February 15, 2007

Lost TV Series: Desmond's Fear and Trembling



I'm no Lost expert, and I doubt the writers were thinking along these lines.  But yesterday's episode got me thinking about how we become who we are.

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"Lost TV Series: Desmond's Fear and Trembling" ››

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February 2, 2007

What Goes Wrong In A Psychiatrist's Family?

So maybe I am generalizing a bit, but I'm trying to get at something that isn't easily explained by science: why do so many psychiatrist families go bad in the same way?

In my experience (see, there's my disclaimer) psychiatrist-parents go wrong in a very specific way. They judge behavior, not the person.  It sounds like a good thing, I know.  For kids, it's a disaster.

Psychiatrists identify the behavior, but then focus on changing not the behavior directly, but the underlying cause of the behavior-- which is still not something intrinsic to the person.  If a guy with bipolar spends $10,000 in a week, psychiatrists link the behavior to the bipolar, and then try to medicate the bipolar.  (NB: "the patient has bipolar," not "the patient is bipolar.")

The obvious problem here is that maybe the guy spent $10,000 in a week because he doesn't give a damn? Or he wanted to impress some girl? i.e. just because someone has bipolar, doesn't mean every breath he takes is related to bipolar.  Psychiatrists are going to deny that they make it so simple, but in actuality they do: the moment you raise the dose of Depakote, you are sending the message that the behavior was related to bipolar. 

The psychiatrists with children-patients handle their kids in the same way.  They teach them what they are allowed to do and what they are not, what is acceptable and what is not-- but make no judgment on the kids themselves. Doing this denies the kid's identity, which is the whole purpose of childhood to begin with.  Rules then exist in an invented framework, or worse, in a vacuum.  There's no internalization of the rules; there's no superego.  Just some arbitrary limits on id.

If you tell a kid that a behavior is unacceptable, the kid has learned nothing about himself; he's only learned that this one thing is something he can't do. But if you make the kid own it-- make the behavior part of his identity, then he has a chance to change his identity.  Instead of learning it is unacceptable to take his brother's potato chips away, he can learn that he has a choice: to be the kind of person who takes chips, or the kind of person who doesn't. 

I understand the trickiness of this; you don't want to make the kid feel like he is a bad person.  But you do have to find a way to teach him that if he does that thing again and again, then he is a bad person.  Is that what he wants?  Who are you, kid?  Who do you want to be?  This also allows his to take personal credit for doing something good:

And you can see the creation of a future borderline here.  For God's sake, will someone please tell me who I am?  Give this storm of emotions some context?  Right now, I get angry/sad/thrilled/terrified over nothing, it just comes over me-- I wish I could be angry/sad/thrilled/terrified over something.  But all people ever do is tell me what I can and can't do.  If I do something bad, people freak. If I do something good, no one even notices.  No one likes me for me, they just over/underreact to what I do.

There's a second lurking trouble: parents' control of their affect. 

The psychiatrist isn't supposed to get mad at his patient; but then he comes home, and tries very hard not to get mad at his kid-- just tells him the behavior is unacceptable, gives him a time out, whatever.  But guess what?  The psychiatrist is exhausted, eventually his patience runs out, and BAM! a tsunami of anger.


The explosion part can come at any time, depending on how much patience the parent has that day.  And that's exactly the problem.  What does the kid learn? That this ethereal rulebook for what is acceptable and unacceptable only has two, binary results: no affect, or all affect-- and you never know what you're going to get.

In the biz, this is called inconsistent parenting.

What the kid needs to know are the rules of the game; they need the parent to be consistent, predictable, so that they can be safely chaotic, experimental, exploratory off of your foundation.   You want her to know exactly how you'll react if she tries pot, you want a superego so well constructed you're superfluous.   And you want levels of emotion, different things get you more or less angry.  We know you went berserk because your boss is a big jerk whose been riding you all day, but your two year old thinks you went berserk because she spilled the milk.  Geez, sorry.  May as well try heroin, what's the difference?

It doesn't necessarily mean you have to be an angry parent-- your predicted reaction could be anxious acceptance or loving disappointment-- but it has to be predictable.  And it has to be about the kid, not the behavior.  The kid needs to know you're connecting with them, not what they do, or else they'll think that the only way to connect is by behaviors.

You can see the further development of a borderline here: what the hell do I have to do to get some emotional response from you?  Kill myself?  Keep pushing until you finally blow up?  I don't even feel like I'm alive, but I'm not sure that you are either-- or is it just me, that I matter so little that I can't even get a little affect? You're insanely jealous if I talk to another guy, but you totally ignore me when I'm with you. At least with jealousy you're being real with me. Etc.

Trust me on this: at age 2, a kid feels your rage and your love the same.  It's exciting, and they haven't yet learned to fully differentiate the two feelings.  What counts is the amount of emotion, not which emotion.  (Horror movies and porn are the same to a 14 yo for this reason.)  Fast forward 20 years-- that all-out screaming match with your boyfriend felt weirdly relaxing.

And so you have a scenario: busy psychiatrist, often tired, can't generate much emotion past anger-- and it can come at any time.  No deep connection with the child as a person-- as their kid, yes; as the sum total of their behaviors, yes-- but not as a developing individual.  The kid learns that as long as some things are done correctly-- e.g. school-- they can get away with other things that the parent won't notice, e.g. pot.

Oh, and this is the best part: if the kid (adult or child) becomes a psychiatric patient, they now have a bond with their parent-- and the parent's over-involvement in their kid's psychiatric care is the framework for a relationship.  It's analogous to helping them build a go cart. 

And that's all the kid ever wanted anyway.

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January 9, 2007

Neither Is This Is A Narcissistic Injury

I have another unrelated post coming, but a quick word on insults vs. narcissistic injuries, and why this distinction is so important.

Narcissistic injuries have nothing to do with sadness.  They are always and only about rage. 

The narcissist says, "I exist."  A narcissistic injury is you showing him that he does not exist in your life.  Kicking him in the teeth and telling him he is a jerk is not a narcisstic injury-- because he must therefore exist. 

Let's say I'm a narcissist, and you send me a 10 page letter explaining why I suck, I'm a jerk, I'm an idiot; you attack my credibility, my intelligence; and you even provide evidence for all of this, college transcripts, records from the Peters Institute, you criticize my penis size, using affidavits from past and future girlfriends-- all of this hurts me, but it is not a narcissistic injury.  

A narcissistic injury would be this: I expect you to write such a letter, and you don't bother. 

This is most easily seen in the failing marriage of a narcissist. 

The reason it's important is because the reaction of the narcissist to either "insult" is different.  In the first example, he will be sad and hurt, but he will yell back, insult you, or cry and beg forgiveness or mercy--he will respond-- maintain the relationship.   He'll say and do outrageous things that he knows will cause you to respond again, to prolong your connections, even if they cause him misery.  He doesn't care that it makes you and him miserable-- he cares only that there is a you and him.

But in the latter case where you ignore him, humiliate him-- an actual narcissisitic injury-- he will want to kill you.



And before everyone flames me, I am not trying to give a scientific explanation of the pathogenesis of narcissism.  This is simply one man's opinion of how we can specify what it is, and what it may predict, past or future.  Nor am I suggesting this isn't "treatable"-- anyone can change.  It may not be easy, but it is always possible.

And I also do not mean to imply that all narcissists will kill everyone who injures them.  The point is rage.  They may never act on it, or they may break a window, or attempt suicide, etc. 


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January 5, 2007


Narcissism- what I believe to be the primary disease of our times-- is one side of a coin.  The other side-- the narcissist's enabler-- is the borderline.

If the analogy for narcissism is "being the main character in their own movie," then the analogy for borderline is being an actress.

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"Borderline" ››

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December 31, 2006

This Is Not A Narcissistic Injury


Saddam Hussein 


I know it looks like one, but it's not.  And why it's not makes every difference in predicting what will happen next. 

My previous post described the modern narcissist, which is slightly different than the kind described by Kohut and others.  In short, the narcissist is the main character in his own movie.  Not necessarily the best, or strongest, but the main character.  A narcissistic injury occurs when the narcissist is confronted with the reality that he is not the main character in his movie; the movie isn't his, and he's just one of 6 billion characters.

The worst thing that could happen to a narcissist is not that his wife cheats on him and leaves him for another man. He'll get angry, scream, stalk, etc, but this doesn't qualify as a narcissist injury because the narcissist still maintains a relationship with the woman.  That it is a bad relationship is besides the point-- the point is that he and she are still linked: they are linked through arguing,  restraining orders, and lawyers, but linked they are.  He's still the main character in his movie; it was a romantic comedy but now it's a break-up film.  But all that matters to the narcissist is that he is still the main character.

No, that's not the worst thing that can happen.  The worst thing that could happen to a narcissist is that his wife cheats on him secretly and never tells him, and she doesn't act any differently towards him, so that  he couldn't even tell.  If she can do all that, that means she exists independently of him.  He is not the main character in the movie.  She has her own movie and he's not even in it. That's a narcissistic injury.  That is the worst calamity that can befall the narcissist. 

Any other kind of injury can produce different emotions; maybe sadness, or pain, or anger, or even apathy.   But all narcissistic injuries lead to rage.  The two aren't just linked; the two are the same.  The reaction may look like sadness, but it isn't: it is rage, only rage.

With every narcissistic injury is a reflexive urge towards violence.  I'll say it again in case the meaning was not clear: a reflexive urge towards violence.  It could be homicide, or suicide, or fire, or breaking a table-- but it is immediate and inevitable.  It may be mitigated, or controlled, but the impulse is there.   The violence serves two necessary psychological functions: first, it's the natural byproduct of rage.  Second, the violence perpetuates the link, the relationship, keeps him in the lead role.   "That slut may have had a whole life outside me, but I will make her forever afraid of me."  Or he kills himself-- not because he can't live without her, but because from now on she won't be able to live without thinking about him.  See? Now it's a drama, but the movie goes on.

So if you cause a narcissist to have a narcissistic injury, get ready for a fight. 

Saddam is not experiencing a narcissistic injury: he is still the main character in the movie.  If he was sentenced to life in prison, to languish, forgotten, no longer relevant, no longer thought about, that would be a narcissistic injury-- then his rage would be intense, his urge towards violence massive.  But who cares?  There's nothing he could  do.

But remaining the main character, he has accomplished the inevitable outcome of such a movie: he has become a martyr.  Even in death, he is still the main character.  That's why the narcissist doesn't fear death.  He continues to live in the minds of others.  That's narcissism.

I'm not saying executing Saddam wasn't the right thing to do, and I'm not sure I have much to add to theoretical discussions about judgment, and punishment, and the sentence of death.  It doesn't matter what your political leanings are,  what matters is we look at a situation that has occurred, and use whatever are our personal talents to try and predict the future.

I understand human nature, and I understand narcissism.   And I understand vengeance.  Saddam was a narcissist, but this wasn't a narcissistic injury. 

This was a call to arms. 

We should all probably get ready.




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December 29, 2006

If This Is One of The Sexiest Things You've Ever Seen, You May Be a Narcissist

white heels


A quick primer on the new Narcissism.

I don't mean the traditional Kernberg, Kohut, or even Freudian descriptions.  In the modern times, I think narcissism has evolved.

A narcissist isn't necessarily an egotist, someone who thinks they are the best.  A quick screen is an inability to appreciate that other people exist, and have thoughts, feelings, and actions unrelated to the narcissist.  These thoughts don't have to be good ones, but they have to be linked to the narcissist. ("I'm going to get some gas-- because that jerk never fills the car.")

The narcissist believes he is the main character in his own movie.  Everyone else has a supporting role-- everyone around him becomes a "type."  You know how in every romantic comedy, there's always the funny friend who helpes the main character figure out her relationship?  In the movie, her whole existence is to be there fore the main character.  But in real life, that funny friend has her own life; she might even be the main character in her own movie, right?  Well the narcissist wouldn't be able to grasp that.  Her friends are always supporting characters, that can be called at any hour of the night, that will always be interested in what she is wearing, or what she did.  That funny friend isn't just being kind, she doesn't just want to help-- she's personally interested in the narcissist's life.  Of course she is.

A comedian I can't remember made a joke about actors in LA, but it's applicable to narcissists: when two narcissists go out, they just wait for the other person's mouth to stop moving so they can talk about themselves.

So on the one hand, the narcissist reduces everyone else to a type, as it relates to himself; on the other hand, the narcissist, as the main character in his movie, has an identity that he wants (i.e. he made it up) and requires all others to supplement that identity.

A narcissist looks the same every day; he has a "look" with a defining characteristic: a certain haircut; a mustache; a type of clothing, a tatoo.  He used these to create an identity in his mind that he will spend a lot of energy keeping up.

Consider the narcissist who wants his wife to wear only white, high heeled pumps.  The narcissist wants this not because he himself likes white high heel pumps-- which he might-- but because the type of person he thinks he is would only be with the type of woman who wears white high heeled pumps.  Or, in other terms, other people would expect someone like himself to be with a woman who wears those shoes.  What he likes isn't the relevant factor, and certainly what she likes is irrelevant.  What matters is that she (and her shoes) are accessories to him.

Never mind that the woman is obese, or 65, or the shoes out of style, or impractical-- the shoes represent something to him, and he is trying to reinforce his identity through that object.

Narcissists typically focus on specific things as proxies for their identity.  As in the example above, that the woman might be obese or a paraplegic could be ignored if the footwear was the proxy for identity.  These proxies are also easy to describe but loaded with implication: "I'm married to a blonde."  Saying "blonde" implies something-- e.g.  she's hot-- that might not be true.  But the narcissist has so fetishized "blondeness" that it is disconnected from reality.  The connotations, not the reality, are what matters (especially if other people can't check.)

This explains why narcissists feel personally sleighted when the fetishized object disappears.  "My wife stopped dying her hair blonde; but when she used to date her other boyfriends, she was in the salon every month.  Bitch."  He doesn't see the obvious passage of time, what he sees is part of his identity being taken from him, on purpose.  Here's the final insult: "she obviously doesn't care about me as much as her old boyfriends."

As a paradigm, the narcissist is the first born (or only) child, aged 2-3.  Everything is about him, and everything is binary.  His, or not his.  Satisfied, or not satisfied.  Hungry, or not hungry.  Mom and Dad are talking to each other and not me?  "Hello!  Focus on me!"  Youngest children don't typicaly become narcissists because from the moment of their birth, they know there are other characters in the movie.  (Youngest more easily becomes borderline.) Control, of course, is important to a narcissist. If you can imagine a 40 year old man with the ego of a 2 year old, you've got a narcissist.

Obviously, not all first borns go on to be narcissists.  Part of their development comes from not learning that there is a right and wrong that exists outside them.  This may come from inconsistent parenting:


Dad says, "you stupid kid, don't watch TV, TV is bad, it'll make you stupid!"  Ok.  Lesson learned.  But then one day Dad has to do some work: "stop making so much noise!  Here, sit down and watch TV."  What's the learned message?  It isn't that TV is sometimes good and sometimes bad.  It's that good and bad are decided by the person with the most power. 


So the goal in development is to become the one with the most power.  Hence, narcissists can be dogmatic ("adultery is immoral!") and hypocrites ("well, she came on to me, and you were ignoring me at home")  at the same time.  There is no right and wrong-- only right and wrong for them.  He's an exaggerated example: if they have to kill someone to get what they want, then so be it.  But when they murder, they don't actually think what they're doing is wrong--they're saying, "I know it's illegal, but if you understood the whole situation, you'd understand..."

Narcissists never feel guilt.  Only shame.

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December 28, 2006

I'm One of The Best Doctors In America. Seriously.


Best Doctors In America 

Continuing my week long celebration of narcissism, let me jump on the wagon:  I got an email informing me I was selected as one of the "Best Doctors in America." (5% of doctors, selected by  peers; and no, I didn't pay them.)  Yay!!  Me!!  Now...


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December 27, 2006

Comedians Tosh, Gaffigan and Hedberg for Narcisissm

I know, I said I was going on Christmas break.  But what better time than the holidays to focus on narcissism?

After thinking about how marketers target our narcissistic leanings, I wondered if other groups did the same.  Stand up comedy seems also to have followed this path.  Most of today's main comics do what I call meta-comedy; they tell jokes, but then also deconstruct the process of joke telling, right there, during the act.  They comment on the act.  Here are some examples:

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"Comedians Tosh, Gaffigan and Hedberg for Narcisissm" ››


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December 26, 2006

An Army of Narcissists? No Way

Army of One

A tremendous example of the societal narcissism I wrote about in my Time article with the funny cover.    If there was any one organization that I would have thought was in direct opposition to narcissism it would be the military, yet here it is, being specifically promoted.

I understand the practical necessity of this approach, of course; trying to tap into a listless and apathetic populace who get their current events from clips of the Colbert Report on YouTube-- they can't even be bothered to find Iraq or Afghanistan on a map, let alone enlist.  But mark my words, when a military cannot effectively appeal to any higher beliefs at all, and must resort to patronizing illusions of self-fulfillment only, then this society cannot last.

Look at the evolution of the slogans, and tell me I am exaggerating (from Army Times:)

“Today’s Army wants to join you”: 1971-73.

“Join the people who’ve joined the Army”: 1973-1979.

“This is the Army”: 1979-1981.

“Be all you can be”: 1981-2001.

“An Army of one”: 2001-2006.

Look at the grammar, the semiotic connotations.  A question for the historians would be whether or not a civilization in decline was aware that it was declining; and if not, what did they think was going on?

But perhaps all is not lost.  The Army just announced their new recruiting motto, which has apparently tested quite well:  "Army Strong."


As an aside, the "Army Strong" campaign was created by the Army's new advertising firm, McCann Erikson.   They're responsible for the MasterCard "priceless/there are some things money can't buy" campaign. Of course, this cost the Army one billion dollars. 

I'll go back to psychiatry now. 

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December 17, 2006

Time's Person of the Year Is Someone Who Doesn't Actually Matter

That would be you.


time person of year


The short version of the Time article is that we as individuals have formed a community on the internet (YouTube, MySpace, Wikipedia, etc), and this community is starting to "build a new kind of international understanding, not politician to politician... but person to person."

Ok, no.  Wrong, wrong, wrong all over the place.

The author of this piece is Lev Grossman.  Grossman is fairly famous book critic, one of the better ones.   He also wrote a novel that's a nod to Borges.  This isn't bad, it's just context.

The entire problem with Grossman's premise is exemplified by his first paragraph:

The "Great Man" theory of history is usually attributed to the Scottish philosopher Thomas Carlyle, who wrote that "the history of the world is but the biography of great men." He believed that it is the few, the powerful and the famous who shape our collective destiny as a species. That theory took a serious beating this year.

Well, not exactly. Grossman's thesis is that we matter, we can shape our destinies; he puts that in contrast to Carlyle's premise that great men help shape destiny.  But that's not what Carlyle actually says.  Here's the actual quote:

In all epochs of the world's history, we shall find the Great Man to have been the indispensable savior of his epoch;--the lightning, without which the fuel would never have burnt. The History of the world, I said already, was the biography of Great Men.

Carlyle doesn't say great men shape destiny; he says great men, and only great men, cause history. These great men should be given power to run society because only they can be trusted to do it.  Great men actually drive history, not shape it.

Democracy can't be trusted.  Paternalistic socialism, or at least a non-hereditary, anti-capitalist, aristocracy is all that can keep us from the dark of ochlocracy.  Individuals trump ideology-- which sounds like a good motto, except when individuals means Stalin and ideology means liberalism.  Oh, and the last book Hitler read was Carlyle's History of Friedrich of Prussia. 

So Grossman is not really paraphrasing Carlyle correctly.  This is important because Grossman is a book critic with a PhD from Harvard in comparative literature.  Either he simply did not know this about Carlyle, which I have to assume is impossible, or it didn't matter: he commandeered the quote, stripped it of the meaning Carlyle intended and used it the way he needed to use it.  And that exactly describes the problem:  truth and reality aren't important, what's important is you.

Because "You" as Person of the Year is actually quite portentuous.  It's is both representative and symptomatic of the problem of our times: narcissism.  Nowadays we are so alienated and matter so very little to larger society that the only thing that inflames any passion is to be reminded of this.   Consider Bush and Cheney.  Put aside politics for a moment, it is clear that their single-mindedness of purpose ignores each of us as individuals.  Give them the benefit of the doubt, that they are doing what they think is best.  But it's best for society, for America: what we hate is that it isn't for us, for you, for me.  That's what people hate about them, the seeming indifference to our individual worth, to our sense of importance.  Our votes don't count; everything is about religion; "Global War On Terror."  Where in all that is the individual?  We are tools to their "higher cause."  I know people say that they are angry at the cause; but I think it's really anger that we're being used for anything.

Being on YouTube, having a blog, having an iPod, being on MySpace-- all of these things are self-validating, they allow that illusion that is so important to narcissists: that we are the main characters in a movie.  Not that we're the best, or the good guys, but the main characters. That everyone around us is supporting cast; the funny friend, the crazy ex, the neurotic mother, the egotistical date, etc.  That makes reminders of our insignificance even more infuriating.

Take a look at the photos in the Time article: a DJ, a punk rocker, a guy in dredlocks, a kid dancing with headphones, a guy singing into a mic, a hot chick taking a photo of herself-- none of these people could ever be "Person of the Year."  They barely have identities outside of their image.  (And observe how so many are defined through music they listen to.)  They must be defined by something from without, like a tattoo.  But they deserve everything anyone else can have.  It's their right.

I'm not saying each of us as individuals is insignificant. We should, could, matter. But to protect ourselves from an existential implosion,  we decide to define ourselves through images and signs, rather than behaviors; lacking an identity founded in anything real makes us vulnerable to anger, resentment.  But no guilt, ever.  The narcissist never feels guilt.  He feels shame.

It can't last.  If society chooses to make narcissism the default, it's going to have to deal with society-wide narcissistic injuries-- when we suddenly realize that it isn't solely our movie and we're really not the main character.  And no one wants to see this stupid movie anyway.  This inevitably leads to violence: the school shooting, inexplicable knifing over Play Station 3, Andrea Yates, beating the wife because she wore the wrong shoes type of violence.  Oh, they weren't white high heeled pumps?  That bitch! She used to wear them for her old boyfriend.

I'm not sure anyone in psychiatry sees this-- they are too busy documenting Pharma excesses and Lamictal outcomes-- but it is the problem of our times.  The only ones who seem to notice are advertisers, marketers-- they see it.  They don't judge it, they simply profit from it. 

Grossman could morph Carlyle into what he wanted because Carlyle doesn't matter, what matters is what Grossman wanted, what Grossman needed.  Carlyle doesn't exist, or he only exists as we need to use him.  He becomes a tool, another supporting character.  Anyone actually read anything by Carlyle anymore?  Why bother?  We only need a few soundbites for our own use.  Grossman is a clearly a good writer and hardly the problem here. But picking "You" as Person of the Year only reinforces the collective delusion that our individual selves matter more than other person, or a collective good, an ideology, truth, or right and wrong.  It's relativism with a cherry twist.

It won't last.  It absolutely can't.



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December 5, 2006


Just thought you should know:

There are about 1200 murder-suicides per year (i.e. 500-600 suicides by the person who just killed someone else).

75% involve the boyfriend/girlfriend or spouse; 96% of the murderers are males (duh)

92% involve guns 

92% occur in the house of the victim

There is an average 6 year age difference between the murderer and his victim.  Risk increases with widening age difference.

23% of murder-suicides (say, about 130), the murderer is 55 or older.  Contrast this with the general homicide rate by 55 year olds: 5% 

Contrast this with the suicide statistics in the general population,  and I think you'll agree that there are an amazingly high number of people dying at the hands of their idiot boyfriends/husbands.     "You don't understand, I loved her, I'd do anything for her, and she lied, slept around-- all that time meant nothing to her-- she wouldn't listen!  How can she just take what we had and just throw it away?  It doesn't make any sense!" 

The societal question is what has happened to many men that they are unable to define themselves, or affirm their value, except through another person.  And "love"-- or its distortion-- and aggression are closely linked in such people.  But that's narcissism, and it's the disease of our times.  

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