“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.”
“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.”
“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.”
“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.”
“Sorry I’m late,” Ryan says, lowering his tall, broad, smartly dressed body into my chair.
So what else is new, I think to myself, aware of the annoyance and sarcasm in my thought.
“The real estate market is really picking up. It’s great. But the customers are keeping me hopping. Have to be there when they want or the sales go elsewhere.”
I remain silent.
“OK, so let me switch gears. What’s been going on? Well, Charlene is starting to drive me crazy. I think I’m going to have to break up with her. The sex is still great and she’s funny, but she’s so needy. I mean, I don’t mind sending her a quick text during the day, but I can’t be stopping to have some intense conversation. And just because I don’t have a 9 to 5 job, doesn’t mean I can see her whenever she wants. It’s not like that. My time isn’t my own. I have to be available to my customers.”
“Kind of like what you said to me about being late.”
“Yeah! Exactly! And you get it.”
“What is it that you think I get?”
“That I can’t help it. That I have to be available to my clients.”
Varying thoughts flood my mind. Lateness and commitment are big issues for Ryan. He came into treatment two years after his divorce saying that he was having difficulty keeping a relationship. At that point he was despondent, dejected, wondering what he was doing wrong. But he’s now lost himself in a flurry of activity, moving away from self-reflection, just as he moves away from commitment.
Lateness can also be an issue for me, although my years of doing treatment have diminished its affect. Still, there’s the scared, abandoned little girl in me waiting in the darkened school for my almost always late mother to pick me up. But Ryan’s lateness has a more dismissive quality, like he’s saying “you’re not worth my time.”
“You do get it, don’t you?” Ryan say, interrupting my thoughts.
“I think lateness and time and commitment is a far more complicated issue for you Ryan.”
“You don’t get it! You think I do it on purpose. Hey, I have to make a living! Remember all that child support I have to pay?”
“Can you say what your anger is about right now, Ryan?”
“Who says I’m angry?”
I feel a flash of annoyance and then, probably drawing on my own childhood experience, I feel sad for Ryan. It’s time to rein him in, to bring him back from his frantic busyness and avoidance. “I wonder if not feeling understood by me makes you feel alone and rejected,” I say.
“Whoa! That feels like a leap!”
“Ryan, let’s slow down here. You came into treatment feeling discouraged with the quality of your life, your relationships. But then you got yourself into a whirlwind – yes I know you have to make a living and that the real estate market is picking up – but I also think you’re trying to avoid yourself and your feelings and me and Charlene as well.”
He stares out the window. “It’s getting darker out there. Looks like it’s going to rain.”
“Sounds like that’s how you feel. If you stop for a minute, you can feel the darkness, the sadness come over you.”
“So what am I so sad about?”
“What are your thoughts?”
“My failed marriage. My not getting to see enough of my kids. I said I’d never get a divorce, never do to my kids what my parents did to me. Split between two homes, neither one having enough time for me, neither one knowing if I was going to school, doing my homework. It felt as though they didn’t give a shit. They probably did, but they were too busy trying to make ends meet.”
“It’s interesting, Ryan, when you just said it felt as though they didn’t give a shit, that’s exactly how it feels to me when you come in here and toss off a ‘sorry I’m late.’ It feels as though you don’t give a shit. So you’re behaving towards me as your parents behaved towards you and allowing me to feel what it felt like to be the kid you.”
“Wow! That’s deep. I’m not sure I’m smart enough to create that scenario.”
“It’s not something that you decide to do or figure out consciously. You act it out automatically so that in your relationships someone is always being the rejecting parent and the other person feels like the rejected child.”
“That would be a good reason for relationships not to work out.”
“Yes, that’s definitely true.”
“And what do I do about it?”
“First step is being aware of it. And we’ll definitely keep it in mind in our work here.”
In an earlier blog, “A Dog’s Life,” I talked about Terri, a patient who became angry with me for canceling a trip because my dog was sick, while she had almost died as a child when her parents left her to go to Japan. Although her anger turned to sadness as she left my office, the anger soon returned.
“What do you mean you care about me? I’m just a patient to you. One of many patients. A patient who gives you money. I’m your livelihood. That’s why you care you me. Would you see me if I didn’t pay you? No, of course not,” Terri says crossing her arms in front of her, glaring at me.
“It’s true that you pay me, Terri, but you’re paying me for my time, not for my caring.”
“Huh!” Terri snorts, “Sounds like you’ve said that before!”
“Yes, I have said it before, but that doesn’t make it any less true.”
“So tell me how you care about me. Show me.”
Although I’m beginning to feel annoyed, I acquiesce to Terri’s demand.
“Well, I listen to you carefully and thoughtfully, I try to say and do what’s in your best interest, I worry about you if you’re having a hard time or if you’re being in any way self-destructive, I talk to you when you call …”
“Fine, if my calling bothers you, I won’t call any more.”
I feel a flash of anger, but recognize that Terri is trying to provoke me.
“Can I ask you something, Terri? Would it be possible for you to believe that I do care about you?”
“What do you mean?” she asks scowling.
“It feels like you’re trying not to take in any of the positive things I’m saying, that you’re turning them around so that you end up feeling rejected.”
“Right, so now it’s my fault that you don’t care about me!”
“Whoa,” I say, raising both hands. “Let’s stop a second here. It’s not a question of fault. What I’m suggesting is that it’s very difficult for you to allow in that anyone cares about you because you felt that neither of your parents loved you. That’s the lens through which you see the world. It’s a world where nobody loves you.”
“Yeah, I guess that’s true.”
“So the idea that I or someone could care about you is entirely foreign, a foreign concept that’s impossible to allow in.”
“That’s depressing.”
“I agree. Now I’m going to go a little further here but, again, I’m not talking about blame, I’m just trying to look at why you might do what you do. Okay?”
“I guess,” Terri says reluctantly.
“I think you also need to reject caring – just as you rejected my caring earlier - because what would it mean if I cared about you and your parents didn’t? It would mean that it wasn’t anything you did as a kid to make them not love you. It would mean that you were and are loveable and that your parents were incapable of loving you the way you needed and deserved to be loved. It wasn’t your deficiency, it was theirs and that means no matter what you do you can never, ever win their love. And that’s really painful.”
“You know what?” Terri says. “I think this is all a bunch of bullshit! We start out talking about you not caring about me and end up back on my parents. I think it’s you who are trying to turn things all around.”
“We’re kind of stymied here, Terri. I can say you’re turning things around to avoid taking in my caring and you can say I’m turning things round to avoid dealing with what you experience as my non-caring.”
“You’ve got a point there,” Terri says, almost smiling. ”I want to ask you something. You’re an analyst, right?”
I nod.
“That means you’ve been in therapy, doesn’t it?”
I nod again.
“Did you feel your therapist cared about you?”
“Yes, I did.”
“How come? How come you did and I don’t?”
“For exactly the reasons I mentioned earlier, except in reverse. Although not everyone in my early life cherished me, there were enough people who did, that caring isn’t foreign to me. I expect people to care about me and I can take in that caring without having to give up on all my early caretakers.”
“Thanks for telling me. I think.”
I smile. “Nothing is ever uncomplicated, Terri. My telling you might feel like a gift, which you might also feel the need to reject. And now you might not only feel envious of my dog, but of me as well.”
“I’ve had it for today,” Terri says as she bolts for the door.
Opening the waiting room door I immediately know something is wrong. Usually bubbly Sarah looks blank and forlorn. Unsmiling, she rises deliberately from the chair and walks slowly to my office.
Sighing she looks down at her hands. “I had a miscarriage,” she says quietly.
“Oh Sarah,” I say. “I’m so sorry. I know how much you and Philip were looking forward to having another child.”
She nods.
Silence envelops the room.
“Have you been able to cry about the loss of your baby?”
She shakes her head. “I can tell you’re concerned about me. Phil is too. I don’t know what’s wrong with me. It’s like a cloud has settled over me, like I don’t feel anything. I guess I’m depressed, but it’s so unlike me. I get anxious, or kind of crazed, but depression, this is new to me. I don’t like it. It’s hard for me to do anything. Even taking care of Josh feels like a chore and you know how much joy I usually get from him.”
“Does being with Josh remind you of the child you won’t have?”
“No, I don’t think so. It’s not like we can’t have other children. We’re both young. We’ll try again.”
“But that rational thought isn’t helping you right now.”
“No, it’s not.”
“Maybe it’s that you’re afraid to feel the extent of your loss. Maybe it reminds you of other losses in your life. You have had a lot of losses.”
“You mean my mother?”
I nod. “I’m sure that was the most difficult. You were only a child. It’s pretty scary to be without your mother.”
“Yeah, that’s true. But you said it exactly as I felt it. It was scary. And that’s usually what I feel about losses, scared and anxious, but not depressed.”
“So what’s making this different, Sarah? What thoughts have come to mind for you.”
“Silly stuff.”
“Like?”
“It keeps going around and around in my head that it’s not fair. And I know that’s ridiculous. Life is never fair. It wasn’t fair that my mother died of ovarian cancer before she was thirty. It wasn’t fair that my father married some crazy woman and dragged me halfway across the country so that I lost everyone I knew. And it’s not fair that I lost this baby. Phil and I are great parents. Why couldn’t we have another child now, when we were so looking forward to it? But I know that’s ridiculous. Life isn’t fair, period.”
“Right now, Sarah, how do you feel about life being unfair?”
“Right now? Right now I guess I feel angry.”
“And you don’t remember feeling angry when your mother died or when your father remarried and took you away from everyone familiar? You certainly sounded angry when you mentioned your father and the “crazy woman” he married.”
“Yeah, I was pretty angry with them. I guess that’s why I did so much acting out as a teenager. But when my mother died, no, I don’t remember being angry, just sad and scared. Real sad.”
“So you’ve mentioned two things that might have kept you from being depressed as a child: being sad and acting out. Now you can’t cry over the loss of your baby and there’s not really anyone you can act out against.”
“Myself.”
Immediately on alert, I ask, “What do you mean?”
“I’m not going to do it, but I’ve had fantasies of cutting my stomach.”
Keeping myself calm I say, “So it’s like you’re blaming yourself for the miscarriage and want to get back at yourself.”
“I hadn’t thought of it that way but it makes sense.”
“Do you blame yourself for the miscarriage, Sarah?”
“Not really, although I did wonder if I’d overdone my exercise, but the doctor said she was sure that had nothing to do with it.”
“I wonder, Sarah, if it feels to you that someone has to be to blame, either you or some unfair force out there that made it happen. Just like with the death of your mother, I suspect it feels way too painful to deal with the reality that awful things do happen and that we’re left to deal with all the pain that remains. You know it rationally. You can say life is unfair. But I wonder if on an emotional level there’s still that helpless, powerless little girl who’s railing against the unfairness of it all.”
Tears fall gently down Sarah’s cheek.
“I’m glad you’re able to cry, Sarah. Hopefully that will be the first step to getting you out from under the cloud.”
