 Many told me that my recent videos are way too morbid and that I should really really try to cheer you up in these days of the pandemic. So I settled on a joyful topic. Disease and illness in their relationship to our inherent in-built narcissism. You all know that everyone is healthy narcissism. This is the foundation of self-esteem and self-confidence and other very nice features of the human personality. So how do we cope with challenges to our narcissism? Challenges to our self-esteem and self-confidence. The biggest of which is of course being disabled, being ill, being unable to function normally. Let's start with the basic fact. We are all terminally ill. It is just a matter of time before we all die. So from the moment we are born, we are on our way to dying. That is a fact that we tend to suppress and negate. We tend to pretend that we will live forever. We plan ahead, we make predictions, we act on them, and we trust fully that we are going to wake up to more money. These are of course ludicrous assumptions. They are statistically founded perhaps, but there is no certainty that. Aging and death remain almost as mysterious as ever. We feel awed and uncomfortable when we contemplate these twin afflictions. We are even trying to convert aging into a disease, saying aging is a kind of illness. And the reason we do this is in order to buttress and enhance our omnipotent grandiosity. Because if aging is an illness or a disease, then obviously there will be one day a cure and we will all live forever. Whether happily or not remains to be seen. Indeed, the very word this is, the very word denoting illness, contains its own best definition. This is not easy. There's a mental component of lack of well-being. And this mental component must exist subjectively. The person must feel bad in order to be sick, must experience discomfort for his condition to qualify as a disease. And to this extent, we are justifying all diseases as actually spiritual or mental. Because without this component, there's no disease. We see this in the pandemic. Many people have the virus, but they are asymptomatic. Because they are asymptomatic, they feel well, they don't cough, they don't sneeze, they don't infect anyone. And so they are not diseased. Is there any other way of distinguishing health from sickness? A way that does not depend on the report that the patient provides regarding his or her subjective experience? Can we come up with some kind of objective test or something? Well, some diseases are manifest. Other diseases are latent or imminent or asymptomatic or presymptomatic. Consider, for example, genetic diseases. They can exist unmanifested for generations. Hemophilia. This raises the philosophical problem of whether a potential disease is a disease. AIDS and hemophilia carriers. Carriers. Are they sick? Should they be treated clinically and ethically speaking? Typhoid Mary. She was isolated on an island in prison. Not because she did anything wrong, but because she was rumored to have spread typhoid around. She was a carrier. She was a super spreader. But these people, Typhoid Mary included, including experienced no disease. She constantly protested. She said, what are you doing? I didn't do anything wrong. They experienced no disease. They report no symptoms and there are no evidence signs. Similarly, in mental health, narcissism don't feel that they are ill or they're sick. On the contrary, they believe that the constellation of their symptoms, the syndrome of narcissistic personality disorder is actually an adaptation, an evolutionary advantage. Something that puts them on the right path. The next step in the evolutionary ladder. So on what moral grounds can we commit these people to treatment? Can we, at some stage in the future, force psychopaths and narcissists to, I don't know, self-quarantine or receive treatment today in incarceration facilities, in penitentiaries, in prisons. Psychopaths are forced to receive mental health treatment as a condition for probation and parole or release. Should these be extended generally to all psychopaths and all narcissists? Aren't psychopaths and narcissists a kind of carriers of a disease that potentially is much worse than COVID-19? On the grounds of the greater benefit, can't we demand that people be treated? Carriers, carriers threaten other people. They must be isolated or otherwise neutered somehow. The threat inherent in carriers must be eradicated. Now this is a dangerous moral precedent and what we call in philosophy, in ethics, we call it a slippery slope. All kinds of people threaten our well-being. I don't know, unsettling ideologies, demagogues, conspiracy theories, the mentally handicapped and of course our neighbors. Not to mention many politicians. Why should we single out our physical well-being as worthy of privileged moral status? Why is our mental well-being, for instance, of less importance? Why not quarantine or self-isolate or social distance people who are in danger or threaten our mental well-being? Moreover, the distinction between the psychic and the physical, psychological and the physical, is hotly disputed philosophically. The psychophysical problem is as intractable today as it ever was, if not more so. It is beyond doubt that the physical affects the mental and the other way around is also true. The mental affects the physical. This is what disciplines like psychiatry are all about. That's why we give psychopharmacological medications. We give you antidepressants because we think the medicine, which is a very, very physical thing, asks any pharmaceutical industry, physical and lucrative. We give you these pills because we believe they will have a mental effect on you. The ability to control so-called autonomous body functions such as, I don't know, heartbeat, pulse, blood pressure, even breathing in case of catalepsy, self-induced catalepsy. Some people can control these autonomous body functions. And there are also mental reactions to pathologies of the brain. And all these are proof of the artificialness of the distinction between body and mind. The mind is an artifact of the body. In the East they would say it's the opposite. The body is an artifact of the mind. The body is a agglomeration of systems. A agglomeration of systems that function together, perhaps because there's an organising principle. And the organising principle can be the mind. And this whole debate is a result of the reductionist view of nature, as divisible, summable, and you know, like parts, some of the parts. But the sum of the parts, of course, is not always the whole. There's some wateriness in water that you cannot trace back to hydrogen and oxygen. There are what we call emergent phenomena, epiphenomenal, epiphenomenal, that cannot be traced back to the parts that constitute the system that gave rise to these phenomena. There is no such thing as an infinite set of the rules of nature. There's only an asymptotic approximation of these rules. And we call the procedure that we use to get to know these rules. Never the total set of rules, but some of these rules. We call it science. The distinction between the patient and the outside world is both superfluous and wrong. It's Cartesian. It comes from a Frenchman, of course, by the name of Descartes. Descartes who broke down the world to an observer and an observed. The patient and his environment are one and the same. This is the holistic approach. Disease is a perturbation, a disturbance in the operation and management of the complex ecosystem known as patient world. Humans absorb their environment. They feed their environment in equal measures. This is an ongoing interaction between environment and organism. And this interaction is the patient. We cannot exist without the intake of water, air, visual stimuli, food. In deprivation experiments, deprivation tanks, we also discovered that we need touch. We need to talk to other people. We are discovering this in social distancing. This gigantic global experiment where about three billion people are confined to their quarters and not about to interact with each other face to face, smell each other, touch each other. Our environment is defined by our actions and output, physical and mental, but we are determined in return by this environment. So there's an infinite loop and it could be a vicious cycle as we are discovering. We have destroyed our planet. Our planet is destroying us in return. There's a direct lineage between what we had done to animals, what animals are now doing to us via zoonotic viruses like the SARS-CoV-2, coronavirus 2. And all of this, as I'm saying, also applies to the mental realm. Our mind is a hive, it's a beehive, it's a collage, it's a kaleidoscopic shimmering, phantasm, reflection of everything we hear and everything we repress, we ignore. And very often we're influenced by things that are outside our consciousness. We are integrated deeply with our environment also mentally. This is precisely where pathological narcissism and psychopathy come in because they induce modification. What is modification? It's a breakdown of this intimate coexistence between us and others. The human society, the human environment, is a giant organism with 8 billion cells. You can look at it this way and there have been scholars who suggested that Earth itself is an organism, the Gaia hypothesis. So, narcissists and psychopaths come in and they break down this relationship we have, this co-optation, this collaboration, this cooperation, this symbiosis, healthy symbiosis between us and other people, us and institutions, us and society, us and culture, us and history, us and others. Psychopaths and narcissists threaten our sense of safety and security. Statistical safety and security, the assumption that people are essentially good, that they are basically telling the truth, that they can be trusted to a large extent, that they will not act in malice to eradicate us, to annihilate us, to hurt us. When we come across a narcissist and psychopaths, the world breaks down, the chain of being breaks down, our whole model, our whole theory of mind, how other people operate, what we call the intersubjectivity agreement. It is undermined and our ability to empathize is undermined as a result because empathy relies crucially on trust. So there's a ripple effect, there's a chain reaction. One psychopath is enough to unsettle and destroy a whole community. So one must question the classical differentiation between internal and external. Some illnesses are considered endogenic generated from the inside, others exogenic generated from the outside, endogenous and exogenous. Natural so-called internal causes, a hard defect, biochemical imbalance, genetic mutation, metabolic process gonorrhoea, they cause disease, no question about it, aging and deformities also belong in this category. In contrast, problems of nurturance and environment, early childhood abuse for instance, malnutrition, domestic abuse and violence, they're external. And so they are the classical pathogens, they are mental health pathogens. They're exactly like viruses and germs. Viruses and germs are classical pathogens, disease inducing organisms. What about accidents? It's the same. Accidents are the same, first because most accidents are preventable. And therefore it is an element of deliberation in an accident. A decision to let go, for example, of caution, recklessness. Natural disasters are perhaps the only category that falls out of all this. But viruses are not natural disasters. They're not natural disasters, not in the sense that they're not natural, they're not man-made. No laboratory has released these virus. But they are the outcome of a chain, a linkage of decisions, cumulative decisions, bad decisions, reckless decisions, hopeless decisions that we have made. And yet this distinction between endogenous and exogenous, internal and external, it's a counterproductive approach. Exogenous and endogenous pathogenesis is inseparable. Mental states, for example, increase or decrease our susceptibility to externally induced disease. You can watch the video I made about vaccines, vaccination. And there I give an overview of the immune system and you will see that mental states mediated via, for example, stress hormones. Mental states, anxiety, depression, suppress the immune system, makes us vulnerable and open to disease. Talk therapy or abuse, external events, verbal abuse, talk therapy. They alter the biochemical balance of the brain. They rewire the brain. The brain is plastic, there's plasticity, neuroplasticity. And so they rewire the pathways in the brain. The inside constantly interacts with the outside. It is so intertwined with it that all distinctions between inside and outside are artificial. They're misleading. The best example is, of course, medication. Medication is an external agent, but it influences internal processes. And it has a very strong mental correlate. The efficacy of medication is influenced by mental factors. And we have proven it numerous times. The placebo effect, the nocebo effect. We have conducted experiments and we gave people water and we told them it's alcohol. Water. You heard well. We told them it's alcohol. They got drunk. They got drunk senseless. They had blackouts. Alcohol-induced blackouts without alcohol. We hypnotized people. We tell them that, you know, it's a hot object and we place it on the skin. And they have burns. Third-degree burns. Third-degree burns. In reaction to hypnotic suggestion. The very nature of dysfunction and sickness is highly, highly culture-dependent, context-dependent. Societal parameters dictate right and wrong in health, especially mental health. It is all a matter of statistics. Certain diseases are accepted in certain parts of the world as a fact of life, or even a sign of distinction or being chosen. For example, the paranoid schizophrenic was considered for a very long stretch of human history as chosen by the gods. Most prophets have been paranoid schizophrenics. If there is no disease, there is no disease. That the physical or mental state of a person can be different does not imply that it must be different. Or even that it is desirable that it should be different. It depends. In another populated world, sterility might be the desirable thing. We may come to a situation where we encourage people to be sterile. China had a one-child policy for a very long time. You know what? In another populated world, over-polluted, overflowing, where resources are not allocated rationally because had they been allocated rationally, they supported a population of 30 or 40 billion. But they are not allocated rationally. One-third of all food is thrown to the garbage, for example. Fact, shocking fact. Well, that's the state of the world. Then in this kind of world, the occasional pandemic is not such a bad thing. There is no such thing as absolute dysfunction. Absolute right, absolute wrong, absolute black, absolute white. This is a splitting infantile defence mechanism to think this way. We call it decotonous thinking. The body and the mind always function, and they always function together. They adapt themselves to their environment. And if the environment changes, they change. Personality disorders are the best possible response a child has to abuse. Personality disorders are adaptive. That's why they are so difficult to heal and eradicate later in life in adulthood because for a very long period of time they had worked. They did their job. They protected the child. They shielded the child. Cancer may be the best possible response to carcinogens. And also, cancer may be the way that evolution experiments with mutations. Cancer may be good for us as a species, bad for some individuals, no doubt. Aging and death are definitely the best possible response to overpopulation. Everyone would dispute this. My biggest nightmare is the resurrection after the date of judgement. Because statistically on earth, the total number of people who had ever lived is about 80 billion. Imagine all of them coming back to life. Perhaps the point of view of the single patient is incommensurate with the point of view of the species. But this should not serve to obscure the issues and derail a rational debate. As a result, it is logical to introduce the notion of positive aberration, positive abnormality. Certain hyper or hyperfunctioning can yield positive results. They can prove to be adaptive. The difference between positive and negative aberrations can never be objective. Nature is morally neutral and a body is no values, no preferences, definitely not ours. Nature simply exists. We, human beings, impose, I would say, our value systems, prejudices, priorities, biases into our activities, including our science. Don't think that science is kind of immune to all this. For example, consider the sentence, it is better to be healthy. Why? Because we feel better when we are healthy. It's a very circular argument. It's better to be healthy because we feel better when we are healthy. And there's no other criteria. Can you convince me that it's better to be healthy? Well, it's better to be healthy because when you're healthy, you're better. If the patient feels good, it is not a disease, even if we all think it is, for example. If the patient feels bad, egodis tonic, unable to function, it is a disease. Even when we all think it is, it is not a disease. That's a problem with depressed people. They come to therapy. Depression, we now know, is essentially a biochemical disturbance of the brain. It's a physical thing, it's a biological, clinical entity. So depressed people come to the therapies. And they say, you know, I'm depressed and this and that, and therapy says, but why are you depressed? Everything is wonderful in your life. So if there is a disease there, even if we all agree that there shouldn't be, needless to say that I'm referring to this medical creature, the fully informed patient. If someone is sick and knows no better, has never been healthy, then his decision should be respected only after he's given the chance to experience health. That's why euthanasia is a serious problem. Because in many cases, the patient has never experienced health, has never experienced the alternative, or believes that there is no alternative when actually there is. All the attempts to introduce objective yardsticks of health are plagued and philosophically contaminated by the insertion of these values, preferences and priorities and biases into the formula. We subject the formula to these yardsticks or benchmarks. There's nothing objective in it. When we talk about health, is it desirable? What is the state of health? How can we achieve accomplished health? What are the limits where we shouldn't overdo it? All this is not an objective debate. Doctors, medical doctors, can't make these decisions. That's why when I'm watching the press conferences of the COVID-19 task force, there's an enormous confusion between objective medical facts and value systems. Values can never be imposed by a central authority, by any authority, because that's the very definition of a loss of freedom. So sometimes we attempt to define health as an increase in order or efficiency of processes or functioning. It's contrasted with illness, which is a decrease in order, increase in entropy, decrease in efficiency of processes, decrease in function. Well, first of all, it's disputable. There are many diseases which actually increase function. For example, autists are very good with mathematics. And narcissists and psychopaths thrived in Nazi Germany. So not all diseases are, you know. So first of all, it's disputable. But there's also this dichotomous diet also suffers from a series of implicit value judgments. For instance, why should we prefer life over death? Why order is better than entropy? Disorder? Chaos? And why efficiency is preferable to inefficiency? For example, there are many cultures and societies and civilizations where to be efficient is to sacrifice other very important values such as, I don't know, community, family. It's a very efficient society in the West. But do we have a society? Do we have a community? Is anyone happy? Is anyone happy? 20% of adults in the United States are diagnosed with clinical depression. It is estimated that another 20 to 30% have anxiety disorders. And yet it's a highly efficient, the most efficient society in human history. So maybe efficiency or functioning is not such a good thing. Health and sickness are different states of affairs. Whether one is preferable to the other is a matter of the specific culture and society in context in which the question is posed. There's no universal answer. Yes, health is always better than disease. Not true. Health and its lack. They are determined by employing three filters as it were. First of all, it's the body affected. Second is the person affected. This is the bridge between physical and mental illnesses. And finally, third question is society affected, the greater good. In the case of mental health, third question is often formulated as is it normal? Is it statistically the norm of this particular society in a particular time? We must re-humanize disease. We live in a culture that rejects critical component of life, disease and death. There is no life without disease and death. It's as important as love, as important as procreation, children. We must reintroduce disease and death, make friends with them, accept them as ineluctable stages in the wonderful cycle that is human life. Ironically, Western civilization, which is by now unfortunately global civilization, is fanatic. It's a death count. It's a civilization that places emphasis on objects rather than people. And yet, while on the societal level, death is revered, death is God. On the individual level, life is revered. But life without disease, without adaptation, without mutation, without change, without death, and so perhaps it's a form of the living dead. Perhaps even what we call life and health in the West is actually being a zombie. By imposing upon issues of health the pretensions of the accurate sciences, we had objectified the patients. And we had objectified the healer. We pretend that medicine is a branch of physics. Nothing can be further from the truth. Medical doctors will not tell you, but diagnosis is always extremely uncertain and they experiment on you. They experiment on you with various treatments, various drugs, all the time, until they find hopefully the right answer or not. There's nothing in common between medicine, psychology, and science, and physics. Medicine and psychology, they deal with raw material, which is mutable, changeable, never the same, from one minute, from one second to the other. By the very interaction with the healer, with the doctor, the patient changes. And we utterly neglected everything that cannot be qualified or measured. In medicine we derelict, we're delinquent, we ignore the human mind, the human spirit, resilience, and so on. Different societies react to health and disease in different ways. Somatic societies place emphasis on bodily health and performance. These societies regard mental functions as secondary or derivative, the outcomes of corporeal bodily processes. Healthy mind in a healthy body, the Roman post-Republic empire. So these societies would emphasize medication they would, medicalize mental health conditions. They would deny actually the existence of the mind. Cerebral societies emphasize mental functions over physiological and biochemical processes, exactly the opposite. These societies regard corporeal bodily events as secondary or derivative, the outcomes of mental processes. Mind of a matter. We can find many of these in India. Elective societies believe that bodily illnesses are beyond the patient's control. But mental health problems are under the patient's control. A very curious and counterfactual distinction, by the way. So in these societies, if you have a body problem, you should be taking care of these. But if you have a mental health problem, it's your problem. Something's wrong with you. It's a choice. These are choices made by the mentally sick people. It is up to them to decide to snap out of it, out of their conditions, heal thyself. The locus of control is internal, never external in the case of mental health. Provincial societies believe that health problems of both physical and mental, they are the outcomes of the intervention or influence of higher power, God, fate. Thus diseases carry messages from God. And they are the expressions for universal design and a supreme volition. The locus of control is external and healing depends on supplication, ritual and magic. In countries such as Russia, it's still very prevalent. And finally, medicalized societies believe that the distinction between physiological disorders and mental disorders, dualism, this distinction is spurious, is wrong and is a result of our ignorance. All health-related processes and functions are bodily. There's no such thing as mental. They're all grounded in human biochemistry and genetics and in hardware. Wetware is hardware. There's nothing there. What we call the mind is our experience of our own hardware. So it's just a label. It doesn't describe anything ontological, any real entity. As a knowledge regarding the human body growth, many dysfunctions, hitherto considered mental, will be reduced to their corporeal body components. So we used to think that schizophrenia, paranoia, is a mental disorder. Now we know it's actually a disorder of the brain. Same with depression and shortly with anxiety. So many, many so-called mental health disorders are fast becoming actually medical problems. Same as tuberculosis or COVID-19. But what about the subjective experience of disease? How does the patient feel? There is one place in which one's privacy, intimacy, integrity and inviolability are guaranteed and that is one's body. The body is a unique shrine. It's a temple. It's a familiar territory of sense and personal history. The process of chronic disease or any disease. It invades the body. It defiles the body, desecrates this shrine. And it does it publicly. Enhancing the sufferer's sense of helplessness and utter humiliation. It's, in other words, a narcissistic modification. Hence the all-pervasive, long-lasting and frequently irreversible effects. Effects and outcomes of illness. Whether short-term but threatening and abrupt like COVID-19 or long-term and intractable. In a way, the patient's own body is rendered his worst enemy. It is corporeal bodily agony that compels the patient to mutate. His identity to fragment. His ideals and principles to crumble. The body becomes an accomplice of the affliction. An uninterruptible channel of communication between the patient and that which threatens the patient. The threat, the horror out there. The body becomes a treasonous, toxic, poisoned territory. Not a friend. We make friends with our body. We have the proprioception. We have a map of our body in our mind. That's why when something is amputated we still feel it because it's in the map. The map survives. The map survives any mutilation. And we still interact with a missing arm. Because we interact via the map, not via the arm. And so we are very intimately, I mean the most intimate relationship we have with him is with our body. So a disease fosters a humiliating dependency of the diseased and the abused and the patient on medicines, on doctors, on bureaucracies, on therapies. The impersonal character of modern healthcare systems objectifies the patient. It further adds to his or her alienation. Anyone who has had a mental health problem and had to resort to bureaucracies, government bureaucracies and so on, know what I'm talking about. Bodily and mental needs are denied in the course of the ailment. Sleep, toilet, food, water. And these are wrongly perceived by the victim as the direct causes of his degradation and dehumanization. As the patient sees it, he's rendered bestial, animal-like, not by the inadequacies of society and medicine, but by his own flesh and blood, by his own mind. It's inescapable. It's like being trapped in the same cage with a tiger. And it used to be a friendly tiger, but then suddenly it starts mauling you via cancer, via mental illness, severe mental illness, via COVID-19. Your body turns against you, becomes your worst enemy. The concept of body can easily be extended to family or to home. One sickness often affects Keen and Keith compatriots or colleagues. We see it today in the age of social distancing and when all societies are trying to cope with the disease of a few. And yes, COVID-19 is a pandemic, but very few people have been affected. Four million people have been diagnosed. And of these four million people, 280,000 died. I know these are shocking numbers, but they're not far in excess of a bed season of flu. Last year, 2019, 650,000 people died of the flu and its complications. And yet we are all reacting with hysteria, with mastaniac, because a disease is never the patients, as I said at the very beginning. A disease is a systemic thing. The whole system gets diseased, infected. Contagion is society-wide, family-wide, community-wide. That's why we cannot isolate mentally ill patients. We can't say, okay, the narcissist can be put aside, the psychopath can be sequestered. We can't do this. The inexorable processes of degeneration and decrepitude, mental and physical, they disrupt the continuity of surroundings, habits, appearances, relationships with others. And that quote is not mine. It's the CIA. The CIA has a torture manual, believe it or not. This is lifted from there. There's a sense of cohesive self-identity, and it depends crucially on the familiar, on the continuous. That's why dissociation in borderline is so destructive that 11% of borderline patients commit suicide. By attacking both one's biological body and one's social body and one's mental body, the patient's psyche is strained to the point of dissociation. Beatrice Patsalides describes this transmogrification in her wonderful article, wonderful paper, Ethics of the Unspeakable, Torture Survivors in Psychoanalytic Treatment. But it applies equally well to hospital settings, for instance, to mental asylum, to the patient's death bed, and to families where there is an abuser, abusive relationships with CPTSD, complex post-traumatic stress disorder, on the one hand, and a psychopathic narcissist on the other. So what I'm about to read applies to this as well. And she says, as the gap between the I and the me deepens, dissociation and alienation increase, the subject that under torture, under disease, under abuse, I'm Eddie. The subject that under torture was forced into the position of pure object has lost his or her sense of interiority, intimacy and privacy. Time is experienced now in the present only, and perspective that which allows for a sense of relativity is foreclosed. Thoughts and dreams attack the mind and invade the body, as if the protective skin that normally contains our thoughts uses space to breathe in between the thought and the thing being thought about and separates between inside and outside, past and present, near and new, as if the skin was lost. That is a wonderful description of certain mental health disorders, for example, borderline personality disorder. People with borderline personality disorder have no skin. There's an emptiness inside, which Kernberg described, but there's no skin to protect it. The narcissist at least, at least the narcissist has this fictitious second personality, this Godlike divinity or deity, the false self, and is shielded and protected by this imaginario, not so the borderline, borderline failed to develop narcissism as Rothstein described. Illness robs the patient of the most basic modes of relating to reality and is in equivalent of cognitive death. Space and time are warped by sleep deprivation, for example. The self, the eye, is shattered. The chronically sick have nothing familiar to hold on, not family, not home, not personal belongings, not loved ones, not language, not name, no identity, nothing. They are reduced to body organs in hospitals. Patients of COVID-19 had to die alone, as no one could get near them, was allowed to get near them. Gradually, patients, mental and physical, lose their mental resilience and sense of freedom. They feel alien, no agency, no self-efficacy. They feel unable to communicate, to relate, to attach, to empathize with others. Terminal or debilitating illness, splinters early childhood grandiose narcissistic fantasies of uniqueness, omnipotence, invulnerability and impenetrability. But this kind of illness enhances the fantasy of merger with an idealized and omnipotent, though not always benign, other. So patients tend to become codependent on the medical doctor. Even though the medical doctor inflicts huge pain on them usually, agony. The twin processes of individuation and separation are reversed. There's a regression in illness, mental or physical. There's a regression. The individuation separation is rewound, fast backward. And there's a regression to infantile states. The patient becomes an infant. Being treated for an illness is the ultimate act of perverted intimacy. The medical professional invades the victim's body, or probes his psyche, if he's a psychiatrist. Bedridden, deprived of contact with others and starved for human interactions. The patient bonds with his caregiver. And that's of course the Stockholm syndrome. Patients, mental and physical, are hostages. Hostages of their own bodies, and then secondary hostages of the medical healthcare system. And more specifically, doctors, psychiatrists, psychologists, therapists, medical doctors. And so we have even pathological phenomena such as Minkhausen syndrome, where people fake, fictitious disorder, they fake their disease. Traumatic bonding akin to the Stockholm syndrome is about hope, and about the search for meaning in a brutal and indifferent and nightmarish universe. Such as the hospital, or mental asylum, or even the outpatient clinic, or even the therapist clinic. The medical doctor, the therapist, the psychiatrist, becomes the black hole at the center of the victim's surrealistic galaxy, sucking in the sufferer's universal need for solace. For Sacor, the victim tries to control his caregiver by becoming one with the caregiver, by interjecting the caregiver, by appealing to the practitioners, presumably nearly desensitized humanity and empathy. Somewhere there, it's just that he has seen too much. There's the belief that the empathy and humanity of the medical doctor who is treating you, the psychiatrist who is treating you, they can be evoked. They can be elicited with the right kind of behavior. So there's an adaptation, there's a kind of acting taking on. Does it sound familiar? Of course it does. Patients become narcissists. Narcissists, manipulative, pretentious, fake, self-centered, no empathy. The bonding between patient and the caregivers is especially strong when the doctor and the patient form a diet, a couple if you wish, a unity, and they collaborate in the rituals and acts of treatment. For instance, when the victim is asked to select the implements and the types of surgery to be inflicted or to choose between two equally vile and agonizing cures or when the patient strikes a therapeutic alliance, so-called with a therapist, as though they are omnipotent, they have the same power. It's not true. There's a power gradient, there's a power differential between patient and anyone who provides treatment, psychotherapists included, but there is the pretension of equality. The psychologist, Shirley Spitz, offers this powerful overview of the contradictory nature of torture. And for me, all diseases torture, all disease. Even I would say more so mental disease. So there's a seminar titled The Psychology of Torture in 1989 and she submitted a paper. Just substitute the words chronic internal illness or mental illness for the word torture in the following text and you get a picture. And she says, torture is an obscenity in that it joins what is most private with what is most public. Torture entails all the isolation and extreme solitude of privacy with none of the usual security embodied in privacy. Torture entails at the same time all the self-exposure of the utterly public with none of its possibilities of camaraderie or shared experience. The presence of an all powerful other with whom to merge without the security of the other's benign intentions. A further obscenity of torture is the inversion it makes of intimate human relations. The interrogation during torture, the treatment during the surgery during the disease, the treatment, the intubation in COVID-19, the CBT in a therapist setting. They are all forms of a social encounter in which the normal rules of communicating, the normal rules of relating of intimacy are manipulated. Dependency needs are elicited by the interrogator, the psychiatrist, the psychologist, the medical doctor, but not so they may be met as enclosed relationships so these needs of dependency are not aroused and evoked and provoked in order to gratify them, to meet them, but in order to weaken and confuse. Even in therapy by the way, parenthesis, my parenthesis, even in therapy we very often weaken the patient by taking away his defences or her defences. Coming back to the text. Speeds. Independence that is offered in return for betrayal is a lie. Silence is intentionally misinterpreted either as confirmation of information or as guilt for complicity. Torture combines complete humiliating exposure with utter devastating isolation. The final products and outcome of torture are a scarred and often shattered victim in an empty display of the fiction of power, applies perfectly to a lot of therapy, a lot of medical treatment in hospitals and so on. Obsessed by endless ruminations, demented by pain and a continuum of sleeplessness, the patient regresses, shedding all but the most primitive defence mechanisms. Infantile defence mechanisms, again, back to childhood, splitting, narcissism, dissociation, projective identification, interjection, cognitive dissonance. The sick person constructs an alternative world, suffering an extremis from depersonalisation, derealisation, dissociative amnesia, hallucinations, ideas of reference, delusions and finally psychotic abysses. Some patients actually refrain. They say pain is not bad, I like pain, I crave pain and so they self mutilate or they attempt suicide or they become masochists because adopting pain, making pain yours, owning pain is a form of reasserting control. Remember previous videos? External modification is difficult to cope with, it's difficult to feel helpless, it's difficult to feel disempowering. So you create an internal modification. You say actually whatever happened, I made it happen. It's my fault, I led to it, I controlled it. Pain, it's nothing, I love pain. Give me more, give me more, I want pain. It's proof and reminder of the individuated existence of such people and because the incestuous process of disease blurs the boundaries between you and the world, between you and others. You feel that you are disintegrating, that you are dissipating, you are diluted in some kind of universal fluid. So this is, owning pain, embracing pain is a way to actually look at me, look at the physical manifestation, it's a way to create a boundary. Pain shields the sufferer from disintegration and capitulation. It possesses a raster to you, it's unthinkable and unspeakable experiences. It is like a decoration for valor, a medal, medal for courage under fire, something to be proud of, something to flow. And you know all these patients that never stop talking about the disease and are horrible the disease, what happened to them was and they go into details and they give you all the very disgusting, because they're proud of their disease. Of course this applies to mental health as well. Psychopaths and nurses are very, very proud of who they are. They are in love with their disorder, they affect their disorder, they invest emotional energy in their disorder because they regard the disorder. As they think the disorder, their personality disorder renders them superior somehow. Many narcissists and psychopaths and many mentally ill people are invested emotionally in their mental health problems because they believe that their creativity depends on their problems. They believe they are creating because they have mental health problems. There is this romantic view of the mad genius or the artist as a suffering person. And they believe that if the therapist for example were to take away the mental illness, they would be left without a spark, without the spark of life. They identify life with mental illness. And these dual processes of the patient's alienation on the one hand and his addiction to anguish on the other hand complement his view of himself as increasingly inhuman. Narcissists describe themselves as robotic or machine like. Or subhuman. Borderlines very often go through enormous guilt and shame trips where they say I'm better dead, better of dead. I'm the reunification of evil. I'm corrupt. The medical doctor assumes the position of the sole authority, the arbiter, the exclusive found of meaning and interpretation, the source of good and evil. The patient is self-visiated, absorbed, digested by the medical establishment. In this can be perceived as a reprogramming of the patient. Reprogramming the patient, first of all, deprogramming the patient of a normal life and then reprogramming the patient to succumb to an alternative interpretation of the world and exegesis, interpretation of the world, preferred by the medical profession. The doctor says, I'm going to, you need to substitute all your values for my values. You need to substitute the way you see the world, like your Weltanschau, the worldview for my world. The doctor takes over body snatches the patient, takes over the patient. The patient tries to conform. His life depends on it. His mental health depends on it. It is an act of deep, indelible, traumatic indoctrination. The sick typically swallow a hole and assimilate the doctor's point of view in their opinions regarding the patient's objects, patients' statistics, patients' scopes as in the making, patients' specific organs, patients' specific disorders. The opinions of these doctors become the opinions of the patient. It's very common for a patient to say, I'm a narcissist. But of course, or I'm a borderline, or I'm depressed. But of course, depression, narcissism, borderline, or I mean, this is not the patient. This is what the patient has. That's the therapist's view of the patient, and the patient adopts it. At times, as a result, patients are rendered suicidal, self-destructive or self-defeating if the medical professional is too overbearing or too narcissistic. The situation is even much worse with mental illness, because mental illness is a form of chronic illness. Chronic diseases, no cut-off date, no hopeful horizon, not even death. The sounds, the voices, the smells, the sensations, the inner, the cognitions, the emotions, they reverberate long after each episode has ended, both in nightmares and in waking moments. The patient's ability to trust, the rationality and benevolence of the world is irrevocably undermined. Social institutions are perceived as precariously poised on the verge of an ominous, Kafkaesque mutation as an impending doom and threat. Nothing is safe, nothing is credible anymore. Long-term patients typically react by undulating between emotional numbing and increased arousal, somnia, irritability, restlessness, tension deficits. Recollections of the traumatic events intrude in the form of dreams, night terrors, flashbacks, distressing associations. Sick people develop compulsive rituals to fend off obsessive thoughts, intrusive thoughts, rumination. Other psychological sequelae reported include cognitive impairment, reduced capacity to learn, memory disorders, sexual dysfunction, social withdrawal, inability to maintain long-term relationships or even mere intimacy, phobias, ideas of reference, superstitions, delusions, hallucinations, psychotic microepisodes, emotional flatness, etc. Depression and anxiety are very common. These are forms and manifestations of self-directed aggression. The sufferer rages at her or his own victimhood. And at the resultant, multiple dysfunctions, lack of self-efficacy, lack of agency autonomy, self-personal autonomy. I mean, it's infuriating that you can't act upon the world, make sure that you extract from the world what you need at the very least. The patient feels shamed by his new disabilities and responsible or even guilty for them, somehow, for his predicament and for the dire consequences borne by his nearest and dearest. The patient's sense of self-worth and self-esteem are crippled and, of course, patients react with narcissistic defences to all this. Determinarily and chronically, ills suffer from complex post-traumatic stress disorder. Their strong feelings of anxiety, guilt and shame are also typical of victims of childhood abuse, torture, domestic violence and rape. Patients feel anxious because the diseases' behavior, progression and trajectory, are seemingly arbitrary and unpredictable or mechanically and humanly regular. But notice the phrase, the diseases' behavior. It's like the disease is anthropomorphized. It's like we humanize the disease, we make it into an entity. Very frequently when we talk to mental health patients, they talk about the disease and also physical body with body afflictions. Patients, they talk about the disease or affliction and separate from them as a kind of, here it is, it's kind of an entity, objective, ontological entity that is threatening them. It's again regression to childhood when we had monsters lurking in the cupboards or under the bed. Patients feel guilty and disgraced because to restore semblance of order to their shattered world and a modicum of dominion over their chaotic life, you know what, over their body functions, they need to transform themselves into the cause of their own degradation and the accomplices of their torment, this is where it ties in with external modification and internal modification. They can't accept the external modification, they can't accept their victimhood. So they internalize the modification, they say it's all my fault, I led to it, I made it happen, I'm bad, I'm evil, I'm stupid. Inevitably in the aftermath of bodily trauma and protracted illness, the victims feel helpless and powerless and this loss of control over one's life and body is manifested physically in impotence for example, erectile dysfunction, attention deficits, somnia. This is often exacerbated by the disbelief many patients encounter when they try to share their experiences, especially if they are unable to produce scars or other objective proof of their ordeal. This is very common in mental health. Language cannot communicate such an intensely private experience as pain and patients are variable. No single list of symptoms or criteria can capture a clinical entity, not even a body clinical entity. There are atypical everything, atypical dermatosis, atypical tuberculosis, atypical cancer, everything has atypical things, even COVID-19 already has an atypical variant that is afflicting children. The aforementioned speech makes the following observation. Pain is also unshareable, you can't share it, it is resistant to language. All our interior states of consciousness, emotional, perceptual, cognitive and somatic, can be described as having an object in the external world. This affirms our capacity to move beyond the boundaries of our own body into the external shareable world. This is the space in which we interact and communicate with our environment. But when we explore the interior state of physical pain, we find that there is no object out there, no external referential content. Pain is not of or for anything, pain is. And it draws us away from the space of interaction, the shareable world, inwards. Pain draws us into the boundaries of our own body, not outside, towards others. Bystanders resent and shun the sick, because they make them feel anxious, and also because they feel guilty somehow. The ill, sick people, especially mentally ill, threaten the healthy person's sense of security and her much needed belief in predictability, justice and the rule of natural law. Patients on their part do not believe that it is possible to effectively communicate to outsiders what they have been through or are going through. The torture chambers known as hospital warrants are another galaxy. This is how Auschwitz was described by the author K. Kacetnik in his testimony in the Eichmann trial in Jerusalem in 1961. He said that Auschwitz was another galaxy, another planet. But more often, continued attempts to repress fearful memories result in psychosomatic illnesses, conversion symptoms. The patient wishes to forget the pain, to avoid re-experiencing the often life-threatening episodes and eruptions, and to shield his human environment from the horrors. In conjunction with the patient's pervasive distrust, this is frequently interpreted as recalcitrance or hostility. And this is where our lack of empathy comes in. We can't really empathize with other people who are sick, bodily sick or mentally sick. Because these are abnormal states, these are aberrations. We have never been there, even if we have been there. Pain is an idiosyncratic. It's ours, and only ours, to experience and to own. And this perhaps is the biggest lesson we all can have when we are dealing with the outcomes of pain, such as narcissists and psychopaths. These are victims. These are post-traumatic states. The psychopath has genetic component. Brain dysfunctions, but still. We should not, of course, let ourselves become victims, but we should absolutely not demonize disease in all its forms.