They’re Not a Narcissist (and Other Things From a Therapist).
As a social worker, I never wanted to do clinical work. For those of you who don’t know, it is required that you obtain 3,000 hours (in the state of California) of clinical work, among other things, in order to receive your license. This gave me the opportunity to practice therapy and surprisingly, I liked it. So I’ve been practicing as a therapist for a few years now and I’ve come across some common things amongst my clients and the media that I want to talk more about.
Narcissism
This is probably the most common thing I hear thrown around incorrectly. People who are assholes, who don’t respect your boundaries, or who are selfish, are not necessarily narcissists. Of all 9 indicators of narcissism, one must possess at least 5 of them to be considered a narcissist. Very few people possess 5 or more. To give you an idea, only 0-6.2% of people in the population (based on research likely comprising samples of white people where the disorder is possibly more common [for a few reasons]) meet criteria for Narcissistic Personality Disorder. So I highly doubt your ex is a narcissist lol.
A key feature of Narcissism is that it is a personality disorder. Personality disorders are difficult or nearly impossible to treat. I think it can be pretty tragic to be aware that you have a personality disorder but be unable to change it. This is different from being unwilling which, admittedly, can be more common than not. Do with this information what you will, but I would urge you not to label someone who pisses you off “a narcissist” so quickly. Language can change the way we address or look at things and the severity of the disorder is serious. Throwing the word around can foil the significance of this disorder. This is not necessarily for the sake of Narcissists, but for victims and other parties where this diagnosis needs to maintain its weight.
Autism Spectrum Disorder
This is a new one that I’ve been hearing a lot. Many of my adult clients are coming to me wondering if or believing that they are on The Spectrum. Firstly, it’s incredibly rare to not be diagnosed in childhood, namely as a 2-3 year old toddler. Secondly, I think this is a much larger issue than just incorrectly diagnosing yourself with a disorder. The reason is because it sheds light on a bigger issue that is wrong within our world and becoming an increasingly bigger issue: people are becoming more and more isolated. What does this have to do with being on The Spectrum? Well adults are believing that they all of a sudden have Autism or were somehow missed as a child. This tells me that something is happening in adulthood that would bring this on. It’s also happening more now than in previous years that people believe they are on The Spectrum. I think because we have been increasingly isolated by capitalism, it is harder for people to develop skills to connect with others, or just have access to other people. The result appears to be more social anxiety than Autism.
Making the effort to build community is necessary for mental health but increasingly difficult in adulthood. Something I think about often is that our social conditions are awful, so are we developing diagnoses or just responding in a normal way to an abnormal situation, which makes us look and feel unhealthy. This is a bit philosophical, but I will leave it here for you to think about if you’d like. Your brain is protecting you, even if it doesn’t feel good. But if you are just now thinking you may be on The Spectrum in adulthood, chances are, you’re not. (Not that there aren’t terrible clinicians, because there are!) But the idea that you would go through multiple clinical professionals, as often the case when being diagnosed in childhood, and they would all be wrong to never suspect Autism, seems highly unlikely. Also the fact that it appears to be a phenomenon that adults are now self-diagnosing themselves with Autism feels like there’s something more to the story than just being missed as child.
ADHD
The big topic! ADHD has become quite common and is truly a difficult disorder to possess. I feel for those who do possess it. I believe that ADHD is largely a symptom of trauma. However, there are instances where it does not come from trauma, although I have not yet treated anyone where it did not come from trauma. ADHD, again, is a normal reaction for a very abnormal world. I believe it goes deeper than attention span (although some of it could be attention span). Our brains have distanced themselves from tasks or the present because it can be too overwhelming. This applies to both cases of ADHD as a result of trauma, as well as ADHD that is not a result of trauma.
Additionally, very often children are misdiagnosed because PTSD can show up and look like ADHD in children. Of course children can have ADHD without trauma as well. But the misdiagnosis for PTSD is a problem because they are medicated to treat ADHD (much easier to treat that PTSD). I am not at all anti-medication, but I am anti-wrong medication, especially due to negligence. Let me explain. PTSD takes lots of time, effort, and skill on both the clinician and the client. PTSD cannot be treated exclusively with medication (if at all). When I worked to help children in prison be released, I saw the prison psychiatrists were misdiagnosing and prescribing children medication for ADHD. It’s cheaper and quicker to give them a pill for ADHD than it is to treat trauma, and they could get away with it because the disorders can look the same in children.
Self-Diagnosing
It’s interesting that in today’s society, we have a huge attachment to diagnoses and tend to make them our identity. I’ve seen this frequently as well, that many people come to me with a diagnosis already and when I question how they came to that conclusion (not necessarily denying it), they tend to get very defensive. I totally understand the desire to self diagnose and the ease with which it is to make it our identity- there is validation and community in it. We are all collectively suffering from capitalism so we all got something going on as a result. It’s hard to have a completely healthy pregnancy or life in the world today with everything going on. So it’s easier to be born with and/or develop the propensity for mental health issues
As we move toward a society that does not stigmatize mental health, I am grateful for the plethora of information out there that allows people to self-diagnose. The caution is that the internet does not analyze behaviors, psyche, and brain chemistry/biology within context or environment and things can (possibly) get sticky without a trained professional. Even if you are someone who can do that analysis on your own, then what? Do we self-diagnose to build identity and community, or do we use it to treat the issue. Are we ready to treat the issue? (And let me make clear that the onus to treat mental health issues should not be solely on the individual because most are born out of systemic problems-this is why a combination of macro and clinical work are absolutely necessary.) Many people that come into my office have the idea that the diagnosis is the hardest part. The hardest part is treatment. Therapy is often not fun and not easy. It requires hard work and dedication that not everyone may be ready for. But when you are ready, it is a magical thing to dive deeply into yourself after putting in the work of self reflection, processing, and unlearning.
In curiosity,
Meghan
