INSTITUTIONAL DENIAL ABOUT THE DARK SIDE OF LAW SCHOOL

[To Those Who Succeed]

[...] For example, the submissive partner in a folie a deux may quickly lose their delusional beliefs when separated from the dominant partner. [...]

Several cases of Shared Psychotic Disorder or Induced Delusional Disorder (folie à deux) have been reported in the literature. Folie à deux has been described as an intriguing condition of great relevance to the understanding of human psychopathology. It is the most impressive example of a pathological relationship. Forensic complications of fatality, admissions into a secure hospital, and suicide pacts related to the condition have been reported. About 8% of a series of cases of Induced Delusional Disorder occur among non-consanguineous patients or friends. Certain conditions are needed for Shared Delusional Disorder to occur during incarceration or in a forensic hospital. The environment of intimate relationships over the years and isolation are fertile grounds for the development of Induced Delusional Disorder. For incarcerated populations and especially those with long sentences, living together for long periods fosters intimacy. Solitary confinement also produces isolation, which is a breeding ground for delusional ideas and paranoid disorders. The interaction between patients with various diagnostic characteristics of dominance and submissiveness could fuel the development of these disorders. These conditions are conducive to paranoia because of the various disordered personality types in the residents of forensic treatment centers. Hypothetically, induction could happen when a patient with suspicious and self-important cluster B personality characteristics befriends a timid, dependent, and suggestible patient with cluster C personality symptoms. The absence of several cases in these settings (prison and forensic hospitals) may be the result of underreporting or the lack of recognition of rare psychiatric syndromes in the penal system.

Such cases are intriguing in the sense that the delusions are not bizarre, were shared strongly, and influenced the patients' functioning. These features are characteristic of Shared Delusional Disorder in 3 patients. Their delusions are held despite incontrovertible proof to the contrary. Although the 3 were non-white, they were only significantly different from the remainder of the patients in their belief in the delusions. The center catered to the mental health needs of over 200 patients, 70% to 80% of whom were non-white. The two induced patients had never expressed those beliefs prior to the inducer's admission to the center. The inducer was the last of the three to be admitted to the center. He was also the oldest, commanding the respect and seniority needed to produce a domineering tendency. He was also looked on as a respected older person by the two induced patients. The first induced patient was vulnerable to desiring early release because of his long sentence. His previous schizophrenic delusions were extended in the form of folie induite (induced psychosis). The third patient, the second one induced, manifested a strong desire to feel important and had recently thought of himself as having a high "social status." The loss of status may have led him to identify with the promises of the delusions. His represented a case described as folie imposée (imposed psychosis). Separation from the inducer led to a loss of delusional beliefs in his case. Furthermore, he was reported to be a slow learner and was thought to have mental retardation. His psychological assessment placed him at the lower end of the normal intelligence range. It is therefore still possible that diminished intelligence, known as a significant etiological factor in developing Shared Delusional Disorder, may have played a part in his case.

This case extends the debate regarding the gene-environment interaction in the development of delusional disorders. Separation, a simple environmental manipulation with therapeutic effects, weakens the genetic argument. This notion is not conclusive, as there are cases of resistance after separation. However, the diagnosis of schizophrenia in the first induced patient and drug-induced delirium with low-normal intelligence in the second induced patient strengthens the idea of genetic and organic pathogeneses of the disorder. Organic brain syndromes and substances like methylphenidate and cannabis have been factors strongly associated with Induced Delusional Disorder. This connection is especially applicable in the case of the second induced patient. The use of psychotropic medication, cognitive verbal challenge, empirical provision of alternative explanations to erroneous beliefs, and the environmental manipulation of the patients resulted in moderate improvements, thus confirming the pathoplastic nature of the origins of the disorder.

[opportunity]

Well, nihilism ensues from anomie, the old order crumbles to dust and a new one is born from the pain and suffering of the transition. Rarely is this recognized as it happens.

[Pine]

[...] 'Members do it with projective identification.' Members of families, couples, groups, institutions, tribes, cultures and so on. Work with survivors of catastrophes shows that the trauma acts like a homing device and ransacks or searches out the history of the victim until it finds a congruent, early experience. It latches onto that -- tightly -- and can only be dislodged with the greatest difficulty. Another image is of hungry birds in a nest -- heads vertical, beaks open, cheeping. You may think that they are only craving, but they are also projecting like mad, and what mother thrusts down their throats on her return goes deep. What is true of worms served up as food for birds is also true of people with respect to prejudices and other deeply held beliefs. They become so deeply implanted or sedimented that they are 'second nature'. From the beginning the infant forms some object relationships, predominantly in phantasy. In her view, the outward deflection of the death instinct postulated by Freud creates the fantasy of a deathly bad object... First we project our destructiveness into others; then we wish to annihilate them without guilt because they contain all the evil and destructiveness'. When we read accounts of the genocide of the Conquistadors, the Stalinists, the Germans, the Kampucheans, the Americans or the Iraqis, we must ask what has been projected into these people from the most primitive parts of their tormentors. [...]

[...] Where positive aspects of the self are forcefully projected similar degrees of depersonalization occur, with feelings of personal worthlessness and with dependent worship of the other's contrasting strengths, powers, uncanny sensitivity, marvellous gifts, thoughts, knowledge, undying goodness etc. This is the world of the devotee, cults and hero-promotion. It is also a world in which people will do anything a Bagwan or a Rev. James Jones tells them to do -- from sexual licence to mass suicide. The same suspension of one's own sense of right and wrong is at work in the followers L. Ron Hubbard in the Church of Scientiology as in the helter-skelter minds of the devotees of Charles Manson, killing rich Californians, and in the convictions of bombers and perpetrators of sectarian murders in Northern Ireland or terrorists from Lybia, though the ideologies of the respective group leaders may have utterly different apparent of real justifications.

CLarification, please...

[p i n e]

Several cases of Shared Psychotic Disorder or Induced Delusional Disorder (folie à deux) have been reported in the literature. Folie à deux has been described as an intriguing condition of great relevance to the understanding of human psychopathology. It is the most impressive example of a pathological relationship. Forensic complications of fatality, admissions into a secure hospital, and suicide pacts related to the condition have been reported. About 8% of a series of cases of Induced Delusional Disorder occur among non-consanguineous patients or friends. Certain conditions are needed for Shared Delusional Disorder to occur during incarceration or in a forensic hospital. The environment of intimate relationships over the years and isolation are fertile grounds for the development of Induced Delusional Disorder. For incarcerated populations and especially those with long sentences, living together for long periods fosters intimacy. Solitary confinement also produces isolation, which is a breeding ground for delusional ideas and paranoid disorders. The interaction between patients with various diagnostic characteristics of dominance and submissiveness could fuel the development of these disorders. These conditions are conducive to paranoia because of the various disordered personality types in the residents of forensic treatment centers. Hypothetically, induction could happen when a patient with suspicious and self-important cluster B personality characteristics befriends a timid, dependent, and suggestible patient with cluster C personality symptoms. The absence of several cases in these settings (prison and forensic hospitals) may be the result of underreporting or the lack of recognition of rare psychiatric syndromes in the penal system.

Such cases are intriguing in the sense that the delusions are not bizarre, were shared strongly, and influenced the patients' functioning. These features are characteristic of Shared Delusional Disorder in 3 patients. Their delusions are held despite incontrovertible proof to the contrary. Although the 3 were non-white, they were only significantly different from the remainder of the patients in their belief in the delusions. The center catered to the mental health needs of over 200 patients, 70% to 80% of whom were non-white. The two induced patients had never expressed those beliefs prior to the inducer's admission to the center. The inducer was the last of the three to be admitted to the center. He was also the oldest, commanding the respect and seniority needed to produce a domineering tendency. He was also looked on as a respected older person by the two induced patients. The first induced patient was vulnerable to desiring early release because of his long sentence. His previous schizophrenic delusions were extended in the form of folie induite (induced psychosis). The third patient, the second one induced, manifested a strong desire to feel important and had recently thought of himself as having a high "social status." The loss of status may have led him to identify with the promises of the delusions. His represented a case described as folie imposée (imposed psychosis). Separation from the inducer led to a loss of delusional beliefs in his case. Furthermore, he was reported to be a slow learner and was thought to have mental retardation. His psychological assessment placed him at the lower end of the normal intelligence range. It is therefore still possible that diminished intelligence, known as a significant etiological factor in developing Shared Delusional Disorder, may have played a part in his case.

This case extends the debate regarding the gene-environment interaction in the development of delusional disorders. Separation, a simple environmental manipulation with therapeutic effects, weakens the genetic argument. This notion is not conclusive, as there are cases of resistance after separation. However, the diagnosis of schizophrenia in the first induced patient and drug-induced delirium with low-normal intelligence in the second induced patient strengthens the idea of genetic and organic pathogeneses of the disorder. Organic brain syndromes and substances like methylphenidate and cannabis have been factors strongly associated with Induced Delusional Disorder. This connection is especially applicable in the case of the second induced patient. The use of psychotropic medication, cognitive verbal challenge, empirical provision of alternative explanations to erroneous beliefs, and the environmental manipulation of the patients resulted in moderate improvements, thus confirming the pathoplastic nature of the origins of the disorder.

T'is very interesting!

[erand]

University of Washington School of Law says that at least 1 out of every 5 of their law students seeks counseling during the course of law school. (if 1/5 law students actually seek counseling, the numbers of students who could actually benefit from counseling is substantially higher.)

If the student has insurance plan, she may receive 15 out-patient mental health visits per policy year. In addition to outside resources, the Law School has a mental health professional on call; services are free of charge to law students. For both financial and workload reasons, the doctor accepts clients on a referral basis.

Sometimes, however, people who could benefit from counseling do not feel as though counseling is necessary. If you have had two or more of the following symptoms for longer than a few days, please seek evaluation and treatment as soon as possible.

The Dysphoric Array:
- Mixture of anxiety, depression, and hostility
- Thoughts of killing self
- Feeling so unhappy that you can not shake it
- Dissatisfied or bored with most aspects of life
- Nicotine use (the most efficient anti-dysphoric on the legal market - significant cancer risk attached)
- Disrupted sleep - never feeling sufficiently rested
- Increased social isolation
- Limiting normal exercise patterns

The Alcohol/Drug Dependent Array:
- Managing sleep patterns through using substance
- Feeling guilty about your use of alcohol or drugs
- Drinking or using drugs creates problems between you and your partner, parent, or relatives
- Neglecting your obligations for longer than a day because of negative consequences related to use
- No memory of time period during use
- Increased social isolation
- Limiting normal exercise patterns

DEPRESSION (di-pres/en) -- a lowering of vital energy (Webster's Dictionary)

Depression is a broad term used to refer to a range of different diseases recognized by the medical field. We also use the term to refer to temporary and minor negative feelings (i.e. I'm depressed because the Pacers lost last night or the post-holiday blues.) Depressive illnesses include major depression, the bipolar disorders, dysthymia, cyclothymia, and variations of these based on timing of the onset (i.e. seasonal or post partum), duration of symptoms, or severity of symptoms. These illnesses impact over 19 million adults in America each year. Depression is frequently seen as a complicating factor in heart attack, stroke, diabetes and cancer patients. In fact, depression increases one's risk of having a heart attack. Almost anyone who kills him or herself suffers from a mental disorder, most often a form of depression or substance abuse or both.

The key factor in diagnosing most of these illnesses is the presence of a major depressive episode. To be diagnosed with a major depressive episode your symptoms must last at least 2 weeks. The symptoms must also appear to be a change from previous functioning. There are people who resemble Winnie the Pooh's Eyre their whole life but are not depressed. The symptoms of a major depressive disorder include:

• Depressed mood.
• Diminished interest or pleasure in most activities.
• Significant weight loss or gain without effort or loss of appetite.
• Difficulty sleeping or sleeping too much.
• Psychomotor agitation or retardation.
• Fatigue.
• Feelings of worthlessness or excessive or inappropriate guilt.
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death, suicidal ideation, or a suicide attempt or plan.

Thankfully, most people do not experience all of the symptoms. To be diagnosed with a major depressive episode one must experience at least 5 of the above symptoms and 1 of the 5 must be either depressed mood or diminished interest or pleasure in most activities. If one meets several of these symptoms, but less than 5, there are milder depressive disorders that can still be diagnosed. It is important to remember that each person will experience a different set of symptoms with their depression and that the symptoms will look different with different people. No two people will experience depression in exactly the same manner. There are, however, some common themes that do repeat themselves, particularly in lawyers. In lawyers the most common symptoms are closely related to the work we are trying to do. Reduced ability to concentrate is one of the most bothersome symptoms for attorneys. They may have had trouble sleeping and a poor appetite for some time but attorneys often seek treatment when they realize that their ability to concentrate and get their work done is compromised. When you add together reduced ability to concentrate with fatigue and loss of interest in most all activities it is highly likely that the attorney's work is going to suffer at least in quantity if not in quality. In addition, attorneys in this condition often try to remedy the problem by working longer hours to keep up on the quantity of their work. In doing so they reduce contact with significant, supportive people in their life, reduce the amount of time they spend on exercise, hobbies, and other stress reducing activities, and cut back further on what is most likely already inadequate sleep. In their attempts to solve the problem they are doing the opposite of what they need and falling deeper into the hole of depression.

If you have a strong family history of depression you may decide that it is best to stay on medication for some time. On the other hand, if you have no family history and your depression occurred during the year that your divorce was final, your mother died, and you lost your job, you might have more of an acute and situational depression and might not be on medication very long. Regardless, the skills you learn in therapy are what will help you to avoid future episodes of depression. This is critical because it is generally accepted in the psychiatric field that if you have one episode of depression there is a 50% chance that you will have a second episode. If you have a second episode of depression there is a 70% chance that you will have a third episode and if you have a third episode there is a 90% chance that you will have yet another episode. Clearly, it is worthwhile to do all you can to treat a first episode of depression to increase the chances that it will be your only experience with depression.

[aria]

Delusions of reference are the ones that are more "fun" -- they generally include experiences such as:

• feeling that people on television or radio are talking about, or talking directly to them
• believing that headlines or stories in newspapers are written especially for them
• having the experience that people (often strangers) drop hints or say things about them behind their back
• believing that events (even world events) have been deliberately contrived for them, or have special personal significance
• seeing objects or events as being deliberately set up to convey a special or particular meaning

You think the narcissist's ideas of reference are less "fun"? The narcissist is the centre of the world. He is not merely the centre of HIS world -- as far as he can tell, he is the centre of THE world. This Archimedean delusion is one of the narcissist's most predominant and all-pervasive cognitive distortions. The narcissist feels certain that he is the source of all events around him, the origin of all the emotions of his nearest or dearest, the fount of all knowledge, both the first and the final cause, the beginning as well as the end.

This is understandable.

The narcissist derives his sense of being, his experience of his own existence, and his self-worth from the outside. He mines others for Narcissistic Supply -- adulation, attention, reflection, fear. Their reactions stoke his furnace. Absent Narcissistic Supply -- the narcissist disintegrates and self-annihilates. When unnoticed, he feels empty and worthless. The narcissist MUST delude himself into believing that he is persistently the focus and object of the attentions, intentions, plans, feelings, and stratagems of other people. The narcissist faces a stark choice - either be (or become) the permanent centre of the world, or cease to be altogether. This constant obsession with one's locus, with one's centrality, with one's position as a hub -- leads to referential ideation ("ideas of reference"). This is the conviction that one is at the receiving end of other people's behaviours, speech, and even thoughts. The person suffering from delusional ideas of reference is at the centre and focus of the constant (and confabulated) attentions of an imaginary audience.

When people talk -- the narcissist is convinced that he is the topic of discussion. When they quarrel -- he is most probably the cause. When they smirk -- he is the victim of their ridicule. If they are unhappy -- he made them so. If they are happy -- they are egotists for ignoring him. He is convinced that his behaviour is continuously monitored, criticized, compared, dissected, approved of, or imitated by others. He deems himself so indispensable and important, such a critical component of other people's lives, that his every act, his every word, his every omission -- is bound to upset, hurt, uplift, or satisfy his audience. And, to the narcissist, everyone is but an audience. It all emanates from him -- and it all reverts to him. The narcissist's is a circular and closed universe. His ideas of reference are a natural extension of his primitive defence mechanisms (omnipotence, omniscience, omnipresence). Being omnipresent explains why everyone, everywhere is concerned with him. Being omnipotent and omniscient excludes other, lesser, beings from enjoying the admiration, adulation, and attention of people.

Yet, the attrition afforded by years of tormenting ideas of reference inevitably yields paranoiac thinking. To preserve his egocentric cosmology, the narcissist is compelled to attribute fitting motives and psychological dynamics to others. Such motives and dynamics have little to do with reality. They are PROJECTED by the narcissist UNTO others so as to maintain his personal mythology. In other words, the narcissist attributes to others HIS OWN motives and psychodynamics. And since narcissists are mostly besieged by transformations of aggression (rage, hatred, envy, fear) -- these they often attribute to others as well. Thus, the narcissist tends to interpret other people's behaviour as motivated by anger, fear, hatred, or envy and as directed at him or revolving around him. The narcissist (often erroneously) believes that people discuss him, gossip about him, hate him, defame him, mock him, berate him, underestimate him, envy him, or fear him. He is (often rightly) convinced that he is, to others, the source of hurt, humiliation, impropriety, and indignation. The narcissist "knows" that he is a wonderful, powerful, talented, and entertaining person -- but this only explains why people are jealous and why they seek to undermine and destroy him. Thus, since the narcissist is unable to secure the long term POSITIVE love, admiration, or even attention of his Sources of Supply -- he resorts to a mirror strategy. In other words, the narcissist becomes paranoid. Better to be the object of (often imaginary and always self inflicted) derision, scorn, and bile -- than to be ignored. Being envied is preferable to being treated with indifference. If he cannot be loved -- the narcissist would rather be feared or hated than forgotten.

[libo]

Depression is a broad term used to refer to a range of different diseases recognized by the medical field. We also use the term to refer to temporary and minor negative feelings (i.e. I'm depressed because the Pacers lost last night or the post-holiday blues.) Depressive illnesses include major depression, the bipolar disorders, dysthymia, cyclothymia, and variations of these based on timing of the onset (i.e. seasonal or post partum), duration of symptoms, or severity of symptoms. These illnesses impact over 19 million adults in America each year. Depression is frequently seen as a complicating factor in heart attack, stroke, diabetes and cancer patients. In fact, depression increases one's risk of having a heart attack. Almost anyone who kills him or herself suffers from a mental disorder, most often a form of depression or substance abuse or both.

The key factor in diagnosing most of these illnesses is the presence of a major depressive episode. To be diagnosed with a major depressive episode your symptoms must last at least 2 weeks. The symptoms must also appear to be a change from previous functioning. There are people who resemble Winnie the Pooh's Eyre their whole life but are not depressed. The symptoms of a major depressive disorder include:

• Depressed mood.
• Diminished interest or pleasure in most activities.
• Significant weight loss or gain without effort or loss of appetite.
• Difficulty sleeping or sleeping too much.
• Psychomotor agitation or retardation.
• Fatigue.
• Feelings of worthlessness or excessive or inappropriate guilt.
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death, suicidal ideation, or a suicide attempt or plan.

Depression is a form of aggression. Transformed, this aggression is directed at the depressed person rather than at his environment. This regime of repressed and mutated aggression is a characteristic of both narcissism and depression. Originally, the narcissist experiences "forbidden" thoughts and urges (sometimes to the point of an obsession). His mind is full of "dirty" words, curses, the remnants of magical thinking ("If I think or wish something it just might happen"), denigrating and malicious thinking concerned with authority figures (mostly parents or teachers). These are all proscribed by the Superego. This is doubly true if the individual possesses a sadistic, capricious Superego (a result of the wrong kind of parenting). These thoughts and wishes do not fully surface. The individual is only aware of them in passing and vaguely. But they are sufficient to provoke intense guilt feelings and to set in motion a chain of self-flagellation and self-punishment. Amplified by an abnormally strict, sadistic, and punitive Superego -- this results in a constant feeling of imminent threat. This is what we call anxiety. It has no discernible external triggers and, therefore, it is not fear. It is the echo of a battle between one part of the personality, which viciously wishes to destroy the individual through excessive punishment -- and the instinct of self-preservation.

Anxiety is not an irrational reaction to internal dynamics involving imaginary threats. Actually, anxiety is more rational than many fears. The powers unleashed by the Superego are so enormous, its intentions so fatal, the self-loathing and self-degradation that it brings with it so intense -- that the threat is real. Overly strict Superegos are usually coupled with weaknesses and vulnerabilities in all other personality structures. Thus, there is no psychic structure able to fight back, to take the side of the depressed person. Small wonder that depressives have constant suicidal ideation (they toy with ideas of self-mutilation and suicide), or worse, commit such acts. Confronted with a horrible internal enemy, lacking in defences, falling apart at the seams, depleted by previous attacks, devoid of energy of life -- the depressed wishes himself dead. Anxiety is about survival, the alternatives being, usually, self-torture or self-annihilation. Depression is how such people experience their overflowing reservoirs of aggression. They are a volcano, which is about to explode and bury them under their own ashes. Anxiety is how they experience the war raging inside them. Sadness is the name that they give to the resulting wariness, to the knowledge that the battle is lost and personal doom is at hand. Depression is the acknowledgement by the depressed individual that something is so fundamentally wrong that there is no way he can win. The individual is depressed because he is fatalistic. As long as he believes that there is a chance -- however slim -- to better his position, he moves in and out of depressive episodes.

True, anxiety disorders and depression (mood disorders) do not belong in the same diagnostic category. But they are very often comorbid. In many cases, the patient tries to exorcise his depressive demons by adopting ever more bizarre rituals. These are the compulsions, which -- by diverting energy and attention away from the "bad" content in more or less symbolic (though totally arbitrary) ways -- bring temporary relief and an easing of the anxiety. It is very common to meet all 4: a mood disorder, an anxiety disorder, an obsessive-compulsive disorder and a personality disorder in one patient. Depression is the most varied of all psychological illnesses. It assumes a myriad of guises and disguises. Many people are chronically depressed without even knowing it and without corresponding cognitive or affective contents. Some depressive episodes are part of a cycle of ups and downs (bipolar disorder and a milder form, the cyclothymic disorder). Other depressions are "built into" the characters and the personalities of the patients (the dysthymic disorder or what used to be known as depressive neurosis). One type of depression is even seasonal and can be cured by photo-therapy (gradual exposure to carefully timed artificial lighting). We all experience "adjustment disorders with depressed mood" (used to be called reactive depression -- which occurs after a stressful life event and as a direct and time-limited reaction to it). These poisoned garden varieties are all-pervasive. Not a single aspect of the human condition escapes them, not one element of human behaviour avoids their grip. It is not wise (has no predictive or explanatory value) to differentiate "good" or "normal" depressions from "pathological" ones. There are no "good" depressions.

[libo]

Whether provoked by misfortune or endogenously (from the inside), whether during childhood or later in life -- it is all one and the same. A depression is a depression is a depression no matter what its precipitating causes are or in which stage in life it appears. The only valid distinction seems to be phenomenological: some depressives slow down (psychomotor retardation), their appetite, sex life (libido) and sleep (known together as the vegetative) functions are notably perturbed. Behaviour patterns change or disappear altogether. These patients feel dead: they are anhedonic (find pleasure or excitement in nothing) and dysphoric (sad). The other type of depressive is psychomotorically active (at times, hyperactive), reporting overwhelming guilt feelings, anxiety, even to the point of having delusions (delusional thinking, not grounded in reality but in a thwarted logic of an outlandish world). The most severe cases (severity is also manifest physiologically, in the worsening of the above-mentioned symptoms) exhibit paranoia (delusions of systematic conspiracies to persecute them), and seriously entertain ideas of self-destruction and the destruction of others (nihilistic delusions). They hallucinate. Their hallucinations reveal their hidden contents: self-deprecation, the need to be (self) punished, humiliation, "bad" or "cruel" or "permissive" thoughts about authority figures. Depressives are almost never psychotic (psychotic depression does not belong to this family). Depression does not necessarily entail a marked change in mood. "Masked depression" is, therefore, difficult to diagnose if we stick to the strict definition of depression as a "mood" disorder.

Depression can happen at any age, to anyone, with or without a preceding stressful event. It can set on gradually or erupt dramatically. The earlier it occurs -- the more likely it is to recur. This apparently arbitrary and shifting nature of depression only enhances the guilt feelings of the patient. He refuses to accept that the source of his problems is beyond his control (at least as much as his aggression) and could be biological, for instance. The depressive patient always blames himself, or events in his immediate past, or his environment. This is a vicious and self-fulfilling prophetic cycle. The depressive feels worthless, doubts his future and his abilities, feels guilty. This constant brooding alienates his dearest and nearest. His interpersonal relationships become distorted and disrupted and this, in turn, exacerbates his depression. The patient finally finds it most convenient and rewarding to avoid human contact altogether. He resigns from his job, shies away from social occasions, sexually abstains, shuts off his few remaining friends and family members. Hostility, avoidance, histrionics all emerge and the existence of personality disorders only make matters worse. Freud said that the depressive person had lost a love object (was deprived of a properly functioning parent). The psychic trauma suffered early on can be alleviated only by inflicting self-punishment (thus implicitly "punishing" and devaluing the internalised version of the disappointing love object). The development of the Ego is conditioned upon a successful resolution of the loss of the love objects (a phase all of us have to go through). When the love object fails -- the child is furious, revengeful, and aggressive. Unable to direct these negative emotions at the frustrating parent -- the child directs them at himself. Narcissistic identification means that the child prefers to love himself (direct his libido at himself) than to love an unpredictable, abandoning parent (mother, in most cases). Thus, the child becomes his own parent -- and directs his aggression at himself (to the parent that he has become). Throughout this wrenching process, the Ego feels helpless and this is another major source of depression.

When depressed, the patient tars his life, people around him, his experiences, places, and memories with a thick brush of schmaltzy, sentimental, and nostalgic longing. The depressive imbues everything with sadness: a tune, a sight, a colour, another person, a situation, a memory. In this sense, the depressive is cognitively distorted. He interprets his experiences, evaluates his self and assesses the future totally negatively. He behaves as though constantly disenchanted, disillusioned, and hurting (dysphoric affect) and this helps to sustain the distorted perceptions. No success, accomplishment, or support can break this cycle because it is so self-contained and self-enhancing. Dysphoric affect supports distorted perceptions, which enhance dysphoria, which encourages self-defeating behaviours, which bring about failure, which justifies depression. This is a cosy little circle, charmed and emotionally protective because it is unfailingly predictable. Depression is addictive because it is a strong love substitute. Much like drugs, it has its own rituals, language and worldview. It imposes rigid order and behavior patterns on the depressive. This is learned helplessness -- the depressive prefers to avoid situations even if they hold the promise of improvement. The depressive patient has been conditioned by repeated aversive stimuli to freeze -- he does not even have the energy needed to exit this cruel world by committing suicide. The depressive is devoid of the positive reinforcements, which are the building blocks of our self-esteem. He is filled with negative thinking about his self, his (lack of) goals, his (lack of) achievements, his emptiness and loneliness and so on. And because his cognition and perceptions are deformed -- no cognitive or rational input can alter the situation. Everything is immediately reinterpreted to fit the paradigm.

[bon gre mal gre]

Delusions of reference are the ones that are more "fun" -- they generally include experiences such as:

• feeling that people on television or radio are talking about, or talking directly to them
• believing that headlines or stories in newspapers are written especially for them
• having the experience that people (often strangers) drop hints or say things about them behind their back
• believing that events (even world events) have been deliberately contrived for them, or have special personal significance
• seeing objects or events as being deliberately set up to convey a special or particular meaning

You think the narcissist's ideas of reference are less "fun"? The narcissist is the centre of the world. He is not merely the centre of HIS world -- as far as he can tell, he is the centre of THE world. This Archimedean delusion is one of the narcissist's most predominant and all-pervasive cognitive distortions. The narcissist feels certain that he is the source of all events around him, the origin of all the emotions of his nearest or dearest, the fount of all knowledge, both the first and the final cause, the beginning as well as the end.

This is understandable.

The narcissist derives his sense of being, his experience of his own existence, and his self-worth from the outside. He mines others for Narcissistic Supply -- adulation, attention, reflection, fear. Their reactions stoke his furnace. Absent Narcissistic Supply -- the narcissist disintegrates and self-annihilates. When unnoticed, he feels empty and worthless. The narcissist MUST delude himself into believing that he is persistently the focus and object of the attentions, intentions, plans, feelings, and stratagems of other people. The narcissist faces a stark choice - either be (or become) the permanent centre of the world, or cease to be altogether. This constant obsession with one's locus, with one's centrality, with one's position as a hub -- leads to referential ideation ("ideas of reference"). This is the conviction that one is at the receiving end of other people's behaviours, speech, and even thoughts. The person suffering from delusional ideas of reference is at the centre and focus of the constant (and confabulated) attentions of an imaginary audience.

When people talk -- the narcissist is convinced that he is the topic of discussion. When they quarrel -- he is most probably the cause. When they smirk -- he is the victim of their ridicule. If they are unhappy -- he made them so. If they are happy -- they are egotists for ignoring him. He is convinced that his behaviour is continuously monitored, criticized, compared, dissected, approved of, or imitated by others. He deems himself so indispensable and important, such a critical component of other people's lives, that his every act, his every word, his every omission -- is bound to upset, hurt, uplift, or satisfy his audience. And, to the narcissist, everyone is but an audience. It all emanates from him -- and it all reverts to him. The narcissist's is a circular and closed universe. His ideas of reference are a natural extension of his primitive defence mechanisms (omnipotence, omniscience, omnipresence). Being omnipresent explains why everyone, everywhere is concerned with him. Being omnipotent and omniscient excludes other, lesser, beings from enjoying the admiration, adulation, and attention of people.

Yet, the attrition afforded by years of tormenting ideas of reference inevitably yields paranoiac thinking. To preserve his egocentric cosmology, the narcissist is compelled to attribute fitting motives and psychological dynamics to others. Such motives and dynamics have little to do with reality. They are PROJECTED by the narcissist UNTO others so as to maintain his personal mythology. In other words, the narcissist attributes to others HIS OWN motives and psychodynamics. And since narcissists are mostly besieged by transformations of aggression (rage, hatred, envy, fear) -- these they often attribute to others as well. Thus, the narcissist tends to interpret other people's behaviour as motivated by anger, fear, hatred, or envy and as directed at him or revolving around him. The narcissist (often erroneously) believes that people discuss him, gossip about him, hate him, defame him, mock him, berate him, underestimate him, envy him, or fear him. He is (often rightly) convinced that he is, to others, the source of hurt, humiliation, impropriety, and indignation. The narcissist "knows" that he is a wonderful, powerful, talented, and entertaining person -- but this only explains why people are jealous and why they seek to undermine and destroy him. Thus, since the narcissist is unable to secure the long term POSITIVE love, admiration, or even attention of his Sources of Supply -- he resorts to a mirror strategy. In other words, the narcissist becomes paranoid. Better to be the object of (often imaginary and always self inflicted) derision, scorn, and bile -- than to be ignored. Being envied is preferable to being treated with indifference. If he cannot be loved -- the narcissist would rather be feared or hated than forgotten.

Great post aria!

[AnneBoleyn]

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