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Appendix: Object Relations Theories and NarcissismOtto Kernberg (1975 order bactrim 480mg with visa, 1984 order 960 mg bactrim overnight delivery, 1987) disagrees with Freud. He regards the division between an "object libido" (energy directed at objects, meaningful others, people in the immediate vicinity of the infant) and a "narcissistic libido" (energy directed at the self as the most immediate and satisfying object), which precedes it - as spurious. Whether a child develops normal or pathological narcissism depends on the relations between the representations of the self (roughly, the image of the self that the child forms in his mind) and the representations of objects (roughly, the images of other people that the child forms in his mind, based on all the emotional and objective information available to him). It is also dependent on the relationship between the representations of the self and real, external, "objective" objects. Add to these instinctual conflicts related to both the libido and to aggression (these very strong emotions give rise to strong conflicts in the child) and a comprehensive explanation concerning the formation of pathological narcissism emerges. The self is dependent upon the unconscious, which exerts a constant influence on all mental functions. Pathological narcissism, therefore, reflects a libidinal investment in a pathologically structured self and not in a normal, integrative structure of the self. The narcissist suffers because his self is devalued or fixated on aggression. All object relations of such a self are distorted: it detaches from real objects (because they hurt him often), dissociates, represses, or projects. Narcissism is not merely a fixation on an early developmental stage. It is not confined to the failure to develop intra-psychic structures. It is an active, libidinal investment in a deformed structure of the self. Franz Kohut regarded narcissism as the final product of the failing efforts of parents to cope with the needs of the child to idealise and to be grandiose (for instance, to be omnipotent). Idealisation is an important developmental path leading to narcissism. This exerts an enormous and all-important influence on the processes of re-internalisation (the processes in which the child re-introduces the objects and their images into his mind) in each of the successive phases. Through these processes, two permanent nuclei of the personality are constructed:The basic, neutralising texture of the psyche, andBoth of them are characterised by an invested instinctual narcissistic cathexis (invested energy of self-love which is instinctual). As he grows, he begins to notice their shortcomings and vices. He withdraws part of the idealising libido from the images of the parents, which is conducive to the natural development of the Superego. This is largely true until the "child" re-internalises the ideal parent image. Also, the very construction of the mental apparatus can be tampered with by traumatic deficiencies and by object losses right through the Oedipal period (and even in latency and in adolescence). The same effect can be attributed to traumatic disappointment by objects. Disturbances leading to the formation of NPD can be thus grouped into:Very early disturbances in the relationship with an ideal object. These lead to a structural weakness of the personality, which develops a deficient and/or dysfunctional stimuli-filtering mechanism. The ability of the individual to maintain a basic narcissistic homeostasis of the personality is damaged. Such a person suffers from diffusive narcissistic vulnerability. A disturbance occurring later in life - but still pre-Oedipally - affects the pre-Oedipal formation of the basic mechanisms for controlling, channelling, and neutralising drives and urges. The nature of the disturbance has to be a traumatic encounter with the ideal object (such as a major disappointment). The symptomatic manifestation of this structural defect is the propensity to re-sexualise drive derivatives and internal and external conflicts, either in the form of fantasies or in the form of deviant acts. A disturbance formed in the Oedipal or even in the early latent phases - inhibits the completion of the Superego idealisation. This is especially true of a disappointment related to an ideal object of the late pre-Oedipal and the Oedipal stages, where the partly idealised external parallel of the newly internalised object is traumatically destroyed. Such a person possesses a set of values and standards, but he is always on the lookout for ideal external figures from whom he aspires to derive the affirmation and the leadership that he cannot get from his insufficiently idealised Superego. Video and chat interviews with Sam Vaknin, self-proclaimed narcissist and expert in narcissism and narcissistic abuse. Extensive collection of videos on narcissism, Narcissistic Personality Disorder (NPD) and the narcissist. Sam Vaknin, author of Malignant Self Love: Narcissism Revisited provides comprehensive information on narcissism and the narcissist. Get insight into what makes the narcissist tick, the different types of narcissists, the Narcissistic Personality Disorder diagnosis, narcissism and coexisting psychiatric conditions. Click on any of the arrows to start the video then mouse-over the bottom black bar to see the selection of videos.

It takes time and work to decide what to do and where to go with the new and changed life that is left behind discount bactrim 960 mg line. The bereaved need others: Find others who are patient order 960mg bactrim with mastercard. 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. 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. BOODMAN The Washington PostSeptember 24 1996, Page Z14It is unlike any other treatment in psychiatry, a therapy that still arouses such passionate controversy after 60 years that supporters and opponents cannot even agree on its name. Proponents call it electroconvulsive therapy, or ECT. They say it is an unfairly maligned, poorly understood and remarkably effective treatment for intractable depression. They claim that it temporarily "lifts" depression by causing transient personality changes similar to those seen in head injury patients: euphoria, confusion and memory loss. Electrodes connected to an ECT machine, which resembles a stereo receiver, are attached to the scalp of a patient who has received general anesthesia and a muscle relaxant. With the flip of a switch the machine delivers enough electricity to power a light bulb for a fraction of a second. A few minutes later the patient wakes up severely confused and without any memory of events surrounding the treatment, which is typically repeated three times a week for about a month. No one knows how or why ECT works, or what the convulsion, similar to a grand mal epileptic seizure, does to the brain. But many psychiatrists and some patients who have undergone ECT say it succeeds when all else -- drugs, psychotherapy, hospitalization -- have failed. The American Psychiatric Association (APA) says that about 80 percent of patients who undergo ECT show substantial improvement. By contrast antidepressant drugs, the cornerstone of treatment for depression, are effective for 60 to 70 percent of patients. There is no doubt that mainstream medicine is solidly behind ECT. The National Institutes of Health has endorsed it and for years has funded research into the treatment. The National Alliance for the Mentally Ill, an influential lobbying group composed of relatives of people with chronic mental illness, supports the use of ECT as does the National Depressive and Manic Depressive Association, an organization composed of psychiatric patients. And the Food and Drug Administration has proposed relaxing restrictions on the use of ECT machines, even though the devices have never undergone the rigorous safety testing that has been required of medical devices for the past two decades. In the past three years a few of these institutions have begun to use the treatment on children, some as young as 8. Managed care organizations, which have sharply cut back on reimbursement for psychiatric treatment, apparently look with favor upon ECT, even though it is performed in a hospital and typically requires the presence of two physicians -- a psychiatrist and an anesthesiologist -- and, sometimes, a cardiologist as well. The cost per treatment ranges from $300 to more than $1,000 and takes about 15 minutes. Increasingly, the treatment is being administered on an outpatient basis. In the Washington area more than a dozen hospitals perform ECT, according to Frank Moscarillo, executive director of the Washington Society for ECT and chief of the ECT service at Sibley Hospital, a private hospital in Northwest Washington. Moscarillo said that Sibley administers about 1,000 ECT treatments annually, more than all other local hospitals combined. We have not run into a situation where a managed care company cut us off prematurely. Among the few who have is talk show host Dick Cavett, who underwent ECT in 1980.