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.

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[Mark Banschick M.D.]
Mark Banschick M.D. The Intelligent Divorce

The Unhappy Marriage: Stay or Go?

Is Divorce Necessary?
Posted May 13, 2013

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I don't know where we went wrong.
But, the feeling's gone and I just can't get it back.

-- Gordon Lightfoot

It’s with great regret that I must inform you that happily ever after is a fairy tale.

Why? Sometimes, it’s because there’s an unforgivable betrayal like infidelity, or a partner becomes abusive and the relationship turns destructive, or as clichéd as it sounds - people often grow apart.

When couples marry, its with the intention of remaining lifelong lovers and partners. But we all know that with the high divorce rates, this ambition isn’t always realized.

How does a love that was all-consuming and wonderfully vibrant wither away and die?

Let’s start by taking a look at why intimate connections have such a strong hold over us.

The allure of romantic love lies in the intimacy it creates.

The Magic of Intimacy: Intimacy brings lovers together and renders us vulnerable. When we are intimate, we feel empowered but we’re also at the mercy of the one we love. Intimacy evokes a powerful mix of emotions – we feel vulnerable, yet valued and embraced. When you experience intimacy, it acts like a field in the world of physics, where all the rules of regular relationships change.

Your beloved can make you feel special unlike any one else.

In fact, he or she can heal you as well.

The promise of marriage is in its ability to mend our wounds. Our most intimate relationships are often therapeutic: they’re able to rehabilitate us psychologically and emotionally. Marriage encourages us to expose ourselves to our partners and lay bare our weaknesses; and in so doing our lovers are agents of healing.

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The Dark Magic of Intimacy:  Yet, the very vulnerability that makes intimacy intensely special can be its greatest undoing.

When our partners criticize or invalidate us, we feel rejected.

When our partners are neglectful or dismissive - we feel intensely hurt.

The pain induced by a partner can be unbearable. When the people we most care about become destructive and hurtful, we react. The very intimacy that can heal early life injuries can invoke those injuries once again.

And, once one party is triggered, you can bet the other will respond.

When attacked, some become defensive, while others attack. Does your partner, for instance, retreat and disengage emotionally?  Others simply check out. They feel the relationship has deteriorated and doesn’t justify the effort needed to repair it.

Others will endure an unhappy marriage for the sake of commitment and to honor vows that they made. And then there are those that will fight for the relationship because they believe in it; they see a future and aren’t ready to give up on the history they’ve created together.

Unhappiness & It's Choices:  When an intimate relationship is no longer healthy – should you jump ship and abandon it, continue to fight for it even though you may be fighting a losing battle, or hold onto the understanding that marriages are imperfect and go through rough patches, but sooner or later things may settle down and improve?

And, how do you consider your children in the calculus?

Unfortunately, there is no clear cut path to follow that will lead to the right outcome. How you resolve this dilemma will depend on your personal circumstances and the conclusions you reach through a lot of thought.

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Time ticks on. And there’s no universal law telling you what to do: it’s truly your choice.

Time ticks on. And every relationship you hold on to is another one that may be missed.

Time ticks on. And each child values their parents together, despite their parent’s pain.

Time ticks on. And you hold on, only to see something rekindled again.

Time ticks on. And you are stuck in an arid relationship while stewing in regret.

Time ticks on. And you make the decision to stay or leave – everyday.

Time ticks on. And no one can predict the future; except that time is unforgiving.

Time is unforgiving because you can’t get it back. But, you can go forward with conviction.

A Marriage Repaired: You can take on your marriage, improve yourself, deal with your children; or look realistically at divorce. There is dignity in making it work. And, there’s dignity in starting fresh for the right reasons. Take a look at Harville Hendrix or John Gottman's work on rehabilitating a marriage. For many, it can be done. Take an active role.

For some, divorce is necessary. But, for most, it should only be considered when all other options have been explored and exhausted. Have you done the work?

The Clear Headed Divorce: The decision to divorce should be made with a sober headset, understanding that it will be a difficult process. A neutral therapist or kind ear can help. It's a big fork in the road.

Just know that like many things, divorce has a beginning, middle and end. Know that although divorce entails pain and grief, it often eases up over time.

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Understand that a divorce can leave casualties behind. You need to make sure that your kids are okay because divorce can undermine their sense of stability and security. You also need to allow yourself to mourn appropriately, because you too have lost something precious.

Take Home Message:  If you're in an impossible marriage with kids: consider therapy. How did your relationship lose its specialness? Remember, the Field of Intimacy can do tricky things. What issues did you bring to the marriage? How about her? Perhaps you stopped communicating, leaving each other filled with resentment?

Does a betrayal hangs over the marriage?

Then, breathe deeply and ask yourself if there's a bit of good will to work with. If so, you may want to throw down the gauntlet and demand change. You never know. I remember one woman who threatened to leave; it led to over twenty years of sobriety for her husband. Most successful cases are less dramatic. Couples get into therapy, start to enjoy each other again and begin to let go of past hurts.

With luck, time can heal.

Yet, some hurts are irrevocable. If divorce has to happen, grieve the loss, tend to your children with sensitivity and deal with your ex with dignity. Look realistically at everyone around you – including yourself.

Your children may need some counseling or treatment. It's a priority.

Despite divorce, your ex will likely continue to be an important relationship in your life; especially if you have children. He or she may be depressed, self centered or even narcissistic. And, sometimes, there's a need to protect yourself.

You don't want to over react or under react to an ex spouse. Both are hazards. Good psychological counseling can help keep you in a centered place.

Finally, for many, a spiritual practice and good friends can really help.

You didn't consciously choose to be in an unhappy marriage. But, you can choose to deal with it with dignity and intelligence. No one can tell you what to do. It may be a lonely place, but it's your place.

I wish good things for you, your spouse and your kids. Now, it's your life to live.

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