Narcissistic Personality - Classification & Diagnosis

Classification & Diagnosis

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Mental illnesses are classed in a bewildering and unscientific scheme that one hopes is more useful to psychiatrists than it is to us. We tend to view them as distinct diseases. We assume that they are organized by severity or by shared characteristics that progress. For example, we class animals as mammals, amphibians, or reptiles by shared characteristics that organize them into an evolutionary progression.

But mental illnesses are not best viewed as discreet diseases. They are clinically observed behaviors that analysts have discerned groups and patterns in. Psychology has far to go in sorting them out, and the nature of mental illness makes that hard, if not impossible.

In fact, the classification of mental illness today is, frankly, a mess. For example, if you are homosexual, one day you were mentally ill, and the next day you were not. But, since you smoke cigarettes, you now have a new mental illness instead. And look out, because obesity and anger are on the list.

In its first edition (1952) The American Psychiatric Association's Diagnostic and Statistical Manual (DSM) listed 107 mental disorders. By the fourth edition (1994), they have more than tripled the number to 365.

For details, see Making Us Crazy by Herb Kutchins and Stuart Kirk or the review of their book by Dr. Ken Livingstone, from which I quote:

The reader of this book comes away with a powerful sense of psychiatry as a profession out of control. Cut off from what ought to be its roots in the basic research community, and at the mercy of the strongest political factions of the moment, psychiatry endlessly expands the range of its diagnostic categories until most ordinary people can be fit into at least one DSM category. Thus does psychiatry seem to be in the business, as the authors contend, of making us all crazy.

Therefore, a healthy dose of skepticism toward this pseudoscience that dabbles in social engineering is in order. Indeed, in return for all the tax dollars spent on it, it has established neither a cause nor a cure for even one of the "diseases" it claims exist.

Mental illness is viewed as occurring on different levels: that of a mental disorder and that of a personality disorder.

A mental disorder is simply being in a state of mental disorder = having a disordered mind. It needn't be a permanent state of mind and may run its course to healing. This is the most common disease, by far, in the world.

Just as we can contribute to our own illness in other diseases, we can contribute to our own mental disorder. We can do this by willfully believing lies. For example, denial of reality, projection, make-believe, phoniness, unknowing, calling things what they ain't, wishful thinking, anti-logic, whistling in the dark, acting out charades, and all the mental tricks people play, and all the little games people play are lies. When a person lies to himself (friends don't lie to friends), he is being his own worst enemy and sabotaging his own mind.

Now don't go counting that as an excuse to blame the victim. It's just a fact we can use to resist falling prey to mental disease, like the facts we use to resist falling prey to heart disease.

But we must never jump to the conclusion that the patient is to blame. The great majority of people lie to themselves every day, so no one is fit to cast the first stone. And, people lie to themselves for a reason. They do it as a defense mechanism. Usually in reaction to some form of mental abuse, either by individuals or by social groups. The pressure exerted on a mind is often so great that we can't blame a person at all for succumbing to it. Especially as a child.

So, just as people get other diseases through no fault of their own, they often acquire mental disorder through no fault of their own. In fact, mental illness can be purely biological and therefore nobody's fault. So, if you're looking for excuses to congratulate yourself on being better than "these people," look somewhere else.

Types of Mental Disorders:

Childhood Disorders

Eating Disorders

Anxiety Disorders

Cognitive Disorders

Mood Disorders

Sleep Disorders

Substance-Related Disorders

Psychotic Disorders

Examples

The Personality Disorders:

Antisocial Personality Disorder

Avoidant Personality Disorder

Borderline Personality Disorder

Dependent Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Obsessive-Compulsive Personality Disorder

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

All these personality disorders run together around the edges, and neither a cause nor a cure has been established for any of them.

A personality disorder runs deeper than a mental disorder. So, to the doctor, personality disorders are more severe, because they are harder to treat. To us, psychosis (a mental disorder) is the most severe, because of the trail of death and destruction it leaves in its wake. From yet another perspective, the patient's, mental illnesses that impair the mind most are the most severe (such as dementia, autism, schizophrenia).

Since personality disorders run deep, they can be the root of a mental disorder. In fact, people suffering from personality disorders usually have one or more mental disorders. When they present for treatment, it is usually for a mental disorder. So, doctors are supposed to check for an underlying personality disorder.

Unfortunately, with NPD, doctors usually treat only for the mental disorder, which is often substance abuse and/or depression. That's partly because the very nature of NPD is to make itself as impregnable to "head shrinking" as the gates of Nether Hell were to Dante and Virgil. It's also partly because the substance abuse and depression are viewed as more immediate threats.

Moreover (and perhaps more telling), many therapists complain that the way their narcissistic patients treat them makes them really mad. So, when the narcissist is dried out and feels grand again, he's gone, before his doctor has begun dealing with the underlying personality disorder.

Good riddance?

If therapists dislike an hour with a narcissist so much, how would they like to live or work with one? What about the Hypocratic Oath? Does this "no harm?" I dare say that giving no treatment would do less harm. Only a Narcissistic Crisis (signaled by severe substance abuse and depression) can make a narcissist get real. Wasting this precious opportunity by ending the crisis without addressing the disorder just enables a narcissist to continue his Magical Thinking.

And what about the narcissist's victims? many of whom will need therapy themselves, as well as other social services, because of his disorder? What about the people narcissists drive all the way to suicide? Have psychiatrists no regard for the innocent? Do government and health insurance companies have any idea how much this "collateral damage" costs them?

© 2004 � 2008, Kathleen Krajco � all rights reserved worldwide.
The URL of this page is: http://www.narcissism.operationdoubles.com/narcissism_diagnosis.htm.
It was last updated on 3/6/2008.
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