Maybe You Should Talk to Someon - Lori Gottlieb Page 0,38
His father, an English professor with aspirations to be a writer, took care of the boys alone until he married a widowed neighbor with no children three years later. John described his stepmom as “vanilla, but I have nothing against her.”
While John has had a lot to say about the various idiots in his life, his parents have been largely absent from our conversations. During my internship, a supervisor suggested that with very defended patients, one way to get a sense of their pasts is by asking them, “Without thinking about it, what three adjectives come immediately to mind in relation to your mom’s [or dad’s] personality?” These off-the-cuff answers have always given me (and my patients) helpful insights into their parental relationships.
But nothing comes of this with John. “Saint, saint, and saint—that’s three words for both of them!” he replies, using nouns instead of adjectives despite his writerly facility with words. (I’ll learn later that his father “might have” had a drinking problem after his wife died and “possibly” still does and that John’s oldest brother once told John that their mother “might have” had “a light version of bipolar disorder,” but, John said, his brother was just “being dramatic.”)
I’m curious about John’s childhood because of his narcissism. His self-involvement, defensiveness, demeaning treatment of others, need to dominate the conversation, and sense of entitlement—basically, his being an asshole—all fall under the diagnostic criteria for narcissistic personality disorder. I noticed these traits at our very first session, and while some therapists might have referred John out (narcissistic personalities aren’t considered good candidates for introspective, insight-oriented therapy due to their struggle to see themselves and others clearly), I was game.
I didn’t want to lose the person behind the diagnosis.
Yes, John had likened me to a prostitute, acted as though he were the only person in the room, and felt that he was better than everyone else. But underneath all that, how different, really, was he from the rest of us?
The term personality disorder evokes all kinds of associations, not just for therapists, who consider these patients to be a handful, but in the popular culture as well. There’s even a Wikipedia entry that catalogs movie characters and the personality disorders they exemplify.
The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the clinical bible of psychological conditions, lists ten types of personality disorders, broken into three groups, called clusters:
In outpatient practice, we mostly see patients in cluster B. People who are untrusting (paranoid), loners (schizoid), or oddballs (schizotypal) don’t tend to seek out therapy, so there goes cluster A. People who shun connection (avoidant), struggle to function like adults (dependent), or are rigid workaholics (obsessive-compulsive) also don’t look for help very often, so there goes cluster C. The antisocial folks in cluster B generally won’t be calling us either. But the people who experience difficulty in relationships and are either extremely emotional (histrionics and borderlines) or married to people like this (narcissists) do make their way to us. (Borderline types tend to couple up with narcissists, and we see that pairing often in couples therapy.)
Until very recently, most mental-health practitioners believed that personality disorders were incurable because unlike mood disorders, such as depression and anxiety, personality disorders consist of long-standing, pervasive patterns of behavior that are very much a part of one’s personality. In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them.
But personality disorders lie on a spectrum. People with borderline personality disorder are terrified of abandonment, but for some, that might mean feeling anxious when their partners don’t respond to texts right away; for others, that might mean choosing to stay in volatile, dysfunctional relationships rather than being alone. Or consider the narcissist. Who doesn’t know somebody who fits the bill to varying degrees—accomplished, charismatic, smart, and witty but alarmingly egocentric?
Most important, having traits of a personality disorder doesn’t necessarily mean that a person meets the criteria for