I Hear the Word Narcissism Batted Around a lot

I hear the word Narcissism batted around a lot in professional quarters these days... to the point that it becomes as meaningless as other diagnostic terms and conditions that become short hand for ways to "professionally" legitimize stigma and excuse an inability to make an impact on someone whose control over their own life looks haphazard and self destructive and resists change and "advice" offered by professionals who do that sort of thing.

For me it seems important to remember that people who have strong narcissist leanings... I mean the real ones... not just vested and assertive self interest or differences of viewpoint that are unpopular in the group think tank...  have inadequate ego strength usually because of trauma or sustained and unrelieved loss.  Their "self" is like an egg shell of necessary bravado that is presented to the world because they feel without it their real self, inside the shell, will never be able to hold together or be put back together again should the shell crack or be cracked. A Humpty Dumpty kind of thing.

Most people in treatment who are defined in this way are failed by and subsequently repulse helpers who act like “all the king’s horses and all the kings men”. They’ve got all the equipment, the armor and weapons, but none of the finesse or skill. Lots of advice, none of the authentic listening skills and ways to give the person control of the rate of their own change and its dynamics. One can’t just take away a defense system even if it is defective. One can’t expect a hardboiled egg in two minutes. I think they, those helpers, also see themselves and their own narcissistic shell represented and it repulses them… and the more they fail to make impact the more it challenges their own narcissism.

A softer and more proactive approach is required here, a kinder one I think, with the understanding that the softness inside is vulnerable to the point of being unformed (or its vulnerability creates a terror of being unformed); but it is also the place where the heart is and it is generally tougher than supposed.

-- Bob Vance

THE OPPOSITE OF PTSD AND WHAT IT LOOKS LIKE

It's time to start thinking about the opposite of PTSD and what it looks like.

Yesterday it thundered and rained much of the day. Every time I found myself out in the rain and listening to the thunder I was transported, quite viscerally, back to my backpacking trip on North Manitou Island in August.

One morning on that trip I woke in the morning and heard some rumbling coming from over the lake. Storms can come from over the water and can often be heard approaching for hours before they "arrive".

I thought I should make a decision to either stay put, get rained on, let my gear dry out, and then proceed to pack up and go on to the place I wanted to be that night, a wonderful lake in the middle of the island (I had been camping on the west shore of the island for two nights), or skip breakfast, pack up right away, and risk getting rained on while I walked, so I could get to the lake early enough to dry up anything necessary before nightfall. I wanted to spend as much time at the lake as possible. It is one of my spirit spots, a truly brilliant place. I decided to get going. I packed up, walked across the field through high underbrush, where there used to be a lakeside village a hundred years before, to the entrance of the woods.

It was getting darker and darker as I walked. I wanted to at least get into the trees before the rain started. I thought I would get less wet. That was true for a while after the rain started. The old growth beech/maple forest was very dark and a little foreboding as the rain started. I felt a bit like Hansel or Gretel walking through the woods, although I was leaving no breadcrumb trail. After about an hour of walking with the rain barely reaching me through the trees, making incredible music through the leaves, the rumbling became louder and more insistent. The rains started in earnest. A fine symphonic roar. The thunder crashed and the lightning was rapids and startling in its urgency.

This went on for about another hour or more. Yes, I was wet, but I was also completely in awe. As it rained the darkness of the storm started to abate. It grew lighter by degrees, and soon there were shafts of filtered light breaking through the pillars and arches of the trees. The wind swelled the orchestration from the rain and the water left in the trees as it was blown off the leaves. I was soaked. My gear was dry for the most part because of a strategically employed garbage bag. I had not seen another person the entire walk and would not until hours later after I had arrived at the lake, taken a swim and had something to eat. By then the sky was almost clear and clean, bright and hot. I was elevated and completely happy. Maslow might call it self-actualized, but I'm not sure that description does the state of being justice. Connected. A Part of the Whole. Convinced of the Integrated Nature of Living. Unexplainable. To be felt. To be remembered.

This is the state I re-experienced every time I heard the thunder and rain yesterday. Reverse PTSD.

In PTSD flashbacks we are forced by the way in which our mind/body connection builds its defenses to replay vivid remembrances of how we've been hurt. So we can avoid being hurt again, or remember how we maneuvered through that hurt. The opposite of this would be an experience like the one I have described... the ability to relive, re-feel, the excellence and spiritual heights that our lives here offer us as often, at least, as it offers us reminders of what has caused pain.

Some Thoughts About the Nature of Successful Addiction Recovery Programs

A successful program would not base effectiveness solely on sobriety, regardless of how ideal that state might be for the addict.

How many of us exist in the ideal state of our goals, dreams and hopes? Why do we insist on it for addicts? Individuation would necessarily dictate that there are people who are more seriously afflicted than others, and in innumerable individual combinations of ways. In that way it becomes essential to re-commit and re-assure those who have more difficulty with the intensity of their addiction, rather than assume weakness of will, intentional sabotage, or fear that failure of the power of intervention is at the basis of any presumed “failure”.

The ultimate test of the success of an addiction program is if it incorporates the understanding that individuation is a primary feature of the human brain and of human behavior. In that way the degree of intensity with which each individual is afflicted by the multi-faceted dis-ease of addiction would be the primary factor in the design of each person's "program" for recovery. Each program would stay, change and grow, evolve, in place regardless of frequency or duration of relapse.

The power of the addiction, the acceptance of the powerlessness over the addiction, is a primary facet of developing a recovery plan that reduces damage, improves quality of life, and informs the will to succeed in whatever way one measures success for each individual. Demanding ultimate sobriety and abandoning individuals to their own means outside the support structure of the program designed to help them manage the addiction because they have a darker and more insidious struggle against addiction is re-traumatizing at the least. This kind of abandonment might best be considered to be against the basic tenets of ethics for any helping professional engaged in the treatment of addiction.

Will-power may be an important ingredient in each person’s efforts to recover, but it too comes in individuated designs and expression. Combined with such a wide spectrum of individually experienced struggles with addiction, the role of Will and its so-called lack can only really account for one piece of the puzzle of why people succumb and relapse.

It is beyond judgmental, and in the end cruel and self-serving, to demand that Will be the primary attribute that determines a person’s success or failure when it is present in such a variety of degrees and presentations. Successful programs, then, would by necessity be required to re-examine and re-calibrate all of these forgone, generally counter-transference based, and all-too-common provider cultural attitudes about relapse and the role of Will in order to be determined to be successful.

Success would be less measured in terms of sobriety but by other means more fitting to the nature of what is possible according to each individual’s spectrum of abilities and strengths as opposed to what is preferable as determined by and for the provider.

Just In Time For the Holidays -- Some Thoughts About the Way Our Families Communicate

There's a short segment in the movie "Annie Hall" that I have used as an example in groups and have recommended in family meetings (I include the YouTube link to that clip at the end of this article). It's perfect for illustrating the cultural differences between what are called high context families and low context. It shows brilliantly and with great humor the kind of family differences that can emerge around the holiday dinner table.

In the clip we see Woody at Annie's family's Connecticut WASP Easter table. Quiet, no one overlaps in conversation, a lot of negative space, one conversation at a time... low context. Soon the screen divides and we are shown Woody's Brooklyn family around their table, much chatter, much conversational overlap and great ranges in dynamics of emotion and volume: high context, high emotional expression.

This range in family communication styles comes to the fore for many of us during the holidays. As families become more diverse in our society, the holiday table becomes more complicated to navigate. We all want to have closeness and love expressed during these, often rare, times of family togetherness, but often find it hard to accomplish. We go away disheartened and sometimes hurt, even when we had the best of intentions. There's a roller coaster ride aspect to the holiday table that makes it difficult for some people to feel comfortable.

I think there is a lot of bias toward low context problem solving in this culture when both are equally fraught with pitfalls and potential relationship dysfunction on a catastrophic level (as opposed to your every day "normal" dysfunction).

I prefer the high context scenario myself, and while that might be a bias, I think more damage is done when people withhold the intensity of feelings that they have and sanitize, silence or pervert them into indirect passive aggression.

Direct, passionate communication is scary stuff for many people from low context/passive aggressively based family systems. Just as many folks from more assertive/aggressive backgrounds and cultures can actually become a little unhinged in a group that is anchored in passive aggressive coping and problem solving strategies.

I believe there are studies that show that passive aggressive behavior is ultimately much more damaging and less likely to be adequately addressed and soothed than behavior on the aggressive end of the spectrum that is easily identified and named, harder to deny. People/families acclimated to it can often be enlisted to be much more readily committed to problem solving and admitting their feelings and shortfalls.

What is thought to be "Yelling" in passively instructed families/groups/systems can be quite mild on the spectrum/range. But avoidance of all conflict that elicits raised voices can be really destructive in the end. Perhaps it would be better to call acting out in passive aggressive ways a kind of yelling as well.

Some people, of course, are simply not equipped to engage in a dynamic passionate manner, and so will not, should not... and often find ways to manage the high emotional states that everyone has in other ways.

It is not so important to attempt to conform yourself or your family to a particular style that appears from the outside to be more "perfect" than your own. The primary strength for each of us, and each of our families, lies in our individuation. In that way, identification of what works about how you and your family function along the spectrum from high to low context can be as instructive and revealing as any plan to change the inherent structure of how your family communicates... especially if the plan is based on one person's judgment and not on some consensus. The holidays are rarely a time to engage in consensus building over anything but who gets the turkey leg or who can have the last of the pumpkin pie... and even that can be fraught with peril!

http://www.youtube.com/watch?v=z8TSvMx2wPI.

WHAT I LEARNED ABOUT HOARDING DISORDER THIS WEEK:

I learned that people with a hoarding disorder often do not, cannot, see the same things in their homes as someone who is visiting them. Their brains distort how the mess in their homes is perceived. If you show them a picture of the inside of their homes, they often do not recognize it as theirs, but if you take them to visit another hoarders home they are appalled.  Hoarding, as we are finding with many other brain disorders, is an integrated dysfunction: it is genetic, brain-based, and nurture based at the same time. In a culture of acquisition like this one, it can become very common and is reinforced.

Hoarders’ brains make it difficult to impossible for them to evaluate comparative worth of one thing from another.  A theme in treatment for hoarders is to try to teach them to make “quick and imperfect” decisions.

Hoarding is not OCD, although it is related. OCD is ego-dystonic, which means it brings no pleasure. Hoarding is ego-syntonic, in that it does bring pleasure. Hoarders have difficulty with jobs and with relationships for some of these related reasons: they are often unable to act as if a relationship (with friends, significant others, children) is more or less valuable than things. They are unable to recognize how their behavior devalues relationships or makes relationships equal to things. They have difficulty with prioritizing decision-making and the idea of perfectionism is a theme in how they approach day-to-day decisions. Hoarders and their hoarding very often come to the attention of authorities through Child Protective Services.

Hoarders often believe that their immense stash is valuable beyond measure and, even if they die suddenly, leaving family in charge of the clean up, they will be forever lauded because of the value of what they have left behind. The truth is that the cost of cleaning up after a hoarder has died costs families between 30,000 and 50,000 dollars.

Confrontation doesn’t work as an approach, mostly due to the manner in which the brain accommodates or produces the need to collect and store things and the inability to measure worth and discard what is unworthy. Neither does purging or forced clean up directed by a concerned friend or family, although there is often a need to do just that. Forced clean ups and purges often reinforce the need to collect and increase the frequency and amount of collection.

Hoarding at various levels occurs in up to 1 out of every twenty to one out of every fifty individuals and is more prevalent in men than in women.

Approaches, Ideas and Guidelines:

·      Cut off all paper flow

·      Steady throwing away daily

·      Throw away pieces if you can’t throw away entire objects

·      Foul the trash (to avoid retrieving)

·      Involve Family Members

·      Seek assistance to help develop guidelines for keeping vs tossing

Themes for Hoarding Behavior Change :

·      Do you want to build a legacy of trash?

·      Everything goes to the dumpster eventually

·      Build relationships with people… not things

·      Things are here to serve us, not the other way around

·      “How does this item add to my life?”

-- taken in part from  “Identifying and treating Hoarding Behaviors”

Laura M. Lokers LCSW

University of Michigan Dept. of Psychiatry

Suggested Reading: ”Stuff” R. Frost and G. Steketee. (good for both clinicians and as self help)