Archive for December, 2011

Getting better should not make you feel good?

Posted in health, mental health, personal, rants with tags , on December 26, 2011 by theweirdphilosopher

I know I´m writing (and ranting) an awful lot about articles lately, but often my reactions to stuff I read are the best pathway into the workings of my psyche. So here is today´s rant: A few months back I read this article and it triggered about all my sensitivities. So, in order to explore my sensitivities, I might want to look back at this article. I guess the best approach would be to highlight the paragraphs which upset me most:

“I think a lot of clients (and some therapists unfortunately) have a misconception that therapy should make you feeling nothing but good. This is simply not true.

Real therapy is very, very hard work. It requires complete honesty on the part of both the client and the therapist. I think a lot of therapists see therapy as something which provides a lot of “hearts and flowers” as one therapist put it. Patting you on the head and telling you how wonderful you are may feel good, but it is not therapy. For that you should get a dog who will wag its tail and love you unconditionally.

I think of a therapist as a mirror. They are someone who is able to reflect back to you a clear and undistorted image of yourself so that you may understand yourself better. This reflection can also provide you with a lot of information about how you appear to and interact with other people. Clear and undistorted images with all of our flaws are hard to take.”

Now what is wrong with that?  First of all, it is unrealistic that any human being can give another human being an “undistorted image” of himself. We´re ALL just human beings with limited knowledge and a very subjective experience of things, and “all” includes therapists! Unfortunately some of them only ever remember that when they fuck up big time, but then, of course, they emphasize ad nauseam they´re, too,  just human.

But there is more.  What kind of message does this deliver? At least to me, that is. Quite frankly, it makes me feel like shit. So if I want to be accepted and loved I should get myself a dog? Why? Because I can´t expect anybody else to be nice to me? Am I that much of a horrible person? Do I need a defenseless, possibly mindless being which I can use for (narcissistic) “supply”, because nobody else would provide it to a person like me?

That does not yet hit the core of my sensitivity, though. The worst part is a bit hard to explain, but I´ll try. So according to this man, in order to be helpful, therapy must be a painful process, and it comes across as if the therapist had to be almost cruel. But what kind of person am I, if one must be harsh and cruel to me in order to help me? Do I not deserve kindness? Is it, in turn, bad for me when people are nice and “tell me I´m wonderful”? Should I be treated like shit, should people make me miserable for my own good?

This whole phrase “pat you on the head and tell you you´re wonderful” is so insulting in itself. Is this really what average people look for in a relationship? No, for fuck´s sake! But there should be encouragement, and, yes, unconditional love! What this guy basically does, is accusing everybody who feels offended or hurt by his methods of wanting to be told they are perfect!

But in fact it is so different. Our own flaws are a difficult subject, yes. And having someone point them out to you is a shameful, often humiliating and potentially damaging endeavor. So if it must happen, we will probably want it to happen in the least painful way possible. Like: It should be done with compassion, with tact, and with respect for the patient´s feelings. And what this guy does, is that he manages to make me feel pathetic for wanting to be treated with compassion, tact, and respect for my feelings. He makes me feel like these needs are a weakness. Well, they are. Nearly everything about me is weak. But it is appalling that a therapist of all people should make me feel like this weakness is stupid and pathetic. Nobody is stupid because of his vulnerabilities. Each time somebody touches my points most sore, though, not only do I have to deal with being hurt, I also get overcome by shame and self-loathing for having these points in the first place. Often I become unable to feel the hurt because I´m so ashamed of being hurt. I guess preying on the vulnerable spots of others is a very human thing to do. The humane thing, however, is to abstain from it.

 

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Treating narcissism, part II

Posted in health, mental health, personal, rants with tags , , on December 25, 2011 by theweirdphilosopher

Yesterday I read through some teaching materials by some psychology professor (Prof. Sachse) who talked in detail about how to treat people with Narcissistic Personality Disorder. It´s all in German, but I´ll post the link anyway. I´m anankastic when it comes to citing sources. You´ll have to go to the “Downloads” section of the site, and then look at “Folien PS”. Here is the link: http://ipp-bochum.de/

What he said was about this: People with NPD have one side to them where they have huge self-esteem and think highly of themselves, and they have another side which makes them believe that deep down, they are worthless as a person. They rely on others´ praise and approval in order to compensate  their lack of genuine self-worth, but that only reinforces the message that if it wasn´t for what they achieve and how great they are, they would be worthless. They often try to compete with the therapist, they might have read psych books. Also, these persons are very distrustful and suspicious of others.

Such a person might present for therapy saying that nothing is wrong with him, he just needs a bit of coaching or something the like. Sachse says that in order to keep him in therapy, you must not correct him on this. Never call his problem a problem, but use praise and compliments (“I think it´s great that you are trying to improve your situation, but a person as special as you sure wants a thorough treatment, so we need to figure out exactly what is not alright at the moment…”) to steer him into a “therapeutically useful” direction. You´ll know what I think about this if you read my last post.  Also, Sachse says, one must make it clear to the patient that everything is up to him. All you can do is inform him of the price he might pay if he doesn´t comply with one or the other therapeutic measure. Ah, yeah. That complete freedom of decision, once again. Sachse advices the therapist to tell the patient whenever possible that the therapist thinks the patient is great, clever, accomplished.  He shall always put emphasis on the patient´s resources and strengths. And I even thought it was a good idea to treat all patients like that…

If, at some point, the patient is on the verge of admitting that there might be something wrong with him after all,  the therapist shall facilitate this by playing down the problem and telling the patient it is great that he is trying to solve his issues. He shall not ever let the patient know how mistaken his self-image is.

Huh. There is so much wrong with all this I don´t even know where to start. I´ll just start somewhere, then. In the very first paragraph, I said that according to Sachse, people with NPD are suspicious of others and highly distrustful. So, dear Professor, do you think that anyone with NPD will just buy all you flattery and compliments?! Also, they tend to have read a psychology book or two, so they might just have read your materials as well! If these folks confront you with the fact that you think they have NPD, how will you react? You will probably deny it. You don´t flatter them to keep them in therapy. You mean what you say. Well, how might that feel to the person with NPD?

I´m really not shit? That is so comforting. But *pang of distrust* what if this is just a psychological trick? He will tell me that I´m great, just so I let my defenses down, and then he will have proof that I´m really a narcissist, and then he will attack and tear me apart. *Feeling distress* I must protect myself somehow. *Cold rage* We´ll see about that, Doctor! I´ll prove that you are just being manipulative, and then you are the one who looks silly! 

It is, of course, nearly impossible to prove, unless you demand to see his notes on you (there is just a limited possibility to do so in Germany). In my own struggles with Dr. Stoneface, I sometimes asked him openly if he wasn´t just manipulating me, as if he would suddenly tell me the truth if only I asked sincerely and nicely enough. Like: “Okay, Dr. Stoneface, according to the rules of our therapist-patient-relationship you may not tell me this, but outside of this we are two grown-up people who can cut the crap and talk like adults, aren´t we? So, for real now, what are you trying to do with me?” Blessed naivety… like it worked that way! “Okay, time-out, we´re not playing anymore because we need to clarify the rules.” There´s no time-out in therapy.

His persistent denial that he was manipulating me led me to the following two options: Either he means what he says and then my perception is completely distorted and unreliable, or his denial is just another means of manipulation and in that case I am 1) stupid and gullible for even doubting my own perception and 2) a truly pathetic person who cannot even be told the truth about how pathetic she is.

And here we arrive at another thing that is wrong with Sachse´s approach. The empty, calculating praise he offers has a devastating effect on people. Even according to his own theory, it would confirm their view that only their success and general awesomeness matter, not them as a person.  But that´s not all.

If your therapist praises you whenever possible, and for the smallest, tiniest things, what kind of self-image do you get? Not that you are great. But that you are hopelessly fucked up. Because if you get praise for good behaviors which are so self-evident that, if performed by other people, they are taken for granted, then your normal behavior (or even worse: character) must be really horrible. Seriously, you don´t boost peoples´ self-esteem by praising them for showing behaviors that everybody should naturally show. If he thinks that he has to praise you for such things, then he must think the worst of you. And what if he is right?!

The fact that your therapist seems to think that this will make you feel good about yourself, or even proud of yourself, is even more insulting. How dumb, arrogant and easy-to-please does he think you are?! Does he think you have no higher standards? And now you will be even more ashamed when he manages to make you feel good about yourself. Because to you it means that your standards must really be low. How pathetic, right?

All this gave me some ideas which might be worth exploring at some point. Looking at myself, I realized that praise does feel good. It does. But it also scares me a great deal. Praise is also dangerous. Feeling good about being praised makes me vulnerable. To what? Huh. To manipulation, obviously. But also to starting to feel really great about myself, and really proud of myself, and not seeing anymore how others might look at me. Like, with cruel intentions. They might want to burst my bubble, they can do so with any ease, and if they do, I´ll be completely exposed. Worse than being naked in front of your whole class.

Want an example? There is no shame in not being intelligent. But there is shame in not being intelligent while believing one is intelligent. And letting others see this bubble in which you live – the belief that you are intelligent, and that it makes you feel good and that it is important to you – makes you very, very vulnerable. You only need to be wrong once, and immediately that bubble bursts and you feel like an absolute fool. I get intrusive memories of moments when I made a fool of myself (like using the word “serotonine” instead of “endorphine”^^), and they make me want to slap myself. Sometimes I actually do.

But I don´t even brag to others that I´m intelligent. I don´t like to talk about my grades in school, for example. (I admit that by talking about the issue on here, I´m contradicting myself.) I feel an urgent need to pretend that I don´t want others to think I´m particularly intelligent (oh, but I do. Trust me. But at least I´m honest, huh? XD). I don´t just need to deliver this message to others, I need to believe in it myself, because otherwise the shame when I get something wrong is unbearable.

I wonder where this is coming from. This fear that I will be attacked. Given how much shame even a small correction evokes in me, almost everything is an attack and I need to be on guard all the time. With such a definition of being attacked, of course, I´ve been attacked many times in my life. I´ve made the experience of this crippling shame many times. But why is there so much shame in being wrong? Because I believe I´m sooo clever (not rationally, but somewhere deep down). But why am I so sure of that? I am not really sure of it, am I? Otherwise I wouldn´t mind mistakes. Maybe I´m just sure that others think so? Sometimes I feel like my mind is just a collection of things that have been said about me, and those in favor of me are in a constant war with those who despise me. Where am I in all this, if I even have a self?

I´m really down at the moment. I feel like a complete piece of garbage. And I cannot even allow myself to feel that. Because straight away my mental representations of Dr. Stoneface and all other kinds of persons jeer with triumph. Yeah, you fuckers, there you have it: Another window of opportunity to destroy me.  I´m vulnerable, my defenses are shaky, and I´m “finally” open to self-doubt, reflection and honesty.  Think quickly, how could you make therapeutic use of the fact that I feel like crying? 

Isn´t it interesting? I´m not just unable to just enjoy praise, I also feel unable to admit to feelings of shame and worthlessness. The reason is similar: It makes me vulnerable. People can use it to manipulate me. “Now that you see you were mistaken on A, you could use the opportunity to also correct B, C, and D! And if you don´t, you´re making the same mistake again, you are just too dumb to see it!” Yes, it´s lovely here inside my head. Nice, caring atmosphere.

Proving I´m sane – a psychology lecture through the eyes of a former mental health patient, part IV

Posted in college, health, mental health, personal with tags on December 13, 2011 by theweirdphilosopher

I guess at some point I´m going to have to write this entry, so I might as well do it now. It will mainly deal with a comment made by the latest professor to hold Dr. Bla´s lecture. I will call him Dr. Curl. So, Dr. Curl talked about personality disorders, and the comment, of course, referred to Narcissistic Personality Disorder. Before I can go into that, I will have to explain why I even attend psychology lectures.

I made three attempts at psychotherapy in my life, two of them being slightly analytically oriented talk therapies. The last attempt, the one with Dr. Stoneface, lasted for about two years before I quit. Quitting took me about one of those two years. I had felt the entire time that he was not being open with me, that he was trying to manipulate me, that he was following some kind of treatment plan or strategy which I was not supposed to know about. Not in the sense of a political or religious agenda. But everything he said was said for the effect it should have on me. I always wondered: “So how is this statement supposed to make me feel?” I felt like he was making secret assumptions about me, weighing his words for the potential effect, and then saying whatever would steer me into the direction he wanted to steer me into. It was like talking to someone who never gives his honest opinion on anything, who is never genuine – and being unable to prove it.

I called Dr. Stoneface out on this so many times. I told him he was toying with me, I told him he had made (potentially unfavorable) assumptions about me without giving me a chance to give my view, and I demanded that he finally told me my diagnosis. He refused. He called me “abnormally distrustful”, conveniently assuming that I was equally distrustful towards everybody else. I wasn´t, but he claimed so in such a convincing manner that I did indeed become abnormally distrustful towards a person other than him: myself.  I told him these were all just tricks to keep me in therapy, and he asked me why he would want to do that. He told me that I was free to leave, and in the same instant he told me I was not ready. When I told him he wasn´t being genuine, he denied it, leaving me to wonder if I should trust my own perception or if, maybe, my perception was distorted by the mysterious disorder I had. How could I have known, given that I didn´t know what my disorder was? Under such circumstances, becoming able to leave was a real victory.

Even though I had finally physically left therapy, Dr. Stoneface stayed with me. I could never stop wondering if I was really just being paranoid, abnormally distrustful, if my perception was distorted. I hoped, though, that if they weren´t going to tell a patient the truth, maybe they would at least be honest with their students. And so I decided to sneak into these two psychology lectures. As an undercover agent, so to say. And last Thursday, the miracle happened. One of them slipped up and told the truth.

It might sound like my life is some kind of weird movie, but on this precise day I had actually wondered if I should really go to the lecture. I wanted to, I was interested in what they´d say about personality disorders, but I was also tired and down. Lately I just don´t manage to get anything done. Therefore, I was at least 15 minutes late for the lecture. I took a seat and listened to Dr. Curl introducing all Cluster A and Cluster B personality disorders before the ran out of time. The last thing he talked about was NPD.  He explained that it is one of the most difficult disorders to treat, because narcissists don´t respond well to criticism or perceived criticism. And then he said  the crucial sentence: “Often you cannot even tell patients that they have Narcissistic Personality Disorder. They´d see that as a slight and they might leave therapy.”

It´s not like the room was shaken by an earthquake. I cannot even claim I was surprised or particularly shocked. It was precisely what I had always suspected, after all.  I guess I was the only one to whom this remark meant anything at all. The other students were already busy leaving. There was no whispering creeping through the ranks, no silent uproar. Nobody apart from me found it remarkable, leave alone outrageous, that it appears to be common practice to treat patients against disorders they have neither been informed of, nor given consent to be treated against. And why, after all? The patient is the “other”, after all, that weird, not-quite-as-human-as-us entity. He is not as clever as us, he won´t notice when we manipulate and deceive him. He is not psychologically enlightened, so we cannot treat him as a mature, equal human being, can we?

For a few moments I felt tempted to raise my hand and confront Dr. Curl about the issue of informed consent in front of everybody. But what for, really? I knew I was a minority of one, after all. I would draw a whole room full of negative  attention to myself, like “oh god, one of those naggers who always have to bitch about something! What´s next, questioning the whole concept of personality disorders because it´s insulting? If you knew how horrible such patients are, you´d understand why we treat them that way!”

What I decided to do, however, was address Dr. Curl personally and make absolutely sure I had gotten right what he said. Dr. Curl had explained that typically people with NPD will present for therapy with depression. What I was going to ask him was if therapists only treated those patients for depression, even if they suspected a personality disorder, or if they also treated them against NPD. If the first was the case, fair enough. If it was the latter, though, then I finally had a proof that my perception of Dr. Stoneface had been right. And I´d also know that Dr. Stoneface wasn´t an unfortunate exception, but the rule.

So I went up to Dr. Curl and, in the most innocuous manner, asked my question. He wavered a bit, then explained that since the depression is often immediately connected to the personality disorder, and that, therefore, therapists do try to work on the personality disorder. I had him confirm for me once again that this specific part of the treatment happened without the patient´s knowledge. He confirmed it for me.

I could now have, equally innocuously, asked him if this wasn´t a violation against the patient´s rights. I don´t know if there is a legal basis for my complaint, but, seriously, treating someone without his informed consent is unethical, particularly when it is against something that touches the core of who he is: A personality disorder. I didn´t ask, though. I just smiled at him, thanked him and left.

Why did I not ask? It´s quite simple, really. I didn´t want to hear any goddamn excuses. He could have told me a lot of things, but none of them would have alleviated my feeling of betrayal and humiliation. And besides, I suddenly felt very sorry for him. I had been deceptive as well, my entire going to this lecture was deceptive. I had exploited his willingness to be honest to his students. Well, maybe in a few months I´ll wonder why I was so scrupulous, but now I didn´t want to make him feel betrayed and humiliated. He doesn´t deserve my vengefulness, anyway. He is not the one who hurt me. He helped me, though unwittingly.

Once outside, I staggered a few steps away from the building and just stared into the void. I cannot recall how I felt. Eventually I went to some reading hall and wrote everything down. Originally I was going to post it all, but it is really hard to make sense of it. Want a sample?

So I went outside and a few steps away from the building, and from everybody. And I just stood there and stared into the void for a few moments, feeling like there should be a storm of feelings going on inside of me, and in fact feeling unable to tell what I felt. I wish I could say that this was a dramatic, life-changing moment, but it was not. Will not be. It shook me up to some extent, yes. And it made me feel like I had quite a good reason to cry now. I didn´t, however. I wanted to hold on to that feeling. Just to feel anything. Feel alive for a few moments. Believe that I had finally proven that I have been wronged. It would be great if I could believe myself. Others won´t get it, I know that by now.

If there was a mixture of feelings, though of feelings I could barely grasp, it would look about like this:

An almost ecstatic, triumphant euphoria. Like I had finally found the answer to a deep, mysterious, incredibly important question. I could not rationally explain why it is so important, but it definitely is.

A sense of complete hopelessness. I know I´m still alone in believing I was wronged, or in believing this whole practice is not alright. I know I must not share my opinion or knowledge with the wrong people or they will demolish me all over, supposedly all with the best intentions.

A sense of tiredness, sadness, brokenness. I get a glimpse on just how hurt and destroyed I am, because for a second it doesn´t matter if I deserve it or not.

A glimmer of compassion for myself. Feeling like I deserve to be taken care of, and be it just by myself. Feeling like I ought to take care of myself. Feeling like I need to mind my needs. Feeling like what I need and want might be important. Feeling like it might be worthwhile to take care of myself. Take care I don´t get hurt.

A voice formulating this blog entry, and a feeling that I must be a complete fake if this is what I think about in such a moment. A feeling like I must be narcissistic beyond redemption. And empty. Completely empty, like all of my feelings are pointless, meaningless, shallow, not really there. Like there is no need to mind them, huh?

So, I can shed some light on this euphoria thing. Have you ever read Orwell´s 1984? It is a book that I downright worship, and for some reason I can relate to a lot of the psychological mechanisms described in there. Main protagonist Winston Smith has a moment very similar to what I experienced on Thursday. For a few moments, he holds physical evidence in his hands that the past is being falsified, and that the confessions of the thought criminals are lies. Though he has known or at least suspected this before, having seen this piece of evidence is of great significance to him. It proves to him that he is not mad. Up to that point he had always realized that the past had been falsified because he remembered things differently than the Party stated they occurred. But how could he ever know if he could trust his memories? Maybe he is just delusional, after all. Well, having his memory corroborated by physical evidence, he knows he is not delusional. And this is similar to what happened to me on Thursday: I know that I can trust my perception. I´m not distorted or delusional, either. My perception of Dr. Stoneface was right all along. I may never be able to prove it to others, but I know it for myself.  I´m not insane.

 

 

 



How being labeled as a narcissist triggers me

Posted in health, mental health, personal with tags , , on December 2, 2011 by theweirdphilosopher

I said that reading/thinking about Narcissistic Personality Disorder triggers me. I will try to dwell on that today.

I guess I can say that NPD is one of the diagnoses which to receive would upset me most. And this knowledge sets off an alarm inside of me. I must have the deeply entrenched belief that if something is said about you and it hurts you or upsets you or, worst of all, makes you really angry – then it must be true. Not that this belief is uncommon in any way. I don´t want to argue in favor or against that belief right now. What´s more important is the conclusion I seem to draw: If the diagnosis would not upset me, then I don´t have it.

This conclusion leads to several consequences. 1) If I read about a disorder being diagnosed with would not upset me too much, like Dissociative Identity Disorder or Schizotypal PD, I am skeptical if I really have it, even if I seem to have a lot of the symptoms. The prospect of having this disorder does not evoke shame, terror, rage and angry denial, after all. 2) If I read about a disorder being diagnosed with would greatly upset me, like NPD, or Histrionic Personality Disorder, or Münchhausen, there is immediately shame; and angry denial that any of it could apply to me – followed by a cruel, nagging voice triumphantly whispering to me that the fact it upsets me so much means that I must have the disorder in question.

I could argue that my shame, and my belief that it is an indicator of truth and accuracy of statements about me obviously causes me to be extremely biased towards believing unfavorable things about myself.  But this applies only to a certain extent. I also believe many great things about myself. These are the good moments in my life. I am torn between adoring and despising myself, to say it dramatically. Besides, telling myself that my shame makes me biased towards believing bad things about myself, true as it might be, is a way of relieving that shame. It seems to say: “You are not really as bad as you fear you are! Your shame just distorts your view!” This, however, serves as a defense mechanism against my shame and my fear of being inherently flawed.

I honor my defense mechanisms. They are there for a reason, even if I don´t fully understand it, if at all. Besides, the thoughts I use as a defense might still be true. But right now the cruel voices in my head are thankfully asleep *touch wood*; it is just me and this computer screen, and I would like to try to investigate this shame and this fear. For that purpose, let us try to disable these mechanisms for a moment. What is the shame telling me? Why do I fear a diagnosis of NPD so much?

First of all, NPD is not just a diagnosis, that is: A statement about where my problems lie, or which parts of me need treatment. It is a label that sticks to everything about me. If I have NPD, then everything I do is about fulfilling pathological narcissistic needs. And that means – that everything I do is worthless. Because when you do something just to feel like a cool, awesome person, then your action loses its value straight away. The reason for this is that this action only makes a person an awesome person if the action is genuine, that is: based on an honest interest in the action itself, without secondary interests like how it would shape that person´s self-image. This sentence is a bit complicated, but the thought behind it is quite simple: If you give a beggar some money because you feel genuinely sympathetic towards him, then you are a compassionate person. If you give him money because it will make you feel like a compassionate person, then you are a fake.

Of course this is a very perfectionist point of view, and on a conscious, rational level I doubt it is applicable. It also gets me into an internal conflict, though: I know that many other people have not such extreme standards. They don´t expect that much of themselves, or at least it seems so to me. But what shall I do with that thought? It is not nice to think like that of other people. A really good person doesn´t do that, she must be blind towards other peoples´ faults (here is another strange belief of mine). So if I feel superior to them, I am not a good person, which means I´m a horrible person, which means everything I fear is true. I could say that other people don´t have to be perfect, it´s just me who has to be perfect. In a way, this is precisely how I feel about things, which is definitely something worth investigating. But this, too, does not resolve the conflict. If only I have to be such a super-good person, then I still feel like I´m better than everybody else, and that makes me a bad person. In a way, this is even worse than ordinary moral snobbery, because now above all I am also an absolutely special person to whom very special standards apply.

But I no longer want to dwell on moral conflicts. That´s not even what bothers me most. On some level I´m very indifferent towards the question if I´m a moral person or not, even though I am much too susceptible to feelings of guilt. An action could also be a hobby. Or writing this blog entry. And such actions, too, would be worthless and not genuine if I had NPD, because then I would not do it because I really enjoy it, but in order to show off what an awesome, interesting, active person I am. And then I feel the emptiness in this. And maybe this goes to the core of what I fear about NPD. It means that I never really experience anything. I only ever watch myself.

This experiential numbness or even deadness makes me feel like a boring, shallow person. Someone who just lives on the surface of her mind. Someone who is out of touch with life, real emotions or just anything that is important to other people. It would be okay if I could see myself as a psychopath like Dexter who just has no emotions other than, maybe, his sick, sadistic urges. It is a self-image I could live with. But the most painful – and shameful – thing is what matters to me and what makes me feel good: I feel good whenever I have reason to believe that I´m actually not that boring, shallow person, but a different kind of person. Maybe someone with Dissociative Identity Disorder. Or a psychopath. Or a future star. Just some kind of identity around which I can center my life and my self-image and the way I explain myself to me and others. Yeah. This is what makes me happy. Watching an image of myself and believing it is real.

And I guess this gets to the inner core of my fear of being labeled as a narcissist. It means that what makes me happy is not real. It means that all my happy moments are based on illusions.

This sounds precisely like what a depressive person would say. I can see how dysthymia and narcissism might be related. But there also seems to be a difference. It´s not like there are real things that really make me happy, but due to some affective disorder I cannot see that anymore and don´t believe in happiness anymore. It´s rather that I fear that everybody else who is less obsessed with his self-image has actual experiences and real happiness, whereas I only feel happy when I have another great illusion about myself. The outcome is that I feel deeply ashamed, and completely inferior to everybody else. I also feel extreme rage because it seems so unfair! “What did I do to deserve this?! It´s not fair that everybody else is happier than me – and superior to me!” Well. Apparently I´m really a complete piece of shit., I think with some kind of grim satisfaction. Here goes my masochism again.

But really – don´t you lead the most senseless of lives when all happiness and pride you ever experience is based on a narcissistic illusion? I cannot bear the thought of leading such a pointless, dead, empty life. I am so scared of waking up one day realizing that I have failed at life big time. I am way too aware of how short life is. Time seems to be slipping through my fingers, and yet I know nothing to do with it. I´m in my mid-twenties and I already feel old. One day I will realize I´m an old lady and my dreams and illusions will be so unrealistic that even I cannot believe them anymore. But then it will be too late to lead a proper life. These thoughts get me into some kind of panic. They make me feel like I need to do something, fast, but I have no idea what. I feel completely stuck, and it´s not a nice place to be stuck in.

But how does one learn to experience things, as opposed to being proud of having done them (because they prove you are alive inside, after all)? I am way too scared of therapists to try psychotherapy again. During all of my previous attempts, my shame and my rage were triggered almost constantly. I don´t want to experience that again. I know they need to be addressed – but not triggered!

Therapists seem so harsh to me. Merciless. I feel like they get some mischievous pleasure out of triggering feelings in me which threaten to destroy me, under the guise of helping me or morally reforming manipulative, uncaring, narcissistic me.  From reading the article I mentioned in my last entry, I know that I am not the only one to experience her therapist as sadistic. I might come back to that in another entry, though, this one is getting too long already.

Treating narcissism?

Posted in health, mental health, personal, rants with tags , , on December 1, 2011 by theweirdphilosopher

I have read an article on the treatment of Narcissistic Personality Disorder today, and while it provided a lot of insights into what happened between me and my therapist a few years back (I don´t know for sure, but I suspect he diagnosed me with NPD. It´s like this: the ICD-10 code on my health insurance bill covered various personality disorders, but the most likely I found among them was NPD) – well, while that article was not entirely unhelpful, some parts of it also upset me.

The first part I would like to talk about deals with the possibility of brief therapy:

“Patients with narcissistic personality disorder who are troubled by limited neurotic symptoms and maintain apparent satisfactory adaptation in other areas of their lives are unlikely to be sufficiently motivated to tolerate the demands of psychoanalysis or psychoanalytic psychotherapy. Short-term psychotherapy is probably the best treatment in such cases. The goal of such treatment is generally to improve adaptation rather than to alter character. These patients, who are generally young and whose narcissism is often well compensated by their life circumstances, may return for treatment later in life as their narcissistic pathology makes further inroads into their interpersonal relationships, their professional endeavors, or their general sense of pleasure. At these later times, they may be capable of greater insight into their need for more intensive psychotherapy.

Okay, allow me to rant for a moment? Good. What I conclude from this paragraph is that it is a moral, medical or at least some kind of imperative that people with NPD must undergo character-altering intensive psychotherapy. Unfortunately, though, one cannot force them to do so, so one must wait until they are so deep in crisis that they are ready to hear it is all their own fault! Their moments of happiness and success are their greatest enemy! It would be good for them if they hit rock bottom as early as possible!

Wow. What a compassionate attitude, really. It is said that people with NPD have no real empathy, but I can empathize enough with people who are in crisis to feel ashamed for even thinking it might be their own fault.  I really see a problem here: A person might show up for therapy after the failure of an important relationship, or whatever. I did. The guy who evaluated me first diagnosed me with adjustment disorder. The therapist I worked with then (Dr. Stoneface) diagnosed me with some type of personality disorder which might or might not be NPD.  Now, if a person comes to me and seeks help because she is in crisis after a break-up, and I think: “Oh great, that´s a window of opportunity for treating her against being a flawed, horrible person!” – then I´m not exactly empathic, I´m not exactly compassionate, and I´m a pretty horrible person myself. It´s like a little boy falling down, crying, and his mum telling him: “See, that´s what you get for running so fast! Now I do hope you learn your lesson  this  time!” It´s not helpful. It´s just cruel.

Another thing that sickens me is the prognosis that the patients might return for treatment later in their life when their pathology has thoroughly fucked things up for them. I mean – is this really a prognosis? Or is it a threat? Isn´t it a way of saying: “Alright, maybe right now you believe that you are awesome and that your life is going great, but in a few years you will be in pieces if you don´t clean up the mess that is your inner world, I can promise you that much! But, of course, it is all your own choice! I might be wrong! I don´t pretend to be omniscient, after all!”

Okay. Next paragraph. This one deals with a patient who actually entered treatment when his life was in shambles, and made first successes:

“The treatment ended with the patient asking to be able to return at a future date to touch base with the therapist. Highlighting the masochistic side of the narcissistic coin, Oldham concluded that “the narcissistic patient whose pathology leads to dismantling his own success may be highly receptive to treatment at such a critical point.” “

To be honest, whatever Oldham says there doesn´t make much sense to me. What I am interested in is “the masochistic side of the narcissistic coin”. I fully believe that such a thing exists. What worries me, though, is that some people might believe it should be used as a motivation for treatment. First of all, it might lead therapists to encourage that masochism in order to keep patients in treatment, and second, whisper it quietly: It doesn´t work.

I entered my last attempt at therapy (Dr. Stoneface) with the most masochistic of intentions: I wanted to be made fully and pain-fully aware of  1) what a flawed, inadequate person I was, 2) how pathetically my rotten core contrasted with  my delusions of grandeur, and 3) how much I had hurt and damaged others upon trying to maintain these delusions and therefore deserved each and every break-up and rejection.

I believed that only this kind of pain could create enough motivation for change. Of course, this idea is highly narcissistic in itself: “If only you could feel with each fiber of your body what a failure you are; then you might at last get up and improve and become a great, wonderful, awesome person, the kind you always wanted to be!” Being a little more self-aware than the average therapist likes to assume, that thought occurred to me even back then. And it crushed my motivation. It crushed my hopes. It convinced me that true healing would be all about recognizing that I was shit – and accepting it and saying “that´s all there is to me”. Resisting the urge to improve and become great and admirable. Instead lead a humble life, not draw any attention to myself, rather watch others become famous and admired and successful and tell myself why I don´t deserve to be in their position: Because I am such a sick, emotionally deranged person. Fame or even praise might endanger my recovery. It might stop me from seeing how flawed and horrible I am. I must stay away from it like a sober ex-addict must stay away from his drug. Now – try to create motivation for that one! Who wants a life like that? Who wants to be healed just so he can spend the rest of his life in purgatory?

Another problem about using masochism for therapeutic purposes, of course,  is another one of my diagnoses. Sexual deviation. Writing down, and, of course, imagining the prospects above gives me a severe adrenaline rush.  It so rapes the wishful fantasies and ambitions I have, the image I tend to have of myself (proud, clever, unbreakable); and it triggers so much shame and outrage in me, that, when faced with such prospects I will either lash out against anybody who I believe suggests them (in this case: a therapist), or I will, in an act of inverted sadism, comply in the most perverted way possible. Bring it on! Hurt me, break me, make me feel as miserable as it gets! It is good for meThe entire therapeutic process gets an obscene touch if you allow masochism to enter into it. That, of course, just increases my overall shame, which, in turn, increases my defense mechanisms: 1. Rage. 2. Masochism.

I´m going to stop here, before this post gets too long and too out of hand. I´m pretty sure I will return to the subject of narcissism, though. It is something that affects and actually even triggers me in many ways. Whether or not I myself have NPD, the disorder seems to play some kind of role in my emotional life.