So what gives?
First, let’s take a look at the heuristic value of Personality Disorders as a whole.
When your orthopedist looks as a broken femur he has a relatively simple task. You have only two femurs, so it is either the right one or the left one. The break may be simple or more complex. But most of us have the same anatomy surrounding our femur, the same joints, muscle construction and ligaments. There are thicker femurs and thinner ones, but the essential anatomy is the same. The doctor has easy ways to access damage. A physical examination often makes the diagnosis obvious. An X-Ray confirms the diagnosis in most cases. If the injury is subtle, an MRI can tease out what’s going on.
Personality Disorders do not have the diagnostic reliability of a broken femur, or of a strep throat or of breast cancer. Each of these has signs and symptoms, coupled with well proven laboratory tests that can verify what you are dealing with. While you can get any of these wrong – the breast cancer turns out to be benign, the broken femur turns out to be a side effect of steroid abuse – there is solid heuristic value to each label. Narcissistic Personality does not have this kind of diagnostic certainty and that’s what the controversy is really all about.
After all, to label someone a Narcissist is pretty damning.
The brain has over 100 Billion neurons, and endlessly more connections between them. So, each brain is remarkably unique. Think about a face. It is a pretty simple structure. You have two eyes, a nose, a forehead, two cheeks, a mouth, two ears, some hair (or not), and a chin. Sounds simple; yet with some minor variations you find that no two faces are the same – with over 7 billion unique faces on the planet. Each brain has an unlimited number of differences that help to make a person what he or she is to become. The femur model does not really apply to personality.
In the world of psychiatric diagnosis we do have disorders that come close, though. Most people with Obsessive Compulsive Disorder or Schizophrenia or Panic Attacks have much in common with each other. Our mental status exam and psychiatric evaluation come closer to the orthopedist and his broken femur. Neuropsychological testing reveals consistent pattern of thinking that indicate whether a person is say, psychotic or just obsessively anxious. Here psychiatry approaches the femur standard – but still falls way short. This is okay, because the human psyche is tougher to assess and highly unique – getting back to the 100 Billion neuron problem.
So, what about Narcissism?
As most of you know, narcissism fits in a psychiatric category called Personality Disorders. These folks have a maladaptive style of functioning in the world that can be hurtful to them or to others. Here is an abbreviated view of narcissism (with some minor alterations to make this character type clearer):
• Exaggerated sense of one’s talents and importance
• Fantasies of great romance, great insight or great achievement
• Excessive need for admiration and attention
• Powerful sense of entitlement – can rationalize selfish acts as perfectly normal
• Tendency to use people as objects
• Lacks true empathy; but often can feign empathy quite well
• Easily hurt – and easily injures others (sometimes badly)
• Obsessed with oneself
• Lacks capacity to be self critical
We all have elements of these traits. Some may argue that this list beautifully describes most healthy teenagers! Yet, what if an adult is truly trapped in this personality set? It can spell trouble for them and those who are their husbands, wives, business partners and children.
However flawed, the diagnosis of Narcissistic Personality Disorder has real value. You need to know what you are dealing with. And if you are the Narcissist, you will ultimately benefit from understanding why you go from failed relationship to failed relationship – and why you never have enough, despite your looks, money or success.
The hole in your life is on the inside.
Every Narcissist is different. They each have a separate array of the 100 Billion neurons. They each have a different upbringing and they each have the above traits in varying degrees. The last criterion is one that I added, because in my experience, it is most critical. Most Personality Disorders lack the ability to look at themselves critically, as if from the outside. Criticism is too easily seen as an attack, and not a useful insight. Narcissists in this way are primitive psychologically. They just can’t be wrong.
Good therapy is about Meta-Cognition, which is the ability to watch yourself while you think. Great therapy helps the patient to go one step further. You ask a patient to Meta-Cognate, and then ask whether he really wants to continue to act the way he does. It is not easy, but we do have choices.
The Narcissist will try to please the therapist with her brilliance, warmth, or charm. She will stake out all the ways she has been let down by others and rationalize everything that she may do that is hurtful. In the world of divorce, for instance, a Narcissist may simply drop the marriage because “the love was not good enough” and then get outraged that her husband won’t just go along with it. After all, “isn’t it better that we both should be happy?”
She fails to see him as a person , and just assumes that he should feel the way she does. Then, she gets angry with him for being upset, avoids any criticism and may go so far as to feel justified in poisoning the kids against their dad. “The kids are better off without him.” Once she cuts bait, how he ends up is not her concern – relationships are ultimately chess pieces to be moved around. The loyalty you sometimes see in a good divorce exists only in her words, not in her deeds.
One scary point: People with NPD can be vicious when frustrated. Divorce regresses them further and sometimes domestic violence is possible. Whether you buy into the NPD diagnosis or not, it is dangerous to be a position of vulnerability with someone who feels justified in hurting you because he or she has lost control. Many women (and some men) can’t get their heads around the fact that someone who once loved them can hurt them (or their kids). Get help if you think this is your problem.
The downside to the diagnosis of Narcissistic Personality Disorder is that it can become a cheap catch phrase that you can use whenever you don’t like someone. It makes you feel superior because you have a label for him or her. It may be a sign of your own self importance if you reduce someone to a diagnosis. I buy into that.
So, does Narcissists exist?
In the fluid world of psychiatric nosology, I think the term Narcissist has value.
Here are some lessons that may be helpful:
1. Narcissists are people who are remarkably self-centered to the point of exploitation.
2. A Narcissist may be so entitled that he doesn’t even see himself as hurting others.
3. It is easy to be attracted to a Narcissist. They often possess admirable talents and looks. In my experience, many love romance – but not long term love.
4. If you have a lover, spouse or ex with these traits, just know that you may not count to her as much as you think. Knowing this can help protect you.
5. Yes, he may have loved you. He may be incredibly handsome, a great lover and an interesting person but notice how much of what he has done is self referential. He is far from selfless.
6. When it comes to love, most narcissists are more in love with love than in love with you.
7. Once the relationship is over, your history with him is not that important.
8. Many of these characters have a tough time getting older and good therapy can help them transition to being a better person. Generally, this happens when their beauty, wealth or accomplishments fail to work for them anymore.
9. The mid life crisis of a narcissist can be one of the more satisfying psychotherapies. They need love like everyone else; and better late than never.
10. Narcissists as a group have a powerful sense of urgency. They want a lot out of this life. And some of them make a real contribution to the worlds of acting, academics, religion, politics, science, literature and yes, psychology. Their pain is often internal – as in a relentless lack of satisfaction – and external – as in the debris of many failed relationships.
Narcissism is a useful term, even if it can be misused. It’s good to have words that can help you know what you’re dealing with. And, if you have these traits, knowing the full picture of narcissism may help you wake up to why you’re so chronically demanding – or empty. And, if your lover, friend, parent or spouse is narcissistic, you’ll have a better picture of what’s going on.
Caution: Not every hurtful person is a Narcissist. Sometimes he is just an A-hole. There is a difference.
Bottom Line: People with Narcissistic Personality Disorder are problematic people. They miss out on much of the subtle beauty of life.
Just, if you are close to one - protect yourself.
For more from Dr. Banschick:
The Intelligent Divorce - Taking Care of Your Children (Kindle)
The Intelligent Divorce - Taking Care of Your Children (Amazon)
The Intelligent Divorce - Taking Care of Yourself (Kindle)
The Intelligent Divorce- Taking Care of Yourself (Amazon)
Course - Raising Healthy Kids Despite Divorce: Sign Up
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