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December 4, 2010
Narcissism: The Malady of Me
By BENEDICT CAREY
Do you follow yourself closely on Twitter? Have you been blogging regularly about your coming
memoir?
Do you make a habit of weeping about your values in public — or in front of videographers
documenting your work?
No one has yet devised the perfect questionnaire to diagnose what’s commonly known as
narcissism. But it hardly matters. Most people can smell it from across the company cafeteria, and
in the most precious precincts of places like New York, Los Angeles and London, it’s a familiar
scent.
This is why an escalating debate among psychiatrists about whether to drop narcissistic personality
disorder from the field’s diagnostic manual is such a juicy one. For amateur psychiatrists (everyone
over the age of 7), the argument strikingly illustrates the ways in which science informs language,
and popular culture in turn broadens and enriches scientific ideas, sometimes altering the
professional debate.
In recent months, experts working to update the American Psychiatric Association’s influential
Diagnostic and Statistical Manual of Mental Disorders have been discussing whether to introduce a
new approach to diagnosing the so-called personality disorders.
In psychiatry, this is a serious business. These disorders are severely disabling, and the new
approach proposes to phase out five of the disorders — dependent, histrionic, schizoid and
paranoid, in addition to narcissistic, the least common — in favor of choosing from a list of
personality traits that best describe a particular patient.
All five disorders have taken on a life of their own among therapists as well as researchers. As with
everything DSM, as the manual is known, the experts will be debating the new approach for years
after the psychiatric association’s task force releases the final draft, expected in 2013.
Nonscientists have been appropriating technical terms going back at least to the ancient Greeks
and their doctors’ notion of the humors. In more recent generations, people have borrowed freely
from physics (black hole, light speed), geology (tectonic shift), cardiology (type A personality) and
most of all psychology.
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Freudian terminology spread like pollen in the first half of the 20th century, especially in postwar
America, transforming precise concepts like ego, repression and projection into widely understood
shorthand for behavior. Therapists in turn have reclaimed and reinterpreted these and other
Freudian ideas as they refine their own work.
“This process goes on in all sciences, where terms with narrow, technical definitions move into
general use and acquire much broader meanings,” said James G. Ennis, a sociologist at Tufts
University. “But especially so in the social sciences, which hit people closer to where they live.
Psychology, sociology, anthropology — all are essentially providing people with a way of
understanding their identities.”
The modern DSM, more so than any other medical document, stirs this crossbreeding, because it
tries to draw a line between normal and abnormal behavior. For years people used the term
“schizophrenic” to mean split-minded, or scattered, despite the severity of the diagnosis. The DSM
committee dropped so-called passive-aggressive personality from the manual years ago, but the
phrase is such an evocative description of a familiar behavior that it has become a fixture of the
shared language. Terms like O.C.D. and A.D.H.D. are quickly gaining a similar status.
Narcissism was always a natural. Its technical definition describes a devastatingly vulnerable
person, compensating for a deeply imprinted inadequacy with a desperate need for admiration,
and a grandiose self-image. “When you see extreme examples of this or other personality
disorders, you sit back and say: ‘Wow. It’s just stunning,’ ” said Dr. Darrel Regier, research director
at the psychiatric association and co-director of the team updating the DSM. “But all of these
disorders are on a continuum with more normal behavior, and people will immediately pick up on
some of more annoying traits in the definition and run with it.”
And why not? Virtually all of the narcissistic types most people see are the milder, more normal
variety, and the idea that these pompous clowns are crying on the inside doesn’t excuse how they
treat others. No blaming it on Mom or Dad or some nanny.
“There’s a lot of self-centeredness in the world, and narcissist has become an instantly recognizable
type,” even if people don’t appreciate the complexity of the diagnosis, said Dr. Andrew E. Skodol
II, chairman of the DSM personality disorders work group and research professor of psychiatry at
the University of Arizona College of Medicine.
Stripped of most — but not quite all — of its pathology, “narcissist” becomes an easy way to flag the
self-smitten (if not used as an all-purpose insult), and sounds so much more thoughtful than
“egomaniac,” the older term, invoking Greek myth and modern psychiatry. “It’s a shorthand you
can apply to all these powerful and famous people that allows you to feel superior and have this
gloss of science,” said Dr. Michael First, a psychiatrist at Columbia and a former editor of the DSM.
A word like that is not going anywhere, regardless of what the experts working on the DSM decide.
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