When I have money, I can exercise my sadistic urges freely and with little fear of repercussions. Money shields me from life itself, from the outcomes of my actions, it insulates me warmly and safely, like a benevolent blanket, like a mother's good night kiss. Yes, money is undoubtedly a love substitute. And it allows me to be my ugly, corrupt, and dilapidated self. Money buys me absolution and my own friendship, forgiveness, and acceptance. With money in the bank, I feel at ease with myself, free, arrogantly soaring supreme above the contemptible masses.

I can always find people poorer than I, a cause for great disdain and bumptiousness on my part.

I rarely use money to buy, corrupt, and intimidate. I wear 15 year old tattered clothes, I have no car, no house, no property. It is so even when I am wealthy. Money has nothing to do with my physical needs or with my social interactions. I never deploy it to acquire status, or to impress others. I hide it, hoard it, accumulate it and, like the proverbial miser, count it daily and in the dark. It is my licence to sin, my narcissistic permit, a promise and its fulfillment all at once. It unleashes the beast in me and, with abandon, encourages it - nay, seduces it - to be itself.

I am not tight-fisted. I spend money on restaurants and trips abroad and books and health products. I buy gifts (though reluctantly). I speculate and have lost hundreds of thousands of dollars in wanton gambling in the stock exchanges. I am insatiable, always want more, always lose the little that I have. But I do all this not for the love of money, for I do not use it to gratify my self or to cater to my needs. No, I do not crave money, nor care for it. I need the power that it bestows on me to dare, to flare, to conquer, to oppose, to resist, to taunt, and to torment.

In all my relationships, I am either the vanquished or the vanquisher, either the haughty master, or his abject slave, either the dominant, or the recessive. I interact along the up-down axis, rather than along the left-right one. My world is rigidly hierarchical and abusively stratified. When submissive, I am contemptibly so. When domineering, I am contemptuously so. My life is a pendulum swinging between oppressed and oppressor.

To subjugate another, one must be capricious, unscrupulous, ruthless, obsessive, hateful, vindictive, and penetrating. One must spot the cracks of vulnerability, the crumbling foundations of susceptibility, the pains, the trigger mechanisms, the Pavlovian reactions of hate, and fear, and hope, and anger. Money liberates my mind. It endows it with the tranquility, detachment, and incisiveness of a natural scientist. With my mind free of the quotidian, I can concentrate on attaining the desired position - on top, dreaded, derided, avoided - yet obeyed and deferred to. I then proceed with cool disinterest to unscramble the human jigsaw puzzles, to manipulate their parts, to enjoy their writhing as I expose their petty misbehaviors, harp on their failures, compare them to their betters, and mock their incompetence, hypocrisy, and cupidity. Oh, I disguise it in socially acceptable cloak - only to draw the dagger. I cast myself in the role of a brave, incorruptible iconoclast, a fighter for social justice, for a better future, for more efficiency, for good causes. But it is all about my sadistic urges, really. It is all about death, not life.

Still, antagonizing and alienating my potential benefactors is a pleasure that I cannot afford on an empty purse. When impoverished, I am altruism embodied - the best of friends, the most caring of tutors, a benevolent guide, a lover of humanity, and a fierce fighter against narcissism, sadism, and abuse in all their myriad forms. I adhere, I obey, I succumb, I agree wholeheartedly, I praise, condone, idolize, and applaud. I am the perfect audience, an admirer and an adulator, a worm and an amoeba - spineless, adaptable in form, slithery flexibility itself. To behave so is unbearable for a narcissist, hence my addiction to money (really, to freedom) in all its forms. It is my evolutionary ladder from slime to the sublime - to mastery.

next: For the Love of God

• Watch the video on Narcissism and Genetic

Is pathological narcissism the outcome of inherited traits - or the sad result of abusive and traumatizing upbringing? Or, maybe it is the confluence of both? It is a common occurrence, after all, that, in the same family, with the same set of parents and an identical emotional environment - some siblings grow to be malignant narcissists, while others are perfectly "normal". Surely, this indicates a predisposition of some people to developing narcissism, a part of one's genetic heritage.

This vigorous debate may be the offshoot of obfuscating semantics.

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

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

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

What about the Narcissistic Personality Disorder?

It would seem reasonable to assume - though, at this stage, there is not a shred of proof - that the narcissist is born with a propensity to develop narcissistic defences. These are triggered by abuse or trauma during the formative years in infancy or during early adolescence. By "abuse" I am referring to a spectrum of behaviours which objectifies the child and treats it as an extension of the caregiver (parent) or an instrument. Dotting and smothering are as much abuse as beating and starving. And abuse can be dished out by peers as well as by adult role models.

Still, I would have to attribute the development of NPD mostly to nurture. The Narcissistic Personality Disorder is an extremely complex battery of phenomena: behaviour patterns, cognitions, emotions, conditioning, and so on. NPD is a PERSONALITY disordered and even the most ardent proponents of the school of genetics do not attribute the development of the whole personality to genes.

From "The Interrupted Self":

"Organic" and "mental" disorders (a dubious distinction at best) have many characteristics in common (confabulation, antisocial behaviour, emotional absence or flatness, indifference, psychotic episodes and so on)."

From "On Dis-ease":

"Moreover, the distinction between the psychic and the physical is hotly disputed, philosophically. The psychophysical problem is as intractable today as it ever was (if not more so). It is beyond doubt that the physical affects the mental and the other way around. This is what disciplines like psychiatry are all about. The ability to control "autonomous" bodily functions (such as heartbeat) and mental reactions to pathogens of the brain are proof of the artificialness of this distinction.

It is a result of the reductionist view of nature as divisible and summable. The sum of the parts, alas, is not always the whole and there is no such thing as an infinite set of the rules of nature, only an asymptotic approximation of it. The distinction between the patient and the outside world is superfluous and wrong. The patient AND his environment are ONE and the same. Disease is a perturbation in the operation and management of the complex ecosystem known as patient-world. Humans absorb their environment and feed it in equal measures. This on-going interaction IS the patient. We cannot exist without the intake of water, air, visual stimuli and food. Our environment is defined by our actions and output, physical and mental.

Thus, one must question the classical differentiation between "internal" and "external". Some illnesses are considered "endogenic" (=generated from the inside). Natural, "internal", causes - a heart defect, a biochemical imbalance, a genetic mutation, a metabolic process gone awry - cause disease. Aging and deformities also belong in this category.

In contrast, problems of nurturance and environment - early childhood abuse, for instance, or malnutrition - are "external" and so are the "classical" pathogens (germs and viruses) and accidents.

But this, again, is a counter-productive approach. Exogenic and Endogenic pathogenesis is inseparable. Mental states increase or decrease the susceptibility to externally induced disease. Talk therapy or abuse (external events) alter the biochemical balance of the brain.

The inside constantly interacts with the outside and is so intertwined with it that all distinctions between them are artificial and misleading. The best example is, of course, medication: it is an external agent, it influences internal processes and it has a very strong mental correlate (=its efficacy is influenced by mental factors as in the placebo effect).

The very nature of dysfunction and sickness is highly culture-dependent.

Societal parameters dictate right and wrong in health (especially mental health). It is all a matter of statistics. Certain diseases are accepted in certain parts of the world as a fact of life or even a sign of distinction (e.g., the paranoid schizophrenic as chosen by the gods). If there is no dis-ease there is no disease. That the physical or mental state of a person CAN be different - does not imply that it MUST be different or even that it is desirable that it should be different. In an over- populated world, sterility might be the desirable thing - or even the occasional epidemic. There is no such thing as ABSOLUTE dysfunction. The body and the mind ALWAYS function. They adapt themselves to their environment and if the latter changes - they change.

Personality disorders are the best possible responses to abuse. Cancer may be the best possible response to carcinogens. Aging and death are definitely the best possible response to over-population. Perhaps the point of view of the single patient is incommensurate with the point of view of his species - but this should not serve to obscure the issues and derail rational debate.

As a result, it is logical to introduce the notion of "positive aberration". Certain hyper- or hypo- functioning can yield positive results and prove to be adaptive. The difference between positive and negative aberrations can never be "objective". Nature is morally-neutral and embodies no "values" or "preferences". It simply exists. WE, humans, introduce our value systems, prejudices and priorities into our activities, science included. It is better to be healthy, we say, because we feel better when we are healthy. Circularity aside - this is the only criterion that we can reasonably employ. If the patient feels good - it is not a disease, even if we all think it is. If the patient feels bad, ego-dystonic, unable to function - it is a disease, even when we all think it isn't. Needless to say that I am referring to that mythical creature, the fully informed patient. If someone is sick and knows no better (has never been healthy) - then his decision should be respected only after he is given the chance to experience health.

All the attempts to introduce "objective" yardsticks of health are plagued and philosophically contaminated by the insertion of values, preferences and priorities into the formula - or by subjecting the formula to them altogether. One such attempt is to define health as "an increase in order or efficiency of processes" as contrasted with illness which is "a decrease in order (=increase of entropy) and in the efficiency of processes". While being factually disputable, this dyad also suffers from a series of implicit value-judgements. For instance, why should we prefer life over death? Order to entropy? Efficiency to inefficiency?"

next: The Silver Pieces of the Narcissist

sexual fantasies

"Sexual fantasizing is a natural, universal psychological phenomenon similar to dreaming," says Wendy Maltz M.S.W. coauthor with Suzie Boss of the newly released book, Private Thoughts: Exploring the Power of Women's Sexual Fantasies. "And, like with dreams, some sexual fantasies are fun and satisfying, while others may trouble us a lot." Maltz, a sexual health expert, encourages women and men to learn more about sexual fantasies. "The more you know about sexual fantasies, the more options you have about what types of sexual fantasies you entertain," says Maltz. "Fantasies that improve self-esteem and intimacy with a partner are usually the most desirable."

Private Thoughts is the first book to take an in-depth look at sexual fantasizing, exploring such topics as, where sexual fantasies come from, how they function, what they mean, and what to do when they are causing problems. Maltz and Boss also explain the differences between male and female fantasies. This book is filled with stories shared by the more than 100 women Wendy Maltz and Suzie Boss personally interviewed. The women vary widely in age, race, sexual history, and lifestyle, so nearly every reader should find some stories that resonate.

The groundbreaking research behind Private Thoughts shows that women experience an amazing range of fantasies, involving everything from sensuous horseback rides to tantalizing chocolate eclairs to erotic encounters with sexy aliens who arrive via spaceship. And women use sexual fantasy in some very clever ways to make themselves feel sexier, reach orgasm, safely satisfy their curiosity, and even relax. "Fantasy is like lavendar bath salts," confided a woman in midlife, "a little something special I do just for myself to help me unwind."

When life presents changes or challenges, we can also draw on sexual fantasy for help. Private Thoughts shares stories from women who have used their imagination to help rebuild sexual desire and enhance self-esteem after a mastectomy or other physical loss, for instance.

One of the most poignant examples of the healing power of sexual fantasy is shared by a woman identified as Georgine in Private Thoughts. Recovering from a car accident that left her paralyzed from the waist down, Georgine used fantasy to get back in touch with her sexual thoughts and feelings. She gave her imagination free reign while lying in tanning beds. Under the lights, I'd feel warm all over. I'd kind of drift into these explicit fantasies. At first, they involved sensations that helped me relax. I remembered how it used to feel to lie in the warm sun and feel cool blades of grass against my bare skin. Gradually, I began to respond sexually. I would lubricate. Then, I started creating the same feelings by imagining myself with a partner." When she would have a particularly vivid fantasy, Georgine said, "I literally felt the heat from my imaginary lover's body." Since she has embraced her fantasy life, she has been reminded of how much she enjoys sensual, sexual energy, and how much pleasure awaits within her own erotic imagination.

People who are confused about whether their sexual fantasies are good or bad for them will find answers in Private Thoughts. Maltz provides a list of nine questions a person can ask themselves to help evaluate whether, and to what extent, a particular fantasy may be causing problems:

• Does the fantasy lead to risky or dangerous behavior?
• Does the fantasy feel out of control or compulsive?
• Is the content of the fantasy disturbing or repulsive?
• Does the fantasy hinder recovery or personal growth?
• Does the fantasy lower my self-esteem or block self-acceptance?
• Does the fantasy distance me from my real-life partner?
• Does the fantasy harm my intimate partner or anyone else?
• Does the fantasy cause sexual problems?
• Does the fantasy really belong to someone else?

Drawing on Maltz's extensive background in sexual healing, the book devotes a chapter to healing unwanted or troubling fantasies that may be the result of sexual abuse or unresolved psychological issues. Maltz also shares guidelines for exploring fantasies with an intimate partner in a way that will enhance, rather than harm, a relationship. The book concludes with a delightful chapter on creating favorite fantasies, and the reminder, as we know ourselves better, we become more free to celebrate our natural erotic rhythms with whatever thoughts quicken our pulses and please our hearts.

What kind of fantasies can be dangerous? They're called "distancing fantasies."

next: Sexual Fantasies - Are They Dangerous? or browse the table of contents of the Sexual Fantasies section

sexual health

Sexuality is a beautiful expression of love. It is an intimate, sacred communion between two people. When experienced with an open heart, it can transcend the limitation of physical reality and allow one to soar into the octaves of ecstasy, wonder and awe; it can fill our very being with peace and contentment and it can expand our capacity to Love.

However, for eons of time, sex has been used to manipulate, dominate, oppress and control people. It has fallen to the depths of abuse and degradation. As this condition developed, the religions of the world began to distance themselves from this physical experience. In order to encourage their followers to do the same, they initiated all kinds of taboos regarding sex. They took vows of celibacy and proclaimed chastity a virtue. This created quite a quandary. Each soul knew and understood that through the sacred communion of sex, one of the most miraculous events on Earth occurs, which is the procreation of life. Yet, on the other hand, we were being told by religious leaders that sex was bad. These two diametrically opposed concepts could not be effectively reconciled in our finite minds, so we learned to muddle through life vacillating between wanting very much to fulfill our sexual experience and beating ourselves up with guilt and shame if we did. This was a coup de grace for our human ego, because our confusion created a very powerful vehicle through which our human ego could manipulate us and keep us bound in self abuse.

However, if we are in the process of physically ascending into the fourth dimension, we cannot just deny part of who we are and pretend it doesn't exist. We also can't eliminate our sexuality by transmuting it into light so it will go away. Our sexuality is part of who we are, and instead of getting rid of it, we need to make peace with it and we need to learn how to express it positively and constructively. We need to recognize it for what it was intended to be an expression of Love. And, we need to love ourselves enough so that we will allow wonderful relationships into our life through which our sexuality can be experienced in its highest level of potential'

Loving Your Body

The first step in awakening to the Divine Intent of our sexuality is learning to love and actually revere our physical body. This vehicle is a miraculous living organism that allows us the opportunity to experience a third dimensional reality. It is the vehicle that is used to project the creative faculties of thought and feeling into the physical plane. Without a physical body we could not become co-creators with God or masters of energy, vibration and consciousness in a physical reality. The physical body is not who we are; it is merely the vehicle we "drive" while we are in embodiment on Earth. We are responsible for how we treat our bodies and, just like our car, the better we take care of it, the better it will serve us.

We have created our physical body, and it is providing us with the exact learning experiences we need. To hate our body just delays our progress and perpetuates our misery. What we need to do is learn to Love it and respect it as the beautiful, miraculous organism it Is.

When you bathe your body feel your hands projecting healing and Love into every single cell. As you rub your hands over your body with soap and water, caress every part of your body with tenderness and Love. Get to know this vehicle as it begins to come alive again and as you allow it to feel and express itself without guilt or shame.

Your body is sensitive and sensual for a reason. The pleasurable feelings you experience when your body is Loved and caressed allow you to feel nurtured, and it encourages you to open the Stargate of your Heart. The beautiful sensations that flow through your body when it is Lovingly touched and caressed trigger chemical changes in the body that enable you to receive and assimilate greater quantities of life force. This increased life force rejuvenates the body and keeps it vibrant and young. It accelerates healing and eliminates the degenerative diseases of aging, which are created by closing down the Heart Center and blocking the flow of life force. The added life force also heals the grief and pain of lost Love, rejection, abandonment, loneliness and despair. It lifts one out of depression and into a sense of well being and inner peace.

Opening up your feeling nature through the physical sensations of gentle, Loving touch creates within your body a sense of trust, security and safety. As you Love your body and increase the flow of God's Love in, through and around you, you begin to truly know that God is the source of your Love, constantly filling you up with the Holy Essence of Divine Love. This inner knowing will enable you to understand that as long as you are open and receptive to this connection with God's Love and the Love of your body, no one outside of you can take Love away from you.

Because of the taboos that have been inflicted upon us, often the thought of touching our body in a pleasurable way seems shocking, but you must recognize that belief is coming from the old patterns of self-deprivation, flagellation and denial.

Sex Is The Experience

We have often allowed ourselves to feel Love emotionally, but sex is the way we feel and experience Love physically. When you begin to allow your body to awaken to physical sensations with the healing Loving caress of your own touch, you will feel safe and trusting. In truth, there is no way you can fully open yourself.

I will assume that you have magnetized into your life a wonderful, nurturing, caring person with whom you want to Lovingly share your sexuality. The person you choose for this very sacred sharing is, of course, your choice. No one outside of you has the right to make that decision for you. No one knows what your life path involves or what learning experiences you have agreed to go through. If both people are adults and the decision to be intimately involved with each other is a mutually Loving and positive agreement, then that is all that matters. It is nobody else's business.

Once you have chosen someone that you would like to have a relationship with, you must remember that sex is intended to be an expression of Love, a deep, intimate sharing, a sacred communion. This means that it is very important for you and your partner to continually be aware of each other throughout your sexual interaction. You must communicate to each other your needs and your feelings, and express to each other your enjoyment and pleasure. Whatever the two of you choose to experience is your business, as long as you both are in agreement and are interacting with Love, respect and reverence for your physical bodies and each other.

Sexuality is about honoring and Loving yourself, your body, your partner and your partner's body. It is about self-discovery in relationship to your body and your partner. Just as you had to take time to learn to become comfortable while Loving and caressing your own body, you need to be patient and tolerant with both yourself and your partner as you learn to feel safe and comfortable touching and caressing each other's body. But, I promise you, the rewards will be well worth the effort.

Sex, the most fearful and fascinating, the most guilt ridden and ecstatic of arts, is a subject we do not discuss easily. Here's how to open up, sexually.

next: Avoiding Sex Talk Opening Up To Sex

sexual health

• STOP ALL CRITICISM. Criticism never changes a thing. Refuse to criticize yourself. Accept yourself exactly as you are. Everybody changes. When you criticize yourself, your changes are negative. When you approve of yourself, your changes are positive.
• DON'T SCARE YOURSELF. Stop terrorizing yourself with your thoughts. It's a dreadful way to live. Find a mental image that gives you pleasure (mine is yellow roses), and immediately switch your scary thought to a pleasure thought.
• BE GENTLE AND KIND AND PATIENT. Be gentle with yourself. Be kind to yourself. Be patient with yourself as you learn the new ways of thinking. Treat yourself as you would someone you really loved.
• BE KIND TO YOUR MIND. Self-hatred is only hating your own thoughts. Don't hate yourself for having the thoughts. Gently change your thoughts.
• PRAISE YOURSELF. Criticism breaks down the inner spirit. Praise builds it up. Praise yourself as much as you can. Tell yourself how well you are doing with every little thing.
• SUPPORT YOURSELF. Find ways to support yourself. Reach out to friends and allow them to help you. It is being strong to ask for help when you need it.
• BE LOVING TO YOUR NEGATIVES. Acknowledge that you created them to fulfill a need. Now you are finding new, positive ways to fulfill those needs. So lovingly release the old negative patterns.
• TAKE CARE OF YOUR BODY. Learn about nutrition. What kind of fuel does your body need to have optimum energy and vitality? Learn about exercise. What kind of exercise can you enjoy? Cherish and revere the temple you live in.
• MIRROR WORK. Look into your eyes often. Express this growing sense of love you have for yourself. Forgive yourself looking into the mirror. Talk to your parents looking into the mirror. Forgive them too. At least once a day say: "I love you, I really love you!"
• LOVE YOURSELF... DO IT NOW. Don't wait until you get well, or lose the weight, or get the new job, or the new relationship. Begin now - and do the best you can. Make peace with your sexuality

next: Attitude and Sexual Health

Michael J. Montegut, Ph.D., Guest Author

'A LETTER from my love to-day!
Oh, unexpected, dear appeal!'
She struck a happy tear away,
And broke the crimson seal.

John Davidson. 1857 - 1909

Communication is a word we hear often when people talk about improving relationships. We receive voluminous communication from every corner of our lives and from a myriad of sources: e-mail, radio, postal mail, telephone, pagers, FAX, television, cell phones and more every year. A lot of people I speak with think they cant escape contact with those around them. They feel that they do a pretty good job of interacting with others, especially when they have all the fancy, high-tech communication tools.

But in relationships it is the quality of the communication that makes the most difference, not necessarily the quantity or speed of delivery. If you say the same thing, in the same way, over and over every day, your loved ones can become inured to it.

This is especially true with the daily I Love You that is the staple of most loving, committed relationships. Just because you say it, does not mean that the message was received or perceived as sincere. Sincerity is always at risk with quick and easy forms of communication. It is easy to get into the habit of saying those three words with such ease that it is automatic.

One of the most powerful and sincerest forms of communication that we see very little of today is letter writing. I am not talking about e-mail or post-its. I mean a real letter that is written on real paper and dropped in the non-virtual mailbox down the street. Letters take time and thoughtfulness to create.

But what about the more efficient forms of communication in this technologically advanced age?

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E-mail is easily written and often curt. Since e-mail is meant to allow quick and easy communication we often send messages without careful consideration. Furthermore, when e-mail is received the reader does not pause for a deep look because of the dozen other e-mail they received at the same time.

And forget those cutsie e-cards. They serve a purpose. They let someone know you are thinking about them and many times they may make them laugh (which is a good thing.) But in general, e-cards are not an effective delivery system for deep communication. As with paper greeting cards, the message in the e-card is filled out for you most of the time.

And the phone? Why not that most ubiquitous of 21st century communication tools, the cell phone?

When you make a phone call you and the person you are talking to can both be doing a handful of other things at the same time, and as a result this form of verbal communication can be poorly thought out and impulsive. Ultimately the phone, especially the cell phone, is meant to be used as a device of convenience. And deep, intimate, carefully considered and sincere communication does not have convenience as the main objective.

Greeting cards do not count (unless the sender has enclosed a substantial personal note which is rare). The greeting card industry has capitalized quite successfully on our inability to write from our own hearts, either due to lack of time or a perceived lack of creativity.

There are thousands of cards for every imaginable occasion with a heartfelt message already written out for us. All we have to do is sign our name (Even this is falling out of vogue in some circles - I have been given cards by people who do not sign their names so that the receiver can recycle the card and use it on someone else Yikes!!) Why is it that we need to buy our heartfelt sentiments in sterile, prepackaged form?

A letter, even a short one, can be symbolic of dedication. It shows commitment because it takes a little more time and care to organize ones thoughts and put them on paper. In addition, the written word is permanent and physical, two things that are a big part of committed relationships. It is a lot harder to deny what we have written than it is to deny what weve said.

For instance, if you say you are sorry to someone verbally you can equivocate and feel the person out so that you can alter your message depending on how you think things are going. Most people see through duplicity and equivocation in written form immediately. A letter forces you to state your feelings with permanence and, if you are practiced and take your time, clarity.

When was the last time you received a letter that was either written or typed out by hand? I am willing to bet that this is an exceedingly uncommon occurrence for most of you.

Please write again soon. Though my own life is filled with activity, letters encourage momentary escape into others lives and I come back to my own with greater contentment.

Elizabeth Forsythe Hailey

The writing of a letter also provides the opportunity to surprise someone. Place it in a location where they will find it at an unusual moment. For example, as they are riding the train to work or about to eat their lunch. Any place where they will discover it and take pause is good.

This is also much more romantic than just handing someone note or sending them an e-mail. In fact, if you are in a long distance relationship and normally correspond by e-mail every day, it will be a big and welcome surprise for your partner to get some real mail.

People often tell me that they do not feel they have any facility with writing and so cannot produce a letter, even a short one. A lot of people simply do not know what to say to their loved ones in a letter. If you think about it, you just have to say how you feel and what you are thinking. No one is completely devoid of feelings and no one has a blank mind (ever).

Sometimes people are overwhelmed with many feelings and thoughts. If you find that this is your situation, make a list of the top 3 feelings and thoughts that are swirling around in your head. Then pick one and address it.

For instance, your top three thoughts or feelings related to your partner might be:

1. You forgot to kiss me goodbye this morning.
2. Do you really like that couch we ordered or are you just going along?
3. I really need some time alone with you. . . without the kids.

Even if you say what you feel in plain, simple, language (and this can be the best way most times) this is more than enough to make the point that you care. And the more you write the easier it will be and you will become more proficient at communicating your true feelings to others.

There is one caveat. Do not use writing as a way of avoiding confrontation or inflicting pain. The "Dear John" letter is a prime example. Remember that just as the written word has the power to spread love, it can also do damage to a relationship.

Choose your words wisely and never send a letter written in anger or use the written word as an alternative for something that should clearly be done face-to-face.

I write entirely to find out what I'm thinking, what I'm looking at, what I see and what it means. What I want and what I fear.

Joan Didion

Many therapists and coaches see writing as a powerful form of therapy. Getting everything down on paper clears your head of tumultuous thoughts and emotion. It helps to calm most people. There is even a sense of accomplishment when you have successfully described your feelings or concerns and can see them on paper. This is why journal writing is prescribed by so many therapists.

You can even write letters to communicate deep feelings that you may not be able to speak of effectively in person at the appropriate time (either because you are unavailable or because you do not remember the exact feeling you had at the time.)

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Here is a great idea that I got from a book by Mark and Dianne Button called, "The Letter Box: A Story of Enduring Love." The authors suggest that you write letters to your loved ones at important times in their lives and keep the letters tucked away in a small box for your loved ones to open at a later date.

For instance, you can write a letter to your child on the day of his birth describing all the joy you are experiencing and what it is like to hold him for the first time. You give this to him when he are 30 years old or perhaps on the occasion of the birth or his first child. Now that's something you can't do with an e-mail!

Take the time to try this. Commit right now to write your partner or a loved one a personal note expressing your positive feelings toward them. Do it on paper. If a letter is too daunting, then write a couple sentences. If that is too scary, then try just a few words.

Just say what you feel, no matter how simple or silly (this is often best). Have faith that it will make their day. Put your letter to them where they will find it unexpectedly or mail it though the regular mail.

I can guarantee that you will receive a positive response from them. And your letter can keep giving. Because, unlike words that are spoken (and then only a memory), a letter can be reread and experienced over and over.

By taking the time to express your love in a permanent and clear form, you will are recommitting to your loved one and to the vitality of your relationship with them.

Copyright © - Michael J. Montegut, Ph.D.. All rights reserved. Reprinted with Permission.

next: Questions, Questions and More Questions

List of national self-help support groups for alcoholism, drug abuse and drug addiction.

The primary goal of addiction support groups, whether for a drug addiction or alcoholism, is to maintain the individual's sobriety and secondarily to help others maintain their sobriety. Below is a short list of alcoholism and drug abuse support groups. A comprehensive listing can be found at the American Self-Help Clearinghouse website.

Alcoholics Anonymous (A.A.)

Alcoholics Anonymous is a 12 step program of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

http://www.alcoholics-anonymous.org/

Narcotics Anonymous (N.A.)

Narcotics Anonymous is a 12 step program fellowship of men and women, who share their experience, strength and hope with each other, that they may solve their common problem and help others to recover from drug addiction. There are no dues or fees for membership, and they are not allied with any institution, organization or denomination. Their primary purpose is to help other addicts achieve recovery from drug addiction.

http://www.na.org/

Alanon

For over 50 years, Al-Anon (which includes Alateen for younger members) has been offering hope and help to families and friends of alcoholics. It is estimated that each alcoholic affects the lives of at least four other people - alcoholism is truly a family disease. No matter what relationship you have with an alcoholic, whether they are still drinking or not, all who have been affected by someone else's drinking can find solutions that lead to serenity in the Al-Anon / Alateen fellowship. There are no dues or fees.

http://www.al-anon-alateen.org/

Naranon

Nar-Anon is a twelve-step program designed to help relatives and friends of addicts recover from the effects of living with an addicted relative or friend. Nar-Anon's program of recovery is adapted from Narcotics Anonymous. The only requirement to be a member is that you have experienced a problem of drug addiction with a family member or friend. Nar-Anon is not affiliated with any other organization or outside entity and there are no dues or fees for membership.

http://nar-anon.org/

Cocaine Anonymous (C.A.)

Cocaine Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and others recover from cocaine and crack addiction. As with other 12 step programs, there are no dues or fees for membership and Cocaine Anonymous is not allied with any other sect, organization or institution. Their primary purpose is to help other Cocaine addicts to achieve recovery.

http://www.ca.org/

Codependents Anonymous (C.O.D.A.)

Codependents Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and recover from dysfunctional relationships. As with other 12 step programs, there are no dues or fees for CODA membership and they are not allied with any other sect, institution or organization. The only requirement of CODA membership is a desire to develop a healthy and loving relationship.

http://codependents.org/

Gamblers Anonymous (G.A.)

Gamblers Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others recover from their gambling addiction. As with other 12 step programs, there are no due or fees for G.A. membership and they are not allied with any other institution, sect or organization. Their primary purpose is to help other compulsive gamblers to recover.

http://www.gamblersanonymous.org/

Overeaters Anonymous (O.A.)

Overeaters Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from overeating and food addiction. As with other 12 step programs, there are no dues or fees for O.A. membership and they are not affiliated with any other organization, sect or institution. Their primary purpose is to help other overeaters to recover.

http://www.oa.org/

Supportive-expressive psychotherapy proves effective in treating hard drug users by helping them maintain gains made in addiction treatment.

Supportive-expressive psychotherapy is a time-limited, focused psychotherapy that has been adapted for heroin addicts and cocaine addicts. The therapy has two main components:

• Supportive techniques to help patients feel comfortable in discussing their personal experiences.
• Expressive techniques to help patients identify and work through interpersonal relationship issues.

Special attention is paid to the role of drugs in relation to problem feelings and behaviors, and how problems may be solved without recourse to drugs.

The efficacy of individual supportive-expressive psychotherapy has been tested with patients in methadone maintenance treatment who had psychiatric problems. In a comparison with patients receiving only drug counseling, both groups fared similarly with regard to opiate use, but the supportive-expressive psychotherapy group had lower cocaine use and required less methadone. Also, the patients who received supportive-expressive psychotherapy maintained many of the gains they had made. In an earlier study, supportive-expressive psychotherapy, when added to drug counseling, improved outcomes for opiate addicts in methadone treatment with moderately severe psychiatric problems.

References:

Luborsky, L. Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive (SE) Treatment. New York: Basic Books, 1984.

Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O'Brien, C.P. Psychotherapy in community methadone programs: a validation study. American Journal of Psychiatry 152(9): 1302-1308, 1995.

Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O'Brien, C.P. Twelve month follow-up of psychotherapy for opiate dependence. American Journal of Psychiatry 144: 590-596, 1987.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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Thoughtful quotes about the past, living in the past, and trying to change the past.

Words of Wisdom

"I do not possess what I remember so much as it possesses me." (Richard Bode)

"The trouble with you is you think you have time." (Don Juan to Carlos Costaneda)

"One can never change the past, only the hold it has on you." (Merle Shain)

"Among the dead there are those that still have to be killed." (Fernad Desnoyers)

"What's past is prologue." (Shakespeare)

"The past should be a springboard, not a hammock." (unknown)

"Every journey into the past is complicated by delusions, false memories, false naming of real events." (Adrienne Rich)

"Life is thickly sewn with thorns, and I know no other remedy than to pass quickly through them. The longer we dwell on our misfortunes, the greater is there power to harm us." (author unknown)

"Life can only be understood backwards, but must be lived forwards." (Soren Kierkegaard)

"One must never lose time in vainly regretting the past or in complaining against the changes which cause us discomfort, for change is the essence of life." (Antole France)

"It's but little good you'll do watering last years crops." (Frederick Loomis)

next:Pleasure

Note to editor: all references which are now in parentheses, in the form of a name and a data, should be numbered as footnotes and placed at the end of the book with the other footnotes, chapter by chapter. The references might best be grouped as a bibliography-reading list, with the footnotes referring to them by name and date.

Are you sad? Do you have a low opinion of yourself? Does a sense of helplessness and hopelessness weigh you down? Do you feel this way for days or weeks at a time? Those are the elements of depression.

If this is how you are feeling, you surely want to regain a pleasant outlook on life. You also need to prevent depression returning later. Happily, there now are aids to attain those goals. (But fighting depression takes effort. And there are certain benefits of being depressed which you may be reluctant to give up.)

Nowadays, a depression sufferer usually can get relief with active cognitive psychotherapy, or with tested anti-depressant medications, or with both. The U. S. Public Health Service summarizes as follows: "Eighty percent of people with serious depression can be treated successfully. Medication or psychological therapies, or combinations of both usually relieve symptoms in weeks."1 Both kinds of treatment have been shown in controlled experimental research to benefit a large proportion of depression sufferers, within a few months or even weeks. Drugs, however, control the depression, whereas psychological therapy can cure it. (For information about the scientific results, see Appendix B and the books cited in the reference list.) All this is good news indeed for depression sufferers.

Only a quarter century ago, medical and psychological science had little to offer depressed people. Traditional Freudian-based therapy put you on a couch or in an easy chair, and started you talking at random. You and your therapist hoped that in the course of two to five expensive hour-long sessions a week, continuing for many months or years, you would come across sensitive incidents in your past. Those "insights" were expected to relieve you of the pain the incidents induced. But the success rate was not high, nor was psychoanalysis proven effective by scientific tests.

Traditional therapy was founded upon the crucial assumption that people are irresistibly disturbed by their past experiences, and cannot change their emotional life by changing their current patterns of thinking. Recent scientific research has shown, however, that this assumption is false. People can indeed overcome depression by changing their current thought patterns. That is, though you may have been disturbed by events in your past, you now (in Albert Ellis's phrase) disturb yourself by your current mental habits.

Modern cognitive therapy -- which fully coincides with the wisdom of the ages on this point -- begins with the assumption that we have considerable control over our own thinking. We can choose what we will think about, even though following through on the choice requires effort and is not always fully successful. We can select our goals, even though the goals are not infinitely flexible. We can decide how much we will agonize over particular events, though our minds are not as obedient as we would like them to be. We can learn better ways to understand the data of our objective situations, just as students learn to gather and analyze data scientifically, rather than being forced to accept the biased assessments we have tended to make until now.

This book teaches you a newly-sharpened version of cognitive psychotherapy that has a more comprehensive theoretical base and wider curative outlook than earlier versions. You may use it by yourself to overcome depression, or you may use it in conjunction with a therapist. Most sufferers can benefit from the assistance of a wise counselor, though finding such a helpful person is not easy.

There is still more good news: Psychiatrist Kenneth Colby, famous for his artificial-intelligence computer simulation of paranoia, has developed a computer-based system of psychotherapy for depression based on the key ideas of this book. You "speak" to the computer, and the computer speaks back on the screen, which helps you help yourself. A disk to run the program on an IBM-PC computer is included with this book. It can be a help and a comfort to many readers.

My Personal Story and Negative Self-Comparisons

This book emerges not only from the body of new scientific discoveries, others' and my own, but also from my personal experience of deep and prolonged melancholy. Here is my story.

I was depressed -- badly depressed -- for thirteen long years from early 1962 to early l975. When I say that I was depressed I mean that, except for some of the hours when I was working or playing sports or making love, I was almost continuously conscious of being miserable, and I almost continuously reflected on my worthlessness. I wished for death, and I refrained from killing myself only because I believed that my children needed me, just as all children need their father. Endless hours every day I reviewed my faults and failures, which made me writhe in pain. I refused to let myself do the pleasurable things that my wife wisely suggested I do, because I thought that I ought to suffer.

As I look back now, in comparison to re-living the better of the days when I felt as I did then, I'd rather have a tooth pulled and have the operation bungled, or have the worst possible case of flu. And in comparison to re-living the worse of those days in the first year or two, I'd rather have a major operation or be in a hellish prison.

Over the years I consulted psychiatrists and psychologists from several traditional schools of thought. A couple of them left me with the impression that they didn't have a clue about what I was saying and had simply somehow passed the necessary exams to get into a well-paying business. A couple of them were human, understanding, and interesting to talk to, but could not help me. And toward the end of that time, the psychiatrists and psychologists did not even offer me hope, and certainly no hope of a quick cure. My own training in psychology was no help, either.

Then I read about what was, at that time, a new and different approach to psychological problems -- Aaron Beck's Cognitive Therapy, which in Albert Ellis's somewhat different form is called Rational-Emotive Therapy. (I shall consider them together under the label "cognitive-behavioral therapy" or just "cognitive therapy", along with Frankl's Logotherapy, recent variants such as Interpersonal Therapy, and also behavioral therapy.)

The core of cognitive-behavioral therapy is a thoughtful problem-solving procedure that quickly can get to the root of the depression, and directly yank out that root. Within that vision of the individual as able to change his or her depressed thinking, I then developed an analysis of the cause of depression centering on the depressed person's negative self-comparisons. And I worked out the logic of what I call "Values Treatment," which can provide a powerful force for people to use the resources of cognitive therapy and thereby cure themselves of depression; that is what Values Treatment did for me.

Within two miraculous weeks I banished my depression, and I have since then been able to keep depression at bay. (Such a quick cure is not usual, but it is not wildly exceptional, either.) Starting April, l975, I have almost always been glad to be alive, and I have taken pleasure in my days. I have occasionally even been ecstatic, skipping and leaping from joy. And I am joyful more often than most people, I would judge. Though I must still fight against depression from time to time, I have not lost more than a minor skirmish since then, and I believe that--if my family and community stay safe from catastrophe--I have beaten depression for life. The Epilogue at the end of the book gives the details of my passage from sadness to joy.

After I had cured myself, I wondered: Could I use my new advances in cognitive therapy --- Self-Comparisons Analysis and Values Treatment -- to help others, too? I proceeded to counsel with other persons who were depressed, and I found that these ideas could indeed help many of them get over their depressions and find new joy in life. Then I wrote a short version of this book, and leading psychiatrists and psychologists who read it agreed with me that the book -- including Self-Comparison Analysis, and the therapeutic approach derived from it -- makes a new contribution not only to sufferers from depression but also to the theory of the subject. And people to whom I have given early copies, some of whose cases I'll mention later, have reported dramatic salvation from their own depressions - not in every case, but often.

*** I hope that there will soon be a smile on your face, too, and laughter bubbling inside you. I don't promise you instant cure. And you will have to work at overcoming the depression. You must exercise your intellect and will in outwitting the traps that your mind lays for you. But I can promise you that cure and joy are possible...A tip for the road: Try treating your fight to overcome depression as an adventure, and think of yourself as a valiant warrior. More power to you, and luck.

Afterword For Those Interested in the Scientific Evidence

The experimental evidence for the success of cognitive therapy in helping depression and other miseries has been mounting up. For thirty years now, a variety of studies have shown cognitive therapy to be helpful. And in 1986 the National Institute of Mental Health of the U. S. Department of Health and Human Services completed a tightly-controlled three-university study lasting six years (and costing ten million dollars!) comparing a) encouragement only, b) drug therapy, c) Beck's Cognitive Therapy, and d) Interpersonal Psychotherapy; both these latter psychotherapies emphasize the key element of altering one's own thinking and behavior. The results at the conclusion of treatment showed that the active psychotherapies were as successful as the standard drug imipramine in reducing the symptoms of depression and improving the patient's ability to function. Drug treatment produced improvement more rapidly, but the active psychotherapies caught up later. Severely depressed and less-severely depressed patients both benefited from the active psychotherapies.(7)

These findings are extraordinarily impressive because drug therapy has been the favorite of the medical establishment in recent years. And cognitive-behavioral therapy has none of the side-effect dangers, physical and psychological, that accompany drugs. Furthermore, as noted earlier, the drugs control rather than cure depression. Hence, even if drugs are to be used, psychotherapy is appropriate in combination with the drugs in order to root out the underlying causes and move toward real cure.

Afterword About Drug Therapy for Depression

Neither I nor anyone else can give you authoritative advice about whether drugs are right for you. It surely makes sense to hear what one or more physicians has to say to you about drugs. Finding a wise physician, however, is particularly difficult when the ailment is depression. The problem is, as two noted psychiatrists put it, that depression "may arise from a biological malfunction, from actual losses, deprivations, or rejections, or from personal limitation. The difficulty in sorting out such causal fact is a source of enormous confusion in the diagnosis and treatment of disorders of mood."(2) And as two other reliable psychiatrists put it, "depression is almost certainly caused by [many] different factors", and hence "there is no single best treatment for depression."(3) Your best bet is listen to medical advice, and also advice from one or more psychologists, and then make your own decision about whether you want to try drugs first, or psychological therapy first, or both together.

Perhaps the most important piece of knowledge is that, contrary to what some physicians will tell you, drugs are not an all-purpose cure for depression. Perhaps the only major exception is the case of a person who has suffered real tragedy from death or other great loss, and is slow in putting the tragedy behind her/her. A sprained brain is very different than a sprained ankle. An out-of-order brain is very different than an out-of-order kidney or pituitary gland. Even if drugs relieve the depression while you are taking the medication, you almost surely need to straighten out your thinking so that the depression will not recur after you stop the drugs, and so that you will know how to fight off depression if it does recur.

Depression is not likely to be caused simply by a biologically-induced chemical imbalance that a drug can neatly restore to balance. As Seligman4 puts it, "Does the physiology cause the cognition, or does the cognition cause the physiological change? ..the arrow of causation goes both ways.." And as another psychiatrist has recently written, "Drugs do not cure the illnesses, they control them."(5)

Only psychotherapy offers true cure in most cases of depression. And as the official statement of the American Psychiatric Association judiciously puts it, "All depressed patients need and can benefit from psychotherapy,"(6) rather than relying upon medication alone. Patients treated with cognitive-behavioral psychotherapy as well as drugs have fewer recurrences than patients treated with drugs alone, in one study.(5.1) Miller, Norman, and Keitner, 1989

I do not intend to suggest, however, that drug therapy may not be appropriate for you. Modern anti-depression drugs offer hope to some people who are otherwise doomed to misery for long periods of time. I myself probably would and should have tried such drugs during my long depression if they had been as well- established as they now are. Drugs are particularly indicated when the depression continues for a very long time, because "One thing seems sadly certain: the person who remains chronically depressed over time has a reduced chance of recovering."(8) What I am suggesting is that you should not only consider drugs, and that it might be wise to try cognitive therapy first. You can read more about anti-depressant drug therapy in Chapter 00.)

bntro 9-148 depressi February 19, 1990

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