Where We, Therapists, Get Things Wrong With NPD

Remember, Narcissus is a daffodil. 

There are versions of the story of Narcissus, but they all agree he was a beautiful man, so taken with his beauty that he stared at his reflection in a river, fell in love with it, and anguished over his longing until he died. He had eschewed the advances of others because he found himself to be so special that he was, essentially, the only person special enough for him to fall in love.

Narcissistic Personality Disorder was introduced as a diagnosis in the United States in 1980. The name functions as a shorthand to highlight the self-absorption and self-congratulation so often associated with individuals who meet criteria for that diagnosis. We can make sense of that choice of word, and also recognize that it inherently casts a value judgement and enforces a stigma, where things like Persistent Depressive Disorder, Generalized Anxiety Disorder, and other named diagnoses do not. We’ve given ourselves a pass to espouse that judgement, because “narcissists,” we’ve decided, are worse, and so deserve it. I put the word narcissist in quotes, because it’s another area where we treat NPD differently than most diagnoses, including other personality disorders* – we don’t call people  “depresseds,” or “schizoids,” so why “narcissists”? Because we’ve decided they deserve even clinical retribution.

All this is to say, we’ve let ourselves off the hook for vilifying an entire group of people, and, frankly, for giving up on them. Which means their getting help – which would benefit everyone! – likely remains out of reach or interest. People with NPD are abusive and inappropriate, we tell ourselves, and so our lack of empathy is the natural consequence of their actions. But how does it benefit society to cast out “narcissists” as unsalvageable and evil? Because while many people with NPD do engage in abusive behaviors of some kind, many do not. And many, many people without NPD abuse others, as well - when should we give up on them?

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When Narcissus died, a daffodil grew where he fell. And, like him, its head drooped downward toward the water, staring at their reflections in the pool. So wild daffodils were called Narcissus pseudonarcissus, and bent their faces from the sun. Like Narcissus, himself, they did not know why they were doing it, it only felt natural.

Often a person with Narcissistic Personality Disorder feels unclear as to the origins of their own beliefs and behaviors. They know what they do is not socially sanctioned, but it’s what feels natural. They see their actions and do not know, with depth, why they are doing them – it’s only what feels right.

There is no equation that lands someone on a mental health diagnosis. There is no singular truth to explain the origins of a diagnosis in someone’s life. One plus one does not equal Bipolar Disorder. So I am speaking broadly when I say that people with NPD have often experienced trauma that has reshaped what may have been their true nature; usually it’s something undermining, something shaming, something loveless. Deep neglect, being treated as a failure, being treated as wholly irrelevant. Many of us have come to understand the groundwork that trauma lays for personality disorders, but we often minimize that when it comes to NPD because the personality it creates can feel so unpleasant. That person learns ways to cope and to navigate life in the presence of those existential disappointments of self, and a lot of those ways are very, very unhealthy, and need adjusting in order to be a positive force in their lives and the lives of others.

It can be done.

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Narcissus never went to therapy, and so we’ll never know fully the origins of his self-obsession. What we do know is that his self-obsession proved fatal – in his attempt to connect with himself, he annihilated himself (his reflection never did return his affection, he was never truly able to love himself). There’s something incredibly sad about that, even before it has the opportunity to become offensive.

 Most people learn that someone they love has Narcissistic Personality Disorder as a result of poor treatment from that person, and so it stands to reason that offense comes to mind much more readily than sympathy. If you hurt me deeply, I’m going to feel the pain before I wonder why you did it. I may never care why you did it, if you hurt me badly enough, and that’s certainly fair. But what’s also true is that you do not need my sympathy nor my understanding to change how you show up in the world. You do, however, likely need a therapist, so therapists’ biases need to stop standing in the way.

 Maybe the daffodil bends its head because it can’t stop staring at its own reflection. Or maybe, somewhere so deep as to have become invisible, it’s never truly believed it deserves the sun.

 *We refer to people as “borderlines,” also, which is equally harmful.