Letter no 3 November 1, 2004
Dear Sam,
We had agreed to keep out any personal experiences in our
exchanges, but it is very hard to intellectualize, at least for
me, my interactions with narcissistic people and NPDs. So I hope
you will allow me to temporize, to talk about two experiences
that illustrate how difficult it is to communicate with other
people, especially NPDs. Not being a psychiatrist I cannot make
a legitimate diagnosis.
Sam:
Don't worry about it. You are in good company. Though first
proposed by Freud in 1915, the construct of pathological
narcissism didn't make it into the DSM - the bible of the
psychiatric profession in North America - until 1980! Even now,
the ICD-10, published by the World Health Organization (WHO),
and used throughout the rest of the world, contains no separate
mental health diagnosis of narcissism! As far as Europe, Asia,
and Africa are concerned, NPD still does not exist!
Moreover, narcissism is still very difficult to diagnose,
even by seasoned professionals. In many cases, it is comorbid
with other mental health disorders. Often, Asperger's
Disorder and Bipolar
I are misdiagnosed as NPD!!!
Stephen:
Now I have no idea if the two people I am going to mention
suffer from Narcissistic Personality Disorder, or not. They may
have been having a bad day, week or year. As they were women,
it could be blamed on PMS or the moon, but I hate to dismiss
women in that manner, and think they are equal to men, and equally
responsible for their actions.
The first incident took place years ago. I was a student
and this woman and I socialized in class. I thought there was
a Platonic relationship developing, or at least camaraderie,
but instead she told me she could tell by my "non-verbal"
communication that I liked her, and even more. After inviting
her to my home for a party of friends, so that she could meet
my wife and son, she persisted in this strange obsession with
me. I finally told her where to get off, and essentially told
her she was a liar.
Now, years later, she has published a book on how to tell
if people are lying. I have not read it, but during a TV interview
she read parts of it, and in the final pages she had written
that people begin lying by lying to themselves.
How true. It gave me some satisfaction that I might have
inspired the book, though I doubt it, and that maybe she had
gained some 'self-reflexivity".
For all I know, she may be following the same behaviors
with other people.
Now in her case, and with some hindsight, I wonder if she
did not suffer from 'border line personality' disorder. Such
cases tend to be self-disillusioned; they think people who are
kind to them are in reality in love with them. They then reject
people they are involved with. They play a sort of love-hate
dance, with the refrain playing in the background of, "I
love you, go away." The actress Glen Close played a 'border
line' in the 1987 movie, Fatal Attraction.
Sam:
Narcissists are often self-delusional.
Don't get me wrong, I think that confabulations are an important
part of life. They serve to heal emotional wounds or to prevent
ones from being inflicted in the first place. They prop-up the
confabulator's self-esteem, regulate his (or her) sense of self-worth,
and buttress his (or her) self-image. They serve as organizing
principles in social interactions.
Father's wartime heroism, mother's youthful good looks, one's
oft-recounted exploits, erstwhile alleged brilliance, and past
purported sexual irresistibility - are typical examples of white,
fuzzy, heart-warming lies wrapped around a shriveled kernel of
truth.
But the distinction between reality and fantasy is rarely
completely lost. Deep inside, the healthy confabulator knows
where facts end and wishful thinking takes over. Father acknowledges
he was no war hero, though he did his share of fighting. Mother
understands she was no ravishing beauty, though she may have
been attractive. The confabulator realizes that his recounted
exploits are overblown, his brilliance exaggerated, and his sexual
irresistibility a myth.
Such distinctions never rise to the surface because everyone
- the confabulator and his audience alike - have a common interest
to maintain the confabulation. To challenge the integrity of
the confabulator or the veracity of his confabulations is to
threaten the very fabric of family and society. Human intercourse
is built around such entertaining deviations from the truth.
This is where the narcissist differs from others (from "normal"
people).
His very self is a piece of fiction concocted to fend off
hurt and to nurture the narcissist's grandiosity. He fails in
his "reality test" - the ability to distinguish the
actual from the imagined. The narcissist fervently believes in
his own infallibility, brilliance, omnipotence, heroism, and
perfection. He doesn't dare confront the truth and admit it even
to himself.
Moreover, he imposes his personal mythology on his nearest
and dearest. Spouse, children, colleagues, friends, neighbors
- sometimes even perfect strangers - must abide by the narcissist's
narrative or face his wrath. The narcissist countenances no disagreement,
alternative points of view, or criticism. To him, confabulation
IS reality.
The coherence of the narcissist's dysfunctional and precariously-balanced
personality depends on the plausibility of his stories and on
their acceptance by his Sources of Narcissistic Supply. The narcissist
invests an inordinate time in substantiating his tales, collecting
"evidence", defending his version of events, and in
re-interpreting reality to fit his scenario. As a result, most
narcissists are self-delusional, obstinate, opinionated, and
argumentative.
The narcissist's lies are not goal-orientated. This is what
makes his constant dishonesty both disconcerting and incomprehensible.
The narcissist lies at the drop of a hat, needlessly, and almost
ceaselessly. He lies in order to avoid the Grandiosity Gap -
when the abyss between fact and (narcissistic) fiction becomes
too gaping to ignore.
The narcissist lies in order to preserve appearances, uphold
fantasies, support the tall (and impossible) tales of his False
Self and extract Narcissistic Supply from unsuspecting sources,
who are not yet on to him. To the narcissist, confabulation is
not merely a way of life - but life itself.
We are all conditioned to let other indulge in pet delusions
and get away with white, not too egregious, lies. The narcissist
makes use of our socialization. We dare not confront or expose
him, despite the outlandishness of his claims, the improbability
of his stories, the implausibility of his alleged accomplishments
and conquests. We simply turn the other cheek, or meekly avert
our eyes, often embarrassed.
Moreover, the narcissist makes clear, from the very beginning,
that it is his way or the highway. His aggression - even violent
streak - are close to the surface. He may be charming in a first
encounter - but even then there are telltale
signs of pent-up abuse. His interlocutors sense this impending
threat and avoid conflict by acquiescing with the narcissist's
fairy tales. Thus he imposes his private universe and virtual
reality on his milieu - sometimes with disastrous consequences.
There is another possibility. She may be an erotomaniac. If
I am right and she is, you are one lucky target. It often takes
years to shake off an erotomanic stalker. Telling them off is
never enough.
On the other hand, maybe she isn't so pathological. Simply
a lonely, narcissistic, and self-deluded personality. As you
correctly observe, in my view, Borderline is also a strong possibility.
The erotomanic stalker believes that she is in love with you.
To show her keen interest, she keeps calling you, dropping by,
writing e-mails, doing unsolicited errands "on your behalf",
talking to your friends, co-workers, and family, and, in general,
making herself available at all times. The erotomaniac feels
free to make for you legal, financial, and emotional decisions
and to commit you without your express consent or even knowledge.
The erotomaniac intrudes on your privacy, does not respect
your express wishes and personal boundaries and ignores your
emotions, needs, and preferences. To her, "love" means
enmeshment and clinging coupled with an overpowering separation
anxiety (fear of being abandoned). She may even force herself
upon you sexually.
Moreover, no amount of denials, chastising, threats, and even
outright hostile actions will convince the erotomaniac that you
are not in love with her. This is why I am not sure about your
case.
The erotomaniac knows better and will make you see the light
as well. You are simply unaware of what is good for you, divorced
as you are from your emotions. The erotomaniac determinedly sees
it as her task to bring life and happiness into your dreary existence.
Thus, regardless of overwhelming evidence to the contrary,
the erotomaniac is convinced that her feelings are reciprocated
- in other words, that you are equally in love with her. The
erotomanic stalker interprets everything you do (or refrain from
doing) as coded
messages confessing to and conveying your eternal devotion
to her and to your "relationship".
Erotomaniacs are socially-inapt, awkward, schizoid,
and suffer from a host of mood and anxiety disorders. They may
also be people with whom you have been involved romantically
(e.g., your former spouse, a former boyfriend, a one night stand)
- or otherwise (for instance, colleagues or co-workers). They
are driven by their all-consuming loneliness and all-pervasive
fantasies.
Consequently, erotomaniacs react badly to any perceived rejection
by their victims. They turn on a dime and become dangerously
vindictive,
out to destroy the source of their mounting frustration - you.
When the "relationship" looks hopeless, many erotomaniacs
turn to violence in a spree of self-destruction. This hasn't
been the case here.
Stephen:
One comment on a message board about the character she
plays in the movie Fatal Attraction goes like this:
Jeez Alex why would you want a sleaze like him anyway?
LOL.
Obviously she was suffering from some mental disorder because
there is no other way to explain such extreme behavior after
just a weekend fling. I mean, I could almost see how she could
become attached if she was sleeping with him for years and there
was some emotional involvement but after 2 days?
I do believe the character had borderline personality disorder
in that she displayed all the obvious characteristics like over
reaction to rejection and the "I hate you- don't leave me"
personality type. Even though she was a mess, I felt sorry for
her in that I don't think she could control her reaction to him
dumping her after the fling.
Myself personally, I could never pursue someone who didn't
want me. It's just so pathetic. I cringed every time she called
his house and stalked him because it was just making her look
worse and worse to him. She should have realized he was "happily"
married and didn't want to be with her and she should have walked
away- but hey- she was psychotic. It was not something she could
control.
If I had a quarter for every married man that hit on me
in bar I'd be rich. LOL.
From L. (identity reserved)
My question to you is how can one differentiate between
say a NPD, a Borderline and an Inverted Narcissist? The Axis
II disorders, according to one of your web pages, are very much
alike? But how so, and to what degree? Should we put them all
into the same kettle of fish?
Sam:
This is one case where discarding the fish together with the
kettle may be a great idea (laughing).
Seriously now: the classification of Axis II personality disorders
- deeply ingrained, maladaptive, lifelong behavior patterns -
in the Diagnostic and Statistical Manual, fourth edition, text
revision [American Psychiatric Association. DSM-IV-TR, Washington,
2000] - or the DSM-IV-TR for short - has come under
sustained and serious criticism from its inception in 1952.
The DSM IV-TR adopts a categorical approach, postulating
that personality disorders are "qualitatively
distinct clinical syndromes" (p. 689). This
is widely doubted. Even the distinction made between "normal"
and "disordered" personalities is increasingly being
rejected. The "diagnostic thresholds" between normal
and abnormal are either absent or weakly supported.
The polythetic form of the DSM's Diagnostic Criteria - only
a subset of the criteria is adequate grounds for a diagnosis
- generates unacceptable diagnostic heterogeneity. In other words,
people diagnosed with the same personality disorder may share
only one criterion or none.
The DSM fails to clarify the exact relationship between Axis
II and Axis I disorders and the way chronic childhood and developmental
problems interact with personality disorders.
The differential diagnoses are vague and the personality
disorders are insufficiently demarcated. The result is excessive
co-morbidity (multiple Axis II diagnoses).
The DSM contains little discussion of what distinguishes normal
character (personality), personality traits, or personality style
(Millon) - from personality disorders.
A dearth of documented clinical experience regarding both
the disorders themselves and the utility of various treatment
modalities.
Numerous personality disorders are "not otherwise specified"
- a catchall, basket "category".
Cultural bias is evident in certain disorders (such as the
Antisocial and the Schizotypal).
The emergence of dimensional alternatives to the categorical
approach is acknowledged in the DSM-IV-TR itself:
'An alternative
to the categorical approach is the dimensional perspective that
Personality Disorders represent maladaptive variants of personality
traits that merge imperceptibly into normality and into one another' (p.689)
The following issues - long neglected in the DSM - are likely
to be tackled in future editions as well as in current research:
- The longitudinal course of the disorder(s) and their temporal
stability from early childhood onwards;
- The genetic and biological underpinnings of personality disorder(s);
- The development of personality psychopathology during childhood
and its emergence in adolescence;
- The interactions between physical health and disease and
personality disorders;
- The effectiveness of various treatments - talk therapies
as well as psychopharmacology.
All personality disorders are interrelated,
at least phenomenologically - though we have no Grand Unifying
Theory of Psychopathology. We do not know whether there are ñ
and what are ñ the mechanisms underlying mental disorders.
At best, mental health professionals record symptoms (as reported
by the patient) and signs (as observed).
Then, they group them into syndromes and,
more specifically, into disorders. This is descriptive, not explanatory
science. Sure, there are a few etiological theories around (psychoanalysis,
to mention the most famous) but they all failed to provide a
coherent, consistent theoretical framework with predictive powers.
Patients suffering from ALL personality
disorders have so many things in common that the differential
diagnoses look forced and artificial:
- Most of these patients are insistent (except
those suffering from the Schizoid or the Avoidant Personality
Disorders). They demand treatment on a preferential and privileged
basis. They complain about numerous symptoms. They never obey
the physician or his treatment recommendations and instructions.
- They regard themselves as unique, display
a streak of grandiosity and a diminished capacity for empathy
(the ability to appreciate and respect the needs and wishes of
other people). They regard the physician as inferior to them,
alienate him using umpteen techniques and bore him with their
never-ending self-preoccupation.
- They are manipulative and exploitative
because they trust no one and usually cannot love or share. They
are socially maladaptive and emotionally unstable.
- Most personality disorders start out as
problems in personal development which peak during adolescence
and then become personality disorders. They stay on as enduring
qualities of the individual. Personality disorders are stable
and all-pervasive ñ not episodic. They affect most of
the areas of functioning of the patient: his career, his interpersonal
relationships, his social functioning.
- The typical patients is unhappy. He is
depressed, suffers from auxiliary mood and anxiety disorders.
He does not like himself, his character, his (deficient) functioning,
or his (crippling) influence on others. But his defences are
so strong, that he is aware only of the distress ñ and
not of the reasons to it.
- The patient with a personality disorder
is vulnerable to and prone to suffer from a host of other psychiatric
problems. It is as though his psychological immunological system
has been disabled by his personality disorder and he falls prey
to other variants of mental illness. So much energy is consumed
by the disorder and by its corollaries (example: by obsessions-compulsions,
or mood swings), that the patient is rendered defenceless.
- Patients with personality disorders are
alloplastic in their defences. They have an external locus of
control. In other words: they tend to blame the outside world
for their mishaps. In stressful situations, they try to pre-empt
a (real or imaginary) threat, change the rules of the game, introduce
new variables, or otherwise influence the world out there to
conform to their needs. This is as opposed to autoplastic defences
(internal locus of control) typical, for instance, of neurotics
(who change their internal psychological processes in stressful
situations).
- The character problems, behavioural deficits
and emotional deficiencies and lability encountered by patients
with personality disorders are, mostly, ego-syntonic. This means
that the patient does not, on the whole, find his personality
traits or behaviour objectionable, unacceptable, disagreeable,
or alien to his self. As opposed to that, neurotics are ego-dystonic:
they do not like who they are and how they behave on a constant
basis.
- The personality-disordered are not psychotic.
They have no hallucinations, delusions or thought disorders (except
those who suffer from the Borderline Personality Disorder and
who experience brief psychotic "microepisodes", mostly
during treatment). They are also fully oriented, with clear senses
(sensorium), good memory and a satisfactory general fund of knowledge.
Stephen:
The notion of imbrication is one that seems to apply to
the intermeshing of narcissists (and other personality disorders)
with "normal" people. Imbroglio, embed, quagmire all
are words that apply to their interpersonal relationships.
Do all of the Axis II disorders have a weak boundary between
themselves and others? Are they all "needy" in the
manner of needing others to confirm their existence? Let me give
you another example of what I mean in the history of Miss X.
Miss X
Now I would like to talk about another situation that has
occurred to me. Let me just say that Miss X was a woman friend
who was intelligent and a pleasure to be around. She always had
a tendency to be bossy, but this was overshadowed by a charming
playfulness.
Yet I had my doubts about her "personality."
She was inordinately attuned to the "important people"
around her, always loosing interest in our conversation whenever
a very expensive car or a supposedly famous person walked by.
She also put her male boyfriends into a want add list of fireman,
policeman, airplane pilot, ski instructor, etc. And she referred
to them as such when discussing them, never by name - she objectified
men.
Over the past months she has become more bitter and aggressive
towards me, and I finally dropped her as a friend. My own life
experiences have been positive for the last months and I have
been traveling and meeting new people. Miss X appeared to be
jealous of all this, and was cold towards me, refusing to see
me as she was too busy. In our last encounter, I had invited
her to walk in the park and talk. When I picked her up I told
her that I was a bit peeved, as I had just dropped one of my
cameras and was worried that it was broken. She said something
flippant about how I always purchased expensive toys. I drove
her to a glass shop where I had a glass cut for a photo print;
she insisted I put the print in right away even though the glass
shop technician told me I should clean the glass first. I tried
to ignore her even more insistent commands, especially when I
was driving (this was nothing new, as she always was bossy as
a passenger, telling me where to turn etc.).
The beginning of the end was when I was looking for a parking
place in a public park, and the entrance was blocked because
they were making a film. She accused me of not having balls to
just barge past and park. I told her I had brains instead of
balls, and she went on to make several sarcastic remarks about
men and their balls and brains. When I did find a place to park,
in the next parking lot, she accused me of parking over the line
and insisted I re-park my car; I did so scrapping the front of
my car. As I was putting money in the parking meter, and trying
to cool down, she went into the back of my car, and grabbed my
dog to take it out (something she had never done before, and
something only I do.) When I told her to never do that again
after telling her to take her hands off my dog, she told me she
was "only trying to help." At this point I told her
that we needed to talk, but she became belligerent, and told
me I was, "weird." Seeing that things were getting
worse and not better, I told her that our friendship was at an
end, and that I doubted any talking could repair it, and I told
her that if she treated her friends the way she treated me, that
she would certainly not have many. Miss X became more abusive
and loud, telling me she had lots of friends. I told her good,
and took my dog and walked away. My temper was at the breaking
point and I did not trust her nor her intelligence. For good
reason.
A year ago, she had phoned me up asking me to go with her
to attack a woman's car because she had gotten into some altercation
over a parking spot. I had told her to grow up and that under
no circumstances would I take part in such a prank that was probably
illegal, if not irrational. If she felt so strongly about it,
I suggested she call a telephone number where you report people
who drive badly, and the police or authorities would handle this
situation.
In hindsight, I probably kept this friendship going out
of pity and hopefulness. But I had noticed that towards the end
of the friendship, in the last months, every time I talked to
her she was very negative, toxic and accused me of being rude
to people (while she was very rude). This double standard is
something I have seen with NPD's. They feel that they can say
and do anything while you have to toe the line; it doesn't start
immediately because they have to charm you into believing they
are nice people. The point where I subconsciously decided to
end it was when I had asked her favor and she just brushed me
off.
I had to tell her all about the many times I had done things
for her, gone out the way to be nice, and she finally and reluctantly
agreed to help me.
Manipulative people are very hard to spot, most of the
time, because they are good at hypnotizing you with their smile
and winning ways. I prefer the French who are nasty to your face,
and only will be nice to you if they really like you; the North
American razzle dazzle make nice social climate is nice but superficial.
I feel that it is because of this superficial niceness, this
adherence to social convention of politeness that we get involved
with bad people.
Unfortunately they cannot have a label, saying 'Hi I'm
Samantha and a pain in the ass', or 'Hi, I'm Sam a real jerk.'
It would all be so much simpler. Of course we are to blame as
well, because the NPDs and jerks are fine tuned to see the people
who have those invisible signs that say, "Hi, I'm just waiting
to be taken advantage of, so kick me and see." As P.T. Barnum
would say, "there's a sucker born every minute."
Hi, I am Sam, I am a real jerk (laughing). Talk about Freudian
slips ...:o))
I want to relate to the latter part of your ordeal with Miss
X (charming epithet, by the way...:o))
The narcissist is confident that people find him irresistible.
His unfailing charm is part of his self-imputed omnipotence.
This inane conviction is what makes the narcissist a "pathological
charmer". The somatic narcissist and the histrionic
flaunt their sex appeal, virility or femininity, sexual prowess,
musculature, physique, training, or athletic achievements.
The cerebral narcissist seeks to enchant and entrance his
audience with intellectual pyrotechnics. Many narcissists brag
about their wealth, health, possessions, collections, spouses,
children, personal history, family tree ñ in short: anything
that garners them attention and renders them alluring.
Both types of narcissists firmly believe that being unique,
they are entitled to special treatment by others. They deploy
their "charm offensives" to manipulate their nearest
and dearest (or even complete strangers) and use them as instruments
of gratification. Exerting personal magnetism and charisma become
ways of asserting control and obviating other people's personal
boundaries.
The pathological charmer feels superior to the person he captivates
and fascinates. To him, charming someone means having power over
her, controlling her, or even subjugating her. It is all a mind
game intertwined with a power play. The person to be thus enthralled
is an object, a mere prop, and of dehumanized utility.
In some cases, pathological charm involves more than a grain
of sadism. It provokes in the narcissist sexual arousal by inflicting
the "pain" of subjugation on the beguiled who "cannot
help" but be enchanted. Conversely, the pathological charmer
engages in infantile magical thinking. He uses charm to help
maintain object constancy and fend off abandonment ñ in
other words, to ensure that the person he "bewitched"
won't disappear on him.
Pathological charmers react with rage and aggression when
their intended targets prove to be impervious and resistant to
their lure. This kind of narcissistic injury ñ being spurned
and rebuffed ñ makes them feel threatened, rejected, and
denuded. Being ignored amounts to a challenge to their uniqueness,
entitlement, control, and superiority. Narcissists wither without
constant Narcissistic Supply. When their charm fails to elicit
it ñ they feel annulled, non-existent, and "dead".
Expectedly, they go to great lengths to secure said supply.
It is only when their efforts are frustrated that the mask of
civility and congeniality drops and reveals the true face of
the narcissist ñ a predator on the prowl.
More generally, I harbor this grandiose conviction that many
mental health disorders are rooted in pathological narcissism.