I’ve written several times about the debates in the therapeutic community concerning the relevence of adding certain types of mental disorders in the upcoming addition of the DSM: Parental Alienation Syndrome, new variations of eating disorders, and Seasonal Affective Disorder. It seems that every other day there is an article in the newspaper or on popular blogs that questions how we define mental disorders. If once named a mental disorder, is is always going to be classified that way? The most recent sighting of therapuetic chatter was found in the New York Times Sunday edition, the author of said blog despaired over the “Malady of Me”. His question: is Narcissistic Personality Disorder relevant for the DSM anymore, given how commonplace narcissistic behaviors are? Where is the line between symptoms of narcissim and a truly pathologic mental condition? Narcissism is clinically most commonly represented in Narcissistic Personality Disorder. Someone diagnosed with this condition would be described as being “excessively preoccupied with issues of personal adequacy, power, prestige, and vanity. It is closely linked with self-centeredness”.
The term “narcissism” has been used for decades – centuries, even. It was coined originally by Freud who named the condition after Narcissus, a character in a Greek myth who fell in love with his own reflection in a pool. While in this myth, Narcissus was forever content staring at himself, real-life narcissists need someone else to validate their self-centeredness. This need for approval, grandiosity and ego stroking begs us to wonder about deeper levels of vulnerability and perhaps a defense against shame. The editors of the upcoming edition of the DSM are considering removing personality disorders completely — Narcissistic Personality Disorder plus four others — and instead picking certain personality traits traits that describe a particular client. This makes diagnoses like this less stigmatizing, but what will happen to the personality disorders — and are they even relevant anymore?
I found this topic fascinating because of the numorous ties that the focus on narcissism draws between medicine, psychology, and pop culture. How do psychiatrists treat narcissism? Is there a medication that can help allieviate symptoms (having a sense of entitlement, preoccupation with having unlimited success, power, beauty, and other complicated criteria)? Can we even treat it? How would we know when it was getting better? We are a culture that is becoming more and more narcissistic every day. Everywhere we turn, there are celebrities, tv stars, and politicians in the public eye trying to get you to learn more about “me! me! me! and how wonderful I am!”. A recent segment on NPR focuses on several examples and types of narcissism in our culture and ties them to psychological constructs. The most blatent figure outlined in this segment is Nicole “Snooki” Polizzi, who told Barbara Walters recently that “I think I’m fascinating”. The degree that Snooki and her Jersey Shore castmates could be diagnosed as narcissistic is questionable, as the lines between psychological symptoms worthy of a clinical diagnosis and plain old self centeredness in our culture today are getting quite blurry.
Clinicians would agree that a diagnosis of Narcissistic Personality Disorder would have to “come after the symptoms are totally pervasive in one’s life, affecting all areas of functioning”, states psychologist Keith Campbell. Whereas vanity and being full of oneself could be off-putting to others and create an aura of disdain around the nacissistic individual, the commonality of these symptoms amongst certain types of individuals make these traits quite expected — almost accepted. So maybe there is no use of Narcissistic Personality Disorder in the DSM anymore? Having that type of diagnosis would almost justify the crazy antics of reality tv shows, wealthy celebrities, and cocky sports stars: “see? there is an explanation for me. It is you all that are crazy, not me!”
I am drawn back again to the counseling professionals’ assertion that underneath the layers of fabulousness (which in reality may not be so fabulous and which may be quite thin) often lies terrifying fears of worthlessness, shame, and vulnerability. What if the tan skin, the million dollar jewels, the bleached hair were taken away? That security blanket often shields one’s true nature which, when exposed, is truly beautiful and worthy. I fear that at the rate this society is going, we may find it more and more difficult to let the inner nature show and we may feel we “must” cover it up with obviously beautiful qualities such as botox and Porsches. Every day with clients I encourage openness and acceptance for who they truly are, and I hold a non-judgmental space for them to explore that person. It is amazing to me to watch as clients realize that the qualities about themselves that they might think are the most “undesirable” are actually the qualities that bring them the most authentic joy and inner peace.