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Wednesday, December 8, 2010

(In)Sanity, Thy Name is Woman (Or, Mirror, Mirror on the Wall)

According to a recent New York Times article, the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 for short) has eliminated five of the current ten personality disorders. Perhaps most noteworthy among the personality disorders to be eliminated is narcissistic personality disorder. (They are also planning to jettison, among others, histrionic personality disorder. Maybe good riddance to that one, as some of the symptoms seem oddly gendered. Consider that sufferers often: "act or look overly seductive"; are "easily influenced by other people"; are "overly concerned with their looks"; are "overly dramatic and emotional", are "overly sensitive to criticism or disapproval" and believe "that relationships are more intimate than they actually are". (Hmm. Sounds like WAY too many people I know.)

In an age that is chock full of people babbling loudly on cell phones about the mundane details of their private lives while riding in crowded public conveyances, and twittering and facebooking and blogging (!) endlessly, it is wonderfully ironic that narcissism is soon to be dead letter from a clinical perspective. The “me generation” has breached the defenses and taken over the fort (asylum).

The problem, apparently, is that the tuna net of narcissistic personality disorder was catching up too many dolphins in its diagnostic mesh. Being excessively self-absorbed is not really enough for a diagnosis of narcissistic personality disorder. Instead, a special kind of self-absorption is required:

--a grandiose sense of self, meaning a serious miscalculation of your abilities and potential that is often accompanied by fantasies of greatness.

--an expectation that others see your superior qualities and tell you so (mirroring)

--extreme sensitivity to personal slights coupled with an insensitivity to other people’s points of view

According to the author of the Times article, most people with narcissistic personality disorder are men. This is perhaps not surprising. Despite the fact that women are often considered vain and self-absorbed, the truth is that there is very little social space in which women may engage in pompous, bombastic, self-aggrandizing behavior. Even calmly assertive, self-confident women who insist on speaking their minds are more subject than men to being told to “just shut up.” (Ever wonder why there aren’t more women bloggers?) Silence becomes her. After all, it wasn’t very long ago that the symptoms of one form of insanity specific to women included “talking incessantly”, self-amused laughter, obscenity and complaining of “imaginary wrongs”.

A perhaps not unrelated story in the Chronicle of Higher Education recently noted that women athletes may be more likely to have concussive head injuries overlooked.

According to the Chronicle piece:

"Male athletes, though, often reported cognitive symptoms like amnesia or disorientation after a suffering a concussion—signs of head trauma that are not easily overlooked. Female athletes, by contrast, often had neurobehavioral symptoms like drowsiness, or somatic symptoms like sensitivity to noise.

The female athletes’ symptoms, the report cautioned, could be more easily missed than the male athletes’ symptoms. They could also lead sports-medicine staff members to attribute them to a different condition—anxiety, for instance."

So, sports-medicine staffers notice if you seem really out of it, as male athletes apparently often do after head trauma. But if you have more subtle symptoms such as drowsiness or noise sensitivity, as women sometimes do in cases of head trauma, the symptoms may be missed altogether or attributed to “anxiety.” Women can be so high strung (as well as vain and self-absorbed). Anxiety, concussion—gee, who could tell the difference? Certainly not the narcissists among us; they generally avoid the helping professions, and when they do engage in them, they tend to focus on their own opinions and not the complaints of those whining patients. How many times have you been asked "How much pain do you feel? [stage direction: show patient picture of sad face, neutral face, ecstatically happy face; ask her to circle one] and thought that you were getting through to anyone with your reply?

I hope that some of the really useful personality disorders such as OCD will continue to be available to us. After all, it has become a mark of intellectual distinction (if not cool and sexy) to be OCD (a sufferer of obsessive-compulsive disorder). The image that used to come to mind was of Lady Macbeth walking around mumbling "out damned spot" while rubbing her hands together. Now we think of brainy, "revenge of the nerd" college (or ex-college) students who turn hours of seemingly repetitive programming tasks into billion dollar Internet businesses.

Time to end this; my mirror is waiting.