Tuesday, August 26, 2014

The Narcissist

“I got into a ridiculous argument with my ex this past weekend when I went to pick up the kids. She greeted me with, ‘Are you a narcissist?’ I knew she’d read about that study that said you could identify narcissists just my asking them if they were narcissists. Of course I said, ‘No.’ Then I asked her the same question and she said no too. But she is a narcissist. So then we got into this whole argument.”

Spencer is probably my fourth patient who has brought up that study which I had also read about. Defining a narcissist as someone who is egotistical, self-focused and vain, the researchers found that asking the one question, “Are you a narcissist?” was as effective as identifying a narcissist as a 40 item diagnostic test. Although I have seen neither the study itself nor the 40 item test, my experience – both clinically and personally – leads me to question whether narcissists will so readily identify themselves.    

“It’s so ridiculous. I can’t see how someone who has had all the plastic surgery she’s had, who takes hours to get ready to go out, can call me a narcissist. It takes me five minutes to get ready for work and if I never looked in a mirror again that would be fine.”

“Why did Bonnie think you were a narcissist?”

“She said I never think of anyone but myself, throw a fit when I don’t get my own way, and am very superficial. Superficial! Look who’s calling who superficial. She’s never done anything worthwhile in her life. I’m the one who busted my ass to get my doctorate, to become a tenured professor, to provide the home that’s now hers, the life-style that she’s grown accustomed to. Superficial, my ass! And I also don’t call that thinking only of myself. I did it for her, for them.”

“Is that true, Spencer, did you do it for them, or did you do it to prove to yourself – and to your father – that you were smart and worthwhile and accomplished?”

“And that makes me a narcissist?”

“I didn’t say that, Spencer. I think there’s always some self-interest in what we do. I was just questioning your saying that you did it for them.”

“That’s beside the point. I was just refuting Bonnie’s argument. I can’t believe I’m wasting my time – and my money! - talking about this. Do you have anything worthwhile we can talk about?” he asks, sarcastically.

I’m instantly flooded with feelings – anxiety, anger, fear. I feel both challenged and diminished. Not for the first time, I’m aware that Spencer reminds me a great deal of my father – angry, demanding, short-tempered and, yes, narcissistic. I’m also aware that the fear and anger are feelings both Spencer and I experienced as children in relation to our respective fathers. This awareness doesn’t make my feelings vanish, but it does help me to remain in my role as therapist.

“Well, I think it’s very important, Spencer, that we look at what’s going on between us right now, because I think you’re treating me just as your father treated you as a child. You’re being challenging, angry, and dismissive towards me just as your father was toward you. And that leaves me feeling both angry and less-than, just as you felt with your father.”

“So now I’m a less-than narcissist,” is Spencer’s retort.

“I can see how tough your father was, Spencer; how he never gave you an inch; how he didn’t listen to what you said; how he always had to come out ahead. I’m not your father, Spencer. I’m not trying to diminish you. I wonder if you could take off your father’s glasses and see me through your own eyes.”

“So do you think I’m a narcissist?” Spencer persists. 

“You’re unrelenting, Spencer,” I say shaking my head. “You know when you said before, that you’re a less-than narcissist? Well, there’s a lot of truth in that, not especially for you, but for many people who have some narcissistic characteristics. They’re people who feel less-than, but who have developed a way of feeling better about themselves, of keeping that less-than feeling at bay. I think you do it by being angry, by shutting down alternative opinions and, probably most importantly, by trying to convince both yourself and others of your accomplishments and specialness.”

“So you’re saying a narcissist looks like someone who thinks a lot of himself, but actually doesn’t think much of himself at all.”

“That’s exactly what I’m saying.”

“I don’t know. I’ll have to think about it. And I’ll have to think about whether it applies to me.”

“I appreciate your being open to thinking about it.”

Tuesday, August 19, 2014


“I’m sure you know what I’m going to talk about today,” Evelyn says, her eyes expressionless, her voice flat.

I nod. As soon as I heard about Robin Williams’ death, I thought about Evelyn, a depressed woman whose suicidal thoughts are a consistent part of both her life and her treatment.

“I saw that animated clip online, where Aladdin frees the genie – Robin Williams - from the lamp and Williams dances around saying ‘I’m free.’ Made me think of Martin Luther King’s, ‘free at last, free at last.’ Maybe that’s what it would be like. I’d be free, free of constantly being drawn down into this abyss.”

I watched that clip myself and immediately worried about Evelyn. Definitely not a good message to give a suicidal patient. “But the genie is set free to live, Evelyn,” I say. “To live without having to be restrained in a lamp. It’s about expanding your life, not destroying it.”         

Evelyn ignores my comment and continues, “I’m having hard time sleeping. I keep thinking about him hanging himself. He had everything. At least it seemed that he did - fame, success, money, family, adoration. And still he killed himself. I don’t have any of that, well not most of it anyway. What’s the point? Why should I keep going? I have nothing to add to the world. I’m just taking up space.”

“But this isn’t always the way you feel, Evelyn. There are many times you enjoy your children, your grandchildren, your painting.”

“It’s meaningless.”

“It feels meaningless today, Evelyn. It doesn’t always feel meaningless. Can you remember when it doesn’t feel meaningless?”

“It’s hard.”

“I know. When you’re in this dark place it’s hard for you to remember the good times, the pleasurable times, like playing with your granddaughter in the pool, or sitting on your back patio painting. Can you tell me what you first felt, what you first thought when you heard about Robin Williams’ suicide?”

“I was surprised. Like I said, he seemed to have everything. And he seemed like such a happy person. I guess I always thought he was kind of manic, but I didn’t know about the depression, or all his drug problems.” She pauses. “Maybe I even felt a little mad, like why should he kill himself? He’s not the one who should be depressed, he’s not the person whose life is meaningless. I’m the one who should kill myself.”

“What do you mean you should kill yourself?” My anxiety is increasing. I’ve seen Evelyn through years of on and off depression and many times when the possibility of her killing herself increased. A few times she went into the hospital. Mostly I’ve trusted her to contract with me to not kill herself. I want to talk about that kind of contract now, but hold myself back. It’s early in the session. Evelyn seems to have a lot of feelings roiling around today. I need to give her time.”

“Well, like I said, I have nothing compared to a man like Robin Williams.”

“You also said that you felt mad when you heard about his taking his life.”

“I said a little mad.”

“So it feels uncomfortable for you to be mad.”

“We already know that.”

Surprised by the sharpness in Evelyn’s voice, I realize that she’s angrier today than I realized. “Are you a little mad today, too, Evelyn?” I ask.

“I guess.”

A few moments pass in silence.

“It’s so confusing,” she continues. “If someone like Robin Williams can kill himself, there’s absolutely no reason in the world I couldn’t or shouldn’t.” She pauses. “But that Aladdin video made me sad and not only because Williams killed himself. I felt sad that he and Aladdin were saying good-bye, that they’d never see each other again. And that’s what happens if you kill yourself, you never see anybody you love again. I don’t want to think about that. I don’t want to think about never seeing my children or grandchildren again. I just want to think about ending my misery. It makes me mad that you brought them up, mad that seeing that video made me think about them. That’s why I’m mad.”

“Mad and sad,” I say, very aware that I too am feeling sad, reminded yet again of the finality of death. “Death does mean saying good-bye and, yes, that’s very sad for both the person who dies and those left behind. And you’re right, Evelyn, that is the other message in the video. Goodbyes are painful, definitely something to consider when you feel suicidal.”

Tuesday, August 12, 2014

I Don’t, Session 2

“I wasn’t sure I wanted to come today,” Patrick begins.

Having realized in our first session that Patrick can put me in an adversarial position, I say nothing.

“I mean, what is there to talk about? Angela and I are engaged and getting married. I know she loves me, even though she says she doesn’t.”

Unable to resist I say, “Didn’t you tell me at the end of our last session that once Angela agreed to marry you you got scared and weren’t sure if she didn’t love you or if you didn’t love her?”

“I said I got scared,” he says with an edge to his voice. “Of course I love her. And, as I said, I know deep down she loves me.”

Already feeling stymied, I change course. “Patrick, I’m not here to talk you out of marrying Angela. I’m here to help you figure out what it is you want; what it is you feel. My sense is you think you have to argue with me. Except we’re on the same side. So I wonder if what you’re doing is arguing with yourself.”

Patrick smiles. “Occupational hazard. I’m a lawyer.”

Realizing that Patrick’s style of interacting is a very effective way of keeping distance, I ask, “Patrick, who in your life have you been really close to?”

“Wow! That came out of left field. Well, I guess my Dad and my brother. I had a girlfriend in college, except she was never really interested in me. And Angela, of course.”

“Can you tell me about your relationship with your Dad and your brother?” I ask, aware that he’s described as “close” two women who didn’t or don’t love him.

“Well, John, my brother, was 10 years older than me, so I guess we didn’t have that much of a chance to be close. But I always knew he had my back. And my Dad, he was a rock, holding it all together after my mother died. He worked a lot, tried to do as much overtime as possible.  But he’d make time to toss a football around with me.”

Feeling the absence of emotional connection in Patrick’s life, but not wanting to get into a battle of words, I proceed cautiously. “When you said you got scared when Angela agreed to marry you, can you say more specifically what you were scared of?” 

“I don’t know. Marriage. It’s a big step.”

“That’s true,” I say nodding. “And what does marriage mean to you?”

“Well, it means being with the same person for the rest of your life. It means being responsible for that person and having to take care of her. It means “for better or for worse.” It means …” Patrick stops and swallows hard.

“What just happened there, Patrick?”

“I was about to say, it means there’s no way out. I didn’t like that I thought that. And thinking it scared me. But it’s not like that with Angela. I love being with her. We have lots of fun together.”

“Your brother has your back, your father was a rock who tossed a football around with you, and you have fun with Angela,” I summarize. “You have relationships with these people, but I don’t know if they’re emotionally close relationships. I think the idea of an emotionally close relationship really scares you.”

“Why should it?” Patrick asks.

“Well, both because it feels so foreign and what’s foreign is scary and also because a really close relationship might open up feelings inside you that you’ve kept buried for a very long time.”

“And you think that’s why I want to be with Angela? I thought it was because I was supposed to be trying to save her like I couldn’t save my mother.”

“The reasons we do whatever we do is always multi-determined, Patrick.”  

“What other reasons?” Patrick asks, challengingly. 

“I’ll answer that, Patrick, but first let me say that my sense is that your need to challenge and dispute is also a way of maintaining distance. You can’t be close to someone you’re always arguing with.”

“Makes sense. But you said you’d answer my question.”    

“I think you also pick unavailable women to try to win in the present with women who are similar to the women you lost with in the past. Let me say, Patrick, that I’m concerned that we’ve covered so much ground today. It feels overwhelming so me, I can only imagine how it feels to you.”

“I’m okay. It’ll give me lots to think about.”

“And maybe if we can slow it down a bit, it will also give you lots of feel about.” 

Tuesday, August 5, 2014

I Don’t

“I appreciate your seeing me,” says Patrick Monahan as he seats himself in the sage chair across from me. Medium build, with curly brown hair and a few extra pounds, I’d guess him to be in his mid-thirties. 

“My brother John said I should talk to someone. He’s a psychologist too. He thinks I’m making a big mistake. You see, I finally got engaged. I’ve been trying for years to get Angela to marry me and she finally agreed. I was really, really happy.”     

I look at him quizzically.

He laughs uncomfortably. “I know, what’s the problem? The problem is she says she doesn’t love me.”

“I can see that would be a problem,” I respond, trying to remain neutral, but wondering why Patrick would want to marry someone who didn’t love him.

“But I don’t believe her. I think she does love me and just doesn’t know it yet.”

“How long have you and Angela been dating?”

“About six years. With some short break-ups scattered in there. She’s always said she didn’t love me, that she cared about me, but didn’t love me. But I just think she’s closed off to her feelings and that if she gives me a chance I can get through to her.”

I flash on a man I dated almost forty years ago, someone who told me he loved me in “his way,” a relationship that ended with much pain and heartache. Those were the days I was still trying to win the love and approval of unavailable men who, unsurprisingly, resembled my father. 

“She had a pretty traumatic background,” Patrick continues. “Abusive parents, foster care. That’s why I’m sure once she learns to really trust me, she’ll love me.”

“Can you tell me what attracts you to Angela?” I ask. “And why she decided to accept your proposal now?”

“It’s her biological clock. She wants to have a baby before she gets too old.”

I groan internally. Definitely not a reason to get married, nor to bring a child into such a tenuous relationship.

“But why I’m attracted to her? That’s easy, she’s perfect. She smart and pretty and funny and determined. We have the same values, the same politics, the same everything.”

“Except she doesn’t love you.”

“She thinks she doesn’t love me.”

“Can you tell me a bit about your background, Patrick?” I ask, changing gears.

“I grew up outside of Detroit. My father worked for the auto industry. In those days there was pretty good money to be made. My brother is 10 years older than me. When I was three my mother got breast cancer. I actually don’t remember her not being sick. And she was pretty sick. She’d have times when she’d be better, but then it was back to chemo, and days and weeks of being in bed. She died when I was 11.”

“Sounds very painful.”

“Yeah. It was. My grandmother came to live with us, to take care of us, of me really. My brother was in college already. But I hardly knew her. And she sure wasn’t the warm, cuddly grandmother type. I counted the years – the months really – before I could go to college and get out of the house.” 

“So you’ve never really had a mother.”

“No, I had a mother. She didn’t die ‘til I was 11.”

“But you didn’t have a mother who was able to take care of you, to nurture you, to love you. Not because she didn’t want to, but because she was understandably involved with her own illness.”

“Yeah. I guess that’s true.”

The connection between a sick, unavailable mother and Angela, who is also unable to fully love Patrick is blatantly obvious to me, but I hesitate to verbalize what might be a premature interpretation. 

“I know where you’re going to this,” Patrick says. “John says the same thing. I’m trying to save Angela, when I couldn’t save my mother.”  

Thinking that is part of the issue, I say, “And what do you think about that?”

“I say, so what if I am? I love Angela. And if I can help her, so much the better.”

Feeling that something is missing from this story I ask, “Why did you decide to come today Patrick? I know your brother said you should talk to someone, but why did you come?”

Patrick looks at me sheepishly. “Truthfully, once Angela said she’d marry me, I got scared. I don’t know if I got scared that she didn’t love me, or scared that maybe I didn’t love her.”

“So when you don’t feel like everyone else is questioning your decision, you can question it yourself. That’s good. Because you clearly do have lots of questions that we’ll need to look at.”