It looks like your wife's diagnosis of Harry Krause is right on the mark.




"Jack Smith" JohnSmithers@hotmailcom wrote in message
...
JimH,
I have nothing to hide, my wife the Dr. Dr. and I have discussed Harry's
sickness. She has diagnosed him as a person suffering from Narcissistic
Personality Disorder. The symptons of NPD is: A pervasive pattern of
grandiosity (in fantasy or behavior), need for admiration, and lack of
empathy, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
(1) has a grandiose sense of self-importance (e.g., exaggerates
achievements and talents, expects to be recognized as superior without
commensurate achievements)
(2) is preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can only be
understood by, or should associate with, other special or high-status
people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of
especially favorable treatment or automatic compliance with his or her
expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to
achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the
feelings and needs of others

(8) is often envious of others or believes that others are envious of him
or her

(9) shows arrogant, haughty behaviors or attitudes

Medical Treatment

Hospitalization
The hospitalization of patients with severe Narcissistic Personality
occurs frequently. For some, such as those who are quite impulsive or
self-destructive, or who have poor reality-testing, this is the result of
Axis I symptoms which are overlaid upon the personality disorder.
Hospitalizations should be brief, and the treatment specific to the
particular symptom involved.

Another group of patients for whom hospitalization is indicated, provided
long-term residential treatment is available, are those who have poor
motivation for outpatient treatment, fragile object relationships, chronic
destructive acting out, and chaotic life-styles. An inpatient program can
offer an intensive milieu which includes individual psychotherapy, family
involvement, and a specialized residential environment. The structure is
physically and emotionally secure enough to sustain the patient with
severe ego weakness throughout the course of expressive, conflict-solving
psychotherapy.

Small staff-patient groups within the wards, as well as large community
meetings, at which feelings are shared and patients' comments taken
seriously by staff, and constructive work assignments, recreational
activities, and opportunities to sublimate painfully conflictual impulses
make the hospital a "holding" environment rather than merely a containing
one. The ultimate goals are of effecting a better integrated internal
world, more cohesive and modulated self-object representation, and a
self-concept less vulnerable to narcissistic injury.



------------------------------------------------------------------------------

Psychosocial Treatment

Basic Principles
Narcissistic patients try to sustain an image of perfection and personal
invincibility for themselves and attempt to project that impression to
others as well. Physical illness may shatter this illusion, and a patient
may lose the feeling of safety inherent in a cohesive sense of self. This
loss precipitates a panicky sensation that "my world is falling to
pieces," and the patient feels a sense of personal fragmentation.

The histrionic patient's idealization of the physician stands in contrast
to the narcissistic patient's frequent contemptuous disregard for the
physician, who is denigrated in a defensive effort to maintain a sense of
superiority and mastery over illness. Only the most senior physician in a
prestigious institution is deemed worthy of respect as the frightened
patient seeks an external reflection of his or her own fragile grandeur in
the doctor. More junior members of the health care team may be the targets
of derision as the patient seeks to establish hierarchical dominance in
order to counter the shame and fear triggered by illness.

Health care professionals must convey a feeling of respect and
acknowledge the patient's sense of self-importance so that the patient can
reestablish a coherent sense of self, but they must at the same time avoid
reinforcing either pathologic grandiosity (which may contribute to denial
of illness) or weakness (which frightens the patient). An initial approach
of support followed by step-by-step confrontation of the patient's
vulnerabilities may enable the patient to deal with the implications of
illness with feelings of greater subjective strength. The increased
self-confidence may reduce the patient's need to attack the health care
team in a misguided effort at psychologic self-preservation and eases the
pressure to provide perfect care, since the patient's antagonistic feeling
of entitlement (defined by DSM-III as an "expectation of special favors
without assuming reciprocal responsibilities") is reduced.

Many of the treatment principles and approaches discussed for this
disorder apply as well to Borderline Personality Disorder.

The individual with narcissistic and related personality disorders is
likely to present with Axis I symptoms and disorders at various times in
his or her life. These should be treated as described elsewhere. Caution
should be observed, however, not to overdiagnose psychotic decompensation
as Schizophrenia unless all DSM-III criteria are apparent. The same caveat
applies to the pharmacologic treatment of depressive symptoms in the
absence of clinical signs of Major Affective Disorder. When treating
presenting symptoms and Axis I disorders in patients with Narcissistic
Personality Disorder and other similar conditions, attention should be
paid to the consequences of removing symptoms in a patient whose
underlying character is primitive and or fragile.

Some clinicians, suggest that the grandiosity and tendency to idealize
and devalue should be interpreted as defensive maneuvers when aspects of
early conflictual relationships are played out in adult life. Other
clinicians, posit that the emergence of the patient's grandiosity and
tendency to idealize the therapist should initially be viewed
supportively. To help the individual develop stronger self-esteem
regulation, the therapist then gradually points out the realistic
limitations of patient and therapist alike while also offering an empathic
ambience to cushion patients in their efforts to accept and integrate
these experiences. Unfortunately, much research will be required to
validate the description and course of narcissistic personality disorder
before further research can answer which techniques bring about a better
response to treatment.


Individual Psychotherapy
Most psychiatrists will, as a practical matter, treat most of their
severely narcissistic patients for symptoms related to crises and
relatively external Axis I diagnoses, rather than in an effort to address
the personality disorder itself. The therapist must be aware of the
importance of narcissism to the contiguity of the patient's psyche,
refrain from confronting the need for self-aggrandizement, and help the
patient use his or her narcissistic characteristics to reconstitute an
intact self-image. Positive transference and therapeutic alliance should
not be relied upon, since the patient may not be able to acknowledge the
real humanness of the therapist but may have to see him/her as either
superhuman or devalued.

Those patients who do not terminate treatment after symptom relief has
been obtained may wish help for some of the problems related to their
personality disorder, such as interpersonal difficulties or depression.
The therapist must have a good understanding of the principles of the
narcissistic personality style, both for interpretation to the patient and
for use in combating countertransference. Goals for ordinary psychotherapy
should not be too great, since the source of these patients' difficulties
lies deep in pathological development.


Group Therapy
The goals are to help the patient develop a healthy individuality (rather
than a resilient narcissism) so that he or she can acknowledge others as
separate persons, and to decrease the need for self-defeating coping
mechanisms. The first step toward developing a working alliance is empathy
with the surprise and hurt that the patient experiences as a result of
confrontations within the group. The external structuring group therapy
provides can control destructive behavior in spite of ego weakness. In
groups, the therapist is less authoritative (and less threatening to the
patient's grandiosity); intensity of emotional experience is lessened; and
regression is more controlled, creating a better setting for confrontation
and clarification.

Outpatient analytic-expressive group therapy requires a concomitant
individual relationship for most patients, which should be somewhat
supportive. The need for this additional support, the likelihood of the
patient's leaving the group at the first sign of psychic insult, and
proneness to disorganized thinking are all found more often in the
Borderline patient. The patient with a Narcissistic Personality Disorder
does not appear so vulnerable to separation anxieties as the Borderline
patient, but is instead involved in issues centered around maintaining a
sense of self-worth




"*JimH*" wrote in message
...
As I am sure you know you have to be careful with Harry Krause. He is an
admitted internet stalker. He stalked both me and my wife, posted our
address and names here, went to the trouble of obtaining a picture of our
house and then made threats to us.

He is a sick man. The less information he knows about you the better off
you are.


"Jack Smith" JohnSmithers@hotmailcom wrote in message
...
Harry,
What would you like to know?


"HarryKrause" wrote in message
...
wrote:
Jack Smith wrote:
Harry,
Show us your imaginary boat. ; )

Show us your stupidity, Smithers. Oops, you've already done that!



For someone who keeps asking others to "show this," "prove that," et
cetera, our dumbboy Smithers sure is secretive about himself, and
that's because he's a doppleganger of another poster here.