Course of Depression by Changing the Environment
How many women in your practice are
leaving your office with prescriptions for
antidepressants? Yet do you know what questions
to ask that can help you determine if their
depression is the result of an emotionally
abusive environment that has them feeling
anxious, stressed, overwhelmed, lost, alone, and
as though they're going crazy?
You bet. And most of you would
be too if you lived in this constant state of
emotional war zone still almost unrecognizable by
our culture even today.
It has taken us decades to jump in with both feet
to really dissect the intricacies of physical and
sexual abuse, but emotional abuse is still barely
perceptible on the horizon. And being
understood...unless you've lived in it, you
cannot begin to understand the "crazy
making" that goes on behind closed
doors...many in homes that look like the perfect
Camelot from the outside.
What Is An Emotionally Abusive Environment?
It is any scenario where one person in a
relationship (parent, boss, romantic partner, or
even just best friends), feels more entitled,
deserving, and/or more powerful than the other
person...and then spends vast amounts of time
proving that theory to their "lesser"
For example, in one
husband/wife relationship I consulted on, the
husband demands from his wife every day,
"Tell me what you're worth, honey... and
don't get it wrong or there will be hell to
pay." And his wife must respond each day,
"I'm worth 29 cents, honey...The price of a
This emotional brainwashing day after day is a
constant message to this woman that she is
absolutely worthless. That her thoughts, actions,
needs, and wants matter not. That her job in life
is to essentially do whatever he
"allows" her to do.
One woman I know has a husband who checks her
odometer every day to determine if she indeed
went exactly where she told him she went.
Yet another must answer her husband's calls by
the third ring or she will be punished when she
Still another controlling man goes through his
wife's purse, closet, and any personal areas she
has, to show her that she had better not hide
anything from him.
Many like to play mind games such as controlling
who their spouse may see or even speak to on the
phone. Often even relatives are not
"allowed" to call the house as the
husband may see this as an invasion of his
privacy and a loss of control of his spouse to
"outsiders." Some of these
"subservient" women are not even
allowed access or information regarding the
Why Do They Take It?
(Please also read this
from an abused female teenager, of why women stay
in abusive relationships as adults.)
All these narcissistic
individuals are so great at hypnotizing their
"loved ones" into believing that they
must indeed accept this treatment that the
victims truly become confused, exhausted, and
lost as to who they are any more. Many almost
lose their own identity in these environments
that do not promote each individual's needs or
wants but focus all attention on the needs and
wants of the narcissist.
By the time the "victim" comes to you,
she may indeed seem like the crazy one. Many
exhibit signs of Post Traumatic Stress Syndrome
as well, when to all outward appearances there
has been no trauma. Of course, physical symptoms
related to stress may also be prevalent.
Not Just Spouses or Intimate
While most easily identifiable in intimate
relationships, the same damage can be inflicted
in any relationship. A mother of grown children
can make their lives miserable with her
controlling, manipulative behavior and condemning
and accusing commentary. A boss who takes credit
for his or her employee's work and then is the
tyrannical leader at the helm, can lead employees
to becoming empty-eyed, "deer in the
headlights." A teenaged girl with a critical
teacher can have trouble sleeping and can fall
prey to the same depressive feelings that the
wife of the physical abuser succumbs to. All are
relationships where pathologically narcissistic
people, with their "stealth" behavior,
can cause vast damage without ever even
While narcissistic people can be of either
gender, odds are you will see mostly women
victims who are willing to discuss these issues,
once you identify them. However, keep in mind
that men may be equally affected by this type of
subtle and emotional brainwashing. Yet men may
not be as willing to talk about their feelings,
so you may have to dig a little deeper. \
What Can You Do?
Become more aware of what emotional abuse looks
like and then consider options for emotional
support for your clients, in addition to
supporting them through their depressive episodes
until such time as they can find an emotionally
healthy, safe environment.
First of all, go rent the old
movie Gaslight. Made in 1944, nearly 40
years before Narcissistic Personality Disorder
was an official diagnosis, one can clearly see
the "crazy-making" behavior that is so
cunningly applied by the narcissist to his
victim. While the motive of the villain is
criminal in this film, the behaviors are classic
narcissist none-the-less. I have actually had
clients of mine watch this film for 20 minutes
and call me to tell me that they had to throw up
as the recognition of the destructive
brainwashing was so clear to them, that seeing it
in the 3rd person suddenly turned on a light of
recognition in their own lives.
Secondly, I give you a list of but a few
questions that you can ask your client to help
reveal if they are living in a toxic, emotionally
abusive environment, (which may have already led
to physical and/or sexual abuse as well.) If you
client answers yes to a majority of these
questions, then they are probably dealing with a
destructive, narcissistic relationship.
The Detective Work
Here are a sampling of the questions which may
open the conversation:
1. Do you struggle with
feelings of guilt or blame that any problems
in your relationship are your fault?
2. Are you frequently fearful of what your
partner's mood might be like when he (or she)
comes home at the end of the day?
3. Do you feel constantly exhausted?
4. Are you having trouble sleeping?
5. Do you ever wonder if your partner is
telling you the complete truth?
6. Do you feel as though your partner is more
important than you are?
7. Do you ever feel as though you are
"walking on eggshells" around your
8. Does your partner ever seem as though his
(or her) personality can change in no time?
For example, he came in the door after work
seemingly happy, and in minutes is sullen,
angry, quiet, or depressed?
9. Do you ever feel as though you are given
the "silent treatment" by your
partner? (They will know what you mean if
10. Do you have to ask your partner's
permission to do anything?
11. Do you have limited or no access to your
12. Do you ever have suicidal thoughts?
13. Do you feel as though you are rarely
getting your needs met in this relationship,
or that your needs always come last?
14. Do you feel as though your partner treats
you as though he or she is your parent, not
Red Flag Narcissistic
In addition, you might ask them
if any of these situations fit their partner's
behavior. If so, they are indeed "red
flags" to unhealthy behaviors.
1. Does your partner have a
big ego and feel that others are less
important than he?
2 Does your partner like to control others
and the environment?
3 Does your partner feel that rules don't
apply to him?
4 Does he or she take advantage of others to
achieve his needs?
5 Does he or she show little respect for
others, and may in fact refer to others as
6 Does he or she often criticize others?
7 Is he or she quick to take offense at
comments others offer towards them, if those
comments are not complimentary?
8 Does he have a quick temper?
9 Can his personality change at a moment's
10 Does he ever exaggerate the truth or
11 Does he deny he has any issues to work on
but believes that if everyone will do as he
tells them to do, then all will be fine?
12 Does he seem totally oblivious to
understanding empathy and compassion for
others but demands everyone jump if he is
slighted or has his feelings hurt?
13 Does he blame others for all his problems?
14 Did he start out the relationship being
very charismatic, charming, romantic, and
almost "perfect" but those
behaviors changed quickly as he became
hardened, abusive, critical, and perhaps
15 Did he suggest love and marriage while
only in the relationship for a short time?
These are just a few of the questions that can
help determine if your client is living in this
dangerous, emotional roller coaster situation.
While an antidepressant may help to minimize her
outward symptoms of depression, as long as the
emotional war zone she lives in continues to hold
fast, the cause of her depression will not likely
While most therapists recognize Narcissistic
Personality Disorder, narcissism itself is on a
scale. Healthy narcissism is what most of us
have. We set goals, strive to reach them, believe
that we are capable of attaining them, and
occasionally, when we stumble and do not reach
the goal, we still pick ourselves up and go on.
We have enough confidence in ourselves as being
valuable people that we do not let occasional
mistakes ruin our lives. At the same time, we
have empathy and compassion for others.
According to the DSM - IV, Narcissistic
Personality Disorder consists of 9 behaviors,
which, if a client demonstrates 5 or more of
these traits, is considered to have the disorder.
These 9 characteristics are:
1.) Grandiose sense of
2.) Obsessed with fantasies of unlimited
power, success or brilliance,
3.) Is unique, can only be understood by
other "worthy" people,
4.) Requires excessive admiration and
5.) Extreme sense of entitlement,
6.) Interpersonally exploitive,
7.) Lacks empathy and compassion,
8.) Envious of others,
9.) Arrogant, haughty behavior
Are Only Those With NPD
My contention is this ? just as there is a wide
range between healthy narcissism and pathological
Narcissistic Personality Disorder, those
perpetrators who only display narcissistic traits
can prove to be just as detrimental to their
partners as those with NPD. Depending upon the
codependent's emotional and psychological
"baggage," a partner who only exhibits
narcissistic "traits" can still inflict
emotional abuse that can, over time, become the
emotional brainwashing that leads to depression
and other pathology.
If we look back to the
"cult" environments of the 70's and
80's, we can see just what a powerful force
emotional abuse can be ? even to the point of
self-destruction, as in the case with Reverend
Jim Jones and the vast suicide of his followers.
Then of course, as the murder of Laci Peterson by
her husband Scott became front page news, we are
left to wonder just what life was like behind
closed doors at the Peterson household. With
Amber Frey's testimony about her "Perfect
Partner" Scott Peterson turning into the
perfect monster before her eyes, one can only
assume that the sly, manipulative, lying, and
controlling predator Peterson, played many more
subtle games before he went on to reach the level
of murder of his wife and unborn child.
While not all environments are
fatal as with Jim Jones or Scott Peterson, let's
hope that we can become aware of a variety of
levels of emotionally toxic environments that our
clients might be living in and stem the tied
before we lose even one to the destructive side
of depression caused by an environment that can
be changeable, if intervention can be introduced
by a sensitive caregiver.
So, before you simply write the next prescription
for an antidepressant for the next woman in your
practice who requests one, ask her some of these
important questions. And if she answers yes to
more than a few, perhaps it's time to find her an
emotional support system in the way of social
services or psychological intervention, at least
at the same time that you write the script for
the Wellbuterine or Prozac.
By Mary Jo Fay, RN, MSN