Welcome to session 13 of our course on Quality Control and Improvement Using Minitab. I am Professor Indrajit Mukherjee from Shailesh J. Makar School of Management at Bombay. So, earlier session we have just started about process capabilities. So, we are talking about CP index. So, from there onwards we will continue in this lecture. So, let me just recap what we have told. So, capability index what we mentioned is that it is a index which shows that ratio between voice of the customer and voice of the process. So, how do we express voice of the process? This is voice of the process 6 multiplied by standard deviation of the process and which is to be estimated this sigma has to be estimated over here. And this sigma estimation is also known as sigma within variability within. So, in this case Minitab expresses this variability as sigma equals to R bar by D2. So, this formulation what you see over here is basically within variability, within sample variability over here. So, this is calculated based on statistical process control chart. So, this is estimation of the sigma over here can be done by if we are drawing the X bar R chart in that case. And we have also told that mentioned that this process capability we estimate whenever it is under natural variation that means common cost variability is only and the process is stable. So, in that case we apply this one. So, this will be the delta the difference between upper specification this will be the delta over here and 6 multiplied by standard deviation estimate over here. And this estimation what you see is given over here in this estimation because and this is the subgroup size based on which I can I can define D2 values. So, this subgroup size is also known to us when we are collecting the samples. So, whenever the process is in statistical control immediately we can calculate the CP index over here. So, this is delta by 6 standard deviation because 6 is the common spread that we have assumed that 99.73 of the observation will be falling in case it is a normal distribution. So, the underlying assumption over here is the CDQs follows normal distribution and for that I am assuming this making a simple assumption over here. And we are also assuming over here that the centering of the process is perfectly on the target. So, there is no variation from that. And so, we can calculate a capability index which is known as CP index over here ok. So, and MINITAB does it automatically for you. So, you have to only mention that whether how to calculate the sigma you mention that one and MINITAB will calculate for you. So, then also we mentioned that just capable process if voice of the customer and voice of the process. So, this is the voice of the customer and this is the voice of the process and the ratio is equals to 1 means I am consuming full tolerance basically. My variability of the process is consuming the full tolerance like that. So, in other words that means that if this is the specification and upper specification limit and lower specification limit. So, completely I am consuming the total variability spread across from USL to MSN like that ok. So, this is not a industry standard that equals to one condition just acceptable like that. So, if you have to improve that one you have to go to 1.63 and beyond for not so critical items, but if it is very critical maybe we go about to 1.67 or 2 as the process capability for a given CTQ for a specific CTQs like that. We want to reach that level of capability like that ok. So, if it is a 6 sigma process we can which is well known like 6 sigma methodology what we talk about and it is linked with CP value of 2 like that and then we have other index over here CP 1.63 about 4, CP 1.67 about 5 like that so ok and so that way we can we can link with CP values and also with sigma level of a process like that, but that is not the right way we will we will see another way of defining the and linking with the sigma levels like that ok and MINITAB gives you some options to do that ok. So, in this case what will happen is that so I can calculate this and also we have to remember that this is for both side specifications. So, CP can be calculated whenever USL and LSL is given like that one sided specification in certain scenarios when we have one sided tolerance or like that. So, in that case CP cannot be calculated like that. MINITAB also does not reveal any such calculation of CP whenever I give one sided specification let us say LSL or USL. So, with some example we will try to see. So, here you can see like that what I explained last time also say if it is not capable in that case rejection some some will be outside the USL condition and this is the LSL condition what you see. So, many many data points will fall over here outside this one. So, there will be rejections like that and let us assume this is the target value. So, what we are getting over here ok. So, this is merely just capable what we told and this is ok 1.334 sigma level what is written over here. So, some companies may accept may be considering this as acceptance level of CP values, but excellent performance we always say that CP value should be equals to 2 which is equivalent to 6 sigma level like that ok. So, towards excellence if you are moving for quality we should we should look for CP close to 2 like that. So, and at least more than 1.33 like that many of the industries follow 1.33 as the basic standards of accepting a CTQ performance like that ok. So, based on this we are just taking an example last time we showed that in MINITAB how we are going to do that. So, I am taking a piston ring example which is having 25 observations and each of the observations has 5 subgroup size over here and at a given time point T 1. So, this was collected at T 1. So, this will be collected at T 2. So, T 1, T 2 observations like that and we have T 25 observations which are at certain gaps the observations are collected at certain intervals like that. Intervals are pre-decided and can be calculated also how much should be the interval like that we are not going to that details, but that is possible and how many subgroup size to be taken that is also rational subgrouping is another concept which is used to define that one ok. So, if that is correct in that case we can analyze the data and we can analyze it using control chart techniques like that ok. So, I am taking the same example the specification is given as 74 point plus or minus 0.035. So, tolerance is about 0.07 total tolerance if you see from USL and USL like that and this is the total delta values that we have or voice of the customer that is given and if it is within this we will and the distribution over here what you see is that this is Minitab output. So, this is LSL this is USL this target I have defined let us say 74 is the target value over here and CP index is calculated 1.17. So, USL this is LSL is 73.965 and USL is 74.035 this you have to enter Minitab and this is 74 we have mentioned. Sample mean is this total observation what you are seeing over here 125 and 25 observations. So, 125 observation. So, overall mean X double bar is 74.035 which we have mentioned are 74.0012 like that ok. 125 observation and you see standard deviation within is calculated over here this is based on Minitab we will ask you what basis I will calculate sigma within. So, we have mentioned over here that you calculate from control chart and the formula to be used is R bar by D2 or from sample range chart you calculate this one. So, Minitab you can assume and also you will find that performance index will be provided over here there is a term which is known as PPM less than LSL and greater than USL like that and PPM total will be this is PPM means parts per million basically less than LSL and PPM more than USL. So, number of items that will fall outside USL and fall below LSL that will be given as performance over here. So, what is observed over here means actually the data set will be plotted over here and Minitab will see if something is going beyond the tolerance and that will be counted there those counts and that will be converted into PPM 10 to the power 6. So, this will be converted into that number how many fall out in this much. So, in million how much it is. So, that will be calculated as observed and expected performance what you will find is that Minitab will place a normal distribution curve over here what you can see dotted line. And so, if this is the and based on certain mean that we have X double bar and we can always calculate that corresponding to USL. So, USL will be converted into Z value. So, Z USL over here and based on that it will it will find out that what is the probability of Z greater than Z values for USL over here and that will give me fraction non-confirming over here and that will give me the PPM that is falling outside. So, a normal distribution assumption will be used over here to see what is the expected performance and also the standardization calculation that will be used for Z conversion will be within that R bar by D to that formulation will be used for calculating this one. So, corresponding to value of X bar and standard deviation that sigma hat over here what I can do is that I can calculate Z USL over here and from there I can I can reach to this PPM level over here on this side and I also I can reach on this side. So, expected within performance is shown over here how much will be less than this. So, probability and then accordingly convert to PPM and here also we can do that. So, expected within and expected PPM more than USL also. So, this is the expectation in case you are just super imposing and thinking that this is a perfect normal distribution with the mean and standard deviation that is calculated from the data set how much will be the fallout from LSL and USL like that and total summation of this two will give you the total values that you see over here ok. So, what are the options that we that we use over here. So, I will just show you the options. So, I will go to the data set and in this case what we will do is that we will use process capability data set and we will try to illustrate the same thing. So, that we can we can see how we are. So, this data set is already I have created. So, I mean it have file I am opening this is the observations of one data set this is the other observation which we will analyze now sample pistons ring 1 to ring 5, 5 subgroups and these are the observations over here. So, I go to stat on top and what I do is that I go for quality tools and over here capability analysis and what I will do is that normal capability because I am assuming normality over here. So, let us assume the data follows normal. So, I am using normal capability then subgroups across row I will use and because all observations are in different columns like that. So, I will use from here to here and then I will say select this one. Then lower specification I will write this is 73.645 maybe and 73.645 and upper specification is 74.035 that is given plus or minus 0.035. So, 45 like that 645. So, I think this is correct. So, we will have 73. Sorry 965. So, this will be 73.965. So, you got the mistake 965. So, this is if you subtract from 74.035. So, that will come and then here you will find that transformation or no trouble in case it is non-normal in that case what is to be done we will see. So, this is we are assuming normalities. So, I will not click anything over here. Estimation over here. So, within capability estimation which method I will follow for subgroup size greater than 1. So, here it is written that you see within subgroup standard deviation how do we calculate. So, you have to mention pulled standard deviation S method R method. So, I will use R method because R control chart we have seen X bar R. So, used unbiased constant we will keep this one as default over here. So, and also in case subgroup is 1. So, in my case it is not true. So, this area you can ignore like that. So, I will click ok like that. So, over here and options over here target is let us say assume 74 is the target like that and within group analysis we are doing. So, overall analysis we are not considering over here. So, then capability CP values I want to see and parts per million also I want to see other than that we do not understand now at this current time point. So, we will just click ok and k value is taken as 6 because 6 standard deviation is the in formulation how much time standard deviation this we do not check. So, 6 we are keeping over here and I click ok and I click ok what will happen is that I will get this analysis what you see over here and you see that LSL I have given target I have given. So, USL is given sample mean was minute I was calculated this is the sample mean and number of observation based on which sample mean is calculated is 1 to 5. Standard deviation within is calculated as from R bar by D2 formulation ok. So, this is calculated as range average and from that D2 is taken from number of subgroup size that is 5. So, based on that this is calculated and PPE observed and expected performance is shown over here same thing what I explained like that Z it is converted into Z and from that we calculate what is PPM less than LSL what is PPM above LSL. So, total PPM parts per million that will fall outside the specification is basically 502 like that and then CP index is 1.17. So, at this time point we are not concerned about CPL, CPU and CPK. So, let us assume the CP is the only measure we know. So, 1.17 and that is the value I am looking for. So, CP 1.17 is not enough. So, 1.33 I told maybe the standard many industries follows that means improvement is needed over here ok. So, that gives you some basis when we have existing scenarios and whether to take improvement initiative or not for a CTQ that we can define from here. So, CP value is less than 1.33 let us say and in that case improvement is needed. So, in that case I have to reduce the variability you see the measures of CP index says that I cannot do anything on the tolerance, I cannot do anything on the tolerance. So, this measure what I have to do is that I have to reduce the sigma level. So, if you can reduce the sigma over here what you see over here. So, if I if I can reduce the sigma values that is coming over here then my CP will go it is inversely proportional to this. So, this will go up like that ok variation reduces CP index goes up. So, in that case. So, my variability deduction is the target over here from the formulation that we see ok. So, what scenario is maybe one sided specification we are having like this if I if I place this one let us say second data set ok one one one more second. So, let me take the next example over here and we have an example over here that is container over here. So, here in this example what you see is that 5 container subgroup size is 5, but LSL is only given 200 over here. So, this example we will take and we have 20 samples with 5 observation. So, total 100 observations we are having 5 subgroup size. So, total 100 observation and lower specification limit is given as 200 PSI. So, if you see on the right hand side it has not calculated potential within capability you see CP is not calculated and star is given over here. So, when I when I do this one. So, let us let us go to the MINITAB file and let us close this one and I will this is the sample observation C1 to C6 I go to STAT and what I do is that control chart sorry quality tools and in this case capability analysis normal capability analysis over here and I give that these are not the data I want container data to be placed over here shift this data set is given over here and LSL is given as 200 over here and upper specifications limit is not there and options over here within that is fine sorry target we have to change options target we will remove because this is a another example. So, here we were not doing this and estimation R bar we have mentioned. So, it will do like that, but what do you see is that when I when I click this one results what do you see CP is star information is given over here. So, star means it cannot calculate that one because this is one sided specification. So, if it is one sided we cannot calculate CP values for that something else has to be done ok. So, this cannot be done. So, because I cannot see delta over here. So, in that case in case you have delta then target values and that case can be calculated, but we are not looking to that. So, one sided specification we will assume that CP index cannot be calculated for that. So, some other index has to be done for those scenarios like that ok. So, that I wanted to mention. So, then let us go back and see this diagram over here. So, this is the concept that is will be used by Minitab. So, Z conversion of this. So, Z conversion I mentioned that X double bar will come from control chart and then we will sigma will be known which is S over here. So, when I get this values what I can do is that what is the B probability of this area over here, B can be calculated, A can be calculated and based on that we can also calculate a Z benchmark concept which is used in calculating the sigma level of the process like that ok. And Minitab gives you this option we will discuss more about this ok, but what I am trying to say is that we can calculate capabilities and we can and we can also calculate that what is the performance expected performance for that some Z conversion is required. So, Z and corresponding to this Z what is the probability that can be converted into PPM on both the sides like that. So, this area and this area can be calculated and then that can be converted into PPM and that is what you see in Minitab's expression what you see over here say expected performance over here this is the portion what you what you can see. So, in case this is normal what is the expected performance in median. So, in long run what what do you expect. So, if this is normal so in population what do you expect this is sample information sample information is giving you a performance observation is around 0 no fallout over here, but if you see if you if you consider the normality assumptions over here then in that case some fallouts are expected that is around 502 ok. So, that is the that is the idea of placing this expected within performance like that in PPM. So, some idea you will get how much PPM fallout will happen parts per million. So, this is the way they calculates and but what you see is that sigma is 2 over here which is freezed and this is the specification what you see upper control limit line and lower control limit line over here and in that case what you see is that sigma is kept same over here, but the distribution is shifting. So, location was here which is the target value let us assume t, but it has moved from here to somewhere over here. So, this may be 50 53 let us say. So, mean is shifting basically. So, x bar was somewhere over here which is on the target. So, specifications was like this. So, sigma remains same and in this case, but the mean is shifting over here towards upper specification line. So, it will move 2 over here, but CP index you see remains same because CP is equals to USL minus LSL divided by 6 into standard deviation. So, standard deviation remains 2. So, it is not changing and USL this is also freezed, but the whole distribution is moving from this end towards this on the higher space upper specification side. So, if you are then the accuracy part is not considered in this formulation what you see of CP. So, accuracy part is missing over here. So, what we have to do is that we have to revise this formulation so that we will penalize if it moves to other upper specification or lower specification limits like that. So, even if CP remains 2, we can we can expect that this is deteriorate performance is deteriorating, but that is not captured is CP. So, what they does is that they use as another index which is known as CPK index what you see over here which is the minimum value of CPL and CPU this minute we will calculate automatically. So, this is for USL how much is X bar from the USL and how much is X bar from this one. So, if the difference between these two comes down and then this CP index also comes down like that. So, whichever way you move it will basically penalize the CP values like that and minimum of this value is taken. So, as to ensure that we want to improve the minimum one. So, in this case so, CP index takes care of this centering concept of where is X double bar. So, not only sigma is considered X double bar is considered over here the formulation is USL minus X double bar we can think of over here and this is X double bar assuming that is the population average what we are getting. So, minimum of these two values what you see will give you the CPK index over here. So, the I want to penalize if it is moving away from the target. So, that is the objective over here and upper capability index is calculated CPU this MINITAB automatically calculates for you because average is known to us and in that case we can calculate sigma is R bar by D2. So, in this case this is also not a problem to calculate and then the MINITAB will calculate CPU and CPL and based on that minimum value it will report CPK index over here. But the assumptions over here what is considered is one of the assumptions is normal distribution assumptions that is taken process is under statistical control that we told that only assignable cause is not there. So, under control so, everything is stable and the mean is centered over here then only we can calculate CP index like that. But if mean shifts in that case we need to consider this formulation which is a revised one and it is measure of potential capability what is mentioned not actual capability. So, in this case just an short term capability you can think of. So, in this case what we can do is that and this can be calculated. So, here when you give the command over here you will find a CPK index that is shown over a 1.33 like that. CP index what we have seen is 1.17 and it will calculate CPL which is based on the previous formulation what we have shown CPL what you see over here this is the formulation X double power minus LSL by 6 multiplied by sigma and the other one is CPU is given over here as USL minus X double power by 66 standard deviation. So, that can be calculated and this is shown over here what you see CPU and minimum of these two is taken as 1.13. So, 1.13, 1.21 the minimum value is 1.13 over here. So, histogram is drawn over here with overlapping normal distribution this is the target which was placed at 74 and this is the upper specification limit with 74.035 and this is 73.695 like that. So, that is the 965 sorry this is the values that is plotted over here and you will see performance observed not a single observation falling outside this one as per the real data and but if you superimpose this and convert into Z and Z USL and Z LSL like that and that some probability we are getting and that can be converted into PPM and this is the number that you get. So, how do you calculate CPK index over here? So, I am just taking you to the same example that is given over here and we will delete eliminate other things then you go to I am showing you again STAT quality tools and capability analysis normal capability analysis and what you do is that you ring 1 to ring 5 and select this one then I then I change the specification as 73.965 and this is 74.035 and then estimation over here R bar is the estimation that we will use other things remain same and options over here target value let us say is 74 we can just mention for observation like that and parts per million will be reported and capability index will be reported over here we will concentrate on that and click ok. What will happen is that you will get this information and this is the graph that will be reported over here and you see standard deviation is calculated this is the standard deviation that you observe over here and this is 0.0099 this is the within standard deviation that means R bar by D 2 and this is the CP index 1.17 and this is the CPK index. CPK is minimum of CPL and CPU that is the formulation we have and minimum is 1.13. So, MINITAB is reporting CPK value 1.13 what is as per the theories that is expected that is the theory that is expected ok. So, within performance is also given over here the actual process spread is represented by 6 standard deviation that MINITAB is expressing because MINITAB has used 6 because I have given 6 as the option to calculate this one. So, that is reported over here and we can take the second example. So, if one sided specification what will happen? So, this example is has a one sided specification. So, I will go to quality tools and then I will go to capability analysis normal over here and then I will give container this example up to this point and I will select those and in this case I will only mention 200 I will not mention the upper capability upper specification and then in estimation we are mentioning R bar formulation and then options over here the target value I am not giving within subgroup analysis we want to do and capability I want to report. So, if you click one sided specification what happens is that you do not get values of CP over here and what you get is CP lower CPL, CPU is not there. So, CPK will be just CPL over here ok. Similarly, if upper specification is given in that case here LSL was given as 200. So, that is why you are seeing this one, but if only upper specification is given it will calculate CPU and that will be the value of CPK basically. So, one sided specification CPK will be reported, but CP will not be reported like that. CPK is the index that we will consider over here. So, CPK is the index that we will consider over here ok. So, that is that is the way we are doing capability analysis. Another option you have in quality tools is that capability 6 pack. Here also there is a normal here we will get one more information that is control chart information also you can see control chart let us say rig 1, this is the 1 and I give specification over here 73.965 and this is 74.035 and then I do estimation same method over here I keep it as it is. So, subgroup size it is not 1. So, within capability analysis so I am doing that one and then what I do in options what I do is that I do not add targets over here because we do not need to calculate CPL. So, that we are not interested into. So, in this case K equals to 6 CP statistics I click ok and then I click ok over here test over here what I see one point going outside 3 sigma that is a condition in control chart that it is asking. So, we are doing that one either all 8 tests that is defined western electric we are not doing that. So, we are taking only one condition over here or other patterns we are not considering any point going beyond plus or minus 3 standard deviation that we are considering as abnormal scenario. So, I click ok and what will happen is that you will get this type of 6 pack many things you will get over here. So, in this case what you will get control charts x bar r chart is plotted over here everything is in control and based on which upper specification lower specification is given. So, within specification CP value 1.17 and CP K is 1.13 that was the value we have calculated earlier and this shows any abnormal day in the 25 subgroup size any observation that is very peculiar ok from the central line. So, nothing peculiar is observed over here. So, and in this case random samples we can say. So, these are there is no problem over here you will also find a normal probability plot that I told that we use for seeing whether the data set is normal or not. So, in this case what is observed from this data set we have we have not gone into that details over here, but we will discuss that in our next session in that and we need to see how to check normality assumptions and over here you will find a value which is mentioned as P and that P value we see to check whether the normality assumption is violated or not because CP and CP K index depends on whether the value whether the data set is normal or not and what we are seeing is that data follows normal over here and all the information in one go 6 pack means all the information in one go you are getting over here. So, you can use that one as a option to see whether x bar r is satisfactory then only we will go for CP CP K index and then we will see whether to improve the process or not to improve the process like that. So, what we will do is that we will stop here, we will start our next session from here and we will try to see some more information on sigma level and how to calculate that one. Thank you for listening to this lecture, we will return back in the next lecture with these topics to continue here.


Hello, Psych2Go viewers. We have a very special episode of Psychology Roundtable for you today. We have not one but two amazing guests for today's live stream for our expert panel. The first is Dr. Tracey Marks. She's a general and forensic psychiatrist with over 20 years of experience. You may recognize Dr. Marks from her own YouTube channel of over a million followers where she creates insightful and educational content centered on psychiatric disorders and mental health. The second is clinical psychologist and narcissism expert Dr. Romani. She's the host of her own YouTube channel, which has over a million subscribers and her own podcast, Navigating Narcissism. Dr. Romani's work has been featured on Vogue, TEDx, Red Table Talk, and the Today Show just to name a few. A huge welcome to both of you. Thank you so much for joining us today. Our audience is extremely excited. Me too. I'm a big admirer of Dr. Marks, so I'm very honored to be here with her. Oh, wow. Well, thank you. Same here. And happy to be actually doing this with you. Yeah, me too. Me too. Guys, we have over 600 people in here. That's like insane. Oh my God. So I wanted to start off the first question on the topic of narcissistic abuse. Often when the topic of narcissism is discussed, people tend to focus more on understanding the narcissist rather than thinking about how the narcissists negatively impact those around them.  So what are some signs that a person may be a victim of narcissistic abuse, and what are some of the physical and emotional symptoms that one can identify in themselves or another person? I'll let you go ahead and start. So this phenomenon of narcissistic abuse is narcissistic abuse is actually the behavior that happens in a narcissistic relationship, right? So it's the experience of invalidation and manipulation and gaslighting and entitlement and rage and dysregulation. That's the stuff that happens in the relationship. That is the narcissistic abuse. What happens to the person in the relationship is something we could term the fallout of narcissistic abuse, if you will, right? So these are the things that happen to a person if they're chronically in a relationship like this. This would be things like confusion, self-doubt, self-blame, anxiety, sadness, anger, a sense of helplessness, a sense of hopelessness, powerlessness, the more severe the narcissistic abusive behavior is, the more severe the fallout is with some people really having symptomatology that looks more like it's in line with complex post trauma. So we see a range of reactions, but the short answer is none of it's good. It definitely takes a person and throws them very off balance with the central tendency being that a person blames themselves and doubts themselves and really wonders, are they the one who's doing wrong? So that's what it does. And you asked also about physical health issues. What we do see is that people who are experiencing narcissistic abuse, for example, often stop caring for themselves. Their sleep is often disrupted because they're ruminating. They're often so absorbed in, how can I make this work? What am I doing wrong? Why do they keep betraying me that they may not adhere to other healthy daily practices that might be taking their medication or eating healthy or exercising? There's sort of this overall devaluation that happens to a person in a narcissistic relationship and that extends to how they treat themselves. Now, as with any chronic stressor, which obviously chronic narcissistic abuse is, over time that's going to have health effects. That kind of accumulative interpersonal stress and we know that interpersonal stress and betrayal stress really represent unique health stressors because of the other kinds of psychological fallout that come there. What we'll often see is that a person, I have worked with countless numbers of clients who had far worse health outcomes than they should have under the circumstances and what the treatments they had. These are people who would say they had a more complicated course of severe illnesses like cancer, that their autoimmune kind of recovery was much, much more complicated, that existing psychiatric conditions were worsened. This is sort of like dropping a bomb into a person's health and when you keep in mind that the narcissistic person is not likely to lift a finger for this person, someone that somebody believed might be a caregiver. This is my spouse. This is my family member is nowhere to be seen when somebody gets sick. You can see that this is a very big phenomenon when we look at it all 360 degrees and there's no doubt that it takes a toll on people and it's very specific to this kind of a relationship. Exactly. And for Dr. Tracy Marks, from a psychiatric standpoint, when you're seeing patients who are dealing with depression and anxiety stemming from narcissistic abuse, what are some coping strategies and treatment options you recommend? Okay. So I was actually going to piggyback on what Dr. Romany was saying about the effect that it has on people. In my experience, how badly someone is damaged depends a lot on when they experience the abuse. So if you've got someone who it was at the hands of a parent, those people tend to look more like the complex PTSD symptoms where it affects their own personality and how they interact with people versus the person who may have gone through their childhood and developed some level of healthy self-esteem, but then get in an abusive relationship with someone and it still takes a toll on them, but they're able to recover better than the person for whom it started in their own development. I see a lot of people with depression and anxiety stemming from this. They may have depression that's independent of the abusive relationship, but even what I'll see is that in treating them, and let's say their depression is improving, there's still these self-esteem issues and there's still a lot of negative self-talk that they have that is not just based on being depressed or depressive ruminations, but it's based on how they've coped with and dealt with these abusive relationships. Exactly. Dr. Romney, did you want to add to that? I think Dr. Marx brings up a really important point here too is that in talking about the shaping of identity, in the sense of that's what these narcissistic relationships do to a person. The earlier in the developmental spectrum it happens, the more impactful that's going to be because the sense of self is still developing, so clearly a narcissistic parent is going to have the most profound impact on a person's sense of self because really what the narcissistic parent does is they in essence sort of hijack the child's identity. The child is sort of existing for the parent.  The other thing we do want to remember is that this is on a spectrum of severity. I can't highlight that enough. One thing we do know is that narcissism and narcissistic personality styles are associated with violence and aggression. So in some cases of narcissistic abuse we will see co-occurring physical or sexual violence and aggression happening. Obviously the outcomes for people who are experiencing that are often quite a bit worse. However, I cannot put too fine a point on what long term exposure to psychological and emotional abuse can do, even in the absence of physical and or sexual violence. And by that I mean I have seen people who they have entered narcissistic relationships in adulthood that lasted long enough from which there was no escape. I mean I think we can never ever underestimate that cultural, religious, financial, intersectional elements that mean a person's often trapped. The more trapped, oftentimes the more profound these effects are. Our identity is largely formed by adulthood, but if a person's in a 30-year narcissistic relationship and somebody's saying you're worthless, you're worthless, you're worthless, you're worthless, it will actually result in adult shifts and shapes. We know that trauma can shape personality both for good and bad. And I think narcissistic abuse at its most severe forms would really qualify as big T trauma. Absolutely. And like just going off of that for both of you, how does complex PTSD manifest after a severely abusive relationship with the narcissist and what are some like coping methods and treatment options for someone dealing with that? Because I feel like complex PTSD, there are people who suffer from it and don't even know after a relationship like that. I'm going to defer to Dr. Mark's expertise there. We'll take turns. Because this is a healthy relationship where people take turns. I don't like when narcissists are right. Absolutely. But I'll recognize my limitations. I have enough self-esteem to be able to do that. So with complex PTSD, people, because of almost like a cracking of the vase that starts really early on so that it never forms properly, so you can easily unravel and have difficulty managing your emotions, emotion dysregulation, and even be more vulnerable to other types of abusive relationships because you don't know much else. I mean, this is what you're used to. So trying to, so what are some signs? What would that look like? Well, some signs can be one, being in numerous relationships where your needs aren't being met and you're feeling used or, you know, hurt or harmed by that. Like, why would that happen? Other signs may be even feeling, you know, I mentioned the depression and anxiety before, but having these difficulty dealing with anxiety and having low frustration tolerance and things like that can be signs of early abuse that has just kind of seeped its way into your personality in the way that you handle and cope with life stressors. You don't have as much emotional fortitude to be able to handle these things. And like, what are some coping strategies that you recommend to like maybe patients that you've seen, like just some examples? Yeah, so it kind of depends on what the problem is and what they're doing because there's not just one size fits all. Just do this and, you know, you'll be good. I think if the focus, if you're trying to help someone say, stop repeating a cycle of being attracted to the wrong person, a person that, you know, that doesn't serve your needs or continues to repeat the pattern, helping that person recognize what is it that is that they are attracted to. Sometimes the attraction is the drama, the negative attention and things like that because that's what you're used to. So helping them see that you need to look in a different direction. Some people aren't attracted to the boring guy because even though that's the best person for them because they're used to someone criticizing them and them getting in this pattern of needing to try and get validation from this person that they'll never get. So helping them recognize some of these patterns as a digression, just because it's something I thought of. I've heard this before a lot from like psychologists and everything. Is it true that people tend to date their worst parent? That's what people always say. Like in psychology videos, what do you guys think? Well, I was raised, if you will, Freudian and so, which I know of not everyone's into, but yeah, that was kind of the thinking is that you are trying to repair a damaged, early dynamic and you keep and so you're attracted to that person to try and correct that experience now that you have more power and control, whether that's actually the case. No, that doesn't always bear out to be that way. But sometimes that is the dynamic. What do you think, Dr. Romney? I mean, Dr. Mark's answer is right on the point and she's and again, as trained as in Freudian methods, I really would defer to her answer because I think that there's more, you know, that she is that more scholarly wisdom around that is it feels right. You know, I think that the reason I always am very careful with those kinds of simple interpretations is many people then feel doomed. And the one thing I want to let people know is that this is not as deterministic as we think that it is, you know, one of the great tragedies of the world is not enough people get into therapy young enough and when they often do, it's often because there's a major, major issue at play, severe psychopathology. But this idea of people sort of entering into a course of sort of exploratory therapy with someone to even understand some of these dynamics, because I don't think somebody is doomed. But I think what does happen is exactly as Dr. Mark's explained, is that that likelihood that we are trying to work through past conflicts. And when people start dating and start meeting mates are often quite young, you know, high school relationships can be more impactful than you think, especially if they're not healthy and it can also in adolescence identity is still shaping. So those early dating experiences actually in some ways can be more impactful than significant adult relationships we have, just because of where our central nervous system is. So I think that there's probably more than a shred of truth to that. And you know, I mean, Dr. Freud's one of those things where you got to take you got to take the good with the bad with him, right? But but the thing is that I think that it is not it's not that simple. And I don't want people are thinking like, I had this horrifically narcissistic parent, I'm doomed. I don't think anyone's doomed. That's why channels like yours and Dr. Mark's and my channels exist to give people education as they're going through these processes. So they're not trying to clean up a mess, but might be able to prevent one before it happens. Yeah, and usually people who say that like, oh, that's for everyone. Usually they aren't experts. They're kind of just throwing something that they found on the internet. And they're like, yeah, this is, you know, the case, right? And so Can I say something? I really like the point you brought up, Dr. Romani, about dating in high school. I think it's counterintuitive what you said we think of, well, this just puppy love, oh, it's not going to matter when really, it's more impactful than we think because of them, the maturity or the lack of maturity at that time. So that's a great point. Usually people don't forget about their high school relationships. It has like an impact later in life. Yeah. And then in terms of like, relationships and trauma bonding, why do some survivors feel so bonded and in some cases deeply in love with the person who inflicted the narcissistic abuse? Because that's sometimes the case where someone just can't let go of the narcissist or the abuser. Well, so trauma bonding, which is a term that's often very misunderstood. So there's a really great chance to clear it up is that it is a very, very deeply felt bond a person has typically in an intimate relationship, but it can be any relationship in an intimate relationship, most commonly, that is that's often created by the alternation between good and bad. And that alternation, that there are moments that feel like this person hung the moon. It is very idealized. They are remembering things. It's the love bombing. It's the whole thing. And then that gets interspersed with these moments of withdrawal, withholding, absence, frank abuse, manipulation, devaluation, picket, picketation, it's not going well, right? So very unhealthy relational patterns. What slowly happens over time is that if you take this back, rewind the tape to one of the person when someone's a child, the parent is the only place where survival needs can get met. So the child has to learn all kinds of internal interpsychic modifications to maintain that attachment. And in general, that usually turns inward, I'm bad, I didn't do good, because at least a child can control that. And so they will attempt to change shape, morph, make themselves better so that those needs get met. Well, that cycle repeats in adulthood. And what happens is that that sort of vacillating partner's behavior is rationalized, justified, they didn't mean it, but we had such a good time, but they really love me. They're stressed or this, you know, all of you listening to this have whatever your favorite justifications are. That's what a trauma bonded relationship looks like. And that alternation, it's not all bad. And it's not all good. In fact, it could be 90% bad and 10% good, but you can get a lot of juice out of that 10% good. It creates something that a person feels that they can't leave. They'll be in the cognitions are things like, well, if I leave now, they're just about to change. And there's a lot of that sort of self future faking, as well as a future faking that happens in the relationship, someone dangling a carrot, it's going to get better after we graduate, it's going to get better after we do this, it's going to get better. And then you start doing that, like, well, if I walk away from this, what if everyone's like this, and maybe it's always like this. And and some people will literally say feels primal. They're like, and in fact, I always say this to psychologists and therapist counselors when I'm training them in this work, I say, ask your client, like, what is it that you find so compelling?  Tell me what you like so much. Tell me what you love so much. And invariably, the answer I get back is something like, I don't know, doc. It's like, I don't know. It's like, it's like this magical kind of, I don't know how to put it into words. Like, I was like, okay, because you know what the healthy answer to that question is, we have shared interests, we have shared values, I feel safe, I feel cared for. That's not what comes up. It's this very ephemeral, can't put their finger on it because it is very primally felt. And so that's what trauma bonding is. The mistake people make is that trauma bonding is a relationship that happens between two traumatized people.  This very peculiar connection created in this way. And this trauma bonded kind of experience is much, much more likely to happen to Dr. Mark's point in people who experiences this childhood, in childhood, because those kinds of internal modifications and that shape shifting becomes second nature for someone who had to do that to get very fundamental survival needs and safety met at a very early stage of development. That kind of self modification then can become a bit more, a bit more natural, if you will. So it's that backing and forthing. And this is the signature of the narcissistic relationship. It's not always bad. If it was always bad, for example, they treated someone badly in public all the time, your friends, your family, they'd noticed, they'd say, Yikes, what is this? But a narcissistic person, those multiple masks they can wear, they're often the most charming, generous, gregarious, charismatic person in public. Everyone thinks you're lucky as soon as the doors close, and they can go at you and get regulated that way, no one's seeing that. And so there's even that level of confusion, which only adds to the trauma bonded experience. Yeah. And if you think you're to blame for some of that, then you accept it and absorb it and try to change and try to and you say, I can do this, I can be this or I can be that or I can be better.  And so now this person just like they would have done as a child is fully taking responsibility for someone else's behavior. And this works out great for the narcissistic person, because they're chronically being forgiven and let off the hook.  Absolutely. And just going off of that, since you talked about how like sometimes people can be people on the outside and public can be fooled by the narcissist, but then they're doing things behind closed doors that are, you know, toxic and horrible. So in that sense, how do we effectively support someone who is a survivor of narcissistic or narcissistic abuse and who's currently dealing with it, you know, just so that we're there as a, you know, person of support. Believe them, you know, don't what you don't want to do is more of that. Well, I've never seen them be like this and everyone has a bad day. When somebody is sharing their pain with you, be with their pain, sit there, hear it, listen and don't try to solve it because there's often not a solution here. Then when we really because I think that what happens is that again, dating just like everything else in this narcissism world on a wide spectrum, there are people who are in marriages with minor children who don't have a lot of money, who are who are stuck, right? Who aren't going to get a fair shake in family court. Don't say, well, you got to get out. That's not an option for them. And so don't try to fix it. Simply be, don't doubt this. This person, by the time they're talking to you about it, has doubted themselves, blamed themselves and second guests themselves so many times that by the they're they're so confused. So when somebody's telling you this, hear them and please never, never, ever, if I can leave everyone with only one takeaway, never ask someone, why didn't you leave? That it is shaming, it is shaming, it is invalidating. There are hundreds of reasons people don't leave, including that they still feel love for this person. And we don't get to say you don't really love them. They're mean to you. They're having an experience. That loss of subjectivity that I get to have an inner world is what's stolen in a narcissistic relationship. If you want to be a supporter of someone who's been narcissistically abused, let them have that sense of subjectivity. It is confusing. It does take a minute. And even if your friend says, like, is this going to take me a while? You can't, you don't get to get exasperated.  I'm right here.  You'd be amazed at how much more quickly healing happens when people know that they have safe sounding boards and places they can take their doubts and they're like, Oh, I don't know if I'm ready to go. And and then they will let and they can unfold it at their own pace. It often speeds up the pace for them. Absolutely. Like you shouldn't invalidate someone and they're going to go at their own pace in terms of maybe ending that relationship. Right. They've already been invalidated enough. They don't know. Exactly. That takes some self restraint not to want to jump in and solve for them or even think to yourself, okay, you're not going to change anything. So why are you telling me this? Or what do you want me to say? Like the person listening can sometimes feel helpless to I don't even know what to say versus I'm glad you made the point that they just want to vent and they just want to know that they're not going to be judged for what they're saying. Absolutely. So with that being said, that brings me to our audience segment where your favorite your favorite experts answer your questions. I'm so excited. There are so many. I don't know where to begin, but let's let's start with this one. And this one's for Dr. Tracy Marks, Lauren asked Dr. Tracy Marks, I still constantly suffer from emotional flashbacks and I'm experiencing constant nightmares about my ex, even though our relationship ended months ago. Is it possible I developed complex PTSD due to this trauma I experienced in my relationship with the narcissist? Any advice or treatment options on how to cope with this? Okay, thanks for that question. I would say so usually, when we refer to or when we talk about complex PTSD, it's multiple traumatic events. Now that could still span a relationship. But usually starting young, as opposed to starting, I'm not sure how old you are, but like as an adult. Um, you know, I don't want to say maybe, you know, Dr. Romney, that that it couldn't be complex PTSD because it started as an adult. But normally that's kind of how we think of it is, you know, multiple traumas over a lifetime, particularly starting young. Um, you know, I would suggest I think the best way to address trauma, especially when it's coming in the form of flashbacks and intrusive thoughts and nightmares and things like that is really professional help. Because with someone who is an expert in trauma treatments, I was just talking with some people about this today of how do you know when you need trauma treatment versus going to see a therapist where they're just going to ask, okay, so tell me what's been going on this past week. The treatment for trauma needs to go way beyond just tell me what's going on this past week. There's evidence based treatments like EMDR, um, or CPT, which is cognitive processing therapy, and then there's prolonged exposure therapy. Those are the three main evidence based treatments for trauma. And they all work differently. And I won't get into all the details here, but they all work differently and address different aspects of how you are manifesting the traumatic experience. Um, but they're there, they can be very good at, um, direct or it, um, at addressing specific symptoms you have like the intrusive thoughts, the flashbacks and the kind of re experiencing, um, and in a very, um, succinct and specific way that could last, you know, some people can get EMDR that's like five or six sessions versus on the couch for a few years twice a week. Absolutely. Thank you for that. And then, um, the next question is Emma asked Dr Romany, growing up, my parents were hyper critical of me and extremely strict in an effort to make me the perfect child. They would starve me if I gained weight and beat me if I didn't have the perfect grades in school. I feel like I didn't have a real childhood because I was constantly bombarded by their demands of perfection. My parents tell me that their abusive treatment of me was worth it because I turned out to be successful. How do I continue to have a relationship with my parents when they can't even apologize for their abusive behavior? It's hurtful and I'm having trouble forgiving them. So first of all, I am so sorry, you know, that that just thank you for asking such a frank and raw question. I'm sorry that you'd experience that. It's a very heavy burden to carry and yet you're certainly not. That's not a you're not alone in that story. It's something that I'm sure I know I've heard many times. I'm sure Dr Marx has heard as well. But this question cuts to the core of a much bigger issue that, you know, listen, I'm not even going to speculate whether these parents were narcissistic. What they were, though, was they were they were viewing their child very conditionally. They were really placing sort of this the kind of this emotional load on if you do these things that we consider important, then you will be loved, then you will be valued. That conditionality is a really tough way.  I'm succeeding. I'm look a certain way, especially around the weight and shape. And I just want to make an aside comment. When parents make those kinds of comments on weight and shape, it's intrusive when they talk about what are you eating and what why do you look like that? And why are you wearing that? It is intrusive. It's a boundary violation. And I think that we think it's sort of open season to be able to talk about this element of a person. But we know that this kind of ideation growing up this way can contribute to an ongoing unhealthy relationship with body and shape and weight and food and exercise and all of those things. But now you're in adulthood and now you face this larger prospect of these are my parents. This isn't like a dating relationship or intimate relationship where like I could try this again, like kind of get one shot at this one. And you feel very hurt. There's a process of grief that one does need to navigate in an ideal situation that this is done in therapy, because it's a unique grief for parents are still living. They're very much there.  So there's a grief about what got lost, how they shaped your identity, how it continues to shape you. And and and what's making this group that can magnify this grief is this sort of the sense it almost feels like a betrayal that this person has these people have done this to you and there's no awareness, there's no accountability. Now I'm going to say again, I don't know if this person's parents are narcissistic don't know enough about the case. But when one thing I do know is working with folks who over sharing a history is quite clear that their parents quite narcissistic is that the that sense of it never being made right, right? One of the hardest things about any narcissistic relationship parent, anyone is the lack of accountability that comes up the lack of responsibility taking the lack of I'm sorry, genuine, genuine contrition that people say I never quite feel whole because they never saw it and they're never going to see it. So the hard work becomes getting to feel whole through radical acceptance and realistic expectations and really understanding what the limits of this relationship are to the person who asks this question, everybody will have a different approach to this. You one of the hardest elements of this is in most of these cases when people have these kinds of maladaptive invalidating, rigid and on and and personality cells where there's no taking responsibility. There's very low likelihood of change. It sounds like you have talked to them. And because of that low likelihood of change, that's the radical acceptance that I now know what these folks are about. This is the hand I was dealt and I have the freedom to choose how I'm going to keep these people in my life. You may very well find that listen, the way I feel I don't have I don't want to fully cut them off or whatever reason, but it's going to be very superficial. I'm going to show up a log time at family events. And then again, the grief that you don't have parents that you would have sort of his lifelong supports. There's a lot of things that are happening at the same time. But then it takes us to this much bigger issue of forgiveness. And this has got to be one of the most thorny issues and people who've experienced any kind of narcissistic abuse.   It's harmful to forgive under those circumstances. This idea of all forgiveness is good forgiveness is actually kind of a crock that if you forgive someone and they keep doing wrong by you, it is actually going to harm you. And that right there is the crux of narcissistic relationships. You're going to keep forgiving them. They view that as permission, like, oh, guys, I can do what I want. And in some cases, it's completely unapologetic. So that destination of forgiveness, be very careful that you don't feel like this is going to be sort of a panacea, something that fixes everything. I'm going to forgive them and it's going to be fine. There's actually a risk it won't be fine. And it could make things worse, especially if they keep betraying you and especially if they're not taking responsibility. But in fact, the path forward to healing is radically accepting, understanding what's realistic in this relationship, and then recognizing that you can make choices for yourself that by what they did to you, they've lost the gift of this relationship of depth with you, that that needs to be cultivated in other places. And some people even say, I had to create more of that adult parental space with an aunt, an uncle, a grandparent, or even other people, older friends, things like that, where I felt like I was getting that. Even as a therapist, I have to say it's been part of the transferential relationship where I've had clients who've gone through narcissistic abuse and have said, you know, like, I, if just one of these sessions, my parents have done any of this, what will you do with me? My parents have done for me as a kid or an adolescent. It would have changed my life. And that is heartbreaking to hear because that's sometimes all it was taken to one moment. Because at this point, this person that you ask this question, you're still not being seen by your parents. Again, grief work, radical acceptance, realistic expectations. You may or may not ever decide to forgive them. Feel no pressure there. You decide what feels right for you. Absolutely. And, you know, forgiving doesn't mean having a relationship with them. Another thing. So I agree with that. And then I wanted to throw this question back to Dr. Tracy Marks. Can narcissistic abuse over my childhood cause major memory loss in the majority of my life? I wanted to know, like, from a psychiatric standpoint, if that's like a symptom of, like maybe PTSD from narcissistic abuse. So, yeah. So my take on that would be that I would believe or guess that that's a dissociative defense mechanism. You just you just kind of forget. And we do that. We do that on a minor level with different things. Something bad happens.  I don't remember. You just kind of let yourself forget. But it's not a conscious process. So it's not something you intentionally decide, I'm just not going to remember these bad things.  And in some ways, it ends up being protective because you're not living in this distress all the time. But in other ways, it's still not the healthiest or psychologically advanced way of managing things because what ends up happening is that you can have these gaps in times of things that were important to remember that you can't. And for many people, it can be distressing that there's a lot of details that they just can't remember about things they think that they should. You know, I can't remember my childhood. And then that's a loss. You've lost that. And to Dr. Romany's point of not have grieving the loss of a relationship with your parents. This is kind of a similar thing of if you have this big gap in time of you can't remember your childhood, you either need to you can do some work to try and recover those memories and work through the pain of the things that you're forgetting or can't remember or you have to accept that you have a chunk of your life that you can't account for and grieve the loss of that and manage that. Most people vote for trying to recover and work through and accept and et cetera, et cetera. Yeah, I like that you mentioned that this association and like depersonalization is something that could be like a symptom of the narcissistic abuse because people often don't like make the connection. So that's good. Right, right. I mean, there's different ways that we cope with things there's healthy coping mechanisms or what we call advanced level, I guess coping mechanisms versus more primitive kind forgetting or dissociating would be more primitive or more advanced or adaptive way would be, you know, I think about this and I go and I go running.  So I there's physical ways that my body manages it. Definitely. Thank you for that. And then for Dr. I think this question is super interesting. It's asked by a melancholy mercury. He asked or here she asked, why is it called narcissistic abuse and not just emotional abuse? This just sounds like a form of emotional abuse that people are tackling or people are naming narcissistic abuse and what that just pushes the stigma. More do you agree with that? I don't entirely and I want to talk a little bit about this because I think it's this form of ideation that's actually pushed a lot of shame onto people who are experiencing these relationships. And again, to avoid making this entire thing too pedantic, I'm using the term narcissistic abuse but I'll go pedantic, you know, to answer melancholy mercury's question. When I'm teaching therapists about this, I actually call this thing called narcissistic abuse or I refer to it as antagonistic relational stress. And the reason I do that is that narcissism is a personality style but if we look at how the DSM is moving forward in terms of how they want to consider personality and personality disorders and it's all very fine diagnostic points, there's a personality style called antagonism. In many ways we could use, view it as a counterweight to agreeableness and antagonism is comprised of things like manipulativeness, exploitativeness, entitlement, hostility, attention seeking, just it's impulsivity. It's a difficult, it's a difficult personality style. Here's where it gets tricky. This idea of emotional abuse is to me an umbrella term and under this umbrella of emotional abuse are many, many things hanging and which I consider to be narcissistic abuse becomes a subset of this or antagonistic relational stress. And I think that the issue here becomes one of the very unique things that goes back to what I was talking about was trauma bonding. Narcissistic people, research is very clear on this. They make higher salaries, they're overrepresented in leadership, they're overrepresented in, and then this is across the board, academic leadership, corporate leadership, nonprofit leadership, school leadership, pick a place, they're in charge. They are, they have better success at mating and dating. So here you have a maladaptive personality style that's actually on a lot of social metrics doing quite well by this person. Even though internally I'm sure they're having whatever experience I have, I'm not saying that everything is moonlight and roses for them, but what comes with that is an interesting form of if you will interpersonal skill. And what I mean by that is that being able to turn it on in public and off in private. And what that does to the person who's in one of these relationships is that unlike, let's say somebody's with someone who's emotionally abusive, who's an alcoholic, okay? That alcoholic person may be drunk around other people. And when they're drunk around other people, they're off and other people witness it. So the person who was experiencing this abuse doesn't feel as crazy. They're like, they might feel ashamed. They might feel embarrassed, but they don't feel insane. But when something only happens behind closed doors, it's like seeing a UFO. There's no one else to see it. Everyone's like, what's wrong with you? I'm like, no, no, no, no, there was a UFO. And that UFO experience is experience of a lot of people in these antagonistic relationships.   And so there's many people on this who are listening to this who say, yep, I was in a narcissistic relationship and this person went off on me in the car ride on the way home. But right up until we got into that car, everyone thought they were the greatest person. Or once we got home or once everyone had left the dinner party or once the guests were away from the party. And that on-offness is what makes this a very unique space. This is why people will go into family court. They're completely shredded by these divorces. The narcissistic person is very well put together in front of the judge. And in fact, when the other person starts sobbing and crying and really under the stress of the relationship, the court will sometimes doubt the mental fitness of that other person, something that has happened repeatedly in these cases. So while I respect that there are people who take Umbridge at this language, it's one of these personality styles that's doing real right by a lot of the folks on a lot of indicators. In fact, I've worked with clients. I've worked with plenty of narcissistic clients who've said to me, don't take away my superpower because they know that this has actually kind of given them the juice and certain, I live in LA. I mean, it's like you can imagine, this works really well with people here. And so I am the first one, again, having done a lot of good clinical work with narcissistic clients, it ain't easy. And I can tell you now, their families are suffering and I was working with a narcissistic person so I can see it all, but I don't think that this is all emotional abuse shows up the same way. Frankly, people who are depressed can be emotionally abusive. There's a real involution and a turning inward and many depressed people are very irritable, right? But there's a universality to that irritability and anyone around that depressed person is kind of in some way similarly experiencing that. That's not the case with narcissism. So I'm pushing back on this one, that this is not just being done to be sort of throwing slings and arrows at people of these personality styles, who by the way could also get into therapy and address this instead of shifting blame onto other people, which is also very characteristic of this. So I think that there is something very unique about the on-off presentation that leaves people uniquely confused in a way that I have not seen in people who are coming out of relationships with folks who are addicts or alcoholic, people who are in relationships with people with other mental health issues and people who may have simply just things like anger dysregulation. No, perfectly. So it has a different footprint, but it doesn't mean that there are other types of emotional abuse. So I mean, that's kind of, yeah, great point. Yeah, I agree. Thank you so much. And that concludes our audience segment. Thank you guys so much for participating. That was amazing. And so I wanted to throw this question to Dr. Tracy Marks, because I thought it was really an insightful point in one of your videos. You mentioned that there is such thing as a healthy form of narcissism and that narcissism exists on a spectrum from like healthy to pathological. This is a question really for both of you. When does narcissism cross the line from healthy to unhealthy and how can one identify it in themselves if their narcissism is unhealthy and toxic? So just to begin with Dr. Tracy Marks. Okay, sure. Yeah, yeah, in that video that you're referring to, it was actually prompted by someone calling me a narcissist in my community feed because I was holding up a plaque of my reaching 100,000 subscribers. And the person said, what a narcissist. You're just pointing at yourself and et cetera, et cetera, I'm unsubscribing. And so I was making the point that we all need some degree of self love, which is what narcissism is. And if I had none, I would be crushed by that comment. I mean, I was still annoyed by it. If I were in a relationship with a person like that and did not have a healthy degree of self love, I would then downplay all of my accomplishments because, oh gosh, I don't wanna displease this person. They would be able to convince me that I'm wrong if I praise myself at all, et cetera, et cetera. So I was making the point that, yes, narcissism is on a spectrum. We all need some of it, the ability to appreciate our accomplishments, strive for things and be proud of ourselves.  And then the pathological, going more toward the pathological is where usually because of not having enough self-esteem, you have this insatiable need for validation and you seek that validation through others, using others at the expense of others, so on and so forth. Yeah, and you just mentioned like a perfect example of misusing the term narcissist. I mean, you were happy about your accomplishment. That doesn't make you a narcissist. Posting pictures doesn't make you a narcissist. So thank you for that. And Dr. Romney, did you have any thoughts on this? I do. And so again, first of all, Dr. Tracy Marx is not narcissistic. And so, but here's why the one time you're gonna see is having a healthy difference of opinion, right? So this is where I will push back. I'm not a fan of the term healthy narcissism and I'll tell you why, because I agree with everything we're saying is that there is a spectrum and the continuum, but I think that this spectrum has a discontinuity, that some of what Dr. Marx was talking about that we all need that a strong sense of self, of self-worth, of accurate self-appraisal, of identity, of the capacity and self-accurate self-appraisal means we know what we're good at, what we're not good at, we can self-advocate, her being proud of what is really a big accomplishment, especially for a mental health person. I mean, I've always used Dr. Marx's work as amazing because she was one of the first people, and especially as a woman of color to be taking this information out there. There's a vulnerability to that. And I do think that people feel more, they give themselves more permission to attack women of color who are putting themselves out in public profiles. I've seen that and it disheartens me because what she did in the first place was courageous. So I think what she did by holding that flag up is not only good for her, it's good for everyone watching that and for anyone even looking to that as I would, anytime I see a woman of color succeeding, it's like mentorship. So that was a super healthy thing that she did. I would then say though, what I would say maybe that was a semantic difference. I think what she's calling healthy narcissism, I'm calling like healthy self-appraisal and self-worth. The reason, and this gets tricky and if we really were to unfold and unspiral the literature on narcissism, when it goes all the way back, to folks like Freud or one of the earliest people to write about this and other sort of early analytic theorists. There's always been a little bit of discontinuity in how do people use this particular term and this idea of healthy self-love and unhealthy self-love and is it pathological? I tend to come in again, I think this is just a semantic difference. I'm not even gonna sit here and say I'm right. I was gonna say it's a difference of opinion. Is that I do view narcissism at its core to be a pathological condition because of that. I don't know that it's self-love because it's all about inaccurate self-appraisal and inaccurate self-esteem. They have overly inflated self-esteem where there's absolutely no fundamentals to back it up. So I think that what everybody needs is an accurate sense of who they are, what they're about and to feel comfortable to be able to talk about who they are. But and this is also happening in a context in a world at large where people again want to shut down people who have less societal power. So there's a whole different thing happening.  To me that somebody would have felt they need to make that comment. Obviously so much more of a comment of Dr. Marks got up and said, yo, everyone I got $100,000 subscribers and I'm better than you? We'd be having a different conversation. Yeah. That's how it works. And so I think that the term healthy narcissism gets confusing because sometimes people will say is like, well, maybe I'm not healthfully narcissistic and my partner's telling me I'm narcissistic. And so if we really kind of reserve the word into the more pathological world cause it really is about people who are not self-aware who are not accurate sort of assessors of themselves who do tend to be poorly regulated and tend again, it's really about a fragile ego. Having a fragile ego is never gonna be healthy. And so I think that that was more that what she's calling healthy narcissism I'm really calling sort of a self-advocacy an accurate self-appraisal. So I think we're talking about exactly the same. Yeah. Yeah. We are. I agree with points on both argument. I definitely just think that it's a semantics a matter of just like a different term. So I agree. And thank you guys so much for being here today. This was amazing. This was our first ever round table and we're hoping to have our next one later this month. And I just love the people here on Psych2Go who asked all these amazing questions. So thank you guys and have a wonderful day everyone. Thank you. Thank you Dr. Marks. I can't tell you what an honor it is to finally I never got to meet her and now we get to meet and doing this. I know. Really, really, I hope we stay in touch. I know. I want to. I would love to stay in touch. Make a video together. Call out. I'm such an admirer of your work and really grateful for all you've done again to be a voice out there for just people who often don't feel their experiences is seen in the mental health world and how it's depicted. So again, thank you. Thank you for what you do. Thank you. We're in the same space. And I hear just as much praise about you and how you save people's lives. I mean, it's just so. Yeah. I'm a huge fan of both of you and I thank you so much. I'm a fangirl of both of you. So thank you so much for being here. Thank you so much. Bye everyone. Bye everyone. Bye.


It's not going to be a thing that we would burn this area off and then never have to do it again. It's something that you have to do. While we were setting up for this I just glanced at the ground behind me. There's two little cedar trees about half inch tall. They won't quit. We have to stop them. The natural system you know they talk about we're kind of in the mixed grass prairie region here and probably looking at five to ten years for a fire return interval and and that's kind of what we probably want to do with the burn association is probably looking at doing that and actually Rich is doing that here looking at doing another burn here. Since this is all kind of brand new to South Dakota we've been South Dakota State University. We've started conducting some studies. What we were finding in that study is that after eight years the growth of those cedar trees just really starts exploding. I mean it just it's an exponential growth and it can really and then it just really starts smothering out you know your forage underneath that cedar tree and then you just have a thick cedar forest again. Really what we're finding the sweet spot is about eight to ten years. You don't want to go past that for a return interval for another prescribed burn to keep everything at bay.