Stigma

Stigma Is Bad… Except for one Diagnosis?

Mental illness is bad... except when people start talking about narcissistic personality disorder? -  graphic of a female version of Narcissus

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 you may have noticed this post make a brief appearance yesterday and then disappear, as I’d mis-scheduled it.)

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?). She 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.

Note: My intent with this post is not to criticize individual people who talk about narcissism in this way. It’s become a massive cultural phenomenon, and this is its language. I just think it’s worth some critical evaluation because of that slippery slope.

Stop mental illness stigma

You can find more about mental illness stigma on the Stop Stigma page.

39 thoughts on “Stigma Is Bad… Except for one Diagnosis?”

  1. Thanks so much! I was at one point in Facebook groups for “narcissistic abuse” survivors, because indeed like you say the idea is validating. However, one major issue I have with the term is that abuse is a power dynamic that (at least in theory) anyone can be a perpetrator of and anyone can fall victim to, whereas NPD is a clinical disorder. Also, the term seeks to sort of excuse abuse by deeming its perpetrators mentally ill.

  2. I think people leap from a personality trait (narcissistic, obsessive, etc.) to using the medical term. I guess I do it with “OCD” for myself, though it has somewhat impacted my life, though not to the extent that I can’t work or leave the house. I’ve never been diagnosed, although I’ve read that an eating disorder (which I have) is another manifestation of OCD. Anyway, yeah. Everyone is a doctor now along with being a constitutional scholar and an expert on the economy. The wonders of a google search 🤣

  3. Very interesting read. I’m glad to know why I couldn’t find this post when I saw it yesterday. I’m also glad WP hasn’t messed up my ability to read your posts..I was a bit concerned. I had an Aunt with NPD and it sounds mean to say, but if she got stigma attached to her because of that, she was nasty enough to have deserved it. I have to wonder what occurred to make her like that, because none of her siblings were the same. Mental illness can be a fascinating subject, as long as one remembers to leave the categorizing to the professionals. Thanks for sharing your expertise!

  4. That is so profound. It raises a lot of questions like, how much control over our behavior do we really have? I can act very badly. [Eyeroll.] (No surprise there.) I sometimes blame it on my issues, because it’s not behavior I’d stand by if I were in a fine mood, if that makes sense. Like, what the Helen of Troy was I thinking?!

    Just so many things there… for whatever reason, I don’t view personality disorders as mental illnesses. It’s just the way my mind processes things. I know personality disorders can be impossible to treat or cure because it’s the core of your personality.

    But you make a really good point that people tend to seek comfort in diagnosing the other person. I think that can be helpful if you’ve just been mistreated, though. I knew this guy several years ago who was just horrible to me, and I couldn’t break free for whatever reason. When I stumbled upon online quizzes asking if he was narcissistic, it filled me with relief–the fault wasn’t mine. That became a lifeline or an anchor.

    But what we never have is narcissists arguing their side of things. That I’d like to see. The rest of us can and do speak up about our stigmas, but the narcissists never do. Where are they? Are they innately not interested in self-improvement or self-growth by nature of being narcissists? Do they not know they’re narcissistic? (That thought terrifies me. What if I’m narcissistic?)

    And about my mother–I’ve noticed that she’s histrionic, which is another personality disorder. Whenever she soaks up attention by causing a scene, which depletes my energy reserves in five seconds flat–she’s being histrionic and narcissistic all at once, which is horrid of her.

    In her defense, at a later point, she’ll apologize profusely and talk at length about how hard it is to be her, how she can’t cope and life is terrible. (She could never cope, and her life has always been terrible, even before it genuinely seemed terrible to the rest of us, though.) And so I guess there I am getting the narcissist’s view of why they can’t keep it together. But I’ll tell ya, my mom’s inner landscape is scary as all hell. I’d HATE to be her.

    Fascinating blog post!!

    1. I can’t think of any personality disorder where there’s fairly vocal representation by people who have the disorder. Part of that is probably an insight issue, but I’m sure it doesn’t help that they’re likely to be faced with stigma or being dismissed if they do speak up.

    2. Not to pick a fight or invalidate your experiences of abuse (I’m a survivor too) but personality disorders are very treatable with certain kinds of therapy and there are clinical studies to back that up. I have avoidant personality disorder, and while a trauma history never excuses abuse of others, a significant portion of people with personality disorders have abuse histories.

      I guess my point in general is that while certain illnesses and beliefs make one more likely to be abusive, no one diagnosis makes someone automatically abusive.

      Abusive people can use anything to excuse their abuse of others, including their personal trauma history, for sure.

      Two books I’ve found helpful with regards to understanding the various factors, traits and beliefs that encourage abuse are _Why does he do that?_ by Lundy Bancoft and _It wasn’t your fault_ by Beverly Engel. 🙂

      1. So true. Abusers may have risk factors that elevate their likelihood of abusing, but in the end, it’s one individual behaving abusively, and that pattern can absolutely be broken.

        1. Oh! Also, thanks for “liking” my comment before replying, because otherwise, WP doesn’t tell me you replied! 😮 So keep doing that!! 😮

      2. That makes sense! I guess I was speaking anecdotally. We can make suggestions to my mom all day long, and they go in one ear and out the other, because she’s incredibly stubborn and refuses to see herself at fault or that she needs to change. I think there’s a difference between abuse where you’re like, “I’m sorry. I don’t know what the hell came over me,” and you try harder versus being abusive all the time without any internal regulatory factor telling you it’s wrong. At any rate, I’m often only capable of the former, rather than being a non-abusive person, but that doesn’t make me happy. Anyway, I would GUESS that for a personality disorder to be treated, you’d have to want treatment. The problem innate in many personality disorders is the strong belief that the person’s outlook is solid gold, and everyone else is wrong. I can see how that would be lesser to some extent with avoidancy, because you’d be motivated to get out there.

        I sort of almost disagree that no diagnosis automatically makes someone abusive. With narcissism in particular, I’ve never known any narcissists who weren’t abusive. But I’ll keep my eyes open, because that would be quite a find!!

        I read a different book by Beverly Engel and found it very helpful! She’s a great writer!! For sure!!

        1. Someone could tell you that they’ve never met anyone with a psychotic disorder who wasn’t violent, but just because someone makes generalized assumptions doesn’t make those assumptions reality-based.

            1. Well, I’ll keep an open mind, but I’ve been deeply hurt by every narcissist I’ve ever known. However, should I meet one who’s not abusive, I’ll grant them that and not draw assumptions.

        2. It definitely must be frustrating for you to deal with your mum.

          And yeah, one with a personality disorder has to want treatment but for those where it’s egosyntonic, they tend to think everyone else is the problem.

  5. “Can’t we just talk about the nature of the abuse itself without dragging the abuser’s mental health, or lack thereof, into it?” < I feel the same a lot of the time. It's funny you wrote this because I've actually seen a heck of a lot of blogs popping up these days about narcissism and the perpetrators of abuse, like a cult following of individuals rising up against narcissists. I'm usually glad for raising awareness, but it does put me on edge a bit. As for the pop culture phenoms themselves and stereotyping, they'll persevere for all of time. When it comes to comments, 'research' or stats, I always look under the surface now to see who's writing it, why they're writing it, what credentials they really have (often none!), and so on. xx

  6. Being the victim gives people power. I see a lot of people broadcasting online that they have some kind of disability. For instance, one girl practically bragged that she was autistic solely for attention. Most genuine people with disabilities don’t go around actively broadcasting that they have a disability. I know this wasn’t related, but I needed to vent!

    Perhaps people use the “narcissistic survivor” as a way to give themselves power and validation. Going around broadcasting that stuff online tells me that they are seeking attention. People who have suffered some kind of trauma often keep to themselves. It’s good to have support groups, but when does it become too much?

  7. This is a thought provoking piece. I never really thought of the stigma attached to personality disorders. You’re right though. If we frown on stigmas associated with other mental illnesses, then we should think critically about the stigmas of personality disorders too.

  8. When it comes to writing about mental illness I only write about what I know, myself! I leave all the rest to the qualified trained people.
    I do not try to understand the mental state of the ones who abused me. I just leave it where it belongs in the past, at least this works for me. I do not sit and brood over them.

  9. I agree on the stigma and misuse of the terms wholeheartedly, I am quite disheartened when people throw around diagnoses as any adjective. The root of all of this is evolutionary which gets parsed out and divided up into more categories and so on and so on. As a shaman, I can clearly see the levels people go to with this labeling and grouping are reactions to the human condition and are systematic trauma responses. As a person who has endured and survived abuse, I don’t like it when that word us thrown around. Great article my dear, indeed a very bright spotlight needs to be shone on this phenomenon or new epidemic.

  10. Today, I found out a friend had a nickname for me with her other friend. You wanna know what it was? Hypochondriac. 😒 Yeah, some people make me cringe. First, you are talking about me and two you are calling me outside of my name but then saying I didn’t come up with it to hurt you. Yeah, emmmkay.

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