9. Cultural Sensitivity of Therapists

Today, therapists are trained to be culturally-sensitive. A person needs help if he does not feel well AFTER ADJUSTING for his cultural and societal idiosyncracies. In many subcultures, a person would feel very bad if unable to marry many women. If the client is a fundamentalist Moslem, then he should be treated (because he does feel bad) in order to ENABLE him to marry many women in accordance with his religious practice.

Therapists/psychologists are taught today to be culturally sensitive. They are taught to confront culture, race and gender issues as early as the first session with a patient to avoid future tensions or misunderstandings.

10. NPD, Culture and Normalcy

Assumptions of normalcy should always be qualified. "Normal WITHIN a given culture/society". If the "disorder" is congruent with the client's culture and society - then he is well-adapted. But, for example, if an aboriginal woman chooses to live in the West, then according to Western cultural and societal norms she might indeed be a dangerous deviant. Dissidents and conscientious intellectuals in authoritarian regimes were often treated by psychiatrists because they were abnormal - and THEY WERE! Within their cultural and societal contexts - they acted abnormally and needed treatment because they endangered their lives and the lives of others.

An abnormal (person) does not conform to cultural and societal values prevailing in his or her actual context.

The issues of morality and deviance should not be confused, though. In certain societies and cultures a person is normal ONLY if he is immoral. In others, being moral is abnormal. Risking one's life to oppose Hitler was an abnormal behavior. But it was, is, and always will be moral (assuming morality includes a hard nucleus of "core values" like "thou shalt not kill").

11. Psychodynamic versus Cognitive-Behavioral Treatments

This is the seemingly eternal debate between the cognitive-behavioral theories of therapy and the psychodynamic ones.

To grossly oversimplify:

The CBTs (cognitive behavioral therapies) are based on the belief that insight - even a merely verbal and intellectual one - is sufficient to induce an emotional outcome. If properly manipulated, verbal cues, insights, analyses of standard sentences we keep saying to ourselves ("I am ugly", "I am afraid no one would like me"), and repeated behavioral patterns (learned behaviors) coupled with positive (and, rarely, negative) reinforcements - are sufficient to induce a cumulative emotional effect tantamount to healing.

Psychodynamic theories do not believe that cognition can influence emotion. They believe that much deeper strata have to be accessed and studied by both patient and therapist. The very exposure of these strata is considered sufficient to induce a dynamic of healing. The therapist's role is either to interpret the material revealed to the patient (psychoanalysis) by allowing the patient to transfer past experience and superimpose it on the therapist - or to actively engage in providing a safe emotional environment conducive to changes in the patient.

I think the latter approach is the right one. Consider me: there are few narcissists who achieved the level of cognitive insight I have. I know myself and my mental defenses reasonably well. Did it induce any substantial change in me? I don't think so. Unfortunately, my case is a hybrid, because I also sustained a series of severe narcissistic (=emotional) injuries simultaneously with the cognitive insights. Rather, the latter were induced by the former.

The sad fact is that no known therapy is effective with narcissism ITSELF - though a few therapies are reasonably successful with coping with its effects.

12. Bill Clinton - a Narcissist?

I think the question is WHY is he behaving the way he does. Is he doing it compulsively, in an uncontrolled manner? Is he looking to be punished, get caught, avoid getting caught?

Is he constantly bored, feels empty and is looking to illicit sex for constant thrills?

Is he contemptuous of others?

Does he lie pathologically (cannot help it) or expediently (in a premeditated manner)?

Is he oblivious to the pain that he inflicts on others - or simply does not care?

Has any of you interviewed him lately to come up with unequivocal answers to all these VERY CRITICAL questions? Has any psychiatrist/psychologist/therapist interviewed him and tested his personality him? I don't believe so.

So, in the absence of HARD facts - how can we diagnose him?