The other day a patient sent me an email with a link to a New York Times article that reported that the upcoming revision of the psychiatric diagnostic standards manual, the DSM-V, has removed the narcissistic personality disorder from its roster.
She asked me, "Are they crazy?"
I wrote back, "I think so." Then, I thought, maybe the lunatics really are running the asylum.
"Removed" in this case appears to mean two things: 1) that the syndrome as they have hitherto described it is not, in their opinions, clear enough to be described as a character pathology; and 2) that it will no longer be an acceptable diagnosis for reimbursement. Insurance companies, hospitals, treatment facilities and protocols will no longer recognize it or use it to direct treatment.
Should that give us hope or terrify us? Does that mean narcissism is slowly going the way of the Dodo, or does it mean that it has become so pervasive that it's no longer thought of as pathological?
My experience personally and professionally has me leaning in the direction of the latter, that it has become so much a part of our culture, particularly our parenting, that narcissistic traits are considered norma -- so much so that if we don't have a reality show named after us, we use our own phones or video up-links to transmit our private lives to anyone from Alaska to Antarctica who will watch.
Our culture, the media-infused air we breathe, has itself become both a breeding ground and a reflecting pool for narcissists.
The Commercial Story
Although raised in Montana in a traditional home, my husband is not technically a conservative man. His guiding principle is "live and let live." So it is highly unusual to see him incensed by anything, let alone a commercial for chicken tenders. But he was so irate that he has committed himself to never, ever buying the product they were selling and spent more than 45 minutes ranting about the decay of American civilization the following day.
The commercial was a 30-second spot in which a group of teenagers ("punks," according to my husband) rush into the home of one of the boys in the group. Within seconds they take over the kitchen, opening every cabinet they could reach, offering unsolicited commentary -- all negative -- on the food they find there.
Rush to the rescue... enter our happy, multi-tasking working/servant mother with a tray full of freshly cooked (previously frozen) chicken (by-product) tenders.
"Yeah, mom," they barely utter as they fling her offering down their throats.
"No one I ever grew up with, tough guy or not, would have ever had the gall, the unabashed audacity to walk into someone's home and, forget just rummaging through their pantry, but to criticize what they found!" He was clearly disgusted. "That's just the height of entitlement. That's insane."
Who can argue with him? Even those of us who were raised in more open, less structured homes than my husband's can see the problem in the scenario and, more importantly, the cultural calamity it forebodes.
He wasn't done: "I would've gasped if any of my friends had done that in my home when I was a kid... or if I'd found out that any of the kids I raised went into someone's home and behaved like that. God, I'd be thoroughly embarrassed. And today... if I was greeted with a horde of self-centered punks ransacking my kitchen and dissing the food that I'd worked hard to provide, I would not run out and hook them up with a platter of chicken tenders. Tender would be the last thing on my mind."
Commercials as Cultural Microcosms
Although some may rightfully make a case for this being an example of life imitating art, it may more sadly be a slice of art that has been drawn directly from modern life.
There are many who would say that somewhere in the 70s and 80s we began witnessing a trend of unrestrained entitlement and narcissism that has undermined not only our expectations (of each other, of government, of business, of life itself) but the natural order of family structure. This is not a commentary on who composes a family, but on who runs it -- the child or the parent.
There have always been families with only one parent, or extended families with aunts and uncles and multiple parenting figures, or families that followed more creative structural arrangements.
What makes those families work is always the same thing: there is someone in charge who can be counted on, who knows what he (or she) is doing, who provides to the best to his or her ability, and whose primary purpose is to love and care for that family.
Once children become the parents, they are effectively abandoned. No child, no matter how clever, how entitled, how sophisticated in appearance can ever raise himself.
The Nature of True Authority
When I teach people the principles of Verbal First Aid™, one of the first things we get into is the need for them to be truly comfortable in and clear about their authority. Taking control of a chaotic situation requires authority. No one is going to follow someone who's confused, insecure and uncommitted to a course of action, no matter how nice they are. This is true whether we need to follow someone literally (as in leaving a burning or crumbling building) or whether we need to take a suggestion to help us heal (e.g., when we are told to lower our blood pressure or stop the bleeding).
People -- particularly parents -- often confuse true authority with meanness of spirit. They are not the same thing. In fact, a parent who has no authority, who cedes his position to his child, has done that child a great disservice.
Authority is benevolent, even though it demands respect. It is loving, even though it will not accept bad behavior. It is structured, which is not the same as strict and certainly does not mean fearsome.
Authority is absolutely necessary if a child is going to feel protected and grow up with any tolerance whatsoever for frustration.
And, finally, benevolent authority is critical if we're going to have anything but a generation of unabashedly self-centered, entitled children who believe the whole world revolves around their desires. That is at least one of the points of origin for pathological narcissism.
What we saw in the frenzy for the chicken tenders and the utter lack of respect for either the parent's role or the effort it takes to be one is the result of years of children taking the reins. This is a form of feral socialization, an American "Lord of the Flies" in which children dictate the market, the mores and the response of the parents, instead of the other way around.
There are many ways for people to become narcissists, and it is not a binary event. It is more gray-scale, moving from black to white along a spectrum, starting with people who are selfless in the extreme to those who have healthy egos and well-modulated self-interest, continuing into the mildly entitled and annoying, moving into the overwhelmingly cloying, attention-seeking and self-satisfied, then finally graduating into the toxic narcissist and full-blown sociopath.
The Passengers on a Train
The following story is a fairly good example of what happens when a culture is itself narcissistic and how subtly the pathology is woven into the laissez-faire attitudes of ordinary adults. Perhaps it will explain some of the cultural shift that is reflected in the decision of the framers of the new DSM-V.
While traveling north on the railroad from New York City, we were seated comfortably by a window seat watching the East River slowly move by.
My husband and I spoke quietly to each other about nothing terribly important. There were several passengers nearby, one of whom was starting to nod off. We figured he had a way to go and didn't mind missing a few stops.
At about the tip of Manhattan, a crew of 10 people, including five kids under the age of 10, got on the train. It felt like we got dropped into Disneyland. Squealing, yelling, jumping up and down, hitting and crying filled the passenger car.
The fella who was sweetly asleep was jarred awake. He was startled and unhappy.
Our conversation was over mainly because we could no longer hear each other speak.
The adults in the group did absolutely nothing to either calm or correct their children. Nothing.
Worse: They encouraged them and applauded their "free expression."
My husband, who is a fourth-generation Montanan, was once again fairly irritated by the behavior of both the children and the adults -- mostly the adults, I think, upon whom children count for guidance in new situations, social or otherwise.
Restricting a child's behavior in public does not have to mean they are joy assassins, which I believe a large number of parents are scared of being. They often explain to me that they want their children to be free to express themselves and be happy.
Do manners preclude that?
I don't think so. I think that consideration for the happiness and comfort of others is actually a prerequisite for real joy. You cannot be selfish and entitled and ever find peace.
As my husband said after we left the train, relieved to be away from them, "They were having a good time, and they thought everyone else should know exactly how good a time they were having and how cool they were."
Parents are so worried about how they're perceived now that they sometimes forget to be parents.
The other night a neighbor's son had a party in the middle of the night in his parent's garage. The floods were on, the music was blaring, the giggles, the beer, the smoking -- all of it for everyone's enjoyment, whether they were sleeping or not.
Finally, we had to call and bring the party to the parents' "attention." My husband believes they had to know what was going on, but I think people can be unaware of the most obvious things, if it serves them on some level.
Good parenting still includes good limits. Limits and love are not mutually exclusive. Love and limits relate to one another the way bones and flesh do. The structure is necessary for its proper expression in the world.
The next time you watch a commercial, particularly one directed to parents about children or to children themselves, ask yourself: What are they really selling? Is it just the product? Is it the urgent need for the product? Or is it the right to the product? What values are being promoted? What are we actually buying?
As for me, the one thing I won't be buying is the new DSM-V.
However, as I write this, I realize that there might be one positive outcome of the whole mess: no one will ever be able to manipulate an insanity defense for a narcissist. And that might be worth it.