The Sound of Music comes along with many wonderful lessons, perhaps the most important being, “Let’s start at the very beginning. A very good place to start.” The last two weeks have been a total shit storm. If you don’t feel that way I suggest checking yourself. There is a lot going on. And there should be.
From a psychoanalytic perspective this time of year is ripe without the current status of our country and leadership. Add in a pandemic and an election year and well, it’s a complete clusterfuck. Emotions are running high and at the day’s end I find myself picking my jaw up off the floor at what is being passed off as science, fact, and just general decency and compassion. I choose to laugh at psychology. If we are to go with my model that psychology is like gravity, we might as well laugh, because it impacts all of us. I guess if I wasn’t laughing I’d be screaming. I’d rather laugh.
In interest of taking the sage advice of Julie Andrews - she's probably right about everything, let’s start with some facts. I thought now would be a nice time to review narcissism. It’s a rich area and one that I find quite fascinating. I’ve worked with narcissistic patients in the past in acute settings and if you are wondering, well, we all have a front row seat to what that looks like. You are nearly as skilled as I am at this point of navigating space with a full blown narcissist, never mind and entire team of them. But when the shit is really hitting the fan, it’s always important to go back to the facts. Here’s one that I find pretty funny, when the updated DSM was released - the DSM or Diagnostic and Statistical Manual of Mental Disorders was published, that would be edition 5, the review board actually discussed eliminating Narcissistic Personality Disorder. Interesting move. There were reasons to do so, but they all seem hilarious right now, considering social media, technology, general feelings of emptiness, and then of course there’s Donald. Ha! Luckily they decided to leave it in. Anyone who has ever worked with someone in acute crisis who also suffered from NPD (Narcissistic Personality Discover) is aware if its existence. It’s big and clunky and awkward and very difficult to treat and get close to. Not to mention be around. It’s rough. The biggest factor in NPD is that individuals act in the exact opposite of how they feel inside. Most don't know they have these deep feelings of worthlessness and unimportance, but that's what drives the behavior and grandiosity. Clinicians like to use the term narcissistic injury or wound, because that's really what it is. A covering up of an emotional wound that will just not stop bleeding. It's awful. And it's powerful.

Each disorder - I use the term loosely- there are many professionals myself included that find the term disorder limiting. What does that mean really? But it is still helpful to have a standard guide created by professionals with research and clinical experiences. Like I said, the facts are important. And a baseline in psychology is essential. Each disorder has a section in the manual with a corresponding number and criteria that must be met tp make the diagnosis. This is mostly to make communication between treatment teams smooth. Everyone is on the same page about what is required for a formal diagnosis. Again, starting with facts is important. Here’s what the Diagnostic and Statistical Manual of Mental Disorders volume IV says about Narcissistic Personality Disorder (The DSM 5 is slightly different - The DSM-IV is the version I can reference from home).

Narcissistic Personality Disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) is often envious of others or believes that others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes

And so there you have it. I’ll let you digest.

What I want you to know, that is usually not evident, is that all of the above hurts. So bad. It's agonizing. Like being trapped. It is very difficult to stop and change and progress. The wound is deep and very, very bloody. But like all things, there is the potential to get better. It's hard. Takes a team. But it's possible. Not ever easy, but better. Perhaps that's what we can wish for in all things. Just to be better.

What did you learn today? Join me by using the #thesethreethings and commenting below with your own These Three Things. I want to hear what you are learning, laughing about, and living through.