What I Wanted to Put on Twitter But Just Couldn't

If President Trump talked to #therapydoc

Hi out there! It has been a super busy "holiday" season, meaning people touch base in therapy as holidays approach, so I'm scrambling to stick to regular hours (working too much at a stressful job can be bad for your health). So I haven't posted in awhile, But this one, hopefully, will make up for that. It is a conversation between me and our President, therapydoc and Donald Trump, about NPD, narcissistic personality disorder.

On Twitter sometimes people have these long, connected, stream of consciousness posts, not exactly lectures, but opinions. If there's one thing you probably guessed about therapydoc, (s)he loves to express her/his practice wisdom, which is an educated opinion. Loving attention, thrilling to the sound of my own voice, you would think that it would be a perfect venue for me. 

But honestly, this one features the President of the United States, or #POTUS, and I don't want to suffer retaliation of any kind, were he to be insulted, having read something tagged #POTUS. I wouldn't want him to interpret it as anything other than a caring, truly worried conversation, if a conversation can be worried. We all have our neuroses, and one of mine is being found out, discovered, trolled, annihilated. There's a fear of annihilation, and I have it. 

So I pulled back from Twitter, knowing that hashtags draw attention, and that the President loves Twitter, in favor of running this conversation by my friends, those of you who still read Everyone Needs Therapy. 

So here goes! You can read it from top to bottom, which you can't do on Twitter! Yay Blogger!

December 5, 2017

Dear #POTUS: I know that many journalists don’t like you and don’t agree with your politics. They are saying that you have #narcissisticpersonalitydisorder, or #NPD. That has to hurt. I cringe when they make fun of you, but sincerely want to discuss it, because it doesn’t have to be that way. You can prove them wrong about the #NPD. 

Dear #therapydoc: You have a lot of nerve even thinking that there is something to discuss. I do not have #NPD, have never had #NPD. That is #FakeNews. Nothing to discuss.

Dear #POTUS: Are you sure there’s nothing to discuss? Everyone is a little narcissistic but they can't all tweet and get the attention they deserve. We get it from family. It isn't easy growing up. We're just responding to how people treated us (although that could be unconscious, it is in the worst cases). We don’t even know, half the time, why we say what we say, do what we do. We’re on auto. 

Dear #therapydoc: I know you are, but what am I! I’m not trying to be funny. You might be on auto but I think about everything I say and it is all correct.

Dear #POTUS: No disrespect, because you are the COMMANDER IN CHIEF! How awesome is that? But it is kind of conceited to say that everything you say is correct. Everyone is wrong once in awhile. 

Dear #therapydoc: I might be wrong sometimes and when I am I tell everyone, and everyone is listening because, in case you forgot, I AM the President of the United States.

Dear #POTUS: That’s great to know, that you apologize, because we all have to apologize sometimes. Like the name calling thing. IS it okay? Let’s talk more, seriously. 

Dear #therapydoc: #RocketMan does not deserve respect. He is aiming his rockets at us. But we have bigger and better rockets. He should know that. We're bigger than he is.

Dear POTUS: Of course we do, of course we do. This is America, the greatest country on earth, and you are the PRESIDENT! That must be an amazing feeling. I mean, if anyone ever teased you as a kid, or even as an adult, it’s like, Who’s crying now right?

Dear #therapydoc, Do you even know who you are talking to? 

Dear #POTUS: I am sorry. You occupy what is the most respected, revered, awe-inspiring, yet terrifying position in the world as #POTUS. I’ll take a step back. Let’s go back to this idea that they, the #fakenews people are calling you names, the idea that you have #NPD, or #narcissism.

#THERAPYDOC!!!! Really? Only liberals and CNN would say that about me. You better watch your step. 

Dear #POTUS:  Did I ever call you that, even once? 

#therapydoc: Now that I think about it, no, you did not. But I think YOU are a narcissist, probably, seeing them in your sleep.

Dear #POTUS: Actually, you’re right, I do see them in my sleep, I am a mental health professional and we see quite a bit of unhealthy #narcissism. I have some, too, and it eats me up, I feel terrible when I think I’m better than anyone, even for a minute. Did you know, however, that in the research there’s evidence that we all do that? We all think we’re a little superior and it helps us be better, more creative people. Even leaders!  Crazy, right?

Dear #therapydoc:  If you don’t love yourself, who will love you? I don’t listen to anyone because I know, in my heart, I’m right. 

Dear #POTUS: Exactly.  When you’re right, you’re right.

Dear #therapydoc: And I AM, mostly right if not always.  

Dear #POTUS:  Can we talk more about the difference between healthy and unhealthy narcissism?  

Dear #therapydoc: Mine is healthy, just so you should know. I think you know that.

Dear #POTUS: Well of course you are right, because if you weren’t healthy, how could you have been elected President of the Free World! Or is that not a thing. President of the United States, I mean. The people trust your instincts. Or at least they did on election day. Is it possible you have lost their trust? I hope not.

Dear #therapydoc: Now you are sounding like the liberal media. Don’t be ridiculous. The people love me. Have you seen how #SarahHuckabeeSanders repeats every word that comes out of my mouth? She always respects me and she is a beautiful woman, a beautiful person, beautiful. SHE gets me. She will keep her job. 

Dear #POTUS: Does she ever try to give you advice? See, that would be proof that you aren’t narcissistic. If you can listen to other people and validate their advice, then you’re good. 

Dear #therapydoc: HA, HA, HA! They listen to me. BELIEVE ME, they listen to me. 

Dear #POTUS: But you don't tune people out when they talk to you, right? You would never do that, just space out, drum you fingers, and go, La, la, la, la, la. 

#therapydoc: You’re an idiot. I would never do that. 

Dear#POTUS:  That’s what I thought. So you could technically respond to the naysayers that you have healthy narcissism, the kind that gets people ahead in the world, inspires them to be creative, inspires them to be leaders. 

Dear #therapydoc: I don’t like that word, narcissism. 

Dear #POTUS: Then what should we call it? 

Dear #therapydoc: Let’s call it BLESSED. I’m gifted, and blessed. 

Dear #POTUS: A good start, Mr. President, a good start.  

therapydoc

What was wrong with Elliot Rodger?

Elliot Rodger spoke at length on a YouTube video about his plan to enter a sorority house and execute a mass murder, retribution for peer rejection. Blonds would be special targets, but everyone would die. He killed seven people on Friday, including himself, wounding another twenty-two.

Watching the video, it is clear he suffered from depression. He speaks of his loneliness and peer rejection, and at first we wonder if perhaps he had a high functioning autism, what used to be called Asperger's disorder. We wonder, like we did with Adam Lanza, who entered an elementary school and killed 20 children, 6 adults (Sandy Hook, Connecticut), if the social correlates of Aspergers depressed him beyond rational thought, drove him to violence. Children reject other children who don't have social skills, who can't follow social cues, as is the case with Aspergers.

But a teacher interviewed speaks of a whiny complainer, an unlikable young man who thought he deserved more (mainly from blonds). Neighbors call him polite and courteous. He'd been arrested three times, prior to his final act, and police didn't feel he needed to be held in custody.

So we know he knew how to talk to people. That, or the police spoke with parents who convinced them to let him go. He was in all types of therapy, although never hospitalized.

Neighbors of his parents say they never heard any shouting in the home. His family was in the process of moving to Santa Barbara to be close to their son.

All of his weapons were registered. On the gun owner registration there is a question: "Have you ever been adjudicated mentally defective?" Elliot could say no, never having been hospitalized.

So one lesson we can take from this (and this is a correction from a previous draft of this post):

We have to take what people say seriously. When someone vocalizes plans to commit violence, someone should take steps to see that it never happens, whether the threat is a public proclamation on a blog, a vlog, on YouTube, or at a coffee shop.

Those steps should include an evaluation by a professional, and hospital emergency rooms should be considered, seriously. Medical professionals won't admit anyone involuntarily for merely joking or venting. Involuntary admissions to hospitals are exceedingly difficult, because frankly, we have rights in democratic countries.

But as a community, we shouldn't rely on hope that a potentially violent situation will just go away. Bring a child, a friend, to the hospital when in doubt. Let the professionals do what they do best. Help.

The conceit expressed in Elliot's selfie-video is typical of the conceit of someone with narcissistic personality disorder. But it is an antisocial act, unfeeling mass murder, more likely to be a function of an antisocial personality. Antisocial people (ironic, since his most sincere desire had been to connect, sexually, with women) are also narcissistic. They can be depressed, too.

And yet, here it is:

Antisocial Personality Disorder 301.7 (F60.2) is a pervasive pattern of disregard for and violation of the rights of other people. A diagnosis requires only three of the following features:

1    A failure to conform to social norms and the law

2    Repeatedly lying and conning for personal profit or pleasure

3    Impulsivity and failure to plan

4    Irritability, aggression in the form of physical fighting

5    Little regard for the safety of others or self

6    Failure to consistently work or honor financial obligations, irresponsibility

7  Lacking remorse, rationalizing behavior that hurts others.

8    The individual must be at least 18 years old

This type of conduct is evident under the age of fifteen, although not diagnosed as such. To meet the diagnosis, schizophrenia and bipolar disorder must be ruled out.

My first guess, even though Elliot Rodger suffered paranoia and features of a narcissistic personality disorder, too, is that he had a co-occurring antisocial personality disorder. It is always a compelling diagnosis, and we don't usually recognize it until a deed is done, until someone steals our life savings, or sets off a bomb. 

Regardless of the trigger, the supposed reason for disregarding the feelings of others, the lives of others, this is a tough one to treat. And most of us, frankly, are uncomfortable, just being in the same room, with those who have it. 

They are scary, the stuff, the creatures of movies and video games. It is sad and ironic that Elliot's father, Peter Roger, is in the film industry, worked as an assistant director of The Hunger Games, among other accomplishments.

This can't be easy for him or his wife. Their son's disorder has biological underpinnings. It isn't their fault (see Adrian Raines' book, The Anatomy of Violence). Despite the fact that he may have had blurred boundaries, identified with movie characters, or watched too many video games, this behavior is likely not a consequence of that.

We're sure to find out much more about his parents and his childhood. The downside of the media, the downside of fame, is that unlike the privacy the Rodger family might have been assured, had Eliot been hospitalized, the gloves will be off.

But maybe that's a good thing. We have to promote awareness, and one thing Elliot has now, if he never had enough before, is that.

therapydoc

Judging Mother

The trend in psychotherapy in the first half of the twentieth century was to blame the mother for whatever the symptoms expressed by anyone else in the family. 

Then in the fifties it became fashionable to blame mom and dad.  Father took blame for supporting mother's pathological influence, be it abuse or neglect, and sometimes for behaving poorly himself.  He was given a pass, however, on neglect, didn't have to participate in family life because: (a) he worked, and (b) guys aren't supposed to talk about feelings or ask about them. Certainly not when they're tired at the end of the day. 

Then in the sixties, seventies and eighties, family therapists caught on to the transgenerational system.  We noted that pathological behavioral and belief patterns are passed down, consciously or not, from parents to children.

So we searched the transgenerational family tree, blamed grandparents, great-grandparents, great-great-great grandparents, even uncles and aunts and distant cousins, way up to the top branches-- the ganztza mishpacha (Yiddish, sounds like fonts-ah- dish-puck-ah) --  the whole family.  We blamed the family system for awhile then finally decreed: No one is to blame. It is the family system that is to blame, family dynamics, patterns that repeat, unchallenged, year after year after year.

At some point we came to realize that no family system is an island, and if we're going to blame anyone, anything, we might have to blame the entire universe; for even people and events in the news affect our thoughts and behavior, as do our teachers and co-workers, the people in the grocery store.  So we added "search" to the ecosystem to find a systems diagnosis, and used that for system change.

But sometimes it is just so obvious.  It's Mom.  We really can blame her, although the tree, those teachers, the neighbors, might be culpable, too; and Dad could get best supporting actor.  But Mom has a corner on emotional power, that power to make us feel happy, or to make us feel sad, and sometimes she knows it, can't help but wield it. And it hurts all the more because, rightly or not, we expect more from women.  When our woman doesn't deliver, it is the unkindest cut of all.

We'll put aside our wide-angle lens when father does it, too.  We stop looking for patterns when one parent or another is consistently hurtful, is negligent or abusive consistently throughout the "child's" life.  We stop looking because the patient, no longer a child, is really, really sick and needs treatment, understanding and empathy, may be cutting or suicidal.

A narrative points to a story of disappointment, pain, insults and drama, a relationship that never healed properly, one that didn't turn out nice, not like parent-child relationships should.  No fairy tale here.

The therapist sees cause and effect and doesn't like it.  The patient has shopped, priced, and compared, knows that many, if not most people have mothers (fine, fathers, too) who are not insistent upon the child's independence, who care for them when they are sick, who praise, rather than criticize, who don't withhold love, don't slap.  The adult patient is thinking that at some point a human being should stop, should shape up, should become someone who knows how to give.  Parental.

In this process, while talking through the narrative, neither the doctor nor the patient wants to label anyone bad.We tiptoe around the word bad, play with deficient, unknowing, mentally ill, a product of his or her parents. Mama didn't know any better; she is an improvement upon her mama.

Mother's culpability only becomes an issue when reality steps up and delivers.A call from her, maybe, asking for money, or time. Maybe new information from a sibling or a cousin.  Someone posts an old family video, or a picture. Facebook.  Anything and everything can be a trigger.  The patient is going along, doing fine, minding her own business, feeling fairly protected, when suddenly anxiety is off the charts, defenses shot to hell.  Like a broken child, she voices it in therapy:  I'm alone.   I was used to it.  But it is so clear, so painful, how she never loved anyone but herself.  What does she want from my life?  Why can't she just leave me alone? I'm alone either way.

That existential dilemma.

Those of us who have healthy parents have tucked inside healthy introjects, representations of the good mom, the good dad, home and goodness, an identity that gets us through tough times.  When a parent has been grossly negligent, absent, deficient, or terrifying, the child has no positive introject, no soothing representation of family.  When there's nothing inside to lean upon, that existential dilemma, loneliness, becomes a crisis.  Save me, they say, silently.

Sometimes I think I see abandonment everywhere, in every relationship, or its dear cousin, narcissism, selfishness. None of us are perfect parents.  We can't always be there for our children, and sometimes we are all about us.  It's true.  But we try to keep that to a minimum, try to be there for our kids, and we express our love, our undying love.  True narcissists, and people who are sick, sometimes people with addictions, might not want to but they abandon their children.  They are the only ones in the room, the only ones with feelings that matter, and their children miss out, suffer a slow emotional starvation.

In a good therapy we do look for the love, try to find what's below the surface, forgotten good vibes.  We spend hours seeking love in the history, giving people the benefit of the doubt, and we may find splashes of it.  Or not. Or the pickings are just so slim we might look at one another and sigh, agree to abandon the search. 

When we do that, it's okay, it really is. A person can do very well without parents, can find others as mentors, can be loved, protected by someone else. We think we need parents to be secure, but we don't.  So much more goes into being secure.

It's very hard to get to that place, to let go, emotionally, to stop hoping for what might never happen. When there is a cut off, miraculously, the world does not stop spinning.  It even feels safer.  It might be inevitable if a parent isn't amenable to therapy, or won't work on the relationship, maybe has no resources.  Or family therapy didn't work.  Most therapists don't bother trying to work with older parents.  Instead, they become highly adept at engineering sturdier umbrellas for surviving adult children.

The triggers are what make the umbrella something to keep in the car because there seems to be some kind of direct neurological pathway between the Mother event in real time and cutting and thoughts of suicide.  The cutting is to leech the pain or to send the therapist, the good mom, a message. Save me.

I bring this up because it begs an ecosystem solution.  Because I don't want to do the saving, not by myself. We talked about this a little in How to Save a Life.

The modest proposal,  a solution to the problem of judging mother is empathizing with son and daughter.  Since they are unidentifiable, since we don't know who they are and there may be thousands of them, we must empathize with everyone in every social context.  This may seem like an impossible solution, for so many of us simply haven't got the chip, but we know that empathy can be learned, like we all learn a new skill, like stopping at stop signs while driving. Those who don't stop at stop signs will be harder sells on empathy.

I'm thinking people should throw it into conversation, should ask one another, Do you think I'm an empathetic person?  Responses are likely to be honest.   It's a relief, honesty.  Expect to feel defensive but good, for this is a teaching moment.

Empathy works like this in a therapeutic context:
1. Someone complains about Mother.
2. The good therapist only cares about that complaint and how it affects the individual.  It is all about feeling this person's experience, the therapist feeling the patient's pain.
3. Questions apply; answers do not. We ask in order to better experience the pain of the patient.
4. We ask more.  We want to know all about it. Empathy is not about giving answers or suggestions; it is all about questions.

When a person is triggered, distressed, it is safe to say that anyone can be therapeutic by staying with this person, this friend in need. And best is to let the friend go ahead and judge. There might be a few rules to keep in mind.

This is not the time to say,

Give the benefit of the doubt. 
There must have been a good reason for. . .
You might have done the same if you were in that situation.

Not therapeutic, and for a person who has been abandoned many, many times over, the benefit of the doubt is hollow, reasons shallow. And you're likely to hear:
No, I would not have done this, no matter the circumstances.With attitude.

This is not the time to say,

You have to let go of your anger.  Forget about it.

Or worse,

You should confront her. Let her know how you feel.

Send the sheep to the wolf, why don't you.

This is not the time to say,

Forgiveness is divine.

Forgiveness is a process, for some, a lifelong process.

This is certainly not the time to say,

What you should do is . . .What you should have done was . . .

It is a good time to say,

Tell me, tell me about your anger.
You have a right to your feelings.

It is safe to believe that these feelings don't come out of nowhere.

There is a proverb, maybe a mishna (Google it) that says,

Don't speak to a man when he is angry.

The cutting, the suicidal behavior, this comes from a very angry, sad place.

Once the anger and sadness has lifted and healing is palpable, in therapy we talk about alternative narratives. We might rewrite the script, employ visual imagery, all kinds of cognitive behavioral interventions.

Wouldn't it have been great if you could have said. . .?
Why don't you put her in the chair and talk to her, tell her how you feel?

You can do that too, after the anger is gone. Timing is everything. Just be sure not to trigger your buddy again. Less said, seriously.

For it really is okay to judge someone, and it's more than okay, it is therapeutic to let another person judge. Even if it is the very same person who brought him into the world.

therapydoc

PS:  If you judge someone's mother, you're taking a huge risk.  I can say whatever I want about my mother, but you better well not.  That's my mother you're talking about.

For Love: George Huguely and Yeardley Love

Can you really blame kids for getting drunk? Isn't that what they do, as college students? Make that, high school students? Athletes?

Well, no. Not every college kid drinks until he loses control, and not every high school student does this. Not every athlete. We can leave the other drugs alone for a minute, concentrate on America's favorite drug, for this is what docs learn in graduate school. Alcohol is America's favorite drug. And it's likely alcohol did drive George Huguely over the edge.

Here. Read the New York Times for yourself, Juliet Macur's got the byline:

CHARLOTTESVILLE, Va. — On a night that was supposed to be a quiet one, with final exams just a day away, more than 1,500 students at the University of Virginia put down their books Wednesday and paid tribute to a fellow student killed this week.

An amphitheater was packed for an hour with students and administrators, some holding candles, all honoring the memory of Yeardley Love, the lacrosse player who was found dead in her apartment early Monday.

Another Virginia lacrosse player, George Huguely, has been charged with first-degree murder in connection with her death. . .

Court documents released this week, though, gave details of how that fateful night unfolded. In an affidavit filed in support of a search warrant, Huguely, a 22-year-old senior from Chevy Chase, Md., told the police that he and Love, also 22, had recently ended a romantic relationship. He said he broke into her bedroom and attacked her, shaking her as her head repeatedly hit a wall. The police said Love’s head was badly bruised.

This post is a little late on the draw, I know. But it's ironic, because I wanted to post about narcissism today, and yet this one smacks of intimate partner violence, or domestic violence, DV. Maybe George Huguely has this disorder, Narcissistic Personality Disorder. We know that some murderers do. I just finished a novel by Alan Jacobson about a serial killer on this. Don't read it if you need to get to sleep at night. Crush. Set in Napa Valley. We get a really good tour of the vineyards.

Today's theme. Crushed grapes, crushed people. Alcohol. Narcissistic Personality Disorder. Intimate partner violence.

We can blame alcohol abuse for the murder of Yeardley Love, and everyone will. But while some drink to oblivion, and don't murder anyone, there are those who do. So it's likely there are other disorders at work, what is called a duo diagnosis. It's likely there's another diagnosis tucked inside George Huguely. He's had priors, meaning he's been arrested before. The Washington Post:

In November 2008, Huguely pleaded guilty to resisting arrest, public swearing and public intoxication after a drunken scuffle with a female police officer during a visit to Lexington, Va. The officer said Huguely told her, "I'll kill you. I'll kill all of y'all. I'm not going to jail," in a diatribe laced with racial, sexual and other vulgar terms. She used a Taser to subdue him.

Oy vay, a Taser.

He received a 60-day suspended sentence, emphasis on the suspended. He had six months of supervised probation, a fine, 50 hours of community service and 20 hours of substance abuse education.

Mostly punishing a bad boy. But are kids bad? Can we say an athlete is misbehaving like that, when he's abusing alcohol, when he's cursing out police officers? That kind of behavior, cursing out an officer is sheer narcissism. Most of us cower when an officer of anything just asks us our names. Well, some of us.

But if you injure some people, offend their egos, what we call narcissistic injuries, then you're likely to catch hell for it. At best, you'll be snubbed. At worst? Maybe murdered. Ms. Yeardley broke up with him. She rejected him. End of a promising young life. My condolences to her family, my prayers for her, for them.

Did she need a police escort to do that, break up with George? Some of us would say yes, maybe. Certainly the police are useful with stalkers. Bring a cop to the door of a teenage stalker and that teenager is going to think twice about bothering his prey again. Catch the kids young, when their personalities are still changing, developing, and you never know.

But order therapy, seriously, not a substance abuse program alone.

And maybe we can prevent deaths like this one.

therapydoc

Another diagnosis heard from: more Cho

Jeffrey Kluger, in this week's issue of TIME MAGAZINE interviewed several forensic psychiatrists and proceeded to propose a theory about Cho's psychology not much different than the one I did on Slow Burn, except that he adds a feature I left out. Narcissism.

It's worth a look as it adds another plausible diagnosis to the soup. Cho fit the features of the disorder, listed below.

Narcissistic Personality Disorder, 301.81.

The DSM IV-TR:

A pervasive pattern of grandiosity (in fantasy and behavior), need for admiration, and lack of empathy, beginning by early childhood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) shows arrogant, haughty behaviors or attitudes

Although it may look like a match, based on the video, keep in mind that people with Narcissistic Personality Disorder (NPD) usually aren't mute. They interact socially with people who respect and flatter them, and can be as physically attractive as anyone else, so they have something of a social network, although it's usually small and the turn-over is high. They're not real likable, despite thinking they should be.

Cho never interacted with anyone, which is why I skipped right over NPD to Schizoid Personality Disorder, premorbid to Schizophrenia, Paranoid Type, which presented later in his early 20's, probably the year before the massacre.

Mr. Kluger says that mass murderers like Cho and Harris and Kliebold (the Columbine murderers) suffered from "clinical narcissism"

a condition characterized by "disablingly low self-esteem, requiring the sufferer to seek almost constant recognition and reward."

He goes on to say that if a narcissist is denied recognition, especially if he has had a history of abuse and marginalization, he can become enraged, gradually moreso. A sense of powerlessness is replaced by a (my addition in parenthetic italics)

"heady experience that may produce an implacable serenity on the one hand (Cho), or the eerily jocular banter that surveillance tapes picked up between Harris and Klebold in Columbine on the other."

Kluger says that the gunman is calm because he knows he's right

". . .the world has brought the carnage upon itself."

I would say that yes, it looks like that, like Cho was confident in his decision to kill and felt justified, like he'd been harmed and was delivering vengeance. But in this case the gunman was calm, very probably, because he knew he was following the orders of the voices in his head that said, They've harmed you, cheated you, ignored you. Kill them. Soon.

The narcissist would be thinking for himself, the person with schizophrenia has help. The thoughts are the same, but the person with schizophrenia is hearing voices and is fearful, not righteously indignant like the narcissist.

This is why I'm not quick to join Time Magazine's journalist who concludes by saying that we can predict these things because murderers who suffer from clinical narcissism do tell people, even brag to others that they intend to perpetrate their crimes. Harris and Kebold said so on the Internet. I don't remember reading that that was the case with Cho at all. Who did he talk to? Did he tell someone? Am I missing something? It would have been difficult for anyone to read his mind. Again, it's very possible that we're missing information. We're only one week from the event. More will tumble out over the coming weeks, months and years.

So I'll stick to my original diagnosis of schizophrenia for now.

Nevertheless, this is a perfect example of why diagnosis per se is often a dead end and tells us little.

On the surface, Cho had most of the symptoms, if not all, of Narcissistic Personality Disorder. But it certainly wasn't a pervasive disorder as it didn't manifest until the episode, the massacre.
We don't even know if he slept. Perhaps he had a manic episode.

And if we add narcissism to Cho's Axis II disorders, does that mean we have to be very careful with every narcissistic adolescent we see? Normal adolescents can go through a very narcissistic phase but the grow out of it and everyone is grateful. Also, in NPD there is typically a LACK of self-destructiveness, impulsiveness, or concern with abandonment. You did this to me might be saying something about abandonment. Suicide IS self-destructive.

I think the key word to look at, forget the clinical diagnosis for a minute, is arousal. Screaming anxiety/anger, uncontrollable, painful arousal, likely caused by dysfunction of the limbic system and perhaps voices in his head or perhaps, as Kluger says, righteous indignation.

Thus when we send psycho-educational teams of mental health professionals and peer counselors to our schools to teach children about mental illness, as I've suggested on other posts, they will focus on communication and anger management. I am working on the program right now.

I base that trajectory, by the way, the Schizoid Personality Disorder premorbid to Schizophrenia upon what the American Psychiatric Association finds statistically significant in the data analysis of studies in the general and clinical populations. The DSM is a product of 13 Work Groups and a Task Force, consensus scholars without previously held views, who analyzed cross-cultural data.

By the way. This is not to say that people who do have personality disorders don't have some kind of genetic predisposition that presents as lacking empathy. We'll save empathy, however, for the next discussion.

Copyright 2007 TherapyDoc