Narcissism

There’s been a lot of debate about Narcissistic Personality Disorder (NPD).

Does NPD really exist? Or, is it an Emperor With No Clothes?

The Narcissist in Your Life: Many of us recognize people who fit this disorder like a glove. They’re divorced from a person who needs endless admiration, is completely self serving and treats others as objects. Do you know someone like this? If so, chances are that you’ve been hurt by a person who needs to win at any cost; and yet is so socially capable, that she’s convinced everyone (except you) that she’s truly a great person.

After covering narcissism from a variety of angles, I often hear from people who finally “get” what they’ve been going through. They say they now have a way to understand the viciousness of their ex, or their parent. Plus, some have found ways to distance themselves and feel more in control. It brings a measure of solace.

Here is a sample comment:

• My husband abandoned me with a text message after 16 years and committed fraud and bigamy. At first, I was obsessed with finding a label: narcissist, sociopath, addict, depressive, or just plain jerk. Regardless of what is was, it was a time of feeling like being in an alternate universe woven out of his stories. My best advice for someone in a similar situation is to make sure that you gain perspective from time to time to remind yourself of your sanity in an insane situation.

There’s much to be concerned about.

• People who are narcissistic are impossibly vain. This is the least problematic issue in dealing with someone with narcissistic traits. It’s always all about them. They need attention, reassurance, and constant validation. And, if it’s not from you, it will have to come from someone else; hence the need for success in business or in extramarital affairs. It may not be about sex, but rather about being wanted.

• People in narcissistic rage can hurt or kill. Do you know someone who is radically unforgiving when they feel judged or betrayed? Normal people get angry. A narcissistic person will often want revenge, and won’t let go.

• People with narcissistic entitlement can psychologically injure those close to them. Do you count; I mean really count? Narcissistic people do fall in love, but they usually fall in love with being in love – and not with you. They crave the excitement of love, but are quickly disappointed when it becomes a relationship - and not just a trip into fantasy. You are left wondering what just happened. And if the narcissist is your Mother or Father, you stop being an adored child when parenting starts getting hard.

• People with narcissistic self righteousness can spend years in divorce court, costing every one pain and suffering...and for what? He may have left you. Or, you may be thankful for getting away from her. But, narcissistically inclined people can torture you for years in court or with your children. Their need to be right, and look great in public, combined with an entitled ruthlessness, can follow you for years to come. Watch out for your combined assets. And, be mindful of your kids. This is not an easy road.

The NPD diagnosis may not be strong, but the experiences I just laid out are well known.

So, let’s talk about Narcissism Undressed.

Narcissistic Personality Disorder is a Diagnosis of Convention: It doesn’t have the validity of a broken bone or of, say, diabetes. There is no brain scan that identifies NPD. There is no genetic test that nails the diagnosis. There is no identifiable brain or developmental trauma that instigates every case of NPD. In fact, there’s little hard evidence, other than the fact that psychiatrists, for years, have seen this pattern of behavior play out again and again.

Narcissistic Personality Disorder, if undressed, has little to hang on.

Yet, we all know a person (or many people) who fit NPD perfectly.

What’s up?

The Diagnostic and Statistical Manual (DSM IV & V) was invented by the American Psychiatric Association (APA) in order to provide standardization to mental health classifications. In a nutshell, the APA decided, years ago, that therapists need a common language when talking about their patients.

We need a common language so that we can talk intelligently about patients. Instead of writing a book on each client, we have a short hand called a diagnosis.

Researchers need classifications in order to proceed with their studies. How does treatment work? Which treatments are the best? Is there a biological basis to a disorder? Once, again, a commonly accepted language serves a purpose.

Finally, insurance companies need diagnostic codes in order to provide payment. This makes a DSM IV or V diagnosis that much more entrenched. No one wants to rock the insurance boat.

The DSM Program is Weak Science: So, without a solid biological or even verifiable developmental basis to the NPD diagnosis, why is it so in vogue? There are good reasons, like common language which helps make sense of chaos. And, there are terrible reasons, like lazily labeling people in order to make you feel morally superior or simply better. Here is a great response from a clear thinking reader:

• I sometimes feel a little bit frustrated when I hear or read people frivolously using the term "Narcissist". It's as if they are describing another race or species, as opposed to a normal individual with an abnormal learned response in certain situations and environments. …The term "Narcissist" plays to our phylogenetic heritage and the need to see parties in an "Us or Them" category. This may have served us well as wandering tribes, but as modern civilized humans it's a lamentable flaw; in other words, if they are a danger to us, if we feel threatened by them, then they must conveniently fall in to the "Them" category and be "Bad people".

Ergo, we have ex spouses accusing their former husband or wife of having NPD. We have attorneys arguing to the court that someone’s NPD makes them an unfit parent. And, we have injured parties, labeling others with NPD, therefore justifying self serving behavior. After all, there are few that can bully as well as someone who considers themselves a victim.

And, now the National Institutes of Mental Health (NIMH) has offered its opinion. Dr. Thomas Insel, the Director of NIMH, announced that they’re withdrawing support for DSM V, because in their opinion, the DSM classification system is inconsistent with contemporary, biologically based science.

DSM V is now like the Emperor with no Clothes. So, what do we do?

My Take on the DSM V controversy – and its Impact on NPD:

• This is a Good Time for Psychiatry. Controversy is useful. We are still in the infancy of understanding the brain, mind, personality interface.

• NPD is Under Attack as a Diagnostic Category. But, no one is saying that Narcissism or Narcissistic Behavior is out the window. We just don’t have a strong diagnosis here.

• All Personality Disorders are Under Scrutiny. Many people have long standing and predictable ways of handling life’s many challenges. Some organize their behavior in terribly unhappy ways. So, there’s value in not giving up on the Narcissistic, Borderline or Sociopathic Personality. But, we should keep these categories in perspective.

• Labeling can be Dangerous. Throughout my training there was an unsaid judgment of people with the Borderline or Narcissistic diagnosis. They were weak, dangerous or simply manipulative people. While the human mind often needs to see things as black and white, real people are infinitely more complex. Remember, Nazi Germany and Soviet Russia used “psychiatric” labels for demonic purposes.

• Insurance Companies are too Influential. DSM IV & V works well for insurance companies. Since we live in a capitalistic system, getting paid for one’s work is important. . This can bias us to holding onto a system pays. Inertia is not a good reason to do things.

• NIMH has a Strong Biologically Based Bias. We are in an age of biology and logical positivism. And, while I have admiration for this approach, I shudder to think that there’s someone out there who may believe that all human unhappiness can be reduced to biology. Maybe, I’m old fashioned, but I choose to believe that our biology is but a part of the totality of the human project. I worry that the best of our humanistic traditions can be lost in this effort.

• Does NIMH have a Better, More Comprehensive System? We will see in the next few years if NIMH can deliver a better, more useful product. The jury’s out.

Psychiatry and Science: Psychiatry desperately wants to be part of biologically based medical practice. This is useful thinking. But, psychiatry also has its roots in ancient healers, sages and spirit as much as neurobiology. The real project of the next hundred years is to take the best of brain research, while combining it with our great healing traditions.

No one has the last say on understanding the human spirit.

As Thomas Kuhn reminds us in his seminal book, The Structure of Scientific Revolutions (1962), scientific advance is more sociology than we may like to think. What’s truth today becomes an interesting sidebar tomorrow. Think of Aristotle, Ptolemy, Copernicus, Newton, Einstein, and others. Today’s certainty becomes tomorrow’s questions.

Take Home Message: I like this controversy, because to my way of thinking the junction of brain, mind and spirit is the most complex frontier of them all.

As for NPD, don’t think about it as an accurate depiction of a person. It’s an approximation, but still probably, a useful one.

Still worried about narcissism? Are you or someone you know intolerably selfish? Without question, narcissistic behavior and narcissist traits are still real. These terms may very well still describe a person who’s making you miserable.

And, that may be enough.