Narcissism - Treatment Modalities and Therapies - Part II

Written by Sam Vaknin

The fourth edition ofrepparttar authoritative "Review of General Psychiatry" (London, Prentice-Hall International, 1995), says (p. 309):

"(People with personality disorders) ... cause resentment and possibly even alienation and burnout inrepparttar 126195 healthcare professionals who treat them ... (p. 318) Long-term psychoanalytic psychotherapy and psychoanalysis have been attempted with (narcissists), although their use has been controversial."

The reason narcissism is under-reported and healing over-stated is that therapists are being fooled by smart narcissists. Most narcissists are expert manipulators and consummate actors and they learn how to deceive their therapists.

Here are some hard facts:

There are gradations and shades of narcissism. The differences between two narcissists can be great. The existence of grandiosity and empathy or lack thereof are not minor variations. They are serious predictors of future psychodynamics. The prognosis is much better if they do exist. There are cases of spontaneous healing, Acquired Situational Narcissism, and of "short-term NPD" [see Gunderson's and Ronningstam work, 1996]. The prognosis for a classical narcissist (grandiosity, lack of empathy and all) is decidedly not good as far as long-term, lasting, and complete healing. Moreover, narcissists are intensely disliked by therapists. BUT…

Side effects, co-morbid disorders (such as Obsessive-Compulsive behaviors) and some aspects of NPD (the dysphorias,repparttar 126196 persecutory delusions,repparttar 126197 sense of entitlement,repparttar 126198 pathological lying) can be modified (using talk therapy and, depending onrepparttar 126199 problem, medication). These are not long-term or complete solutions – but some of them do have long-term effects. The DSM is a billing and administration oriented diagnostic tool. It is intended to "tidy" uprepparttar 126200 psychiatrist's desk. The Axis II Personality Disorders are ill demarcated. The differential diagnoses are vaguely defined. There are some cultural biases and judgements [seerepparttar 126201 diagnostic criteria ofrepparttar 126202 Schizotypal and Antisocial PDs]. The result is sizeable confusion and multiple diagnoses ("co-morbidity"). NPD was introduced torepparttar 126203 DSM in 1980 [DSM-III]. There isn't enough research to substantiate any view or hypothesis about NPD. Future DSM editions may abolish it altogether withinrepparttar 126204 framework of a cluster or a single "personality disorder" category. When we ask: "Can NPD be healed?" we need to realise that we don't know for sure what is NPD and what constitutes long-term healing inrepparttar 126205 case of an NPD. There are those who seriously claim that NPD is a cultural disease (culture-bound) with a societal determinant. Narcissists in Therapy

In therapy,repparttar 126206 general idea is to createrepparttar 126207 conditions forrepparttar 126208 True Self to resume its growth: safety, predictability, justice, love and acceptance - a mirroring, re-aprenting, and holding environment. Therapy is supposed to provide these conditions of nurturance and guidance (through transference, cognitive re-labelling or other methods). The narcissist must learn that his past experiences are not laws of nature, that not all adults are abusive, that relationships can be nurturing and supportive.

Most therapists try to co-optrepparttar 126209 narcissist's inflated ego (False Self) and defences. They complimentrepparttar 126210 narcissist, challenging him to prove his omnipotence by overcoming his disorder. They appeal to his quest for perfection, brilliance, and eternal love - and his paranoid tendencies - in an attempt to get rid of counterproductive, self-defeating, and dysfunctional behaviour patterns.

By strokingrepparttar 126211 narcissist's grandiosity, they hope to modify or counter cognitive deficits, thinking errors, andrepparttar 126212 narcissist's victim-stance. They contract withrepparttar 126213 narcissist to alter his conduct. Some even go torepparttar 126214 extent of medicalizingrepparttar 126215 disorder, attributing it to a hereditary or biochemical origin and thus "absolving"repparttar 126216 narcissist from his responsibility and freeing his mental resources to concentrate onrepparttar 126217 therapy.

The Myth of Mental Illness - Part II

Written by Sam Vaknin

That psychoactive medication alters behaviour and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. Thatrepparttar changes brought about by prescription are desirable – is debatable and involves tautological thinking. If a certain pattern of behaviour is described as (socially) "dysfunctional" or (psychologically) "sick" – clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".

The same applies torepparttar 126194 alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behaviour patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven aboutrepparttar 126195 interaction of nature and nurture, genotype and phenotype,repparttar 126196 plasticity ofrepparttar 126197 brain andrepparttar 126198 psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.

Nor isrepparttar 126199 distinction between psychotropic substances and talk therapy that clear-cut. Words andrepparttar 126200 interaction withrepparttar 126201 therapist also affectrepparttar 126202 brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines – as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) – treat symptoms, notrepparttar 126203 underlying processes that yield them.

IV. The Variance of Mental Disease

If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed,repparttar 126204 case. Psychological diseases are not context dependent – butrepparttar 126205 pathologizing of certain behaviours is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures – and utterly normative or advantageous in others.

This was to be expected. The human mind and its dysfunctions are alike aroundrepparttar 126206 world. But values differ from time to time and from one place to another. Hence, disagreements aboutrepparttar 126207 propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.

As long asrepparttar 126208 pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms – i.e., mostly on observed or reported behaviours – they remain vulnerable to such discord and devoid of much-sought universality and rigor.

V. Mental Disorders andrepparttar 126209 Social Order

The mentally sick receiverepparttar 126210 same treatment as carriers of AIDS or SARS orrepparttar 126211 Ebola virus or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done inrepparttar 126212 name ofrepparttar 126213 greater good, largely as a preventive policy.

Conspiracy theories notwithstanding, it is impossible to ignorerepparttar 126214 enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, onrepparttar 126215 propagation ofrepparttar 126216 concept of "mental illness" and its corollaries: treatment and research.

VI. Mental Ailment as a Useful Metaphor

Abstract concepts formrepparttar 126217 core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visitedrepparttar 126218 unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.

"Mental health disorders" are no different. They are shorthand for capturingrepparttar 126219 unsettling quiddity of "the Other". Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating bothrepparttar 126220 dangerous andrepparttar 126221 idiosyncratic torepparttar 126222 collective fringes is a vital technique of social engineering.

The aim is progress through social cohesion andrepparttar 126223 regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is oftenrepparttar 126224 case with human endeavour, it is a noble cause, unscrupulously and dogmatically pursued.

VII. The Insanity Defense

"It is an ill thing to knock against a deaf-mute, an imbecile, or a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)

If mental illness is culture-dependent and mostly serves as an organizing social principle - what should we make ofrepparttar 126225 insanity defense (NGRI- Not Guilty by Reason of Insanity)?

A person is held not responsible for his criminal actions if s/he cannot tell right from wrong ("lacks substantial capacity either to appreciaterepparttar 126226 criminality (wrongfulness) of his conduct" - diminished capacity), did not intend to actrepparttar 126227 way he did (absent "mens rea") and/or could not control his behavior ("irresistible impulse"). These handicaps are often associated with "mental disease or defect" or "mental retardation".

Cont'd on page 2 ==> © 2005
Terms of Use