What Does Being Sick Reveal About People’s Personalities?

The psychology of hospitalization presents a number of interesting angles for understanding what happens when people get sick, especially if those people are rich and famous. In the latest case to reach public attention, the hospitalization of President Donald Trump for treatment of complications from COVID-19 illustrates what physicians have for decades called “VIP Syndrome.”

A 1993 editorial in the journal Chest by Dr. A. Jay Block chronicles the history of VIP syndrome, which Block defines as follows: “It occurs when a very important person (VIP) is admitted to a health care facility and the status of that person affects decisions about medical care” (p. 989).

The first discussion of the syndrome in the research literature involved the attempted assassinations of both President Ronald Reagan and Pope John Paul II in 1981 and 1980, respectively. At the time, physicians discussed the reactions of the “star-struck” medical personnel who can, if they’re not careful, become distracted from the need to stick to usual medical protocols.

As Block points out, though, it’s not only a world leader who can generate this reaction in world-class medical centers. The scenario can unfold even in “tertiary referral hospitals” and involve only minor government officials. If you think about your own town or city, imagine what happens when the mayor or even a state representative shows up in the emergency room. Hospital personnel will scurry to put that locally prominent individual ahead in whatever line of patients already exists.

That desire to provide immediate service is just one piece of what can happen when a luminary, even a local one, enters a medical facility. As Block notes, the medical personnel might alter their treatment in such a way as to try to spare the VIP from pain or possible negative PR implications. As a result, they perform fewer medical procedures, especially the ones that can hurt.

The second reaction goes to the opposite extreme of giving the VIP more intense treatment in order for the physicians to “follow up every minuscule abnormality so as to appear to be a more complete and competent physician.” Finally, as if all of these weren’t bad enough, there are the VIP visitors, from family to high profile associates, who come and insert their own opinions and directions onto the patient's care.

All of this attention given toward the VIP patient can produce what Block refers to as “deviations from standard care [that] often result in unforeseen catastrophes.” If these “deviations” were actually recommended by standards of care, then all patients would receive these treatments, not just the VIPs, notes Block.

Where, then, is the VIP in the middle of all of this? Block believes that the situation arises not so much from the patient but from everyone else—hospital administrators, important family and friends, and the overly curious public. Normally, Block maintains, the VIP doesn’t present physicians with unreasonable treatment demands. However, what if the VIP is the problem? Here’s where personality may come into play.

The idea that you deserve special treatment is at the heart of the personality trait of narcissism. What’s more, people high in narcissism tend to view illness and disability as in some way diminishing their appearance as strong and powerful. A 2017 paper by the University of Florida’s Elizabeth Kacel and colleagues presented two case studies illustrating the clinical challenges of working with patients with diagnosed Narcissistic Personality Disorder (NPD) in a health care setting.

Several key themes emerged from these case studies as challenges to treatment, both psychotherapeutic and medical. The psychotherapeutic challenges are those shown in other psychology research to be involved with working with NPD patients, such as the need for admiration, defensiveness, and inability to tolerate distress.

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From the VIP/NPD perspective, the treatment challenges additionally involve what Kacel et al. refer to as “idealizing and devaluing providers” (p. 162). One of the two patients in the study, for example, referred to his world-renowned medical providers as “jerks,” and the other manifested this behavior as seeking extensive consultations and second opinions.

The need for special treatment can further lead to poor adherence to medical advice, such as not following dietary guidelines and/or unpleasant direct treatment recommendations. This expectation of special treatment can also lead patients to engage in “doctor shopping” and getting angry at providers who give them advice they don’t like.

Imagine now how much harder it is for the medical personnel to treat VIP patients who themselves are high in narcissism. Not only is there the circus of onlookers who think they know better than you, but there is a patient who rejects your advice or demands multiple opinions from other providers. Although Block seemed to let the VIP off the hook as having a role in the demands for special treatment, the NPD case study suggests how personality and circumstances can interact to create these very unpleasant and anti-therapeutic dynamics.

Think about the people in your own life who’ve given you a hard time as they’ve progressed through medical treatment. Ask yourself: How many of these VIP-like behaviors they exhibited? Did they constantly complain about their providers? Did they reject advice they didn’t want to take? Did they produce printouts of Internet pages with unfounded but supposedly legitimate claims? When you tried to explain that health providers know more than they do, did they tell you not to bother to visit them anymore?

As you can see, then, the traits of the highly entitled, whether by virtue of personality or status, can contribute to potentially bad health outcomes. Returning to Block’s advice, it would seem that your best strategy with those in your life is to hold your ground, and regardless of how much anger this causes, siding with the health care experts rather than the patient.

To sum up, for the highly entitled and narcissistic, illness presents a unique set of challenges. Learning from the examples of the rich and famous can help you meet these challenges with the people in your own life whose personality can get in the way of their health.

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