I'll go really quickly because I think that a lot of the points have already been made through the discussion. So this is basically, we discussed the policy framework yesterday, but the issues are applicable across medicine, many of these. And I do need to acknowledge all the people who worked on this policy framework. And so what I'm going to be doing is talking about the clinically relevant issues and the recommendations that are made for advocacy that the college will be focusing on. And so these are the ones I picked out as the clinical issues. So there are a lack of tools for NGS interpretation. We've talked about the need for a clinical variant database and it's genotypes plus phenotypes. So and inherited as well as somatic, I think are both needed. And not only phenotype, but potentially outcomes data also. And then we need reference genomes for different racial and ethnic groups. This was discussed earlier, but there's some question, I guess, as to whether you need the race-ethnicity differences. But the more your patient is different than the reference genome, the more variants you get. And the more irrelevant variants you get because it has to do with race-ethnicity difference. And in addition, we need potentially normal genomes because the reference genomes that we are using, you might miss calls that are incidental findings of, you know, in the patient or in the reference genome. So this whole issue of reference genomes for clinical testing is, I think, a very important issue to define what it is we do need and what's best. We feel the gene patents limit patient access and restrict medical practice. So CAP is on the U.S. Supreme Court case. Oral arguments were heard in April and the decision is expected in June against, from Myriad. HIT, we're generating extremely large data sets. We need interoperability standards between the instruments, the laboratory information system, the, sorry, EHR and PHR. And so working with policymakers and stakeholders as well as industry partners to participate in national discussions of standards for clinical genomic data, storage, and management. And incorporate standards eventually when these standards are developed, CAP is an accrediting body under CLIA, and so we would include these standards in the accreditation processes for laboratories doing this testing. There is regulatory uncertainty about the oversight for laboratory-developed tests, and I know Liz said don't ask any questions about LDTs, but the CAP will advocate for rational oversight and is working with the FDA in providing information of both commercial IVD test kits and laboratory-developed tests. We think the uses of these are different, how they're used, and the standards need to reflect those differences, but we do want to promote rigorous laboratory and interpretive standards for clinical genomic testing and strive for a balance between patient safety, the technology advances which are moving really rapidly, and translation of new scientific knowledge into clinical tests for patient care. On genomic consultations, this is not a recognized role for pathologists, although pathologists do provide patient consultations. We need to advocate for pathologists. So this is a very pathology-centric, but it's related to clinical practice. Many pathologists don't have access to the electronic health record of patients, and the only way that they can get patient information is by going through the clinician who ordered the test. And sometimes that's impossible to get that information, and sometimes, state by state, this is actually legislated that you can't have access to the record. So we also need to develop billing codes for genomic consultations, not only for pathologists, but for all physicians. These consultations aren't both for the interpretations and the consultations aren't well reimbursed. And I know this ties into the whole payment reform and how is anything going to be paid in the future, that's a great deal of uncertainty layered on top of this. And we also want to advocate, or even develop, user-friendly model reports like the synoptic reports we have for cancer for genomic tests that are understandable by the ordering provider as well as can be used in the PHR to help patients understand their genomic information. There is a great deal of payment uncertainty for genomics. We think that we should advocate that the interpretation of genomic data is the practice of medicine. And so we also, so that is a controversy with the FDA where the FDA oversight begins and ends. We also think we should advocate for appropriate coverage of genomic and molecular technical and professional work. So CPT codes for genomic tests, that would be on the clinical laboratory fee schedule, but compensation appropriate for the professional time for interpretations. And so this is an issue in molecular pathology testing that everything is on the clinical laboratory fee schedule, and there is a very trivial professional fee of, you know, about $20 that you get for doing any professional interpretation of any test, molecular test. And so that was with the old stacking codes. This hasn't been fixed really with the molecular pathology codes. They're still on the clinical laboratory fee schedule. So we need privacy around genomics but balanced against clinical access. So genomic information does have a high potential for impact on healthcare decision-making, but also for misuse or at least the fear of misuse. So we need to assess the legal and policy needs to assure privacy for generating, storing and protecting the genetic or genomic health information for patients, but advocate for patient privacy protections that allow for clinical access, appropriate clinical access and use. And again, I mentioned the HIV testing issue that was back in the 90s where it was so privacy protected that many physicians couldn't access that information and didn't know that they were treating patients who were HIV positive. And then we need evidence for genomic medicine and we need to, we feel we need to advocate for funding for clinical studies that will generate clinical outcomes data to provide evidence-based support for the clinical usefulness as well as the cost effectiveness of genomic testing. So there are many case studies and there are some small studies. I think on a more population-based level, we need to generate the evidence that genomics is or is not cost effective and improves patient outcomes. I don't think that that's clearly been proven yet. And assure that when these studies are being designed that there is and implemented that they are inclusive of all the needed expertise. So read in there, pathologists need to be included but I made it a broader statement that all kinds of expertise is needed on these interdisciplinary teams. And finally, the final issue that we discuss is genomic medicine and accountable care organizations or health care delivery reform. These seem to be two separate national discussions that are going on. I find them very merged in Vermont. But the promise of genomic medicine is to improve patient outcomes and reduce overall health care costs. We hope that's what it will achieve. This aligns very much with the managed care goals and actually could be synergistic. And so this genomic evidence development needs to happen and then that evidence of the genomic value needs to be shared in the managed care settings. So this College of American Pathologists is developing advocacy approaches to the key issues in this document and we plan an annual update of the policy framework because many people are doing many things and the issues will progress, we think, on an annual basis. So I don't know if you want me to leave this up here or you want me to just end, but these were the topics that I discussed. So that's it. So I think we have time for a couple of questions. Thank you for keeping that short. I just want to ask a question on the reimbursement for interpretation. I don't answer any questions on reimbursement. Can I say that since Liz carved out what we could talk to her about? Well, I'm not sure Liz is the one who directs this to you either. So are you interpreting that as the reinterpretation as well and how do you see that changing if a patient changes insurance? There are huge issues. And insurance, I mean that's one of the issues when you talk about the family implications of genomic information that UK and Canada don't have to deal with, but payers don't want to pay necessarily for family member assessments to help with the patient that you're dealing with. I mean, so there's a great deal of complexity and we also don't know about reinterpretations. We don't know whether those will be ordered, whether the laboratory will just do them because new scientific information is available. And so you push that information out. If it's new information for the patient, you push that out to their clinician, but there's no way of billing for that. There are many reimbursement issues around genomic information and how it will be paid for. This is a combo between what Les talked about and the issues you talked about. And that's the role of the treating clinician. And my understanding is you had consent that the patient signed, correct? Saying you can't pick or choose. Here's what's going to be. Let's just pretend that's a scenario. I guess my question there is, does that make the clinician just a passive pass-through? I mean, there's a clinician sign the consent to say, I am willing to participate in tracking the phenotype of any little genetic thing you find. And I guess at what point do we engage the clinician in that? If I were a patient, I signed the consent, but yes, I agree that I have all these things done. I would anticipate that I would automatically get that back. The clinician is almost, yeah, it's nice that he or she will be there and might do the confirmatory phenotype testing, but I'm the one who signed the consent that says these are all the things I'm going to test. So I'm just wondering, it seems a weird role, and I would also worry as a clinician would I have liability issues if I were sitting on a finding that I did not share, that I thought, well, I've taken care of this person for 40 years. I know this phenotype is not there, therefore I won't hassle. Is this that space and kind of... Well, I don't want to talk for less, but that was basically my question, is ACMG is saying return the result to the clinician, but then there's no guidance for the clinician. The assumption is that they know what to do with that, but I think that's a very large assumption on ACMG's part. So Les, I don't know... Yeah, so we have to strike an appropriate balance here between asking and expecting too much of clinicians and asking or expecting nothing of them. And I think, again, we live in a real world, and when Olympus made, I think they made the first flexible endoscope, no one knew how to use them, and we figured out how to use them, and they work great. And so I think in some ways you have to sort of break out of the cycle of we can't implement it because none of the clinicians are ready for it, and then we can't, because none of the clinicians are ready for it, we can't roll out the technology. And so, and the clinicians also say, don't, we're not going to do your facility genetics CME because there isn't anything out there that's actually clinically useful yet. And so we're in this funny cycle, and we just have to break the cycle, and we do have to stress the system a little bit and push this and make it an issue that people feel like they need to deal with, and it's like, and we're talking with other groups now to say, okay, now we have a CME problem where we need to get clinicians to be comfortable with this and know what these boundaries are, and I think we actually can do it. And the clinicians order complex tests all the time, and their job is to make sure that the patient understands what they're getting into, not all the details of everything that's downstream, but to say, okay, we're starting this process, here's some of the kinds of things that could emanate from this process. You need to be comfortable with that, or if you're not comfortable with that, maybe we shouldn't go forward with this right now. And I think that's a very appropriate role for an experienced clinician who understands what this stuff is about to do that. I think the notion that as new information is received, it somehow has to be communicated to the patient may just simply be unrealistic and not really consonant with the way medicine is practiced, which is that people move. There's no guarantee they're going to notify their physician when they do and provide a referring address. And so I think you're going to have chaos if there's any long-term expectation that what genomic information is obtained now is going to be continuously updated throughout the life of the patient unless we create a completely new paradigm of not just genomic medicine, but how medicine is practiced in general. I think, in fact, it creates an interesting opportunity that I don't know how the health care system or the entrepreneurial environment will respond to it, which is we keep talking as though what's going to happen is that we're going to learn something new about a genomic variant already found and it's going to shed new light on the patient's health. And maybe that'll happen almost surely it will, but I'm skeptical about our ability to keep track of the patients. I think the inverse is just as likely and maybe more likely, which is that the patient's phenotype evolves as they get older and they develop a problem that you could look back at the genome sequence and maybe get inside into what that is. You know, their joints become swollen and which of the 10 things that could do that is most likely in this patient and the genome may actually help kind of direct the further work up. And that too won't happen if you had your genome sequence in 2013 in Boston and now you live in California because we don't have interoperable medical records or any realistic sort of conduit to communicate that information. And it raises the question will there be places and groups that will create sort of central storage that will go outside the healthcare system into some sort of entrepreneurial environment where people could draw on that data wherever it is that they live. But anyway, I think we just need to realize that this problem is probably best addressed by just saying this is a snapshot in time. Here's what we know now about you and there's no guarantee that we're going to update this in five years because we don't know where you're going to be. I think you have to be careful given how stressed the system is right now for the average clinician. So the average clinician out there is dealing with new requirements under the ACA for electronic medical records which often don't work very well depending on the institution and how much money your institution spent on electronic medical record for example University of Chicago. We implemented EPIC, the electronic medical record but we still use paper billing forms just to show you how logical some institutions are and how they implement things. Huh? And I think the evolving business of medicine is creating great uncertainty for the average. So I think you can forget it when you're talking to senior primary care physicians that are only trying to figure out how they can get out of what they're doing. I think the real opportunity is in training the new generation. We've been thinking about similar issues in the context of pharmacogenomics is whether there's an opportunity to create a geneticist's light or a pharmacogeneticist's light for primary care physicians. We're calling this potentially some sort of executive training program where you could take primary care physicians and provide them some training enough to have more expertise than their peers and this would be particularly attractive for primary care physicians that are completing residency, taking their first job often at academic medical centers in many cases and might see an opportunity to work as a primary care physician while getting special training in genetics and interpretation and then being a resource for their colleagues. So a result gets returned to a primary care physician and that patient, you know, if the patient's physician doesn't feel comfortable, they know that there's a colleague that they can seek input for, send the patient for a formal consult. And so I think, but to think that you're going to educate senior primary care physicians, I think that's just not going to work. Oh, I would say, first of all, that a lot of times we, in the past, we try to not go with the flow of how medicine is actually practiced. And to your point of sending the data to the patient, almost all private docs, you know, it's their patient and they want to have that control and if they need help, then they'll want to ask. So I think that we have to realize that to get them to use the data we have to fill, go with how data is normally presented through doctors. The other thing, relative to this last point, I'm actually working with the AAN to develop American Academy of Neurology, sorry, to develop training programs and some creative ways to train existing physicians. The neurologist, I was on the science committee, just came off and our last plenary session had two RNA talks in the plenary for neurology. So neurologists have come to the realization that they need to know. So I think there is a need, the question is how to do it, because your points are very well taken. You have to do it with them, not how we want to do it, but how they want to do it. All right, I think we probably need to move on. Next up is Brad, who's going to give an overview of phase one of CSER.


I'm recording on my end and you need to record on your end. You need to press the button. We're ready to go. I just wanted to say to you if it's all right. I need to get a better understanding of this journey that you took. If you don't mind 1995 from what I understand was a pivotal moment in in human history, let alone in your your history. Oh, they're saying my daughter's a say goodbye. Okay, they see me enough. They want to go listen now. So 1995, you had a book that started. Well, your journey with everyone. That book has changed a lot of people's lives. But what has it been like for you since you essentially in 1995 came out with what the malignant self love book. Yeah, I was diagnosed with narcissistic personality disorder twice. And I found myself in a situation where there was no no literature. There was academic literature which dated to the beginning of the 20th century, believe it or not. There were some studies conducted in the 70s. But there was no literature, definitely not popular literature. I wanted to understand my disorder. I wanted to put myself out of the out of the rock bottom situation I found myself in. And so I started to study and then the first thing I discovered is there was no language. There was simply no language I was trying to explain was trying to describe internal dynamics in myself. I was trying to commit to paper relationships. What happened in my interpersonal relationships intimate relationships workplace relationships, etc. And I couldn't there was no language simply. So the first thing I did in 1995 was invent a whole new language. So the bulk of the language in use today, for example, narcissistic abuse. Right, but not not only was actually either. I invented it either coined it, or I borrowed from early psychoanalytic literature, psychoanalytic literature in 1930s up to the 1960s. I borrowed terms and phrases from that literature, and I adopted them to the study of narcissism. So today about 90% of the language in use is the language that I came up with in the in the 90s. I did it first and foremost to capture my experience initially. So today, much is a derivative of your exploration into understanding or setting a language for what you were going through. Yeah, it started 90%. I'm gonna make sure I understand 90% of what everyone is batting around came about because Well, the language, the language, the language is easily 90%, if not more coming flying monkeys, hovering somatic narcissists, cerebral narcissists, inverted narcissists, narcissistic supply, false self devalued discard narcissistic abuse. These are all my creations or adaptations of early early psychoanalytic analytic literature. In 1985, you're a professional at that time, yes, right. I was actually a businessman.  No. Right. Right. That's right. You're, yeah, I'm telling you that's right. I'm just saying everything that I've been reading about you. You would consider me a stalker. I've been studying you haven't got much sleep since we've been talking. I just want to tell you this. I'm trying to wrap my brain around this much. Before that timeframe, there was no one that could help you with the language where you see in a therapist or anything like that at that time, nobody was diagnosed by two therapists, but you must, you must realize that the first time narcissistic personality disorder had appeared in any meaningful text was 1980. That's not a long time ago. No, that is not. Okay, you're, you're blowing my mind sale night. Okay, that's not long ago. Not long ago. So when the first time I've been diagnosed with narcissistic personality disorder was 1985. There was five years after NPD made it into the diagnostic and statistical manual. No one knew anything about NPD. Nothing. There was nothing. There was no literature, no scholarship. No, nothing. It was virgin land. And when I, when I attempted to describe to people what's going on inside me. And what it is that I'm doing to my so called nearest and dearest my insignificant others, my non intimate partners, you know, when I was trying to convey this when I was trying to communicate. I had to resort to phrases half a page long and then I said the heck with it.  Right. So I did, I did come up with a language. Of course, a lot of time that passed since then the field that evolved beyond recognition. There are many dozens of new contributors and hundreds maybe new contributors and so on. But I think I think my initial work was pioneering. And I think it had transformed. It has transformed society in several ways. For example, today, the concept of narcissism is an organizing principle. Today, when you try to explain someone's behavior politics, yes, yes, corporate misbehavior, the law law enforcement, victimhood movements or, you know, when today narcissism serves as the principle of organization of social and individual interactions. I see it in movies. I can't go, I can't watch any movie. I can't watch any documentary without coming across the word narcissism in the first five minutes. Narcissism, narcissism, this, that. So today, narcissism is a buzzword and a keyword. It is by far the hot button topic in psychology. Yes, yes. If that's the case, does it seem like the very concept of what it what it stood for when you started has been watered down diluted or confused? Yes, narcissism, of course, pathological narcissism is a clinical entity. In other words, it's a diagnosis in clinical psychology abnormal psychology. And now it's been exactly, as you say, it's been diluted or watered down and it become a pejorative. It became a curse word. It became a way to demean and devalue other people you don't like. Label institutions, institutions I don't like. Politicians, whatever it may be, it could be any structure, you can label it that way. And people could run with it in many directions. But when it came to your life, it began to give you an opportunity to explain what you were putting others through. Would you say, how'd you say insignificant others? Is that what you said? Yeah, that's what I said. That's a new, that's a new hashtag. You need to put that on one of your postings that is that's a hashtag you should start. That's a whole t-shirt line that you merchandise line. You can start right there. The insignificant others, what were you doing to others? If you had a way to describe it succinctly shrink wrap. How would you describe back then, the SAM of 1995, 80, 85 to 95 before you nothing, nothing has changed. It's a common myth. It's a common myth that insight and learning and knowledge cause transformation. I know everything there is to know about narcissism, I wish to believe. And yet nothing has changed in me. I'm exactly the same as I always been. And what I do to other people, especially intimate partners, but not only business partners. What I do to other people is that I objectify them. I take away their vitality. I reduce them, I reduce them to a function, an instrument, a tool, a device. I make them lose the ability to conceive of themselves as separate entities with rights, wishes, preferences, priorities and so on. I assimilate and digest them. I body snatch and mind snatch. And then I take over from the inside. Okay, so do you find yourself affecting other individuals, thought patterns, desires, motivation? And if so, do you affect other people's thought patterns? Because when you walk into a room or when you begin to just talk with them?  But I zombify them. I take away their vitalities, I just say. I render them zombies. They go through the motions. They say the right things. But there's no sparkle in their eyes. There's no spark in their eyes anymore. It's zapped. It's zapped. It's not in their eyes anymore. So then I ask you this, because you're educating me beyond belief. This is like an audience of one. So just bear with me. You're going to see me being giddy because, dude, I just, you're like in my Petri dish. I just want to just check you out. I just find you fascinating.  The word affection, how do you view the word affection and any connotations or thoughts that come with that from your perspective? I'm even incapable of experiencing positive emotions because in my world, positive emotions are intimately linked with negative emotions and negative emotions are life-threatening or dysregulated. Got it. So if I allow myself to experience anything positive, the gates of trauma will open wide and I'll drown, I'll dysregulate. The gates of trauma for you will open up. So therefore you have to navigate and pivot away from those. I have to repress my positive emotions because if I allow myself to emote, I will have opened the gates of my early childhood trauma. And I will drown. I'll become dysregulated. Technically, I'll become borderline. Okay. And when a person, say you, when a person, let's say it's me, let's say I'm doing that. If I start to move toward being borderline, what does that mean for those, because a lot of beginners down this journey or dealing with narcissism, listen and watch Narc Abuse TV Network, what my daughters and I provide for people, the public service channel. If I start moving toward borderline, what does that mean? What does that mean for me and the people around me? There was a scholar by the name of Rothschild. He said that Rothschild, he said that borderline personality disorder is a failed attempt to become a narcissist.  Now what happens with the narcissist is reverse engineering. When you expose the narcissist to stress, especially a challenge to the narcissist's grandiosity, humiliation, especially public humiliation. The narcissist goes through a process called narcissistic injury or narcissistic wounding. Another much, much more profound process is called narcissistic modification. In these two processes, the defenses of the narcissist crumble, disappear. And consequently, the narcissist is exposed to a tsunami of negative emotionality, including shame, guilt, fear, etc. At that point, he becomes technically a borderline. So narcissistic rage is a borderline state of narcissism. At that point, he becomes a borderline in the sense that he can no longer control his emotions. They become dysregulated. They take over. He's overwhelmed. He drowns in them and he flails around and he lashes out. So he becomes very injurious to other people, dangerous to other people. Now, in some cases, a psychopathic state emerges. So the transition is from narcissism to borderline and then to psychopathy. That's not a steady pattern that will happen all the time then, but it can lead to a psychopathic aspect from the borderline. A derivative of it will, they can move into that area or let me rephrase that. I'm gonna go back to me. I could go from being borderline and then move to that psychopathic state. All borderlines, all people in a borderline state, let alone with borderline personality disorder, all of them have a psychopathic self state. It's a protective state. It's a savior state. It's a rescuer state. The psychopathic state? Yes, the psychopathic state helps to defend and protect the borderline from abandonment, from humiliation, from rejection, from fear, from shame, from guilt. So when the borderline experiences stress, when she feels that she's about to be abandoned, abandoned anxiety, when she can no longer regulate her emotions, suddenly she becomes a secondary psychopath. A secondary psychopath is a psychopath with emotions and empathy. So she becomes a secondary psychopath and she begins to behave like a psychopath would. It's the same with the narcissist. When the narcissist is challenged, his grandiosity is challenged and undermined, when he's devalued, when he's humiliated. Exposed. When he's exposed. Right. Right. Then he then transitions to borderline. And then the borderline experiences dysregulated emotions and the narcissist becomes a psychopath. A temporary secondary psychopath. When they get into that, excuse me, I'm back to me. So I get into a secondary psychopath state. Excuse me, just correct. As a narcissist, you're incapable of empathy and emotions. So you will transition to a primary psychopath, not secondary. Okay, got it. And now, once, once I'm in that state, everybody in my, in my sphere, everyone in my, anybody that I come across, I'm going to super duper lash out.   You are reckless. You're impulsive. You're aggressive in the psychopathic sense. Huge emotional pushback and defiance will come to the fore, is kind of what you're saying. Defiance aggression. Correct me if I understand you.   Right, right, right. And now, is it possible that I would de-escalate or come down from that? You do always. This is a temporary self state. It's a temporary self state. Having re-established your grandiosity as a narcissist.  You set everything back in order, as it were. Yes, you feel good like. Because everyone is terrified of you. And so your grandiosity is restored. And once your grandiosity is restored, you don't need to be a psychopath anymore. You can go back to being a narcissist. If this becomes a pattern that a person can, if this is a pattern that I have from childhood and I've perfected it, I can set the world or the universe in my mind. I'm just saying this. You're the expert. Again, an audience of one. You're enduring my weirdness here. Okay, so then I can pretty much set the world back in order if I don't think everything's going my way and I'm about to get exposed to childhood trauma and emotions or whatever it may be. All I have to do is when I get to that psychopathic, a primary stage, if I'm understanding you correctly. Primary psychopathic self state. Okay, I can pretty much set the world back in order and I could be godlike and put everything back and now everything's okay. Because I've made sure everybody's afraid of me. Yes. What I, or what I could do to them, leave them, abandon them, take their affect their fight. You feel omnipotent. You feel omnipotent. You feel all powerful. All powerful. And then, then you don't need to be a psychopath because your grandiosity has been restored. Yeah, I can go back down to being a narcissist as it were. This pattern of existence is not just one or two people on the planet. Have you recognized that it's an ongoing pattern that's growing? Well, we should distinguish very carefully and this distinction is lost on many self-styled experts and so on. We should distinguish between narcissistic personality disorder, malignant narcissism, which is a confluence of psychopathy and narcissism. And narcissistic style. Now the concept of narcissistic style was first described by Lin Sperry. Lin Sperry is a scholar, Theodore Millen, another guy. I'm taking notes. Lin Sperry and Theodore Millen describe the narcissistic style. Narcissistic style is simply someone who is an a-hole, you know, just an a-hole. He tramples on everyone. He's insensitive. He cracks the wrong jokes at the wrong time. He's exploitative. He's a bit abusive and so on and so forth. But he doesn't amount to a full-fledged narcissist. It is estimated that up to 15%, 15% of the population have narcissistic style. The figure is much higher among the young, among people under the age of 25. Really? Yes. Just real quick before you keep going. The narcissistic style, we're not talking to somebody that's going to give a major pushback. They're just being a major jerk. Okay. All right, go ahead. That's a word, jerks. And this is much more common among the young than among the older generations. There are studies by John Twench and Keith Campbell and many others that have demonstrated that this kind of narcissistic style had exploded among the young and is five times higher than 40 years ago. So it seems to be the style, the personality style, the dominant personality style of young people, possibly because of the influence of social media. Social media. I was going to say that, yeah. Possibly. Possibly. We don't know which is the chicken which is the egg. Yeah, but one thing is for sure, you're going to get chicken in one way or the other. Either scrambled or you're going to get it cooked, one or the other. So either way, social media could be feeding that. But that's something, that's a whole nother show. That's a narcissistic style. And then you have narcissistic personality disorder. Okay. The narcissistic personality disorder is diagnosed in about 1% of the population. 1%. Okay. So there are nine diagnostic criteria and there is an alternative model of narcissistic personality disorder in the fifth edition of the diagnostic and statistical manual. It's a severe, a very severe mental health disorder. Kernberg auto Kernberg was one of the leading scholars of the field in the field thought that narcissism is a form of psychosis psychotic disorder. So it's a really, really a very bad affliction. I have the combination of this with psychopathy. And that is not that is not narcissism. With all due respect, please bear with me. When you because I'm writing this down when you get to this aspect of the NPD before we get to the one you just mentioned. The NPD now the first one we said you know we're talking about a major jerk. You were described this for those who are just trying to understand and who will watch this later. Everything is more extreme in the narcissistic style there's a deficit in empathy in NPD there's no empathy. The narcissistic style would try to leverage people to use people to obtain goals. The narcissists would trample and destroy people in the pursuit of everything is simply more extreme. So the last is for example the narcissistic style would be mildly mildly envious of other people's accomplishments and so on. The narcissists would try to destroy. Envies. So we're talking about somebody that does some major demolition to somebody's life. They're not coming in and just kicking a few things around and throwing the table. They're not you're not benign. No, by any means they're not benign. They're coming in driven by envy or something like that and fueled with anger and other things and they're trying to make sure you don't exist. Entitlement. People with narcissistic style are not entitled people with NPD are entitled entitlement simply means that simply means that you think you deserve some things. Special treatment to talk to the top people whatever without any commensurate achievements without any investment without any effort without any. So you believe you deserve to be to have a PhD without having invested a minute in studies. Yeah. And everything that comes with the PhD you want you want the piece. You want the prestige. A lifestyle with everything. And you don't want to invest in your studies. No word for it. Right. Right. That's entitlement. Now, now that's not that's not that's not apparent or a part of a narcissistic style though correct. Okay, got it. I'm sorry go ahead you're going to say. So, so these these narcissists this one percent of population and today there is a trend in academia in universities where I teach I teach psychology in several universities colleagues of mine in other universities. They try to espouse the view that narcissism and psychopathy are positive evolutionary adaptations. That it's good to be a narcissist that we need narcissistic positions of power and authority like chief executive offices president of the United States. All I can do is I strongly oppose this ignorant view. This is enormous ignorance. This is not knowing the first thing about narcissism. I'm surprised by that. Kevin, Kevin Dutton MacCoby, I can give you many names high functioning high functioning narcissists. Let's go. So, wow, productive productive narcissists and high functioning narcissists and productive psychopaths. I don't even know what to say to that. There's a whole there's a whole library of books saying that psychopaths are the best thing that had happened to humanity because they can make tough decisions. They, they, you know, they're great military leaders and surgeons. I mean, it's a great thing we have psychopaths. We should encourage them and egg them on and breed them as it were. Yeah, in a way. So I don't think these people know what the heck they're talking about. Honestly, because for example, narcissists, they start off very convincingly and very charmingly. They, they co-opt everyone around them, they create counts, personality counts and so on. But they end up badly. Everything around them goes up in flames. Adolf Hitler, Donald Trump, everything goes up in flames at the end. There's no such thing as a productive high functioning narcissists. It's nonsensical myth, you know, and not not backed by the by most of the literature, most. So that's a problem. Now, Malignant narcissists are really, really by far the most dangerous. They are even more dangerous than psychopaths because. Are this, is this a part of the psychopathy part that you're talking about the Malignant? Are they in there? Is this the whole difference? Are confluence, combination, psychopaths and narcissists in the same. Got it. Okay. They are by far the most dangerous breed. And you are talking to one right now. They're the most dangerous breed. Why is that? Because a proper psychopath, what we call factor one psychopath, a proper psychopath. He is goal oriented. He wants money. He wants sex. He wants power. He gets what he wants. He doesn't bother with you. He's not going to harm you. So he's very goal oriented. Yeah, he's ruthless. He's callous. He has no scruples. He's impulsive. He's defined. He is aggressive. It's all true. But at least he's human.  You want money. You want power. It's a human aspiration.  He's chopping down trees through the forest to get to where he wants to go instead of just walking through the forest and enjoying the trees. He's looking at him. Well, like, you know what? That tree don't need to be there. It's in my way. But you're both headed to the same destination. You're driven by the same as it were natural human impulse or desires. Burgers. Except. Except. Not so the malignant. The malignant. Not so the narcissist when it, when it is combined with psychopath. Because when the narcissist is combined with psychopath, then this, this type is not driven by goals. It's driven by impulses, dysregulated emotions, envy, hatred, lack of empathy. So it's like this kind of narcissists has all the tools of the psychopath. Lack of morality. Right. Right. And leverages the psychopath to accomplish narcissistic. Gratification goals and gratification. Right. It's the, the, the everything, the horses have been let out of the pen when the, when the two are combined and it's often running. Now, now in the process of it. Being often running. They are combined. Can they mask it and people have no idea they're like that. Can they be overly charming to the point that someone could end up thinking they can have a relationship with them, do business with them. Depends. I wouldn't generalize. People online tend to generalize and say, yes, I wouldn't generalize. Depends. I think it depends on Thespian skills, on skills of acting. Some of us can act well. Some of us cannot act well. For example, many narcissists, they're too grandiose. They say, why would I invest any effort in acting? Who are you that I would invest an effort for you? Okay, I'm sorry. That's pretty good. Why do I need to act? I don't need to act.  Why would I act for you? Do what I'm going to do. My way with the highway. A few. Why would I act for you? I don't need to act. That's a waste of my time. It demigrates me. It means I'm inferior to you. It means I want something from you. It means I need something from you.  I don't have to. I just, I just take it from you. Somebody else, if I have power to go and take it from you, bring it to me. I am who I am. It's my way of the highway. You don't like it. Yeah. Simple. So why would I need to act for you?  Why would I need to demean myself and humiliate myself and humble myself to act for you? Right. To even take, waste my energy to, to go that route. Now, is that considered a psychopath? Oh, no, go ahead. You're going to say, please. Similarly, many, many narcissists and psychopaths do not lie. They're brutally honest. Oh, wait, hold on a second. Wait. Why would I need to lie for you? I mean, to lie is to invest in effort. Do you deserve this effort? Do they brag about the fact that they don't lie? Yeah, I do. I never lie. Why do I have to lie? I never lie because no one deserves the effort that I have to put into line, you know. Got it. No, I see what you're saying. Yeah. I'm God. Why would I need to lie for, for the sake of ants?   Why would I need to? So I never lie. So these online myths that narcissists always lie that they always act. It's expressly untrue. Some narcissists act. Some narcissists lie. And I don't think it's much different in the general population. So, but if there is any tendency, it's the tendency to not act, to not lie.   You don't deserve my acting. You don't deserve the time and effort it takes to act and lie. You're inferior to me. But there be any moment that they feel that they may need to, if someone else, they may perceive has more God-like authority or power than them. This could happen with narcissists. Narcissists have role models. Okay. And they idolize and idealize. But never with psychopaths and never with psychopathic narcissists. All right. When it, when it comes to a psychopath. Just do me a huge favor. I know somebody's going to ask me this. Your definition of a psychopath is what? First of all, it may come as a shock to many people. Psychopath is not an accepted diagnosis. It's not really, it's clinically rejected. It's not accepted. It is espoused by a group of scholars which are outliers and outcasts even like Robert Hare and others, baby. The scholars claim that there is a very extreme form of antisocial personality disorder. Yeah. That is so extreme that it needs to be differentiated. It needs to be separated. And they call this extreme form psychopath. But it, but you won't find the psychopath, for example, in the diagnostic and statistical manual. It's not there. The word doesn't exist. Psychopath is simply someone who is extremely antisocial in the sense that he disrespects social mores, rules and conventions. He's defined. He's impulsive. He abhors and rejects authority. He is impulsive. He's reckless. Above all, he's reckless. He doesn't care. They're, they're, they're devil is he just goes. That's on a whim. That's one of the identifying major identifying factors that they're reckless. Yes. Okay. But it's not, it's not a clinical term. You're saying? No. It's thrown around. It's like, they can, you can make a series of movies by just making sure you throw that word in there. If long as you can say the villain is that everybody's going to fall in love with the villain. And I want to see him be crazy again. So it becomes a comment. It's almost thrown around. Like you said earlier at the beginning. Narcissism. There are two types, two types of psychopaths, according to the proponents of psychopathy, the proponents of psychopathy are an outside group. They are not in the establishment. So according to them, there are two types of psychopaths, primary psychopath and secondary psychopath. Secondary psychopath is a primary psychopath. Who has emotions and empathy. Okay. That's all primary psychopath. He's a secondary psychopath without emotions in him. So because borderline, his emotions and empathy, when she becomes a psychopath, she becomes a secondary psychopath. When the narcissist becomes a psychopath, he becomes a primary psychopath because he has no emotions. No emotion. No action. No action. All right. Okay. Now I have. Listen, I'm telling you. Professor. Sam. I do my research. I have, I get into it because, but you, man. I could. I'm glad you're not a woman because I might want to take you out because I want to. I bear that in mind for the next. Don't you don't even start with me. I want to pick your brain. So here we go. This is all, everything is from your Instagram page. And of course your videos. I got a smash up of stuff. I just want to get a deeper understanding. I just want to talk about victim hood.  Shed some light on that for those who maybe have an inclination to lean toward victim hood.  You're not. You're not, you're not a victim. Let's start with a few facts. that had uncovered the fact that some people have a tendency to feel like victims, even when they're not. There's a new construct called TIV, interpersonal victimhood. TIV, it was discovered by Gabai, G-A-B-A-Y and others. There are other studies and so it would seem there's Cartman with a drama triangle and so on and so forth. And so today we tend to think that some people are more prone to believe themselves to be victims, more prone. They have a tendency, a proclivity. And so this is fact number one. Fact number two, when victims organize and when they create victimhood movements, victimhood oriented movements, these movements tend to be hijacked by narcissists and psychopaths. Time out, that's mind-blowing what you just said. This is also established in the series of recent studies and can essentially get hijacked by a narcissist movement. These are facts. These are all established by recent studies, 2020-2021. The third fact is that victims of trauma, people who have been exposed to trauma, in when they enter the post traumatic condition, they tend to display pronounced narcissistic and psychopathic behaviors. In other words, they become temporary psychopaths and narcissists. Consequently, there is a very dominant movement in psychology today, spearheaded by Judith Herman, the woman who coined the phrase complex trauma or complex PTSD. Judith Herman suggests to eliminate the diagnosis of borderline personality disorder because she claims that it is a form of complex post-traumatic stress disorder. And she says, and many others say, and I say, and many scholars say that it's impossible to distinguish the victim of a trauma from an active borderline grandiose narcissistic, psychopathic state. So these are the three facts we can start with. Now, as to your question, what's the difference between being victimized and being a victim? Everyone is victimized in a lifetime. I've been mugged. I've been mugged twice, actually.  I mean, everyone is victimized. No, you can't go through life unscarred. Life is the agglomeration and conglomeration of losses.  So to be victimized is simply a synonym to being alive. To become a victim means to adopt the state of victimhood as your defining attribute as a part of your identity, to convert what had happened to you into your identity. Got it. Not to say, for example, I'm a woman who had been victimized, but to say, I'm a victim. It's like, I would ask you, who are you? So you could say I'm a man. I'm, I have a podcast.  It becomes part of the identity, a defining feature of who one is, one's essence. Becomes a driven part of the personality and the character of the person. Yeah. They're identifying, they're identifying their existence and not what happened to them. But they're identifying it what, what has happened as their existence. Take a Holocaust victim. You can ask a Holocaust victim who are you? So he would say, he would say I'm an accountant. I'm a father. I'm a husband. But some of them, some of them would say, I'm a Holocaust victim. Yeah. What kind of thing is this? Holocaust was a horrible event. And of course, survivors are entitled to be wounded and traumatized and so on. But is this who you are? It's not who you are. It's what had happened to you.    You're just perpetuating the abuse by remaining an eternal victim. This aspect that you're, you're bringing to the fore. This is not something that a lot of people will find easy to swallow. Yes, they call it victim blaming victim shaming victim, I don't know what. But even this, I mean, look at these phrases, victim blaming as though they are nothing but victims. When I when I tell someone, you're not a victim, you've just been victimized, and you've had contributions to your own victimhood, which you should study in order to avoid them in the future to avoid the same pitfalls. So that person doesn't say you're shaming me as a woman, or you're shaming me as a 40 year old, or you're shaming, she says you're shaming me as a victim. That means she's only a victim. Victim shaming means that I'm shaming someone who is only a victim, nothing else. And that, of course, is sick. It's pathological. You are never one thing.  And from your perspective, what you're highlighting is that we don't have to pigeonhole ourselves by what someone else did to us. But we can look beyond what they did and get them out of our head. And we can create new memories, new concepts, we can structure it and move on with our life. Even though it may be challenging and difficult, I know you're understanding that, but, but over, overall, you're saying it's not a matter of victim blaming and shaming from what you're, you're laying out right now. There's a bigger picture involved in which a person may not see themselves as a victim. But because of the way society often puts people in a position to only be a victim. Now, I'm just going to tell you this right now, I'm going to throw this in. Nobody's expecting me to say this. And I know you're not. But I'm just going to say this. I wasn't planning on saying it. That's a common concept and construct that you're talking about right now in many minority neighborhoods. I'm just going to tell you, I grew up in one.   But when you flip that around, it can, it can sound kind of funny to others that may hear it. But there are a huge swat, a huge group of individuals that can understand what you're saying. That was that was my street ghetto explaining what was in my head that just popped into my head.  Simple. As long as you remain a victim, your abuse is continued. Only you can stop the abuse by refusing to be a victim. Well, any mis, any mistreatment can either be minimized or eliminated by the way we handle and perceive what has transpired. The whole concept of resistance, including peaceful resistance, Martin Luther King, Gandhi, etc. The whole concept of resistance is about refusing to be a victim, refusing to be a victim.  They could either live as they see themselves as a victim, or they could see themselves as a common ground between you and them, and live together. If they continue to live with me, they're making a choice, aren't they? Yeah, I read some of the stuff you said about that. I find you fascinating. Well, the minute they've made a choice, they're no longer victims. Even if I victimize them, they're no longer victims, because they've made a choice. It's important to understand. Victim, victims, I believe that the label victim should be applied much less liberally. I understand a child two years old, victimized by his parents. That I understand that's a victim, that's a real victim. A grown up woman who chooses to stay in a relationship with her abuser, despite the abuse. Allow me to doubt her victimhood status. That becomes an opportunity for us to do another show, if I could so convince you to do that. Anyhow, I just wanted to drop that in front of you to keep in mind, because I truly want to dissect that, but I'm not going to throw away what's in front of me that I have to ask you about. I'm going to say a word. The word is boundaries. Give me your perspective on that word that is often mentioned in the community of those who talk about narcissism. Boundary, the boundary is where I stop and you begin. Simple. Where I stop and you begin, I can let you enter. I can let you enter like crossing the border into a foreign country. You need a visa. You need to qualify. You need a negative PCR test recently. You need to be vaccinated. Then I may let you cross it. But even then, before a limited period of time and you have to exit. That was good. That was really good to exit. Simple. If you refuse to exit, you're violating the law and you can set up camp and just take over and take over the territory. Now the boundaries. You have to recognize my separateness. The problem in narcissism is that there is a process in childhood. It's called separation individuation. It's when the child learns to separate from mommy and explore the world.  You have to be seriously grandiose. So it's intimately linked with narcissism. Separation individuation is intimately linked with narcissism. If the process gets gets disrupted, what remains is the narcissism. But the separation individuation fails. There's a failure. So you don't know how to separate. You remain a narcissist, but you don't know how to separate.  You want her to become an extension. You don't know how to separate from her. You can't regard her as a separate entity. You take a snapshot of her. You internalize the snapshot. You interact with the snapshot. She sees us to exist. And if she reminds you that she does exist by being independent and autonomous, it infuriates you. You want to suppress her autonomy and independence. You want her to vanish as a separate entity because you don't do separation very well. You don't know how to do it. It turns you don't know how to do it. You never learn.  So you are grandiose. But the grandiosity didn't have an outlet because you were not allowed to separate. Got it. You were not allowed to separate from mommy. So you don't know how to separate from your spouse. So I gotta ask a question. So if that's the case, let's say it's me. I don't know how to separate. Do I start to sense when there's a possibility I start to perceive, oh, here comes some separation, or they're gonna ask me to look at it a certain way. Do I go into a certain mode and try to cause havoc so that I don't have to have that separation? Do I make pushback? Anytime your intimate partner, for example, your business partner, remind you that they are actually separate from you. Yeah, autonomous. They have their own needs are independent. They make decisions. They have agencies that certifications. They don't look at, they don't look at the things the same way I do. They disagree with you. They criticize you. They give you advice. They give you advice. Give me advice. Right. Right. What happened? You react with panic. You react with panic. You don't have the tools, the basic tools to cope with such a situation. You must assimilate them. You must digest them. You must break their spirit. I must have them agree with me and not come at me. You must have them disappear as separate entities. Of course, if they are, if they are not separate entities, if you're a part of you, they can never disagree with you because they're part of you. Yeah, of course not. No, because yeah, pardon me. So what's the, what's the disagreement? What's the disagreement?  Wow. Anytime you show a sign of autonomy, I will ruin your day. I will penalize you. I will provide you with negative reinforcements. I will torture you. I bully you just to take away your separateness. I don't want you to be separate because I don't know how to deal with separateness. It Okay, so separateness opens the door for what then I don't want separateness. I don't want this person, the children, workmate, business partner to have this separate mindset because once that happens, it says what about me? Can abandon me. Got it. Got it. Can abandon me. Simply. Yeah, you could find something better. You could see something better. We're not going to have commonality.  And we get along just fine is the is the mindset that I would be having. You need to be in my head.  I need to internalize you as well.  That was okay.  Does that mean I'm pretty much inside my head? The mentor inside my head? Yeah. You don't exist anymore.  So I take I take a snapshot of Pakistan. I internalize it and I begin to interact with the snapshot because it's a controllable object which will never abandon me. Right.  The internal head just vanished. The snapshot is what you function and deal with every time you see quote unquote Pakistan.  You disagree with me or you go to take a leak or I don't know what you show signs of life. Right. You show signs of life. Okay. You show signs of life and then you will do what? It threatens the snapshot. It threatens the snapshot because the snapshot is static and fully under my control. And you're not. So you become an enemy. It's called persecretary object. You become a bad object and enemy because you're threatening the snapshot by being independent and autonomous. I'm essentially ruining your life. If I start to show you.  Yes.  Because you should understand this. If you destroy one snapshot. Yeah.  The whole wall keeps the company. The whole photo gallery is shot. If I go to one, then then it's going to play out in other aspects. Either snapshots work or they don't work. If you prove to me that your snapshot is not working. Yeah. Other snapshot will stop working. So chain reaction, chain reaction. It's very, very serious. Very. And now this is go to enormous length to eliminate you as a separate entity. Because you, in other words, the snapshot doesn't work when it comes to Paxton. Then you got to get rid of me because the other snapshots come under threat. Yes. It's easier to get rid of you than all the snapshots in my head. There are two ways to get rid of you. One way is to devalue you and discard you.    You will never threaten the snapshot. There's a famous movie by Hitchcock. Psycho. Yes. His mother. He mummified his mother. Got it. And every morning he puts her next to the window and puts her to bed in the evening in cases of forehead and so on. This is a kind of mother who doesn't threaten the snapshot. So at first I will try to eliminate your separate existence. I'll try to break your spirit. Simply put. Period. Yeah. In other words, put me, put me, put me back in my corner as it were. It doesn't work.  If it escalates, then you have to go into a whole nother level to destroy. Depends on how resilient you are. How much you push back. And whether you want to go through that or just discard me and move on to something else. I would put every narcissist will put a considerable effort before before the devaluation of the discard. Got it. Before that. Okay. There will be huge, huge fights and conflicts and so there'll be a lot of. Well, wait, a lot of ruining people's days just to get to that point of saying, okay, then you know what, then I'll just discard you. If you, if I can't put you back in into snap, I need you to conform to my snapshot. I need you to conform 100% that can be not divergence of deviation. You're doing it to me. I say, you have no idea. You know what? I don't know if I'm going to be alright the rest of this Saturday out here. I'm used to doing this to people. Hey, you smiling. Yeah. Okay. So now what am I looking at? I'm looking at a clock over here. Make sure just bear with me. I'm gonna do this real quick. No, don't be under pressure. Go ahead. I'll give you the key when we're done. Okay, here we go. Um, people, people simply don't have patience to watch more than one hour. Um, I hate to tell you this. All my shows are at least an hour, maybe a little bit more, but I agree with you, but you're gonna, you know, you're all right. Okay, here we go. Here we go. Uh, price to price approach versus the long term commitment. I hope you can. This is, it's a posting that you have.  I hope that makes some sense to you. If it doesn't, we can kick. We won't kick the tires on it. Uh, does that make any sense? Do you remember that posting? It's, it's a rough as a society, we had removed the incentives for long term commitment. Um, sex, sex is an incentive for long term commitment between two people. For example, the availability of regular sex is an incentive. Today you can have regular sex without any commitment. Um, economic incentives are important in long term commitment today. Actually, you don't need anyone, whether a woman or a man, you're totally independent economically. So there's no incentive there to team up with anyone. We have reached a situation to that a long story short. We have dis dis incentivized intimacy and dis incentivize long term commitment. There is no reason to commit. There's only, there's no price, only price.  And what am I getting in return? I'm getting sex, which anyhow I can get using Tinder. I'm getting, what am I getting? Honestly, what am I getting? Not much. I can have children with women without getting married without even being committed. 40% of all children are raised in single single mother families.  Yeah. And they actually are terrified of intimacy. And they, they distance them. They don't want relationships. Marriage rates have collapsed. Relationships have the rate of relationships collapse. Dating is down by 60% in the last 10 years. Dating.  The dominant sexual script is hookups. Only, only 18, only 19%. Only 19%. That's one 9% of people under the age of 25 ever had sex in an intimate relationship. Wow. 81% of people under age 25 had sex or had only casual sex, never had any kind, any other kind of sex. No long term commitment, no relationship, no, don't know how to do it. Structure. They don't know how to do it. They don't know the skills. Which is an outworking of not having the skills to have. It's a use it or lose it. Use it or lose it.  If you have no intimacy. I found that posting in regards to this fascinating which you're talking about right now. I just, I just wanted to throw that at you because I wanted my audience to be able to, to hear that they could always go to your, your Instagram page and watch your videos to get more on that.   The, the word is addiction. I think again, like victimhood, we should make a distinction between addiction and addicted people. People who are addicted are people who are reacting pathologically to a chemical substance or to a process like falling in love. You can be addicted to falling in love. You don't have to be addicted to Coke or something, you know, right? There's chemical addiction and process addiction. Some people react in a pathological way to addictions. And so they are the addicts. But addiction is actually a healthy process. How do I know? 40% of the brain is dedicated to addictions. 40% of our brain is intended to foster addiction and gender and courage, batteries, create addiction. Why? Because the mother needs to get addicted to her baby. A man needs to get addicted to a woman. Addiction is the force of life. It is what binds us all together. There are dozens of hormones which are intended to create addiction of cytosine, for example. They are addiction hormones. Addiction is a healthy process, including by the way. Addiction to substances. For example, we can get addicted to food. So addiction by itself is healthy and normal and facilitates life and bonding and facilitates social interactions and so on. Some people are pathologized. They have a sickness. So they react to addiction in a sick way. These are the addicts. But we generalize, over generalize, and we said addiction is bad. Addiction is not bad. Addiction is healthy. It's good. Just when you don't know how to manage addiction, then it's bad. You can love a woman. You can love a woman and be addicted to her. That's good. That's love. But if you become a stalker, that's bad. That's a problem. That's a problem. You don't know how to manage your addiction. Simple. When it when it comes to this, this term, here, I'll throw it out to you. Triangulation, what does that mean from your perspective and from your studies and what you know the facts? Triangulation is any attempt to introduce a third party could be another person could be an institution. Any attempt to introduce a third factor or third party into a two-way relationship into a diet technically is called interrelationship in order to obtain favorable outcomes in the relationship, whether emotionally or financially or otherwise. That's triangulation. So if I have a relationship with someone and I want to get a rise out of them and I flirt with the third party, that's triangulation. If I want to obtain financial benefits from someone and I use my accountant to kind of interfere or intervene in the couple dynamics, that's triangulation. If I use an institution, if I'm a minority and I want to obtain favorable outcomes from the majority and I co-opt Congress or some institution, that's triangulation. All of this is triangulation is whenever we use third party factors. Now there was a guy called Carpman. Carpman described what he called the drama triangle and he was the first to explain that in the drama triangle, the two original parties and the third party interchange, they change roles all the time. The victim becomes rescuer, the rescuer becomes abuser, the abuser becomes victim. He demonstrated how the three parties change roles all the time. It's not true. It's not fixed. Okay, that's, okay, that's fascinating. It's not fixed then. One person can begin to initiate the triangulation. Somebody else can end up coming right behind them and moving them right along and end up taking that spot that they initiated and take it further. For example, I can feel abused in my relationship.  I start to flirt with another woman at that stage. My wife is the abuser and the victim. The third party is the rescuer. But then the dynamics change.   This is what I did to her was abusing. She becomes a victim. I'm the abuser. I used to be the victim. And the third party now becomes the main has a main role because I fell in love with her. So wow, it's shifting all the time. It's shifting all the time. Okay. Cartman drama triangle, drama triangle. Okay, now we're really going to take a stretch here and you're going to have to. All right, this is from your this is from your page. I just put it on here. It's part of it is in my head. I just wanted to get you to talk about it. Let's see what happens to pass to self destruction. Does that ring a bell? I'm sorry. I didn't pull it up on my my screen over here to pass. There are many parts to self destruction. I don't I don't remember that particular post and what I had in mind, but there are many parts to self destruction. Okay, let's talk about many past the self destruction. Self destruction is any attempt to reorganize your internal landscape, your mind or your life in a way that would produce outcomes that are less than optimal and definitely less beneficial than they are right now. So right now you have outcomes you secure results and then you reorganize your life for your mind. The results that you get much worse than the results you had before the reorganization. That's a good definition of self destruction. The self destruction masquerades. Very often it doesn't look like self destruction at all. For example, if you persist, if you persist in a job that you hate, that's self destructive or technically self defeating. There's a form of self destruction. But from the outside, people are going to praise you. They're going to praise you. You're going to work every day. You're looking looking good. You're looking good. You are, you know, but that's that's a form of self destruction. If you're in the wrong, if you're in the wrong marriage and you don't, you don't exit, you don't do anything about it. It's a form of self destruction.  The irony is that most of the pathways to self destruction are socially, socially commendable, socially acceptable. Society encourages you to self destruct. Consider, for example, social media. Social media is an enemy of intimacy. Enemy marks Mark Zuckerberg makes money every time you're watching the screen. Every time you're using Facebook, he makes money because you're exposed to advertising.  Facebook doesn't want you to be with your daughters. Okay, okay. No, I'm just going to, I got it for everybody to hurt. If you, I know you may have heard that, but everybody that will see this, that's a part of my audience will know. I got to repeat that for everybody. That was awesome what you just said. They are a net loss.  Intimacy. We're talking about, we'll just say Zuckerberg right now. If we're have a family, right? If we're spending time as a net loss, yes, or Facebook or any other social media platform, let alone television, let alone television. It's a financial fact. No, that's a fact. That's a very, very good point.  Addict you to the screen. So here's an activity that is why widely used and so on. No one would consider it self-destructive, but it is self-destructive in the extreme. It is camouflaged. It's disguised. It's one of the most self-destructive activities I know. It's worse than drugs, actually, in many ways, because in drugs, if you drink alcohol, most people are social drinkers. They do it with other people. You have a social dimension somehow. You end up having sex. I mean, alcohol brings people together. Social media breaks people apart. It's even much more self-destructive in alcohol and drugs. And yet we dedicate billions and tens of billions of dollars to fighting, fighting off crack and coke and heroin and I don't know what, which is, of course, OK. But we don't do it. We don't lift a finger when it comes to this, which is far, far more pernicious than any drug ever invented. Well, you are. You you definitely you definitely give rise to thoughts that many people will not. They may not have heard before and they will not forget. Here we go. We're going to be ending at some point, but I've got to put this word in because too many people would would want to come after me and I don't have that problem. But they would if I don't ask you about the word gas lighting. Gaslighting is a common phrase that's used often just as much as narcissism. Your perspective on that word was that one of the words you got started with? Is that one of the words you came up with? I did not invent the word. I did not coin it, but I borrowed it and I was the first to use it in the context of narcissistic of it. Yes, in 95. Gaslighting or ambient abuse. It's any attempt to convince you that something is wrong with your mind.  Any attempt to impair your reality testing. In clinical terms. Yeah. Now, gaslighting is much more common than you would think. Studies by Dana Rielly and others have demonstrated that people frequently lie. And when they lie, they automatically gaslight other people because they want them to believe the lies. And this is all people, not only narcissists. Gaslighting seems to be an integral part of the repertoire of human communication. Now, narcissists and psychopaths. Narcissist gaslight a lot less than psychopaths. Psychopaths tend to gaslight a lot more. Psychopaths are goal oriented and there when they gaslight, they want to convince you to do something. They want to push you to do something. So by falsifying your reality, they cause you disorientation. And when you're disoriented, they push you to do something you wouldn't have done. Had your perception of reality prevailed. Narcissists would gaslight would gaslight when they are in in the throes of narcissistic injury or narcissistic modification, but they would gaslight for usually one reason to restore grandiosity usually. So narcissistic gaslighting is actually a lot more rare than psychopathic gaslight. And as I said before, gaslighting is much more common than you know. Advertising is a form of gaslighting. Marketing is a form of gaslighting. Political propaganda is a form of gaslighting. Messaging, messaging, I mean, on television, on mass media is a form of gaslighting. These are all forms of gaslighting where algorithms, algorithms in YouTube, Facebook, they're form forms of gaslighting. That's the goal is because it's the algorithm that decides for you what is reality, not you. That year, yeah. And so the minute someone the minute someone confiscates, appropriates your ability to determine what is reality, they're gaslighting you. When you search Sam Vaknin on Google, Google is gaslighting you because they choose the results for you. They determine your reality. They don't let you determine your reality. They determine it for you in an opaque way. It's not transparent because gaslighting can never be transparent. Opaqueness, opacity is very crucial in gaslighting. So gaslighting is an integral part of technology. Everything, by the way, you're using your laptop, you're being gaslit because the operating system is not transparent to you. There are numerous thousands of decisions taking place every time you open your laptop. Which are not transparent to you. You don't realize these decisions are taking place. And that's why people keep saying that computers actually have a mind of their own. They do things you never told them to do. What is autocomplete, autocorrect? Autocomplete and autocorrect are forms of gaslighting. They decide for you what you should type or what you should be looking, searching for. So it's very common phenomenon. The psychopath leverages gaslighting to obtain goals. It's the only difference.  And when you have diminished capacity, he then makes you do things that he wants you to do. The narcissist does it to you, does the same to you. Because when you have diminished capacity, the narcissist can feel superior to you.  You see how crazy? And then he can feel superior to you. And this restores his sense of grandiosity. So gaslighting can be used by either one of those psychopaths or narcissism for the purpose to restore grandiosity if need be. Narcissism is to restore grandiosity. Psychopath is for for goal orientation to take goals. Goal orientation. OK, so when somebody is married to living with, dealing with, working with, grew up with generational narcissism, whatever it may be, they're doing it to hold on to the power, per se. If I understand you correctly, please correct me.  So narcissists and psychopaths create. Virtual, virtual realities. They create an ambience, an environment which is not real. It's a fantasy. A shared fantasy in the case of in their head, in their head. No, for you, for you. They convince you that reality is not as it is, but as they want you to see. So and within this reality, they impose rules. They they create outcomes. They force you to behave in specific ways. And so you gradually lose touch with reality.  When you want to know if something is real, you go to the psychopath and you ask him, it's telling me, is it real or am I just imagining it? They become they become the thermometer in the room. They are the ones telling the temperature of everything. They tell you what's really the thermometer and the thermostat. They regulate. And so the thing is, this is the dynamic of a cult. This is a cult dynamic. Wow. So narcissists and psychopaths create mini, mini cults or microcults with one or two people, three people, four people, family or children, whatever it may be, parents, grandparents. A cult is the suspension of reality. In a cult, you believe things that are not real because the leader told you to believe them. And whenever you want to gauge reality, you go to the leader and you say, is it real or am I just imagining it? And this is the dynamic of a narcissistic family. OK, so they can pretty much tell you whatever they want to hold you within the cult. They can tell you that you don't love them or whatever the case, just to let you recognize what you did that. So that means you don't love me.   I mean, don't drive. Driving a wedge wherever they don't trust your best friend. She pretending to be a best friend, but she tried to seduce me, you know. Oh, wow. Isolate, isolate, isolate. Then you're totally isolated. You become an island and then they hit, then they create an alternative reality. And because you can't consult anyone else, you can't calibrate yourself because you don't you're not in touch anymore with family, with friends, with neighbors, with colleagues, many narcissists and psychopaths would sabotage your work, your workplace because they want you to be financially dependent. So you end up having nobody around, no one to ask. So the narcissists, the psychopaths become becomes the northern star. The compass, the only reference. That's it. The only reference. The only emotional reference, spiritual reference, everything. They become that on purpose is what you're saying. Yes, that's intentional. The overall reason they want to do that is for what, Sam, for those who are beginners to try to understand. They want to control you. They want to control the intimate partner to be in the case of a narcissist to prevent abandonment in the case of a psychopath to obtain goals. So both could be anything, whatever it is, a rich woman, the psychopath would target you for your money.  That's the the narcissist would just want to make sure that you want to abandon it.  If that's the case. Before we end this today. Truly appreciate you doing this more than you. Thank you. And of course, I'm glad we hit the my daughters are glad you hit the record button after they left the room. But you're you're I think you're the only person that has actually met them. So they were happy to stick their head in and say, Hi, do you before we started? But I want to I want to ask you this. If that's the case, that a narcissist psychopath moving in those areas can do that. How does a person regain their life before they entered that cult? Life, they have to live. Absolutely. The only effective strategy is not there are many strategies for managing the relationship within the relationship. There's gray rock. There's background noise. There are many I've invented all of them except gray rock. So I've invented seven techniques and gray rock was invented by someone else. And I invented no contact as a set of 23 strategies. And that's the only set that works. You have you have to run for your life.  You're vitality. There's nothing they will leave you as a husk. Nothing will be left of you. You have to run away. You don't feel it. It's incremental. It's pernicious. It's like slow acting poison. These toxins will be with you for years after you had left the narcissist for years for years. It's it's a trauma that takes years to undo. But the sooner the better. You just have to run away.   Get the heck out of there. There's no way for you to end this profitably. There's no way for you to manage. Don't kid yourself. You can manage in the short term. You can gray rock. You can mirror. You can be background noise. That will that'll work for a week or two or three.  You just need to just walk away. End of story. Now there's a set of 23 strategies called no content. I have a video available. I invented the no contact strategies in 1995. It's not simply walking away. It's much more complex than this. But you need to follow this. It's a recipe. It contains about 60 steps and you need to follow all of them from one to 60. And it's only hope. And then you need to then you need to deep program yourself because you had been in a cult. You need to deep program yourself with the help of professionals with the help of friends online forums. This kind of interviews other interviews. I mean you need to deep program yourself. You need to recreate your social network. You need to to acquire new friends or re acquire old friends. You need to get back in touch with your with your family. It's like the 12 step program. Yeah.  There is. There is no way around it. There is no trying to talk oneself or keep checking with others. Should I try to do this? Should I should I do this or do that? It gets to the point. Would you say got the losses? You have to cut it. I mean everyone is a malignant optimist. Everyone says if I only do this. Everyone is a perfect excuse.  I have to talk to her. You know, everyone is these perfect excuses why to stay in touch with the narcissist. But touches deadly is what you're saying. Deadly to the body as well. We have documented numerous documented studies bad for the body. Extremely bad for the long term. We have numerous long term bad for your body. Long term. It almost damaged to the immune system and enormous damage to cardiovascular system and enormous enormous Wow. I have a video. I have a video about the body effects of trauma of this of this kind of abuse. It's bad. It's really bad. The video that you're talking about right now is on your YouTube channel. Yeah, they're all on my YouTube channel. They're all on YouTube channel. 23 strategies one to 60 in regards to no contact. Yeah, there's another one about the effects of the body and effects on the body. Seven techniques of of what again? Seven techniques. There are eight techniques of coping with narcissists. I invented seven and some other guy invented gray rock and gray rock is by far the best. By the way, really? Okay. If you have to quote, you're talking about a temporary aspect. Yes. Or an occasional aspect. Yes. Very rock. But we're talking severing and stopping the addiction and the potent poison. Cold turkey, cold turkey. Not not easy. I mean, I know you know this. I mean, you spearheaded this in many different ways. But you know, a lot of people find that extremely difficult. But it's a reality. That is reality. What they're trying to hold on to is not reality is what you're saying. Yeah, because the reality has been falsified. They're living in a cult. The reality is so free. It's a fantasy. It's a lie. And it's addictive. The love was never real. The relationship was never real is what you're saying. It was a complete facade. And a person bought into it. Yeah, it's called in clinical terms shared fantasy. It was first described in 1989 by Sender, not by Vaknin. So the shared fantasy is an elaborate and elaborate virtual reality universe to which you are introduced by a love pumping and grooming. What happens is a process called co idealization. The narcissist idealizes you and makes you fall in love with your own idealized image. Okay, okay, they make you your good sale. You're good. You need your own TV show. They make you fall in love with your own idea of love. Yes, idealized image of yourself. If you ask women, what did you most like about your narcissist? They would say, I liked the way he loved me. I liked the way he saw me. Many, many women would answer this. They wouldn't say I love the narcissist, but I love the way the narcissist saw it. I get you. I've heard it. I've heard it when I've interviewed people for my show. That is true. The narcissist idealizes you. And then he shows you this idealization, and it's irresistible. Because in this ideal view of you, you're perfect. Exactly what you wanted to see. And it's exactly, wait, and it's coming back perfectly to that man or woman. And it's exactly the taste. It's the perfect recipe of love because it's exactly what you've been waiting for. Actually, technically, you told him the recipe, per se. Technically, you're falling in love with yourself. Technically, with an idealized version of yourself. That's why it's so difficult to break. Because you're not in love with the narcissist. You're in love with what the narcissist can do for you. And what the narcissist can do for you is time and again, show you this idealized image of you with which you had fallen in love. They can show you that they can pull it out at any moment. It's almost like a mirror. They can just put, oh, wait a minute, they're getting too close to me. Let me pull this mirror out. See, I love you. And we'll back down. A person can back down and think, well, they really love me. And then they go back to being, well, mean and difficult. They can withhold it. We call it intermittent reinforcement. Hot and cold. They can withhold this image, but you're addicted to this image. You would do anything for the drug, you know? Hot and cold. Getting a hit. Getting a hit on what actually is you. You're getting a hit on yourself. Yes. You're getting a little shot of yourself every now and then. They give you to hold you in place and they still feel grandiose because they can manipulate you.  You have blown my mind, Sam. Sam, we better stop here. I don't want to, but it is important for me.  You can relate to this as a senior citizen myself. I have. I have the night.  So you're what's the name? Jack Benny. You're Jack Benny. 39.  39. You're an amazing man.   I'm going to I'm going to do this before we go. I want to do this normally when I have people on my show on Instagram, these lives. I ask them certain questions before we end the show. I technically play a game with people. We're not going to do that, but I'm going to ask you these two things. 1995, you embarked on the malignant self-love and narcissism revisited everybody. You got you need to get a copy of the book. Everybody get a copy of the book because I said so. Put the pizza down. You guys know what I say. Ice of a pizza. Come on. Seriously, your your mental health and learning about no contact and go to Sam's YouTube page. Make it happen. Watch it. Learn. Go to class. I enjoyed this audience of one. Just you and I and doing this with others maybe listening in as I stream this audio live to my page. I'm going to tell you this. Please just bear with me from the age of five to 15. What was Sam like? What was young Sam like? Wait, no, just in a couple of words, three words or something like that. How would you describe Sam or a sentence when you were between the ages of five and 15 before you became Professor Sam? Well, were you back then?  I started. I attended. I started to attend university at age nine. So you're not you're not that far off the mark. Oh, I'm a mess. I became I became a John Professor at 17. So you're not that far off the mark. OK, I quit. I was I was a bookworm. I was I books were my escape. My mother was torturing me physically and psychologically. And so I used to escape to the library, spend all my days and sometimes nights. Books were my my alternative universe, my alternative world. And I spent all my life with 10 hours a day, 12 hours a day, 16 hours a day, just reading and reading and reading, trying to escape from essentially my mother. And that's how it was. Well, into well into age 17 when I joined the army. You joined the army at age 17 from the age of 17 to present day this this moment in time that we're sharing together. From that age of 17 till now, so much has transpired. But if someone had to ask you describe Sam between the ages of 17, when he's sitting there taking his time and explaining things to Paxton. Twenty twenty one from when you were 17 to now this moment in time. Who is that Sam? How would you describe the exact exact opposite of the previous Sam? I became an adventurer, a businessman, a secret agent, a criminal. Professor. I had transformed my life into a movie, a kind of movie I would like to to watch when I'm 90 years old and about to expire. So the exact opposite, the previous Sam was a bookworm Sam afterwards was an adventurer. Yeah, an adventurer in every possible way. All over the world. And to this very day to see. You find yourself living a life in which people want to spend time with you so that they can learn from you, pick your brain. They can find ways to get to know you better without being too nosy or intrusive. A number of things I've heard people say we've only my daughters and I've only been doing this since August of last year. We're coming up on a year and it is an honor to be able to talk to you. But the most pressing question that I tossed and turned over that I wanted to ask you is one that I know my father would have said, Hey, ask him this question and I'm going to I'm going to do it. I thought about not doing it, but I'm going to ask you. Do you have a nickname, Sam? Sam is my nickname. My real name is also. Oh, OK. I'm listening. Shmo. Wait, whoa, what was that? Shmo, that's the Hebrew for Samuel. Moe. That's it, right? Shmo. Yeah, shmo. All right, so. Your nickname is Sam. Yeah. So I am kind of close to you because I use your nickname then. All right. We're like twins. We're like twins. Listen, you've been a you've been an age. Except for the age. You're much younger. OK, you know, you didn't you didn't have to go back there. I was going to let that alone. But thanks for calling me. You're the one. You're the one who introduced it. You said I'm 18. I'm going to get my discount at a restaurant for getting this. Did I say why? You said I'm 18. You're the one. Yeah. Hey, you're 18. Hey, you're 18 until I were done.  I didn't realize this provides though. I think we have to call it today because we are going to lose most of our audience by now. You got to go. All right. Hey, it's been fun, my friend. Thank you so much. I am honored to meet you and my daughters are out there. But, you know, hey, I'll do this. Damn, they're waiting. Wait, no, no, hold on. Hold on one second. We're going to do this. One mystery guys. Right. They're coming. They're coming in. They're saying bye. Hey, we'll see you later, my friend. Take care. OK. Take care. Bye bye. Bye. I'm stopping the recording.


You see his eyes close while he's saying the sense of service. You're not being paid for this interview? No, I'm not. Why are you doing this? It's a sense of service, you know? And this closed eye talking is most common in Western countries when somebody's patting themselves on a back in like a pretentious manner while they're trying to make it look humble. And the example is when you ask your neighbor why they bought some solar panels for their house or an electric car and they go, oh well, you know, it's good for the environment. You see the same exact behavior.