A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

D. Suicide

No discussion of severe depression is complete without a mention of suicide. Let us first ask "Why do people suicide? Why do they want to die?". Many studies of this question have been made through interviews of people who have attempted suicide, but failed (or were "rescued"), and people who intended to commit suicide, but found a compelling reason not to. The very clear answer that emerges is that people who suicide do not actually want to die, but rather have reached a point where their present life is unendurable any longer, and they see no way to change it.

Under these circumstances suicide is viewed as the lesser of two evils: a quick, clean, relatively painless death in the face of death by a slow, grim, grinding misery. Let me emphasize again that suicide cannot be viewed as a "positive" act fulfilling a "death wish'', but rather as a final, abject, act of despair and defeat. There are hundreds of known cases where a suicide failed either because what the victim did didn't work (it is actually not very easy to kill oneself painlessly!) or because someone else intervened in time; almost always the person who made the attempt will say "Thank God. I'm glad it didn't work; maybe I still have a chance."

I remember lying on the Kona beach of Hawaii in the first week of January 1988, thinking "Hey! This is pretty nice! I'm really glad my plan to shoot myself two years ago didn't work out! I would have missed this!" And now I quietly, but happily, observe the anniversary of that event every year.

Of course, severe depression fits the description given above perfectly. If depression becomes severe enough, for long enough, there comes the day when anyone will think "I can't stand this any longer. And I'm not going to get over it ever. I'm a failure at everything, and I'm a drag on my family and friends. There is really only one sensible way out." If this line of thinking is followed to its logical conclusion it represents certain death. It also represents a terrible defeat both for the victim, and for society, because in the case of depression, in particular, there is a good chance that his/her life can be improved, with treatment, at least to the point where it is no longer unendurable.

For this reason, when a depressed person starts talking about suicide, he/she should be considered to be in a medical emergency, and medical intervention is urgent! If you ever find yourself considering suicide, and you don't have a regular doctor, and you don't know how to get help, call the crisis line in your community; almost all communities have one; if one doesn't exist, then when all else fails call 911. But get help. Fast! The same applies if you are in the person's family or are a friend.

One of the first lines of defense against suicide is the crisis line. The dedicated people who man those lines lead a difficult life. They know that they are fighting to save someone's life, often when that person is unable or unwilling to provide straight answers to questions and may even be fighting against the process of rescue. This is a difficult job and a terrible responsibility.

We should all remember crisis line workers as people who routinely perform "above and beyond the call of duty". There is no question that these services save many lives every year. The service provided by a crisis line isn't just superficial talking with the caller, trying to reassure him/her. If the caller is talking suicide, the person taking the call will try to make an assessment of how acute the emergency is: is the caller just feeling very bad, and needs to talk about it, or is he/she ready to do the act now? The methods vary from place to place, but in our community the caller will be asked a series of questions, each probing the next higher level of emergency. It goes something like this:

1. Do you have a plan for how you will kill yourself? If the caller doesn't even have a plan, then it is unlikely that the emergency is extreme. Clearly he/she still needs help, but maybe not this very minute.
2. Do you have the means to carry out your plan? That is, do you have the gun, the pills, the garage you can close and run your car in, the bridge to jump off ... whatever. If the means exist, then the plan can be executed. The next thing to establish is whether it will be executed.
3. Do you know how to use the means you have selected? That is, do you know how to load the gun and pull the trigger, do you know how many pills are lethal, and so on. If you don't, then the plan is less likely to work; but if you do, we have a crisis.
4. Do you have the will to do it? Some people can get everything ready, but at the last moment can't bear to think of themselves covered with blood, crumpled and broken, or whatever.
5. Is there anything that can change your mind? Sometimes people attach "contingencies" to the plan of death: e.g. if some loss can be recovered (girlfriend, husband, job, etc.) Or sometimes they won't carry out their plan until some other event occurs (e.g. ailing parent dies). The existence of such a condition buys time: time to get help to the caller.
6. Are you ready to do it now? This is the bottom line. If the conversation has gotten this far, the crisis is extreme, and help should be on the way. This will often be a police car and an ambulance. The person answering the call now has two tasks: (a) keeping the caller talking, no matter what, and (b) telling him/her that help is on the way, describing what will happen when it gets there so that the caller won't panic and pull the trigger when someone knocks on the door.

There is more to it than this, but this gives the flavor. As you can see, crisis line operators lead a stressful life, and they feel the loss keenly when the procedure ``fails'' (or was it the caller?), and help doesn't get there in time. The gift they give to humanity through their compassion is incalculable.

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Children may experience brief eating problems, as may adults. It is only when a problem is prolonged and affects their behavior that action should be taken, as it can have serious implications for their health. Although there are some factors that seem to trigger eating disorders, it is impossible to predict which children it will affect. Some will refuse to eat at all, while others will 'binge' on food only to force vomiting later on. It is seen most in teenage and young adult women, although an increasing degree of eating disorder is now recognized in young men as well. There is no distinction between ethnicities or social backgrounds. Although showing itself as an obsession with body image, weight and eating, it may be due to an underlying problem with issues over which children have little control, such as sexual persuasion, chronic disease, family strife or school pressure.

Symptoms

• Continual weight-checking or examination in a mirror
• Irrational fear of gaining weight or looking overweight
• Binge eating followed by forced vomiting and fasting
• Laxative and water-tablet abuse without any apparent need
• Compulsive exercise such as gymnastics, jogging or cycling
• Secret eating with the same kind of food, especially cakes or sweet food
• Hoarding secret supplies of food
• Poor insight into real body image with a constant perception of being grossly overweight

Causes

• Lack of self-esteem
• Bullying
• Peer, parental and social pressure to diet
• Depression and anxiety are linked but it can be difficult to tell which came first
• Solvent, alcohol or drug abuse is also linked
• Media promotion of 'slim is beautiful'
• Child abuse

Prevention

Never put children on a diet unless medically advised to do so (see obesity in children). Be prepared to talk through their concerns and show them ways to cope with them. Aim for containing the problem if it has already taken place, then move on to improve things. Being judgmental will make things worse.

Complications

Eating disorders can be life-threatening or can damage the physical and mental development of the person concerned. Tragically, suicide is also higher in children with eating disorders.

Self care

• Expert medical help is needed but parents can help, particularly by being supportive.
• Avoid talk of diets and weight loss.
• Be honest about your own feelings without being angry.
• Avoid unloading your worries on the child and, in a way, reversing roles.
• Life must go on, so try not to allow the eating disorder to disrupt the family's everyday activities.
• Involve the child in planning the next day's meal.

Action

• Contact your health visitor, or see your doctor. 

next: Eating Disorders Rise Among All Children
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Learn how to help a child or an adult friend or family member deal with the death of a loved one and how to support someone in their grief.

• How can I help a child deal with the death of a loved one?
• How can I help an adult friend or family member deal with the death of a loved one?
• How can I deal with the death of a loved one?

How can I help a child deal with the death of a loved one?

Children grieve just as adults do. Any child old enough to form a relationship will experience some form of grief when a relationship is severed. Adults may not view a child behavior as grief as it is often demonstrated in behavioral patterns which we misunderstand and do not appear to us to be grief such as "moody," "cranky," or "withdrawn." When a death occurs children need to be surrounded by feelings of warmth, acceptance and understanding. This may be a tall order to expect of the adults who are experiencing their own grief and upset. Caring adults can guide children through this time when the child is experiencing feelings for which they have no words and thus can not identify. In a very real way, this time can be a growth experience for the child, teaching about love and relationships. The first task is to create an atmosphere in which the child's thoughts, fears and wishes are recognized. This means that they should be allowed to participate in any of the arrangements, ceremonies and gatherings which are comfortable for them. First, explain what will be happening and why it is happening at a level the child can understand. A child may not be able to speak at a grandparent's funeral but would benefit greatly from the opportunity to draw a picture to be placed in the casket or displayed at the service. Be aware that children will probably have short attention spans and may need to leave a service or gathering before the adults are ready. Many families provide a non-family attendant to care for the children in this event. The key is to allow the participation, not to force it. Forced participation can be harmful. Children instinctively have a good sense of how involved they wish to be. They should be listened to carefully.

How can I help an adult friend or family member deal with the death of a loved one?

Someone you know may be experiencing grief - perhaps the loss of a loved one, perhaps another type of loss - and you want to help. The fear of making things worse may encourage you to do nothing. Yet you do not wish to appear to be uncaring. Remember that it is better to try to do something, inadequate as you may feel, than to do nothing at all. Don't attempt to sooth or stifle the emotions of the griever. Tears and anger are an important part of the healing process. Grief is not a sign of weakness. It is the result of a strong relationship and deserves the honor of strong emotion. When supporting someone in their grief the most important thing is to simply listen. Grief is a very confusing process, expressions of logic are lost on the griever. The question "tell me how you are feeling" followed by a patient and attentive ear will seem like a major blessing to the grief stricken. Be present, reveal your caring, listen. Your desire is to assist your friend down the path of healing. They will find their own way down that path, but they need a helping hand, an assurance that they are not entirely alone on their journey. It does not matter that you do not understand the details, your presence is enough. Risk a visit, it need not be long. The mourner may need time to be alone but will surely appreciate the effort you made to visit. Do some act of kindness. There are always ways to help. Run errands, answer the phone, prepare meals, mow the lawn, care for the children, shop for groceries, meet incoming planes or provide lodging for out of town relatives. The smallest good deed is better than the grandest good intention.

How can I deal with the death of a loved one?

Bereavement is a powerful, life-changing experience that most people find overwhelming the first time. Although grief is a natural process of human life, most of us are not inherently able to manage it alone. At the same time, others are often unable to provide aid or insight because of discomfort with the situation and the desire to avoid making things worse. The following passage explains how some of our "normal" assumptions about grief may make it more difficult to deal with.

Five Assumptions That May Complicate

1. Life prepares us for loss. More is learned about loss through experience than through preparation. Living may not provide preparation for survival. Handling grief resulting from the death of a loved one is a process that takes hard work. The fortunate experience of a happy life may not have built a complete foundation for handling loss. Healing is built through perseverance, support and understanding. The bereaved need others: Find others who are empathetic.

2. Family and friends will understand. If a spouse dies children lose a parent, a sibling loses a sibling, a parent loses a child and a friend loses a friend. Only one loses a spouse. Each response is different according to the relationship. Family and friends may not be capable of understanding each other thoroughly. Consider the story of Job's grief in the Bible. Job's wife did not understand his grief. His friends did their best work the first week when they just sat and did not speak. It was when they began to share their judgements of Job and his life that they complicated Job's grief. Allowance must be made so that grief may be experienced and processed over time. The bereaved need others: Find others who are accepting.

3. The bereaved should be finished with their grief within one year or something is wrong. During the first year the bereaved will experience one of everything for the first time alone: anniversaries, birthdays, occasions, etc. Therefore grief will last for at least one year. The cliche, "the healing hands of time," does not go far enough to explain what must take place. The key to handling grief is in what work is done over time. It takes time and work to decide what to do and where to go with the new and changed life that is left behind. The bereaved need others: Find others who are patient.

4. Along with the end of grief's pain comes the end of the memories. At times, the bereaved may embrace the pain of grief believing it is all they have left. The lingering close bond to the deceased is sometimes thought to maintain the memories while, in fact, just the opposite is true. In learning to let go and live a new and changed life memories tend to come back more clearly. Growth and healing comes in learning to enjoy memories. The bereaved need others: Find new friends and interests.

5. The bereaved should grieve alone. After the funeral service is over the bereaved may find themselves alone. They may feel as though they are going crazy, painfully uncertain in their world of thoughts and emotions. The bereaved begin to feel normal again when the experience is shared with others who have lost a loved one. Then, in reaching out, the focus of life becomes forward. The bereaved need others: Find others who are experienced.

Provided courtesy of Jack Redden, CCE, M.A., President; John Redden, M.S., Vice President, Cemetery-Mortuary Consultants Inc., Memphis, Tennessee

next: What Is Grief?
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Coaxing an alcoholic to get help can be a challenge. An alcoholic can't be forced to get help except under certain circumstances, such as a traffic violation or arrest that results in court-ordered treatment. But you don't have to wait for someone to "hit rock bottom" to act.

Many alcoholism treatment specialists suggest the following steps to help an alcoholic get treatment:

Stop all "cover ups." Family members often make excuses to others or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.

Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has occurred--like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.

Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.

State the results. Explain to the drinker what you will do if he or she doesn't go for help--not to punish the drinker, but to protect yourself from his or her problems. What you say may range from refusing to go with the person to any social activity where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry out.

Get help. Gather information in advance about addiction treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous meeting.

Call on a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an alcoholic to seek help.

Find strength in numbers. With the help of a health care professional, some families join with other relatives and friends to confront an alcoholic as a group. This approach should only be tried under the guidance of a health care professional who is experienced in this kind of group intervention.

Get support. It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, which is geared to children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help.

You can call the National Drug and Alcohol Treatment Referral Routing Service (Center for Substance Abuse Treatment) at 1-800-662-HELP (4357) for information about treatment programs in your local community and to speak to someone about an alcohol problem.

Sources:

• National Institute on Alcohol Abuse and Alcoholism - National Institute of Health.

Depression can be especially cruel in that it doesn't affect just the depressed person, but everyone around them, too. Someone who is depressed can be very difficult and draining to deal with. What makes this so cruel is, that as a depressed person's relationships become strained--to the point where others actively avoid having anything to do with them. This further contributes to a worsening self-image and makes the person feel even more isolated, intensifying the depression.

(If you're getting the idea that depression is an exceedingly heinous illness, preventing those it afflicts from finding treatment, and plunging them into ever-deeper isolation, then you understand just how horrid this illness is. No other disease, physical or mental, reinforces and feeds itself, as depression does.)

Depressed patients must learn to understand how their illness affects other people, and expect that their relationships will not be what they were, for some time. By the same token, those around them must understand that it is not the person, but the illness, which is an inconvenience. The best way for them to be relieved of the stress, is to help the patient toward recovery. This means getting the person into treatment, if he or she isn't already, and remaining supportive--no matter how difficult that may be. (Often the depression causes patients to drive others away, so this can be very daunting, indeed.)

Friends and family must remember that the depression patient did not ask for this illness, it is not a character flaw, and the patient often doesn't have much control over what he or she does. They cannot afford to take the symptoms of depression in someone else, personally.

next: Getting Help For Depression or Helping Someone With Depression
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G.P.4.o

Margaret wrote to us about G.P.4.o:

"G.P.4.o, is a nutritional formula of vitamins and minerals formulated by Dr. Bruce Woolley, Doctor of Pharmacy, specifically for youths between the ages of 6 and 18 diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder. The product is intended to help them concentrate longer on a task thereby increasing their performance academically, athletically and socially. The product would supplement the daily diet with nutrition that the youthful body requires to function more effectively." More information is available at www.bodysentials.com/"

Ginko Biloba

We have also had reports of the herb Ginko Biloba helping with the symptoms of ADD/ADHD.

We have recently read in the media about some problems with regard to Ginko Biloba. On further checking with others we, would like visitors to note that:

A negative about Ginko Biloba is a problem with anti-clotting. It can interfere with coagulation (whether this is with the platelets or the clotting factors, we cannot say with certainty). It would add to the effect of aspirin or other blood thinners in "thinning" the blood and thus could be dangerous.

Also we received the following references:........

"The effect of platelet-aggregation inhibitors may be enhanced. The case of a spontaneous hyphema after combined intake of a Ginkgo-biloba-containing pharmaceutical and aspirin has been documented" (Schwabe, 1999)."

"Janssens, D. et al. 1995. Protection of hypoxia-induced ATP decrease in endothelial cells by Ginkgo biloba extract and bilobalide. (Biochem Pharmacol 50(7):991-999)."

"Jung, F., C. Mrowietz, H. Kiesewetter, E. Wenzel. 1990. Effect of Gingko Biloba on fluidity of blood and peripheral microcirculation in volunteers. (Arzneimforsch 40(5):589-593)."

We will add more when information becomes available but would suggest to people interested in trying this to seek medical advice from their doctor or advice form a Registered Homeopath to ensure that it will not have adverse reactions with any medication, pharmaceutical or otherwise, they may be taking.

Wayne from South Africa wrote to us saying......

"I would like to let you know that before I was diagnosed with ADD, I took Ginko Biloba and vitamin B complex for a period of four months coupled with aerobic exercises three times a week. I, for the first time, felt great. My concentration and relationships with others was so much for the better and would highly recommend Ginko Biloba, aerorobic excercise, and a good vitamin B complex. It will change your life for the better."

Rolanda wrote......

"I have used it and find the Quest make the only one that has worked for me. I find that it has improved my memory and I am not so scatterbrained. In fact I was able to start studying again because my short term memory was so much better."

Kelvin wrote......

"I've tried taking Ginko. I'm not sure I've noticed any benefit. I would like to try more long term particularly as I suffer from Raynard's Syndrome (poor circulation). However, after a short while I found I needed the toilet far less though didn't feel constipated. Is this an expected side effect? I stopped after about 3 weeks just in case."

Raul wrote......

"I AM A PERSON WHO HAS NEVER BEEN DIAGNOSED WITH ADD, but I feel I have it. I lack concentration and am very fidgety and unorganized. This has posed a problem at home and at work. Now that I am starting the police academy in Chicago, I needed something that would help me get through the academy. I have taken ginko biloba plus and so far it has worked. I feel much more attentative. I didn't want medication because it probably could bar me from the academy, so recommend ginka biloba plus. I dont know how long it will work, but it is working..."

This comes from University of Michigan ......

"There have been a number of reported cases of serious and even lethal side effects from herbal products. In addition, some so-called natural remedies were found to contain standard prescription medication. Of specific concern are studies suggesting that up to 30% of herbal patent remedies imported from China having been laced with potent pharmaceuticals such as phenacetin and steroids. Most problems reported occur in herbal remedies imported from Asia, with one study reporting a significant percentage of such remedies containing toxic metals. The following warnings are of particular importance for people with attention-deficit disorders.

• Melatonin. High doses of melatonin have been associated with an increased risk for seizures in children with existing neurologic disorders.
• Gingko. The risk for side effects from gingko appear to be low, but there is an increased risk for bleeding and interaction with anti-clotting medications at high doses.
• Ginseng. There have been contaminated forms of imported ginseng.

It also has been associated with a hypoglycemia and a higher risk for bleeding. In addition, a great number of ginseng products have been found to contain little or no ginseng."

Ed. Note: Please remember, we do not endorse any treatments and strongly advise you to check with your doctor before using, stopping or changing any treatment.

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Here are some conversation techniques that help us to effectively communicate with others. Some may think these are tricks, but they are techniques commonly used by everyone. They are used in everyday conversation and there's no shame in using them. The difference here is that they are typed out.

These conversation techniques are taught to salesmen, and executives, and are not designed for people who try to use them to take advantage of others. I promise they work and will make you much stronger in communicating with others. They will also help you to see and to know the humanity in other people.

Here goes:

1. The thing that most people want to hear in a conversation is their own voice. You can use this to your advantage by asking opinion type questions. Leave the other person a way to elaborate. After you ask, shut up and listen. If you keep talking, and do not allow the other party to answer, you will be seen as rude.
2. Ask open-ended questions. They can make you a hero. An example: "How do you feel about ....?, What is your thinking on ....?, Do you believe that ....?. These are questions that can't be answered with a "yes" or a "no".
3. Be direct and look the other person in the eye while you talk. Avoiding eye contact may cause what you say to be taken as untruthful.
4. Recount or reflect what the other person says. When you reflect, you take part of what the other person said, and repeat it with the "do you mean ...?", or the "are you saying ....?" in front of it. Things like "Oh?", "Really?", and "You don't say" also make someone elaborate on what they have said, but are not reflective. Don't say "Oh, really"? that infers that you don't believe the speaker and it requires him to try to convince you. Of course, that's okay, if that is your intent.
5. Listen for concepts and don't concentrate on facts. Facts are there to back up the concepts. Ask yourself "What is this person telling me"? I went to college years ago and because no one ever told me this, I made lots of totally useless notes with all sorts of facts. To practice this, listen to speeches and you may find that the speaker had no concepts at all!
6. Try to use your thought speed to mentally recap what is being said. You think more than 4-times faster than a speaker will be speaking. Don't waste that thought speed on anything else.
7. Know that whatever you say, the facts are that after a conversation, the listener will only retain something like 50% of it. And after 48-hours, he will have retained only 25% of what he heard. Also note that because the backgrounds (histories) are not the same from speaker-to-listener, we cannot get 100% of the information transferred between two people. There is always a big loss.
8. Pauses in conversation usually will cause the other person to speak. They will do so because the other person feels awkward and unnatural if you stop saying anything. This technique will cause the person to expand on what he has said or sometimes to recant or rephrase his statement. This is a very powerful tool of conversation. And, if you are in control of the conversation, you can make the pause as long as is necessary. You will also see when someone is using pauses on you.
9. Conversational skills can be gauged by how you read the body language of the other person. While you listen to them, watch them. Sometimes they say one thing and really are feeling something quite different. It takes a lot of practice to be good at this. Look for the topics "body language" and "nonverbal communication" to learn more about them.

Try some of these things, and watch people open up to you. Wow, instant conversational expert! I hope that these things will get you started in a direction to be more comfortable when you talk with other people. These things work. I have firsthand knowledge that they do. I have used them and taught them in communication classes. If you are not American, there may be some differences in your native language or customs.

I would suggest that you print these for future reference. Now, is that guy conceited or what?

next: A Depressed Person's Letter
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"In order to stop giving our power away, to stop reacting out of our inner children, to stop setting ourselves up to be victims, so that we can start learning to trust and Love ourselves, we need to begin to practice discernment. Discernment is having the eyes to see, and the ears to hear - and the ability to feel the emotional energy that is Truth.

We cannot become clear on what we are seeing or hearing if we are reacting to emotional wounds that we have not been willing/able to feel and subconscious attitudes that we have not been willing/able to look at. We cannot learn to trust ourselves as long as we are still setting ourselves up to be victimized by untrustworthy people."

"Not only were we taught to be victims of people, places, and things, we were taught to be victims of ourselves, of our own humanity. We were taught to take our ego-strength, our self-definition from external manifestations of our being. . . Looks, talent, intelligence external manifestations of our being are gifts to be celebrated. They are temporary gifts. They are not our total being. They do not define us or dictate if we have worth. We were taught to do it backwards. To take our self-definition and self-worth from temporary illusions outside of, or external to our beings. It does not work. It is dysfunctional."

Codependence: The Dance of Wounded Souls

Codependence and interdependence are two very different dynamics.

Codependence is about giving away power over our self-esteem. Taking our self-definition and self-worth from outside or external sources is dysfunctional because it causes us to give power over how we feel about ourselves to people and forces which we cannot control. Any time that we give power over our self-esteem to something outside of ourselves we are making that person or thing our higher power. We are worshiping false gods.

If my self-esteem is based on people, places, and things; money, property, and prestige; looks, talent, intelligence; then I am set up to be a victim. People will not always do what I want them too; property can be destroyed by an earthquake or flood or fire; money can disappear in a stock market crash or bad investment; looks change as I get older. Everything changes. All outside or external conditions are temporary.

That is why it is so important to get in touch with our Spiritual connection. To start realizing that we have worth because we are children of God. That we are all part of the Eternal ONENESS that is the God Force/Goddess Energy/Great Spirit. We are Spiritual beings having a human experience our worth as beings is not dependent upon any outer or external condition. We are Unconditionally Loved and we always have been.

The more we can start owning the Truth of who we really are and integrating it into our relationship with ourselves, the more we can enjoy this human experience that we are having. Then we can start learning how to be interdependent - how to give power away in conscious, healthy ways because our self-worth is no longer dependent on outside sources.

Interdependence is about making allies, forming partnerships. It is about forming connections with other beings. Interdependence means that we give someone else some power over our welfare and our feelings.

Anytime we care about somebody or something we give away some power over our feelings. It is impossible to Love without giving away some power. When we choose to Love someone (or thing - a pet, a car, anything) we are giving them the power to make us happy - we cannot do that without also giving them the power to hurt us or cause us to feel angry or scared.

In order to live we need to be interdependent. We cannot participate in life without giving away some power over our feelings and our welfare. I am not talking here just about people. If we put money in a bank we are giving some power over our feelings and welfare to that bank. If we have a car we have a dependence on it and will have feelings if it something happens to it. If we live in society we have to be interdependent to some extent and give some power away. The key is to be conscious in our choices and own responsibility for the consequences.

The way to healthy interdependence is to be able to see things clearly - to see people, situations, life dynamics and most of all ourselves clearly. If we are not working on healing our childhood wounds and changing our childhood programming then we cannot begin to see ourselves clearly let alone anything else in life.

The disease of Codependence causes us to keep repeating patterns that are familiar. So we pick untrustworthy people to trust, undependable people to depend on, unavailable people to love. By healing our emotional wounds and changing our intellectual programming we can start to practice discernment in our choices so that we can change our patterns and learn to trust ourselves.

As we develop healthy self-esteem based on knowing that the Force is with us and Loves us, then we can consciously take the risk of Loving, of being interdependent, without buying into the belief that the behavior of others determines our self-worth. We will have feelings - we will get hurt, we will be scared, we will get angry - because those feelings are an unavoidable part of life. Feelings are a part of the human experience that we came here to learn about - they cannot be avoided. And trying to avoid them only causes us to miss out on the Joy and Love and happiness that can also be a part of the human experience.

next: The Evolution of the Term 'Codependence'

"As long as we look outside of Self - with a capital S - to find out who we are, to define ourselves and give us self-worth, we are setting ourselves up to be victims.

We were taught to look outside of ourselves - to people, places, and things; to money, property, and prestige - for fulfillment and happiness. It does not work, it is dysfunctional. We cannot fill the hole within with anything outside of Self.

You can get all the money, property, and prestige in the world, have everyone in the world adore you, but if you are not at peace within, if you don't Love and accept yourself, none of it will work to make you Truly happy."

Codependence: The Dance of Wounded Souls by Robert Burney

My friend Robert died the other day. He died alone in a hotel room and his body wasn't found for two days. He weighed 125 pounds when he died.

Robert was an alcoholic who couldn't stay sober. He had been through full thirty day (and longer) treatment programs at least 15 times. He had been in detox fifty times easily. Drinking had destroyed his body. Robert should have been dead years ago. In the past 3 or 4 years almost every time he drank he ended up in intensive care. I did much of my grieving for my friend three years ago, the last time I rescued him from his cabin on Taos Mountain and took him to the emergency room.

Robert went to lots of meetings and tried real hard to work the program but on one critical point he didn't have enough humility. He did not have enough humility to accept that he was lovable.

My friend had made and lost fortunes in his life. He had been with lots of women and had lots of possessions. He still had lots of possessions when he died. He still had the cabin in Taos Ski Valley but he didn't have the strength to walk up the fifty steps to the front door.

Robert used money to try to buy friendship and love. And then he felt betrayed because he believed that people only wanted to be around him for his money. If you were friendly to him for no apparent reason then he would talk about giving you money because that gave you an excuse to care about him. He just could not believe that he was worthy of love just for who he was.

Robert was full of shame. He was full of shame because he was raised in a dysfunctional family in a shame-based society. His Father was a verbally/emotionally abusive perfectionist for whom nothing was ever good enough. His mother was too terrified and shame-based to protect her son.

As a young child Robert got the message that he wasn't lovable but that if he was successful enough and made enough money he might earn the right to be loved. He was successful and made lots of money but it did not work to convince him that he was good enough.

My friend had no permission from himself to receive love. When I published my book I listed him among people who had touched my life on the Acknowledgements Page. When he saw his name listed there he cursed me (his generation, and mine, were taught to relate to other men that way, to say 'I love you' by calling each other names) and cried briefly (which he felt was very shameful) and then he drank. In his relationship with himself Robert was too shame-based to believe that he was lovable.

I believe that the great majority of Alcoholics are born with a genetic, hereditary predisposition that is physiological. Environment does not cause Alcoholism. Robert was not an Alcoholic because he was shame-based - it was because of his shame that he could not stay sober. He had a blustery, 'hail-fellow-well-met', in your face kind of ego-strength that was very fragile. As soon as he got sober his ego defenses would fracture and the shame underneath would cause him to sabotage his sobriety.

That doesn't mean that people who can stay sober don't have shame. Some of us just have more ego defenses that buries the shame deeper. That is good news in early sobriety because it helps one to stay sober. It can be bad news later on because it can cause us to resist growth and to not have the humility to be teachable The reason that I am alive today is because I was able to go to treatment for Codependence in my fifth year of recovery while working as a therapist in a treatment center. I had sworn that I would kill myself before I drank again and the feelings which were surfacing had me close to it when I went to Sierra Tucson. That was where I met Robert.

What killed my friend were the grave emotional and mental disorders caused by growing up with parents who did not love themselves in a dysfunctional family in an emotionally-dishonest, Spiritually-hostile, shame-based society. What killed Robert was his Codependence. His relationship with himself was full of self-hatred and shame and he couldn't stay sober long enough to get to the point where he could deal with his childhood issues.

Robert was born with a genetic predisposition to have a fatal disease, Alcoholism. His childhood inflicted a second fatal disease on him. My friend Robert was one more of the many Alcoholics to die of Codependence.

next: Grave Emotional and Mental Disorders

• Watch the video on Debate About Causes and Types of Narcissists

The study of narcissism is a century old and the two scholarly debates central to its conception are still undecided. Is there such a thing as HEALTHY adult narcissism (Kohut) - or are all the manifestations of narcissism in adulthood pathological (Freud, Kernberg)? Moreover, is pathological narcissism the outcome of verbal, sexual, physical, or psychological abuse (the overwhelming view) - or, on the contrary, the sad result of spoiling the child and idolizing it (Millon, the late Freud)?

The second debate is easier to resolve if one agrees to adopt a more comprehensive definition of "abuse". Overweening, smothering, spoiling, overvaluing, and idolizing the child - are all forms of parental abuse.

This is because, as Horney pointed out, the child is dehumanized and instrumentalized. His parents love him not for what he really is - but for what they wish and imagine him to be: the fulfilment of their dreams and frustrated wishes. The child becomes the vessel of his parents' discontented lives, a tool, the magic brush with which they can transform their failures into successes, their humiliation into victory, their frustrations into happiness. The child is taught to ignore reality and to occupy the parental fantastic space. Such an unfortunate child feels omnipotent and omniscient, perfect and brilliant, worthy of adoration and entitled to special treatment. The faculties that are honed by constantly brushing against bruising reality - empathy, compassion, a realistic assessment of one's abilities and limitations, realistic expectations of oneself and of others, personal boundaries, team work, social skills, perseverance and goal-orientation, not to mention the ability to postpone gratification and to work hard to achieve it - are all lacking or missing altogether. The child turned adult sees no reason to invest in his skills and education, convinced that his inherent genius should suffice. He feels entitled for merely being, rather than for actually doing (rather as the nobility in days gone by felt entitled not by virtue of its merit but as the inevitable, foreordained outcome of its birth right). In other words, he is not meritocratic - but aristocratic. In short: a narcissist is born.

But such a mental structure is brittle, susceptible to criticism and disagreement, vulnerable to the incessant encounter with a harsh and intolerant world. Deep inside, narcissists of both kinds (those wrought by "classic" abuse and those yielded by being idolized) - feel inadequate, phoney, fake, inferior, and deserving of punishment. This is Millon's mistake. He makes a distinction between several types of narcissists. He wrongly assumes that the "classic" narcissist is the outcome of overvaluation, idolization, and spoiling and, thus, is possessed of supreme, unchallenged, self confidence, and is devoid of all self-doubt. According to Millon, it is the "compensatory" narcissist that falls prey to nagging self doubts, feelings of inferiority, and a masochistic desire for self-punishment. Yet, the distinction is both wrong and unnecessary. There is only ONE type of narcissist - though there are TWO developmental paths to it. And ALL narcissists are besieged by deeply ingrained (though at times not conscious) feelings of inadequacy, fears of failure, masochistic desires to be penalized, a fluctuating sense of self worth (regulated by narcissistic supply), and an overwhelming sensation of fakeness.

The "grandiosity gap" (between a fantastically grandiose - and unlimited - self-image and actual - limited - accomplishments and achievements) is grating. Its recurrence threatens the precariously balanced house of cards that is the narcissistic personality. The narcissist finds, to his chagrin, that people out there are much less admiring, accommodating and accepting than his parents. As he grows old, the narcissist often become the target of constant derision and mockery, a sorry sight indeed. His claims for superiority appear less plausible and substantial the more and the longer he makes them.

The narcissist then resorts to self-delusion. Unable to completely ignore contrarian opinion and data - he transmutes them. Unable to face the dismal failure that he is, the narcissist partially withdraws from reality. To soothe and salve the pain of disillusionment, he administers to his aching soul a mixture of lies, distortions, half-truths and outlandish interpretations of events around him. These solutions can be classified thus:

The Delusional Narrative Solutions

The narcissist constructs a narrative in which he figures as the hero - brilliant, perfect, irresistibly handsome, destined for great things, entitled, powerful, wealthy, the centre of attention, etc. The bigger the strain on this delusional charade - the greater the gap between fantasy and reality - the more the delusion coalesces and solidifies.

Finally, if it is sufficiently protracted, it replaces reality and the narcissist's reality test deteriorates. He withdraws his bridges and may become Schizotypal, catatonic, or schizoid.

The Reality Renouncing Solutions

The narcissist renounces reality. To his mind, those who pusillanimously fail to recognize his unbound talents, innate superiority, overarching brilliance, benevolent nature, entitlement, cosmically important mission, perfection, etc. - do not deserve consideration. The narcissist's natural affinity with the criminal - his lack of empathy and compassion, his deficient social skills, his disregard for social laws and morals - now erupts and blossoms. He becomes a full fledged antisocial (sociopath or psychopath). He ignores the wishes and needs of others, he breaks the law, he violates all rights - natural and legal, he hold people in contempt and disdain, he derides society and its codes, he punishes the ignorant ingrates - that, to his mind, drove him to this state - by acting criminally and by jeopardising their safety, lives, or property.

The Paranoid Schizoid Solution

The narcissist develops persecutory delusions. He perceives slights and insults where none were intended. He becomes subject to ideas of reference (people are gossiping about him, mocking him, prying into his affairs, cracking his e-mail, etc.). He is convinced that he is the centre of malign and mal-intentioned attention. People are conspiring to humiliate him, punish him, abscond with his property, delude him, impoverish him, confine him physically or intellectually, censor him, impose on his time, force him to action (or to inaction), frighten him, coerce him, surround and besiege him, change his mind, part with his values, even murder him, and so on.

Some narcissists withdraw completely from a world populated with such minacious and ominous objects (really projections of internal objects and processes). They avoid all social contact, except the most necessary. They refrain from meeting people, falling in love, having sex, talking to others, or even corresponding with them. In short: they become schizoids - not out of social shyness, but out of what they feel to be their choice. "The world does not deserve me" - goes the inner refrain - "and I shall waste none of my time and resources on it".

The Paranoid Aggressive (Explosive) Solution

Other narcissists who develop persecutory delusions, resort to an aggressive stance, a more violent resolution of their internal conflict. They become verbally, psychologically, situationally (and, very rarely, physically) abusive. They insult, castigate, chastise, berate, demean, and deride their nearest and dearest (often well wishers and loved ones). They explode in unprovoked displays of indignation, righteousness, condemnation, and blame. Theirs is an exegetic Bedlam. They interpret everything - even the most innocuous, inadvertent, and innocent - as designed to provoke and humiliate them. They sow fear, revulsion, hate, and malignant envy. They flail against the windmills of reality - a pathetic, forlorn, sight. But often they cause real and lasting damage - fortunately, mainly to themselves.

next: The Selfish Gene -The Genetic Underpinnings of Narcissism