A butterfly in the house

Kind of like that one.
Kind of like that one.

In the morning, when I was first getting up, a butterfly flew through the hall. Was this a good omen?

I can’t say. I’ve had a cold for the last three days, and on top of that some stomach problems that don’t seem to be any kind of waterborne illness, but just one of those things. (The doc prescribed some tablets. They’re helping.)

These things are difficult for me. They’re probably difficult for a lot of us who were badly mistreated as children. Sickness, first of all, doesn’t always bring out the best in abusive parents. Sickness in a child is something out of the parent’s control. It’s an inconvenience, and it’s also solid evidence that the world does not always operate according to the parent’s wishes.

So abusive parents often abuse their children for being sick. I say that not because I’ve read extensive studies on this or have come across hard evidence, but just because it’s something people seem to keep telling me. Being sick when your parent doesn’t parent is awful.

Even when this kind of parent isn’t actively abusive, she is often neglectful, leaving the child to deal with discomfort and fear and the physical issues involved with being unwell on his own. I’ve seen both ends of this, as well as a third factor that is also connected: abuse tends to make you sick. So body aches and nausea are reminders to me of horrifying maltreatment. Being sick can sometimes feel like one long flashback.

It felt that way this time. Sometimes, when the full detail of the memories surfaces for me, it feels impossible to grasp the inhumanity and the cruelty of how I was treated as a child. Knowing even that my father was a psychopath, that my mother was only sort of living in the real world, it’s just difficult.

And yet I do know.

Psychopathy has four dimensions: grandiosity and lack of empathy are two of them, and they work together. Because of the extreme degree of my father’s sense of his own importance, he believed that the normal rules of society didn’t apply to him. Yes, it’s wrong to torture and rape your own children. He knew that. But not for him. He was special and he had his reasons. He knew things about life (or so he thought) that ordinary people don’t know, and he was entitled to privileges they don’t have.

I’ve also come to see that his belief in his own importance was a part of the attraction the women in his life—his wife (my mother) and his girlfriends. There’s something about spending your life in the company of genius, and of course my father isn’t really a genius—not in the slightest, although he’s no slouch either. He’s a smart enough man. But he has yet to determine what really causes gravity or why light behaves as both energy and matter–or anything else useful, really. But if you can’t have a genius, you might be able to find someone who’s simply convinced he is. And that’s what my mother had done. All that importance provides a kind of reflected glow. My life was the collateral damage.

So I do know. But I also can’t grasp it. The extent of the wrongness is just so great.

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Empathy, Mentalization, and Complex Trauma

Affective (or emotional) empathy and cognitive empathy have been compared to nested Russian dolls, but I prefer to see them as distinct systems that work together to help us interact with and understand our worlds.

It amazes me sometimes what I don’t know, and what I know now that I didn’t know before.

Mados tells me that empathy has two components: an emotional component and a cognitive component. It turns out that she is absolutely right.

The emotional component allows us to literally feel what others are feeling and seems to have something to do with our mirror neuron system. It is what makes histrionic personalities so difficult to be around and can make meditating with others who are also meditating especially calming. Emotional empathy makes affective states contagious.

Cognitive empathy involves mentalization–being able to think about someone else’s thoughts and feelings–and perspective-taking. The Sally-Anne test is really a test of the very first stage of the development of cognitive empathy: recognizing that a different person with access to different information will have a different thought about a situation. Children without Autism Spectrum Disorders (ASD) have a good grasp of this idea by the time they are four years old.

Children with ASD don’t, because they seem to have delayed cognitive empathy skills, although they may have perfectly average emotional empathy. Difficulties with cognitive empathy have all kinds of other implications, including problems with developing social, language, and academic skills, because our ability to understand the minds of others impacts how well we are able to learn from them.

We notice the social aspects of ASD because social interactions are such a high priority for most of us–human beings are among the most social creatures on the planet. But I’m not convinced they are causal. Difficulties with social information processing may result from general difficulties processing sensory information that interfere with taking in and making sense of social cues.

ObstacleCourseTires1However, this post is not actually about ASD. It is about how our empathic skills work together to help us interact with and understand our worlds–or don’t.

Just as with ASD, some of the difficulties associated with complex trauma may have to do with skill gaps in cognitive empathy that also lead to a vast array of other difficulties, including difficulties in mentalization–thinking about our own minds and the minds of others.

I am involved in several online groups for family members of people with Borderline Personality Disorder (BPD), and many of the struggles new members have revolve around difficulties with mentalization–perhaps not generally, but in regards to the BPD. Most of their questions boil down to, “How is she thinking? Why is she acting this way? What motivates her?” And, “What can I be doing to help?”

Mentalization.

Understanding how someone else’s mind works, what they are thinking and feeling and why, help us to interact with others in successful ways. It is like knowing how to navigate an obstacle course. When we know how high to jump to get over the wall, how fast we can manage to run through the tires without tripping,  and how low to stoop for the tunnel, it is almost fun.

When we know how someone’s mind works, we can navigate them too. We can make ourselves understood, we can repair breaks in communication, we can provide comfort and support when others need it. When the minds of others are incomprehensible, we can’t. And it isn’t fun.

The Sponge People. Click the image to follow link.
The Sponge People. Click the image to follow link.

It is frightening.

It is frightening when we can literally feel the distress of others, but we can’t make sense of it and we don’t know what to do about it.

And it isn’t just a practical problem. We use mentalization to regulate our own affective states. When we “catch” someone else’s emotional distress, we consider their mental state to reframe the distress as nonthreatening. We use it to take action that relieves their distress (and ours). When the distress is incomprehensible, we have one less tool with which to manage it.

When have never learned to properly understand our own minds either, because those around us had disordered minds, then we are doubly disadvantaged. We become sponges, with nothing to dry us out again.

Distress Tolerance

Distress tolerance is a component of Dialectical Behavior Therapy. It’s just the idea that there is a value in simply being with a feeling–not thinking about the feeling, not analyzing the feeling, just naming it and then being there with it.

I did a lot of that today. I cleaned my house. I like to do this on the weekends. I suppose a lot of people do.

But it’s complicated for me. House-cleaning is intimately tied up in my mind with suicidal ideation–my own, and my mother’s. Doing the laundry makes me want to cut my wrists. Dusting is enough to get me thinking about buying a gun. Cleaning the toilet is a dance with death.

So it’s tough. And some weekends I spend the entire time just trying to cope with the fallout of that, and still end up with unfolded laundry on Sunday night. It’s tedious. And for someone who prefers order and tidiness, it’s frustrating.

So, today I thought, “I’ll just do it for ten minutes. If I can handle that, I’ll do it for another ten. If I can’t, I’ll stop. “I set a goal for myself I believed I couldn’t fail, knowing that success is always more motivating than failure.

And I could handle it. Again and again, I could. I did think about suicide. I did feel I couldn’t keep doing washing the dishes or folding laundry. But I made it to the end of ten minutes every single time. My house is swept, dusted, wiped down, clean. I have clean dishes to eat with and clean clothes to wear. And it’s only Saturday. Early Saturday evening. I haven’t done this well in months.

In fact, after about 30 minutes of setting the timer in 10 minute increments, something magical happened. For the first time in my life, I felt in control of my own mind, my own feelings, my own life. I thought, “This is terrible. This is absolutely horrible. But I can stand it. I can stand my feelings. I can stand the memories. I can stand the thoughts that go with them. I can stand it all for ten minutes, and I think I can stand it for hours. I am free. Absolutely free.”

My trauma didn’t disappear. That wasn’t the magic. I still remember dishes being thrown at my head. I still feel consumed by despair at my life having no meaning or value. I still have visions of my mother slicing her wrists in front of me. None of that has changed. The magic was only being able to stand it. Because what you can stand no longer controls you.

Life after Sobibor

As I read Dov Freiberg’s account of his survival in Sobibor and after, I am struck repeatedly by the similarities of our own internal experiences despite the differences in what we endured or how we escaped.  (For more on my background, see Towards a Unified Theory of Evil.)

Dov Freiberg.  Credit: Yad Vashem Photo Archive.
Dov Freiberg. Credit: Yad Vashem Photo Archive.

Just as Freiberg dreamed repeatedly of being again in the place of his captivity, of being caught and returned, or of attempting escape all over again, I dreamed for years of escaping from my parents’ house.  I dreamed of packing and leaving, of flight through new and strange areas, and of hiding.  Like Freiberg, it took time to be able accept that I could no longer be kept in captivity and that I was finally and unquestionably free of my torturers.   My dreams were as exhausting as they were terrifying, just as escape was.

And just as Freiberg was repeatedly haunted by a profound sense of aloneness as he negotiated a world without family, I am as well.

What surprises me most is how Freiberg ends his account:

“That same day, in January 1948, forty years ago, a new chapter opened in my life: a chapter nevertheless full of wars and conflicts, of battle fronts…a chapter in which I, Dov ben Moisheh and Rivkah Freiberg, the Last of the Freibergs, survived and can work and produce and raise a family in Israel and be like any other human being.”  (The Last of the Freibergs.)

Despite a heroic part in the revolt at Sobibor, and terrible years of suffering in which he displayed tremendous courage and a continued ability to remain human and decent, Freiberg’s goal was not to attain some form of recognition or power, but to have an average life.

And that has been my goal as well.  Such hard work?  Such tremendous suffering?  So that you can do what most other people do as a matter of course?  But, yes, that was the goal all along.  I didn’t work so hard to survive so that I could save the world.  I survived so that I could get up in the morning, eat breakfast, and have a cup of coffee in peace.

It has been with some surprise that I have discovered that the world I have escaped into is not a world full of good people, in contrast to the evil world I grew up in.  The real world is a mixed world.  It is one populated by many good people, some evil people, and countless others who work and raise kids and post hoaxes on Facebook without thinking too much about their lives or the world.

Sometimes this world disappoints me.  Was this really so worth fighting for?  Does it remain worth fighting for?  Is an ordinary life worth so much struggle?  But, yes, it is, because it is a world in which I have choices.  And remaining a principled, caring person does not come only as a tremendous act of will and at the price of terrible suffering.  It’s something I can do everyday, without having to risk life and sanity over.

Moreover, an ordinary life is sublime.

Further reading:

Freiberg, Dov.  (1988).  The Last of the Freibergs.  http://www.jewishgen.org/yizkor/Freiberg/Freiberg.html#TOC

Freiberg, Dov.  (2007)  To Survive Sobibor.  New York: Gefen.

Sobibor Testimony of Dov Freiberg.  (2004, May 31).  Axis History Forum.  http://forum.axishistory.com/viewtopic.php?t=51471

The Cat Carrier and Other Fear Structures

A photo of 2×2 ministers in Lakewood, California at a “special meeting” when I was 12. I have personally met and remember everyone in this photo. Source: VotisAlive.com

One of the consequences of having grown up in a religious cult is that I often find it very difficult to not think in the terms an authority figure suggests, even if I know that way of thinking to be incorrect or inappropriate for the situation.

What I’m getting at is I keep thinking of the trauma I’ve experienced in terms of what I “think” about it.  I identify a feeling–say, guilt–then I try to locate the thought that might have been given rise to the feeling.  For example, I recognize I feel guilty and then speculate that I must have felt guilty because I believe the abuse was my fault.  And I do this, unconsciously, even when I know better, because I’ve seen enough therapists who have suggested that that is how it works and what you should do to heal.

It isn’t.  I wasn’t, most likely, thinking anything when I was traumatized.  In some situations, I was too little to be thinking very much, and in all cases I was too frightened.  If I did think, the thoughts came later and are anciliary to other aspects of the trauma.  Thoughts aren’t really part of the core trauma or the core problem.  They aren’t causing my symptoms.

Photo credit: Brookhollow Lane

The core trauma, and what is causing my symptoms, involves overwhelming, intense sensory information, including unmanageable internal emotional states.

So, I do recognize guilt as part of the experience of my mother hitting me over the head with a chair, but I know I wasn’t thinking anything.  I didn’t think I made mommy hit me.  I didn’t think I’m a bad kid–although I do think that now.  I merely reacted to perceptual information: Mommy is mad at me.  And I reacted by feeling guilty.  No intervening cognition or meaning making.  Just an animal emotional reaction.

In other words, the link between perception and emotion is shorter than we assume it is during stressful times.  We assume it works the way it usually works: perception-cognition-emotion.  But trauma can shorten the link to perception-emotion.  Cognition is usually left out.

If we try to insert cognition into the experience, we distort it and actually move further away from understanding what happened and how we perceived it at the time that the trauma occurred.

The cognitions we have about traumatic events all come later, after the trauma has ended and it is safe enough to relax a little and turn our brains back on.  Our cognitions about traumatic events do affect us, but less immediately than the shorter link of perception-emotion.

The cats. Not at all scared.

Although trauma largely affects the limbic system, which is extremely primitive, and evolutionarily descended from before our break from reptiles, I suspect there are also mammalian brain structures at work as well (as distinct from human structures, which are the most evolutionarily advanced and the most recent).

I’ll give an example.  I took both of my cats to the vet in August for an annual exam.  Violet, who is 16 and has had kidney failure for the last two years, underwent a number of blood tests, an x-ray of her abdomen, and a urine sample (and since cats won’t pee into a cup, you can imagine that as another invasive and frightening procedure.)

The carrier I took them to the vet in is one of those black, mesh-lined duffel bags for animals.  It zips.  The next day, when I took my backpack, which also zips and is dark-colored, into the bedroom to pack something or other in it before going out, Violet quietly slunk under the bed and hid.

I doubt very much she thought anything in particular about my backpack.  Cats do have a frontal lobe, but not a pre-frontal cortex.  I am not sure how much a cat’s frontal lobe can think in a conscious way, but probably not very much.

Her link between perception and action was most likely very short: perception-emotion-action.  She saw the bag and heard the rattling zipper, felt uneasy, and slunk under the bed.  No cognition.

Ventral view of the cat brain. Source: David Frankhauser. Removal and Study of the Cat Brain.

I imagine my traumatic experiences have been a lot like that: perception-emotion-action.  There aren’t many cognitions directly linked to the experience.  The thoughts I have now are telegraphic memories of what I saw or heard–and often of what someone else said.  They are not real thoughts.

It makes me wonder if we are missing something about how trauma is processed, especially in how trauma affects very young children–and the most damaging traumatic experiences usually do occur very early for children who grow up in abusive homes.

Although the mind does need to construct meaning from events, especially very emotionally charged events, our beliefs form only a small portion of how the event is processed and is not what gives rise to the symptoms of traumatic stress.

The symptoms are cause by the creation of fear structures during the traumatic event (very strong neural pathways formed between perception and fear) as well as by the chaotic and disorganized nature of the memory within the amygdala.

A fear structure. Source: Neuner, F. et al.

Our conscious minds know the trauma occurred, but we are unable to fully access it, usually because remembering prompts such an intense emotional state that construction of a narrative memory is repeatedly interrupted by the reactivation of the limbic system.

In other words, we do sometimes construct maladaptive beliefs around traumatic symptoms and these beliefs can negatively affect our lives, but they aren’t what lead to panic attacks, nightmares, sleeplessness, hypervigilance, or IBS.  On a triage scale, beliefs rank rather lower down.  It is the memory itself that is causing us the greatest distress and needs the most immediate attention.

So as we work with the memory of traumatic events to integrate them into our conscious minds, it may help to recognize that our emotional reactions are usually direct responses to perception and cognitions may not be present at all.  There is no need to go looking for things that aren’t there.  Perception and sensation, both bodily and emotional, are what are most important.

References:

Brookhollow Lane.  (2011, January 18).  Kitchen Chair Covers.  Retrieved from: http://brookhollowlane.blogspot.com/2011/01/kichen-chair-covers.html

Frankhauser, D.  (2011).  Removal and Study of the Cat Brain. Retreived from: http://biology.clc.uc.edu/fankhauser/Labs/Anatomy_&_Physiology/A&P202/Brain_Dissection/CAT_BRAIN.htm

Marcus, G.  (2008).  Kluge: The Haphazard Construction of the Human Mind.  Boston: Houghton Mifflin.

Neuner, F. et al. (2008, July). Narrative Exposure Therapy for the Treatment of Traumatized Children and Adolescents (KidNET),  Neurocognitive Theory to Field Intervention. Child and Adolescent Psychiatrict Clinics of North America.

Via.  http://www.votisalive.com

The Thought of Death in the Morning Goes Well with Tea

Black tea. Source: http://www.elite-tea.com/page/2/

I wake up most mornings thinking I should kill myself.  I get up, put tea on, use the loo, feed the cat, and then start thinking I should die.

This has been going on for years.  It doesn’t happen every day.  Just most days.

I’m not suicidal.

It took me a long time to realize that, and these kinds of thoughts used to scare the pants off me.  Especially in the days when I really was depressed, because suicidality and depression go together and I really didn’t want to wake up dead one morning.  Well, so to speak.

In reality, not all suicide is about despair.  Some suicidal gestures are about rage or impulsivity or both.  I ought to know.  I’ve seen a lot of them.  Suicidal gestures, I mean.

So, the rest of the story from the juice/chair incident I wrote about in Scent of a Lion: Trauma and the Brain is that I woke up in a pool of blood on the floor in the kitchen and went looking rather dazedly for my mother.  I found her in the bathtub with her wrists slit.  The water was pink and tasted salty.  I am not entirely sure this really happened, but I am mostly sure.  Sure enough.  The fact that I tasted the water is oddly convincing for me.  Perhaps mainly because it’s such a strange thing to do, and so exactly what I would do, and so intensely, vividly there.

I am sharing this with you, my reader, not to shock or horrify you.  I don’t want pity for what a rough start I had in life.  I am telling you because I am not so very different from other people, and if I found my mother semi-conscious after the climax of a raging fit, you might have also.  Or someone you know might have.  Maybe not a mother, but maybe a father, or a sibling, or a friend.  And you–or the person you know–might be very confused about that.

Our bathtub did not look anything this elegant. Source: http://www.orrplumbing.com/bathtub-plumbing-repair/how-to-plumb-a-new-bath-tub-bath-tub-plumbing-repair/

Losing a loved one to suicide is always deeply distressing.  It’s a loss, as much as any loss is, but it also has that added element of being almost completely incomprehensible.  Why would you choose to die?  Was life really so awful?  Was there something I should have done?  Why didn’t I see it?  It’s doubly puzzling when even what we are told about suicide doesn’t quite fit.  We can try to make it fit, but it doesn’t.

People who engage in enraged acts of self-harm are always in a great deal of pain, or at least communicate that they are.  That part fits.

But angry suicides blame other people for the distress they are in.  Their gestures are often public, as if to say, “Look what you’re doing to me!”  Sometimes, they literally say it.  I know my mother said it to me.

Mainly, what doesn’t fit is that raging suicides are raging.  They are really and truly angry, even if they may also be saying how much pain they are feeling–which does make a certain degree of sense.  After all, we sometimes do lash out when we are hurting.  Just maybe not so much.

Essentially, the raging suicidal gesture is a way to hurt other people by hurting someone important to the people you are trying to hurt–namely, yourself.  And that’s very different from simply giving up on life, or even trying to communicate in the only way you know how that you are hurting.  And, the thing is, it works.

It does hurt.  I know it hurt me.

The reason I wake up in the morning thinking I should die is that I once woke up in the morning and my mother told me she wished I were dead.  And then she nearly killed me, and after that she nearly killed herself.

I still can’t make sense of it, and it still hurts.

Uh-oh, a Dirty Diaper, and the Hell Inside

Photo: A Forest Frolic/Creative Commons

“Uh-oh.”

First words.  At least according my mother, whose memories of my life are about as reliable as dreaming.  (So there’s a good chance this is not at all true.)

But I still wonder.  “Uh-oh,” because I needed a diaper change.  “Uh-oh,” like I wasn’t supposed to soil my diaper at 6 months or 8 months or however old I was when I said it.  Did I feel ashamed then?  I must have.  I felt ashamed all the time.  So much so that shame felt like a part of who I was.  But did it really start that early? Am I reading too much into this?  Do infants feel shame?

Even if you weren’t abused the way I was, shame is often a part of our childhoods, part of adulthood, part of life.  Many of us feel ashamed because we were instructed to do so: “You ought to be ashamed of yourself!”  But why?  Isn’t it enough if we are just really very sorry?  Do we also need to be ashamed?

What is shame, anyway?  It’s an emotion, Wikipedia says, and it’s also a set of thoughts.  If that’s any indication.  Probably, not much.

I want to get at the feeling aspect of shame in this bit of writing, because the feeling is so much harder to deal with.  Thoughts you can just replace with different thoughts if you don’t like them.  Feelings, I find, I am stuck with even if I hate having them.  If you can’t make friends with a feeling, it is happy to stay on as an enemy.

And shame really is terribly unpleasant.  The worst.  Worse than deep sorrow.  Definitely worse than anger.   Worse than guilt.  Sorrow we can release and feel better from: crying does wonders for sorrow.  Anger has the benefit of jolting us with energy and purpose.  Guilt can be expiated with apologies and making amends.

Shame sucks.

I read a book by John Bradshaw a few years back.  He says shame is a sense that we don’t have any worth.  It’s the sense that we are a mistake.  Not necessarily that we’ve made a mistake, but that we are the mistake itself.  That sounds a lot like the thought part of shame.  I’m not so interested.

I want the feeling.

What I think about my own situation is that I felt shame when someone else felt contempt for me.  Gershen Kaufman describes shame as contempt directed at the self.  I think of it more as the mirror image of it, a response to contempt, which partly involves the contempt, but also involves some other things.  It’s what you feel when someone else finds you to be disgusting, less than them, less than human.

Contempt
Contempt. Photo Credit: Paul Ekman

What shame feels like to me is that I am being cast out, which I suppose is a thought rather than a feeling.  But the feelings are harder to name.  I’ll try: a deep sorrow and disappointment, profound loneliness, and a fear of being cast out even further.  All that, mixed with the contempt leaked into me from someone else.  So, a confusing blend of anger and disgust as well.

As social creatures, we tend to reflect the feelings of those around us to a certain extent, especially those of powerful or important others, like our parents or siblings or the most popular kid in the class.  If we are children, and our psychological boundaries are still porous, this is all the more true.

So there is a little anger in there, a little disgust—the two closest relatives of contempt—but then also that other part: the sadness and the loneliness and the isolation.

Disgust. Photo credit: Paul Ekman.

It seems to me shame is used most often to keep people in line.  Being cast out of the group of people we call our own is often the worst kind of punishment possible.  Contempt casts us out into a desert of the soul.

Often the things we are most ashamed of do come from when we were young, when other people were most directly trying to control us, so maybe that’s no accident.  Our parents want us to do certain things, our teachers want us to do other things, the most popular kid in the class wants us to do something else.  They all have a reason to try to shame us into behaving the way they would like.  And sometimes they do.

So I suspect many of the situations that trigger shame are related to those from when we were very young,  When shame rises up in us and overtakes us, some of that shame is from the present and some of it is merely a memory of what has already happened.

But all in all it is a long-standing association of thoughts and feelings.  For example, a link between a certain quality of ours or a certain action, and contempt or disapproval that is activated when we display it, even to ourselves, we can become overwhelmed with that sense of being exiled from those we most want acceptance from.

If you read my last blog entry on trauma, and are familiar with the whole juice/chair episode, then you’ll understand that what I feel most urgently when that trauma is activated is shame.  I feel terrified as well, but a good measure of what I feel is shame.  The intensity of my lizard brain’s need to remember every detail of the episode makes shame a part of what needs to be remembered, because the emotions are as much a part of the experience as the events.

Near Ayparahui, Bolivia, South America, 1998. Photograph by Maria Stenzel. Copyright: National Geographic Society

It’s part of what I find tedious, and repetitive, and wish I could get out of my head and can’t.  I suppose it counts as what many people consider to be toxic shame.  But I wonder if the only difference is one of degree.  “Healthy” shame is manageable.  Toxic shame is not.

And maybe toxic shame is stimulated by actual contempt, while “healthy” shame is stimulated by its milder friend, disapproval.  But I still believe they are an instinctive, emotional response to real or imagined exile.

For a toddler, exile is dangerous, life-threatening.  A toddler exiled from humanity will die.  So, even if my mother hadn’t hit me over the head with a chair and left me in a pool of blood, the intensity of her contempt for me was in itself a life-or-death situation.

I suppose that’s why it’s so important for me to remember it.  The contempt was a large part of the danger.  The exile was what might kill me, even if my mother didn’t.

Further Reading:

Bradshaw, J. (1988).  Bradshaw On: Healing the Shame that Binds You.  Health Communications, Inc.: Deerfield Beach, FL.

Ekman, P.  Dr. Paul Ekman: Cutting Edge Behavioral Science for Real World Applications (Personal website).  Retrieved from: http://www.paulekman.com/

Kreger, R.  (2012, January 5).  Shame is at the Root of Narcissistic, Borderline Personality Disorders.  Retrieved from:  http://www.psychologytoday.com/blog/stop-walking-eggshells/201201/shame-is-the-root-narcissistic-borderline-personality-disorders

Science Daily.  (2009, August 16).  Facial Expressions Show Language Barriers, Too.  Retrieved from:  http://www.sciencedaily.com/releases/2009/08/090813142131.htm