Labelling People – Thinking About Narcissistic Personality Disorder

Recently, the New York Times reported that the mental health diagnostic “bible,” the DSM is going to drop Narcissistic Personality Disorder in its 5th Edition.   Laura Smith, Ph.D. provides a good explanation for why this was done, here.  While an interesting development in its own right, the move brings to mind an overriding concern about the easy use of labels like “narcissistic.”  Many, many, times have I heard people in recent years label someone as “narcissistic.”   It’s not that “people who believe the world only exists if seen through their own eyes” don’t exist – and it’s not that these folks don’t cause a lot of distress to those close to them. (I remember hearing in my training that the only way you see a person with NPD in therapy is if their spouse or family basically says, “Get help on this or we’re outta here!”)  San Diego mediator Bill Eddy identifies people struggling with NPD as one of a handful of “high conflict personalities” who challenge helping professionals mightily.  But here’s the problem – it’s easy to label, isolate and dismiss another person, losing sight of the fact that this rigid shell of a personality they present to the world covers enormous, old pain.   Eddy has suggested that the 4 major “high conflict personalities” at their core, are protecting themselves from the pain of early, constant violations to their developing, tender personalities.  The “borderline” personality is driven by the Fear of (emotional) Abandonment, suffered so early.  The “antisocial” personality is driven by the Fear of Being Dominated.  The “histrionic” personality is driven by the Fear of Being Ignored.   The “narcissistic personality” is driven by the Fear of Inferiority.  In fact, these people with hugely (over)inflated views of themselves have buried within their hearts a glass shard of failure to measure up – of not being good enough.  When we almost cavalierly label others as “narcissists” (or any other thing) we rob them of their humanity and pain.  Of course,  in their striving to protect themselves from the ancient, overwhelming wounds that are long-buried within,  they may often overwhelm and deeply injure their intimates.  But as with all injuries which we suffer at the hands of others, our own healing comes in part through our own halting efforts to understand and even hold compassion for the other. It’s not necessary to label the other so that we don’t take on responsibility for our own injuries.  It was never our fault anyway.  To humanize ourselves without dehumanizing the person who wounded us is an ongoing challenge and, I think, righteous goal.

Attachment – The Tie That Truly Binds

Two lovers come into the therapist’s office, raw and wounded from months, or years, of painful conflict.  Perhaps they are in their seventh year of marriage.   Maybe they’ve been together 20 years.  (Marriage expert John Gottman says that the two peaks for divorce are in the first 7 years of marriage or in the 16-20 year range.)   Whatever their time together, there is one thing that most of these very sad and stressed couples have in common:  Their relationship shares the basic need for Attachment that this mother and child display .   What is “attachment?”   As John Bowlby first explained to us, attachment is a fundamental need for connection with another.  It is as biologically driven as food.  Children deprived of a safe, secure bond with a caregiver (usually the mother, but not always) will suffer dearly.  This need doesn’t go away just because we grow hair under our arms.   It prevails throughout life.   Attachment for a one year old means a secure base.  Touch mom.  Know she’s there.  Then explore your world.  Without that base, life is overwhelming and the child is lost.  Attachment means a safe haven.   When life threatens, our attachment figure is where we turn for security.  If you think this is just about babies ask yourself: Have I been more productive and comfortable in the world as an adult when I was in a secure relationship (if you have been so fortunate)?  Ask as well:  Who did adults call on their cell phones when the airliners slammed into the Twin Towers on 9/11?  Their husbands/wives/partners/closest friends…first call was to attachment figures.  The godmother of adult attachment theory and how it affects our intimate relationships is Dr. Sue Johnson.  Her approach to marital therapy for these desperately struggling people who are bonded, yet alienated, is Emotionally Focused Therapy.  Her book  Hold Me Tight is a guiding light for couples seeking reconnection.

The Marital Dance of Conflict

Our fights sometimes have the feel of a couple of siblings in the back of the car on an endless road trip. “Johnny, Susie, stop fighting!” The inevitable response is something like: Susie – “He hit me first!” Johnnie – “I did not! She kicked me.” Susie – “That’s because he took my pencil.” Johnny – “Did not!” Susie – “Did too!” Etc. Now this is not to say that the hurt and anger we feel when we are locked in painful conflict with our partner is child-like or immature. Quite the contrary – it seems to go to the core of who we are sometimes. That’s not the point here. If you look at the above scene, you’ll see a circular argument in which each person believes the other person started it…that the other person is the cause of the distress. Of course, the other person thinks that it started with you. In law, partners who are locked into this conflict will go and hire lawyers, who in turn will try to convince a judge that their side is right and the cause of the problem is the other person. I promise you, that in every case that a judge says one person is the cause of the problem, that decision will never, ever, ever convince the other disputant. He or she will just feel screwed – unheard – misunderstood. For good reason, too, because our ongoing conflicts are ultimately circular in causation. We ultimately react to the other person who ultimately reacts to us. By the time the circle is joined, the conflict has a life of its own and the start is about as obscure as trying to find the missing link in the fog of antiquity. The key isn’t who is right. Rather the key is, how can we disengage from this cycle and stop hurting each other and get back on track. Helping with this often difficult task is, by the way, one of the great services a skilled marital therapist can provide.