Histrionic, Somatic Personality Disorders - Excerpts Part 4 - Narcissists and Depression

Written by Sam Vaknin

7. NPD and ADHD

NPD has been associated lately with Attention Deficit / Hyperactivity Disorder (ADHD or ADD). The rationale is that children suffering from ADHD are unlikely to develop the attachment necessary to prevent a narcissistic regression (Freud) or adaptation (Jung). Bonding and object relations ought to be affected by ADHD. Research which supports this conjecture has yet to be made available. Still, many psychotherapists and psychiatrists use it as a working hypothesis.

8. Psychodynamic Therapies

Dynamic psychotherapy (or psychodynamic therapy, psychoanalytic psychotherapy, psychoanalytically psychotherapy):

Let us start with what it is NOT. As opposed to (wrong) common opinion it is NOT psychoanalysis. It is an intensive psychotherapy BASED on psychoanalytic theory WITHOUT the (very important) element of free association. This is not to say that free association is not used - only that it is not a pillar and the technique of choice in dynamic therapies. Dynamic therapies are usually applied to patients not considered "suitable" for psychoanalysis (such as PDs, except the Avoidant PD). Usually, different modes of interpretation are employed and other techniques borrowed from other treatments. But the material interpreted is not necessarily the result of free association or dreams and the psychotherapist is a lot more active than the psychoanalyst.

These treatments are open ended. At the commencement of the therapy the therapist (or analyst) makes an agreement (a "pact") with the analysand (AKA patient or client). The pact states that the patient undertakes to explore his problems no matter how long it takes (and how expensive it becomes). The patient is made to feel guilty if he breaks the pact. I never heard of a more brilliant marketing technique. This is a prime demonstration of the "captive market" concept. On the other hand, this makes the therapeutic environment much more relaxed because the patient knows that the analyst is at his/her disposal no matter how many meetings would be required in order to broach painful subject matter.

Sometimes, these therapies are divided to expressive versus supportive.

Expressive therapies uncover (=make conscious) the patient's conflicts but study his/her defences and resistances. The analyst interprets the conflict in view of the new knowledge thus gained and the happy ending, the resolution of the conflict, is at hand. the conflict, in other words, is "interpreted away" through insight and the change in the patient motivated by his/her insights.

Supportive therapies seek to strengthen the ego. Their premise is that a strong ego can cope better (and later on, alone) with external (situational) or internal (instincts, drives) pressures. notice that this is DIAMETRICALLY opposed to expressive therapies. Supportive therapies seek to increase the patient's ability to SUPPRESS conflicts (rather than bring them to the surface of consciousness). As painful conflict is suppressed - so are all manner of dysphorias and symptoms. This is somewhat reminiscent of behaviourism (the main aim is to change behaviour and to relieve symptoms). It usually makes no use of insight or interpretation (though there are exceptions).

9. Self-Pity and Grief

I think that grieving is an emotional process intended to overcome the clear and irrevocable loss of a loved object (including one's self). It is a coherent, all-consuming, all-pervasive, highly focused emotion. As a result it is short lived (has an "expiry date") and highly efficient and functional in that it allows for the removal / suppression / repression of the representation of the loved object and its transformation into a memory.

Self pity seems to me to be a diffuse, general, though also all-pervasive, emotion. It has no clear emotional aim. It is non-coherent. It is long lived, inefficient and dysfunctional (disturbs proper functioning).

10. Should We Licence Parents?

When we want to drive a car, to become a bank teller, or a dental assistant - we need to study and to be licensed.

Only if we want to become parents - it is a free for all. I honestly do not understand why. Parenting is by far the most complicated human vocation (or avocation) in existence. It involves the exercise of the highest possible mental and physical faculties in combination. A parent deals constantly with the most fragile, vulnerable, susceptible thing on earth (children). You need a licence to educate or care for someone else's children - but not for yours. This is insane. Every future parent must go through a course and learn basic parenting skills before obtaining a licence to procreate. As opposed to well-ingrained common opinion, parenthood is NOT a natural gift. It is learnt and usually from the wrong role models.

Should the mentally disabled be prevented from getting such a license? Should schizophrenics have children? what about MPDs? Other PDs? NPDs like me? OCDs? AsPDs? Where should the line be drawn and by whom on whose authority?

I don't have children because I think I will propagate my PD through them and to them. I don't want to reproduce myself because I conceive of myself as a defective product. But do I have the right NOT to give life to my children? I don't know.

11. BPD, NPD and Other Cluster B PDs

If NPD and BPD have a common source (pathological narcissism) this could be very meaningful. It could open up new vistas of understanding, coping and treatment.