.....(Revised, April 18, 2016)
As I say on my "Dirty Laundry" page, mental illness is nothing to be ashamed of. But I have to admit, what I'm going to talk about here is something that I do feel ashamed of. Not because of society's stigma surrounding mental illness or even the specific disorder I've been diagnosed with but because of the way it's manifested itself in me. It has cost me friends, jobs and opportunities; and I'm still trying to figure out how to go about overcoming it. Or at least diminishing the hold it has had over me.
I am one of many people in this country who receives disability income through the Social Security Administration. When I went to my hearing to determine if I qualified for this program, I was asked by the judge why I thought I was disabled. My reasons were my struggle with depression and anxiety which has been debilitating for me. It's a condition that isn't accomodated by most jobs I've had and resulted in hospitalizations and treatment that wasn't compatible with most vocational obligations. This resulted in an inability not only to maintain regular employment but to just live a normal life.
As the court's expert witness looked through my medical records, he said to the judge that while my depression and anxiety certainly contributed to my status as a disabled person, he was more inclined to base the reason on a diagnosis of something called "Narcissistic Personality Disorder" (NPD).
When I heard those words, I turned to my attorney and said, "No one told me about that."
My attorney replied, "Don't worry about it."
The judge ruled in my favor. He determined that I was disabled by NPD, Dysthymia and General Anxiety Disorder (GAD) and I started receiving a disability stipend in early 2006. But that term, "Narcissistic Personality Disorder," haunted me. It didn't sound very flattering (which should have been my first clue that I should learn exactly what it is). But I put it off for quite a while then relented and looked it up online.
As I read about the disorder, particularly the list of diagnostic criteria, I recognized myself in it. That's when I stopped reading.
I wouldn't try reading it again until several months later after I had acted out in a way that I would later learn is characteristic of someone with NPD and lost a close friend in the process. It was at that point that I swallowed my pride (restrained my narcissism) and looked up the disorder once again.
As the description scrolled on my computer screen, I was tempted to stop reading and just run away from the problem. Once again I recognized myself, particularly in the following examples—accompanied by my reactions to them.
- "has a grandiose sense of self-importance" —That's me.
- "is often envious or believes others are envious of him or her" —That's me.
- "arrogant affect" —Also me.
- "believes that he or she is 'special' and unique..."
—What the hell do you mean I only BELIEVE I'm special and unique?!?... Okay, that's me too.
"DSM-IV[*] divides personality disorders into three clusters based on symptom similarities:
- "Cluster A (paranoid, schizoid, schizotypal): odd or eccentric disorders
- "Cluster B (antisocial, borderline, histrionic, narcissistic): dramatic, emotional or erratic disorders
- "Cluster C (avoidant, dependent, obsessive-compulsive): anxious or fearful disorders
According to the World Health Organization, "Narcissistic Personality Disorder (NPD) [is] 'a personality disorder that fits none of the specific rubrics'. It relegates it to the category known as 'Other specific personality disorders', which also includes the eccentric, 'haltlose', immature, passive-aggressive, and psychoneurotic personality disorders.
"People who are narcissistic...often react with disdain, rage, and/or defiance to any slight, real or imagined."
I imagine that's why none of my therapists or psychiatrists bothered to tell me about it and for a long time, I kept this little fact to myself. Admitting it to only a very few people.
In addition to the stigma surrounding mental illness, there is also a stigma associated with people receiving a government stipend for a disability. Accusations abound in certain circles about "disability fraud" and people "gaming the system."
As someone who has personally been through the disability claims process, I can assure you that fraudulent claims are rare. The application process is so long and complicated, and requires so much supporting medical evidence and testimony to verify such claims that it would be incredibly difficult to fake one's way into the system. Many people with completely legitimate claims for compensation are denied those benefits at least once in the application process. The poverty-level benefits can also be discouraging for those considering to apply fraudulently.
Bottom line, disability fraud is the rare exception and not the rule.
Recipients of disability income are often leery of questions regarding their benefits. The most common question—in my estimation—is, "Why are you on disability?" Rarely is the question worded as, "What is your disability?" (especially for those of us with "invisible" conditions—i.e. mental illness.) This leeriness stems from the aforementioned stigma associated with being "disabled."
I do my best to try and be honest in all of my interactions, even when it comes to my status as a disabled person. However, I do tend to choose my words carefully. When asked, "Why are you on disability?" my answer is usually vague: "Mental health issues." If pressed for details, "I have clinical depression and GAD," which is true but an incomplete answer.
How can one say, "I'm disabled by chronic narcissism" without worrying that one won't be taken seriously?
I've often joked in the past, in a self depricating tone, that I was narcissistic (this was before I was diagnosed with NPD) but I never thought of it as debilitating. Now I realize it was NPD episodes that made it very difficult for people to work with me and for me to work for others. As a result, I have been fired from jobs or quit in frustration (usually with the writing on the wall that I would probably be "let go" anyway). In hindsight, it all seems to make sense. Who would want to work with a guy who can go from zero-to-asshole at the drop of a hat (real or imagined)?
While there is no doubt in my mind about my struggles with depression and anxiety (they manifest themselves pretty clearly), it isn't as easy to figure out when the NPD is acting up. To know where to draw the line between a "normal" reaction to a triggering event and when the disorder "takes over."
With anxiety, for example, one can be presented with a task that seems to be overwhelming. GAD takes over when the sufferer's reaction is to shy away from it or to avoid it altogether.
With situational clinical depression, a triggering event may be something that would lead to non-clinical depression in almost anyone like the death of a family member. In a "normal" person, they will become depressed, grieve for a period of time, accept the loss and return to a non-depressive state of mind. If the condition persists for a longer than average period, this individual might benefit from a temporary prescription of anti-depressant medication that is eventually no longer needed. However, for someone with chronic depression (like Dysthymia), the trigger may simply aggravate an existing depressive state which is already difficult to deal with and may go away only with the assistance of anti-depressants (or an adjustment of dosage or change in an existing prescription) that they might have to continue taking for the rest of their lives (I fall under that category).
One can't draw such a clear line when it comes to NPD. A person dealing with GAD or clinical depression can tell when they're affected by those conditions. They recognize their anxiety and/or their depression for what they are. The same can't always be said for a person with NPD who is acting out from a triggering event.
I've often been puzzled by the experiences of patients who deal with other mental illnesses and their claims that they seem separated from themeselves when going through an episode related to their disorders. Until I finally recognized an NPD episode that I went through. Unfortunately, during the episode itself, I was oblivious to the effects of my behavior. Until after it had gone on to a point that I realized how I was behaving and recognized that I was not reacting in a normal way to what triggered it. I'm not saying that I'm not responsible for my actions but now I understand why they happened the way they did. I was once able to recognize myself acting out while it was happening and I did feel separated from the event, watching myself do and say things that I knew I shouldn't have. It's frustrating and scary to know that those behaviors aren't appropriate; I knew better... but I did it anyway. When I realized that, it reminded me of that old saying attributed to Benjamin Franklin and Albert Einstein, among others:
"Insanity is doing the same thing over and over again and expecting different results."As a result of that first recognized experience--what one of my therapists described as a quasi-"meta-narcissism"--for the first time in my life I questioned, for the lack of a better term, my own sanity.
"Am I totally out of control?" I thought. "Am I deranged? Am I, as one person said, a 'nut case'?"
Of course, another old saying came to mind: "If you find yourself asking whether or not you're crazy, then you're probably not." After the experience where I recognized what was happening as it was happening, I knew that I had to learn how to deal with this problem. I still feel awful about the things that I said and did. Even those that happened months and even years ago. And I don't know how to make it right other than to try and explain it here. Writing about this disorder--my disorder... my personality disorder--is one of the hardest things I've ever done.
As for what causes NPD, all I know is what I've read:
"...Studies have not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.
"Some Narcissistic traits are common and a normal developmental phase. When these traits are compounded by a failure of the interpersonal environment and continue into adulthood they may intensify to the point where NPD is diagnosed. The disorder occurs 50 to 75 percent more frequently in men than in women."
My own layman's research leads me to the opinion that NPD's cause is social, more than anything else. As I look back at my upbringing I recognize similar traits in my family, particularly when I read that "These traits will lead narcissistic parents to be very intrusive in some ways, and entirely neglectful in others. The children are punished if they do not respond adequately to the parents' needs. This punishment may take a variety of forms, including physical abuse, angry outbursts, blame, attempts to instill guilt, emotional withdrawal, and criticism. Whatever form it takes, the purpose of the punishment is to enforce compliance with the parents' narcissistic needs."
The neglect was there. The punishment, the abuse, angry outbursts, instilling guilt. It was all there.
NPD itself cannot be treated medically. That is to say, there is no drug that can "fix" it. All that can be done is to treat the peripheral symptoms of the disorder like depression and anxiety which can be treated medically. As for treating the personality disorder itself. It's often a very long process that requires a therapist to gauge how the patient with NPD will react to being confronted with his or her own narcissism. Often, when NPD patients are presented with the diagnosis, they discontinue treatment, seeing such a diagnosis as a slight, thus triggering a textbook NPD response. It is for that reason that such an "intervention" must be eased into over time.
As for my own treatment. I returned to therapy and being treated for my depression and anxiety. I have also taken steps to address the deeper issues contributing to my narcissism. Coming forward with these concerns really surprised my therapists and was actually very encouraging. I still find myself acting out from time to time but I think I'm getting better at nipping those perceived slights in the bud before they escalate... but not always. A big part of successfully treating an NPD patient is the willingness of the patient to seek or accept such treatment. Bottom line: Swallowing a whole lot of pride and setting aside one's ego so that they may address the causes of their behavior which often comes from a poor self-image.
One unexpected side-effect of the progress that I've made with my NPD has been an escalation in my levels of anxiety. I was once told that it makes sense that someone who has become aware of their narcissism and is actively trying to keep it in check would tend to feel more anxious in general. I've also found the effort to be physically and emotionally exhausting but I think it's worth it if it means that I can better manage the NPD and get along better with others.
*Current at the time of this page's original publication.