You are about to watch yet another video about gaslighting from a different unusual eccentric angle. As usual, before I go there I want to remind you, there are two types of gaslighting, one often discussed and analysed and of course with a lot of misinformation and nonsense that is verbal gaslighting. But there is another type of much neglected gaslighting, behavioural gaslighting, gaslighting via signalling. For example, virtue signalling is a form of gaslighting, it's when a behaviour, a pattern of behaviour, a type of conduct, choices, decisions and actions convey information about reality which is erroneous, wrong, misinformation, disinformation. The gaslighter behaves in ways that mislead the target or the victim into misapprehending and misperceiving reality, misjudging it. So certain behaviours and certain actions, certain courses of action are intended essentially to manipulate other people, to modify the behaviours to secure favourable outcomes. This is behavioural signalling gaslighting, it's distinct from the first type which is verbal gaslighting. Bear this in mind as you proceed into the remainder of this video. But before we go there, two service announcements. This is Mongolia, no Mongolia is a bit bigger, this is a postcard from Mongolia, from the ENK E-N-K-H Empire Publishers in Mongolia and they just published the first volume of Malignant Self-Love Narcissism Revisited in, what else, Mongolian. We are very proud and excited to see this rendition of Malignant Self-Love and we are grateful to our publishers there, ENK Empire, well done. The next service announcement has to do with series of forthcoming videos about walk movements and victimhood movements and together with Jordan Peterson and other scholars I helped Ginger Koi compile a taxonomy of the psychopathology of walk movements. It is now available on public.substack.com. This is Michael Schellenberger's and Peter Bohusian's blog. You can also watch interviews I've given to these various personalities and so on so forth but shortly I'm going to, I mean within the next few days I'm going to release two video compilations. One interviews that I've granted regarding walk movements and victimhood movements and these interviews have never been seen, they are not on this channel, so they are new. And the second part is a compilation of all the videos I've made about the psychological underpinnings and psychological theories that pertain to victimhood movements and walk movements, so in two parts. This is it. This is as far as service announcements and let us delve right into the issue of gaslighting. This is going to be a very short video. Really Vaknin, you're not kidding, you promise, please, you're not gaslighting us. Oh Shoshanim, I am not gaslighting you.  Here's the problem, if he's telling the truth then he doesn't always lie but if he always lies then definitely he's telling the truth. Same here, I am not going to gaslight you, trust me. Okay, today we are going to deal with a few issues related to gaslighting. And I propose gaslighting, my name is Sam Baknin, I'm the author of Malignant Self-Love, Narcissism Revisited, former visiting professor of psychology and currently on the faculty of CIAPS, Commonwealth for International Advanced Professional Studies, it can't get any longer. Here's the problem. Victims of narcissists and victims of psychopaths experience gaslighting the same way. They have an identical experience and they label it gaslighting. A victim cannot tell the difference between the narcissist confabulations and the psychopaths cunning and scheming lies. As far as the victim is concerned, he or she is being gaslit. Now this is the victim side, but this channel is an academic channel and deals with clinical psychology so we need to have a look at the perpetrator side, the narcissist, the psychopath. Gaslighting requires premeditation, gaslighting requires power asymmetry, and gaslighting requires an unimpaired, intact reality testing of the perpetrator. So the perpetrator of gaslighting needs to know the difference between reality and his lies, he needs to be able to tell the distinction between fantasy and reality. Number one, number two, he needs to intentionally gaslight. There needs to be premeditation, premeditation, planning, cunning, scheming, essentially malice, malevolence. The third requirement is power asymmetry, I'm not going to it right now.  And at any minute, he can tell the difference between what's real and what's not real, what's out there, and what's fantastic. Psychopath maintains intact, perfect, reality testing throughout the gaslighting process. Second thing is that psychopaths use gaslighting, instrumentalize it, weaponize it to obtain outcomes, their goal oriented. Only psychopaths gaslight. Psychopathies truly believe their own fantasies and confabulations. Their reality testing is impaired beyond repair. And they don't do it intentionally, they do it instinctively, they do it reflexively, they do it automatically, the way perhaps an artificial intelligence machine would do one day in the future. This is their programming. If there's anyone, the narcissist gaslight, gaslight, it's himself. The narcissist self-gaslights. Then he becomes convinced of his own fantasies, confabulations, narratives, fiction, and he tries to sell it on to you, tries to convince you, cajole you and convert you into his view of reality, of which he is 100% convinced. That's why narcissists are vehement and defensive when you challenge their confabulations, because they don't feel that they're lying.  I'm talking about major lies, like future faking for example. Narcissists don't future fake. They believe in the future. They believe that you're going to get married and have three children and live happily ever after. They believe they're going to become the richest men in the world. They believe they're going to divorce and marry you. They believe all this. They don't future fake.  There's a reason there. There's something behind the scenes, there's a hidden agenda, ulterior motive. That's the psychopath, not the narcissist. How do you experience gaslighting? Gaslighting is a form of dissociation. I am pretty shocked and surprised that I couldn't find this very basic insight anywhere in the literature, scholarly and YouTube self-styled expert nonsense. I couldn't find it anywhere, but stop to think about it for a minute and you will see how right I am, because I'm always right. Gaslighting is a form of dissociation. We know of three types of dissociation, amnesia, forgetting things, derealization, when we experience reality as unreal, dreamlike, nightmarish, and depersonalization, when we experience ourselves as not being there, as floating above our bodies, this is not happening to me. This is common in trauma states or post-traumatic conditions. So these are the three forms of dissociation and immediately you see the parallels between dissociation and gaslighting, because when you experience gaslighting, reality doesn't feel real. You are forced to derealize. The psychopath or the narcissist force you to derealize, to let go of reality, to lose your grasp on it, to doubt your own judgment regarding reality, and then to adopt alternative facts and alternative reality, and this is derealization. Similarly, when you are in the throes of gaslighting, you feel that you are not you. You feel that somehow you have abandoned and vanquished your own identity. You feel alienated and estranged from yourself. You feel that someone else has taken over. You feel body and mind snatched. This is gaslighting. And so this is a form of dissociation. But how does the narcissist succeed, or the psychopath, succeed to inducing you this state of affairs, this state of mind? How do they coerce you into dissociation via entraining? The narcissist uses entraining to convert you, the victim, into an extension of himself. He renders you an internal object. But not only does he regard you as an internal object, you begin to regard yourself as a figment of the narcissist's imagination and mind.  You feel unreal. You feel that you are reduced to two dimensions, a cartoonish figure in the narcissist's strip.  I don't know which of these terms appeals to you.   You become diffuse.  And then the narcissist inhales you in, and you become an element in his mind. And this is done via entraining, and I encourage you to watch my videos on entraining. This allows the narcissist to treat you as if you were a part of himself, not a separate external object, because narcissists don't do external objects. They cannot perceive other people's externality and separateness. They don't realize or cannot conceive of other people as out there with your own needs and wishes and priorities and emotions and cognitions. As far as the narcissist is concerned, you're an avatar, you're just part of his imagination. So the narcissist proceeds to experience himself vicariously through you, the victim. Narcissists use victims as extensions of themselves, as internal objects that allow them to experience themselves by proxy via the victim. The narcissist experiences his own dissociation, his own derealization, his own depersonalization through you.  Gradually, you merge and fuse on a cellular level with the narcissist until nothing is left of you. You become one of his tissues, I mean organic tissues.  He uses you to experience himself and this is what people erroneously call the narcissist's gaslighting. The narcissist has to confabulate in order to bridge over substantive memory gaps. He needs to invent narratives and stories that make sense somehow of his disjointed, disrupted, broken existence, discontinuous non-identity. He has to make sense of all this, of all this mess. The same way someone with multiple personality disorder used to be called split personality or dissociative identity disorder also tries, she tries to make sense of her existence and Narcissists is doing the same. He's trying to make sense of it all and he creates stories that are plausible, probable, likely, yeah, it must have happened this way. There's no other way.  It's not, it's a desperate attempt to convert you, to force you to confirm to the narcissist that his fantasy is not a fantasy, it's reality. That his confabulations are not mere or pure inventions, they've actually happened. He wants you to tell him that his false self is not false. He wants you in short to become his reality testing and this is the narcissist gaslighting. Psychopath is an entirely different thing and if you want to understand the psychopath gaslighting, why not watch the two original movies titled Gaslight, where you see a skimming, cunning, con artist who marries a rich woman and then abscones or tries to abscone with her property and wealth and money by convincing her that she's going insane. This is gaslighting, this is psychopathic gaslighting, it's gone oriented, it's premeditated, it's carefully planned, meticulously planned, every detail and it's intended to drive you insane, to convince you that your grasp of reality has slipped and you're no longer, you're no longer with us, you're no longer there. Your dependency on the psychopath grows as the gaslighting proceeds to the point that you no longer trust your own senses, you need to see everything and hear everything and taste everything and judge everything through the psychopath. You lose your agency and he becomes your external regulator and external agent. This does not happen with the narcissist, the narcissist is not goal-oriented, his goal is for you to become his reality tester, for you to tell him what is reality. Psychopathic gaslighting and narcissistic so-called gaslighting are exactly the opposite.  Okay, listen guys, this is video number 246 that I've made about gaslighting, really there's nothing more I can say. If I didn't dump it enough for you, dump it down enough for you, then I am afraid I'm the wrong guy.  This is the most basic way I can discuss psychopathic gaslighting versus narcissistic confabulation which is misperceived as gaslight. So I hope I made some sense and help you to differentiate between these two phenomena although I repeat again, as victims this doesn't matter to you because the experience is identical. So walk away, no contact in both cases. Have a nice lit but not gaslit day.


We had some resistance the first few years because teachers weren't understanding well How does this matter to me and how does this fit into my classroom? And so we've been able to frame our summer institutes and frame the work that we do a little bit differently So that they understand larger concepts and themes about US history So that if we're talking about race class and gender That we're gonna talk about that over multiple time periods and they're gonna select the information that they need for their standards And so in the past we've really worked with eighth-grade teachers working with eighth-grade teachers and fifth-grade teachers working with fifth-grade teachers this year we experimented a little bit and we actually were working with the Constitution as our main topic and We brought together fifth eighth and eleventh grade teachers working Collaboratively on a lesson plan. So we had fifth grade teachers working with eleventh grade teachers and eighth grade teachers And we had a little resistance at first because they really don't teach the same things about the Constitution But they trusted us enough over time. We have we don't keep a common cohort for all three years We have teachers coming and going throughout the life of the grant so that we have some people who have been with us for multiple years and some teachers who come in for a year and They trusted us enough and they trusted the lesson study process enough that it became a really rich and valuable experience for them And so we have eleventh grade teachers who are learning from the fifth-grade teachers simple things like how to give directions for a multi-step process and putting those directions on the board which an Eleventh-grade teacher would never do because they think their students know how to do that when really they don't and a fifth-grade teacher learning how to very eloquently deliver difficult concepts That they don't wouldn't necessarily deliver in the same way that a high school teacher has so we have a lot this year We actually really we felt like we really sort of pushed the edge of that a little bit for our teachers and got them out of their Comfort zone and it ended up being very successful you


All right, thank you so much for the opportunity to present today. So today I'll be presenting on Oxervate, a new therapy for neurotrophic keratitis. Is it the answer? So what is the problem? So as we're familiar with, neurotrophic keratitis is a huge issue in ophthalmology. Here's a photo of stage one, neurotrophic keratitis with epithelial regularity. Here's a photo of stage two with persistent epithelial defect. And here's a photo of stage three with actual stromal ulceration and in the worst case perforation. What are the current therapies that we have? Well, we have preservative-free artificial tears, bandage contact lenses, temporary tarsorophy, serum tears, amniotic membrane. None of these are actually approved specifically for neurotrophic keratitis, although they're definitely widely used and each of them have their own pros and cons. Now, Oxervate, also known as Cenedermin, was approved in August 2018 by the FDA for neurotrophic keratitis. It's made by a company in Italy named or called Dompe. It's a recombinant human nerve growth factor developed in E. coli cells and promotes differentiation and maintenance of neurons. So there have been two phase two trials that have compared the efficacy of Oxervate with placebo in adults with stage two or stage three neurotrophic keratitis. The first one is the one that we're probably familiar with, published in ophthalmology. It was actually a European trial performed in 2018. And the second is actually not published but is available from FDA statistical review and is in the package insert. And this was a U.S. trial performed by the FDA. So for the first trial, which we're probably more familiar with, the author has compared eight weeks of Cenedermin, 20 micrograms per milliliter compared with placebo in stage two or three NK followed by a 48-week observation period. Of note, this manuscript also compared the 10 microgram per milliliter concentration. However, that was not what was ultimately approved by the FDA, so I won't focus on that here. The patients in this study were allowed oculolubricants, antivirals, and antibiotics. The medication was administered six times a day for those eight weeks. The primary outcome was corneal healing less than 0.5 millimeters after four weeks of therapy, and the secondary outcome was corneal healing less than 0.5 millimeters after eight weeks of therapy. Both at four and eight weeks, the study results favored the treatment group. When using in a post-talk analysis zero millimeter defect as the goal, the results were actually still significant at both four and eight weeks. Interestingly, however, visual acuity had no difference between the groups, the treatment and the placebo group, and there was some recurrence in both the treatment and the placebo group at week 56. So for the U.S. trial, the authors compared eight weeks of synedromine, 20 micrograms per milliliter, compared with placebo in stage two or three NK, followed by a 24-week observation period. The primary outcome was corneal healing less than 0.5 millimeters after eight weeks of therapy, and the secondary outcome was corneal healing less than 0.5 millimeters after four weeks of therapy. Although at four weeks, interestingly in this study, the results were not significant at eight weeks they were, and when using zero millimeter defect as the goal, as in complete epithelial healing, the results were significant for both four and eight weeks. Once again, in this study, there was no difference in visual acuity, and there was still some recurrence at week 32 in the treatment group. So what are the adverse effects or precautions? So in this study, the primary side effect was ocular pain and up to 16% of individuals in the European trial, other side effects included ocular hyperemia. There were no serious ocular or serious adverse events related to the medication itself. It's unclear the safety in patients who are pregnant or lactating. However, there were no concerns in animal trials, and this medication is actually approved for patients age two and older. So it's approved in the majority of the pediatric population. So how do we use this medication? What does six times a day actually mean? Your oxervate will arrive in a box that contains dry ice. Be sure to wear protective gloves when removing the box of oxervate. You will receive a sufficient number of devices to apply oxervate. For every week of treatment, you will need seven multiple dose vials of oxervate. You will have one vial per day of the week per affected eye, seven vial adapters, 42 pipettes, 42 sterile disinfectant wipes. You will also receive a dose recording card and spares of adapters, pipettes and wipes, the daily materials needed for each affected eye are one vial, one adapter, six pipettes, six wipes and your dose recording card. Next, let's discuss how to assemble your multi-dose vials of oxervate. First, wash your hands. If you wear contact lenses, take them out before using oxervate. You may reinsert them 15 minutes after using oxervate. Remove the plastic flip-off cap from the vial. Without removing the vial adapter from its blister pack, peel off the back. If the adapter becomes dislodged out of its holder, place it back in securely before peeling off the back. Connect the vial adapter to the vial by firmly pushing it down until it snaps into place over the neck of the vial. The vial adapter's spike should pierce through the vial's rubber stopper. Be careful when handling. After the vial adapter has been connected correctly, do not remove it from the vial. Make sure that the vial adapter is well connected to the neck of the vial. You can remove and throw away the packaging of the vial adapter. Your multi-dose vial of oxervate is now ready to have the pipette attached. Every two hours, you'll use this vial and adapter with a new pipette, so you'll apply oxervate every two hours six times a day in a 12-hour time frame. The vial and adapter must be discarded after 12 hours. Next, let's discuss how to prepare oxervate for administration. Take a single sterile disinfectant wipe and gently clean the surface of the valve on the connector part of the vial adapter. After cleaning, wait about one minute to allow the valve to dry. Remove a pipette from its protective packaging. Firmly push the pipette down and twist clockwise into the connector part of the vial adapter. Make sure that the pipette plunger is pushed all the way down and secure. With the pipette still connected, turn the vial upside down to draw the eyedrop solution into the pipette. Gently pull the plunger until it stops. The plunger in the pipette will hit a stopping point when it's not able to be pulled out any further. Check the pipette to make sure it contains the eyedrop solution. If the pipette is empty, keep the vial with the connected pipette upside down. Push the plunger all the way in and pull it out again. The first time you withdraw the eyedrop solution, you may see air bubbles. If you do, push the plunger back into the vial and draw the liquid out again. Keep it upside down while you do this. After the pipette has been filled, unscrew the pipette counterclockwise from the connector part of the vial adapter. Now, let's discuss how to administer oxervate into your affected eye. Sit or lie down to steady yourself when you instill oxervate, holding the pipette pointing down between your middle finger and thumb. All right, so what are some future questions? So this medication was studied in stage two or three disease, and it's approved for all stages, but there's unclear benefits. How does it compare with placebo or current treatment in stage one disease? I'm curious what the visual cutie long-term data is. What is the role of extending beyond eight weeks if the epithelial defect is not healed yet at that stage, and would insurance even approve this? What is the role of using additional courses? Let's say you have a neurotrophic-haritized recurrence. What's the role of using additional courses? And finally, why I wanted to show that video is I think one of my questions is, you know, are patients going to be able to use the medication correctly? Even when I was watching, I thought it was a little bit confusing. So we'll see. I think only by prescribing will we be able to tell, and certainly good in-clinic teaching and support resources by D'Ampe will help, but I think that we'll have to see how that goes. Now, how do you get the medication? So it's only available via a specialty pharmacy at Crado. So what you do is if you are a physician interested, you go online to the website, and you fill out this patient enrollment form, and then you fax it to D'Ampe. And just so you know, the actual cost of this medication without any insurance or any prior authorizations, the pure cost of it is $14,000, although patients would not pay this amount. And speaking with the representative, in her experience, there's been a few different groups of patients who have had or who have had the medication prescribed for them, and based upon her experiences for commercial insurance, you know, what a physician would do is you'd fill out the form, you'd fax it to to observate who would contact the insurance plan, the physician will get the prior authorization, and it, you know, may be denied if it denied another appeal will have to get filled out. And I think this part is a little bit nebulous. At some point there's some notification, and I'm not sure, you know, to who that notification goes to or if it's always consistent, whether the patient's notified, the physician, a credo is notified, and a credo contacts the patient. So someone gets notified and the patient can contact a credo to start the medication. And the cost is approximately $100 in copay per eight weeks of treatment.  Per the representative, patients somehow get this medication without charge. I don't know how that actually applies in practice. I think we'll have to start prescribing and see what actually happens for this population of patients. And finally, for patients with Medicare or Medicaid, it's a similar process to the commercial insurance. There is a certain amount of copay. It's not high. I don't know exactly what that amount is though. Alrighty. So going back to our initial question is the answer. You know, I don't think it's the answer, but I do think it's one answer. And I actually, personally, I'm excited to start prescribing it because I think that the data is very encouraging with the caveats that I think, A, you know, our patient's going to be able to use the medication appropriately. And two, you know, I don't know what the experience will actually be in terms of going through the prior authorization process and the different populations of patients depending upon their insurance. Are they going to be able to get the medication? So thank you so much for your time. Thank you especially to Dan for his help with this presentation and to Dr. Lynn Mifflin-Zog.