a healthy weight and know when and how to refer patients to other specialists when needed.

next: Eating Disorders Up Risk in Newborns
~ eating disorders library
~ all articles on eating disorders

Correspondence with M. William Phelps

Author of "PERFECT POISON" (August, 2003)

Copyright M. William Phelps, Kensington Publishing Corp. 2002

Pathological narcissism pervades every facet of the personality, every behaviour, every cognition, and every emotion. This makes it difficult to treat. Add to this the narcissist's unthinking and deeply-ingrained resistance to authority figures, such as therapists - and healing, or even mere behaviour modification, are rendered unattainable.

Pathological narcissism is often co-morbid with mood disorders, compulsive rituals, substance abuse, paraphilias, or reckless behaviour patterns. Many narcissists are also anti-social. Lacking empathy and convinced of their own magnificence, they feel that they are above social conventions and the Law.

Some of these concomitant problems are amenable to a combination of medication and talk therapy. Not so the core defence mechanisms of the narcissist.

The narcissist is both victimizer and victim. The essence of the narcissistic disorder is a breakdown of internal communication. The narcissist invents and nurtures a false self intended to elicit attention - positive or negative - from others and thus to fill his innermost void. He is so engrossed in securing narcissistic supply from his sources by putting on an energy-sapping show - that he fails to materialize his potential, to have mature, adult relationships, to feel, and, in general, to enjoy life.

To the narcissist, other people are never more than potential sources of supply with a useful "shelf life". The narcissist invariably ends up cruelly devaluing and discarding them, like dysfunctional objects. Little wonder that the narcissist - haughty, abrasive, exploitive, manipulative, untruthful - is universally held in contempt, derided, hated, persecuted, and cast out. But we should never forget that he pays a dear price for something which, essentially, is beyond his full control - i.e., for his illness."

Correspondence with Abigail Esman

Upbringing and Narcissism

There are no authoritative studies to back a genetic predisposition to pathological narcissism - nor the oft-heard claim that it is the outcome of abuse. But anecdotal evidence, case studies, and the investigation of population in outpatient clinics and so on - reveals a correlation between abuse in early childhood and infancy and the emergence of pathological narcissism as a defence mechanism.

There are many forms of abuse. The most well-known and frequently discussed include incest, molestation, beatings, constant berating, terrorizing, abandonment, arbitrary punishment, capricious and unstable parental behaviour and environment, authoritarian, emotionless, rigid and hierarchical home regime and so on.

But more pernicious are the subtle and socially-acceptable forms of abuse - such as doting, smothering, treating the child as an extension of the parent, forcing the child to realize the parents' unfulfilled dreams and unrealized wishes, putting the child on constant display, maintaining unrealistic expectations of him and so on. These modes of abuse permeate the tenuous self-boundaries formed by the child and teach him that he is loved because of what he accomplishes rather than due to who he is.

Treating Narcissism

Every aspect of the personality is pervaded by pathological narcissism. It colours the narcissist's behaviour, cognition, and emotional landscape. This ubiquity renders it virtually untreatable. Additionally, the narcissist develops deep-set resistance to authority figures, such as therapists. His attitude to treatment is conflictual, competitive, and hostile. When he fails to co-opt the therapist into upholding his grandiose self-image, the narcissist devalues and discards both the treatment and the mental health practitioner administering it.

Mood disorders, compulsive rituals, substance abuse, paraphilias, reckless, or anti-social behaviour patterns often accompany pathological narcissism (they are co-morbid). While some of these coexistent problems can be ameliorated through a combination of medication and talk therapy - not so the core defence mechanisms of the narcissist.

next: Grandiosity Hangover and Narcissistic Baiting

• Watch the video on The Old Narcissist

"The permanent temptation of life is to confuse dreams with reality. Then permanent defeat of life comes when dreams are surrendered to reality."
James Michener, Author

The narcissist ages without mercy and without grace. His withered body and his overwrought mind betray him all at once. He stares with incredulity and rage at cruel mirrors. He refuses to accept his growing fallibility. He rebels against his decrepitude and mediocrity. Accustomed to being awe-inspiring and the recipient of adulation - the narcissist cannot countenance his social isolation and the pathetic figure that he cuts.

As a child prodigy, a sex symbol, a stud, a public intellectual, an actor, an idol - the narcissist was at the centre of attention, the eye of his personal twister, a black hole which sucked people's energy and resources dry and spat out with indifference their mutilated carcasses. No longer. With old age comes disillusionment. Old charms wear thin.

Having been exposed for what he is - a deceitful, treacherous, malignant egotist - the narcissist's old tricks now fail him. People are on their guard, their gullibility reduced. The narcissist - being the rigid, precariously balanced structure that he is - can't change. He reverts to old forms, re-adopts hoary habits, succumbs to erstwhile temptations. He is made a mockery by his accentuated denial of reality, by his obdurate refusal to grow up, an eternal, malformed child in the sagging body of a decaying man.

It is the fable of the grasshopper and the ant revisited.

The narcissist - the grasshopper - having relied on supercilious stratagems throughout his life - is singularly ill-adapted to life's rigors and tribulations. He feels entitled - but fails to elicit narcissistic supply. Wrinkled time makes child prodigies lose their magic, lovers exhaust their potency, philanderers waste their allure, and geniuses miss their touch. The longer the narcissist lives - the more average he becomes. The wider the gulf between his pretensions and his accomplishments - the more he is the object of derision and contempt.

Yet, few narcissists save for rainy days. Few bother to study a trade, or get a degree, pursue a career, maintain a business, keep their jobs, or raise functioning families, nurture their friendships, or broaden their horizons. Narcissists are perennially ill-prepared. Those who succeed in their vocation, end up bitterly alone having squandered the love of spouse, off-spring, and mates. The more gregarious and family-orientated - often flunk at work, leap from one job to another, relocate erratically, forever itinerant and peripatetic.

The contrast between his youth and prime and his dilapidated present constitutes a permanent narcissistic injury. The narcissist retreats deeper into himself to find solace. He withdraws into the penumbral universe of his grandiose fantasies. There - almost psychotic - he salves his wounds and comforts himself with trophies of his past.

A rare minority of narcissists accept their fate with fatalism or good humour. These precious few are healed mysteriously by the deepest offense to their megalomania - old age. They lose their narcissism and confront the outer world with the poise and composure that they lacked when they were captives of their own, distorted, narrative.

Such changed narcissists develop new, more realistic, expectations and hopes - commensurate with their talents, skills, accomplishments and education. Ironically, it is invariably too late. They are avoided and ignored, rendered transparent by their checkered past. They are passed over for promotion, never invited to professional or social gatherings, cold-shouldered by the media. They are snubbed and disregarded. They are never the recipients of perks, benefits, or awards. They are blamed when not blameworthy and rarely praised when deserving. They are being constantly and consistently punished for who they were. It is poetic justice in more than one way. They are being treated narcissistically by their erstwhile victims. They finally are tasting their own medicine, the bitter harvest of their wrath and arrogance.

next: Discussing Narcissism

Overview of St. John's wort, an herbal treatment for mild to moderate depression. Includes side-effects of St. John's wort.

On this page

• Introduction
• What It Is Used For
• How It Is Used
• What the Science Says
• Side Effects and Cautions
• Sources
• For More Information

Introduction

This fact sheet provides basic information about the herb St. John's wort--common names, uses, potential side effects, and resources for more information. St. John's wort is a plant with yellow flowers.

Common Names--St. John's wort, hypericum, Klamath weed, goat weed

Latin Name--Hypericum perforatum

What It Is Used For

• St. John's wort has been used for centuries to treat mental disorders and nerve pain.

• In ancient times, herbalists wrote about its use as a sedative and a treatment for malaria, as well as a balm for wounds, burns, and insect bites.

• Today, St. John's wort is used by some for depression, anxiety, and/or sleep disorders.

How It Is Used

The flowering tops of St. John's wort are used to prepare teas and tablets containing concentrated extracts.

What the Science Says

• There is some scientific evidence that St. John's wort is useful for treating mild to moderate depression. However, two large studies, one sponsored by NCCAM, showed that the herb was no more effective than placebo in treating major depression of moderate severity.

• NCCAM is studying the use of St. John's wort in a wider spectrum of mood disorders, including minor depression.

Side Effects of St. John's Wort and Cautions

• St. John's wort may cause increased sensitivity to sunlight. Other side effects can include anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction.

• Research shows that St. John's wort interacts with some drugs. The herb affects the way the body processes or breaks down many drugs; in some cases, it may speed or slow a drug's breakdown. Drugs that can be affected include:

  • Indinavir and possibly other drugs used to control HIV infection

  • Irinotecan and possibly other drugs used to treat cancer

  • Cyclosporine, which prevents the body from rejecting transplanted organs

  • Digoxin, which strengthens heart muscle contractions

  • Warfarin and related anticoagulants

  • Birth control pills

  • Antidepressants

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  When combined with certain antidepressants, St. John's wort may increase side effects such as nausea, anxiety, headache, and confusion.

• St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe. Anyone who may have depression should see a health care provider. There are effective proven therapies available.

• It is important to inform your health care providers about any herb or dietary supplement you are using, including St. John's wort. This helps to ensure safe and coordinated care.

You can find here information on St. John's Wort and the Treatment of Depression

Sources

National Center for Complementary and Alternative Medicine. St. John's Wort and the Treatment of Depression. National Center for Complementary and Alternative Medicine Web site. Accessed June 30, 2005.

St. John's Wort. Natural Medicines Comprehensive Database Web site. Accessed June 30, 2005.

St. John's wort (Hypericum perforatum L.). Natural Standard Database Web site. Accessed June 30, 2005.

St. John's wort. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:359-366.

De Smet PA. Herbal remedies. New England Journal of Medicine. 2002;347(25):2046-2056.

Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St. John's wort) in major depressive disorder: a randomized controlled trial. Journal of the American Medical Association. 2002;287(14):1807-1814.

For More Information

Visit the NCCAM Web site and view:

"What's in the Bottle? An Introduction to Dietary Supplements" "Herbal Supplements: Consider Safety, Too"

NCCAM Clearinghouse
Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
E-mail: info@nccam.nih.gov

CAM on PubMed
Web site: www.nlm.nih.gov/nccam/camonpubmed.html

NIH Office of Dietary Supplements
Web site: http://ods.od.nih.gov

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

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