Sacramento Street Psychiatry

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Narcissists, Psychopaths, and Other Bad Guys

What do personality labels contribute to popular discourse?

A patient of mine recently observed that the increasing use of the the term “psychopath” in popular media is really a disguised way of criticizing selfishness. Dressing up selfishness as an odd and frightening clinical disorder — slapping a diagnostic label on it — makes for catchy news copy, and grants pundits emotional distance between themselves and those monsters who look just like us, but who lack the empathy and remorse that make us human.

I immediately thought of how narcissism had its heyday in popular culture very recently as well, and to similar ends. Narcissists and psychopaths care only about themselves, and have no qualms about hurting and sacrificing others when it suits their purposes. These are dangerous people lurking among us; all the more reason to publish lightweight magazine and newspaper pieces on how to spot them in the wild.

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Both labels sound like psychiatric diagnoses, but actually they’re not. According to Heinz Kohut and other theorists, narcissism is a quality everyone has to a greater or lesser degree. It normally develops in infancy: the sense all babies have that the world revolves around them. However, we gradually learn that we are not the center of the world, and that other people, including our primary caregivers, have their own goals and perspectives separate from our own. Infantile narcissism is thus tempered by the reality of healthy relationships, although its vestiges are present in our self-pride, and perhaps in our proven tendency to overestimate our own efficacy and performance. Pathological narcissism in this view is infantile normality carried abnormally into adulthood. It only becomes a psychiatric diagnosis when the condition fulfills certain observable criteria and impairs social and/or occupational functioning. Likewise, psychopathy is a personality trait, not a diagnosis. Renowned psychopathy researcher Robert Hare notes that “psychopathy is dimensional (i.e., more or less), not categorical (i.e., either or).” DSM-IV doesn’t include a diagnosis called “psychopathy” or “sociopathy.” Instead, there is antisocial personality disorder, which overlaps with psychopathy but is not the same thing.

These terms, psychopath and narcissist, are loosely applied personality labels when popularized in the media. What do they add over simply calling someone callous or selfish? First, they offer an explanation — a pseudo-explanation really — of frightening and/or mystifying behavior. Our feeling of powerlessness is eased by the label, as though now that the threat is identified, we may be able to do something about it. Second, such labels imply that misbehavior is a function of one’s character, a categorical determination. Yet categorical psychiatric diagnosis, especially of personality, is controversial in general. Moreover, we often overestimate personality factors and underestimate situational ones (the “fundamental attribution error“) in explaining the behavior of others. Using a label like psychopath or narcissist to describe another person (whom we’ve only heard about in the news, and haven’t formally evaluated) reaches for a premature conclusion about the cause of that person’s behavior. In a way, we are falsely reassured.

Third, the label adds power to our verbal disapproval. We have a long history of abusing psychiatric labels in the service of putting others down. Consider “idiot,” “moron,” and “imbecile,” all originally coined as official categories describing low IQ. Or “cretin,” which originally referred to physical and mental disability due to congenital thyroid deficiency. Or the casual use of “crazy” and its synonyms. Some patient advocates argue further that any diagnostic label used as a noun is demeaning, i.e., calling someone a schizophrenic, a neurotic, a borderline, etc. Instead, it is more respectful to refer to a person (or patient) who has schizophrenia, or a narcissistic personality. But that’s exactly the point of the popular use of terms like psychopath and narcissist: To show disrespect and disdain, to disapprove. And to underscore the difference between ourselves and the person with the label.

Our earliest social categories are “good guys” and “bad guys,” defining one against the other. From “cops and robbers,” to team sports, to bipartisan politics, to our allies and foes on the world stage, we divide self and other at every level, calling the former good and the latter bad. Callousness and selfishness are in all of us to some degree, and it hurts to admit it; it damages our self-image. Instead, we psychologically defend against this realization in ourselves by projecting these traits onto others using a broad brush and pejorative terms. While some people truly are unusually callous or selfish, the popular use of scientific-sounding labels serves our own psychological needs by identifying “bad guys” and making us feel better about ourselves.

© 2013 Steven P Reidbord MD.  All rights reserved.

Steven Reidbord, M.D., is a psychiatrist and psychiatric educator, and chairs the Continuing Medical Education Committee at California Pacific Medical Center.

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