The Myth of Mental Illness

"You can know the name of a bird in all the languages of the world, but when you're finished, you'll know absolutely nothing whatever about the bird? So let's look at the bird and see what it's doing - that's what counts. I learned very early the difference between knowing the name of something and knowing something."

Richard Feynman, Physicist and 1965 Nobel Prize laureate (1918-1988)

"You have all I dare say heard of the animal spirits and how they are transfused from father to son etcetera etcetera - well you may take my word that nine parts in ten of a man's sense or his nonsense, his successes and miscarriages in this world depend on their motions and activities, and the different tracks and trains you put them into, so that when they are once set a-going, whether right or wrong, away they go cluttering like hey-go-mad."

Lawrence Sterne (1713-1758), "The Life and Opinions of Tristram Shandy, Gentleman" (1759)

I. Overview

Someone is considered mentally "ill" if:

His conduct rigidly and consistently deviates from the typical, average behaviour of all other people in his culture and society that fit his profile (whether this conventional behaviour is moral or rational is immaterial), or

His judgment and grasp of objective, physical reality is impaired, and

His conduct is not a matter of choice but is innate and irresistible, and

His behavior causes him or others discomfort, and is

Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.

Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated - is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) - or brought on by abusive or wrong nurturance?

These questions are the domain of the "medical" school of mental health.

Others cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium - the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.

The members of the functional school regard mental health disorders as perturbations in the proper, statistically "normal", behaviours and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual - ill at ease with himself (ego-dystonic) or making others unhappy (deviant) - is "mended" when rendered functional again by the prevailing standards of his social and cultural frame of reference.

In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter - but, to a counter intuitively large degree, a faulty methodology.

As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his article "The Lying Truths of Psychiatry", mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.

This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" - even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) - are usually none of these things.

The outcome is a bewildering array of ever-shifting mental health "diagnoses" expressly centred around Western civilisation and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a "personality disorder", almost seven decades after it was first described by Freud.

II. Personality Disorders

Indeed, personality disorders are an excellent example of the kaleidoscopic landscape of "objective" psychiatry.

The classification of Axis II personality disorders - deeply ingrained, maladaptive, lifelong behavior patterns - in the Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] - or the DSM-IV-TR for short - has come under sustained and serious criticism from its inception in 1952, in the first edition of the DSM.

The DSM IV-TR adopts a categorical approach, postulating that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). This is widely doubted. Even the distinction made between "normal" and "disordered" personalities is increasingly being rejected. The "diagnostic thresholds" between normal and abnormal are either absent or weakly supported.

The polythetic form of the DSM's Diagnostic Criteria - only a subset of the criteria is adequate grounds for a diagnosis - generates unacceptable diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none.

The DSM fails to clarify the exact relationship between Axis II and Axis I disorders and the way chronic childhood and developmental problems interact with personality disorders.

The differential diagnoses are vague and the personality disorders are insufficiently demarcated. The result is excessive co-morbidity (multiple Axis II diagnoses).

The DSM contains little discussion of what distinguishes normal character (personality), personality traits, or personality style (Millon) - from personality disorders.

A dearth of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities.

Numerous personality disorders are "not otherwise specified" - a catchall, basket "category".

Cultural bias is evident in certain disorders (such as the Antisocial and the Schizotypal).

The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSM-IV-TR itself:

"An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another" (p.689)

The following issues - long neglected in the DSM - are likely to be tackled in future editions as well as in current research. But their omission from official discourse hitherto is both startling and telling:

The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;

The genetic and biological underpinnings of personality disorder(s);

The development of personality psychopathology during childhood and its emergence in adolescence;

The interactions between physical health and disease and personality disorders;

The effectiveness of various treatments - talk therapies as well as psychopharmacology.

III. The Biochemistry and Genetics of Mental Health

Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain - or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.

To designate a pattern of behaviour as a mental health disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist - but are they truly the roots of mental perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness - or the other way around?

That psychoactive medication alters behaviour and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable - is debatable and involves tautological thinking. If a certain pattern of behaviour is described as (socially) "dysfunctional" or (psychologically) "sick" - clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".

The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behaviour patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.

Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also affect the brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines - as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) - treat symptoms, not the underlying processes that yield them.

IV. The Variance of Mental Disease

If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, the case. Psychological diseases are not context dependent - but the pathologizing of certain behaviours is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures - and utterly normative or advantageous in others.

This was to be expected. The human mind and its dysfunctions are alike around the world. But values differ from time to time and from one place to another. Hence, disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.

As long as the pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms - i.e., mostly on observed or reported behaviours - they remain vulnerable to such discord and devoid of much-sought universality and rigor.

V. Mental Disorders and the Social Order

The mentally sick receive the same treatment as carriers of AIDS or SARS or the Ebola virus or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in the name of the greater good, largely as a preventive policy.

Conspiracy theories notwithstanding, it is impossible to ignore the enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, on the propagation of the concept of "mental illness" and its corollaries: treatment and research.

VI. Mental Ailment as a Useful Metaphor

Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited the unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.

"Mental health disorders" are no different. They are shorthand for capturing the unsettling quiddity of "the Other". Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both the dangerous and the idiosyncratic to the collective fringes is a vital technique of social engineering.

The aim is progress through social cohesion and the regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is often the case with human endeavour, it is a noble cause, unscrupulously and dogmatically pursued.


By Sam Vaknin

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Eating Disorders and the Narcissist

Patients suffering from eating disorders binge on food and sometimes are both anorectic and bulimic. This is an impulsive behaviour as defined by the DSM (particularly in the case of BPD and to a lesser extent of Cluster B disorders in general). Some patients develop these disorders as a way to self-mutilate. It is a convergence of two pathological behaviours: self-mutilation and an impulsive (rather, compulsive or ritualistic) behaviour.

The key to improving the mental state of patients with dual diagnosis (a personality disorder plus an eating disorder) lies in concentrating upon their eating and sleeping disorders.

By controlling their eating disorders, patients assert control over their lives. This is bound to reduce their depression (even eliminate it altogether as a constant feature of their mental life). This is likely to ameliorate other facets of their personality disorders. Here is the chain: controlling one's eating disorders controlling one's life enhanced sense of self-worth, self-confidence, self-esteem a challenge, an interest, an enemy to subjugate a feeling of strength socialising feeling better.

When a patient has a personality disorder and an eating disorder, the therapist should concentrate on the eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like OCD, or depression can be ameliorated with medication). Their treatment calls for the 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. Also personality disorders are not the real threat. If a patient with a personality disorder is cured of it but her eating disorders are aggravated, she 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 control at least ONE aspect of my life."

This is where we can and should begin to help the patient. Help him to regain control. The family or other supporting figures must think what they can do to make the patient feel that he is in control, that he manages things his own way, that he is contributing, has his own schedules, his own agenda, 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, paralysingly helpless and ineffective. His eating disorders are an effort to exert and reassert mastery over his own life. At this stage, he is unable to differentiate his own feelings and needs from those of others. His cognitive and perceptual distortions (for instance, regarding body image - somatoform disorders) only increase his feeling of personal ineffectiveness and his need to exercise even more self-control (on his diet, the only thing left).

The patient does not trust himself in the slightest. He is his worst enemy, a mortal enemy, and he knows it. Therefore, any efforts to collaborate with HIM against his disorder - are perceived as collaboration with his worst enemy against his only mode of controlling his life to some extent.

The patient views the world in terms of black and white, of absolutes. So, he cannot let go even to a very small degree. He is HORRIFIED - constantly. 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 shame and disgust directed at their bodies).

There is a chance to cure the patient of his eating disorders (though the dual diagnosis of eating disorder and personality disorder has a poor prognosis). This - and ONLY this - must be done at the first stage. The patient's family should consider therapy AND support groups (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.

Medication, cognitive or behavioural therapy, psychodynamic therapy and family therapy ought to do it.

The change in the patient IF the treatment of his eating disorders is successful 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. Our goal is to buy them time. The older they get, the more experienced they become, the more their body chemistry changes with age - the better their prognosis.


By Sam Vaknin

No Picnic In Sight

Upon being diagnosed with Obsessive-Compulsive Disorder, I saw the reality behind the greatest myth of mental illness, the myth that The Victim Is Unaware of His or Her Own Condition. A childhood flooded with media depictions of the mentally ill had lead me to believe that the afflicted had somehow been robbed of their objectivity, thrown into a dark hall-of-mirrors beyond the realm of rational perspective.

Nonsense. My rational mind remained intact, albeit uncomfortably so. From the lighter corner of my mind, I watched darkness flow in. Obsessive images of violence and amorality. Urges, or rather, "pseudo-urges" to do things I didn't want to. Yin (the rational mind) duking it out with yang (the imbalanced, irrational mind) on a daily basis. The word "Hell" was used often when describing this state.

I'm certain that the suffering of many leads to punctured objectivity and the loss of rational self-awareness. Fortunately, I remained aware. No matter how awful I felt, I could at least articulate what was going on. The power of descriptive articulation should not be underestimated. It keeps the disorder in context as a disorder, preserving a firm boundary between the right mind and the ill mind. For me, imagining such a boundary was a vital survival tool. I focused on finding a day when Yin overran Yang, so to speak.

The afflicted mind has difficulty inspiring itself to seek assistance. What a complex entity the mind is; even in sickness, it has only itself to rely upon. Unlike somebody with a broken leg, a person with an anxiety disorder cannot lean on his or her other mind. Overcoming mental duress is like trying to kiss your own lips. Quite tricky, but possible with enough imagination.

Imagination and resourcefulness, that's what it comes down to. These strange ailments go just as they came. I knew that elements of my mind were strong; the challenge was getting these elements to positively influence the weaker ones. This required many analysts, many appointments, many schools of healing. Psychology, psychiatry, homeopathy, reflexology, reiki, energy healing-- these were all thrown in the pot to little avail. Finally and unexpectedly, acupuncture provided balance. I've improved significantly. I thank acupuncture and I thank my supportive family, but, most importantly, I thank counter-mythology: even when afflicted, the human mind sees itself. And in itself, it sees solutions.


Eric Shapiro

Narcissism, Substance Abuse, and Reckless Behaviours

Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours - workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving - piggyback on this primary dependence.

The narcissist - like other types of addicts - derives pleasure from these exploits. But they also sustain and enhance his grandiose fantasies as "unique", "superior", "entitled", and "chosen". They place him above the laws and pressures of the mundane and away from the humiliating and sobering demands of reality. They render him the centre of attention - but also place him in "splendid isolation" from the madding and inferior crowd.

Such compulsory and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford the narcissist with an agenda, with timetables, goals, and faux achievements. The narcissist - the adrenaline junkie - feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in charge of his addiction, that he can quit at will and on short notice.

The narcissist denies his cravings for fear of "losing face" and subverting the flawless, perfect, immaculate, and omnipotent image he projects. When caught red handed, the narcissist underestimates, rationalises, or intellectualises his addictive and reckless behaviours - converting them into an integral part of his grandiose and fantastic False Self.

Thus, a drug abusing narcissist may claim to be conducting first hand research for the benefit of humanity - or that his substance abuse results in enhanced creativity and productivity. The dependence of some narcissists becomes a way of life: busy corporate executives, race car drivers, or professional gamblers come to mind.

The narcissist's addictive behaviours take his mind off his inherent limitations, inevitable failures, painful and much-feared rejections, and the Grandiosity Gap - the abyss between the image he projects (the False Self) and the injurious truth. They relieve his anxiety and resolve the tension between his unrealistic expectations and inflated self-image - and his incommensurate achievements, position, status, recognition, intelligence, wealth, and physique.

Thus, there is no point in treating the dependence and recklessness of the narcissist without first treating the underlying personality disorder. The narcissist's addictions serve deeply ingrained emotional needs. They intermesh seamlessly with the pathological structure of his disorganised personality, with his character faults, and primitive defence mechanisms.

Techniques such as "12 steps" may prove more efficacious in treating the narcissist's grandiosity, rigidity, sense of entitlement, exploitativeness, and lack of empathy. This is because - as opposed to traditional treatment modalities - the emphasis is on tackling the narcissist's psychological makeup, rather than on behaviour modification.

The narcissist's overwhelming need to feel omnipotent and superior can be co-opted in the therapeutic process. Overcoming an addictive behaviour can be - truthfully - presented by the therapist as a rare and impressive feat, worthy of the narcissist's unique mettle.

Narcissists fall for these transparent pitches surprisingly often. But this approach can backfire. Should the narcissist relapse - an almost certain occurrence - he will feel ashamed to admit his fallibility, need for emotional sustenance, and impotence. He is likely to avoid treatment altogether and convince himself that now, having succeeded once to get rid of his addiction, he is self-sufficient and omniscient.

First published in my
"Narcissistic Personality Disorder"
Topic Page on Suite 101


By Sam Vaknin

The Cyber Narcissist

To the narcissist, the Internet is an alluring and irresistible combination of playground and hunting grounds, the gathering place of numerous potential Sources of Narcissistic Supply, a world where false identities are the norm and mind games the bon ton. And it is beyond the reach of the law, the pale of social norms, the strictures of civilized conduct.

The somatic finds cyber-sex and cyber-relationships aplenty. The cerebral claims false accomplishments, fake skills, erudition and talents. Both, if minimally communicative, end up at the instantly gratifying epicenter of a cult of fans, followers, stalkers, erotomaniacs, denigrators, and plain nuts. The constant attention and attendant quasi-celebrity feed and sustain their grandiose fantasies and inflated self-image.

The Internet is an extension of the real-life Narcissistic Pathological Space but without its risks, injuries, and disappointments. In the virtual universe of the Web, the narcissist vanishes and reappears with ease, often adopting a myriad aliases and nicknames. He (or she) can thus fend off criticism, abuse, disagreement, and disapproval effectively and in real time - and, simultaneously, preserve the precarious balance of his infantile personality. Narcissists are, therefore, prone to Internet addiction.

The positive characteristics of the Net are largely lost on the narcissist. He is not keen on expanding his horizons, fostering true relationships, or getting in real contact with other people. The narcissist is forever the provincial because he filters everything through the narrow lens of his addiction. He measures others - and idealizes or devalues them - according to one criterion only: how useful they might be as Sources of Narcissistic Supply.

The Internet is an egalitarian medium where people are judged by the consistency and quality of their contributions rather than by the content or bombast of their claims. But the narcissist is driven to distracting discomfiture by a lack of clear and commonly accepted hierarchy (with himself at the pinnacle). He fervently and aggressively tries to impose the "natural order" - either by monopolizing the interaction or, if that fails, by becoming a major disruptive influence.

But the Internet may also be the closest many narcissists get to psychodynamic therapy. Because it is still largely text-based, the Web is populated by disembodied entities. By interacting with these intermittent, unpredictable, ultimately unknowable, ephemeral, and ethereal voices - the narcissist is compelled to project unto them his own experiences, fears, hopes, and prejudices.

Transference (and counter-transference) are quite common on the Net and the narcissist's defence mechanisms - notably projection and projective identification - are frequently aroused. The therapeutic process is set in motion by the - unbridled, uncensored, and brutally honest - reactions to the narcissist's repertory of antics, pretensions, delusions, and fantasies.

The narcissist - ever the intimidating bully - is not accustomed to such resistance. Initially, it may heighten and sharpen his paranoia and lead him to compensate by extending and deepening his grandiosity. Some narcissists withdraw altogether, reverting to the schizoid posture. Others become openly antisocial and seek to subvert, sabotage, and destroy the online sources of their frustration. A few retreat and confine themselves to the company of adoring sycophants and unquestioning groupies.

But a long exposure to the culture of the Net - irreverent, skeptical, and populist - usually exerts a beneficial effect even on the staunchest and most rigid narcissist. Far less convinced of his own superiority and infallibility, the online narcissist mellows and begins - hesitantly - to listen to others and to collaborate with them.

First published in my
"Narcissistic Personality Disorder"
Topic Page on Suite 101


By Sam Vaknin

Treatment Modalities and Therapies

Narcissism constitutes the entire personality. It is all-pervasive. Being a narcissist is akin to being an alcoholic but much more so. Alcoholism is an impulsive behaviour. Narcissists exhibit dozens of similarly reckless behaviours, some of them uncontrollable (like their rage, the outcome of their wounded grandiosity). Narcissism is not a vocation. Narcissism resembles depression or other disorders and cannot be changed at will.

Adult pathological narcissism is no more "curable" than the entirety of one's personality is disposable. The patient is a narcissist. Narcissism is more akin to the colour of one's skin rather than to one's choice of subjects at the university.

Moreover, the Narcissistic Personality Disorder (NPD) is frequently diagnosed with other, even more intractable personality disorders, mental illnesses, and substance abuse.

Cognitive-Behavioral Therapies (CBTs)

The CBTs believe that insight - even if merely verbal and intellectual - is sufficient to induce an emotional outcome. If properly manipulated, verbal cues, insights, analyses of standard sentences we keep saying to ourselves ("I am ugly", "I am afraid no one would like to be with me"), inner dialogues and narratives, and repeated behavioural patterns (learned behaviours) coupled with positive (and, rarely, negative) reinforcements - are sufficient to induce a cumulative emotional effect tantamount to healing.

Psychodynamic theories do not believe that cognition can influence emotion. They believe that much deeper strata have to be accessed and studied by both patient and therapist. The very exposure of these strata is considered sufficient to induce a dynamic of healing. The therapist's role is either to interpret the material revealed to the patient (psychoanalysis) by allowing the patient to transfer past experience and superimpose it on the therapist - or to actively engage in providing a safe emotional and holding environment conducive to changes in the patient.

The sad fact is that no known therapy is effective with narcissism ITSELF - though a few therapies are reasonably successful as far as coping with some of its effects goes (behavioural modification).

Dynamic Psychotherapy

Or Psychodynamic Therapy, Psychoanalytic Psychotherapy

As opposed to common opinion it is NOT psychoanalysis. It is an intensive psychotherapy BASED on psychoanalytic theory WITHOUT the (very important) element of free association. This is not to say that free association is not used - only that it is not a pillar of the technique in dynamic therapies. Dynamic therapies are usually applied to patients not considered "suitable" for psychoanalysis (such as Personality Disorders, except the Avoidant PD).

Typically, different modes of interpretation are employed and other techniques borrowed from other treatments modalities. But the material interpreted is not necessarily the result of free association or dreams and the psychotherapist is a lot more active than the psychoanalyst.

These treatments are open-ended. At the commencement of the therapy the therapist (analyst) makes an agreement (a "pact") with the analysand (patient or client). The pact says that the patient undertakes to explore his problems no matter how long it takes (and how expensive it becomes). This is supposed to make the therapeutic environment much more relaxed because the patient knows that the analyst is at his/her disposal no matter how many meetings would be required in order to broach painful subject matter.

Sometimes, these therapies are divided to expressive versus supportive, but I regard this division as misleading.

Expressive means uncovering (=making conscious) the patient's conflicts and studying his/her defences and resistances. The analyst interprets the conflict in view of the new knowledge gained and guides the therapy towards a resolution of the conflict. The conflict, in other words, is "interpreted away" through insight and the change in the patient motivated by his/her insights.

The supportive therapies seek to strengthen the Ego. Their premise is that a strong Ego can cope better (and later on, alone) with external (situational) or internal (instincts, drives) pressures. Supportive therapies seek to increase the patient's ability to REPRESS conflicts (rather than bring them to the surface of consciousness). As a painful conflict is suppressed - so are all manner of dysphorias and symptoms. This is somewhat reminiscent of behaviourism (the main aim is to change behaviour and to relieve symptoms). It usually makes no use of insight or interpretation (though there are exceptions).

Group Therapies

Narcissists are notoriously unsuitable for collaborative efforts of any kind, let alone group therapy. They immediately size up others as potential Sources of Narcissistic Supply - or potential competitors. They idealise the first (suppliers) and devalue the latter (competitors). This, obviously, is not very conducive to group therapy.

Moreover, the dynamic of the group is bound to reflect the interactions of its members. Narcissists are individualists. They regard coalitions with disdain and contempt. The need to resort to team work, to adhere to group rules, to succumb to a moderator, and to honour and respect the other members as equals - is perceived by them to be humiliating and degrading (a contemptible weakness). Thus, a group containing one or more narcissists is likely to fluctuate between short-term, very small size, coalitions (based on "superiority" and contempt) and outbreaks (acting outs) of rage and coercion.

Can Narcissism be Cured?

Adult narcissists can rarely be "cured", though some scholars think otherwise. Still, the earlier the therapeutic intervention, the better the prognosis. A correct diagnosis and a proper mix of treatment modalities in early adolescence guarantees success without relapse in anywhere between one third and one half the cases. Additionally, ageing ameliorates or even vanquishes some antisocial behaviors.

In their seminal tome, "Personality Disorders in Modern Life" (New York, John Wiley & Sons, 2000), Theodore Millon and Roger Davis write (p. 308):

"Most narcissists strongly resist psychotherapy. For those who choose to remain in therapy, there are several pitfalls that are difficult to avoid ... Interpretation and even general assessment are often difficult to accomplish..."

The third edition of the "Oxford Textbook of Psychiatry" (Oxford, Oxford University Press, reprinted 2000), cautions (p. 128):

"... (P)eople cannot change their natures, but can only change their situations. There has been some progress in finding ways of effecting small changes in disorders of personality, but management still consists largely of helping the person to find a way of life that conflicts less with his character ... Whatever treatment is used, aims should be modest and considerable time should be allowed to achieve them."

The fourth edition of the authoritative "Review of General Psychiatry" (London, Prentice-Hall International, 1995), says (p. 309):

"(People with personality disorders) ... cause resentment and possibly even alienation and burnout in the healthcare professionals who treat them ... (p. 318) Long-term psychoanalytic psychotherapy and psychoanalysis have been attempted with (narcissists), although their use has been controversial."

The reason narcissism is under-reported and healing over-stated is that therapists are being fooled by smart narcissists. Most narcissists are expert manipulators and they learn how to deceive their therapists.

Here are some hard facts:

There are gradations and shades of narcissism. The difference between two narcissists can be great. The existence of grandiosity and empathy or lack thereof are not minor variations. They are serious predictors of future dynamics. The prognosis is much better if they do exist.

There are cases of spontaneous healing and of "short-term NPD" [see Gunderson's and Roningstam work, 1996].

The prognosis for a classical NPD case (grandiosity, lack of empathy and all) is decidedly not good as far as long-term, lasting, and complete healing. Moreover, narcissists are intensely disliked by therapists.

BUT?

Side effects, co-morbid disorders (such as Obsessive-Compulsive behaviors) and some aspects of NPD (the dysphorias, the paranoiac dimensions, the outcomes of the sense of entitlement, the pathological lying) can be modified (using talk therapy and, depending on the problem, medication). these are not short-term or complete solutions - but some of them do have long-term effects.

The DSM is a billing and administration oriented diagnostic tool. It is intended to "tidy" up the psychiatrist's desk. The Personality Disorders are ill demarcated. The differential diagnoses are vaguely defined. There are some cultural biases and judgements [see the diagnostic criteria of the Schizotypal PD]. The result is sizeable confusion and multiple diagnoses ("co-morbidity"). NPD was introduced to the DSM in 1980 [DSM-III]. There isn't enough research to substantiate any view or hypothesis about NPD. Future DSM editions may abolish it altogether within the framework of a cluster or a single "personality disorder" category. As it is, the difference between HPD, BPD, AsPD, and NPD is, to my mind, rather blurred. When we ask: "Can NPD be healed?" we need to realise that we don't know for sure what is NPD and what constitutes long-term healing in the case of an NPD. There are those who seriously claim that NPD is a cultural disease with a societal determinant.

Narcissists in Therapy

In therapy, the general idea is to create the conditions for the True Self to resume its growth: safety, predictability, justice, love and acceptance - a mirroring and holding environment. Therapy is supposed to provide these conditions of nurturance and the guidance necessary to achieve these goals (through transference, cognitive re-labelling or other methods). The narcissist must learn that his past experiences are not laws of nature, that not all adults are abusive, that relationships can be nurturing and supportive.

Most therapists try to co-opt the narcissist's inflated ego (False Self) and defences. They compliment the narcissist, challenging him to prove his omnipotence by overcoming his disorder. They appeal to his quest for perfection, brilliance, and eternal love - and his paranoid tendencies - in an attempt to get rid of counterproductive, self-defeating, and dysfunctional behaviour patterns.

By stroking the narcissist's grandiosity, they hope to modify or counter cognitive deficits, thinking errors, and the narcissist's victim-stance. They contract with the narcissist to alter his conduct. Some even go to the extent of medicalizing the disorder, attributing it to a hereditary or biochemical origin and thus "absolving" the narcissist from guilt and responsibility and freeing his mental resources to concentrate on the therapy.

Confronting the narcissist head on and engaging in power politics ("I am cleverer", "My will should prevail", and so on) is decidedly unhelpful and could lead to rage attacks and a deepening of the narcissist's persecutory delusions, bred by his humiliation in the therapeutic setting.

Successes have been reported by applying 12-step techniques (as modified for patients suffering from the Antisocial Personality Disorder), and with treatment modalities as diverse as NLP (Neurolinguistic Programming), Schema Therapy, and EMDR (Eye Movement Desensitization).

But, whatever the type of talk therapy, the narcissist devalues the therapist. His internal dialogue is: "I know best, I know it all, the therapist is less intelligent than I, I can't afford the top level therapists who are the only ones qualified to treat me (as my equals, needless to say), I am actually a therapist myself?"

A litany of self-delusion and fantastic grandiosity (really, defences and resistances): "He (my therapist) should be my colleague, in certain respects it is he who should accept my professional authority, why won't he be my friend, after all I can use the lingo (psycho-babble) even better than he does? It's us (him and me) against a hostile and ignorant world (follies-a-deux)?"

Then there is: "Just who does he think he is, asking me all these questions? What are his professional credentials? I am a success and he is a nobody therapist in a dingy office, he is trying to negate my uniqueness, he is an authority figure, I hate him, I will show him, I will humiliate him, prove him ignorant, have his licence revoked (transference). Actually, he is pitiable, a zero, a failure?"

And this is only in the first three sessions of the therapy. This abusive internal dialogue becomes more vituperative and pejorative as therapy progresses.

Narcissists generally are averse to receiving medication. Resorting to medicines is an implied admission that something is wrong. Narcissists are control freaks. Additionally, many of them believe that medication is the "great equaliser" - it will make them lose their uniqueness, superiority and so on. That is unless they can convincingly present the act of taking their medicines as "heroism", a part of a daring enterprise of self-exploration, a distinguishing feature and so on.

They often claim that the medicine affects them differently than it does other people, or that they have discovered a new, exciting way of using it, or that they are part of someone's (usually themselves) learning curve ("part of a new approach to dosage", "part of a new cocktail which holds great promise"). Narcissists must dramatise their lives to feel worthy and special. Aut nihil aut unique - either be special or don't be at all. Narcissists are drama queens.

Very much like in the physical world, change is brought about only through incredible powers of torsion and breakage. Only when the narcissist's elasticity gives way, only when he is wounded by his own intransigence - only then is there hope.

It takes nothing less than a real crisis. Ennui is not enough.


By Sam Vaknin

Traumas as Social Interactions

("He" in this text - to mean "He" or "She")

We react to serious mishaps, life altering setbacks, disasters, abuse, and death by going through the phases of grieving. Traumas are the complex outcomes of psychodynamic and biochemical processes. But the particulars of traumas depend heavily on the interaction between the victim and his social milieu.

It would seem that while the victim progresses from denial to helplessness, rage, depression and thence to acceptance of the traumatizing events - society demonstrates a diametrically opposed progression. This incompatibility, this mismatch of psychological phases is what leads to the formation and crystallization of trauma.

PHASE I

Victim phase I - DENIAL

The magnitude of such unfortunate events is often so overwhelming, their nature so alien, and their message so menacing - that denial sets in as a defence mechanism aimed at self preservation. The victim denies that the event occurred, that he or she is being abused, that a loved one passed away.

Society phase I - ACCEPTANCE, MOVING ON

The victim's nearest ("Society") - his colleagues, his employees, his clients, even his spouse, children, and friends - rarely experience the events with the same shattering intensity. They are likely to accept the bad news and move on. Even at their most considerate and empathic, they are likely to lose patience with the victim's state of mind. They tend to ignore the victim, or chastise him, to mock, or to deride his feelings or behaviour, to collude to repress the painful memories, or to trivialize them.

Summary Phase I

The mismatch between the victim's reactive patterns and emotional needs and society's matter-of-fact attitude hinders growth and healing. The victim requires society's help in avoiding a head-on confrontation with a reality he cannot digest. Instead, society serves as a constant and mentally destabilizing reminder of the root of the victim's unbearable agony (the Job syndrome).

PHASE II

Victim phase II - HELPLESSNESS

Denial gradually gives way to a sense of all-pervasive and humiliating helplessness, often accompanied by debilitating fatigue and mental disintegration. These are among the classic symptoms of PTSD (Post Traumatic Stress Disorder). These are the bitter results of the internalization and integration of the harsh realization that there is nothing one can do to alter the outcomes of a natural, or man-made, catastrophe. The horror in confronting one's finiteness, meaninglessness, negligibility, and powerlessness - is overpowering.

Society phase II - DEPRESSION

The more the members of society come to grips with the magnitude of the loss, or evil, or threat represented by the grief inducing events - the sadder they become. Depression is often little more than suppressed or self-directed anger. The anger, in this case, is belatedly induced by an identified or diffuse source of threat, or of evil, or loss. It is a higher level variant of the "fight or flight" reaction, tampered by the rational understanding that the "source" is often too abstract to tackle directly.

Summary Phase II

Thus, when the victim is most in need, terrified by his helplessness and adrift - society is immersed in depression and unable to provide a holding and supporting environment. Growth and healing is again retarded by social interaction. The victim's innate sense of annulment is enhanced by the self-addressed anger (=depression) of those around him.

PHASE III

Both the victim and society react with RAGE to their predicaments. In an effort to narcissistically reassert himself, the victim develops a grandiose sense of anger directed at paranoidally selected, unreal, diffuse, and abstract targets (=frustration sources). By expressing aggression, the victim re-acquires mastery of the world and of himself.

Members of society use rage to re-direct the root cause of their depression (which is, as we said, self directed anger) and to channel it safely. To ensure that this expressed aggression alleviates their depression - real targets must are selected and real punishments meted out. In this respect, "social rage" differs from the victim's. The former is intended to sublimate aggression and channel it in a socially acceptable manner - the latter to reassert narcissistic self-love as an antidote to an all-devouring sense of helplessness.

In other words, society, by itself being in a state of rage, positively enforces the narcissistic rage reactions of the grieving victim. This, in the long run, is counter-productive, inhibits personal growth, and prevents healing. It also erodes the reality test of the victim and encourages self-delusions, paranoidal ideation, and ideas of reference.

PHASE IV

Victim Phase IV - DEPRESSION

As the consequences of narcissistic rage - both social and personal - grow more unacceptable, depression sets in. The victim internalizes his aggressive impulses. Self directed rage is safer but is the cause of great sadness and even suicidal ideation. The victim's depression is a way of conforming to social norms. It is also instrumental in ridding the victim of the unhealthy residues of narcissistic regression. It is when the victim acknowledges the malignancy of his rage (and its anti-social nature) that he adopts a depressive stance.

Society Phase IV - HELPLESSNESS

People around the victim ("society") also emerge from their phase of rage transformed. As they realize the futility of their rage, they feel more and more helpless and devoid of options. They grasp their limitations and the irrelevance of their good intentions. They accept the inevitability of loss and evil and Kafkaesquely agree to live under an ominous cloud of arbitrary judgement, meted out by impersonal powers.

Summary Phase IV

Again, the members of society are unable to help the victim to emerge from a self-destructive phase. His depression is enhanced by their apparent helplessness. Their introversion and inefficacy induce in the victim a feeling of nightmarish isolation and alienation. Healing and growth are once again retarded or even inhibited.

PHASE V

Victim Phase V - ACCEPTANCE AND MOVING ON

Depression - if pathologically protracted and in conjunction with other mental health problems - sometimes leads to suicide. But more often, it allows the victim to process mentally hurtful and potentially harmful material and paves the way to acceptance. Depression is a laboratory of the psyche. Withdrawal from social pressures enables the direct transformation of anger into other emotions, some of them otherwise socially unacceptable. The honest encounter between the victim and his own (possible) death often becomes a cathartic and self-empowering inner dynamic. The victim emerges ready to move on.

Society Phase V - DENIAL

Society, on the other hand, having exhausted its reactive arsenal - resorts to denial. As memories fade and as the victim recovers and abandons his obsessive-compulsive dwelling on his pain - society feels morally justified to forget and forgive. This mood of historical revisionism, of moral leniency, of effusive forgiveness, of re-interpretation, and of a refusal to remember in detail - leads to a repression and denial of the painful events by society.

Summary Phase V

This final mismatch between the victim's emotional needs and society's reactions is less damaging to the victim. He is now more resilient, stronger, more flexible, and more willing to forgive and forget. Society's denial is really a denial of the victim. But, having ridden himself of more primitive narcissistic defences - the victim can do without society's acceptance, approval, or look. Having endured the purgatory of grieving, he has now re-acquired his self, independent of society's acknowledgement.


By Sam Vaknin

Time Out of Mind

Let us first consider the role of time in our lives, then let us consider that role in terms of mental illness. Buddhists and Hindus, among others, propose that time does not actually exist. The Western world, however, with its dependence on clocks and deadlines, scoffs at such a notion, relying upon sayings such as "Time is money" and "Time is of the essence."

Time is of the essence. What an expression. Its inherent suggestion is that time comes from our essences; time exists within our souls. This is consistent with the Western position that time was discovered rather than created. Then again, the question haunts us: what if we did, in fact, create time? What if all our ticking clocks and watches amount to nothing more than a symbolic quest for orderly and coherent living? It's a terrifying yet convincing idea.

One considers, then, how time functions from the perspective of a person with a mental disorder. The sufferer of depression, or anxiety, or psychotic ailments, likely travels life's trajectory in creaky slow-motion. Catchy sayings such as "Life's too short" make such victims grin wearily, responding in their minds, "No, life's too long." Given the incessant presence of pain in the victim's mind-- the ceaseless worrying, excessive self-reflection, and troubling sensory distortion-- hours tend to stretch, stretch, stretch until the act of exiting one's bed in the morning becomes overwhelming.

Another kind of smile, likely even more weary, will cross the sufferer's face when met with this maxim: "Time flies when you're having fun." Indeed it does, and indeed the patient's schedule leaves no room for fun of any kind. Unless, of course, one counts the quiet joy of the moment when the depressed person sees that it's already six o'clock and thinks, "I can't believe I've made it another hour."

It is this writer's suggestion that given the dark relationship between the aching mind and the ticking clock, the mentally ill should ignore time altogether. Take a note from our Eastern thinkers and do not, as my father always told me, "try to live the whole future in one day." Again, time needn't be regarded as a finite fact of life. One may choose to doubt it, or, moreover, disapprove of it! Who needs time, anyway? Whose mind needs a sweltering flurry of images from a thousand yesterdays and ten thousand tomorrows?

The path to wellness may take two months or it may take two years. This is of no consequence. The moment is of the essence.


By Eric Shapiro

The Diagnosis Myth

Although I risk dissension by doing so, I must say something that I think many of us in the mental health community have acknowledged for quite some time: every single diagnosis of a mental disorder is fallible.

Before I proceed, I should note the value of diagnoses. They are immensely useful categorical tools. The human being cannot productively navigate the uncertain tides of reality without the use of symbols and structures. Symbols and structures allow us to determine where our glasses end and our tables begin. Accordingly, when Patient A is compulsively cleaning her apartment and Patient B is speaking to invisible demons, it is important to have the words "Obsessive-Compulsive Disorder" to describe the former and the word "Schizophrenia" to describe the latter. Categorizations such as these not only help us to distinguish between ailments, they also assist us in making reliable behavioral predictions and selecting appropriate modes of treatment. I have no intention of ignoring these facts.

However, two unsettling flaws consistently accompany diagnoses of mental disorders.

When one breaks an arm and is diagnosed with the linguistically sophisticated ailment known as a "broken arm," there is finitude on display. Witnesses could line up from the patient's bed to the hospital parking lot, and they would all agree that the patient was suffering from a broken arm. The Law of Averages insists that one or two jokers would, due to rebelliousness or sheer foolishness, concoct some other diagnosis, but I believe that my point is clear: physical diagnoses are better suited for objective consideration than are mental ones.

Despite the probable existence of Patient A and Patient B, the mind is a realm of liquidity and abstractions. Absent are any features remotely approaching the rigidity of a bone. Even for its most stubborn bearers, the mind is a place of motion. When it is possible for a Depressed patient to shift from numbness to panic to auditory hallucinations within the space of a single afternoon, of what ultimate use is the "Depression" label? To be sure, some symptoms achieve prominence within some minds, but all minds, we must acknowledge, never stop shifting, advancing, reversing, and flowing. Every mental disorder is therefore an abstraction at best.

I have been diagnosed with Obsessive-Compulsive Disorder. This seems about right, but what am I to make of my occasional bouts of Panic? Are they "part of" my O.C.D., or do I also have Panic Disorder? And, further, what am I to make of the one or two professionals who have said that I may have Attention-Deficit Disorder? Is my A.D.D. an offshoot of my O.C.D. or does my O.C.D. stem from my A.D.D.? Which of the two shares a stronger bond with my Panic? Even more confusing: as part of my O.C.D., I sometimes obsess about the possibility of becoming Manic. This obsession seems to tangibly alter my moods, but am I authentically Manic, or am I merely Obsessed? I feel like panicking.

We must admit that all mental disorders, however distinctive their given names, are members of one large dysfunctional family. This family is so huge that I question the merits of memorizing all its members' names and faces.

The second inevitable defect of a mental illness diagnosis is the fact that Its Recipient Is Also Its Source. In other words, because the mind of a diagnosed patient is the seat of her affliction, knowledge of a diagnosis can provoke greater mental distress. Said distress can arrive in several forms. The patient's symptoms may increase due to her renewed awareness. The patient may develop an Inferiority Complex (yet another disorder!) or drift into a state of panic. Most troubling, the patient may adhere so strongly to the notion of being SICK that her mind will never trust itself to part with its imbalance.

I can sense the naysayers closing in on me. You likely think, "The patient will surely never improve if she's ignorant about the existence of her disorder!"

I agree wholeheartedly. Acknowledging the presence of a problem is the first step toward solving it. Nonetheless, our collective perception of mental diagnoses is ripe for a change. Not only do these labels fail to holistically summarize the people they're attached to, they also tend to make said people feel stuck.

Upon being diagnosed with a mental disorder, a patient should regard her diagnosis as a handy signpost en route to treatment and recovery. Regarding such disorders as fixed, deep-rooted states is a terrific way to make them hang around longer and sink in even deeper.


By Eric Shapiro

Ericksons Theory of Human Development

I'm sure you've heard the term "Identity Crisis" before. It's thought of as a conflict of self and society and its introduction came from one of the most famous psychoanalyst of the 20th century.

Sigmund Freud is probably the most familiar name that comes to mind when one thinks of famous psychologists. His basic foundation theories of instinct, phallic symbol obsession and oedipal complexes are prevalent in almost every artistic aspect of our culture. However, it was a friend and fellow psychoanalyst of Freud's, Erik Erickson, who created one of the major theories that open a window to the development of everything that makes us who we are on the inside. It is referred to as Erickson's Theory of Human Development and it simplifies the complex topic of human personality.

First, let's talk about the man himself. Erik Homberger was born in Frankfurt, Germany in 1902. The conditions under which he began life give a great deal of insight into his obsession with identity. He was challenged with it from the stat. His parents weren't married and his Danish father left before Erik was born. His Jewish mother married Erik's pediatrician when he was three. Erik had Nordic features; he was tall, blond and had blue eyes. Neither the Jewish children at temple nor the German children at school accepted him.

As he grew up, psychology and art began to interest Erik and led him to various institutes including one where he was psychoanalyzed by Anna Freud, wife of Sigmund. Both later became close friends to Erickson. When the Nazis came to power, Erik moved to Boston where he studied child psychoanalysis and was influenced by many psychologists and anthropologists Mead, but many famous psychologists and anthropologists.

He is considered a Freudian ego-psychologist, meaning he takes the basic foundation of Freud's theories, but veers away by focus on social and cultural orientation. Erickson's theory closely ties personality growth with parental and societal values. His 1950 book, Childhood and Society, is considered a classic in its field.

There are eight stages of human development, each focusing on a different conflict that we need to solve in order to development successfully into the next stage of our lives. The idea is that if we don't resolve each stage or we choose the wrong of two choices, our ability to deal with the consecutive stages is impaired and the failure will return to us at some point later in life.

Stage One: Oral Sensory
Ages: Birth To 12-18 Months
Conflict: Trust vs Mistrust
The infant's bond with their primary caregiver is about trust and love. The connection with that person (usually Mommy) allows them to feel like they are safe and can rely on the person who is basically the only thing they know. It's about touch and being there and can be seen in that tender stare they give you as you feed them.

Stage Two: Muscular Anal
Ages: 18 Months To 3 Years
Conflict: Autonomy vs Doubt
This stage focuses on self control and self confidence and Erickson gives toilet training as the greatest example of this conflict. He also points out that this is the stage where an overprotective parent can do the most damage. The child wants autonomy. We're all familiar with the two hour wait because they have to tie their own shoes. We wait because in this stage, failure to reinforce these efforts will lead the child to doubt themselves and your trust in them.

Stage Three: Locomotor
Ages: 3 To 6 Years
Conflict: Initiative vs Guilt
This is all about independence and letting the child exert his/her initiative. This is the stage where carrying your car keys or helping Mommy in any way possible is very important. They are developing a sense of responsibility and limitations. They will try to do things they can't and the response the parent gives them, encouragement or refusal, will allow the child to understand limitations without guilt.

Stage Four: Latency
Ages: 6 To 12 Years
Conflict: Industry vs Inferiority
This is about completion. Before this stage, we're all familiar with the child beginning to do something, but then snap; he drops it and is on to something else. In this stage, completion and the pleasure it brings becomes crucial. This is greatly influenced by their introduction to school beyond day care. It is the coming together of mental and physical capabilities as well. Parents need to encourage their child to handle the different experiences of a home atmosphere and the atmosphere at school among others.

Stage Five: Adolescence
Ages: 12 To 18 Years
Conflict: Identity vs Role Confusion
This stage could be a book in itself; the teenage years. They are hard on everyone, but especially the child herself. They are aware that they will become a contributor to society (industry) and the search for who they are drives their actions and thoughts. The desire to know what it is they want and believe separate from what they've adopted from their parents is crucial to their self confidence.

Stage Six: Young Adulthood
Ages: 19 To 40 Years
Conflict: Psychosocial Development
Love relationships dominate this stage for all of us and relies heavily on our ability to solve the conflicts faced in stage five. Can you be intimate? Can you be open? Can you commit? Intimacy is referred to as the ability to make a personal commitment and doesn't necessarily mean sex. Personal commitment, met with mutual satisfaction, make this a successful stage. If unable to handle this stage, an adult will resort to isolation.

Stage Seven: Middle Adulthood
Ages: 40 To 65 Years
Conflict: Generativity vs Stagnation
The words are getting bigger, but stay with me. Generativity is our ability to care for someone else which is mostly displayed in parenting. Specifically, it's the ability to direct someone into society and the next generation. We don't focus on death, but we begin to understand that we are high in the order of society and owe society something. If we haven't dealt with our previous conflicts, we become stagnant and our lives won't exhibit anything we can look back on.

Stage Eight: Maturity
Ages: 65 to Death
Conflict: Ego Integrity vs Despair
This is when we begin to reflect on our lives, accepting it for what it was. If we have done well in previous stages, especially stage seven, we can feel a sense of fulfillment and accept death as an unavoidable reality with dignity. If we haven't done well, we can be filled with regret, despair over the time running out and fear of death.

When you read through the stages, it's impossible not to identify them as you've experienced them or as you see your children experiencing them. However, Erickson's theory is not without critics. Many say that it is too focused on infancy and childhood and isn't very helpful for later in life. Others say it really applies to boys and not girls using Erickson's belief (Freudian) that boys and girls naturally develop different personalities.

In general, Erickson's Theory of Human Development is widely accepted and plays a major role in all human and psychological development studies and theories. The best advice is to use the theory as a framework or map for understanding and identifying what issues/conflicts unresolved lead to current behavior and preparing for the stages to come.


By Angela Winters

What is the Treatment for Bipolar Disorder?

How do we treat bipolar disorder? Specifically, how do we treat mania or depression associated with bipolar disorder? The treatment of these two clinical states is not the same.

The treatment of mania is dependent upon its severity and acuity. For mild to moderate mania, mood stabilizers such as lithium and valproic acid (Valproate) are still the standard of treatment and may be sufficient to contain the symptoms. Lithium starts to work after 10 to 14 days while valproic acid, about 7 to 10 days.

Also, recent studies have shown the effectiveness of atypical antipsychotics such as risperidone, olanzapine, and quetiapine even when used alone to treat the acute phase of bipolar disorder.

These drugs are relatively safe but they don't come without side effects. Nausea, vomiting, tremors, and dizziness during the initial phase of treatment are commonly experienced. The more serious side effects such as renal and thyroid problem from lithium, liver dysfunction and pancreatitis from valproic acid, and increased risk of diabetes and high cholesterol from atypical antipsychotics are uncommon. However, regular blood tests are required to monitor any abnormalities.

For moderate to severe cases, atypical antipsychotics such as risperidone and quetiapine should be added to the mood stabilizers during the acute phase. Once the illness has stabilized and the symptoms have subsided, then the atypical neuroleptics can be gradually tapered off. But the mood stabilizers should continue. Regardless of severity, patients usually do well on a combination of mood stabilizer and atypical antipsychotic during the acute phase.

What is the treatment for bipolar depression? In general, the mood stabilizers' dosage should be optimized or if the patient is not on any medication yet, a mood stabilizer such as lithium should be started. Physicians should make sure that the medication maintains a "therapeutic level." If not, the dosage should be adjusted. Moreover, possible precipitants such as stresses at home should be addressed.

If these measures don't help and the depression is so severe, an antidepressant with the least risk to induce mania such as bupropion should be added to the mood stabilizer. When the depression is resolved, then the antidepressant can be gradually tapered off because its prolonged use even in the presence of mood stabilizer can still induce mania.

When should the medication be discontinued? Bipolar patients have to continue taking the medication for several months even after they become normal. High relapse rate is common if medications are prematurely stopped. Also, for patients with multiple or difficult-to-treat episodes, they may need to take the medication for years or even for life to prevent recurrence.

Patients and their physicians should thoroughly discuss the risk and benefits of any treatment intervention. Knowledge about the drug's indication, side effects, and prognosis with or without treatment is a must.

Furthermore, it is crucial that bipolar patients should also receive individual psychotherapy to help them deal with the many personal and psychosocial issues they face on a daily basis. As you know, medication alone won't suffice to address financial problems, marital conflict, work issues, and prior abuse.

In summary, the combination of medication and psychotherapy is the best treatment for bipolar disorder.

By Dr. Michael G. Rayel

What Is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder is a medical condition. It is caused by genetic factors that result in certain neurological differences. Attention Deficit Hyperactivity Disorder comes in various forms, and there are five or six different types of ADHD.

In the DSM-IV Diagnostic manual, each of these forms, or "types" of ADHD falls under the diagnostic category of Attention Deficit Hyperactivity Disorder (ADHD). The main category is then subdivided into ADHD Inattentive Type, or ADHD Impulsive-Hyperactive Type, or ADHD Combined Type. In the recent past, the terms attention deficit disorder "with" or "without" hyperactivity were also commonly used. Attention Deficit Hyperactivity Disorder comes in various forms, and truly, no two ADD or ADHD kids are exactly alike.

Attention Deficit Hyperactivity Disorder might affect one, two, or several areas of the brain, resulting in several different "styles" or "profiles" of children (and adults) with ADD ADHD.

These different profiles impact performance in these four areas:

First, problems with Attention.
Second, problems with a lack of Impulse Control.
Third, problems with Over-activity or motor restlessness,
Fourth, a problem which is not yet an "official" problem found in the diagnostic manuals, but ought to be: being easily Bored.

A few other important characteristics of this disorder are:

1) That it is SEEN IN MOST SITUATIONS, not just at school, or just in the home. When the problem is seen only at home, we then would wonder if perhaps the child is depressed, or if the child is just being non-compliant with the parents;

2) That the problems are apparent BEFORE the AGE OF SEVEN (7). Since Attention Deficit Hyperactivity Disorder is thought to be a neurologically based disorder, we would expect that, outside of acquiring its symptoms from a head injury, the individual with Attention Deficit Hyperactivity Disorder would have been born with the disorder. Even though the disorder might not become much of a problem until the second or third grade when the school work becomes more demanding, one would expect that at least some of the symptoms were noted before the age of seven.

About one of twenty people, children and adults, have Attention Deficit Hyperactivity Disorder. It is a significant problem for these people, and for their families. Learn more about the different types of ADHD at and visit the ADHD Information Library's family of web sites.



By Douglas Cowan, Psy.D.

Intro to Being an ADHD Parent

In my fifteen years of private practice working with children with ADHD, one of the common concerns that I observed by parents was the fear that they had done something, or failed to do something, that caused their child's ADHD. I guess it is normal to blame yourself when your child is having problems.

However, it is important for parents to know that Attention Deficit Hyperactivity Disorder is not the result of "bad parenting" or obnoxious, willful defiance on the part of the child. Attention Deficit Hyperactivity Disorder is a medical condition, caused by genetic factors that result in certain neurological differences.

Yes, a child may be willfully defiant whether he has Attention Deficit Hyperactivity Disorder or not. But defiance, rebelliousness, and selfishness are usually "moral" issues, not neurological issues. Make no excuses for "immoral," "selfish," or "destructive" behaviors, whether from individuals with ADD ADHD or not. Parents need to step up and correct these behavior problems whether a child has ADHD or not.

It may also be true that the parents may need further training. We are constantly amazed at how many young parents today grew up in homes where their parents were gone all day. We now see "grown up latch key kids" trying to parent as best as they can, but without having had the benefit of growing up with good parental role models. This is a problem in any family, but especially when there is a child in the home who is inattentive, impulsive, and possibly hyperactive.

Parents should consider becoming a part of a parenting class offered by a local therapist, or a local church. These classes can be a good investment of your time. More information about Attention Deficit Disorder is available at the ADHD Information Library.

By Douglas Cowan, Psy.D.

Behavioral Manifestations of Alzheimer's Dementia

Alzheimer's Dementia has a combination of cognitive and behavioral manifestations. Cognitive impairment is the core problem which includes memory deficits and at least one of the following: aphasia or language problem, agnosia or problems with recognition, apraxia or motor activity problem, and impairment in executive functioning (e.g. planning, abstract reasoning, and organizing).

As the disease advances, the cognitive decline becomes associated with behavioral manifestations. What are these behavioral manifestations of dementia?

Behavioral syndromes in Alzheimer's can be grouped into two categories: psychological and behavioral. Major psychological syndromes consist of depression, anxiety, delusions, and hallucinations.

Depression in dementia is very common. Up to about 87% of patients develop some form of depression. It is characterized by tearfulness or crying episodes, feelings of sadness, and neurovegetative signs and symptoms such as inability to sleep, lack of appetite, poor energy, and thoughts of death. Irritability is also common. Depression can occur even in the early or mild phase of the illness.

About 50% of demented patients show delusions or false fixed beliefs. Such delusions include beliefs that a relative is stealing, that a spouse is just an impostor or is having an affair with a neighbor, or that friends and relatives are conspiring to cause trouble.

Moreover, many patients with dementia may experience hallucinations. Most of these hallucinations are visual - seeing strangers in the house, an animal or insects in the living room, people in the bedroom or on top of the TV set. Occasionally, auditory hallucinations may be experienced - hearing footsteps or knocking on the door or even people singing church hymns.

Regarding major behavioral syndromes associated with dementia, these problems include agitation, verbal outbursts, repetitive behavior, wandering, and aggression or even violence. Agitation can be manifested by pacing back and forth, restlessness, and inability to sit still.

Verbal outbursts consist of day-long screaming or occasional yelling at someone. Repetitive behavior is manifested by closing and opening a closet or a purse or a drawer. Asking questions repetitively for instance about a relative's visit is very common.

Wandering can happen especially at the late stages of the illness. If doors are left unlock, some patients wander away from the house. Hence, safety level becomes an issue.

Aggression likewise may occur. Hitting the caregiver or throwing things are some complaints. Destroying things although rare can also ensue. A gentleman for example hit the wall with a cane and broke the window by smashing a chair.

Although difficult to deal with, most of these behavioral consequences of dementia can be treated especially if recognized and addressed early.

By Dr. Michael G. Rayel

How Big of a Problem is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder - "ADD" or "ADHD" - affects between five to ten percent (5% - 10%) of all children in the United States, and three to six percent (3% - 6%) of adults. About 35% of all children referred to mental health clinics are referred for Attention Deficit Hyperactivity Disorder, making it one of the most prevalent of all childhood psychiatric disorders.

The 5% number is a solid, conservative number supported by a lot of research. Even at 5% each classroom in America will have one or two (2) ADHD kids in the class. So it is a very real, and very significant problem across America.

When only Parent Rating Scales are used in a research project, the numbers will range from a low of seven percent (7%) of school-aged children to a high of twenty-three percent (23%) of children.

You may see published estimates stating that Attention Deficit Hyperactivity Disorder may effect as many as 20% to 30% of children in America, but these numbers are not really supported by research data, and are probably inflated for the purpose of trying to sell something.

However, we should note that Fetal Alcohol Syndrome, Head Injuries, or other Specific Learning Disabilities, are often mistaken for ADD ADHD, which can inflate the numbers reported. As many as 10% of children are now being born with FAS or are drug exposed babies.

ADHD is not a "fad" disorder, nor is it a conspiracy by pharmaceutical companies to get more kids on drugs. It is a very real neurological condition that is common enough as to require parents, teachers, and physicians to become better educated about its causes, the available treatment options, and the potential problems with doing nothing. Learn more about ADHD at the ADHD Information Library.

By Douglas Cowan, Psy.D.

You, I and We

Our life in society hovers around the concept of 'You-I- We'. The first stage is 'You-You' which is called 'dependent' stage. As a child, we are dependent on others for our needs and expect help and support from others. The dependence can be either emotional or physical. The second stage is 'I - I', where in we attain relative freedom and corresponding changes are noticeable in terms of speech, behavior, movements, preferences, interests and perceptions.In this stage we act with absolute freedom both mentally and physically. The feeling of 'Me-Mine' will be at a high point during this stage. Typical thought processes will be as follows:

1. I can do anything independently

2. I have a set of tastes, beliefs, desires and goals

3. I am the decision maker of my actions

4. I am responsible for my actions

The final and most important stage is 'We-We', which is a state of maturity, and get out of the earlier restlessness. This stage brings us to realization that we cannot live alone and need help and support of others and do things in mutual cooperation and understanding. Typically in this stage the thought processes are as follows:

1. Let us do this

2. Let us cooperate

3. This is ours

4. We can do this

Broadmindedness and reduced selfishness are the characteristics of this state. Some of us remain stagnated at the 'dependent' stage and further in the life cannot take any decisions independently. People who gradually pass through each of these stages will be successful in life, be it personal or professional. Interdependence stage is the most important one in relation to ones career growth too, for interdependence gives us the capability to communicate effectively and participate in team work.

By Ravikumar Uppaluri

Anti-Social Behaviors and Attention Deficit Hyperactivity Disorder

Anti-social behaviors are common with ADHD individuals. About 60% of Attention Deficit Hyperactivity Disorder kids are also oppositional or defiant. Some are even getting in trouble with the law.

Impulsive-Hyperactive ADHD kids are the most likely to get into trouble than are the Inattentive ADHD kids, as they tend to crave the stimulation of anti-social behaviors, and impulsively "act-out". Because they are impulsive, they don't plan their crimes well, and are usually easily caught.

Teens untreated for Attention Deficit Hyperactivity Disorder average two arrests by the age of 18. About 20% of teens untreated for Attention Deficit Hyperactivity Disorder will be arrested for a felony, versus only about 3% of teens without ADHD.

As many as 50% of all men in prisons have Attention Deficit Hyperactivity Disorder, and were untreated as children or teens for ADHD. It is also estimated that as many as 50% of all teenagers in juvenile facilities have Attention Deficit Hyperactivity Disorder but were untreated for ADHD.

Teenagers with Attention Deficit Hyperactivity Disorder - Impulsive Type ADHD - have 400% more traffic accidents and traffic tickets related to speeding, than teens without ADD ADHD. 

Twice as many teens with ADHD will run away from home than teens without ADHD. About 16% of teens run away from home at some point, versus 32% of teens untreated for Attention Deficit Hyperactivity Disorder.

Arson is often associated with Attention Deficit Disorder, as teens with untreated Attention Deficit Hyperactivity Disorder are three times more likely to be arrested for arson than those without ADHD: 16% vs. 5%.

Teenagers untreated for Attention Deficit Hyperactivity Disorder are ten times more likely to get pregnant, or cause a pregnancy, than those without ADHD.

Teenagers untreated for Attention Deficit Hyperactivity Disorder are 400% more likely to contract a sexually transmitted disease than teens without ADHD: 16% to 4%.

Around the house, the inattentive kids tend to be non-compliant due to not being motivated enough to remember the things he was asked to do.

ADHD causes problems in our homes, and in our nation. We need to learn more about Attention Deficit Disorder, how to diagnose it and how to treat it successfully. To learn more visit the ADHD Information Library.

By Douglas Cowan, Psy.D.

Its Never Too Late

First of all, a bit of background: A high school dropout,
stay-at-home mom until the age of 40, I wasn't too
motivated to learn. Then I read the following quote:
"Old Bureaucrat, my comrade, it is not you who are
to blame. No one ever helped you to escape.?
Nobody grasped you by the shoulder while there
was still time. Now the clay of which you were
shaped has dried and hardened, and naught in you
will ever awaken the sleeping musician, the poet,
the astronomer that possibly inhabited you in
the beginning."
(Antoine de Saint Exupery)

I didn't want it to be too late, so I finished high school,
then took a full-time computer course, and finally
business courses. My desire to learn and my self-
confidence grew with each step forward.

I love using computers and realize that the more
you learn, the more there is to learn. So I thought
I'd take a trip down memory lane:

My first computer had no hard drive, but I still
thought it was pretty neat.

The first time using an online encyclopedia - we
were amazed to see pictures of birds and animals,
and actually hear their sounds.

The first time we connected to the Internet -
hearing someone's voice and responding by
standing in front of the monitor and yelling into it.

The first family newsletter, complete with clip
art and three columns, written faithfully every
week for almost a year and sent to my family.

My first emails to my daughter, so much easier
than trying to think of a long letter. Instead I
could send a line or two as things happened.
Emails back and forth, to keep for future
generations.

My first chat using a webcam; watching my
grand-daughter lift her new puppy up for
me to see.

My first multiple chat, trying to talk to daughter
and granddaughter in two different cities at
the same time and trying not to get confused.

My first time opening up a computer, with the
aid of my sidekick mother, and adding a cd
rewritable drive.

Learning that you should always note where
the screws came from or there will be one
left over.



So many firsts, especially mistakes, too many of
those to count. I learned:

not to pull the plug out of the monitor end or
you will have to buy a new monitor.

not to fiddle with your monitor settings too
much or you may not see anything.

not to continue without saving your work every
so often, unless you enjoy panic attacks.

not to select public chatting on MSN, unless
you want to see a strange man's face on your
screen saying hello to you, just before you
quickly turn it off.

not to buy more software until you at least
try the last one out first.

not to let your grandchildren print in colour
as much as they like.

not to expect that your computer will always
do what you want. It often has a mind of it's own.

not to sit for hours in front of the computer
without a break. No more meals at the desk.

And above all, not to ever, ever think you won't
learn to tame that machine. No matter who you
are, or how old you are, it's never too late 2 learn!





Creative Home Computing is a unique online resource, providing the help and ideas to use computers confidently and creatively and have fun in the process. Regardless of your age or skill level, computer literacy will enlarge your world. 

What Causes Attention Deficit Hyperactivity Disorder?

The most recent models that attempt to describe what is happening in the brains of people with Attention Deficit Hyperactivity Disorder suggest that several areas of the brain may be affected by the disorder. They include the frontal lobes, the inhibitory mechanisms of the cortex, the limbic system, and the reticular activating system. Each of these areas of the brain is associated with various neurological functions.

There are several areas of the brain potentially impacted, and there are several possible "types" of ADHD. Daniel Amen, a medical doctor using SPECT scans as identified six different types of ADHD, each with its own set of problems, and each different from the other "types." In our practice we used five different "types" of ADHD, identifying each "type" with a character from the Winnie the Pooh stories (Pooh is inattentive, Tigger is hyperactive, Eeyore is depressive, and so on).

The frontal lobes help us to pay attention to tasks, focus concentration, make good decisions, plan ahead, learn and remember what we have learned, and behave appropriately for the situation. The inhibitory mechanisms of the cortex keep us from being hyperactive, from saying things out of turn, and from getting mad at inappropriate times, for examples. They help us to "inhibit" our behaviors. It has been said that 70% of the brain is there to inhibit the other 30%.

When the inhibitory mechanisms of the brain aren't working as hard as they ought to, then we can see results of what are sometimes called "dis-inhibition disorders" which allow for impulsive behaviors, quick temper, poor decision making, hyperactivity, and so on.

The limbic system is the base of our emotions and our highly vigilant look-out tower. If over-activated, a person might have wide mood swings, or quick temper outbursts. He might also be "over-aroused," quick to startle, touching everything around him, hyper-vigilant. A normally functioning limbic system would provide for normal emotional changes, normal levels of energy, normal sleep routines, and normal levels of coping with stress. A dysfunctional limbic system results in problems with those areas.

The Attention Deficit Hyperactivity Disorder might affect one, two, or all three of these areas, resulting in several different "styles" or "profiles" of children (and adults) with ADD ADHD.

Learn more about the impact of ADHD on children and teens, treatment options for ADHD, and much more at the ADHD Information Library. 


By Douglas Cowan, Psy.D.

Attention Deficit Hyperactivity Disorder is Not Related to I.Q.

It's important to know that Attention Deficit Hyperactivity Disorder and Intelligence, as measured by I.Q., are two different things.

Some parents are convinced that if their child has ADD it means that they are retarded. On the other hand, other parents say, "I've heard that ADD kids are really very, very bright. I think my child must have ADD," as if they wanted to wear a button that said, "My child is smarter than your child because he has ADD." Both of these points of view are unfortunate, and are based on bad information.

Intelligence falls into a Bell Curve, even for those with Attention Deficit Hyperactivity Disorder. Some Attention Deficit Hyperactivity Disorder kids are below average I.Q., and some are even retarded. Other ADD ADHD kids are above average I.Q., and some are even quite brilliant. But the awful truth for a parent to hear is that MOST children (about 2 out of 3) are AVERAGE I.Q. That's why they call it "average." And most Attention Deficit Hyperactivity Disorder kids have average I.Q. as well.

Children with Attention Deficit Hyperactivity Disorder just have a very tough time in the classroom setting. We tend to see lower academic achievement than we would predict based on the child's I.Q. If they are really smart and they ought to be A students, we are disappointed when they're getting C's instead. If they ought to be B students, they're getting D's instead. Their school performance is disappointing, but it may not be due to a lack of intelligence.

The ADHD Information Library has six web sites with information to help children and teens with Attention Deficit Disorder be more successful in school, at home, and in life. At our site dedicated to helping children and teens succeed in the classroom you will find over 500 classroom interventions for teachers and parents to use. Visit ADDinSchool.com and look around for four or five suggestions to help your child succeed.

By Douglas Cowan, Psy.D.

Panic Attacks: Effective Ways to Cope

Jill is a 21 y/o college student who used to do well until about a few months ago when she started to experience "weird" attacks almost daily. She described her experience as "horrible." When she has the attack, she feels that she's about to die or develop a stroke.

One day while she was in a mall, she suddenly developed an "overwhelming" sensation all over her body. She was sweaty and tremulous and felt that her heart was pumping so fast. Within a few seconds, she also suffered from chest pain and shortness of breath. This episode lasted for about 10 minutes but she felt that this was her worst ten minutes of her life.

Overwhelmed by her experience, she has stayed away from malls and has avoided being in a crowd of people. Because of the frequency of the attacks, Jill can't anymore function normally. She is afraid to leave the house and go to work.

Jill's experience is typical of someone with Panic Disorder. A person with panic disorder develops anxiety attacks associated with the thought that he or she would die or develop a stroke or heart attack. Physical changes such as fast heart beat, shortness of breath, fainting episodes, sweating and tremulousness are some of the accompanying symptoms.

A typical episode usually comes "out of the blue" and not precipitated by any triggers. It can therefore happen any time and anywhere. An attack can last for a few to several minutes.

One episode can make a person feel scared of having another one. In fact, a lot of people feel distressed anticipating the occurrence of another attack. So most individuals prefer to stay at home and isolate themselves from friends, co-workers, and even relatives. Eventually they become incapacitated.

If you're like Jill, is there any treatment that can help?

Yes, there is. Individuals with this condition are successfully treated with an antidepressant such as the serotonin-reuptake inhibitors. Usually, the dose should be started low, for instance 10 mg/day of citalopram. After a few weeks, the dose should be gradually increased depending upon the person's clinical status.

Cognitive behavior therapy is likewise very effective. This type of "talk psychotherapy" helps the individual to restructure his or her thinking. Negative cognition associated with the illness should be addressed in therapy because it creates more harm than good. Relaxation techniques such as breathing exercises should also help.

During treatment, patience is very important because it takes a while before any intervention helps. However, don't despair. After a few weeks, the medication should start working and should give you a feeling of comfort.

What's the role of benzodiazepines (e.g. lorazepam or clonazepam) in the treatment of panic disorder? This type of drug can provide acute relief but should be used only on a short-term basis because of its addiction potential. For long-term treatment, antidepressants and psychotherapy are still preferable.

By Dr. Michael G. Rayel

Biometrics

ABSTRACT

Biometric identification refers to identifying an individual based on his/her distinguishing physiological and/or behavioural characteristics. As these characteristics are distinctive to each and every person, biometric identification is more reliable and capable than the traditional token based and knowledge based technologies differentiating between an authorized and a fraudulent person. This paper discusses the mainstream biometric technologies and the advantages and disadvantages of biometric technologies, their security issues and finally their applications in day today life.

INTRODUCTION:

"Biometrics" are automated methods of recognizing an individual based on their physical or behavioral characteristics. Some common commercial examples are fingerprint, face, iris, hand geometry, voice and dynamic signature. These, as well as many others, are in various stages of development and/or deployment. The type of biometric that is "best " will vary significantly from one application to another. These methods of identification are preferred over traditional methods involving passwords and PIN numbers for various reasons: (i) the person to be identified is required to be physically present at the point-of-identification; (ii) identification based on biometric techniques obviates the need to remember a password or carry a token. Biometric recognition can be used in identification mode, where the biometric system identifies a person from the entire enrolled population by searching a database for a match.

A BIOMETRIC SYSTEM:

All biometric systems consist of three basic elements:

Enrollment, or the process of collecting biometric samples from an individual, known as the enrollee, and the subsequent generation of his template.

Templates, or the data representing the enrollee's biometric.

Matching, or the process of comparing a live biometric sample against one or many templates in the system's database.

Enrollment

Enrollment is the crucial first stage for biometric authentication because enrollment generates a template that will be used for all subsequent matching. Typically, the device takes three samples of the same biometric and averages them to produce an enrollment template. Enrollment is complicated by the dependence of the performance of many biometric systems on the users' familiarity with the biometric device because enrollment is usually the first time the user is exposed to the device. Environmental conditions also affect enrollment. Enrollment should take place under conditions similar to those expected during the routine matching process. For example, if voice verification is used in an environment where there is background noise, the system's ability to match voices to enrolled templates depends on capturing these templates in the same environment. In addition to user and environmental issues, biometrics themselves change over time. Many biometric systems account for these changes by continuously averaging. Templates are averaged and updated each time the user attempts authentication.

Templates

As the data representing the enrollee's biometric, the biometric device creates templates. The device uses a proprietary algorithm to extract "features" appropriate to that biometric from the enrollee's samples. Templates are only a record of distinguishing features, sometimes called minutiae points, of a person's biometric characteristic or trait. For example, templates are not an image or record of the actual fingerprint or voice. In basic terms, templates are numerical representations of key points taken from a person's body. The template is usually small in terms of computer memory use, and this allows for quick processing, which is a hallmark of biometric authentication. The template must be stored somewhere so that subsequent templates, created when a user tries to access the system using a sensor, can be compared. Some biometric experts claim it is impossible to reverse-engineer, or recreate, a person's print or image from the biometric template.

Matching

Matching is the comparison of two templates, the template produced at the time of enrollment (or at previous sessions, if there is continuous updating) with the one produced "on the spot" as a user tries to gain access by providing a biometric via a sensor. There are three ways a match can fail:

Failure to enroll.
False match.
False nonmatch.

Failure to enroll (or acquire) is the failure of the technology to extract distinguishing features appropriate to that technology. For example, a small percentage of the population fails to enroll in fingerprint-based biometric authentication systems. Two reasons account for this failure: the individual's fingerprints are not distinctive enough to be picked up by the system, or the distinguishing characteristics of the individual's fingerprints have been altered because of the individual's age or occupation, e.g., an elderly bricklayer.

In addition, the possibility of a false match (FM) or a false nonmatch (FNM) exists. These two terms are frequently misnomered "false acceptance" and "false rejection," respectively, but these terms are application-dependent in meaning. FM and FNM are application-neutral terms to describe the matching process between a live sample and a biometric template. A false match occurs when a sample is incorrectly matched to a template in the database (i.e., an imposter is accepted). A false non-match occurs when a sample is incorrectly not matched to a truly matching template in the database (i.e., a legitimate match is denied). Rates for FM and FNM are calculated and used to make tradeoffs between security and convenience. For example, a heavy security emphasis errs on the side of denying legitimate matches and does not tolerate acceptance of imposters. A heavy emphasis on user convenience results in little tolerance for denying legitimate matches but will tolerate some acceptance of imposters.

BIOMETRIC TECHNOLOGIES:

The function of a biometric technologies authentication system is to facilitate controlled access to applications, networks, personal computers (PCs), and physical facilities. A biometric authentication system is essentially a method of establishing a person's identity by comparing the binary code of a uniquely specific biological or physical characteristic to the binary code of an electronically stored characteristic called a biometric. The defining factor for implementing a biometric authentication system is that it cannot fall prey to hackers; it can't be shared, lost, or guessed. Simply put, a biometric authentication system is an efficient way to replace the traditional password based authentication system. While there are many possible biometrics, at least eight mainstream biometric authentication technologies have been deployed or pilot-tested in applications in the public and private sectors and are grouped into two as given,

Contact Biometric Technologies
fingerprint,
hand/finger geometry,
dynamic signature verification, and
keystroke dynamics

Contactless Biometric Technologies
facial recognition,
voice recognition
iris scan,
retinal scan,

CONTACT BIOMETRIC TECHNOLOGIES:

For the purpose of this study, a biometric technology that requires an individual to make direct contact with an electronic device (scanner) will be referred to as a contact biometric. Given that the very nature of a contact biometric is that a person desiring access is required to make direct contact with an electronic device in order to attain logical or physical access. Because of the inherent need of a person to make direct contact, many people have come to consider a contact biometric to be a technology that encroaches on personal space and to be intrusive to personal privacy.

Fingerprint

The fingerprint biometric is an automated digital version of the old ink-and-paper method used for more than a century for identification, primarily by law enforcement agencies. The biometric device involves users placing their finger on a platen for the print to be read. The minutiae are then extracted by the vendor's algorithm, which also makes a fingerprint pattern analysis. Fingerprint template sizes are typically 50 to 1,000 bytes. Fingerprint biometrics currently have three main application arenas: large-scale Automated Finger Imaging Systems (AFIS) generally used for law enforcement purposes, fraud prevention in entitlement pro-grams, and physical and computer access.

Hand/Finger Geometry

Hand or finger geometry is an automated measurement of many dimensions of the hand and fingers. Neither of these methods takes actual prints of the palm or fingers. Only the spatial geometry is examined as the user puts his hand on the sensor's surface and uses guiding poles between the fingers to properly place the hand and initiate the reading. Hand geometry templates are typically 9 bytes, and finger geometry templates are 20 to 25 bytes. Finger geometry usually measures two or three fingers. Hand geometry is a well-developed technology that has been thoroughly field-tested and is easily accepted by users.

Dynamic Signature Verification

Dynamic signature verification is an automated method of examining an individual's signature. This technology examines such dynamics as speed, direction, and pressure of writing; the time that the stylus is in and out of contact with the "paper"; the total time taken to make the signature; and where the stylus is raised from and lowered onto the "paper." Dynamic signature verification templates are typically 50 to 300 bytes.

Keystroke Dynamics

Keystroke dynamics is an automated method of examining an individual's keystrokes on a keyboard. This technology examines such dynamics as speed and pressure, the total time of typing a particular password, and the time a user takes between hitting certain keys. This technology's algorithms are still being developed to improve robustness and distinctiveness. One potentially useful application that may emerge is computer access, where this biometric could be used to verify the computer user's identity continuously.

CONTACTLESS BIOMETRIC TECHNOLOGIES:

A contactless biometric can either come in the form of a passive (biometric device continuously monitors for the correct activation frequency) or active (user initiates activation at will) biometric. In either event, authentication of the user biometric should not take place until the user voluntarily agrees to present the biometric for sampling. A contactless biometric can be used to verify a persons identity and offers at least two dimension that contact biometric technologies cannot match. A contactless biometric is one that does not require undesirable contact in order to extract the required data sample of the biological characteristic and in that respect a contactless biometric is most adaptable to people of variable ability levels.

Facial Recognition

Facial recognition records the spatial geometry of distinguishing features of the face. Different vendors use different methods of facial recognition, however, all focus on measures of key features. Facial recognition templates are typically 83 to 1,000 bytes. Facial recognition technologies can encounter performance problems stemming from such factors as no cooperative behavior of the user, lighting, and other environmental variables. Facial recognition has been used in projects to identify card counters in casinos, shoplifters in stores, criminals in targeted urban areas, and terrorists overseas.

Voice Recognition

Voice or speaker recognition uses vocal characteristics to identify individuals using a pass-phrase. Voice recognition can be affected by such environmental factors as background noise. Additionally it is unclear whether the technologies actually recognize the voice or just the pronunciation of the pass-phrase (password) used. This technology has been the focus of considerable efforts on the part of the telecommunications industry and NSA, which continue to work on

improving reliability. A telephone or microphone can serve as a sensor, which makes it a relatively cheap and easily deployable technology.

Iris Scan

Iris scanning measures the iris pattern in the colored part of the eye, although the iris color has nothing to do with the biometric. Iris patterns are formed randomly. As a result, the iris patterns in your left and right eyes are different, and so are the iris patterns of identical-cal twins. Iris scan templates are typically around 256 bytes. Iris scanning can be used quickly for both identification and verification

Applications because of its large number of degrees of freedom. Current pilot programs and applications include ATMs ("Eye-TMs"), grocery stores (for checking out), and the few International Airports (physical access).

Retinal Scan

Retinal scans measure the blood vessel patterns in the back of the eye. Retinal scan templates are typically 40 to 96 bytes. Because users perceive the technology to be somewhat intrusive, retinal scanning has not gained popularity with end-users. The device involves a light source shined into the eye of a user who must be standing very still within inches of the device. Because the retina can change with certain medical conditions, such as pregnancy, high blood pressure, and AIDS, this biometric might have the potential to reveal more information than just an individual's identity.

Emerging biometric technologies:

Many inventors, companies, and universities continue to search the frontier for the next biometric that shows potential of becoming the best. Emerging biometric is a biometric that is in the infancy stages of proven technological maturation. Once proven, an emerging biometric will evolve in to that of an established biometric. Such types of emerging technologies are the following:

Brainwave Biometric
DNA Identification
Vascular Pattern Recognition
Body Odor Recognition
Fingernail Bed Recognition
Gait Recognition
Handgrip Recognition
Ear Pattern Recognition
Body Salinity Identification
Infrared Fingertip Imaging & Pattern Recognition


SECURITY ISSUES:

The most common standardized encryption method used to secure a company's infrastructure is the Public Key Infrastructure (PKI) approach. This approach consists of two keys with a binary string ranging in size from 1024-bits to 2048-bits, the first key is a public key (widely known) and the second key is a private key (only known by the owner). However, the PKI must also be stored and inherently it too can fall prey to the same authentication limitation of a password, PIN, or token. It too can be guessed, lost, stolen, shared, hacked, or circumvented; this is even further justification for a biometric authentication system. Because of the structure of the technology industry, making biometric security a feature of embedded systems, such as cellular phones, may be simpler than adding similar features to PCs. Unlike the personal computer, the cell phone is a fixed-purpose device. To successfully incorporate Biometrics, cell-phone developers need not gather support from nearly as many groups as PC-application developers must.

Security has always been a major concern for company executives and information technology professionals of all entities. A biometric authentication system that is correctly implemented can provide unparalleled security, enhanced convenience, heightened accountability, superior fraud detection, and is extremely effective in discouraging fraud. Controlling access to logical and physical assets of a company is not the only concern that must be addressed. Companies, executives, and security managers must also take into account security of the biometric data (template). There are many urban biometric legends about cutting off someone finger or removing a body part for the purpose of gain access. This is not true for once the blood supply of a body part is taken away, the unique details of that body part starts to deteriorate within minutes. Hence the unique details of the severed body part(s) is no longer in any condition to function as an acceptable input for scanners.

The best overall way to secure an enterprise infrastructure, whether it be small or large is to use a smart card. A smart card is a portable device with an embedded central processing unit (CPU). The smart card can either be fashioned to resemble a credit card, identification card, radio frequency identification (RFID), or a Personal Computer Memory Card International Association (PCMCIA) card. The smart card can be used to store data of all types, but it is commonly used to store encrypted data, human resources data, medical data, financial data, and biometric data (template). The smart card can be access via a card reader, PCMCIA slot, or proximity reader. In most biometric-security applications, the system itself determines the identity of the person who presents himself to the system. Usually, the identity is supplied to the system, often by presenting a machine-readable ID card, and then the system asked to confirm. This problem is "one-to- one matching." Today's PCs can conduct a one-to-one match in, at most, a few seconds. One-to-one matching differs significantly from one-to-many matching. In a system that stores a million sets of prints, a one-to-many match requires comparing the presented fingerprint with 10 million prints (1 million sets times 10 prints/set). A smart card is a must when implementing a biometric authentication system; only by the using a smart card can an organization satisfy all security and legal requirements. Smart cards possess the basic elements of a computer (interface, processor, and storage), and are therefore very capable of performing authentication functions right on the card.

The function of performing authentication within the confines of the card is known as 'Matching on the Card (MOC)'. From a security prospective MOC is ideal as the biometric template, biometric sampling and associated algorithms never leave the card and as such cannot be intercepted or spoofed by others (Smart Card Alliance). The problem with smart cards is the public-key infrastructure certificates built into card does not solve the problem of someone stealing the card or creating one. A TTP (Trusted Third Party) can be used to verify the authenticity of a card via an encrypted MAC (Media Access Control).

CULTURAL BARRIERS/PERCEPTIONS:

People as diverse as those of variable abilities are subject to many barriers, theories, concepts, and practices that stem from the relative culture (i.e. stigma, dignity or heritage) and perceptions (i.e. religion or philosophical) of the international community. These factors are so great that they could encompass a study of their own. To that end, it is also theorized that to a certain degree that the application of diversity factors from current theories, concepts, and practices may be capable of providing a sturdy framework to the management of employees with disabilities. Moreover, it has been implied that the term diversity is a synonymous reflection of the initiatives and objectives of affirmative action policies. The concept of diversity in the workplace actually refers to the differences embodied by the workforce members at large. The differences between all employees in the workforce can be equated to those employees of different or diverse ethnic origin, racial descent, gender, sexual orientation, chronological maturity, and ability; in effect minorities.

ADVANTAGES OF BIOMETRIC TECHNOLOGIES:

Biometric technologies can be applied to areas requiring logical access solutions, and it can be used to access applications, personal computers, networks, financial accounts, human resource records, the telephone system, and invoke customized profiles to enhance the mobility of the disabled. In a business-to-business scenario, the biometric authentication system can be linked to the business processes of a company to increase accountability of financial systems, vendors, and supplier transactions; the results can be extremely beneficial.

The global reach of the Internet has made the services and products of a company available 24/7, provided the consumer has a user name and password to login. In many cases the consumer may have forgotten his/her user name, password, or both. The consumer must then take steps to retrieve or reset his/her lost or forgotten login information. By implementing a biometric authentication system consumers can opt to register their biometric trait or smart card with a company's business-to-consumer e-commerce environment, which will allow a consumer to access their account and pay for goods and services (e-commerce). The benefit is that a consumer will never lose or forget his/her user name or password, and will be able to conduct business at their convenience. A biometric authentications system can be applied to areas requiring physical access solutions, such as entry into a building, a room, a safe or it may be used to start a motorized vehicle. Additionally, a biometric authentication system can easily be linked to a computer-based application used to monitor time and attendance of employees as they enter and leave company facilities. In short, contactless biometrics can and do lend themselves to people of all ability levels.

DISADVANTAGES OF BIOMETRIC TECHNOLOGIES:

Some people, especially those with disabilities may have problems with contact biometrics. Not because they do not want to use it, but because they endure a disability that either prevents them from maneuvering into a position that will allow them to make use the biometric or because the biometric authentication system (solution) is not adaptable to the user. For example, if the user is blind a voice biometric may be more appropriate.

BIOMETRIC APPLICATIONS:

Most biometric applications fall into one of nine general categories:

Financial services (e.g., ATMs and kiosks).

Immigration and border control (e.g., points of entry, precleared frequent travelers, passport and visa issuance, asylum cases).

Social services (e.g., fraud prevention in entitlement programs).

Health care (e.g., security measure for privacy of medical records).

Physical access control (e.g., institutional, government, and residential).

Time and attendance (e.g., replacement of time punch card).

Computer security (e.g., personal computer access, network access, Internet use, e-commerce, e-mail, encryption).

Telecommunications (e.g., mobile phones, call center technology, phone cards, televised shopping).

Law enforcement (e.g., criminal investigation, national ID, driver's license, correctional institutions/prisons, home confinement, smart gun).


CONCLUSION:

Currently, there exist a gap between the number of feasible biometric projects and knowledgeable experts in the field of biometric technologies. The post September 11 th, 2002 attack (a.k.a. 9-11) on the World Trade Center has given rise to the knowledge gap. Post 9-11 many nations have recognized the need for increased security and identification protocols of both domestic and international fronts. This is however, changing as studies and curriculum associated to biometric technologies are starting to be offered at more colleges and universities. A method of closing the biometric knowledge gap is for knowledge seekers of biometric technologies to participate in biometric discussion groups and biometric standards committees.

The solutions only needs the user to possess a minimum of require user knowledge and effort. A biometric solution with minimum user knowledge and effort would be very welcomed to both the purchase and the end user. But, keep in mind that at the end of the day all that the end users care about is that their computer is functioning correctly and that the interface is friendly, for users of all ability levels. Alternative methods of authenticating a person's identity are not only a good practice for making biometric systems accessible to people of variable ability level. But it will also serve as a viable alternative method of dealing with authentication and enrollment errors.

Auditing processes and procedures on a regular basis during and after installation is an excellent method of ensuring that the solution is functioning within normal parameters. A well-orchestrated biometric authentication solution should not only prevent and detect an impostor in instantaneous, but it should also keep a secure log of the transaction activities for prosecution of impostors. This is especially important, because a great deal of ID theft and fraud involves employees and a secure log of the transaction activities will provide the means for prosecution or quick resolution of altercations.



K.Murali