December 1, 2010

Narcissism Out Of The DSM-- And Into The Open

finnegan.jpg
nothing to be said


Jay Mohr, popular comic and actor, did a phone-in to the Opie & Anthony radio show and told this story (I recite from memory):

So I'm shooting Hereafter, and there's a scene where I walk up these flights of stairs, I fumble for my keys and my next door neighbor is supposed to hand me my mail, and it's a letter from Matt Damon and blah blah blah. 

So all she has to do is hand me the letter and say, "here's your mail."  But she's some San Francisco wannabe actress, and she's decided she's going to get her Oscar on this movie.  So she comes over, all dramatic, and she says, "so, ummmm, hi.... You want your mail?... Looks like you got a letter here...."  And she hands it to me, but then she pulls it back at the last second, because she wants to be a cunt, and I reach for it, she pulls it out of my hand again.  So finally I just grab it, and she says, "well, enjoy your mail."

So Clint Eastwood (the director) is down at the bottom of these three flights of stairs watching all this on the monitors, and you hear him say, "goddamn it!"-- he doesn't even yell cut-- and he starts coming up the stairs, he's like 9000 year sold, coming up, puffing, really slowly.  Finally he gets up to the top and he looks at her and he says, "honey, I can't begin to tell you how much this movie isn't about you.  If I could have hired just your goddamn arm, I would have."
II.

You may have heard the news: "Narcissism is being removed form the DSM."

Narcissistic personality disorder, characterized by an inflated sense of self-importance and the need for constant attention, has been eliminated from the upcoming manual of mental disorders, which psychiatrists use to diagnose mental illness.
That sentence is technically accurate.  What's missing, however, is that it would be replaced by something else, a more wordy, symptom cluster description of a personality disorder.  You can still "diagnose" someone with narcissistic traits.

However, on the face of it, people are understandably freaked out:

One of the sharpest critics of the DSM committee on personality disorders is a Harvard psychiatrist, Dr. John Gunderson, an old lion in the field of personality disorders and the person who led the personality disorders committee for the current manual.

Asked what he thought about the elimination of narcissistic personality disorder, he said it showed how "unenlightened" the personality disorders committee is.

"They have little appreciation for the damage they could be doing." He said the diagnosis is important in terms of organizing and planning treatment.

Since he doesn't get Pharma money, there's no need to disclose his megalodon sized bias: his whole career is about measurement tools for narcissism.

And so if you're thinking that the craziness is that psychiatry is the doing away with the concept of narcissism you have fully missed the point: the issue isn't whether narcissism exists or not, the issue is who gets to decide if narcissism exists or not.

You break it, you bought it.

III.

Here's a metaphor.  When The Oscars, defying all logic and sanity, choose Sandra Bullock as best actress-- a woman who Gwyneth Paltrow (Shakespeare In Love) once used as an example of the kind of actress she didn't ever want to be (Demolition Man-- anyone see the irony?) the strength of that choice isn't that her performance in The Blind Side is even good but that I, me, a guy who watches movies, believes that The Oscars are nuts for choosing her: they have tricked me into thinking that their decision has any relevance.

I realize it matters to the actors' future salaries and sales and blah blah, but these annual terrible picks reinforce to me that they should have picked something else.  But why should they have?  As a reasonably educated person I recognize that people have individual tastes; but that there are some things that make a work of art better or worse; but neither of those things are the purview of The Oscars-- they only make me think it's their domain.  In other words, who cares what they think?  But while I have no problem dismissing the relevancy of the Super Bowl victor, it still infuriates me that the Oscar goes to X, and that's because they've beat me.  I know they don't have any say about what is good.  And yet I'm furious, every single year.

IV.

You want a historical example, here you go.  No one gets diagnosed with obsessional  neurosis anymore.  People do, however, get called obsessional and neurotic by regular people.

What happened is that a term that highly educated and philosophically precise people used all the time was turned into a vernacular label; and the power of "diagnosis"-- read: labeling-- seized by the new emperors of psychiatry with a different paradigm.

The person in the chair is still recognized to have a pathology: but one group is dismissed by the other group as being mean, pejorative and unrigorous: "we don't call it that, that has no construct validity, it's better described as this."

Never mind that the new terms have no more validity than the old terms, and are equally invented.  That's not the point, diagnosing the patient isn't really the point, the point is that the DSM is the authority.  They've made it that the burden of proof of disagreement is on you, not them.  They gain the credibility not by improving the diagnosis, but merely by altering it.  And so you all say, "well, I think they're wrong, but they must have had some scientific reason that I don't fully understand..."

And you're stuck.  You're left suspecting that there is something really, really wrong, but since it's not bipolar and it's not a unicorn you're left wondering if you're not just a prejudiced ass.  Worse, the only one you can turn to for "support" is Freud, et al, which immediately gets you labeled as a nut.

Yet you can't help but see it-- so you tentatively try to dress it up in the least disparaging way you can, and turn to psychiatry for a little help, but:

"Well, we all know there's no such thing as hysterical neurosis.  Allow me to offer an equally arbitrary but nonetheless reliable construct that puts all the power of labeling in our hands."

Wait, that's not what I was going for...

V.

Let's go back to that telling scene in Hereafter.  To the extent one can make a judgment on a single anecdote, let's agree that at that moment the actress was behaving narcissistically.  Psychiatry, however, would not have a quick way of discussing this (and, truthfully, it didn't a year ago either.)  But by not having a useful description of it, that behavior is no longer  psychiatry's problem.

Added bonus: it's yours.







Comments

I understand that we give t... (Below threshold)

December 1, 2010 7:38 PM | Posted by Anonymous: | Reply

I understand that we give those who put together the DSM the authority to define what is and what is not an illness but my question is why was narcissistic personality disorder removed in the first place? In so far as Alone always advocates that narcissism is widespread in America, are we to assume that narcissism has somehow become the norm and we've opened a kind of pandora's box that will not take back this epidemic?

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it's all just ego.... (Below threshold)

December 1, 2010 8:06 PM | Posted by k: | Reply

it's all just ego.

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They way you're presenting ... (Below threshold)

December 1, 2010 8:44 PM | Posted by nohope: | Reply

They way you're presenting it, TLP, I'd characterize this change as a Good Thing. Now that "we" own neurotic and obsessive, we feel free to criticize people with those words without worrying that we're being callous towards someone's "medical condition." Culture has actually a chance to modify behaviors that aren't trapped in the medical racket.

But I still wonder...borderline's out of the new DSM, too. So is schizotypal. What's going to happen to all those "borderlines" now? Will the heuristic you wrote about in an earlier post persist?

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I would think this would be... (Below threshold)

December 1, 2010 9:01 PM | Posted by BHE: | Reply

I would think this would be exciting news for you. Now your definition of narcissism has as much validity as anyone's...

"The New Narcissism: An American Epidemic" by Alone, on bookshelves this spring.

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"Worse, the only one you ca... (Below threshold)

December 1, 2010 9:01 PM | Posted by Anonymous: | Reply

"Worse, the only one you can turn to for "support" is Freud, et al, which immediately gets you labeled as a nut."

Only if you give them the authority to make that call. I'm under the impression you don't though.

I half agree with dropping narcissism; I can't consider it an issue at this point worth medicalizing. Besides, are there clear biological correlates of narcissism, or is it learned behavior?

Hey, there's always the ICD-10!

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"..are there clear biologic... (Below threshold)

December 1, 2010 9:44 PM | Posted, in reply to Anonymous's comment, by Gary: | Reply

"..are there clear biological correlates of narcissism, or is it learned behavior?"

How does learning take place in the absence of "biological correlates"? Where do you think your knowledge is, floating around in space? Learning is a change in biology. Somewhere along the way, you began to think that less than 100% of your experiences on Earth had biological correlates. I'm glad I just altered your biology.

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I think it's a more honest ... (Below threshold)

December 1, 2010 11:37 PM | Posted by casualhero: | Reply

I think it's a more honest position to admit that psych is more than a science. It's philosophical and ideological, which means some of what people point out will never get beyond being a possible model. Like the will to power, or will to meaning, or will to pleasure -- nobody can say with certainty which of these is the most influential, what is for certain going through someone else's thoughts, and so on. Additionally, the idea that someone will come along and quantify the matter is far-fetched. As advanced as neurology is, it's nothing like being inside someone's head. The point is, these ideas, like narcissism or the will to X, give people something to look for. They give you something to work with, discuss. You may conclude in some instances that it is the case, and in others not.

Ultimately, of course, everything rests on your own shoulders as far as what you're going to actually believe. That can be terrifying or freeing.

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marry me alone.... (Below threshold)

December 2, 2010 12:01 AM | Posted by oohlala: | Reply

marry me alone.

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At least religion is clear ... (Below threshold)

December 2, 2010 12:37 AM | Posted by Anna: | Reply

At least religion is clear about right and wrong behaviors.

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right and wrong is pretty s... (Below threshold)

December 2, 2010 1:20 AM | Posted by Anonymous: | Reply

right and wrong is pretty subjective. is it really wrong not to believe in jesus?

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And shouldn't this bring th... (Below threshold)

December 2, 2010 1:28 AM | Posted by Anonymous: | Reply

And shouldn't this bring the bible into question? we give unfounded authority to the DSM and oscar committees, don't we do the same with the bible?

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When I say "biological corr... (Below threshold)

December 2, 2010 1:31 AM | Posted, in reply to Gary's comment, by Anonymous: | Reply

When I say "biological correlates" I imply something like differences in neural architecture associated with psychopathology (like a hypothesized dysfunctional HPA axis in PTSD, or low serotonin levels in people with antisocial personality disorder) or endocrine dysfunction.

Your statement was about as meaningless as the term neuroplasticity. Sure, there are synaptic changes in the brain. That happens with everything though. Congratulations, you didn't even attempt to answer my question.

My point is that if narcissism is psychogenic, than it could be culture bound (DING DING DING - WINNER!). If narcissism is the norm (as has been promoted on this blog), than how is it a dysfunctional state? Why keep it in the book?

...but that's the point, isn't it.

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Models in science aren't pe... (Below threshold)

December 2, 2010 1:35 AM | Posted, in reply to casualhero's comment, by Anonymous: | Reply

Models in science aren't perfect representations of phenomenon..hence they're models.

Speculation and theory are still within the purview of naturalistic empiricism, don't be so quick to check it at the door for some other explanation. Science attempts to seek evidence, but if you want responses without any "proof," then by all means, seek out philosophy.

If these models lack really any supportive evidence after a point, it really doesn't matter if they give you something to discuss.. you may as well spend your time chatting about unicorns or invisible teacups. Both are equally meaningless.

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So this entire blog is real... (Below threshold)

December 2, 2010 2:09 AM | Posted by Walenty Lisek: | Reply

So this entire blog is really just a giant sequel to Christopher Lasch's "Culture of Narcissism"?

I wonder how Lasch's writing would have been effected if blogging had been popular when he was alive.

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Is this just part of a larg... (Below threshold)

December 2, 2010 3:44 AM | Posted by Dave: | Reply

Is this just part of a larger trend, where as different forms of behavior become more socially acceptable, it becomes verboten to keep them in the DSM (e.g., some readers here may not realize that until 1973, homosexuality was in the DSM as a mental disorder)?

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"I think it's a more honest... (Below threshold)

December 2, 2010 6:10 AM | Posted, in reply to casualhero's comment, by Ben: | Reply

"I think it's a more honest position to admit that psych is more than a science. It's philosophical and ideological, which means some of what people point out will never get beyond being a possible model."

Just a second hero. We could probably agree that psychiatry is not a science, but what makes it *more* than a science? If calling it philosophical and ideological means that it's absolved of the responsibility of basing its claims on evidence, then one could just as easily argue that it's LESS than a science. I don't want to in play the 'what did TLP, our Great Leader, really mean?'-game, but in an older post, he described it (aptly) as 'not even wrong' (http://thelastpsychiatrist.com/2007/04/the_trouble_with_psychiatry_no.html).

In a science, truth is independent of ideology, which is why Angela Merkel chose to study physics in the former East Germany - the powers that were couldn't bend the truths of physics as they could and did in other disciplines. If you abandon this model, truth becomes merely a function of power - it is what the powerful say it is. If you revel in psychiatry's ideological manifestations, get ready for a Cold War. And don't forget what Julius Nyerere said about the Cold War: "It matters not whether the animals are fighting or making love, they still trample the grass." Granting it the status of ideology delivers truth into the hands of the powerful, and I'll bet that you and I would be grass under their feet.

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Hey doc, check this out:</p... (Below threshold)

December 2, 2010 6:20 AM | Posted by Whatever: | Reply

Hey doc, check this out:

http://www.nytimes.com/2010/12/02/garden/02parents.html

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To Alone:I'm not s... (Below threshold)

December 2, 2010 7:43 AM | Posted by syntaxfree: | Reply

To Alone:

I'm not sure how your last sentence follows from the rest of the article. You show by analogy to the Oscars that the DSM tricks its way into being The Manual by giving pompous names ("antisocial personality disorder") to things that already had names ("psychopath") without adding specificity, ddx power, etc. (It's been a while since I had to write on screening validity).

Then you tell us that by excluding NPD from The Manual's list of Mental Illnesses, psychiatry exculpates itself from the societal problem of narcissism. Following your narrative, wouldn't they just invent a new category (maybe something less judgmental like "Interpersonal unawareness disorder")? Don't you shrinks have access privileges to the proceedings of the DSM-V working team that we common nutcases don't?

Besides, isn't this contrary to one of the general narratives of your blog -- namely, how society offloads its problems to psychiatry?

Anyway, maybe the correct thing would have been to keep a NPD category that's more restrictive on Axis II and add "Interpersonal unawareness" along with koro and susto in Axis IV (culture-bound disorders). Or go dr. McCoy on this and start working on an Axis V (socialization issues related to personality disorders), which would absorb many "social anxiety"-like things that are messing up the concept of "anxiety" right now.

Of course, Axis IV isn't nearly as glam as Axis II, which is already perceived as something of a dirty, overreaching thing where psychiatry judges people on their personality without even a theory on brain-based etiology. Cf. how the cool Axis II diagnoses (e.g. borderline) are angling for a biological etiology that makes it an Axis I candidate.

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Damn, mah grammar be broken... (Below threshold)

December 2, 2010 7:45 AM | Posted by syntaxfree: | Reply

Damn, mah grammar be broken. English is my third language, I'm late for work and got caught up on this, yadda yadda. Forgive.

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"Right and wrong is pretty ... (Below threshold)

December 2, 2010 9:20 AM | Posted, in reply to Anonymous's comment, by Anna: | Reply

"Right and wrong is pretty subjective". Isn't that the problem right there???

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Scrooge; narcissist with a ... (Below threshold)

December 2, 2010 10:47 AM | Posted by rox: | Reply

Scrooge; narcissist with a medical condition or miserly jerk? DSM says jerk. Now we can just call him a jerk.

The cure wasn't therapy, but self reflection and awareness of others. Which can be encouraged in therapy but really isn't the only light, truth, and way. Like so much else that therapists and psychiatrists claim to have the patent in curing, the real cure is our own awareness, and consideration of others when we make decisions about how to behave. Which of course, follows the decision to actually make decisions about how to behave at all.


Where therapy can help is if you are able to become aware that you aren't happy with your relationships with others. the narcissist may go to therapy because s/he thinks others are inadequate and the goal of the therapist would be to show him/her that s/he may be inadequate. The next step is realizing that no one is in fact inadequate, there is faulty thinking about what being a good person is. It isn't being perfect at social interaction, having a PhD, being in the NFL, having the best art, poetry, music, films, or even curing all of your psychological problems and having a stellar perfect understanding of your own psyche; it's about considering others as well as yourself in your thoughts and actions, and doing the best you can.

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Meh. DSM is like a diction... (Below threshold)

December 2, 2010 11:27 AM | Posted by Anonymous: | Reply

Meh. DSM is like a dictionary. It helps to clarify and establish a shared meaning for various terms. It's not a "Bible" or a prescription but is taken as such by the anti-psychiatry movement.

The DSM-5 people will make some mistakes. Psychiatrists remain uncertain of causal factors in mental disorders. Thankfully they will have fudge factors like "narcissistic traits" or "NOS" categories, and life will go on much as before.

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No, nice try. You ask "...... (Below threshold)

December 2, 2010 11:55 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

No, nice try. You ask "...or..." and create a distinction that doesn't exist. You're question couldn't be answered because its foundation is based on ignorance. Even your reply is nonsense, although you come close.

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"Psychiatrists remain uncer... (Below threshold)

December 2, 2010 11:58 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

"Psychiatrists remain uncertain of causal factors in mental disorders."

The cause of mental disorders is known: Psychiatry.
You don't think they exists independently in nature, do you?

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In reply to: "Speculation a... (Below threshold)

December 2, 2010 1:17 PM | Posted, in reply to Anonymous's comment, by casualhero: | Reply

In reply to: "Speculation and theory are still within the purview of naturalistic empiricism, don't be so quick to check it at the door for some other explanation. Science attempts to seek evidence, but if you want responses without any 'proof,' then by all means, seek out philosophy."

and:

"If these models lack really any supportive evidence after a point, it really doesn't matter if they give you something to discuss.. you may as well spend your time chatting about unicorns or invisible teacups. Both are equally meaningless."

You're taking what I said to some extreme. I never said to throw out science. But it's important to recognize that there is more to life than quantified measurements. And what isn't quantified, scientific, certain, is uncertain. You may be able to name a hundred cases where the will to x is persuasive, and all I need is one counterexample to prove that it isn't universal. Does that destroy the plausibility that the will to x is a powerful motivator? No.

A lot of psych is like this; Alone can't really prove for certain that narcissism is what drove a murder. He can't even use the writings of a person to prove it without a doubt. It's a hypothesis, and whether you find it convincing or not is a matter of how convincing you find Alone's reasoning, and what he gives as evidence -- contrary to what you say in your first paragraph that I propose we ignore it. The reasons behind a hypothesis are still very important.

Alone's entire that America is inundated with narcissism is an example of the sort of hypothesis I mean. He can't prove it. But he can give a long list of reasons, and maybe you will find it convincing that he's on to something. Let's not pretend that what he's doing is "science", in the conventional sense, though. He incorporates it, referring to surveys, medicine, etc. but his basic claim can never be proven the same way that someone has a broken arm.

That doesn't mean Alone's hypothesis is worthless, like "chatting about unicorns or invisible teacups." Alone has good reasons for what he believes. He has reasons. Does anyone have reasons for believing in unicorns or invisible teacups? Does either have any explanatory power? But does narcissism? The will to x? Unicorns and invisible teacups are not the same.

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Speaking of which, I... (Below threshold)

December 2, 2010 1:58 PM | Posted by DOB: | Reply


Speaking of which, I just found this. I think it's hilarious.

"Scientology Claims 'Epidemic of Rape' by Psychiatrists"

http://www.digitaljournal.com/article/270102

Does Scientology fit the pro-narcissism profile? Besides of course being a joke only they don't get.

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For the record, only... (Below threshold)

December 2, 2010 2:05 PM | Posted by DOB: | Reply


For the record, only one "mental health practitioner" has ever made a pass at me, one time in 1986, and I told him no thanks -- if I wanted a Daddy Figure I knew where the leather ever bars were.


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So before Psychiatry... (Below threshold)

December 2, 2010 4:44 PM | Posted, in reply to Anonymous's comment, by DOB: | Reply


So before Psychiatry why did people hear voices and/or want to kill themselves? Without using any herbs or mushrooms, I mean. I'm not saying I swallow the "Mental Illness" paradigm whole, only that at least in places it seems to be addressing something that might really be there.

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Ben, you asked: "Just a sec... (Below threshold)

December 2, 2010 4:46 PM | Posted, in reply to Ben's comment, by casualhero: | Reply

Ben, you asked: "Just a second hero. We could probably agree that psychiatry is not a science, but what makes it *more* than a science? If calling it philosophical and ideological means that it's absolved of the responsibility of basing its claims on evidence, then one could just as easily argue that it's LESS than a science. I don't want to in play the 'what did TLP, our Great Leader, really mean?'-game, but in an older post, he described it (aptly) as 'not even wrong' (http://thelastpsychiatrist.com/2007/04/the_trouble_with_psychiatry_no.html)."

Calling it "more" or "less" than science is a matter of semantics; it uses some science, but not all of it is science. I said it was "more" than science in that sense. It goes further than scientific observation into less certain territory. I suppose I also chose "more" because without going beyond the strictly scientific, we wouldn't have "narcissism" at all. I'm willing to give up scientific certainty for a hypothesis with explanatory value. (And just fyi, I agree with what TLP says in the post you linked.)

In reply to: "In a science, truth is independent of ideology, which is why Angela Merkel chose to study physics in the former East Germany - the powers that were couldn't bend the truths of physics as they could and did in other disciplines. If you abandon this model, truth becomes merely a function of power - it is what the powerful say it is. If you revel in psychiatry's ideological manifestations, get ready for a Cold War. And don't forget what Julius Nyerere said about the Cold War: 'It matters not whether the animals are fighting or making love, they still trample the grass.' Granting it the status of ideology delivers truth into the hands of the powerful, and I'll bet that you and I would be grass under their feet."

I'm not in favor of granting any "status of ideology"; I'm pointing out it's already there, and, if anything, to be wary of it. Just like we should be wary of giving too much credence to hypothesis like narcissism.

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Funny, when I read the arti... (Below threshold)

December 2, 2010 8:59 PM | Posted by Anonimo (rhymes with Geronimo): | Reply

Funny, when I read the article in the NYTimes a few days ago, I didn't even think how earth-shattering this would be for my favorite narcissist-observer. Sure enough, here it is.

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"But it's important to reco... (Below threshold)

December 3, 2010 12:30 AM | Posted, in reply to casualhero's comment, by Anonymous: | Reply

"But it's important to recognize that there is more to life than quantified measurements. And what isn't quantified, scientific, certain, is uncertain."

Time to burn down your strawman. Quantification =! Science, and certainly, if science is anything, it's pursuing uncertainty (it's why it keeps seeking explanations). The methodology is to keep searching for answers - there are no absolute truths.

"You may be able to name a hundred cases where the will to x is persuasive, and all I need is one counterexample to prove that it isn't universal."

That's part of science! The requirements of falsification! What are you talking about?

I'll explain some of what science isn't though: Science isn't continuous post-hoc assumptions. Say that Alone's work has some validity... shouldn't it be predictive, won't you say? It's easy to show all of these cases where a man murders his family and all the dots are painted in, but why can't we anticipate this if it's a valid construct?

I'd be impressed if we could induce narcissistic rage. Set up an experimental condition and test it. If anything, it's become a descriptor, and really not a good one at that.

"Alone's entire that America is inundated with narcissism is an example of the sort of hypothesis I mean. He can't prove it. But he can give a long list of reasons, and maybe you will find it convincing that he's on to something."

If you can't test it, it isn't a hypothesis. It's a response.

You need to brush up on the scientific method.

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Please, specify which "or" ... (Below threshold)

December 3, 2010 12:43 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Please, specify which "or" I was referring to before you spout victory. Both points (neural architecture and endocrine function) are observable, biological phenomenon, which could demonstrate predictive relationships to behavior. Eg. low serotonin = shitty mood, sleep disruption, so on and so forth. Atrophied PFC? Poor inhibition and executive functioning. I'm referring to observations with empirical backing.

You're telling me my "brain changes" without explaining how and in what way. You're giving me a useless answer. Like I said prior, all experience "changes" your brain at some level. I'd expect something like that from Depok Chopra.

When I mention psychogenesis, I'm still referring to something in the brain (I thought we put dualism to bed about 200 years ago). I'm just saying it's far more nebulous an answer than others we can pin point (Like those I mentioned).

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Anon wrote: "Quantification... (Below threshold)

December 3, 2010 1:58 AM | Posted, in reply to Anonymous's comment, by casualhero: | Reply

Anon wrote: "Quantification =! Science, and certainly, if science is anything, it's pursuing uncertainty (it's why it keeps seeking explanations). The methodology is to keep searching for answers - there are no absolute truths."

If it isn't quantification, you can't test it, and it isn't science. You can test and quantify evolution, medicine, gravity, physics, and astronomy. You can't test the inner workings of the human mind; people lie, repress, are uncooperative and have a tendency to deceive themselves. It's impossible to generalize universally from self-reported statements from people.

"Say that Alone's work has some validity... shouldn't it be predictive, won't you say? It's easy to show all of these cases where a man murders his family and all the dots are painted in, but why can't we anticipate this if it's a valid construct?"

The will to power has predictive utility, too. I believe hypothesis are to be taken seriously, even though we can't get anywhere near proving them.

"If you can't test it, it isn't a hypothesis. It's a response. You need to brush up on the scientific method."

Hypothesis doesn't only refer to the scientific method's definition. I hoped this was clear in my earlier posts since I was saying the hypotheses weren't scientific, but in any case, in a positive sense, a hypothesis like this has explanatory power without being testable.

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Every time I start pining f... (Below threshold)

December 3, 2010 3:46 AM | Posted by Whatever: | Reply

Every time I start pining for the "good old days" I read something like this.

http://www.cbsnews.com/stories/2010/11/28/sunday/main7096335.shtml

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Equating scientific method ... (Below threshold)

December 3, 2010 5:49 AM | Posted, in reply to Anonymous's comment, by Ben: | Reply

Equating scientific method with falsification is kinda naive. From your symptoms, I'd guess that you haven't taken any new ideas since Bacon or Popper. To prevent this acute condition from going chronic, please take two Bhaskars and a Lakatos, and call me in the morning. (Kuhn is a treatment method of last resort whose side-effects can outweigh the benefits. If it all, it needs to be administered with other ideas to maintain perspective.)

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anonymous - "It's easy to s... (Below threshold)

December 3, 2010 9:48 AM | Posted, in reply to Anonymous's comment, by AnAnon: | Reply

anonymous - "It's easy to show all of these cases where a man murders his family and all the dots are painted in, but why can't we anticipate this if it's a valid construct?"

Depends who you mean by "we" really. These predictions are made all the time, it's why restraining orders exist and are used (the wives of the men with these kinds of personality disorders, if they can leave, often end up in women's shelters for protection). If the prediction is accurate, the murder is averted. (I believe Alone or a commenter once pointed out that delaying tactics were very important to give the person some time to live with the collapse of their image, in some cases it's necessary to hide the wife and children since even time makes no difference.) There are a couple of reasons why you get "he was such a nice guy, I never suspected he was a violent asshole"...most of them have to do with not knowing the person at all...people think murderers are scary people on TV not real people, the false image many narcissists present is one that some other people aspire to so that means they buy the whole con because they're already invested in it on their own behalf, there's a weird belief that if someone is "successful" that they must be happy/healthy/"good"/not have any problems, etc. It reminds me a bit of how poor people in the US vote not to tax the rich, you know, just in case they're rich one day.

anonymous - "I'd be impressed if we could induce narcissistic rage. Set up an experimental condition and test it. If anything, it's become a descriptor, and really not a good one at that."

It's not hard to "induce narcissistic rage" in someone with a NPD in real life - people with NPDs are controlling of others but that's because they lack self control themselves and their interior life is entirely dependent upon what's going on outside of them. However, it would obviously be an incredibly difficult thing to study "scientifically". The whole nature of social interaction and emotions is terribly hard to study because it's so context specific that putting it into an experimental context changes everything. As soon as the person is aware it's an experiment, their behavior changes.

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Seriously, why would... (Below threshold)

December 3, 2010 2:35 PM | Posted by Anonymous: | Reply


Seriously, why would it matter whether to an MD whether "Narcissistic Personality Disorder" is in the DSM since there's no pill for it? If I understand correctly, at least on the outpatient side non-pharmaceutical treatments are now the preserve of "mental health counselors" like LCSWs and "holistic therapists." What CAN a contemporary psychiatrist DO, in the short appointment time allotted, for someone who thinks he matters more than everybody else (the true short definition of "narcissism") except to refer him to someone who specializes in that sort of thing?

Do people who don't have to rely on psychiatrists who take Medicaid (or some "managed care" thing) get anything BUT 15 minute med checks these days? I'm starting to wonder if any shrink bothers to remember anybody's face from one appointment to the next. If my experience of the last 18 years is indeed typical (which the other guys say it is), then I don't see the point to psychiatry of a medical degree except to legally write prescriptions, which any half-way intelligent LCSW could be trained to do in less than a week.

"Antidepressants > non-sedating > won't make pt. fat > covered by Medicaid or $4 generic." How hard is that?

Given that most of the several dozen shrinks I've seen since 1992 have wanted to prescribe the latest wonder drug with the snazziest brochure, a half-dozen of which have given me such annoying side-effects that I've had to insist on switching off of, it's not like there's much that's really going on. ("Yes, I've read that they also market Cymbalta as an anti-migraine drug, but I've had a migraine at least 5 days a week in the two weeks I've been on it; that didn't happen with Lexapro so I want to switch back, even if The Literature says it's less effective.")

If there's no pill to treat a Disorder (even "off-label") why would a prescription-writer care about the deletion of that diagnosis?

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Hey, now that pathological ... (Below threshold)

December 3, 2010 8:59 PM | Posted by vanderleun: | Reply

Hey, now that pathological narcissism has been installed in the White House, what makes you think that shrinks want it to be officially nuts to have it any longer?

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Since when has patho... (Below threshold)

December 3, 2010 10:16 PM | Posted, in reply to vanderleun's comment, by Anonymous: | Reply


Since when has pathological narcissism NOT been installed in the White House? "Pathological narcissist" is another word for politician. Of any party, on anylevel, anwhere.

You're a bit wet behind the ears still, aintcha?!?

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Oh, anon, you really need t... (Below threshold)

December 4, 2010 1:39 AM | Posted by vanderleun: | Reply

Oh, anon, you really need to wake up your brain and not just jerk your knee. Don't let catch phrases numb your brain. Continue to rely on alcohol.

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The main battle in psychiat... (Below threshold)

December 4, 2010 10:17 AM | Posted by AnAnon: | Reply

The main battle in psychiatry is between psychiatrists who believe their job involves treating people and those who believe their job is only treating bodies with pharmaceuticals. We know which side the corporations (those who sell medical insurance, pharmaceuticals, etc..this also includes all those "alternative practitioners" who push vitamin/supplement scams but have fought and won the right to prescribe pharmaceuticals in some place in the US and Canada) are on and finance (or threaten to pull financing from) are on.

http://www.rawstory.com/rs/2010/12/drug-company-ghostwriters-author-work-bylined-academics-documents-show/

http://en.wikipedia.org/wiki/David_Healy_%28psychiatrist%29

If we admit there are social/contextual/cultural aspects to mental illness, and individual and collective misery, that can be treated by treating the person (and not just their body) or making societal changes, then people may want to change the system/society. (This doesn't mean that drugs can't be useful, but it does mean that drugs ONLY are not a solution.) You know, the revolting masses may actually revolt and reclaim society for people instead of corporations posing as people and claiming human rights.

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"If we admit ther... (Below threshold)

December 4, 2010 12:36 PM | Posted, in reply to AnAnon's comment, by Anonymous: | Reply


"If we admit there are social/contextual/cultural aspects to mental illness, and individual and collective misery, that can be treated by treating the person (and not just their body) or making societal changes, then people may want to change the system/society."

Yes. Societal changes. Indeed.


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Grew up, Teabagger. ... (Below threshold)

December 4, 2010 12:38 PM | Posted, in reply to vanderleun's comment, by Anonymous: | Reply


Grew up, Teabagger. Obama's not anything like a socialist, and the System was rotten before he was born.

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Don't you think the reason ... (Below threshold)

December 4, 2010 7:10 PM | Posted by Anonymous: | Reply

Don't you think the reason you can accept the Super Bowl victor is that it's not a subjective decision that makes them so?

Great Jay Mohr story. Sadly, many acting schools encourage such "actor choices" and put the "great stories" in the canon ( ex.: James Dean giggling and saying "that tickles" while being frisked in RWAC; Richard Gere getting naked during the audition for "Looking for Mr. Goodbar").

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You're free now!... (Below threshold)

December 4, 2010 9:54 PM | Posted by Anonymous: | Reply

You're free now!

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At least religion is cle... (Below threshold)

December 6, 2010 1:41 PM | Posted, in reply to Anna's comment, by harpy: | Reply

At least religion is clear about right and wrong behaviors

come again?

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Anonymous Dec 6 @ 7:10PM</p... (Below threshold)

December 7, 2010 10:02 AM | Posted, in reply to Anonymous's comment, by Jack Coupal: | Reply

Anonymous Dec 6 @ 7:10PM

regarding the Jay Mohr story, Anyone who has seen Clint Eastwood in Gran Torino knows that Clint was Walt Kowalski and not just pretending to be him.

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Speaking of narcissi... (Below threshold)

January 9, 2011 6:57 PM | Posted by Anonymous: | Reply


Speaking of narcissism:

"Young people prefer praise to sex, money"

http://www.usatoday.com/yourlife/parenting-family/teen-ya/2011-01-08-selfesteem08_ST_N.htm

To me that's backward and stupid: I'd much rather be anonymous and ignored while having lots of sex and money. Instead, because I'm "mentally defective," I'm a world-famous Net Kook. Ah well, such is life.

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"Kids from a very early age... (Below threshold)

January 9, 2011 7:09 PM | Posted by Anna: | Reply

"Kids from a very early age are being socialized to do well — to be hard workers. It creates this sense of entitlement."

Uh, what? Achieving things through hard work doesn't make you entitled. This guy is an idiot.

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Jeans are popular to both m... (Below threshold)

January 11, 2011 5:21 AM | Posted by True religion : | Reply

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The point is that whatever ... (Below threshold)

January 18, 2011 2:43 AM | Posted, in reply to Anonymous's comment, by Rookie: | Reply

The point is that whatever narcissism is, it is. It will be what it is no matter what the DSM personality disorder panel says it is. Changing the criteria does not alter people and reality, and clinicians will still have to work with the same clients, the same presentations and treat each individual as they come.

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Notice: Diagnosic and Stati... (Below threshold)

February 2, 2011 10:07 PM | Posted by Thomas: | Reply

Notice: Diagnosic and Statistical Manual IVTR- I urge readers to search for any statistical argument or analysis anywhere in its pages. The word "statistical" is there for the same reason a fat man wears a bathing suit.

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While I love the "fat man i... (Below threshold)

February 2, 2011 10:38 PM | Posted, in reply to Thomas's comment, by syntaxfree: | Reply

While I love the "fat man in a bathing suit" image and fully intend to steal it and use it as soon as possible, "statistics" isn't a synonym for "statistical analysis". The DSM is a Manual for Diagnosing and keeping Statistics -- it's a function that has a fucked up person as its domain and a list of Dxes as its image. Such statistical coding is useful for epidemiology -- comparing prevalence rates across population cohorts with different characteristics, for instance -- and for keeping clinical trials consistent with each other.

Does this always work well? Not really. I like to discuss every time these things come up what I call the Topamax Problem. Topamax has been rejected in clinical trials for bipolar, and yet there are countless individual case reports where Topamax has been the golden ticket -- in monotherapy, no less. Suppose "bipolar" isn't really an unified category, and in reality there are "Topamax-responsive bipolars" and "Topamax-resistant bipolars". In first place, clumping both groups in one category means you're going to confirm the null hypothesis (that Topamax does nothing), leaving Mr. T out of the scientific loop. In second place, and most importantly, every other pharmacological therapy study in bipolar disorder is broken. (And then we have dozens of respected scientists whose careers have just been rendered void.)

Science is supposed to be a bidirectional process. Preliminary clustering evidence (such as the apparent Topamax-responsive group) should inform the ontologies used to conduct further studies. But of course, that would lead to a situation where studies aren't comparable at first sight, and who wants to _read_ articles? That's why they have the DSM.

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Folks are already bragging ... (Below threshold)

February 4, 2011 12:46 PM | Posted by sisyphus: | Reply

Folks are already bragging to me that they suffer from "emotional intensity disorder," usually after engaging in inappropriate, disruptive behavior and unpredictable responses that we once termed narcissistic and labile. "EID" just sounds so much artsier--tortured, misunderstood--than "borderline."

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Thank you! The content is e... (Below threshold)

August 18, 2011 10:18 PM | Posted by cheap jewelry: | Reply

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"Biological correlates" -- ... (Below threshold)

October 8, 2011 7:48 PM | Posted by Altostrata: | Reply

"Biological correlates" -- LOL!! So last century!

Dr. Last, couldn't agree with you more about Sandra Bullock. Don't even bother to watch the Oscars, unless you're interested in fancy dress. It's about fashion.

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Who was supposed to be the ... (Below threshold)

March 14, 2013 7:08 PM | Posted by But who: | Reply

Who was supposed to be the narcissist in the first story you told? The actress, the comic, or Clint Eastwood?

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