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Here is a very interesting article written for doctors by a nurse.



Changing the Course of Depression by Changing the Environment
By Mary Jo Fay

Selected Quotes

- 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.

- 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?

This article was written for doctors.It was published in Medical News Today


Changing the 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" partner.

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 bullet."

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 comes home.

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 family finances.

Why Do They Take It?

(Please also read this explanation, 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 Partners

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 attracting attention.

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 partner?
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 they are.)
10. Do you have to ask your partner's permission to do anything?
11. Do you have limited or no access to your financial accounts?
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 your equal?

Red Flag Narcissistic Behaviors

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 "idiots"?
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 notice?
10 Does he ever exaggerate the truth or outright lie?
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 violent?
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 go away.

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 self-importance,
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 attention
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 Dangerous?

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


See also more signs of emotional abuse

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From her video

Red flags

Things an emotionally healthy person would see.. like someone says "That was stupid."