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:
There’s much to be concerned about.
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.
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:
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:
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.
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)
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