How do you tell if a person's psychiatric symptoms are really symptoms related to a personality disorder? That's where differential diagnosis comes in.

It is not easy to tell when the patient's anxiety and depression are autonomous and neurotic problems or symptoms of a personality disorder. These should, therefore, be ruled out as differential diagnostic criteria. In other words, the mere existence of depression or anxiety in a patient does not prove that he or she has a personality disorder.

Instead, the diagnostician should concentrate on the patient's defenses and perceived locus of control.

Patients with personality disorders have alloplastic defenses and an external locus of control. In other words, they blame outside influences, people, events, and circumstances for their own failures. Under stress and when they experience frustration, disappointment, and pain - they seek to change the external environment. For instance, such patients may try to manipulate others to gratify them and thus alleviate their distress. They achieve such manipulative outcome by threatening, cajoling, seducing, tempting, or co-opting their "sources of supply".

Patients with personality disorders also lack self-awareness and are ego-syntonic. They do not find themselves, their conduct, traits, or the lives they lead to be objectionable, unacceptable or alien to their true self. They are mostly happy-go-lucky people.

Consequently, they rarely assume responsibility for the consequences of their actions. This is further compounded, in some personality disorders, by a startling absence of empathy and scruples (conscience).

The lives of personality disordered subjects are chaotic. Both the patient's social (interpersonal) and occupational functioning suffer grievously. But though cognitive and emotional processes may be disturbed, psychosis is rare. Thought disorders (the loosening of associations), delusions, and hallucinations are either absent or restricted to transient and self-limiting micropsychotic episodes under duress.

Finally, some medical conditions (such as brain trauma) and organic issues (such as metabolic problems) produce behaviors and traits more often associated with personality disorders. The onset of these behaviors and traits is a crucial differentiating criterion. Personality disorders start their pernicious work during early adolescence. They involve a clear sensorium (processed input from sense organs), good temporal and spatial orientation, and normal intellectual functioning (memory, fund of general knowledge, ability to read and calculate, etc.).

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

---

---

next: Psychological Tests

Read about the therapeutic techniques used to help abuse victims recover.

• Watch the video on Victims Affected by Abuse: Recovery and Healing

How Victims Are Affected by Abuse: Recovery and Healing

Victims of abuse in all its forms - verbal, emotional, financial, physical, and sexual - are often disorientated. They require not only therapy to heal their emotional wounds, but also practical guidance and topical education. At first, the victim is, naturally, distrustful and even hostile. The therapist or case worker must establish confidence and rapport painstakingly and patiently.

The therapeutic alliance requires constant reassurance that the environment and treatment modalities chosen are safe and supportive. This is not easy to do, partly because of objective factors such as the fact that the records and notes of the therapist are not confidential. The offender can force their disclosure in a court of law simply by filing a civil lawsuit against the survivor!

The first task is to legitimise and validate the victim's fears. This is done by making clear to her that she is not responsible for her abuse or guilty for what happened. Victimisation is the abuser's fault - it is not the victim's choice. Victims do not seek abuse - although, admittedly some of them keep finding abusive partners and forming relationships of co-dependence. Facing, reconstructing, and reframing the traumatic experiences is a crucial and indispensable first phase.

 

The therapist should present the victim with her own ambivalence and the ambiguity of her messages - but this ought to be done gently, non-judgementally, and without condemnation. The more willing and able the abuse survivor is to confront the reality of her mistreatment (and the offender), the stronger she would feel and the less guilty.

Typically, the patient's helplessness decreases together with her self-denial. Her self-esteem as well as her sense of self-worth stabilise. The therapist should emphasise the survivor's strengths and demonstrate how they can save her from a recurrence of the abuse or help her cope with it and with her abuser.

Education is an a important tool in this process of recovery. The patient should be made aware of the prevalence and nature of violence against women and stalking, their emotional and physical effects, warning signs and red flags, legal redresses, coping strategies, and safety precautions.

The therapist or social worker should provide the victim with lists of contacts - help organisations, law enforcement agencies, other women in her condition, domestic violence shelters, and victims' support groups both online and in her neighbourhood or city. Knowledge empowers and reduces the victim's sense of isolation and worthlessness.

Helping the survivor regain control of her life is the over-riding goal of the entire therapeutic process. With this aim in mind, she should be encouraged to re-establish contact with family, friends, colleagues, and the community at large. The importance of a tightly-knit social support network cannot be exaggerated.

Ideally, after a period of combined tutoring, talk therapy, and (anti-anxiety or antidepressant) medications, the survivor will self-mobilize and emerge from the experience more resilient and assertive and less gullible and self-deprecating.

But therapy is not always a smooth ride. We tackle this problem in our next article.

back to: How Victims are Affected by Abuse

 

---

---

next: How Victims are Affected by Abuse - The Conflicts of Therapy

The history of personality disorders is an interesting one. Read how the different types of personality disorders came into being.

Well into the eighteenth century, the only types of mental illness - then collectively known as "delirium" or "mania" - were depression (melancholy), psychoses, and delusions. At the beginning of the nineteenth century, the French psychiatrist Pinel coined the phrase "manie sans delire" (insanity without delusions). He described patients who lacked impulse control, often raged when frustrated, and were prone to outbursts of violence. He noted that such patients were not subject to delusions. He was referring, of course, to psychopaths (subjects with the Antisocial Personality Disorder). Across the ocean, in the United States, Benjamin Rush made similar observations.

In 1835, the British J. C. Pritchard, working as senior Physician at the Bristol Infirmary (hospital), published a seminal work titled "Treatise on Insanity and Other Disorders of the Mind". He, in turn, suggested the neologism "moral insanity".

To quote him, moral insanity consisted of "a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses without any remarkable disorder or defect of the intellect or knowing or reasoning faculties and in particular without any insane delusion or hallucination" (p. 6).

He then proceeded to elucidate the psychopathic (antisocial) personality in great detail:

"(A) propensity to theft is sometimes a feature of moral insanity and sometimes it is its leading if not sole characteristic." (p. 27). "(E)ccentricity of conduct, singular and absurd habits, a propensity to perform the common actions of life in a different way from that usually practised, is a feature of many cases of moral insanity but can hardly be said to contribute sufficient evidence of its existence." (p. 23).

"When however such phenomena are observed in connection with a wayward and intractable temper with a decay of social affections, an aversion to the nearest relatives and friends formerly beloved - in short, with a change in the moral character of the individual, the case becomes tolerably well marked." (p. 23)

But the distinctions between personality, affective, and mood disorders were still murky.

Pritchard muddied it further:

"(A) considerable proportion among the most striking instances of moral insanity are those in which a tendency to gloom or sorrow is the predominant feature ... (A) state of gloom or melancholy depression occasionally gives way ... to the opposite condition of preternatural excitement." (pp. 18-19)

Another half century were to pass before a system of classification emerged that offered differential diagnoses of mental illness without delusions (later known as personality disorders), affective disorders, schizophrenia, and depressive illnesses. Still, the term "moral insanity" was being widely used.

Henry Maudsley applied it in 1885 to a patient whom he described as:

"(Having) no capacity for true moral feeling - all his impulses and desires, to which he yields without check, are egoistic, his conduct appears to be governed by immoral motives, which are cherished and obeyed without any evident desire to resist them." ("Responsibility in Mental Illness", p. 171).

But Maudsley already belonged to a generation of physicians who felt increasingly uncomfortable with the vague and judgmental coinage "moral insanity" and sought to replace it with something a bit more scientific.

Maudsley bitterly criticized the ambiguous term "moral insanity":

"(It is) a form of mental alienation which has so much the look of vice or crime that many people regard it as an unfounded medical invention (p. 170).

In his book "Die Psychopatischen Minderwertigkeiter", published in 1891, the German doctor J. L. A. Koch tried to improve on the situation by suggesting the phrase "psychopathic inferiority". He limited his diagnosis to people who are not retarded or mentally ill but still display a rigid pattern of misconduct and dysfunction throughout their increasingly disordered lives. In later editions, he replaced "inferiority" with "personality" to avoid sounding judgmental. Hence the "psychopathic personality".

Twenty years of controversy later, the diagnosis found its way into the 8th edition of E. Kraepelin's seminal "Lehrbuch der Psychiatrie" ("Clinical Psychiatry: a textbook for students and physicians"). By that time, it merited a whole lengthy chapter in which Kraepelin suggested six additional types of disturbed personalities: excitable, unstable, eccentric, liar, swindler, and quarrelsome.

Still, the focus was on antisocial behavior. If one's conduct caused inconvenience or suffering or even merely annoyed someone or flaunted the norms of society, one was liable to be diagnosed as "psychopathic".

---

---

---

In his influential books, "The Psychopathic Personality" (9th edition, 1950) and "Clinical Psychopathology" (1959), another German psychiatrist, K. Schneider sought to expand the diagnosis to include people who harm and inconvenience themselves as well as others. Patients who are depressed, socially anxious, excessively shy and insecure were all deemed by him to be "psychopaths" (in another word, abnormal).

This broadening of the definition of psychopathy directly challenged the earlier work of Scottish psychiatrist, Sir David Henderson. In 1939, Henderson published "Psychopathic States", a book that was to become an instant classic. In it, he postulated that, though not mentally subnormal, psychopaths are people who:

"(T)hroughout their lives or from a comparatively early age, have exhibited disorders of conduct of an antisocial or asocial nature, usually of a recurrent episodic type which in many instances have proved difficult to influence by methods of social, penal and medical care or for whom we have no adequate provision of a preventative or curative nature."

But Henderson went a lot further than that and transcended the narrow view of psychopathy (the German school) then prevailing throughout Europe.

In his work (1939), Henderson described three types of psychopaths. Aggressive psychopaths were violent, suicidal, and prone to substance abuse. Passive and inadequate psychopaths were over-sensitive, unstable and hypochondriacal. They were also introverts (schizoid) and pathological liars. Creative psychopaths were all dysfunctional people who managed to become famous or infamous.

Twenty years later, in the 1959 Mental Health Act for England and Wales, "psychopathic disorder" was defined thus, in section 4(4):

"(A) persistent disorder or disability of mind (whether or not including subnormality of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient, and requires or is susceptible to medical treatment."

This definition reverted to the minimalist and cyclical (tautological) approach: abnormal behavior is that which causes harm, suffering, or discomfort to others. Such behavior is, ipso facto, aggressive or irresponsible. Additionally it failed to tackle and even excluded manifestly abnormal behavior that does not require or is not susceptible to medical treatment.

Thus, "psychopathic personality" came to mean both "abnormal" and "antisocial". This confusion persists to this very day. Scholarly debate still rages between those, such as the Canadian Robert, Hare, who distinguish the psychopath from the patient with mere antisocial personality disorder and those (the orthodoxy) who wish to avoid ambiguity by using only the latter term.

Moreover, these nebulous constructs resulted in co-morbidity. Patients were frequently diagnosed with multiple and largely overlapping personality disorders, traits, and styles. As early as 1950, Schneider wrote:

"Any clinician would be greatly embarrassed if asked to classify into appropriate types the psychopaths (that is abnormal personalities) encountered in any one year."

Today, most practitioners rely on either the Diagnostic and Statistical Manual (DSM), now in its fourth, revised text, edition or on the International Classification of Diseases (ICD), now in its tenth edition.

The two tomes disagree on some issues but, by and large, conform to each other.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

---

---

next: Differential Diagnoses of Personality Disorders

Discover how a person develops a personality disorder; specifically Narcissistic, Histrionic, Dependent  or Schizoid  Personality Disorder.

Are all personality disorders the outcomes of frustrated narcissism?

During our formative years (6 months to 6 years old), we are all "narcissists". Primary Narcissism is a useful and critically important defense mechanism. As the infant separates from his mother and becomes an individual, it is likely to experience great apprehension, fear, and pain. Narcissism shields the child from these negative emotions. By pretending to be omnipotent, the toddler fends off the profound feelings of isolation, unease, pending doom, and helplessness that are attendant on the individuation-separation phase of personal development. 

Well into early adolescence, the empathic support of parents, caregivers, role models, authority figures, and peers is indispensable to the evolution of a stable sense of self-worth, self-esteem, and self-confidence. Traumas and abuse, smothering and doting, and the constant breach of emerging boundaries yield the entrenchment of rigid adult narcissistic defenses.

In my book "Malignant Self Love - Narcissism Revisited", I defined pathological narcissism thus:

"Secondary or pathological narcissism is a pattern of thinking and behaving in adolescence and adulthood, which involves infatuation and obsession with one's self to the exclusion of others. It manifests in the chronic pursuit of personal gratification and attention (narcissistic supply), in social dominance and personal ambition, bragging, insensitivity to others, lack of empathy and/or excessive dependence on others to meet his/her responsibilities in daily living and thinking. Pathological narcissism is at the core of the narcissistic personality disorder."

What happens when such an individual faces disappointments, setbacks, failures, criticism and disillusionment?

They "resolve" these recurrent frustrations by developing personality disorders.

The Narcissistic Solution - The patient creates and projects an omnipotent, omniscient, and omnipresent False Self that largely replaces and represses the discredited and dilapidated True Self. He uses the False Self to garner narcissistic supply (attention, both positive and negative) and thus support his inflated fantasies. Both the Narcissistic and the Schizotypal Personality Disorders belong here because both involve grandiose, fantastic, and magical thinking. When the narcissistic solution fails, we have the Borderline Personality Disorder (BPD). The Borderline patient's awareness that the solution that she had opted for is "not working" generates in her an overwhelming separation anxiety (fear of abandonment), an identity disturbance, affective and emotional lability, suicidal ideation, and suicidal action, chronic feelings of emptiness, rage attacks, and transient (stress related) paranoid ideation.

The Appropriation Solution - This solution involves the appropriation of someone else's imagined (and, therefore, confabulated and false) self instead of one's dysfunctional True Self. Such people live vicariously, through others, and by proxy. Consider the Histrionic Personality Disorder. Histrionics sexualize and objectify others and then internalize (introject) them. Lacking an inner reality (True Self) they over-rate and over-emphasise their bodies. Histrionics and other "appropriators" misjudge the intimacy of their faux relationships and the degree of commitment involved. They are easily suggestible and their senses of self and self-worth shift and fluctuate with input from the outside (narcissistic supply). Another example of this type of solution is the Dependent Personality Disorder (codependents). Manipulative mothers who "sacrifice" their lives for their children, "drama queens", and people with factitious disorders (for instance, Munchausen Syndrome) also belong to this category.

The Schizoid Solution - Sometimes the emergence of the False Self is stunted or disrupted. The True Self remain immature and dysfunctional but it is not replaced by a functioning narcissistic defense mechanism. Such patients are mental zombies, trapped forever in the no-man's land between infancy and adulthood. They lack empathy, their psychosexual life is impoverished, they prefer to avoid contact with others, and withdraw from the world. The Schizotypal Personality Disorder is a mixture of the narcissistic and the schizoid solutions. The Avoidant Personality Disorder is a close kin.

In my book "Malignant Self Love - Narcissism Revisited", I described the Aggressive Destructive Solution thus:

"The Aggressive Destructive Solution - These people suffer from hypochondriasis, depression, suicidal ideation, dysphoria, anhedonia, compulsions and obsessions and other expressions of internalized and transformed aggression directed at a self which is perceived to be inadequate, guilty, disappointing and worthy of nothing but elimination. Many of the narcissistic elements are present in an exaggerated form. Lack of empathy becomes reckless disregard for others, irritability, deceitfulness and criminal violence. Undulating self-esteem is transformed into impulsiveness and failure to plan ahead. The Antisocial Personality Disorder is a prime example of this solution, whose essence is: the total control of a False Self, without the mitigating presence of a shred of True Self.

I tend to believe that malignant self love underlies all known personality disorders. Granted, different attributes and traits are emphasized in each personality disorder. But they all share the foundation of a failed personal psychological and psychosocial evolution. They are all the lamentable end results of stunted and compensatory trajectories of deformed growth and development."

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

---

---

next: The History of Personality Disorders

You're an abuse victim, and you may think it's impossible, but there are ways to cope with your abuser. Learn how.

1. I want to stay with him
2. I can't Take It Any Longer - I Have Decided to Leave Him
3. Watch the video on Coping with Narcisistic Abusers

How to cope with your abuser?

Sometimes it looks hopeless. Abusers are ruthless, immoral, sadistic, calculated, cunning, persuasive, deceitful - in short, they appear to be invincible. They easily sway the system in their favor.

Here is a list of escalating countermeasures. They represent the distilled experience of thousands of victims of abuse. They may help you cope with abuse and overcome it.

Not included are legal or medical steps. Consult an attorney, an accountant, a therapist, or a psychiatrist, where appropriate.

First, you must decide:

Do you want to stay with him - or terminate the relationship?

If you want to leave him and your children are above the age of 18 - Click HERE

If you have Children with Him (under the age of 18) - Click HERE

1. I want to Stay with Him

FIVE DON'T DO'S - How to Avoid the Wrath of the Narcissist

• Never disagree with the narcissist or contradict him;
• Never offer him any intimacy;
• Look awed by whatever attribute matters to him (for instance: by his professional achievements or by his good looks, or by his success with women and so on);
• Never remind him of life out there and if you do, connect it somehow to his sense of grandiosity;
• Do not make any comment, which might directly or indirectly impinge on his self-image, omnipotence, judgment, omniscience, skills, capabilities, professional record, or even omnipresence.

  The TEN DO'S - How to Make your Narcissist Dependent on You If you INSIST on Staying with Him

  • • Listen attentively to everything the narcissist says and agree with it all. Don't believe a word of it but let it slide as if everything is just fine, business as usual.
    • Personally offer something absolutely unique to the narcissist which they cannot obtain anywhere else. Also be prepared to line up future Sources of Primary Narcissistic Supply for your narcissist because you will not be IT for very long, if at all. If you take over the procuring function for the narcissist, they become that much more dependent on you.
    • Be endlessly patient and go way out of your way to be accommodating, thus keeping the narcissistic supply flowing liberally, and keeping the peace.
    • Be endlessly giving. This one may not be attractive to you, but it is a take it or leave it proposition.
    • Be absolutely emotionally and financially independent of the narcissist. Take what you need: the excitement and engulfment and refuse to get upset or hurt when the narcissist does or says something dumb, rude, or insensitive. Yelling back works really well but should be reserved for special occasions when you fear your narcissist may be on the verge of leaving you; the silent treatment is better as an ordinary response, but it must be carried out without any emotional content, more with the air of boredom and "I'll talk to you later, when I am good and ready, and when you are behaving in a more reasonable fashion". Treat your narcissist as you would a child.
  • If your narcissist is cerebral and not interested in having much sex - then give yourself ample permission to have "hidden" sex with other people. Your cerebral narcissist will not be indifferent to infidelity so discretion and secrecy is of paramount importance.
  • If your narcissist is somatic and you don't mind, join in on group sex encounters but make sure that you choose properly for your narcissist. If you do mind - leave him. Somatic narcissists are sex addicts and incurably unfaithful.
  • If you are a "fixer", then focus on fixing situations, preferably before they become "situations". Don't for one moment delude yourself that you can fix the narcissist - it simply will not happen.
  • If there is any fixing that can be done, it is to help your narcissist become aware of their condition, with no negative implications or accusations in the process at all. It is like living with a physically handicapped person and being able to discuss, calmly, unemotionally, what the limitations and benefits of the handicap are and how the two of you can work with these factors, rather than trying to change them.
  • Finally, and most important of all: Know Yourself.

  What are you getting from the relationship? Are you actually a masochist? A codependent? Why is this relationship attractive and interesting?

  Define for yourself what good and beneficial things you believe you are receiving in this relationship.

  Define the things that you find harmful to you. Develop strategies to minimize the harm to yourself. Don't expect that you will cognitively be able to reason with the narcissist to change who he is. You may have some limited success in getting your narcissist to tone down on the really harmful behaviors that affect you - but this can only be accomplished in a very trusting, frank and open relationship.

 

---

---

---

(1a) Insist on Your Boundaries - Resist Abuse

• • Refuse to accept abusive behavior. Demand reasonably predictable and rational actions and reactions. Insist on respect for your boundaries, predilections, preferences, and priorities.
  • Demand a just and proportional treatment. Reject or ignore unjust and capricious behavior.
  • If you are up to the inevitable confrontation, react in kind. Let him taste some of his own medicine.
  • Never show your abuser that you are afraid of him. Do not negotiate with bullies. They are insatiable. Do not succumb to blackmail.
  • If things get rough- disengage, involve law enforcement officers, friends and colleagues, or threaten him (legally).
  • Do not keep your abuse a secret. Secrecy is the abuser's weapon.
  • Never give him a second chance. React with your full arsenal to the first transgression.
  • Be guarded. Don't be too forthcoming in a first or casual meeting. Gather intelligence.
  • Be yourself. Don't misrepresent your wishes, boundaries, preferences, priorities, and red lines.
  • Do not behave inconsistently. Do not go back on your word. Be firm and resolute.
  • Stay away from such quagmires. Scrutinize every offer and suggestion, no matter how innocuous.
  • Prepare backup plans. Keep others informed of your whereabouts and appraised of your situation.
  • Be vigilant and doubting. Do not be gullible and suggestible. Better safe than sorry.
  • Often the abuser's proxies are unaware of their role. Expose him. Inform them. Demonstrate to them how they are being abused, misused, and plain used by the abuser.
  • Trap your abuser. Treat him as he treats you. Involve others. Bring it into the open. Nothing like sunshine to disinfest abuse.

(1b) Mirror His Behavior

Mirror the narcissist's actions and repeat his words.

If, for instance, he is having a rage attack - rage back. If he threatens - threaten back and credibly try to use the same language and content. If he leaves the house - leave it as well, disappear on him. If he is suspicious - act suspicious. Be critical, denigrating, humiliating, go down to his level.

(1c) Frighten Him

Identify the vulnerabilities and susceptibilities of the narcissist and strike repeated, escalating blows at them.

If a narcissist has a secret or something he wishes to conceal - use your knowledge of it to threaten him. Drop cryptic hints that there are mysterious witnesses to the events and recently revealed evidence. Do it cleverly, noncommittally, gradually, in an escalating manner.

Let his imagination do the rest. You don't have to do much except utter a vague reference, make an ominous allusion, delineate a possible turn of events.

Needless to add that all these activities have to be pursued legally, preferably through the good services of law offices and in broad daylight. If done in the wrong way - they might constitute extortion or blackmail, harassment and a host of other criminal offences.

(1d) Lure Him

Offer him continued Narcissistic Supply. You can make a narcissist do anything by offering, withholding, or threatening to withhold Narcissistic Supply (adulation, admiration, attention, sex, awe, subservience, etc.).

(1e) Play on His Fear of Abandonment

If nothing else works, explicitly threaten to abandon him.

You can condition the threat ("If you don't do something or if you do it - I will desert you").

The narcissists perceives the following as threats of abandonment, even if they are not meant as such:

• Confrontation, fundamental disagreement, and protracted criticism
• When completely ignored
• When you insist on respect for your boundaries, needs, emotions, choices, preferences
• When you retaliate (for instance, shout back at him).

---

---

---

2. I can't Take It Any Longer - I Have Decided to Leave Him

(2a) Fight Him in Court

Here are a few of the things the narcissist finds devastating, especially in a court of law, for instance during a deposition:

• • Any statement or fact, which seems to contradict his inflated perception of his grandiose self. Any criticism, disagreement, exposure of fake achievements, belittling of "talents and skills" which the narcissist fantasizes that he possesses, any hint that he is subordinated, subjugated, controlled, owned or dependent upon a third party. Any description of the narcissist as average and common, indistinguishable from many others. Any hint that the narcissist is weak, needy, dependent, deficient, slow, not intelligent, naive, gullible, susceptible, not in the know, manipulated, a victim.
  • The narcissist is likely to react with rage to all these and, in an effort to re-establish his fantastic grandiosity, he is likely to expose facts and stratagems he had no conscious intention of exposing.
  • The narcissist reacts with narcissistic rage, hatred, aggression, or violence to an infringement of what he perceives to be his entitlement. Any insinuation, hint, intimation, or direct declaration that the narcissist is not special at all, that he is average, common, not even sufficiently idiosyncratic to warrant a fleeting interest will inflame the narcissist.
  • Tell the narcissist that he does not deserve the best treatment, that his needs are not everyone's priority, that he is boring, that his needs can be catered to by an average practitioner (medical doctor, accountant, lawyer, psychiatrist), that he and his motives are transparent and can be easily gauged, that he will do what he is told, that his temper tantrums will not be tolerated, that no special concessions will be made to accommodate his inflated sense of self, that he is subject to court procedures, etc. - and the narcissist will lose control.
  • Contradict, expose, humiliate, and berate the narcissist ("You are not as intelligent as you think you are", "Who is really behind all this? It takes sophistication which you don't seem to have", "So, you have no formal education", "you are (mistake his age, make him much older) ... sorry, you are ... old", "What did you do in your life? Did you study? Do you have a degree? Did you ever establish or run a business? Would you define yourself as a success?", "Would your children share your view that you are a good father?", "You were last seen with a Ms. ... who is (suppressed grin) a cleaning lady (in demeaning disbelief)".
  • Be equipped with absolutely unequivocal, first rate, thoroughly authenticated and vouched for information.

(2b) If You Have Common Children

I described in "The Guilt of the Abused - Pathologizing the Victim" how the system is biased and titled against the victim.

Regrettably, mental health professionals and practitioners - marital and couple therapists, counselors - are conditioned, by years of indoctrinating and dogmatic education, to respond favorably to specific verbal cues.

The paradigm is that abuse is rarely one sided - in other words, that it is invariably "triggered" either by the victim or by the mental health problems of the abuser. Another common lie is that all mental health problems can be successfully treated one way (talk therapy) or another (medication).

This shifts the responsibility from the offender to his prey. The abused must have done something to bring about their own maltreatment - or simply were emotionally "unavailable" to help the abuser with his problems. Healing is guaranteed if only the victim were willing to participate in a treatment plan and communicate with the abuser. So goes the orthodoxy.

Refusal to do so - in other words, refusal to risk further abuse - is harshly judged by the therapist. The victim is labeled uncooperative, resistant, or even abusive!

The key is, therefore, feigned acquiescence and collaboration with the therapist's scheme, acceptance of his/her interpretation of the events, and the use of key phrases such as: "I wish to communicate/work with (the abuser)", "trauma", "relationship", "healing process", "inner child", "the good of the children", "the importance of fathering", "significant other" and other psycho-babble. Learn the jargon, use it intelligently and you are bound to win the therapist's sympathy.

Above all - do not be assertive, or aggressive and do not overtly criticize the therapist or disagree with him/her.

I make the therapist sound like yet another potential abuser - because in many cases, he/she becomes one as they inadvertently collude with the abuser, invalidate the abuse experiences, and pathologize the victim.

---

---

---

(2c) Refuse All Contact

 

• • Be sure to maintain as much contact with your abuser as the courts, counsellors, mediators, guardians, or law enforcement officials mandate.
  • Do NOT contravene the decisions of the system. Work from the inside to change judgments, evaluations, or rulings - but NEVER rebel against them or ignore them. You will only turn the system against you and your interests.
  • But with the exception of the minimum mandated by the courts - decline any and all gratuitous contact with the narcissist.
  • Do not respond to his pleading, romantic, nostalgic, flattering, or threatening e-mail messages.
  • Return all gifts he sends you.
  • Refuse him entry to your premises. Do not even respond to the intercom.
  • Do not talk to him on the phone. Hang up the minute you hear his voice while making clear to him, in a single, polite but firm, sentence, that you are determined not to talk to him.
  • Do not answer his letters.
  • Do not visit him on special occasions, or in emergencies.
  • Do not respond to questions, requests, or pleas forwarded to you through third parties.
  • Disconnect from third parties whom you know are spying on you at his behest.
  • Do not discuss him with your children.
  • Do not gossip about him.
  • Do not ask him for anything, even if you are in dire need.
  • When you are forced to meet him, do not discuss your personal affairs - or his.
  • Relegate any inevitable contact with him - when and where possible - to professionals: your lawyer, or your accountant.

How to avoid contact is the subject of the next article.

---

---

next: The Abuser in Denial

• Why Good People Ignore Abuse
• Watch the video on Ignored Abuse

How do abusers get away with their abusive behaviors and abuse victims, many times, take the blame for being abused? Learn about this phenomenon.

It is telling that precious few psychology and psychopathology textbooks dedicate an entire chapter to abuse and violence. Even the most egregious manifestations - such as child sexual abuse - merit a fleeting mention, usually as a sub-chapter in a larger section dedicated to paraphilias or personality disorders.

Abusive behavior did not make it into the diagnostic criteria of mental health disorders, nor were its psychodynamic, cultural and social roots explored in-depth. As a result of this deficient education and lacking awareness, most law enforcement officers, judges, counselors, guardians, and mediators are worryingly ignorant about the phenomenon.

Only 4% of hospital emergency room admissions of women in the United States are attributed by staff to domestic violence. The true figure, according to the FBI, is more like 50%. One in three murdered women was done in by her spouse, current or former.

The US Department of Justice pegs the number of spouses (mostly women) threatened with a deadly weapon at almost 2 million annually. Domestic violence erupts in a mind-boggling half of all American homes at least once a year. Nor are these isolated, "out of the blue", incidents.

Mistreatment and violence are part of an enduring pattern of maladaptive behavior within the relationship and are sometimes coupled with substance abuse. Abusers are possessive, pathologically jealous, dependent, and, often, narcissistic. Invariably, both the abuser and his victim seek to conceal the abusive episodes and their aftermath from family, friends, neighbors, or colleagues.

 

This dismal state of things is an abuser's and stalker's paradise. This is especially true with psychological (verbal and emotional) abuse which leaves no visible marks and renders the victim incapable of coherence.

Still, there is no "typical" offender. Maltreatment crosses racial, cultural, social, and economic lines. This is because, until very recently, abuse has constituted normative, socially-acceptable, and, sometimes, condoned, behavior. For the bulk of human history, women and children were considered no better than property.

Indeed, well into the 18th century, they still made it into lists of assets and liabilities of the household. Early legislation in America - fashioned after European law, both Anglo-Saxon and Continental - permitted wife battering for the purpose of behavior modification. The circumference of the stick used, specified the statute, should not exceed that of the husband's thumb.

Inevitably, many victims blame themselves for the dismal state of affairs. The abused party may have low self-esteem, a fluctuating sense of self-worth, primitive defense mechanisms, phobias, mental health problems, a disability, a history of failure, or a tendency to blame herself, or to feel inadequate (autoplastic neurosis).

She may have come from an abusive family or environment - which conditioned her to expect abuse as inevitable and "normal". In extreme and rare cases - the victim is a masochist, possessed of an urge to seek ill-treatment and pain. Gradually, the victims convert these unhealthy emotions and their learned helplessness in the face of persistent "gaslighting" into psychosomatic symptoms, anxiety and panic attacks, depression, or, in extremis, suicidal ideation and gestures.

From the Narcissistic Personality Disorders list - excerpt from my book "Toxic Relationships - Abuse and its Aftermath" (November 2005):

Therapists, marriage counselors, mediators, court-appointed guardians, police officers, and judges are human. Some of them are social reactionaries, others are narcissists, and a few are themselves spouse abusers. Many things work against the victim facing the justice system and the psychological profession.

Start with denial. Abuse is such a horrid phenomenon that society and its delegates often choose to ignore it or to convert it into a more benign manifestation, typically by pathologizing the situation or the victim - rather than the perpetrator.

A man's home is still his castle and the authorities are loath to intrude.

Most abusers are men and most victims are women. Even the most advanced communities in the world are largely patriarchal. Misogynistic gender stereotypes, superstitions, and prejudices are strong.

Therapists are not immune to these ubiquitous and age-old influences and biases.

They are amenable to the considerable charm, persuasiveness, and manipulativeness of the abuser and to his impressive thespian skills. The abuser offers a plausible rendition of the events and interprets them to his favor. The therapist rarely has a chance to witness an abusive exchange first hand and at close quarters. In contrast, the abused are often on the verge of a nervous breakdown: harassed, unkempt, irritable, impatient, abrasive, and hysterical.

Confronted with this contrast between a polished, self-controlled, and suave abuser and his harried casualties - it is easy to reach the conclusion that the real victim is the abuser, or that both parties abuse each other equally. The prey's acts of self-defense, assertiveness, or insistence on her rights are interpreted as aggression, lability, or a mental health problem.

 

---

---

---

The profession's propensity to pathologize extends to the wrongdoers as well. Alas, few therapists are equipped to do proper clinical work, including diagnosis.

Abusers are thought by practitioners of psychology to be emotionally disturbed, the twisted outcomes of a history of familial violence and childhood traumas. They are typically diagnosed as suffering from a personality disorder, an inordinately low self-esteem, or codependence coupled with an all-devouring fear of abandonment. Consummate abusers use the right vocabulary and feign the appropriate "emotions" and affect and, thus, sway the evaluator's judgment.

But while the victim's "pathology" works against her - especially in custody battles - the culprit's "illness" works for him, as a mitigating circumstance, especially in criminal proceedings.

In his seminal essay, "Understanding the Batterer in Visitation and Custody Disputes", Lundy Bancroft sums up the asymmetry in favor of the offender:

"Batterers ... adopt the role of a hurt, sensitive man who doesn't understand how things got so bad and just wants to work it all out 'for the good of the children.' He may cry ... and use language that demonstrates considerable insight into his own feelings. He is likely to be skilled at explaining how other people have turned the victim against him, and how she is denying him access to the children as a form of revenge ... He commonly accuses her of having mental health problems, and may state that her family and friends agree with him ... that she is hysterical and that she is promiscuous. The abuser tends to be comfortable lying, having years of practice, and so can sound believable when making baseless statements. The abuser benefits ... when professionals believe that they can "just tell" who is lying and who is telling the truth, and so fail to adequately investigate.

Because of the effects of trauma, the victim of battering will often seem hostile, disjointed, and agitated, while the abuser appears friendly, articulate, and calm. Evaluators are thus tempted to conclude that the victim is the source of the problems in the relationship."

There is little the victim can do to "educate" the therapist or "prove" to him who is the guilty party. Mental health professionals are as ego-centered as the next person. They are emotionally invested in opinions they form or in their interpretation of the abusive relationship. They perceive every disagreement as a challenge to their authority and are likely to pathologize such behavior, labeling it "resistance" (or worse).

In the process of mediation, marital therapy, or evaluation, counselors frequently propose various techniques to ameliorate the abuse or bring it under control. Woe betides the party that dares object or turn these "recommendations" down. Thus, an abuse victim who declines to have any further contact with her batterer - is bound to be chastised by her therapist for obstinately refusing to constructively communicate with her violent spouse.

Better to play ball and adopt the sleek mannerisms of your abuser. Sadly, sometimes the only way to convince your therapist that it is not all in your head and that you are a victim - is by being insincere and by staging a well-calibrated performance, replete with the correct vocabulary. Therapists have Pavlovian reactions to certain phrases and theories and to certain "presenting signs and symptoms" (behaviors during the first few sessions). Learn these - and use them to your advantage. It is your only chance.

This is the subject of the next article.

Appendix - Why Good People Ignore Abuse

Why do good people - church-goers, pillars of the community, the salt of the earth - ignore abuse and neglect, even when it is on their doorstep and in their proverbial backyard (for instance, in hospitals, orphanages, shelters, prisons, and the like)?

I. Lack of Clear Definition

Perhaps because the word "abuse" is so ill-defined and so open to culture-bound interpretation.

We should distinguish functional abuse from the sadistic variety. The former is calculated to ensure outcomes or to punish transgressors. It is measured, impersonal, efficient, and disinterested.

The latter - the sadistic variety - fulfils the emotional needs of the perpetrator.

This distinction is often blurred. People feel uncertain and, therefore, reluctant to intervene. "The authorities know best" - they lie to themselves.

II. Avoiding the Unpleasant

People, good people, tend to avert their eyes from certain institutions which deal with anomalies and pain, death and illness - the unsavory aspects of life which no one likes to be reminded of.

Like poor relatives, these institutions and events inside them are ignored and shunned.

 

---

---

---

III. The Common Guilt

 

Moreover, even good people abuse others habitually. Abusive conduct is so widespread that no one is exempt. Ours is a narcissistic - and, therefore, abusive - civilization.

People who find themselves caught up in anomic states - for instance, soldiers in war, nurses in hospitals, managers in corporations, parents or spouses in disintegrating families, or incarcerated inmates - tend to feel helpless and alienated. They experience a partial or total loss of control.

They are rendered vulnerable, powerless, and defenseless by events and circumstances beyond their influence.

Abuse amounts to exerting an absolute and all-pervasive domination of the victim's existence. It is a coping strategy employed by the abuser who wishes to reassert control over his life and, thus, to re-establish his mastery and superiority. By subjugating the victim - he regains his self-confidence and regulate his sense of self-worth.

IV. Abuse as Catharsis

Even perfectly "normal" and good people (witness the events in the Abu Ghraib prison in Iraq) channel their negative emotions - pent up aggression, humiliation, rage, envy, diffuse hatred - and displace them.

The victims of abuse become symbols of everything that's wrong in the abuser's life and the situation he finds himself caught in. The act of abuse amounts to misplaced and violent venting.

V. The Wish to Conform and Belong - The Ethics of Peer Pressure

Many "good people" perpetrate heinous acts - or refrain from criticizing or opposing evil - out of a wish to conform. Abusing others is their way of demonstrating obsequious obeisance to authority, group affiliation, colleagueship, and adherence to the same ethical code of conduct and common values. They bask in the praise that is heaped on them by their superiors, fellow workers, associates, team mates, or collaborators.

Their need to belong is so strong that it overpowers ethical, moral, or legal considerations. They remain silent in the face of neglect, abuse, and atrocities because they feel insecure and they derive their identity almost entirely from the group.

Abuse rarely occurs where it does not have the sanction and blessing of the authorities, whether local or national. A permissive environment is sine qua non. The more abnormal the circumstances, the less normative the milieu, the further the scene of the crime is from public scrutiny - the more is egregious abuse likely to occur. This acquiescence is especially true in totalitarian societies where the use of physical force to discipline or eliminate dissent is an acceptable practice. But, unfortunately, it is also rampant in democratic societies.

---

---

next: Coping with Your Abuser

Analysis of pros and cons of the DSM-IV, especially as it relates to personality disorders.

• Watch the video on DSM Classification for Personality Disorders 

The Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] - or the DSM-IV-TR for short - describes Axis II personality disorders as "deeply ingrained, maladaptive, lifelong behavior patterns". But the classificatory model the DSM has been using since 1952 is harshly criticized as woefully inadequate by many scholars and practitioners.

The DSM is categorical. It states that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). But this is by no means widely accepted. As we saw in my previous article and blog entry, the professionals cannot even agree on what constitutes "normal" and how to distinguish it from the "disordered" and the "abnormal". The DSM does not provide a clear "threshold" or "critical mass" beyond which the subject should be considered mentally ill.

Moreover, the DSM's diagnostic criteria are ploythetic. In other words, suffice it to satisfy only a subset of the criteria to diagnose a personality disorder. Thus, people diagnosed with the same personality disorder may share only one criterion or none. This diagnostic heterogeneity (great variance) is unacceptable and non-scientific.

In another article we deal with the five diagnostic axes employed by the DSM to capture the way clinical syndromes (such as anxiety, mood, and eating disorders), general medical conditions, psychosocial and environmental problems, chronic childhood and developmental problems, and functional issues interact with personality disorders.

Yet, the DSM's "laundry lists" obscure rather than clarify the interactions between the various axes. As a result, the differential diagnoses that are supposed to help us distinguish one personality disorder from all others, are vague. In psych-parlance: the personality disorders are insufficiently demarcated. This unfortunate state of affairs leads to excessive co-morbidity: multiple personality disorders diagnosed in the same subject. Thus, psychopaths (Antisocial Personality Disorder) are often also diagnosed as narcissists (Narcissistic Personality Disorder) or borderlines (Borderline Personality Disorder).

 

The DSM also fails to distinguish between personality, personality traits, character, temperament, personality styles (Theodore Millon's contribution) and full-fledged personality disorders. It does not accommodate personality disorders induced by circumstances (reactive personality disorders, such as Milman's proposed "Acquired Situational Narcissism"). Nor does it efficaciously cope with personality disorders that are the result of medical conditions (such as brain injuries, metabolic conditions, or protracted poisoning). The DSM had to resort to classifying some personality disorders as NOS "not otherwise specified", a catchall, meaningless, unhelpful, and dangerously vague diagnostic "category".

One of the reasons for this dismal taxonomy is the dearth of research and rigorously documented clinical experience regarding both the disorders and various treatment modalities. Read this week's article to learn about the DSM's other great failing: many of the personality disorders are "culture-bound". They reflect social and contemporary biases, values, and prejudices rather than authentic and invariable psychological constructs and entities.

The DSM-IV-TR distances itself from the categorical model and hints at the emergence of an alternative: the dimensional approach:

"An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another" (p.689)

According to the deliberations of the DSM V Committee, the next edition of this work of reference (due to be published in 2010) will tackle these long neglected issues:

The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;

The genetic and biological underpinnings of personality disorder(s);

The development of personality psychopathology during childhood and its emergence in adolescence;

The interactions between physical health and disease and personality disorders;

The effectiveness of various treatments - talk therapies as well as psychopharmacology.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

 

---

---

next: Narcissism and Personality Disorders

• Watch the video on Stockholm Syndrome

Psychologically, how does someone become a victim of spousal abuse or the abuser? Insights into the dynamics of spousal abuse.

Articles Menu

II. The Mind of the Abuser

III. Condoning Abuse

IV. The Anomaly of Abuse

V. Reconditioning the Abuser

VI. Reforming the Abuser

VII. Contracting with Your Abuser

VIII. Your Abuser in Therapy

IX. Testing the Abuser

X. Conning the System

XI. Befriending the System

XII. Working with Professionals

XIII. Interacting with Your Abuser

XIV. Coping with Your Stalker

XV. Statistics of Abuse and Stalking

XVI. The Stalker as Antisocial Bully

XVII. Coping with Various Types of Stalkers

XVIII. The Erotomanic Stalker

XIX. The Narcissistic Stalker

XX. The Psychopathic (Antisocial) Stalker

XXI. How Victims are Affected by Abuse

XXII. Post-Traumatic Stress Disorder (PTSD)

XXIII. Recovery and Healing from Trauma and Abuse

XXIV. The Conflicts of Therapy

Important Comment

Most abusers are men. Still, some are women. We use the masculine and feminine adjectives and pronouns ('he", his", "him", "she", her") to designate both sexes: male and female as the case may be.

 

It takes two to tango - and an equal number to sustain a long-term abusive relationship. The abuser and the abused form a bond, a dynamic, and a dependence. Expressions such as "folie a deux" and the "Stockholm Syndrome" capture facets - two of a myriad - of this danse macabre. It often ends fatally. It is always an excruciatingly painful affair.

Abuse is closely correlated with alcoholism, drug consumption, intimate-partner homicide, teen pregnancy, infant and child mortality, spontaneous abortion, reckless behaviours, suicide, and the onset of mental health disorders. It doesn't help that society refuses to openly and frankly tackle this pernicious phenomenon and the guilt and shame associated with it.

People - overwhelmingly women - remain in an abusive household for a variety of reasons: economic, parental (to protect the children), and psychological. But the objective obstacles facing the battered spouse cannot be overstated.

 

---

---

---

The abuser treats his spouse as an object, an extension of himself, devoid of a separate existence and denuded of distinct needs. Thus, typically, the couple's assets are on his name - from real estate to medical insurance policies. The victim has no family or friends because her abusive partner or husband frowns on her initial independence and regards it as a threat. By intimidating, cajoling, charming, and making false promises, the abuser isolates his prey from the rest of society and, thus, makes her dependence on him total. She is often also denied the option to study and acquire marketable skills or augment them.

Abandoning the abusive spouse frequently leads to a prolonged period of destitution and peregrination. Custody is usually denied to parents without a permanent address, a job, income security, and, therefore, stability. Thus, the victim stands to lose not only her mate and nest - but also her off-spring. There is the added menace of violent retribution by the abuser or his proxies - coupled with emphatic contrition on his part and a protracted and irresistible "charm offensive".

Gradually, she is convinced to put up with her spouse's cruelty in order to avoid this harrowing predicament.

But there is more to an abusive dyad than mere pecuniary convenience. The abuser - stealthily but unfailingly - exploits the vulnerabilities in the psychological makeup of his victim. The abused party may have low self-esteem, a fluctuating sense of self-worth, primitive defence mechanisms, phobias, mental health problems, a disability, a history of failure, or a tendency to blame herself, or to feel inadequate (autoplastic neurosis). She may have come from an abusive family or environment - which conditioned her to expect abuse as inevitable and "normal". In extreme and rare cases - the victim is a masochist, possessed of an urge to seek ill-treatment and pain.

The abuser may be functional or dysfunctional, a pillar of society, or a peripatetic con-artist, rich or poor, young or old. There is no universally-applicable profile of the "typical abuser". Yet, abusive behaviour often indicates serious underlying psychopathologies. Absent empathy, the abuser perceives the abused spouse only dimly and partly, as one would an inanimate source of frustration. The abuser, in his mind, interacts only with himself and with "introjects" - representations of outside objects, such as his victims.

This crucial insight is the subject of the next article.

---

---

next: The Mind of the Abuser

There seems to be a heirarchy based on the damage caused to the  abuse victim  by the particular types of abuse.

Is sexual abuse worse than emotional abuse? Is verbal abuse less deleterious than physical abuse (beatings)? Somehow, the professional literature implies that there is a hierarchy with sexual mistreatment at its nadir. It is rare to hear about a dissociative identity disorder ("multiple personality") that is the outcome of constant oral humiliation in early childhood. But it is thought to be a common response to egregious sexual molestation of infants and to other forms of deviance and perversions with minors.

Yet, these distinctions are spurious. One's mental space is as important to one's healthy development and proper adult functioning as one's body. Indeed. the damage in sexual abuse is hardly corporeal. It is the psychological intrusion, coercion, and the demolition of nascent boundaries of the self that inflict the most damage.

Abuse is a form of long-term torture usually inflicted by one's nearest and dearest. It is a grievous violation of trust and it leads to disorientation, fear, depression, and suicidal ideation. It generates aggression in the abused and this overwhelming and all-pervasive emotion metastasizes and transforms into pathological envy, violence, rage, and hatred.

The abused are deformed by the abuser both overtly - many develop mental health disorders and dysfunctional behaviours - and, more perniciously, covertly. The abuser, like some kind of alien life form, invades and colonizes the victim's mind and becomes a permanent presence. Abused and abuser never cease the dialog of hurt, recrimination, and glib denial or rationalization that is an integral part of the act.

In a way, psychological abuse - emotional and verbal - is harder to "erase" and "deprogram". Words resonate and reverberate, pain resurfaces, narcissistic wounds keep opening. The victims proceeds to pay with stunted growth and recurrent failure for his own earlier degradation and objectification.

Social attitudes don't help. While sexual and physical abuse are slowly coming to the open and being recognized as the scourges that they are - psychological abuse is still largely ignored. It is difficult to draw a line between strict discipline and verbal harassment. Abusers find refuge in the general disdain for the weak and the vulnerable which is the result of suppressed collective guilt. The "good intentions" defence is still going strong.

The professional community is no less to blame. Emotional and verbal abuse are perceived and analyzed in "relative" terms - not as the absolute evils that they are. Cultural and moral relativism mean tat many aberrant and deplorable behaviour patterns are justified based on bogus cultural "sensitivities" and malignant political correctness.

Some scholars even go as far as blaming the victim for his or her maltreatment (the discipline is known as victimology). Is the abused guilty - even partially - for the abuse? Does the victim emit a "come-on" signal, picked up by would-be abusers? Are certain types of people more prone to abuse than others?

This is the subject of the next article.

---

---

next: The Guilt of the Abused - Pathologizing the Victim

What is normal, when it comes to human behavior?  An analysis of how  mental health professionals and other groups view normal behavior.

Personality disorders are dysfunctions of our whole identity, tears in the fabric of who we are. They are all-pervasive because our personality is ubiquitous and permeates each and every one of our mental cells. I just published the first article in this topic titled "What is Personality?". Read it to understand the subtle differences between "personality", "character", and "temperament".

In the background lurks the question: what constitutes normal behavior? Who is normal?

There is the statistical response: the average and the common are normal. But it is unsatisfactory and incomplete. Conforming to social edicts and mores does not guarantee normalcy. Think about anomic societies and periods of history such as Hitler's Germany or Stalin's Russia. Model citizens in these hellish environments were the criminal and the sadist.

Rather than look to the outside for a clear definition, many mental health professionals ask: is the patient functioning and happy (ego-syntonic)? If he or she is both then all is well and normal. Abnormal traits, behaviors, and personalities are, therefore defined as those traits, behaviors, and personalities that are dysfunctional and cause subjective distress.

But, of course, this falls flat on its face at the slightest scrutiny. Many evidently mentally ill people are rather happy and reasonably functional.

 

Some scholars reject the concept of "normalcy" altogether. The anti-psychiatry movement object to the medicalization and pathologization of whole swathes of human conduct. Others prefer to study the disorders themselves rather to "go metaphysical" by trying to distinguish them from an imaginary and ideal state of being "mentally healthy".

I subscribe to the later approach. I much prefer to delve into the phenomenology of mental health disorders: their traits, characteristics, and impact on others.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

 

---

---

next: The Diagnostic and Statistical Manual (DSM) - Pros and Cons