A couple of years ago, I put up this post about overcoming my own mental illness. In particular, I wrote in response to this post by the Happy Feminist about her relationship with her narcissistic father.
In my years in and around the mental health system, I was consistently diagnosed not with depression but with a personality disorder. More precisely, I was regularly described (by several psychiatrists) as having “cluster b” personality disorders: Narcissistic, Antisocial, and everyone’s favorite, Borderline. Based on the traditional criteria, I hit each and every one of the criteria for the last of these, and many of the crucial ones for the first two. From late adolescence until the cusp of thirty, as I cycled in and out of doctors’ offices and hospitals, these diagnoses were offered again and again. And in my 2006 post, I talked in general terms about my recovery, conversion, and transformation. But I didn’t get much into specifics.
I’ve corresponded a bit with Jan at Planetjan, who has written quite a bit about dealing with folks with Narcissistic Personality Disorder. (See her first, second, and third excellent pieces.) She wrote something that stirred me up a bit, for understandable reasons:
How is a personality disorder different from mental illness? I had a hard time initially wrapping my head around this one. A mental illness (schizophrenia being the most widely known) can be treated, with varying degrees of success, with medications or cognitive therapy. Most mental illnesses are caused by brain cell synaptic disruptions, most of which are believed to be genetic in origin. I have friends who are bipolar and as long as they take their meds, any symptoms subside and they feel and act relatively “normal.” Mental illnesses typically present themselves in late adolescence or early adulthood. The onset of the mental illness is often sudden and profound. A mental illness descends over a person’s personality like a heavy wool blanket feels on an already warm summer night.
A personality disorder, on the other hand, is all pervasive. The DSM-IV describes a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”
With mental illness, a person’s personality is blanketed, or suffocated, by the onset of the mental illness. But the personality of someone with a personality disorder is virtually interwoven into every fiber of that blanket. Unravel the blanket and you unravel their personality.
So someone doesn’t have a personality disorder; they ARE the personality disorder. These personality traits are so deeply ingrained that they defy change.
Bold emphasis mine.
I’ve heard this distinction between mental illness and personality disorders before, of course, though rarely so succinctly expressed. And of course, it brings me up short. Looking at my life narrative, three possibilities suggest themselves as a response to her position (widely but not universally held by the psychiatric profession) that personality disorders “defy change”:
1. Despite being diagnosed with cluster B disorders again and again over more than a decade by a number of doctors, perhaps I never really had a personality disorder — the shrinks were wrong. I just met a whole bunch of the diagnostic criteria, but not the disorders themselves.
2. The diagnoses were correct in the first place, and I’m fooling myself — and a lot of other people — when I claim that I have “overcome” the pernicious influence of these disorders on my psyche and my life. I may have gotten better at disguising the NPD and the Borderline characteristics of my identity, but they still dominate my identity at its very foundation.
3. Jan, and a great many doctors, are wrong. Personality disorders, as powerful as they are, can be overcome.
I want to believe #3, and most of the time, I do believe #3. I seldom give much credence to #1, largely because of the preponderance of evidence over a fairly significant period of time. I do worry, less and less as I grow older, about #2. The fear that I am broken, “maimed from the start” by an aspect of my identity that can be hidden but never erased, comes up occasionally. I know that I have aspects of my personality which continue to meet the diagnostic criteria for at least some of the named disorders, even if I do what I imagine is a very credible job of keeping them from becoming manifest and obvious to others.
I’ve known for a long time that my self-involvement, my preoccupation with Hugo, is stronger than the normal self-regard we see in other, well-adjusted folks. And particularly in the past decade, I’ve been very intentional about developing the ability to hear and connect with others and prioritize their concerns. The problem, of course, is that like many narcissists I was always very good at feigning empathy in order to get close to others so that I could win their approval. (Most folks who knew me in my teens and twenties would nod vigorously at this.) The dilemma, as I first began to contemplate my recovery seriously in the late ’90s, was a simple one: how do I make something real out of something I fake very well?
My Twelve-Step sponsor, Jack, told me to practice a new way of listening to people. Normally, my mind would wander in most conversations, even as my eyes and expressions continued to suggest interest. I spent a great deal of time not only wondering what it was that the other person was thinking about me, but also about what I needed to say or do in order to get him or her to do what I wanted (leave me alone, sleep with me, validate me, co-sign some bizarre or dangerous impulse.) Jack told me to repeat, in my head, everything that was said to me — so that I would hear the other person’s words in the voice I clearly paid the most attention to, my own. He told me to ask the universe (or God) to help me to see what the other person really needed from me. Jack told me that if I let their words rather than my own sink in, I would begin to be able to act in response to them with genuine rather than manufactured empathy. It seemed simple, perhaps too much so — but I tried it. And bless him, Jack’s direction worked.
What I came to understand was that while I might have a personality disorder (exacerbated by drug and alcohol addiction), I was not a sociopath. I was not incapable of empathy; indeed, I had a surprising capacity to connect with others. I was able to imagine, quite vividly, how others might feel — and indeed, the intensity of that realization (once the drugs and the alcohol were out of my system permanently) was almost incapacitating. What I realized was that narcissism, for me, functioned like a very loud radio station. As long as I was tuned into to “KHGO” at full volume, listening to a litany of my own needs and anxieties and desires, I couldn’t hear anyone else’s “station” very well. If I had genuinely lacked empathy, I would have lacked the ability to “hear their sounds” at all. But someone who is listening to loud music isn’t incapable of hearing other sounds — they’ve just chosen to drown out everything else. And so learning to lower the volume on my own broadcast was the first key step in learning to hear, really hear, what others were saying and what others needed.
It’s no accident that in the nearly eleven years since I began what has proved (thank God) to be a lasting recovery, my primary volunteer work has been in just two areas: with teenagers, and with animals. I’ve been a youth minister with various churches and the Kabbalah Centre for nine years; my wife and I have run our chinchilla rescue charity for nearly five. Adolescents and domesticated chinchillas are, almost by definition, remarkably dependent upon loving, caring, responsible adults. Taking care of teens and other small creatures proved the great litmus test to determine the degree to which I had been able to overcome my staggering, clinically disordered self-centeredness. But of course, it’s tricky to use this sort of public volunteerism as evidence for having overcome narcissism. After all, I get at least a fair amount of approbation as a result of what I do. Something teenagers and other non-human animals definitely have in common is a tendency to respond to love and attention with a great deal of the same. I get a lot of love and validation and praise from this work, and that is of course pleasing to my ego as well as to my soul.
I’ve come to accept a basic truth, however: true service to others does involve a commitment to de-prioritize one’s own desires. But a willingness to serve doesn’t mean that one’s own pleasure and validation must be absent. In many areas of life, the greatest moments of delight often come at times of shared joys. (Cooking, sex, traveling, and so on and so on). Rubbing my chinchillas behind their ears feels good for them and it feels good for me. And while it doesn’t mean that there is anything deficient about solitary pleasures (from reading a good book in a hammock to masturbation to a nice long run in the mountains), there is a particularly fulfilling aspect to experiencing one’s own capacity to bring delight to another. The fact that I get deep satisfaction and validation from public service doesn’t mean that my narcissism has wormed its way into every aspect of my life. And it’s only been in the last couple of years that I’ve come to accept that commonsensical and happy truth.
Some would say that my first hypothesis above was right: the doctors in the various hospitals were wrong, and I was never a “true” Narcissist or a “true” Borderline. Symptoms are not always proof of a particular illness, and there are those who aren’t even sure that personality disorders exist, or can be accurately diagnosed. All I can prove is that I was repeatedly diagnosed with the same personality disorder cluster again and again during multiple hospitalizations. And if — perhaps a big “if” — the shrinks were right, then I think the friends and mentees and students and family and spouse who know me best today can say that yes, Hugo Schwyzer is capable of being loving and empathetic. (Either that, or I’m a pretty swell actor.) The narcissism that was and still perhaps is in me is not nearly as manifest as it once was.
In the end, I believe that personality disorders can be managed. The disorder is, in some sense, so much a part of my identity that it can never be fully removed, just as my physical allergy to alcohol means that I can almost certainly never drink in moderation again. But just as spiritual work and physical abstinence keeps my alcoholism in check, so too does this constant intentional focus on “lowering the volume on KHGO” work, I pray and believe, to keep my narcissism under control. I believe in the Twelve Step model of mental illness and addiction as a disease. Thus I believe that the disease is in me, and in me forever; one aspect of that disease is made manifest in a disordered, narcissistic personality. But recovery — though perhaps not a cure — is real. If I choose to ignore my “work”, the volume on that self-obsessed broadcast will quickly drown out everyone and everything that doesn’t meet my immediate needs. But if I do the conscious work I’ve been taught to do, then I will hear you, and feel you, and be able to connect to you without first evaluating how it is you can validate me.
And I’ve got people in my life who can attest to all this: to the man I was and the man I am and the difference between the two. That’s a happy thing.
I’m a doctoral student in clinical psychology, so take what I say with a big grain of salt!
I don’t know you personally, Hugo, but your blog posts don’t suggest that you’re looking at the world in a seriously warped way. Your language doesn’t give that indefinable hair-raising feeling one gets in the presence of serious personality problems. I WOULD say that (having faithfully read your blog for a year or so) I’m not surprised that a much more distressed you, years ago, might have won a PD diagnosis. It is obvious that you do get very involved with yourself, who you are, where you’re going, what the meanings of your actions are, to a level that is higher than average. I’m not willing to make a moral or psychopathological judgement about that, though. It takes all kinds, and you’re one of the kinds.
I should note that your stronger-than-average self-involvement does make you remarkably capable of self-reflection, and I think you use your blog to fiarly fearlessly share quite a bit of valuable stuff! Sounds positive to me!
But let me tell you my view on PDs:
1. The DSM-IV-TR diagnoses are for shit. It is way too easy to win a PD diagnosis. Look at borderline, for example. You just need five of nine criteria. That means you can have two almost exactly different clients, both of whom can be diagnosed with borderline PD. The diagnoses are badly abused by practitioners. When you see that someone was diagnosed with borderline PD, for example, you don’t know whether this is someone with genuine problems or just a woman who wasn’t much liked by her last therapist. (Borderline PD is almost always awarded to women, BTW. I imagine you know that. You would have been that rare animal, a “male borderline”. Notice the marked category? Congratulations!)
Then there’s the whole problem of things like “is it Avoidant PD or is it Social Phobia, Generalized Type?” You make the call! Let me not get into that, it makes me too angry.
2. That said, there are definitely people who have long-standing, deeply-ingrained personality thingies — that’s a technical term, there — that involve seriously skewed ways of interpreting the world that (a) do not rise to the level of psychosis or delusion and (b) are not easily treated because they are so very much a part of how the person sees the world. It’s not easy for the person to decide that it’s a problem that needs to be treated. I would not say “the person is the disorder” but I would say “the symptoms involve chunks of the person’s identity”. Nuanced, hey?
3. So what do we do about it? Opinions vary, including my own. I think it has to depend on the client, the severity of the problems incurred by the client’s behaviors, the level of the client’s willingness to engage in treatment (or the amount of trouble s/he has gotten into that may have forced him/her into treatment, sadly), and quite a few other factors.
Best of luck to you, Hugo. Thanks for sharing the journey.
My mother, as you know, suffered from several mental illnesses when I was a kid. The thing is, though, is that she KNEW that she had a problem and sought help for it. With personality disorders, specifically, NPD, the people who need the help often don’t know it because they’re so involved with themselves; they reject the therapy that they need so badly because of their own narcissism. I do believe NPD disorder is real, and that it can be overcome, but overcoming it is a very, very rare thing indeed. I am not optimistic that most narcissists will realize that they need help because they generally don’t realize how messed up they truly are. Your story is living proof that breaking out of it is possible though, and I thank you for sharing it here.
Thanks, Luis and Sarah.
Luis, in the old DSM-IIIR, I hit nine of nine criteria for Borderline. They were always a bit surer of that than NPD. But yes, these are moving targets, and as you rightly point out, different people with very different problems can end up with the same diagnosis. And of course, when I was first encountering the psychiatric profession in all its glory, it was the late-1980s and everyone and their sister was getting diagnosed Borderline!
I was fortunate, too, to have a cluster — so that my NPD, if that is what it was, was accompanied by other problems that tended to lead towards hospitals and encounters with law enforcement. I could not maintain an illusion, even to myself, that everything was fine when I kept ending up handcuffed or on temporary psych holds in various facilities. Those who don’t have the other complicating issues may not get the message.
Jack’s advice on repeating is a sound one and also has many uses in studying!
While the original quoted passage is kind of pessimistic about treatment for personality disorders, I don’t think it actually conflicts with your experience, Hugo.
Overcoming something is not the same as excising it. You didn’t unravel the blanket and take out the narcissistic parts. You came to understand yourself better, and find ways to identify and take conscious action against giving into the worst impulses of those aspects of your personality. They’re not gone, but you’ve learned to master them - to be in control of them rather than letting them control you.
I think the biggest difference suggested by the quoted passage is the role of drugs/medicine in successful treatment. The writer suggests that you can “lift the blanket” of mental illness by taking prescribed medications, but that personality disorder cannot be so easily lifted away. In other words it requires self-ananlysis, a desire to change, and on-going strategies for learning ways to turn down the narcissistic/borderline/antisocial impulses and turn up the opposite impulses/skills.
Anyway, very interesting post.
Well I can tell you that my mom was diagnosed as borderline several years back and at the time it was accurate. I was told that that one was virtualy irreversable. Within the last two years, quite possibly thanks to ECT treatments, she is basically back to her old preborderline self.
Nothing real intelligent to sat here. Just that that was my experience.
In other news, I was recently diagnosed with dependant presonality disorder and no one has suggested to me that this can’t shift.
I might have a form of ADD, and when I was reading about this, I recall someone wrote that it isn’t polite to say someone “is” ADD, rather that they have it. The lack of an adjectival form for every noun in the language can be a problem, because not enough people know about how nouns and adjectives work, or something, and so we get usages like that that sound like they are reducing a person to whatever someone diagnosed them with, even if they don’t mean to.
Someone else said that psychology now is in the same stage that cardiology was before Harvey discovered circulation. That sounds about right, sometimes. One doctor says you have X, another says you have Y, someone else thinks you have Z, when it really might be W, and they all wind up with your $.
Now, about inherent anomalies that might or might not be disorders. This would be #2 on Luis’s list. I’m one of those that are wired differently–more into things/ideas than people, and affected strongly by certain shapes. I figure it is a mutation of some kind. I share some of the qualities of Aspergers syndrome according to the questionaire, but not enough to really converge, and I have always felt that whatever I am is unknown and unnamed. But some doctors would have crammed me into the “autistic spectrum”, just as my mom keeps saying, based on her reading of Temple Grandin books. I say I have read just as many books by Robert E. Howard, and I thought I was some sort of changeling. But I still suspect there are a lot more spectra out there, and they don’t all intersect. And if I am anywhere near as smart as some folks think they can fool me into believing they think I am, then no one else can tell me what I am.
Once upon a time, homosexuality was considered a disorder, whether it was inborn or not. Some are more enlightened now, and I hope this tolerance eventually trickles down to us introverts/lonw wolves. Lack of proper tolerance, among other things, is part of what led one therapist to decide I have PTSD. I am still uncomfortable with having my problems share the same name with the agonies suffered by those who have actually been in combat, but a word is needed. Perhaps the bad effects of extended childhood physical, verbal and sexual abuse on me were more subtle. I don’t want to diminsh them, but it still doesn’t sound like it should have the same name as what my stepbrother went thru–creeping thru the jungle where death lurked at every turn in the trail, seeing the enemy first and still not being able to save his comrades, and seeing a child fall under the wheels of his truck, and still having shrapnel in him. Well, this is just a case of language falling short. At least he got to shoot back! Okay, enough with that digression. But it sounds like it has to do with how 2 people can have 8 different symptoms and both get the same label if all 8 happen to be on someone’s 9-point list. Nuanced, for sure.
Personality disorders–another tangly and confusing term. Some disorders, that is, things that really do cause problems, I suspect could have been prevented if the person afflicted with them had early on gotten more training in not just self-defense but manners. (Guilty as charged.) And posibly habits, of thought and work. (Ditto.) Some of this can help in existing conditions, e.g. compulsive exercising or not exercising enough, or a resolve to be friendlier and listen-i-er to everyone in one’s next job. But a person can need help with all these, and just blaming them is not the answer. Do we have any personal responsibility? Well, yes…maybe–but my hackles automatically raise when someone starts talking about mine, because so often it is used as a dodge for them to get out of theirs. E.g., someone says the poor have choices in living better, and even if that person knew the life situations of each poor person in the land, it still sounds like they are letting the rest of the society, that did so much to cause poverty in the 1st place, right off the hook. Even if they don’t mean to do so. How about asking them what they think their choices are, and using a little diplomacy in leading them to any better ones they just don’t know about?
A good post and thread. By the way, if anyone here has Vyvance prescribed for them, be advised, withdrawal is not pleasant. Taper off. And I hope your doctor is affordable enough that you can actually commmunicate with them enough not to find out the hard way.
Oh, and happy new year.
I might add that the current and past system of naming disorders has also gotten in the way of naming and attacking some other problems that I observed in my parents–Can’t Keep One’s Hands To Oneself Disorder, Can’t Understand The Need To Stick Up For One’s Child Disorder, Can’t Deal With One’s 1960’s Anxieties So Projects Them Onto The Kid Disorder, and Can’t Seem To @#$%^&! LISTEN Disorder.
But if this method was extended, darn near everyone would wind up being diagnosed with some form of mental illness. I don’t claim to have the answer.
The last people I trusted with my care seemed to think that drugs would fix everything, and when they didn’t, these people wanted to up the dose to what I consider a dangerous level. If my heart beats too fast, there’d better be a bike under me. They did not seem to notice that at least part of the problem was a corrupt system that neither helped my problems nor noticed my strengths. If I pointed this out, they would say, “Oh, but that can’t be helped, we have to focus on what we can change, which is you.” This just does not smell right any more. I don’t deny I have some problems, but I start to feel like even if I could be made perfect it would not help me.
I’m getting new therapists now. With any luck they will help in not only such stratagems as recommended by Emily, but some inroad on social change.
Angiportus, I am a great believer in helping folks to change what they can about themselves. But of course, it’s worth pointing out, again and again, that happiness isn’t the automatic default of living. Grief happens. Medicating away sadness, without being willing to look at the root of that sadness holistically and globally, is a woeful strategy. But insurance companies like it.
Luis, great post. Personally I’ve always wondered if “Borderline Personality Disorder” is just a fancy way for a therapist to say “I think this patient is kind of a bitch.”
Very interesting post and comment thread! Just wanted to add that I am also inclined to disagree with #3. A growing, methodologically rigorous research literature is demonstrating that PDs are not necessarily lifelong and do respond to psychotherapy!
I found your post interesting and have taken several days to “sit on it.” Yes,I’ve had numerous visitors to my blog planetjan. (Hugo sent me!) Thank you very much.
It’s ironic that your name and picture popped up on Facebook through a mutual friend. I recognized your name. Sure enough, I still had your post on flirtation bookmarked from two years ago, when I was first researching NPD.
I hadn’t read any of your other posts about your hospitalizations and diagnoses, but now I have. I appreciate your honesty and candor as one of my sons has OCD and also spent a stint as a minor at Las Encinas due to drug-related problems. I had to laugh when you described how cute the nurses thought it was that you wore duck slippers, as that sounds so much like my son.
Though you obviously have narcissistic tendencies (but on some days, so do I), ultimately you don’t seem grandiose (in the clinical sense), which is what distinguishes NPD from the other Cluster B disorders. Sam Vaknin, himself a narcissist, said that “self-reflection” is the antonym for “narcissism.”
Narcissists, as a rule, are not self-destructive, and none I know have ever shown self destructive tendencies (other than substance abuse). None have sought help from a therapist (unless they were literally dragged there by a significant other) as they were convinced they didn’t have a problem. I tend to agree with Emily’s comment above. My friends in 12-step programs are quick to point out that they are always “recovering,” as opposed to “cured.”
So, from my own (albeit limited) experience, I’d give you a clean bill of health when it comes to NPD. Narcissism, though, is like a ground fog that swirls about ALL of the Cluster B disorders.
Your relentless introspection runs contrary to this diagnosis. BTW, your sponsor sounds like a wise and very patient man. I imagine when you did Step 10 - “Continued to take personal inventory and when we were wrong promptly admitted it,” you took it to the nth degree! I say this with all due sincerity.
Fascinating post - I grew up with a father with severe mental health problems. Was told it was manic-depression at some point but I’ve since suspected some sort of personality disorder that wasn’t diagnosed or my parents decided not to say (ironically, they are both psychologists). The key for me is (in most cases) whether someone wants to change, wants treatment. My father clearly didn’t and never did get better - was consistently narassisitc and anti-social.