Narcissists & Their Relationships (Part II) by Rokelle Lerner

The Many Faces of Narcissists
Narcissists must have a constant supply of admiration and attention. In this article, I'll examine two general types of narcissists that utilize different methods to obtain this supply. I want to remind the reader that narcissism is caused by emotional and developmental trauma in childhood and their inner world is typically empty and bleak.

Cerebral Narcissists
Cerebral narcissists will try to impress others by their erudite knowledge and command of the language, which is employed not just to impress, but also to obliterate anyone who stands in their way. The body and its maintenance are a burden and a distraction. For example, this man or woman often prefers celibacy (even if he or she has a spouse).

Arrogance is the most obvious quality of this narcissist, and ruthless ambition is most apparent as they climb to the top. The cerebral narcissist is convinced that he or she is unique and should only associate with other special or high-status individuals. In fact, when accused of making mistakes, you can bet that their reaction will be explosive and malicious.

There is a profound lack of empathy for others, and contempt is shown for inferiors, who are barely recognized as human. Decisions are made without thought to the consequences for those affected. When this narcissist experiences a loss of admiration he/she will become emotionally abusive. His or her verbal acuity is such that no one stands a chance at combating an assault by a cerebral narcissist.

Although this description is hardly flattering, such a person can be charming and have qualities widely admired in our society. Intelligence, status, and power attract attention. There can be the 'appearance' of a genuine sense of benevolence towards others--though mostly in manipulative and patronizing ways.


Somatic Narcissists
A somatic narcissist uses her/his body, looks, and sexuality to romance, charm, and seduce. She is seductive and obsessive-compulsive when it comes to her body. They often think they look younger than they are; a youthful appearance is the primary source feeding their false self. Some somatic narcissists will emphasize their pride in their youthful looks by either dressing in clothes that were popular in their golden youth or wearing the styles of people much younger then they. (Ashmun 2004) Imagine the pressure of living with this self-absorbed narcissist, where a "bad hair day" might mean the demise of a relationship!

Somatic narcissists have no qualms about sharing the vivid details of their sex life, their divorce, their therapy discussion, or their underwear selections. These men and women cannot (or will not) respond to the cues of discomfort around them as they continue to prattle on about themselves.

Somatic narcissists have a marked intolerance for any imperfection in their partner. Once imperfection is acknowledged, it means the end of the fantasy of perfection.

While cerebral narcissists may tend to end their relationships with cutting words or a long diatribe of reasons, somatic narcissists tend to end their relationships with a flurry of high drama. Narcissists will make sure that their partners know how they've suffered in the relationship and, ironically, how they haven't received the compassion and empathy they deserve.

Rokelle Lerner is one of the most sought after speakers and trainers on relationships, women's issues and addicted family systems. She has inspired audiences throughout the world with her ability to address difficulties with insight, humor, and astounding clarity.


She has received numerous awards for her work with children and families including Esquire Magazine's "Top 100 Women in the U.S. Who Are Changing the Nation."  Rokelle has been an advisor and consultant with foreign governments, US agencies, corporations, schools and hundreds of individuals on relationships, boundary issues and addiction. She is also co-founder and consultant to Children Are People, Inc., a program used in thousands of schools throughout the country. Rokelle has appeared as a guest consultant on numerous television shows such as Oprah, Good Morning America, CBS Morning News and 20/20. Her articles and interviews have been featured in the Washington Post, New York Times, Newsweek, Time, People Magazine and Parents Magazine.

Rokelle has published the best selling books, Living in the Comfort Zone: The Gift of Boundaries in Relationships, Affirmations for Adult Children of Alcoholics and Affirmations for the Inner Child. Her latest book is The Object of My Affection is in My Reflection: Narcissists and Their Relationships. Ms. Lerner facilitates the InnerPath Retreats for Cottonwood de Tucson in Arizona.

Medically Prescribed Heroin

There was a very interesting study that just came out in the New England Journal of Medicine. It was a Canadian study which compared medically prescribed heroin and methadone to see which is more effective for long term, chronic, treatment refractory opioid addiction. Chronic intravenous heroin addiction is extremely difficult to treat with most patients experiencing multiple relapses and often simply dropping out of treatment. There are multiple complications including very high rates of Hepatitis C and HIV infections as well as strong association with various criminal behaviors. As most heroin addicts are unable to successfuly maintain abstinence the concept of harm reduction is often used as a goal rather than sustained abstinence. The idea is to reduce the risks of chronic communicable infections and criminal behavior by various means such as providing needle exchange programs, safe injection sites, and opioid substitution with either methadone or buprenorphine. Rates of illicit drug use and criminal behavior drop about 50% with use of methadone but there remains a large number of addicts who continue to use even while on methadone or drop out of treatment altogether.

Medically prescribed heroin has been used in Europe before but never in North America. The plan was to do the study both in Canada as well as the United States but the researchers could not get govermental approval here. At 12 months 87.8% of individuals taking the heroin remained in treatment compared to 54.1% of those on methadone and reduction in rates of illicit drug use and criminality was 67% compared with 47.7%  with methadone. The average daily dose was 392.3 milligrams per day and generally was given twice per day. It is interesting that there were 51 serious adverse events out of a total of 89,924 injections including 10 overdoses and 6 seizures. The overdoses were treated and the was no long term effect.

What was not commented on by the researchers were what the base rate of hepatitis C and HIV were and whether the one year treatment resulted in any change in newly diagnosed cases. I think this is important to know to help determine whether or not it is cost effective to provide heroin to addicts. There was also no comment on what rates of illegal diversion are seen in Europe. I also would like to see some comparison in disease rates with needle exchange programs.

I do not think that we will be seeing medically prescribed heroin in the United States in any near future but am interested in the experiences in Canada if they at some time adopt this approach.

Thought for the day

Harm reduction is controversial in the United States but I believe has real merit as an alternative strategy to abstinence and I would like to see more needle exchange programs here.

HR 3200 Health Care Reform part 4

I have been writing recently about the House proposed health care reform bill HR 3200 and why I think it is a bad way to go about reform. I do want to comment today about two different topics, that of the so called "death panels" as well as some of the positive aspects of the bill.

First of all there are no "death panels".  Pages 424-434 do  cover advance care planning consultations. I have read this section a number of times and I can see there are two areas that I believe have led to the concerns. One is the requirement for there to be a consultation between the patient and the doctor at minimum every five years regarding advance care planning. The bill outlines what must be included in this consultation.There are a number of things but I think the areas of concern are "An explanation by the practicioner of the continuum of end-of-life services and supports available" and the "reasons why the development of such an order (regarding life sustaining treatment) is beneficial to the individual and the individual's family". This coupled with  a requirement for there to be developed quality measures on end of life care and the monitoring of physician's adherence to these quality measures (page 432)  can lead one to conclude that there could be external pressure imposed by the government to try to limit life sustaining treatments. I have to say that this is worded vaguely enough that it may be possible that that is exactly what is intended. I say this partly because of the great costs of end of life care to Medicare which I will discuss in another blog. But there are no "death panels" per se.

Secondly the latter half of the bill includes a great deal which I hope can be incorporated into any health care reform bill and those are incentives to increase the number of people going into primary care specialties and the Public Health Corp along with scholarships for disadvanteged students, prevention and wellness services grants, school based health clinics and increased incentives to make it easier and more attractive to get into nursing.

I will discuss later more about end-of-life services and how this is an issue that we can't just hope will go away.

Thought for the day

" How good it is to sing praises to God for He is gracious and a song of praise is fitting"

The psalmist

HR 3200 Health Care Reform part 3

The views expressed in this blog are my own personal views and do not reflect the views of Cottonwood nor it's administration.

Well, I finally did it! I finished reading HR 3200 "America's Affordable Health Choices Act of 2009" which is the current House version of health care reform, all 1017 pages of it. I have to admit though that I skimmed sections relating to health care in Puerto Rico and a vast array of nursing home regulations. I did this because there is a great deal of controversy regarding health care reform, what it entails, what it means etc. and I like to get my facts straight before spouting off my own opinions on this bill. I wish President Obama would do the same as he continues to tell us that if we like our health plans and our doctors we don't need to change them when HR 3200 clearly indicates otherwise.

As I mentioned before the current biggest controversy is over whether or not a health care reform bill would include a "public plan option", a government sponsored Medicare like program available to all Americans regardless of age or economic status. Those of you who have followed this blog know that I am not in favor of such a plan but that is not the problem I have with HR 3200. While I am not in favor of a public plan there are many good arguments for it as well as my arguments against it and I have to admit that my arguments may be faulty. But HR 3200 does not propose simply a public plan option but proposes a complete takover of the health care system in the United States, full governmental control of what now is a public -private enterprise. For those who think this statement sounds too dramatic I invite you to read the bill yourself.

HR 3200 proposes a brand new independent government agency the Health Choices Administration headed by a Health Choices Commissioner with broad powers. The name of the agency as health choices is very Orwellian as the purpose of the agency is to ensure that we have no choices regarding health care. The Commissioner has broad powers that include:

establishing limitations on individual health insurance coverage (page 18)
establishing premium rates (page 21)
the right to full access of all financial records of any company that wants to self insure (page22)
make sure that no law can provide any incentives for a company to self insure (page 22, 23)
setting the standards for all provider networks (page 24)
determining what benefits will be covered in all basic and enhanced plans (page 30 -37)
establishes standards for coordination of benefits and reimbursements (page 40)
decides what qualifies as a "Qualified Health Benefit Plan" to which all plans must meet within 5 years of    enactment of the law (page 17)
prohibits enrollment of any new individual to any currently existing plans (page 16)
operates a "health insurance exchange" by which the government takes control of any new private plans (page  72 )
defines all terms used in health insurance coverage (page 45)
has access to individual's bank accounts to enable "real time determination" of an individual's financial responsibility (page 58)
issues a machine readable health id card that must be used before it can be determined what services you may or may not qualify for (page 58)
cancels all state mandated benefits unless the state reimburses the federal government for the increased costs (page 87)
decides which benefits any qualified plan may provide for any given service area (page 84)
imposes an 8 % payroll tax on all employers who do not offer health care coverage (page 149-150)
requires employers to provide health care coverage for part time employees (page 145-146)
taxes any individual without health care coverage (page 167)

I will discuss later some of the implications of these in regard to our freedoms and choices in health care.

Thought for the day

Universal access and coverage, yes! HR 3200 no.

HR 3200 Health Care Reform part 2

The views expressed in this blog are my own personal opinions and do not represent Cottonwood nor it's administration.

I indicated before that I would discuss further HR 3200 the House version of health care reform, " America's Affordable Health Choices Act of 2009". I know I keep on talking about various aspects of health care reform but it is an issue that will affect us all greatly.

Currently the main controversy is over whether health care reform will include a "public option" in which the Federal government would compete directly with private insurers in a plan that would be available to all of any age and regardless of income status. While I am in general opposed to a public plan option there are ways in which it could be done that I can live with but HR 3200 goes way beyond just a public plan option. I mentioned before that it represents a possible complete goverment takeover of health care delivery in the United States. That is a pretty bold and striking statement and I need to back that up by directly examining HR 3200.

First of all HR 3200 proposes a new government agency, the Health Choices Administration. This agency would be an independent agency in the executive branch. (page 41)

The Health Choices Administration would be headed by A Health Choices Commisioner appointed by the president. (page 41)

The Health Choices Commisioner would have broad powers which I will outline in a separate blog. (pages 41-470

No new person can be enrolled in any currently existing health plan as of the date that the law is enacted (page 16) For us this means that no new Cottonwood employees would be permitted to enroll in our current existing plan.

Within 5 years all currently existing health plans must conform to all the requirements of the public plan option. (page 17)

Our current health care plan cannot change any terms or conditions without it voiding the plan. This includes coverage benefits, and co - pays. (page 16-17). For us this means that we will have to continue paying higher premiums as there can be no negotiating on any benefit modifications, co -pays, or deductibles. Cottonwood administration will have no ability whatesover to negotiate with United or any other insurer that does not meet all the same qualifications as the public plan option. Cottonwood will have no other financially responsible choice other than enroll us all in a plan that meets all Federal requirements for a "Qualified Health Benefits Plan". I will outline these qualifications in a separate blog. The bottom line here is that regardless of what the president says we will not be able to keep our current plan or our doctors as we have it now.

HR 3200 cancels all state mandated benefits unless the state pays the additional costs. (page 87)

There are other changes as well which I will outline in further blogs including what a "Qualified Health Benefits Plan" is and what powers the new Health Commisioner would have.

Thought for the day

One size does not fit all.

HR 3200 Health Care Reform

The views expressed in this blog are my own personal opinions and do not represent the views of Coottnwood nor it's administration

The controversy over the type of health care reform we will have appears to be heating up and it may take some time for a  cooperative consensus to take place. I wish that we all agreed on the idea of universal access and coverage for health care and could rationally discuss the many potential ways that we can work to achieve that goal but political discussion rarely is that way.

A lot of controversy surrounds the proposed House health care bill HR 3200, the "'American Affordable Health Care Choice Act of 2009". President Obama admitted that hasn't read it. I don't believe that many congressman or senators have taken the time to read it either. So I thought I would read it. All 1,017 pages of it! I tried. I really did try. I haven't given up yet and am still working on it but have only read to page 95. I don't know how many have read proposed bills before, but they are often very confusing, are in "legalese" that most of us do not understand easily. I have read a lot of proposed bills but they have all been on much smaller scale issues.Iin addition to it's length HR 3200 is extremely confusing and complex with definitions that are not explained at the time of the word's use and have to be found later in the document. I did spend a lot of time with this and plan on continuing to do so (My wife has been and is still out of town).

I do not think anyone who closely reads even 95 pages of this bill can come to any other conclusion than   this one: This bill  proposes a complete goverment takeover of the health care system: a complete takeover that would be fully accomplished within the next five years. Those of you who have been reading this blog know that for various reasons I have been oppossed to a universal public plan option. HR 3200, however, does not just propose a government sponsored Medicare like program but a government takeover of the whole health care system. In further blogs I will outline some of the proposals in this bill and will happily discuss this bill with anyone who really does interpret it differently than I do. And all I have read is just 95 pages.

Thought for the day

I would like to see this issue rationally discussed.

Kiva Microloans

I am glad to be back writing again. I have continued to be absent due to a variety of personal problems which seem to be improved now. My family is well as am I at this point.

I want to talk about an interesting organization, Kiva. The 2006 Nobel Peace prize went to Muhmmad Yunus and Grameen Bank from Bangledesh for their pioneering work in developing the concept of micro credit. Muhmmad Yunis is an economist who saw that one way to reduce poverty was by lending small amounts of money to start up businesses in the developing world. What he noted was that often only a little capital is required to help a third world fledging business to succeed. Helping the efforts of those trying to better their situation seemed a better idea than simply charity.

Many small or start up businesses have a hard time raising the initial capital needed. Banks tend to loan money to large borrowers and require collateral as well as a great deal of paperwork. The idea instead is small loans, collateral free which can be provided even to illiterate people. The average loan amount is about $200  U.S. dollars. The repayment rate of Muhmmad's organization has been better than 98%.

In 2005 an American couple Matt Flannery and Jessica Jackson Flannery started the organization Kiva to allow the average person to be a microloan contributor by peer to peer loans through the internet which can connect an individual to microbusinesses in the developing world. It allows anyone to essentially function like the Bill Gate's Foundation with amounts of money that are reasonable for the average person. You are able to loan as little as $25. Kiva has been endorsed by Pesident Clinton and is becoming one of the world's largest microfinance facilitators. Anyone wanting more information can find it at Kiva.org.

Thought for the day

We can make a difference one life at a time.