Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Central Europe Review, PopMatters, and eBookWeb, a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory, Bellaonline, and Suite101.

Until recently, he served as the Economic Advisor to the Government of Macedonia.

Visit Sam's Web site at http://samvak.tripod.com

 

The Sample Articles (please scroll down to review them):

I. Letter about Trust
II. Taming the Beast: Pathological Narcissism and the Quality of Life
III. Psychology as Storytelling
IV. Eating Disorders and Personality Disorders


Author: Sam Vaknin

Contact Info: palma.unet.com.mk; vaknin.link.com.mk

The Narcissistic condition emanates from a seismic break of trust, a tectonic shift of what should have been a healthy relationship with his "primary objects" and the transformation of his self into the subject of love. Some of these bad feelings are the result of deeply entrenched misunderstandings regarding the nature of trust and the continuous act of trusting.
For millions of years nature embedded in us the notion that the past can teach us a lot about the future. This is very useful for survival. And it is also mostly true with inanimate objects. With humans the story is somewhat different: it is reasonable to learn from someone's past behaviour about his future behaviour (even though this proves erroneous most of the time). But it is mistaken to learn from someone's behaviour about other people's. Actually, most psychotherapy is nothing but the effort to disentangle past from present, to teach the patient that the past is gone and has no reign over him anymore, unless the patient lets it to.
Our natural tendency is to trust, because we trust our parents. It feels good to really trust. It is also an essential component of love and an important test. Love without trust is dependence masquerading as love. We must trust, it is almost biological. Most of the time, we do trust. We trust the Universe to behave itself according to the laws of physics, our army not to go mad and shoot us all, our nearest and dearest not to betray us. When trust is broken, the feeling is that a part of us dies, is hollowed out. Not to trust is abnormal and is the natural result of bitter or even traumatic life experiences. Mistrust or distrust are induced not by our own thoughts, nor by some device or machination of ours - but by life's sad circumstances. To continue not to trust is to reward the people who wronged us and made us distrustful in the first place. These people have long abandoned us and still they have a great, malignant, influence on our lives. This is the irony of the lack of trust.
So, some of us prefer not to experience this sinking feeling: not to trust and not to be disappointed. This is both a fallacy and a folly. Trusting releases enormous amounts of mental energy, which could be better invested elsewhere. Naturally trust - like knives - can be dangerous to your health if used improperly.
You have to know WHO to trust, you have to know HOW to trust and you have to know HOW to CONFIRM the existence of a functioning trust.
First let me state clearly: people often disappoint and are not worthy of trust. They are often arbitrary, treacherous and vicious, or, worse, offhanded. You have to select your targets carefully. He who has the most common interests with you, who is investing in you for the long term, who is incapable of breaching trust ("a good person"), who doesn't have much to gain from betraying you - is not likely to mislead you. These people you can trust.
You should not trust indiscriminately. No one is completely trustworthy in all areas of life. Most often our disappointments stem from our inability to separate one area of life from another. A person could be sexually loyal - but an utter danger when it comes to money (for instance, a gambler). Or a good, reliable father - but a womanizer. You can trust someone to carry out some types of activities - but not others, because they are more complicated, more boring, or do not appeal to his conscience. We should distinguish between people and allocate our trust accordingly. Then, we are not likely to be disappointed. We should not trust with reservations - this is the kind of "trust" that is common in business and among criminals and its source is rational. Game Theory in Mathematics deals with questions of calculated trust. We should trust wholeheartedly but know who to trust in which field. Then we will be rarely disappointed.
As opposed to popular opinion, trust must be put to the test, lest it goes stale and staid. We are all somewhat paranoid. The world around us is so complex, so inexplicable, so overwhelming - that we find refuge in the invention of superior forces. Some forces are benign (God) - some arbitrarily conspiratorial in nature. There must be an explanation, we feel, to all these amazing coincidences, to us, to events. This tendency to introduce external powers and ulterior motives permeates human relations, as well. We gradually grow suspicious, inadvertently hunt for clues of infidelity or worse, masochistically relieved, even happy when we find some. The more tested, the stronger our pattern-prone brain will embrace the trust established. Constantly in a precarious balance, our brain needs and devours reinforcements. Such testing should not be explicit - it should be deduced from circumstances. My husband could easily have had a mistress or my partner could easily have stolen our money - and, behold, they haven't.
Trust is based on the ability to predict the future. It is not so much the act of betrayal that we react to - as it is the feeling that the very foundations of the world are shaking, that it is no longer safe because it is no longer predictable. These are the throes of death of one theory - and the birth of another, as yet untested.
Here is another important lesson: whatever the act of betrayal (with the exception of grave criminal corporeal acts) - it is always limited, confined, negligible. Naturally, we tend to exaggerate the importance of the event. This serves a double purpose: indirectly it aggrandizes us. If we were "worthy" of such an unprecedented, unheard of, major betrayal - we must be worthy, period. The magnitude of the betrayal reflects on us and reestablishes the fragile balance of powers between us and the universe. The second purpose is simply to gain sympathy and empathy - mainly from ourselves, but also from our human environment. Catastrophes are a dozen a dime and in today's world it is difficult to provoke anyone to regard your personal disaster as anything exceptional. Amplifying the event has, therefore, some very utilitarian purposes. But, finally, the emotional lie is absorbed by the very liar and poisons his mental circulation. Re-proportioning, reordering and putting the event in perspective will go a long way towards the commencement of a healing process. No betrayal stamps the world irreversibly or eliminates other possibilities, opportunities, chances and people. Time goes on, people meet and part, lovers quarrel and make love, dear ones live and die. It is the very essence of time that it erodes us all to the finest dust. Our only weapon - however crude and maybe unwise - against this unstoppable process is to trust each other.


 



Storytelling has been with us since the days of campfire and besieging wild animals. It served a number of important functions: amelioration of fears, communication of vital information (regarding survival tactics and the characteristics of animals, for instance), the satisfaction of a sense of order (justice), the development of the ability to hypothesize, predict and introduce theories and so on.
We are all endowed with a sense of wonder. The world around us in inexplicable, baffling in its diversity and myriad forms. We experience an urge to organize it, to "explain the wonder away", to order it in order to know what to expect next (predict). These are the essentials of survival. But while we have been successful at imposing our mind's structures on the outside world – we have been much less successful when we tried to cope with our internal universe.
The relationship between the structure and functioning of our (ephemeral) mind, the structure and modes of operation of our (physical) brain and the structure and conduct of the outside world have been the matter of heated debate for millennia. Broadly speaking, there were (and still are) two ways of treating it:
There were those who, for all practical purposes, identified the origin (brain) with its product (mind). Some of them postulated the existence of a lattice of preconceived, born categorical knowledge about the universe – the vessels into which we pour our experience and which mould it. Others have regarded the mind as a black box. While it was possible in principle to know its input and output, it was impossible, again in principle, to understand its internal functioning and management of information. Pavlov coined the word "conditioning", Watson adopted it and invented "behaviourism", Skinner came up with "reinforcement". The school of epiphenomenologists (emergent phenomena) regarded the mind as the by product of the brain's "hardware" and "wiring" complexity. But all ignored the psychophysical question: what IS the mind and HOW is it linked to the brain?
The other camp was more "scientific" and "positivist". It speculated that the mind (whether a physical entity, an epiphenomenon, a non-physical principle of organization, or the result of introspection) – had a structure and a limited set of functions. They argued that a "user's manual" could be composed, replete with engineering and maintenance instructions. The most prominent of these "psychodynamists" was, of course, Freud. Though his disciples (Adler, Horney, the object-relations lot) diverged wildly from his initial theories – they all shared his belief in the need to "scientify" and objectify psychology. Freud – a medical doctor by profession (Neurologist) and Bleuler before him – came with a theory regarding the structure of the mind and its mechanics: (suppressed) energies and (reactive) forces. Flow charts were provided together with a method of analysis, a mathematical physics of the mind.
But this was a mirage. An essential part was missing: the ability to test the hypotheses, which derived from these "theories". They were all very convincing, though, and, surprisingly, had great explanatory power. But - non-verifiable and non-falsifiable as they were – they could not be deemed to possess the redeeming features of a scientific theory.
Deciding between the two camps was and is a crucial matter. Consider the clash - however repressed - between psychiatry and psychology. The former regards "mental disorders" as euphemisms - it acknowledges only the reality of brain dysfunctions (such as biochemical or electric imbalances) and of hereditary factors. The latter (psychology) implicitly assumes that something exists (the "mind", the "psyche") which cannot be reduced to hardware or to wiring diagrams. Talk therapy is aimed at that something and supposedly interacts with it.
But perhaps the distinction is artificial. Perhaps the mind is simply the way we experience our brains. Endowed with the gift (or curse) of introspection, we experience a duality, a split, constantly being both observer and observed. Moreover, talk therapy involves TALKING - which is the transfer of energy from one brain to another through the air. This is directed, specifically formed energy, intended to trigger certain circuits in the recipient brain. It should come as no surprise if it were to be discovered that talk therapy has clear physiological effects upon the brain of the patient (blood volume, electrical activity, discharge and absorption of hormones, etc.).
All this would be doubly true if the mind was, indeed, only an emergent phenomenon of the complex brain - two sides of the same coin.
Psychological theories of the mind are metaphors of the mind. They are fables and myths, narratives, stories, hypotheses, conjunctures. They play (exceedingly) important roles in the psychotherapeutic setting – but not in the laboratory. Their form is artistic, not rigorous, not testable, less structured than theories in the natural sciences. The language used is polyvalent, rich, effusive, and fuzzy – in short, metaphorical. They are suffused with value judgements, preferences, fears, post facto and ad hoc constructions. None of this has methodological, systematic, analytic and predictive merits.
Still, the theories in psychology are powerful instruments, admirable constructs of the mind. As such, they are bound to satisfy some needs. Their very existence proves it.
The attainment of peace of mind is a need, which was neglected by Maslow in his famous rendition. People will sacrifice material wealth and welfare, will forgo temptations, will ignore opportunities, and will put their lives in danger – just to reach this bliss of wholeness and completeness. There is, in other words, a preference of inner equilibrium over homeostasis. It is the fulfilment of this overriding need that psychological theories set out to cater to. In this, they are no different than other collective narratives (myths, for instance).
In some respects, though, there are striking differences:
Psychology is desperately trying to link up to reality and to scientific discipline by employing observation and measurement and by organizing the results and presenting them using the language of mathematics. This does not atone for its primordial sin: that its subject matter is ethereal and inaccessible. Still, it lends an air of credibility and rigorousness to it.
The second difference is that while historical narratives are "blanket" narratives – psychology is "tailored", "customized". A unique narrative is invented for every listener (patient, client) and he is incorporated in it as the main hero (or anti-hero). This flexible "production line" seems to be the result of an age of increasing individualism. True, the "language units" (large chunks of denotates and connotates) are one and the same for every "user". In psychoanalysis, the therapist is likely to always employ the tripartite structure (Id, Ego, Superego). But these are language elements and need not be confused with the plots. Each client, each person, and his own, unique, irreplicable, plot.
To qualify as a "psychological" plot, it must be:
a. All-inclusive (anamnetic) – It must encompass, integrate and incorporate all the facts known about the protagonist.
b. Coherent – It must be chronological, structured and causal.
c. Consistent – Self-consistent (its subplots cannot contradict one another or go against the grain of the main plot) and consistent with the observed phenomena (both those related to the protagonist and those pertaining to the rest of the universe).
d. Logically compatible – It must not violate the laws of logic both internally (the plot must abide by some internally imposed logic) and externally (the Aristotelian logic which is applicable to the observable world).
e. Insightful (diagnostic) – It must inspire in the client a sense of awe and astonishment which is the result of seeing something familiar in a new light or the result of seeing a pattern emerging out of a big body of data. The insights must be the logical conclusion of the logic, the language and of the development of the plot.
f. Aesthetic – The plot must be both plausible and "right", beautiful, not cumbersome, not awkward, not discontinuous, smooth and so on.
g. Parsimonious – The plot must employ the minimum numbers of assumptions and entities in order to satisfy all the above conditions.
h. Explanatory – The plot must explain the behaviour of other characters in the plot, the hero's decisions and behaviour, why events developed the way that they did.
i. Predictive (prognostic) – The plot must possess the ability to predict future events, the future behaviour of the hero and of other meaningful figures and the inner emotional and cognitive dynamics.
j. Therapeutic – With the power to induce change (whether it is for the better, is a matter of contemporary value judgements and fashions).
k. Imposing – The plot must be regarded by the client as the preferable organizing principle of his life's events and the torch to guide him in the darkness to come.
l. Elastic – The plot must possess the intrinsic abilities to self organize, reorganize, give room to emerging order, accommodate new data comfortably, avoid rigidity in its modes of reaction to attacks from within and from without.
In all these respects, a psychological plot is a theory in disguise. Scientific theories should satisfy most of the same conditions. But the equation is flawed. The important elements of testability, verifiability, refutability, falsifiability, and repeatability – are all missing. No experiment could be designed to test the statements within the plot, to establish their truth-value and, thus, to convert them to theorems.
There are three reasons to account for this shortcoming:
a. Ethical – Experiments would have to be conducted, involving the hero and other humans. To achieve the necessary result, the subjects will have to be ignorant of the reasons for the experiments and their aims. Sometimes even the very performance of an experiment will have to remain a secret (double blind experiments). Some experiments may involve unpleasant experiences. This is ethically unacceptable.
b. The Psychological Uncertainty Principle – The current position of a human subject can be fully known. But both treatment and experimentation influence the subject and void this knowledge. The very processes of measurement and observation influence the subject and change him.
c. Uniqueness – Psychological experiments are, therefore, bound to be unique, unrepeatable, cannot be replicated elsewhere and at other times even if they deal with the SAME subjects. The subjects are never the same due to the psychological uncertainty principle. Repeating the experiments with other subjects adversely affects the scientific value of the results.
d. The undergeneration of testable hypotheses – Psychology does not generate a sufficient number of hypotheses, which can be subjected to scientific testing. This has to do with the fabulous (=storytelling) nature of psychology. In a way, psychology has affinity with some private languages. It is a form of art and, as such, is self-sufficient. If structural, internal constraints and requirements are met – a statement is deemed true even if it does not satisfy external scientific requirements.
So, what are plots good for? They are the instruments used in the procedures, which induce peace of mind (even happiness) in the client. This is done with the help of a few embedded mechanisms:
a. The Organizing Principle – Psychological plots offer the client an organizing principle, a sense of order and ensuing justice, of an inexorable drive toward well defined (though, perhaps, hidden) goals, the ubiquity of meaning, being part of a whole. It strives to answer the "why’s" and "how’s". It is dialogic. The client asks: "why am I (here follows a syndrome)". Then, the plot is spun: "you are like this not because the world is whimsically cruel but because your parents mistreated you when you were very young, or because a person important to you died, or was taken away from you when you were still impressionable, or because you were sexually abused and so on". The client is calmed by the very fact that there is an explanation to that which until now monstrously taunted and haunted him, that he is not the plaything of vicious Gods, that there is who to blame (focussing diffused anger is a very important result) and, that, therefore, his belief in order, justice and their administration by some supreme, transcendental principle is restored. This sense of "law and order" is further enhanced when the plot yields predictions which come true (either because they are self-fulfilling or because some real "law" has been discovered).
b. The Integrative Principle – The client is offered, through the plot, access to the innermost, hitherto inaccessible, recesses of his mind. He feels that he is being reintegrated, that "things fall into place". In psychodynamic terms, the energy is released to do productive and positive work, rather than to induce distorted and destructive forces.
c. The Purgatory Principle – In most cases, the client feels sinful, debased, inhuman, decrepit, corrupting, guilty, punishable, hateful, alienated, strange, mocked and so on. The plot offers him absolution. Like the highly symbolic figure of the Saviour before him – the client's sufferings expurgate, cleanse, absolve, and atone for his sins and handicaps. A feeling of hard won achievement accompanies a successful plot. The client sheds layers of functional, adaptive clothing. This is inordinately painful. The client feels dangerously naked, precariously exposed. He then assimilates the plot offered to him, thus enjoying the benefits emanating from the previous two principles and only then does he develop new mechanisms of coping. Therapy is a mental crucifixion and resurrection and atonement for the sins. It is highly religious with the plot in the role of the scriptures from which solace and consolation can be always gleaned.




Eating Disorders and Personality Disorders
By: Dr. Sam Vaknin



Patients suffering from eating disorders either binge on food or refrain from eating and sometimes are both anorectic and bulimic. This is an impulsive behaviour as defined by the DSM and is sometimes comorbid with Cluster B personality disorder, particularly with the Borderline Personality Disorder.

Some patients develop eating disorders as the convergence and confluence of two pathological behaviours: self-mutilation and an impulsive (rather, obsessive-compulsive or ritualistic) behaviour.

The key to improving the mental state of patients who have been diagnosed with both a personality disorder and an eating disorder lies in focusing at first upon their eating and sleeping disorders.

By controlling his eating disorder, the patient reasserts control over his life. This newfound power is bound to reduce depression, or even eliminate it altogether as a constant feature of his mental life. It is also likely to ameliorate other facets of his personality disorder.

It is a chain reaction: controlling one's eating disorders leads to a better regulation of one's sense of self-worth, self-confidence, and self-esteem. Successfully coping with one challenge - the eating disorder - generates a feeling of inner strength and results in better social functioning and an enhanced sense of well-being.

When a patient has a personality disorder and an eating disorder, the therapist would do well to first tackle the eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like obsessive-compulsive behaviours, or depression can be ameliorated with medication or modified). The treatment of personality disorders requires  enormous, persistent and continuous investment of resources of every kind by everyone involved.

From the patient's point of view, the treatment of her personality disorder is not an efficient allocation of scarce mental resources. Neither are personality disorders the real threat. If one's personality disorder is cured but one's eating disorders are left untouched, one might die (though mentally healthy)…

An eating disorder is both a signal of distress ("I wish to die, I feel so bad, somebody help me") and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and discharge. This way I can control at least ONE aspect of my life."

This is where we can and should begin to help the patient - by letting her regain control of her life. The family or other supporting figures must think what they can do to make the patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences, and choices matter.

Eating disorders indicate the strong combined activity of an underlying sense of lack of personal autonomy and an underlying sense of lack of self-control. The patient feels inordinately, paralyzingly helpless and ineffective. His eating disorders are an effort to exert and reassert mastery over his own life.

At this early stage, the patient is unable to differentiate his own feelings and needs from those of others. His cognitive and perceptual distortions and deficits (for instance, regarding his body image – known as a somatoform disorder) only increase his feeling of personal ineffectualness and his need to exercise even more self-control (by way of his diet).

The patient does not trust himself in the slightest. He rightly considers himself to be his worst enemy, a mortal adversary. Therefore, any effort to collaborate with the patient against his own disorder is perceived by the patient as self-destructive. The patient is emotionally invested in his disorder - his vestigial mode of self-control.

The patient views the world in terms of black and white, of absolutes ("splitting"). Thus, he cannot let go even to a very small degree. He is constantly anxious. This is why he finds it impossible to form relationships: he mistrusts (himself and by extension others), he does not want to become an adult, he does not enjoy sex or love (which both entail a modicum of loss of control).

All this leads to a chronic absence of self-esteem. These patients like their disorder. Their eating disorder is their only achievement. Otherwise they are ashamed of themselves and disgusted by their shortcomings (expressed through the distaste with which they hold their body).

Eating disorders are amenable to treatment, though comorbidity with a personality disorder presages a poorer prognosis. The patient should be referred to talk therapy, medication, and enrol in online and offline support groups (such as Overeaters Anonymous).

Recovery prognosis is good after 2 years of treatment and support. The family must be heavily involved in the therapeutic process. Family dynamics usually contribute to the development of such disorders.

In short: medication, cognitive or behavioural therapy, psychodynamic therapy and family therapy ought to do it.

The change in the patient following a successful course of treatment is VERY MARKED. His major depression disappears together with his sleeping disorders. He becomes socially active again and gets a life. His personality disorder might make it difficult for him – but, in isolation, without the exacerbating circumstances of his other disorders, he finds it much easier to cope with.

Patients with eating disorders may be in mortal danger. Their behaviour is ruining their bodies relentlessly and inexorably. They might attempt suicide. They might do drugs. It is only a question of time. The therapist's goal is to buy them that time. The older they get, the more experienced they become, the more their body chemistry changes with age – the better their chances to survive and thrive.100 psychological articles and essays available by the same author!

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