Stigma Is Bad… Except for one Diagnosis?

The slippery slope of narcissistic personality disorder and mental illness stigma

Reproduction of Narcissus by Caravaggio — public domain

Mental illness stigma is a very real problem. Those of us living with mental illness usually aren’t thrilled when people casually toss around mental illness diagnoses as adjectives, such as “she’s so bipolar” or “he’s so OCD” or “everyone’s a little ADHD.”

And yet, when it comes to narcissistic personality disorder (NPD), all of a sudden there are boatloads of people all over the internet becoming armchair diagnosticians and talking about “narcissistic abuse.”

Here’s my issue. Emotional/psychological abuse is horrendously damaging, and it’s an issue that doesn’t get anywhere near the attention that it deserves. But when you drag a diagnostic term into it in relation to the abuser, that can cause a number of problems. And if it can be done so zealously with one diagnostic term, who’s to say that the next big pop culture fad isn’t going to be borderline abuse, or bipolar abuse? Can’t we just talk about the nature of the abuse itself without dragging the abuser’s mental health, or lack thereof, into it?

Within the mental illness world, armchair diagnosing is generally frowned upon as being unlikely to be either accurate or helpful. Yet armchair diagnosis seems to be enthusiastically embraced in pop culture when it comes to NPD, which raises the question, if someone with another presumed diagnosis is an abuser, should that abuse also be referred to by the abuser’s presumed diagnosis?

Being a pop psychology phenomenon, there are a lot of people online claiming to be authoritative on the matter, but there isn’t a solid foundation to ground it all. As an example, there’s an article on Psych Central by a licensed clinical social worker with the title Narcissistic Abuse Affects Over 158 Million People in the U.S. Her definition of narcissistic abuse includes people (and apparently all people) with NPD or antisocial personality disorder (so narcissistic and friends abuse?).

The author makes some assumptions and makes up some numbers and arrives at the conclusion that 3.4 billion people are affected by narcissistic abuse.

Those numbers sound high, don’t they? They’re also pure speculation. Numbers are not statistics when they’re based on assumptions rather than actual data.

The Psych Central author quotes a 2010 article from Psychology Today by Sandra L. Brown, titled 60 Million People in the U.S. Negatively Affected By Someone Else’s Pathology:

“There are 304 million persons in the U.S. One in 25 people will have the disorders associated with ‘no conscience’ which include anti-social personality disorder, sociopath, and psychopath. Three hundred and four million divided by 25 = 12.16 million people with no conscience. Each anti-social/psychopath will have approximately five partners who will be negatively affected by their pathology = 60.8 million people!”

The Psychology Today author then goes on to say that if that many people were affected by a heart disorder, society would be doing something about it. Now, in case you wondered, she’s not talking about developing therapies that can help people with NPD function more adaptively in their social environment and have healthier interpersonal relationships, because in that sense, it’s not convenient to call it an illness.

The author of the Psychology Today article lumped anyone with a cluster B personality disorder, including antisocial PD, NPD and borderline PD, into an umbrella label of “pathologicals.” She warns that “our future is highly dependent on what we provide as Public Pathology Education,” and makes assorted generalizations from there. Perhaps she forgot to check the dictionary, because, aside from the labelling problem, I don’t think pathological means what she thinks it means. Psychopathology just refers to having a psychological disorder, which includes me and anyone else who has a mental illness.

It’s hard to know where to begin, but it’s about as nonsensical as throwing into a pot everyone with a mental illness that can cause psychosis, including depression, bipolar, schizophrenia, schizoaffective, etc., and concluding that all of those people experience command auditory hallucinations and are likely to kill one person and maim 2 more.

This is only a tiny sample of what’s out there online, but what I find concerning is that no one seems to be trying to apply the brakes to any of this. I can see how this kind of content is likely to resonate with survivors of emotional abuse because it’s validating, it offers a “why” for the abuse they’ve experienced, and confirmation bias means that we’re more likely to seek out, believe, and perceive as authoritative, information that matches with our beliefs.

Again, emotional abuse is a very serious problem that should not be minimized. But when people start pulling numbers out of their asses (and these articles aren’t alone in that), it just starts to turn into a circus show. Maybe the next act in the circus will be to start spraying aerosolized antipsychotics to treat all of us who must be hallucinating and therefore getting ready to go on a shooting spree.

Why can’t we just talk about abuse without the circus show?

Even the way terms like “the narcissist” and “the narc” are used would probably be considered cringeworthy if one were to substitute “the borderline,” “the schizo,” “the bipolar,” or “the psycho.”

If it’s not okay with other conditions, why is it so enthusiastically embraced with another? Language use is a surface issue in terms of the greater pop culture phenomenon, but it does clearly illustrate the contrast.

I’m not trying to defend people with NPD as a monolithic entity, nor am I trying to suggest that the disorder is an excuse for abuse. In fact, calling it narcissistic abuse, and suggesting that it’s inevitable that everyone with NPD will be an emotional abuser, seems to shift the responsibility away from the individual abuser and squarely onto their mental disorder, absolving them of responsibility for their abusive actions because the disorder made them do it. Of course, that’s completely absurd, but if we’re to hold individuals responsible for their abusive behaviours, it doesn’t work to say at the same time that it’s fundamentally inherent in the mental disorder. Individuals commit abuse, not personality or other mental disorders.

Some people with NPD are emotional abusers, and that’s a very serious problem. Other people without NPD are also emotional abusers, and that’s just as serious a problem. Should we start treating psychotic and violent as synonymous? Or should we be using “borderline” as synonymous with manipulative, as the popular stereotype suggests?

Generalizing that everyone with a certain type of disorder is exactly the same and behaves in exactly the same way is stereotyping, which is a key pillar of mental illness stigma in general.

It’s a slippery slope. Maybe it’s best to back away from the armchair and focus on supporting the people we should be talking about in this situation (i.e. those who have been emotionally abused) without trying to weave the abuser’s mental health into the mix.

Originally published at https://mentalhealthathome.org on October 27, 2020.

Written by

Mental health blogger | MH Nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle | mentalhealthathome.org

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