A Google Reader friend linked to this article. Now, as a trained (and training, and training) clinician, obviously it's going to punch my buttons as hard as Mario looking for fire-flowers. It took me a while to stop fuming, read through the article, and figure out just what got me going. I'll start with the most insulting stuff, then try to work my way backward into a counter-argument.
...the pretensions of the DSM to science are sketchy at best, when its real-world usage has more to do with rationalizing billing codes of shrink service.This is both disingenuous and unfair. First, because of the actual science involved in every study resulting in an entry in or change to the DSM. The DSM is imperfect because our understandings of human neurology (the measurable), human behavior (the observable) and human nature (the intangible) are imperfect. It’s a living text - otherwise, homosexuality would still be a paraphilia. Second, because to conflate the ethical or unethical practices of clinicians with the text sitting on their desks, or the APA itself, is to create a horrible stereotype. But the most insulting part is the use of the phrase "shrink service" to suggest that therapy itself is nothing more than a shell game. Follow the queen, follow the queen, confront your issues…
Given Ron Rosenbaum’s apparent frame of mind regarding therapy and self-help, I’m inclined to ask: does he find no value in the concept of people figuring out what’s wrong with them and taking steps to make it better?
What he seems to be simultaneously ranting about and ignoring: narcissism and low self-esteem are not societal issues. They're psychological ones. They cannot be usefully generalized to the societal level or viewed in macrocosm. The manner in which narcissism operates in an individual life cannot be predicted from one person to the next; the same is true of low self-esteem. Therefore, the same is true of what treatment is most useful.
Ron Rosenbaum attempts this generalization – from character defect to national trend – but still wishes to use these elements as diagnostic tools. The apparent reductio ad absurdum of labeling Churchill a pathological narcissist is an oversimplification of a complex process, and more a non sequitur than a Socratic "gotcha." An accurate diagnosis of pathological narcissism requires far more in the way of symptoms than pride, leadership skills, and apparent overconfidence; no mental health clinician would make that call without taking a history consisting of a great deal more than the PM’s wartime bravado.
Furthermore, and this diagnosis I can provide: Winston Churchill was an alcoholic. From the diagnostic school of It Takes One to Know One: every alcoholic I’ve ever met, the dude in my mirror included, has struggled with concurrent bouts of narcissism and low self-esteem. So this ‘debate’ also proceeds from a false dichotomy: that narcissism and low self-esteem are fundamentally mutually exclusive. I’d go so far as to say they’re inextricably linked most of the time.
And to put a sock in Rosenbaum’s sarcastic observations, whoever said that a character defect couldn’t save an Empire or build an industry?
I don't hold any more than Rosenbaum with the rush to constantly diagnose people with this or that; but he doesn’t go far enough. Ron Rosenbaum details his ideological journey with respect to these perceived movements (using the imagery of political parties, just one more trouble I have with his article), and seems to arrive at the conclusion that neither has much merit; but he fails to take the next step, to rise above this faulty discourse and perceive its weak foundation. He ridicules the theories themselves, instead of their misapplication. In so doing, he fails to grasp the actual problem here. It’s not the diagnoses at fault; it’s their use. NPD cannot be used to exculpate a man from murder; it is, rather, a potential framework for understanding his culpability and preventing future crimes.
Rosenbaum takes issue with two diagnostic trends. I take issue with the notion of a diagnostic trend. I have since I was fourteen and doctors were handing out Ritalin to everyone with a short attention span. My sister had learning disabilities growing up, and attended a school for such children; I, having attended a “normal” school (only in comparison, trust me), was and am very clear on the difference between poor study skills and ADD/ADHD. (And here’s a diagnostic trend that did us all the favor of introducing wide swaths of misdiagnosed adolescents to prescription-strength psycho-stimulants! And they call marijuana the gateway drug.)
Finally: doesn’t the concept of “the banality of evil” intrinsically yield itself to overuse? I’d rather live in a society where everyone was on watch for it, and so hear the phrase bandied about too often, than one in which the concept remained novel because it failed to arouse concern. In other words: don’t talk shit about Hannah. I kick yo ass.
