Whoever writes on shame knows as much about pain and failure as about the healing balm of love
Few experiences in life are so pleasant as the moment of release from shame or the realization that our foibles are accepted with love
~ Donald L. Nathanson ~
Most people, clinicians included, have difficulty differentiating the "narcissistic" from the "sociopathic" personality, based upon the unscientific, unproven, and ultimately false distinction of ability to experience emotional pain, sadness, or empathy, and the inability to learn from their prior bad acts. Ok, but first, let us be clear in our terminology. I am not referring to narcissistic people. Most successful people are narcissistic on some level. I am referring to Narcissistic Personality Disorder (NPD) and Antisocial Personality Disorder (APD). Personality disorders are by definition, chronic, enduring, pervasive, and color the way in which one perceives, feels and acts upon their world and everything in it. A personality disorder is a severe distortion of aspects of the personality, deviating widely from normal personality functioning. It is not to be confused with "traits" or aspects of a persons personality or mood. Having a personality disorder is serious business. Of all the personality disorders, the "dramatic cluster" are the most difficult for clinicians to treat, and most do not. Included in this "cluster" are the two disorders mentioned here.
There are good reasons why most clinicians do not treat these personality disorders - of all the possible disorders, these are the two that are not in touch with having any problems, other than having to deal with the rest of the world and their problems and as such, will not generally be seen in treatment. For what? Those with NPD and APD are not at all aware they have a disorder of any kind and will argue this in the face of evidence to the contrary. Part of the problem. These folks are not going to waltz into anyone's office and ask for help. Won't happen. Unless of course one is being treated for a sex addiction and/or sexual offense. I do not believe in God. But if I did, this is where I would say how "God works in mysterious ways".
The thing (or things) that separate the two personality disorders is not, as I began by stating, a litany of traits that prevent one from feeling bad for acting bad, for hurting others, and/or not learning from prior bad behavior and repeating the error of their ways over and over and over again - all of these by the way referring to the Antisocial Personality. A sex addicted individual is by definition someone with a Narcissistic Personality Disorder, sometimes accompanying a Borderline Personality Disorder, or traits of the later, particularly as it pertains to an intense and unrealistic fear of abandonment and perceived rejection, and characterized by highly unstable relationships of approach and avoidant behaviors. Sex addicts and those with NPD share many commonalities as those with APD. And in fact, anyone who has ever been involved in an intimate relationship with someone who has a NPD, with or without a sexual addiction can tell you all the war stories. Ok, so what exactly is the difference? First allow me to muddy the waters just alittle further...
The psychopathic individual as we used to call these folks, are quite capable of feeling not just their pain, but pain and longing, sadness, and even empathy. Is it true that there is a virulent version of psychopathy wherein the individual does not appear to have the ability to empathize? Yes, with emphasis on "appear" however. That said, there is a virulent version of NPD as well and I am not referring to what Vaknin and others call a "malignant" narcissism. There are plenty of NPD individuals, many of which I have and do treat, that appear not to be capable of empathizing and simply go through the motions. It isn't that they can't, it is that they don't. And they don't because they won't - they are scared to death, very well psychologically defended, and for pretty good reason at that. What then is the distinguishing factor between the two personality disorders? Better yet, IS there a distinguishing factor or are they as many suggest, just two sides of the same coin?
There is intriguing new evidence suggesting that in fact, one of the very definitive qualities that characterize the sociopathic personality - their inability to learn from their mistakes - may not at all be accurate. I think they are on to something. I do not think either APD or NPD individuals are somehow hardwired to "not learn from prior acts", because neuropsychologically speaking, and from the standpoint of classical conditioning and operant conditioning paradigms, I am not certain this even makes sense to suggest that it is not possible. So, what, are we saying ,that they can learn SOME things just not things that have to do with people being in pain? That would mean there is a very special part of the brain that can distinguish between learning related to emotional pain and learning related to every thing else. Is this possible? That they can learn from the "good" things they have done, but they just cannot learn from the "bad" things they have done? Is there a part in the brain that is specific to "bad" things as opposed to "good" things? I am not saying that NPD and APD are one and the same diagnosis and that we have gotten it all wrong. No, I am quite aware that they are distinct disorders, but I am challenging, as have others, that the clinical distinctions we are using are not entirely all correct. I think the problem lies in some of our faulty diagnostic criteria and the often difficult distinction between these two personality disorders. What is that magical distinction? Shame. Shame is the answer and it is the answer because there IS a specialized part or parts of the brain that distinguish between these "good" and "bad" emotions and learning has everything to do with it, not just psychologically, but biochemically.
Psychopaths, or what we nowadays call the Antisocial Personality Disordered individual - sounds much tamer by comparison - has no idea, no clue that they are sociopathic. Those around them might indeed, but trust me, they are the very last to know and in fact, until confronted with the evidence, will genuinely fight you tooth-and-nail, trying to convince both you and them, not necessarily in that order, that they are not the monsters that the word implies. Nor by the way, do NPD individuals know they are narcissistic, and nowhere have I seen more evidence of narcissistic rage, as when I present and explain, with MMPI-2 held firmly in hand and in as soft and empathic a voice as possible, the diagnostic information. The problem is that by clinical definition, those with APD and NPD will never provide you the opportunity to explain because they will never have stepped foot in your office in the first place. Unless of course you work with sex offenders and/or sex addicts, both of which make up the majority of my clinical practice and research efforts. What then brings them to the attention of the clinician is not their personality disorder as I have made mention. Rather, it is the behaviors which are the direct byproduct of the PD. If you are all sniffly and miserable, what you have is probably a cold or the flu (of course it could also be inhalation Anthrax or early morning symptoms of heart failure). What brought you to the doctor's office however, was all the sniffly miserable stuff so that you can 1, be rest assured that it was not Anthrax or heart failure and rejoice in confirmation that it is in fact simply a rotten cold, and 2, that you are given a means to reduce/eliminate the sniffly miserable symptoms. and get on with your life.
In what is unquestionably the most famous and well-read account of psychopathy, The Mask of Sanity (1982), Cleckley was among the first to operationalize the psychopath. The Mask of Sanity was a fascinating read - an eye-opener into the deep dank recesses of the mind of the psychopathic personality as it was called, even though he used the term "antisocial personality". We are horrified by the accounts he presents of the cold, empty, emotionally vacuous shells that look just like the rest of us. Cleckley, and his heir apparent, Robert Hare, talk about the absence of "guilt". The problem, and how we all have such difficulty separating the two PD's, is because of our cultural difficulty distinguishing between "shame" and "guilt". In fact, more clinicians, psychologists and psychiatrists, those that should know better, continue to this very day, to use the word interchangeably. SHAME and GUILT are NOT interchangeable. In fact, they could not be more different psychologically, neurologically, or biochemically. And therein lies the proverbial rub. Period.
The brilliant psychiatrist Donald L. Nathanson speaks of the difference between "shame" and "guilt" in that "often shame is confused with guilt, a related but quite different discomfort. Whereas shame is about the quality of our person or self, guilt is the painful emotion triggered when we become aware that we have acted in a way to bring harm to another person or to violate some important code. Guilt is about action and laws" (1992, p.19). In the most recognized and first work to distinguish between the two emotions, Lewis in 1971 described "shame" as an "acutely painful emotion accompanied by a sense of shrinking or of "being small" and by a sense of worthlessness and powerlessness. Shamed people also feel exposed" (Tangney & Dearing, p. 19, 2002). While guilt-prone persons may also experience a fear of exposure, it is in a decidedly different context. Shame-based persons are afraid of SELF exposure, whereas guilt-based persons are afraid of OTHER exposure. Shame-based persons feel horrible about themselves. Guilt-based persons feel horrible about what they did to harm another and what the discovery of that action or actions will do to harm still others in a dominoes-knock-the-one-down-and-you-knock-them-all-down kind of effect. Sex addiction is a disorder of shame - more of a disease process really, in that it follows a progressive course. Shame can FEEL lethal but to the sex addict, is generally a symptom of the larger more pervasive narcissistic personality style, such that no matter how painful or intolerable their shame may feel or be, they are expert at very swiftly and deftly detaching themselves with a cool and quite calculated precision, from the source of that shame and moving on - not healing mind you, and not necessarily absent feeling entirely, just moving on. Individuals with NPD do not allow themselves to wallow in misery, a trait I often wish I had a tad more of. They pay a heavy price for this particular skill mind you, but it serves them quite well in the short run. The ability to cut loose with spectacular precision and efficiency does exact a pay-off, you must admit. Like I said, there are times I wish I could borrow or bottle some of it.
In all, it would be fair and accurate to say that the single most distinguishing feature between shame and guilt is that shame is about the self and guilt is about the other. Shame is a fairly foreign concept for me - I am hard-pressed to think of anything that I feel or have felt much if any shame over, not in any outrageous way, certainly. Guilt however, now there is something I am intimately familiar with. Guilt definitely continues to guide my life and much of what I do, say, think, act on, and feel. Both good and bad. Is guilt the other side of the shame coin? Not at all, but they are complimentary in both healthy and maladaptive ways. As I made mention in my last post, when treating a sexual addiction, it is important to move a shame-prone person to a guilt-prone place, in order to heal their deep and painful wounds. Although shame and guilt, alongside pride, embarrassment, rejection, humiliation, abandonment, disgust, and lust are all considered the primitive social emotions, they are in important ways, neurologically quite distinct. They come from entirely different places and those that are shame-based think, feel, and view the world in very different ways than the guilt-based person. The beauty, if it can be stated in such terms, is that the guilt-based person has a gift to offer the shame-based person if they can figure out a way to work together.
From a neurological perspective, different parts of the brain light up when a shame-based person experiences shame, then when a guilt-prone person experiences guilt. Early on, Nathanson was the first to point out that "classical depression involved the thinking, the feeling, and the chemistry of guilt, and that the atypical depressionswere about shame" (1992, p. 22). Suffice it to say, diffferent antidepressant medications work for the "classical" vs the "atypical" depressions as they target a different symptom picture. This is rather remarkable - think about it, we are saying that clinical depresssion is different, and the brain of the clinically depressed individual is different depending on whether they are shame- or guilt-based. Incredible! What causes the brain to become "shame-based" as opposed to "guilt-based"? Does brain impairment cause shame or rather, does shame change the brain? Is this a nature-nurture thing? Does experience decide? And if so, then is it early childhood experience? Is it genetics or biology or both? Does our early childhood dictate which style we will adopt? The answer, as Daniel J. Siegel and others tell us, is "yes". Through the plasticity of the brain, our very earliest childhood relationships, mostly with our caregivers, interact to make us who we are and whether or not we become shame- or guilt-based adults. Let us take a closer look...
Specifically, the orbitofrontal cortex (OFC), the anterior cingulate (AC), and the amygdala, a part of the limbic system, are involved in emotional memory, empathy, and affect regulation (especially impaired in the Borderline and Narcissistic Personality Disorders). Additionally, the medial and the ventral lateral prefrontal cortex areas are known to be involved in the ability to perceive the mental state of others, an area impaired in the autism-spectrum disorders. Further, the insula, a region located deep within the cerebral cortex, picks up messages bi-directionally from the cortical areas to and from the body, the limbic system and the brain stem, and integrates interoceptive states into conscious feeling states and decision-making processes that involve things like risk and reward. All of these areas play a part, one way or another in the social emotions which of course include shame and guilt.
The insula receives signals from the body that correspond to more intense emotions such as panic or love that the brain then interprets as such. Of particular interest, the insula processes and gives us interpretive information about future things that have not actually happened yet enabling us to act in an "as-if" fashion, or said another way, in anticipation. Meaning, a sex addicted individual who walks around in a fairly constant state of shame for their prior bad acts of utilizing the services of a prostitute for example, while even passing through a neighborhood or section of town that is known for prostitution, will light up their insula like the fourth of July in anticipation of seeing the prostitute, knowing, on a non-intuitive but somewhat aware level, that once the insula is lit, a deep co-mingling of sexual excitement and intense shame will be triggered based upon the memory of having visited with prostitutes before. This is all about the "people, places, things" of the 12-step vernacular. But which areas of the brain are more responsible, or said another way, more active, in shame versus guilt?
Stein & Kaminer (2006), Clark (2005), Farrow, et al (2001), Newberg, et al (2000), and a host of other neuroscience researchers have empirical support that the frontal-limbic areas - no surprise here - are responsible not just for the processing of guilt and shame, but for empathy and forgiveness. Specifically however, the posterior cingulate is also involved in the self-evaluation of behaviors. If you have been following my posts the past year, you have already learned that my research and the research of many others that have followed, all support various aspects of the prefrontal cortex as being intricately involved in being able to moderate the emotionality of the limbic areas, specifically the amygdala. It is the role of the prefrontal cortex, and ultimately the health of the prefrontal cortex that seems to determine whether an individual can be shame- or guilt-based.
Sex addiction is a disruption and damage of the right prefrontal cortex, mostly in the dorsolateral and orbital frontal areas of the prefrontal cortex, as a direct result of a rattled and impaired limbic system secondary to a very toxic childhood. When the limbic system is disrupted, but there is no prefrontal damage, then an individual can experience guilt, and generally, copious amounts of it, sometimes in a pathological manner. But shame occurs when the limbic system is disrupted AND it causes prefrontal cortex damage as well. When the prefrontal cortex is damaged, then the higher-order emotion of GUILT cannot be expressed, and it stays at SHAME, a lower, more primitive emotion. Shame feeds on itself in a never-ending feedback loop and so it continually self-feeds. Sex addiction treatment as I have always maintained, should be about the healing of the frontal lobe. When the frontal lobe is healed, then the sex addicted individual can move from shame to guilt and begin to live the life they are entitled to live, free of the ties that bind and free to feel love, free to experience forgiveness of self and others, and free to experience the range of emotions that make life worth living, then they have indeed changed their brain and the lives of all they touch.
Daniel J. Siegel reminds us that "Repeated patterns of children's interactions with their caregivers become "remembered" in the various modalities of memory and directly shape not just what children recall, but how the representational processes develop" (1999, p.5). Healing the adult sex addicted brain is accomplished by gently and lovingly and painstakingly providing new memories, healthy, loving memories from those with expertise and in positions of primary emotional support - replacing the old with the new, and healing the brain within. The heart will surely follow.
When blackness was a virtue and the road was full of mud
I came in from the wilderness, a creature void of form
"come in" she said
"I'll give you shelter from the storm"
Daniel Alkon, MD, wrote in one of my all-time favorite books on the planet that "...memory's permanence maintains trauma's grip on our behavior" (Memory's Voice: Deciphering the Mind-Brain Code, 1994, p.1). In studying memory and the brain as he has for decades, he (and countless others) long since came to the conclusion that early childhood psychological trauma can structurally and biochemically damage the brain and alter both the behavior and lifestyle of a portion of those that have been abused, and while a stunning concept no doubt, is certainly neither new nor at this juncture in our rather meager scientific development, controversial. In Parts I and II of this thread, a (really basic) overview and clinical definition of Narcissistic Personality Disorder (NPD) was discussed, with emphasis on the neurobiological correlates of NPD. In this final portion of the discussion, we shall see how sex addiction is related to NPD, and how both disorders are the tragic consequence of a neurochemically deprived brain that leaves in its wake, among other things, a complete inability to love and bond to another human being, AKA attachment.
What makes these disorders all the more tragic, is that they are generally borne out of the very same pathology, passed down from one generation to another, like a virulent disease that both society and to a large extent, the treatment community, seem to want no part of. With advances in both scientific methodology, etiology, and consilliance across fields, this is beginning, thank goodness, to change. How exactly does one become immune to love and attachement in the first place? Technically, the answer lies somewhere between the ventral tegmental and anterior cigulate cortex areas, and the neurohypophyseal peptides oxytocin and vasopressin. And if you happen to be sexually addicted to boot, then what you are addicted to is not sex of course, but gobs and gobs of that luscious free-flowing dopaminergic candy, made readily available by the inability to suck up enough oxytocin and vasopressin to keep you "nailed down" and out of the proverbial pantry. "Cooledge Effect" anyone?
From the very moment of birth, our mammalian brain (that would be yours) is busy orchestrating; receiving, processing, and sending crucial information throughout our central and peripheral nervous systems which in turn enable us to act on that information in specific ways. This information is composed of an exquisite array of biochemical signals and messages that operate like a gigantic switchboard, knowing where to go and how to get certain information, what brain "station" to send the information to, in what "language" it should be read or translated, and ultimately, how to transcribe the messages once they are received and processed at the correct "facility". This switchboard is of course our central nervous system (CNS), and the messengers are our neurotransmitters and specialized neuropeptides. It is these hundreds o f neurotransmitters that allow us to think, perceive, and behave in the remarkable (and sometimes not so remarkable) ways in which we do. They tell us what to think and feel, how and when to feel what, and how and when to behave. Even more basic then that, they tell us when we are hungry and how much and when to eat, when we are tired, and when and how much we should sleep. They regulate every aspect of who we are and how we perceive the world at any given moment. They are a magnificently orchestrated cocktail of neurochemical slop that can quickly become our greatest enemy in the fight to self-regulate our own body, brain, and mind. And when this happens, one's time and energy is spent on little else, but trying desperately to self-correct a nightmarish system that has somehow turned against itself and run completely amuck. They have become prisoners of their own self - they know they're broken but they don't know why or how to fix it.
There is a clear, and many would suggest, causal connection between states of addiction and states of physiological dysregulation secondary to psychological trauma. Posttraumatic states and disorders of arousal dysregulation can be defined in the simplest of terms as a dysregulation of the pleasure, pain, and fear centers of the brains reward circuitry. What is addiction if not a continual biochemical cocktail that feeds the pleasure centers of the brain in order to squelch the tide of unremitting pain and unmitigated fear? Both processes are fueled by the incessant out-of-control drive to seek that ever-higher dopaminergic rush, in a failed but panic-driven mixed-up effort to self-regulate with the dream of someday finding that neurochemical homeostatic comfort zone - which does not exist if you are arousal dysregulated. This is the very struggle for the traumatized individual who desperately seeks shelter form the perfect storm of constatnt assault - of biochemical dysregulation and emotional and behavioral toxicity, left as a legacy for having survived the initial onslaught of exposure to trauma that they never ever asked to have happen in the first place.
Candace Pert appropriately dubbed the endogenous neuroamine, phenylethylamine (PEA), the "love molecule" (check out her 1997 book Molecules of Emotion: The Science Behind Mind-Body Medicine). She's the one that also says "god is a neuropeptide", but we'll just have to save that juicy little morsal for another issue - if not another blog - altogether. PEA, in addition to dopamine (DA), oxytocin (OT), and arginine vasopressin (AVP), are all neuropeptides (remember? neuropeptides are the highly specialized neurotransmitters - brain messengers - that talk to one another) that are implicated in the feeling states related to sexual arousal and the "thrill" of falling in love. You might think PEA sounds familiar if you tend to consume dark chocolate. PEA stimulates the CNS, producing the rapid heart rate, flush, and "rush" of being in love. Makes sense considering that it's an amphetamine!. More importantly however, PEA releases DA, which we know to be the culprit behind sexual arousal, of which DA, post coitus, then stimulates the release of OT, also known as the "cuddle chemical", and AVP. OT is secreted by DA in the anterior pituitary gland sending a wash of calmness over the body, and increasing the bodies sensitivity to touch. More touching increases more OT, which then continues the cycle (see the post in this blog on "Prairie Voles"). OT is the neurochemical tie that binds. This little cycle of neurochemistry is an extraordinarily important component of mammalian (again, that would be you) bonding, trust, attachment, and love. BUT...
When only PEA and more importantly, only DA are released without the ensuing OT "cuddle chemical", there is simply sex without bonding, attachment, and love. It is as if the system is all jacked up and in desperate addictive need of another "hit", as soon as possible. There is no time to hang out and snuggle. Uh-uh. You are big-time DA jonesing for another DA fix, and the very thought of hanging out and smelling the roses for an extended 'spoon' session with your significant other, is simply out of the damn question! Further, when only DA is released and the release of OT is inhibited, then DA is continually released in the absence of OT. If OT is attenuated or inhibited altogether, then the brain builds an actual tolerance to DA, and more and more DA is needed and sought, making OT a veritable thing of the past, and DA the drug-addicts drug-of-choice. No OT - no attachment or love. Period. Only the ever-increased pursuit of sex with multiple partners (or at the very least, lots of "you" all by your lonesome) since DA seeks out novelty (and seeks to avoid anything like love and attachment that might get in its way) and without OT, there is literally, no tie to bind! This becomes the psychological equivalent of the Coolidge Effect personified. It may also explain much of the addictive aspect and impairment in intimate bonding and attachment that many, if not all, sex addicts struggle with.
Sex addiction is an addiction to shame. They are ashamed of who they are and who they are not, of what they do, and of being seemingly incapable of controlling their own desires. They are ashamed of having something that society perceives as deviant and in the same column as pedophilia. Shame produces a rush of neurochemicals that fuels the release of DA like little else. Sex addicts act out. Acting out causes severe shame (sex addicts are not sociopaths or antisocial, and feel tremendous amounts of guilt and shame on a continually spiraling basis). They also sometimes act "in" as a way of preventing themselves from acting "out". Either way, if they are sexual in inappropriate addictive ways, they are not sober (see the 1st article in this blog). The prime consideration for sex addicts, just as it is for drug addicts, is to stop acting out. But WHY do sex addicts act out? Because of sex? No. Just like alcoholics and drug addicts, acting out (take drugs) is a way to medicate or anesthetize their pain. What are sex addicts anesthetizing? LOVE and ATTACHMENT! Because all sex addicts by definition also carry a NPD, they are attachment disordered. Sex addiction comes about in the massive majority of all cases, secondary to a traumatic early childhood, either secondary to sexual abuse and/or malignant narcissistic assault from one or both parents or prime caregivers. It completely disrupts their physiology, their limbic system is a total mess, and the end result is that they are scared to DEATH of becoming attached. It represents a death knell for them. I urge the reader to check out Dr Sam Valknins site for a remarkably thorough and easy-to-digest account of NPD as it relates to love and attachment. So what is the "cure"? Of course we don't use the "C" word, but learning to trust, bond, attach, and love, is the remedy. How? By doing so with someone who is very safe, in a safe and protected environment, and very, very slowly, without knowing what is happening! How does this treat the sex addicted NPD? Because it allows them to s-l-o-w down, to stop diving in for the DA hits by having lots of unattached sex, and when there is trust, attachment, and love, OT and AVP flow like the Trevi fountain.
To my patients in treatment I become the veritable love-hate object. The more attached they become, the more resentment and anger and unadulterated FEAR they have for me. In Freudian terms, it is the epitome of the Madonna-Whore complex in all its glory. Male sex addicts, be they gay or straight, or somewhere in the middle, are generally petrified of women (though deny it with no small modicum of vehemence they initially do). Why - refer to the previous post. Women - that would be women with whom they are either attracted to or have respect for - the later part being in short supply - represent a mother that never attached to them, and/or protect them from a raging out-of-control malignantly narcissistic father. Women are perceived as either exceedingly weak or embodying the power of some mythical goddess capable of snuffing out their existence with the mere blink of an eye. Emotional castration on the half-shell. Give away your power to one? Tell them your secrets? Hell, fall in love with one? Are you KIDDING me?? That would be the penultimate suicide, and not a quick one at that. To be out of control and in total service to the one thing you so fear? Therapy with this population is neither for the faint of heart or inexperienced. So then. Is treatment really possible? For those willing to do the work, of course it is - possible and effective, and I dare say not just a tad humbling on my end.
Alcon likens childhood trauma to memories encapsulated in one of those familiar snow globes wherein he cautions "Like falling snowflakes that obscure a miniature landscape under glass, the memories take time to settle down before the scene within slowly becomes visible" (1994, p.xviii).
"Hidden inside modern biomedical science, there is a tale that each of us should know. A tale of the starlight and the darkness inside, a tale of the sins of the father and the flame of spontaneous human combusion, a tale of madness and love, of faith and despair. Wrapped up inside of that tale is a portrait of each man and woman in all our wonder, a portrait full of the intensity of life... you must take a step or two backward if you wish to see the mystery" (Callahan, 2002, p.xvii).
While narcissism is not pathological per se, Narcissistic Personality Disorder (NPD) certainly is, and in Part I, a definition of a personality disorder was presented. NPD is generally acquired secondary to early childhood trauma, more specifically, a toxic family life. There is also a heritable component. My parents used to have a plexiglass plaque that sat proudly on display in the living room. One could not help but notice it as soon as you walked into the room. The plaque read "insanity is hereditary. You get it from your children." Very funny. With NPD, you mostly develop it secondary to your narcissistic parent or parents. NPD is a disorder of arousal dysregulation in that the limbic system and the neurochemicals used to communicate with one another that flow in and out of the limbic system, become so disrupted and discombobulated, that the system breaks down and what is an abnormal condition becomes the new normal. When a young child is exposed to the callous, self-absorbed, unpredictable, angry and often rageful antics and chaotic family life that centers around a narcissistic parent or two, that young child quickly learns several very important survival-oriented skills: life is unpredictable and people can hurt you - make certain your armor is impenetrable and your forcefield stays "on"; remain in complete control at all times when dealing with others, because clearly others have no control; make absolutely certain that you have or can quickly attain at a moments notice, a ready supply of dutiful admirers from those clearly more psychologically wounded than you; and remember; never let them see you sweat. Narcissists do not have a clearly defined identity (psychopathology notwithstanding). They know who they are based upon the responses and feedback received from other people. If people laugh at their jokes they must be funny. If they are told they are smart, or good looking or talented, then it must indeed be so. It therefore behooves them to find people who will endlessly subjugate themselves in service to the needs of the narcissist.
Individuals with NPD are rather adept at not visiting the psychological places that most of us go to, in an attempt to understand and give meaning to our behavior and our lives. People and the world at large for that matter, are instruments for their use, fair and square, and the object is to get their needs met at all costs, each man for himself. In fairness, it should be added at this juncture, that individuals with NPD are not sociopaths and do not have Antisocial Personality Disorder (APD). In fact, I never met an indivudual with NPD that did not genuinely think of themselves in anything other than vainglorious and stellar terms. Until, that is, you begin to point out the glaring inconsistencies... But therein lies the rub. Those with NPD do not surround themselves with individuals that pose a threat to them - it is part of their well-defined defense system. Should you make the horrendous mistake of even appearing to do or say something to challenge a directive, appear to criticize or correct their motives, or otherwise be less than completely beneficent, they will, with stunning alacrity. let you know in no uncertain terms (so quick in fact that it may take you awhile to realize you were just speared in the gut and that gurgling sound you hear as you walk away is the sound it makes when there is a gapping hole in your belly from where you were just impaled), that you have entered dangerous territory and you will be penalized for your obviously malicious expression of whatever it was, in a loud, clear, and bill-board-sized message that will make you instantly recoil and clearly regret whatever it was you said or did to them that they perceived as threatening - which by the way, may in actuality not have been threatening at all. In a word, get too close and you will pay the price for it. A veritable lifetime is spent perfecting their impenetrable armor and devising their always-on forcefield, such that when someone gets close enough to where the alarm is sounded, nuclear missiles are deployed without so much as a second thought. Should you have gotten wounded in the attack, and make no mistake, you will, (which part of "nuclear" was unclear?), then it was absolutely and positively 110% your own fault for doing or saying something to sound the alarm in the first place. I mean, hells bells, just what were you thinking?? Someone with NPD in psychiatric treatment? Treatment for what? For being well-defended? If that were all of it, the story would stop here.
Individuals with NPD are (more often than not unbeknown to themselves) angry, rageful (expressed or repressed), resentful, and fear exposure of being "found out". Criticism, rejection, and abandonement are their death nell - they are to be avoided at all costs. They cannot, or better said, will not, love. NPD is about control - something they feel they must possess at all costs and in all situations. And therein lies the narcissists paradox. They are usually desperate for a REAL relationship with someone they admire and respect, but anyone they admire and respect would by definition be smart enough to figure them out, something they cannot afford to have happen. So, they attract the individuals that they do not admire and respect, and with whom they often are contemptous of, because these are the individuals not smart enough or are psychologically wounded enough themselves, not to figure them out, and hence, they pose no threat to the narcissist and are by default, ammenable to being dominated or controlled. So what is the big attraction? NPDs are also unusually charming, APPEAR to attach quickly and well, and are generally more often than not, rather socially facile. For a remarkable account of narcissistic personality disorder, it would be worth your while to visit Dr. Samuel Vaknin's cite http://samvak.tripod.com, or read his book Malignant Self-Love. Dr. Vaknin is neither a psychologist nor psychiatrist, but a physicist and well-diagnosed narcissist, with an uncanny ability to recognize and describe what he himself is all too familiar with. Is NPD heritable?
Adults with NPD were at one time otherwise normal children with a heritable (genetic) predisposition that when exposed to one or more parents with NPD, their genetic predisposition in conjunction with their toxic environment, produced the very thing they were exposed to - narcissistic pathology. Being the child of a narcissistic parent is in and of itself a traumatic experience, and make no mistake, one that can and more often then not, does, change the neurology and biochemistry of those living under the same roof. This is one diagnosis whereby the sins of the parent really do visit upon the children. How does all of this acutally happen? How can being a narcissist change your brain and biochemistry? The best scientific explanation I have yet to come across is still Cloninger's tridemensional model. In Cloninger, C.R. (1986). A unified biosocial theory of personality and its role in the development of anxiety states, Psychiatric Developments, 3, 167-226, Cloninger ties 3 genetically independent but functionally related dimensions (Novelty Seeking, NS; Harm Avoidance, HA; and Reward Dependence, RD), to specific neurobiological substrates and the interaction between genes and environment. According to Cloninger, each of these dimensions, NS, HA, and RD, are associated with the neuromodulators dopamine, serotonin, and norepinephrine, respectively. Cloninger defines each personality type as follows: Novelty Seeking individuals are those with "a tendency toward frequent exploratory activity and intense exhilaration in response to novel or appetitive stimuli" and when high in this category are said to be "impulsive, exploratory, fickle, excitable, quick-tempered, extravagant, and disorderly" whereas persons low in this dimension are "reflective, rigid, loyal, stoic, slow-tempered, orderly, and persistant" (1987, p.575). Those described as Harm Avoidance are described as having "a tendency to respond intensely to aversive stimuli and their conditioned signals, thereby facilitating learning to inhibit behavior in order to avoid punishment, novelty, and frustrative omission of expected rewards". Those high in HA are seen as "cautious, tense, apprehensive, fearful, inhibited, shy, easily fatigable, and apprehensive worriers" while low in this dimension is characteristic of being "confident, relaxed, optimistic, carefree, uninhibited, outgoing, and energetic" (1987, p.575). Finally, Cloninger defined Reward Dependence as "a resistance to extinction of conditioned signals of reward or relief of punishment" and those high in RD are "ambitious, sentimental, and persistent" while those low in this dimension were described as "detached, tough minded, and irresolute" (1987, p.575). In the last installment of this series, we shall see how dopamine specifically, is implicated in this disorder and its relation to sex addiction.
When growing up in a narcissistic household, one is exposed to chaotic, irrational, inconsistent, debilitating, verbally aggressive and/or physically assaultive behavior that may or may not be aimed directly at you, and eratic, inconsistent or totally absent messages of love, concern, or attachment. The role of the child is to be the vessel for the desires of the parent. There is no such thing as individuality, and you are no more and no less than an absolute conduit for the demands of the parent. There is no negotiation, no debate, no individuation. You are to become what the parent wants you to become, and your life as you know it is in service to those dictates. Make no mistake, the narcissistic home is a dictatorship in a completely totalitarian state. The child either willingly fulfills these demands, wishes, and desires, and knowingly and intently, sets their sights on fulfilling the wishes of the parent without further discussion, or else willfully fights tooth and nail, but realizes that he or she is no match for the powerful parent. The fact that you are also angry beyond measure at your parents and the fact that you can never ever measure up in the eyes of the very parent that you sacrificed your life for or fought to change, has, in your understandably but nonetheless psychologically-limited and skewed perception of the world, nothing whatsoever to do with your childhood, your family, or your parents. You have deeply internalized and thereby deduced that you are merely a defective, angry, resentful and hollow human being who couldn't even be a good-enough child let alone adequate adult. And besides which, what does love have to do with it... Or, you are the invisible child. These are horrible internalizations that significantly damage and psychologically consumme the bearer. The narcissist has, through repeated exposure, become exquisitely sensitive to criticism and simply cannot tolerate the thought of enduring any more of it.
For those that develop a Narcissistic Personality Disorder, chaos, which is by definition, an out-of-control condition, becomes the very thing to avoid, and the only way to avoid it is to shut down the entire system. And so, to the individual with NPD, deep emotions are the enemy, and the biggest enemy of all, is love. Love is a two-pronged problem. First, it means that if you are experiencing it, you are also experiencing powerlessness over it. To be in love is to be out of control. Second, the love-object is the equivalent of a god or goddess as the case may be, replete with the power and strength to crush you like an itty-bitty bug at but a moments notice. The object of one's love can not only crush you, but much worse than that - it can reject and eventually abandon you. Therein lies the rub - a paradox if ever there was one. To the disordered narcissistic personality, the very thing you were never given but desperately wanted more than anything else, is the one thing you are, quite simply put, neuropsychologically unequipped to handle.
The Neurochemistry of Love and Attachment... Please stay tuned for Part III in this 3-part series
"Amazing grace, how sweet the sound that sav'd a wretch like me! I once was lost, but now am found, was blind, but now I see"
How do we separate out from sight, that which we cannot see?
Back in the day, that would be a summer's day somewhere ca. 386 or so, the soon-to-be Bishop of Hippo, battling his own long-standing sexual demons, concubine indulgences, and out-of-wedlock dalliances, decided that Adam's narcissism (of Adam and Eve infamy) was to blame for all the worlds debauched struggles. Not only was Adam's, shall we say, indiscretion, with Eve to blame for the Bishop's own cravings of the flesh, but Adam it seems, was to blame for all mankind's sexual thoughts, feelings, and behavior, until the end of time - the sins of the father, if you were to believe the tale, would indeed be visited upon the sons in a never-ending intergenerational nightmare of unbridled sexual upheaval and death. According to Augustine, and backed to this very day without hesitation by the Roman Catholic Church, Adam, at the very moment of his great lapse in restraint, turned himself from what was considered man's natural inclination of outward focus (toward God), to that of the wholly unholy incurvatus in se - a life curved inward (and away from God) - and right smack into the dark and dank nebulous crevices of his narcissistic soul. It was there, in that one forever frozen moment in time that humanity's assumed prelapsarian existence would cease forever - wherein Adam's fall from his apparent state of grace, would doom all of mankind to carnal chaos and certain death. So saith Augustine and the Roman Catholic Church. That Adam utterly objectified Eve, thought only of his own earthly desire without care of consequence, and certainly banished any trace of "God" or "Godliness" for that matter, from consideration, goes a long way toward the modern Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of narcissistic personality disorder (NPD) - not to mention sexual addiction. It has, unfortunately, taken us a mere couple thousand years or so, to grasp the part about genetics, or said another way, the neurobiological connection and intergenerational legacy of NPD, but more on this exceedingly important point a little later. I like stories. And I like allegories. As allegories go, this one is up there among my favorites. The bit about Pelagious's banishment (the one dissenting lone voice in the crowd - a veritable humanist that believed man has choice of whether or not to engage in good or evil) and any of his documents or evidence voicing objection to Augustine's morbidly skewed view of original sin and hereditary doom, promptly destroyed by the Roman Catholic Church notwithstanding, it is certainly central to the origins of narcissism and its place in the bowels of human suffering. After all, it is the narcissistic incurvatus in se, and not sexual desire and temptation per se, that is said to be the Original Sin, is it not - depending I suppose, upon which side of the alter one is standing. And then there was Ovid...
Unlike Augustine's Confessions, Ovid's Metamorphosis, cleverly told in dactylic hexameter, tells the story of the son of Leirope of Thespia and Cephisus the river god. We all know the story of the handsome Narcissus, doomed to love only his shallow reflection, and the poor little nymph, Echo, equally doomed to love the reflection of a man incapable of loving her back. The literature is filled with religious, psychological, and artistic interpretations of the myth of Narcissus. For the psychologists and psychiatrists that diagnose and (albeit very seldom) treat it, and the lay persons that live with those afflicted with it, NPD by anybody's standards is certainly more Greek tragedy than myth. While I whole-heartedly disagree with Augustine's (and the Roman Catholic Church in general) fanciful if not delusional fable of Original Sin, I do agree with the genetic legacy and the bit about the sins of the father (or mother for that matter) as it pertains to incurvatus in se, and having nothing whatsoever to do with sin, original or otherwise. As we shall shortly see, while it is certainly possible, and more often than not is the case, that one can have a NPD without also being sexually addicted, it is only the case that if one is sexually addicted, then by diagnostic definition, they have NPD. Treating the sex addicted individual is to treat their narcissistic personality disorder. Nowhere can I think of a more fitting application of incurvatus in se, then those that are sexually addicted.
What does narcissistic personality disorder have to do with sexual addiction? To the sex addict, they are one and the same.
In psychiatric terms, we diagnose a personality disorder separate from any other mental disorder. We do this, like we do everything else, by virtue of its operational definition. A personality disorder is defined in large part as an enduring and inflexible, long-standing pervasive pattern of thinking and behaving that significantly impacts and impedes an individual's cognitive, affective, and interpersonal world, and one in which is deviant or abnormally different, from the basic cultural expectations of society. A personality disorder will exacerbate and or skew any other presenting problem, perception, thought or feeling, about themselves, others, and the world at large, the individual may have or hold. The old thinking was that personality disorders were immutable and unchangeable and the best that was hoped for would be a temporary gross symptom stabilization, otherwise known as a band-aid during flare-ups. While personality disorders are among the most researched, written about, and discussed of the mental disorders, and while they continue to be fodder for many a lay person, media talking head, and most freshman psych-101 class, they remain the minority of actual psychological and psychiatric clinical cases. Why? Because generally speaking, and herein lies the awful rub, those with personality disorders do not see themselves as disordered - au contrare. Because personality is so entrenched and tied to our very identity (go ahead, try and separate out the two, and while you are at it, do tell me what traits you are putting into which column), most of us cannot ferret out what is normal versus what is abnormal about who we are and how we see ourselves. How does a personality become disordered in the first place? The answer? Not easily. Unless of course we are talking the Cluster "B" personality disorders which include the "antisocial", "borderline", "histrionic", and "narcissistic" PDs. This cluster, particularly the "borderline" and "narcissistic" PDs, the two I work with extensively, are more often than not, acquired during early childhood trauma. These PDs in particular, are severe but protective reactions to equally severe and debilitating traumatic events (for more on this, you might want to refer to one of the earlier posts in this blog). Although the following example pertains to psychosis and not personality, there is a rather poignant scene in the movie A Beautiful Mind, wherein the chief character, the real-life Nobel prize laureate and paranoid schizophrenic played by Russell Crowe, is sitting with his wife and psychiatrist, debating the demerits of going back to the psychiatric institution for further help (read: electro shock treatment). Crowe says to the psychiatrist played by Christopher Plummer, "I can fix this thing" referring to his progressively disorganized and schizophrenically ill mind. The psychiatrist says "no". "No you can't". "Why not, why can't I" says Crowe. "Because" says Plummer, "it is your mind that is broken"... Just exactly how does a broken mind fix itself let alone perceive itself as broken in the first place?
Please stay tuned for Part II...