Wednesday, June 13, 2012

Suicide Threats and the Narcissist

I received a comment on this post in the last 24 hours that actually provoked me to write.  And I wrote with enough substance that I decided to put it on the front page so that all may read it.  Here is the comment:

I agree with a lot of what is said on here. Regarding the comments about being scared of death meaning the person won't commit suicide... I just want to share that one of my family members may have been narcissistic, and threatened suicide often as a manipulation tactic. We thought that she would not do it but she did. Being scared of death might be a narcissistic trait, and they might threaten suicide as a manipulation, but I'm just sharing that that doesn't mean a person won't do it. I think it might be helpful to remember that narcissism is a disorder... so while it is angering keep some perspective about the person still being a person you don't want to die from suicide.

I will comment on the final point first: perspective is exactly what I present on this blog.  The perspective is this:  narcissists are their own creation.  Their "disorder" isn't something that just accidentally happened without their contribution.  They create their own "disorder" and then they inflict it on everyone around them.  When narcissists threaten suicide this perspective still applies.

It is well established that most people who serially threaten suicide aren't very serious about actually doing it.  The serious ones will almost always do it without giving even a hint of their intentions.  Or they will do just that: hint without an overt threat being made.  Many times those hints aren't recognized by others for what they were until it is too late. 

While suicide is always a tragic end to any life we shouldn't pretend that we can actually stop someone who is serious about doing it. That doesn't mean we shouldn't try to intervene, it simply means we shouldn't blame ourselves if they successfully complete the act. I don't know of any caring family member, friend or even co-worker who wouldn't try to stop someone who has threatened to kill themselves.  People will go to great lengths to help an apparently suicidal person.  This is the very reason that narcissists love to use this threat to get attention whenever they want it.  If there was an ongoing problem of people ignoring suicide threats then do you think that narcissists would use those threats to get attention?  Obviously answer is no.  If a narcissist is frequently threatening suicide then you have all the proof you need that the threats are garnering them much attention.  If they move on from threats to actually doing it then the blame rests squarely on them.

If the suicidal person doesn't accept the help when they make threats to kill themselves then I think it highly irresponsible to blame the people around them for not doing enough to stop them.  I'm not saying that this commenter is blaming people for this, but it can be inferred that they think the way this topic has been discussed on this post would lead people to not do enough to stop the suicidal person.  I'm just pointing out what I think is obvious...the truly suicidal person will carry through no matter what people may do to try to stop them.  Additionally, individuals who frequently make these threats without any real attempts should also accept the blame when people stop believing them.

The problem presented in the post (and the comments) isn't that people don't or won't do enough to help suicidal individuals.  The problem is how there are crassly manipulative people who will use suicidal threats to get what they want.  In the end, the narcissist is always after all the attention in the room.  All I was trying to get across is that there is a distinct possibility that all those suicidal threats are actually being used to get compliant behavior from us.  Recognition of that possibility isn't going to stop people from trying to help someone who threatens suicide with regularity.  I think that people deserve to know they are being manipulated when these threats are ongoing.  Being aware of this (not slight) possibility will allow people to do their own assessments of what is happening and decide when they will stop letting these threats rule their own lives.  

That the narcissistic person in this commenter's life seems to have defied this logic above doesn't negate what I've said.  There are exceptions to every rule.  There is also a possibility that the suicide wasn't supposed to work. It is well known that there are people who attempt suicide but the method and timing often reveal that the person was hoping someone would intervene.  It is usually called a "cry for help" and not seen as a total commitment to offing themselves.  These individuals do get help.  Whether they will avail themselves of it is another matter.

Suicide is recognized by the psych community as very often being a hostile act toward others.  It can be used to stick a shiv between the ribs of family and friends that can never be removed.  That is a lot of power to wield.  To pretend that suicidal people don't factor that in is to be stupidly naive.  So putting more potential blame on those who've had a family member or friend kill themselves is cruelty.  They already shoulder far too much blame.  Blame that was foisted on them by the act of suicide itself. 

Here's another thought for all to chew on:  suicide is homicidal behavior inflicted upon oneself.  (I'm sure I've pointed that out before somewhere on this blog.) Homicidal behavior is just a fancy phrase for murder.  Murder is in the heart of the suicidal person.  That murderous intent has all too often spilled over into murdering other humans for us to safely ignore this reality.  This is not something people are willing to point out very often, but if you have someone in your life who is suicidal, you also are dealing with a person who could very possibly justify killing others.  It must be said.  To say it another way, a suicidal person is not just a danger to themselves; they may easily also be a danger to those around them.  People deserve to know that fact and adjust their lives accordingly.  Frankly, I would advise anyone to try to help an openly suicidal person, but when it becomes apparent that help is not being accepted then it is best to be on guard.  Put some distance between yourself and that person.  But that is my opinion.  If you choose to risk continued close association that is your choice.  No one is going to stop you.

No one here wants anyone to commit suicide.  Not even the narcissist. Not even when they make us angry. What I have provided here is plenty of perspective.  It is perspective that factors in multiple realities...not just one.  People are smart enough to figure this out without being talked down to.  The problem out there isn't that people are dehumanizing narcissists and hoping they will follow through on their death threats against their own person.  The ongoing problem is that narcissists dehumanize us.  And then abuse us accordingly.  To point this and other realities out about narcissists doesn't dehumanize them.  It exposes them.  Narcissists are, without exception, predatory.  I have expended much effort to help people stop being prey.  Our right to life, liberty and the pursuit of happiness isn't suspended by hungry narcissists even when they act like they want to kill themselves. 

Please read all the above with the realization the the blog author here fully understands that people who aren't narcissists may threaten suicide.  They may actually carry it out.  I'm not saying all people who threaten suicide are narcissists.  Please don't construe anything I've said to be implicating that.  But if you know you're dealing with a narcissist then all the above must be considered.

Also, I want to add that the person whose comment I responded to in this post deserves to know this all applies to her/him too.  I hope this person isn't blaming themselves for the suicide of their family member.  That is a heavy burden to carry.  Please don't carry it.  I want to make sure that no one carries that burden unnecessarily.  That is what this response is about.

Sunday, December 19, 2010

More on the Removal of NPD from newest DSM

Because of the length of the following comment to the last post on this blog I'm presenting it on the front page.  The comments field is limited in terms of space so I'm putting it here.  I'm also putting it here because it deserves front and center placement as a professional opinion on the subject.  It provides some important historical background on the DSM that must be factored into this discussion.

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As a psychiatrist with personal experience with NPDs, I fully concur with Anna's views that this change in the DSM is essentially a non-event for all the reasons she enumerated.  Perhaps some additional information about the DSM may be helpful in fully appreciating some of the reasons for its meretriciousness.  (To save some of you from consulting a dictionary, "meretricious" is defined as apparently attractive but having in reality no value or integrity.  I also use this word not unintentionally for its archaic meaning - of, relating to, or characteristic of a prostitute.)

Some of the individuals who first developed the DSM are well known among psychiatric circles to have severe NPD themselves.  The interests of one DSM "innovator" in particular were in statistics and in ways to categorize knowledge generally.  At the time in the 1960s, a dedicated system of classification of mental disorders was lacking.  Previously these disorders were given codes in a manual called the International Classification of Diseases (ICD) along with all other medical disorders.  Seeing an "opportunity," one DSM originator chose to go to medical school and specialize in psychiatry exclusively in order to have the credentials to create a classification system.  Medicine and psychiatry were merely means to another end.  The womb of the DSM resided in an obsessive individual who possessed a prominent dearth of humanity and who by the same token could have easily chosen to classify machine tools, toads or sea shells.  In addition, for the initial DSM there was very little consensus.  It is the product of just a few individuals.  This was the inauspicious inception of the run-away train we now call the DSM.

Another critical point to remember is that the primary impetus for a classification of mental disorders was for research purposes - not for clinical utility.  That is why it is a diagnostic and STATISTICAL manual.  The use of medications in psychiatry began in earnest in the 1950s creating a need to do clinical trials.  A system was needed to enable researchers to group individuals together diagnostically.  One cannot for example do a trial of a drug for schizophrenia without defining the population for which the medication is purported to be effective.  Thus the birth of the DSM and its subsequent revisions has been influenced in no small way by changes in the field of psychiatry and in pharmaceutical technology. 

The pharmaceutical industry is not the only one that has influenced the evolution of the DSM.  Since the 1980s, the health insurance industry has exerted an increasingly formidable influence on the way mental health disorders are viewed.  Because it determines the reimbursement of treatment services, it creates demands on the field for the EXPLICIT purpose of decreasing expenditures.  This industry has clearly had an impact on how individuals are diagnosed.  In stage one, personality disorders were excluded from any reimbursement.  The DSM then responded by creating all sorts of other reimbursable categories into which a psychiatrist could "fit" that patient.  More recently the insurance companies for reimbursement considerations have created strata of severity of mental illnesses in which, for example, major depression, schizophrenia and full-blown bipolar disorder are reimbursed more fully than other less debilitating "disorders" such as adjustment disorders, anxiety disorders, etc.

Perhaps one day a historian will go back and rigorously track the developments in the DSM against the developments in the pharmaceutical and insurance industries.    I am convinced that we will see clear concordance.

And as other industries as well as cultural views continue to pressure and influence how we view behavior, thought and "feelings," the DSM will follow in kind.  One example is "Social Anxiety Disorder" as if there is one person who doesn't get anxious speaking in front of a group of people.  The list of inane diagnostic classifications is endless.

In order to keep ahead of the game, the DSM revisionists employ two other strategies.  The first has always been unspoken and is rarely contested: that all behavior, thought and "feeling" is under the purview of "mental health" and its soldiers, psychotherapists (psychiatrist, psychologists, etc.).  Should tomorrow many people start snapping their fingers frequently, the DSMers would have a classification for that in the next revision.  The underlying problem here is that there is no definition of "mental illness" or "mental disorder."

A fine example is just this topic:  NPD.  For years, I frequently have read laying down on my sofa and crossing my legs.  Now I have a knee problem, one that the orthopedic surgeon can directly relate to my bad reading habits.  With proper changes in behavior and stretching, the knee problem is much improved.  So is the case with malignant narcissists.  As this blog pointed out several times, "garbage in, garbage out."  If one goes through life executing malice and then must distort the truth in order to not be caught, one's thinking will become disordered.  That is NOT a mental disorder.  It is the ramification of a habit over which one can exert control.  The DSM makes no distinction between the ramifications of controllable and self-modifiable bad habits versus the ramifications of a process over which volitional control is impossible (e.g., schizophrenia). 

The second DSM strategy is to create categorical buckets so over-inclusive that it is irrefutable.  Hence nearly every "diagnosis" contains a "disclaimer" with language such as, "The present symptoms cannot be otherwise better accounted for by [another] diagnosis."  Or, another sub-category is created to allow for any exception to the rule.  This sub-category is termed "NOS" which stands for "Not Otherwise Specified."  Thus if someone complains of depression of a type that does not fit exactly with the sub-types enumerated in the DSM, that depression is deemed, "Not otherwise specified."

Therefore the DSM "takes all comers."  It is set up in a way that one cannot even attempt to challenge or refute it because it contains inherent escape clauses which are designed only to make it immune from any criticism.  Thus it exists to perpetuate its own existence.  It is a simulacrum; i.e., an image without the substance or qualities of the original.  Simulacra may contain elements of truth (e.g., the DSM's description of schizophrenia), but due to the lack of definition, coherence, mission  and integrity in its core being, its utility is best characterized by where my copy ended up.

One winter, I ran out of firewood...

One postscript.  It may appear that the DSM committee is composed of "academics" and not clinicians.  The distinction today is not very sharp as nearly all "academics" do clinical work.  (I know not a few of them and can vouch for that statement).  In my opinion, psychiatrists have thrown their hands up in trying to understand the "personality disordered" for which, not for nothing, they have little chance of obtaining research funding.  And although they will never publicly admit it, they don't want to even see those "bad and difficult patients" anyway.

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The above was contributed by H2tat
http://www.blogger.com/profile/07402389084387348536

Thursday, December 09, 2010

My Two Cents on NPD Being Removed from the Newest DSM

It seems there is some expectation that I have an opinion and need to weigh in on the latest news about NPD and four other personality disorders being removed from the upcoming DSM V since a few people have emailed me about this development. I haven't felt compelled to say anything because I've already stated what my position on psychiatry's labels is. In case you haven't read every word of this blog I'll consent to stating my reaction to the above news. It is more of a non-reaction, really.

Okay, to be systematic about this, the New York Times published an article on November 29, 2010 about the deletion of Narcissistic Personality Disorder from the upcoming DSM. You can find the article here. It is titled, "Narcissism No Longer a Psychiatric Disorder."

Let me state categorically that this deletion in no way affects any of the content of this blog. This blog is established on the authority of eyewitnesses as well as the authority of an objective morality not on the authority of the grand poobahs of psychiatry. I have been unimpressed with the so-called science behind the labeling game of this profession and have stated so on this blog. You know as well as I do that a pen stroke in some stuffy conference room doesn't dismiss the reality of those who are malignantly narcissistic. These pointy-headed academics cannot eradicate the colossal damage narcissists inflict in every realm of human interaction with their decision to shift or erase labels.

Here are a couple quotes from my own blog that should clarify for you how little this news affects my view of anything on this subject. In my article titled, "Narcissist or psychopath....both are human predators" I stated:

Speaking of categorization...I think we would all do well to remember the rather arbitrary lines that have been drawn up for us by the psych community. They are allowed the freedom to re-draw the lines as they deem necessary which only tends to prove the non-scientific nature of the categorization.

Rather a succinct statement for such a windy blogger. But there it is. The labels are not scientific. With this in mind, they can f*&% around with the labels all they want. It won't change a damned thing as far as we are concerned. It will change the way these people are given "treatment", but considering how few actually ever end up in a clinical setting I'm not sure it is going to affect much there either. All this newest deletion of NPD and four other labels does is prove my statement above...once again. Labels aren't science. They are names. What the academic egg heads decide to name a thing isn't going to change my view on those people out there who wreak their damage on everyone in their sphere of influence. Period.

In my blog post titled, "Irresponsible Journalism or Psychologists...or Both" I was talking about the psychoanalyzing of Blagojevich (then mayor of Chicago) going on in the media at the time. The quotes are longer to provide some of the context:

First of all, the so-called professionals love to tell us laypeople that we are not qualified to determine whether or not someone we know has NPD by comparing that individual's behaviors with an checklist. What the article from the Sun-Times illustrates to me is how the 'professionals' are the ones who are unqualified. I think it is highly unprofessional for a psychologist to make pronunciations on someone's mental state to the media when that psychologist has never even met the person in question. They should at least try to uphold some of the standards they hold the rest of us to. They tell us we can't diagnose persons whom we've grown up with or married or worked with for years yet, sight unseen, they can make absolute statements about a person's mental health just from reports they've read in the media and a few pictures of a person? Bah.

This is just one very good illustration of why you should ignore anyone, especially the 'professionals', who tells you that you can't tell whether or not someone in your life has NPD. They don't know Jack themselves. No one knows what NPD is more than someone who has suffered from its predations for years. Eggheads in ivory towers only know NPD from textbooks.

Obviously, I've already expressed how little reverence I have for the labeling game of the professionals. This being the case I'm not affected when they again play with their labels. Whatever. While they're masturbating themselves with their power to pronounce someone mentally ill or "normal" I'm content to know what I know. That is because I know what I know from extensive personal experience. I know what I've seen, heard and lived through, so the labels that are in the DSM, or that aren't in the DSM, don't affect my knowledge or shift my past experience in the least.

I used the label of NPD on this blog because of the ease of communication. It was a convenient label for a couple of reasons. First, because it was an objective listing of behaviors to compare someone's actions to in order to know that we're talking about the same animal. Second, the description of the behaviors and attitudes that this label represented has become rather well known to the general public which means that people who are searching for answers on this subject will usually use the label of NPD. So it made sense for me to use the psychological term for ease of communication and in order to reach as many people out there looking for answers as I could. I didn't use the label of NPD on this blog because I recognize the authority of psychiatry to draw the lines or make the labels correctly in every instance. They had it right with the over-arching description of Narcissistic Personality Disorder so I consented on that basis alone to use their label. They had the label right because it was restricted to describing what is observable about this personality type. Observation is the basis of real science. Therefore I wasn't opposed to using a label that was based on the scientific exercise of what can be observed. Because the label of NPD was a comprehensive, over-arching view of this personality type it has become a good tool for the clinicians out there who have to deal with these people in therapy. This reality tends to prove that the label was an effective description of the scope of behaviors seen in narcissists. Again, another vote in favor of the label NPD.

Even though I am dismissive of the "science" of labels I do recognize the great power this profession wields because of their generally accepted power to label. This profession's ability to apply labels to their fellow human beings has a potentially profound effect on lives. It is a power that is too often misused and can devastate lives. When I apply a label to a person I don't have that kind of power. That is because my labels don't have the authority to put someone into an institution without their consent therefore depriving them of their freedom. My labels can't force a person into therapy. My labels can't deny a person a job or put them in prison. My labels can't make money for innumerable doctors or sell pharmaceuticals. My labels are therefore quantifiably different than those that psychiatry makes. The power to name things is a significant thing when you are called a scientist and have the power brokers of society acceding to your right to make those labels.

All this being said, I suspect that this newest development will not be permanent. The article in the New York Times hints at the internal war that has commenced between the clinicians who actually deal with these people and the academics who largely don't. I'll be mildly interested to see who wins the war. I'm hoping that reality wins. Narcissists are not normal because they exist in large numbers. Narcissists are destructive and often dangerous to others. And by dangerous I don't just mean in the mortal sense. They are dangerous to the emotional and mental well-being of others. They destroy lives without necessarily taking lives. This is not normal. Not ever. The DSM manual may be the bible of the psychiatric world, but it isn't ours. Know what you know and let those in their cloistered halls of academe play their little naming games amongst themselves.

Tuesday, January 05, 2010

Book Review: The Narcissism Epidemic

I came across an older article by U.S. News & World Report that contains excerpts from the reporter's interview with one of the authors of the book, "The Narcissism Epidemic: Living in the Age of Entitlement" and thought I'd highlight both the article and the book in a post. No, I haven't read the book as I only just found out about it, but I'm going to be buying it because it looks like a stellar treatment of the subject of narcissism from both the excerpts of this article and the reviews I've read.

It appears to me that we have a couple of Ph.Ds actually applying some science to the subject and, therefore, they break away from the usual cliches about narcissism that comes from pop psychology. I agree with all seven points in this article (for the most part) and I adore the answer to #4 (a little narcissism is healthy). I have not explicitly come out against this pat phrase that continually comes out in discussions about narcissism, but I've definitely in no way supported this belief on my blog. I don't and never have believed that "a little narcissism is healthy." Quoting from the article:

You have to ask, "Healthy for whom?" Narcissism is basically never healthy for other people. It tends to work out OK for the narcissist in the short term, but in the long term, they end up messing up their relationships at work and at home, and they end up depressed later in life.

Another way to phrase this is to substitute the word "narcissism" for "selfish". As in, "Selfishness is basically never healthy for other people..." You can decide to deny this but your denial won't ever change my mind. Selfishness always ends up subtracting from the lives of those around you. Now, don't go defining selfishness as the necessary care we must take of our persons. If we don't make sound decisions about how we take care of our health then we're useless to ourselves and everyone else. Stick to the true meaning of words. See here if you don't know the definition of selfishness.

I also want to hug these people for coming out against this blather: "You have to love yourself to love someone else". I have profoundly disagreed with this statement myself for many years now as I've come to see the truth of the matter. That these psychiatrists have actually grasped and unapologetically oppose this idea is surprising to me but thrilling. This idea of needing to love yourself first before you can love someone else is tirelessly chanted in Christian circles because of poor exegesis of Christ's statement to "love one another as you love yourself." What a good student of Scripture realizes is that God's perspective on how we love ourselves is that we do it unconditionally. So this statement is a command to love others as unconditionally as you already love yourself.


The U.S. News article can be found here.


Friday, September 25, 2009

If your mother was a narcissist then you'll understand this...

An interesting article appeared on the UK Daily Mail a few days ago. Erin Pizzey is stating a solemn truth that must be seriously considered by the world: that women are every bit as capable of cruelty and abuse as men are and that it is time to stop pretending that men have the corner on being abusers. She describes her childhood growing up with two abusive parents and describes her mother's abuse as being much worse:

...it was my mother's more emotional, verbal form of abuse that scarred me most deeply. She indulged in a particular kind of soul murder...

Those of us raised by a malignant narcissist mother certainly can understand what Erin is describing.

I won't be entertaining heated defenses of feminism in the comments section. Keep the comments confined to the point of this article...that women are just as capable of being abusers as men are. And women may very well be more damaging in their form of abuse because they understand the nuances of emotional and verbal slaughter and have more access to their children to carry out their abuses.

Read it and weep:

Why I loathe feminism... and believe it will ultimately destroy the family