Psychological Theories and Psychotherapy of Personality Disorders

Frequently Asked Question # 24

Narcissism, Pathological Narcissism, The Narcissistic Personality Disorder (NPD), the Narcissist,

and Relationships with Abusive Narcissists and Psychopaths

By: Dr. Sam Vaknin

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Storytelling has been with us since the days of campfire and besieging wild animals. It serves a number of important functions: amelioration of fears, communication of vital information (regarding survival tactics and the characteristics of animals, for instance), the satisfaction of a sense of order (justice), the development of the ability to hypothesize, predict and introduce theories and so on.

We are all endowed with a sense of wonder. The world around us in inexplicable, baffling in its diversity and myriad forms. We experience an urge to organize it, to "explain the wonder away", to order it in order to know what to expect next (predict). These are the essentials of survival. But while we have been successful at imposing the structures of our mind on the outside world – we are less successful when we try to cope with our internal universe.

The relationship between the structure and functioning of our (ephemeral) mind, the structure and modes of operation of our (physical) brain and the structure and conduct of the outside world have been the subject matter of heated debate for millennia. Broadly speaking, there were (and still are) two schools of thought:

There are those who, for all intents and purposes, identify the substrate (brain) with its product (mind). Some of them postulate the existence of a lattice of preconceived, inborn categorical knowledge about the universe – the vessels into which we pour our experience to be molded.

Others regard the mind as a black box. While it is possible in principle to know its input and output, it is impossible, again in principle, to understand its internal functioning and management of information. Pavlov coined the word "conditioning", Watson adopted it and invented "behaviorism", Skinner came up with "reinforcement". But they all ignored the psychophysical question: what IS the mind and HOW is it linked to the brain?

The other camp fancies itself more "scientific" and "positivist". It speculates that the mind (whether a physical entity, an epiphenomenon, a non-physical principle of organization, or the result of introspection) – has a structure and a limited set of functions.

They argue that a "user's manual" for the mind could be composed, replete with engineering and maintenance instructions. The most prominent of these "psychodynamists" was, of course, Freud. Though his disciples (Adler, Horney, the object-relations lot) diverged wildly from his initial theories – they all shared his belief in the need to "scientify" and objectify psychology.

Freud – a medical doctor by profession (Neurologist) and Josef Breuer before him – came with a theory regarding the structure of the mind and its mechanics: (suppressed) energies and (reactive) forces. Flow charts were provided together with a method of analysis, a mathematical physics (dynamics) of the mind.

But this was a mirage. An essential part was missing: the ability to test the hypotheses derived from these "theories". Still, their theories sounded convincing and, surprisingly, had great explanatory power. But - non-verifiable and non-falsifiable as they were – they could not be deemed to be scientific.

Psychological theories of the mind are metaphors of the mind. They are fables and myths, narratives, stories, hypotheses, conjunctures. They play (exceedingly) important roles in the psychotherapeutic setting – but not in the laboratory. Their form is artistic, not rigorous, not testable, less structured than theories in the natural sciences.

The language used in psychological theories is literary, polyvalent, rich, effusive, and fuzzy – in short, metaphorical. They are suffused with value judgments, cultural preferences, fears, post facto and ad hoc constructions. None of this has methodological, systematic, analytic and predictive merits.

Still, these theories are powerful descriptive instruments, admirable constructs of the mind. As such, they are bound to satisfy some needs. Their very existence proves it.

Peace of mind is an essential need, which was neglected by Maslow in his famous hierarchy of needs. People sacrifice material wealth, resist temptation, ignore opportunities, and sometimes risk themselves and others – just to attain this bliss.

People prefer inner equilibrium to outer homeostasis. It is the fulfillment of this overriding need that psychological theories cater to. In this, they are no different than other collective narratives (myths, for instance).

In some respects, though, there are striking differences:

First, psychology is desperately trying to link up to reality and to scientific discipline by employing observation and measurement and by organizing its results and presenting them using the language of mathematics. This does not atone for its primordial sin: that its subject matter is ethereal, ephemeral and inaccessible. Still, it lends it an air of credibility and rigorousness.

Second, while historical narratives are "blanket" narratives – psychology is "tailored" or "customized". A unique narrative is invented for every patient (client) in which s/he is the protagonist (hero or anti-hero). This mass customization seems to reflect an age of increasing individualism.

True, the "language units" used in therapy (large chunks of denotates and connotates) are one and the same for every "user". In psychoanalysis, the therapist is likely to always make use of the tripartite structure of Id, Ego, Superego. But these are language elements and need not be confused with the plots. Each client, each person, and his own, unique, irreplicative, plot.

(continued below)

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To qualify as a "psychological" plot, the narrative must be:

1.  All-inclusive (anamnetic) – It must encompass, integrate and incorporate all the facts known about the protagonist.

2. Coherent – It must be chronological, structured and causal.

3. Consistent – Self-consistent (its subplots cannot contradict one another or go against the grain of the main plot) and consistent with the observed phenomena (both those related to the protagonist and those pertaining to the rest of the universe).

4. Logically compatible – It must not violate the laws of logic both internally (the plot must abide by some internally imposed logic) and externally (the Aristotelian logic which is applicable to the observable world).

5. Insightful (diagnostic) – It must inspire in the client a sense of awe and astonishment which is the result of seeing something familiar in a new light or the outcome of seeing a pattern emerging out of a big body of data. The insights must appear to be a logical conclusion of the development of the plot.

6. Aesthetic – The plot must be both plausible and "right", beautiful, not cumbersome, not awkward, not discontinuous, smooth and so on.

7. Parsimonious – The plot must employ the minimum numbers of assumptions and entities in order to satisfy all the above conditions.

8. Explanatory – The plot must explain the behavior of other characters, the hero's decisions and behavior, and why events unfolded the way that they did.

9. Predictive (prognostic) – The plot must possess the ability to predict future events, the future behavior of the hero and of other meaningful figures and the inner emotional and cognitive dynamics.

10. Therapeutic – With the power to induce change (whether it is for the better, is a matter of contemporary value judgments and fashions).

11. Imposing – The plot must be regarded by the client as a useful organizing principle of his life's events past, present, and future.

12. Elastic – The plot must possess the intrinsic abilities to self organize, reorganize, assimilate emerging order, accommodate new data comfortably, avoid rigidity in its modes of reaction to attacks from within and from without.

In all these respects, a psychological plot is a theory in disguise. Scientific theories must satisfy most of the same conditions. But the equation is flawed. The important elements of testability, verifiability, refutability, falsifiability, and repeatability – are all missing. No experiment could be designed to test the statements within the plot, to establish their truth-value and, thus, to convert them to theorems.

There are four reasons to account for this shortcoming:

1. Ethical – To substantiate a theory experiments would have to be conducted on the patient and others. To achieve the necessary result, the subjects must be ignorant of the fact that they are being experimented upon (in double blind experiments) or remain in the dark regarding what the experimenters want to achieve. Some experiments may involve unpleasant or even traumatic experiences. This is ethically unacceptable.

2. The Psychological Uncertainty Principle – The current position of a human subject can be fully known. But both treatment and experimentation influence the subject and void this knowledge. The very processes of measurement and observation influence the subject and change him or her.

3. Uniqueness – Psychological experiments are, therefore, bound to be unique. They cannot be repeated elsewhere and at other times even if they involve the SAME subjects. This is because the subjects are never really the same due to the above-mentioned psychological uncertainty principle. Repeating the experiments with other subjects adversely affects the scientific value of the results.

4. The undergeneration of testable hypotheses – Psychology does not generate a sufficient number of hypotheses, which can be subjected to scientific testing. This has to do with the fabulous (=storytelling) nature of psychology. In a way, psychology has affinity with some private languages. It is a form of art and, as such, is self-sufficient. If structural, internal constraints and requirements are met – a statement is deemed true even if it does not satisfy external scientific requirements.

So, what are plots good for? They are the instruments used in the procedures which induce peace of mind (even happiness) in the client. This is done with the help of a few embedded mechanisms:

1. The Organizing Principle – Psychological plots offer the client an organizing principle, a sense of order and ensuing justice, of an inexorable drive toward well defined (though, perhaps, hidden) goals, the ubiquity of meaning, being part of a whole. They strive to answer the "why’s" and "how’s". Plots are dialogic. The client asks: "why do I suffer from  (here follows a syndrome)". Then, the plot is spun: "You are like this not because the world is whimsically cruel but because your parents mistreated you when you were very young, or because a person important to you died, or was taken away from you when you were still impressionable, or because you were sexually abused and so on". The client is calmed by the very fact that there is an explanation to that which until now monstrously taunted and haunted him, that he is not the plaything of vicious gods, that his discomfort has a label, that there is someone to blame (helpfully focusing his diffused anger) and, that, therefore, his belief in order, justice and their administration by some supreme, transcendental principle (or being) is restored. This sense of "law and order" is further enhanced when the plot yields predictions which come true (either because they are self-fulfilling prophesies or because some real "law" has been discovered).

2. The Integrative Principle – The client is offered, through the plot, access to the innermost, hitherto inaccessible, recesses of his mind. He feels that he is being reintegrated, that "things fall into place". In psychodynamic terms, his energy is released to do productive and positive work, rather than to be channeled distorted and destructive forces.

3. The Purgatory Principle – In most cases, the client feels sinful, debased, inhuman, decrepit, corrupting, guilty, punishable, hateful, alienated, strange, mocked and so on. The plot offers him absolution. Like the highly symbolic story of the Savior – the client's sufferings expurgate, cleanse, absolve, and atone for his sins and handicaps. A feeling of hard won achievement accompanies the spinning of a successful plot. The client sheds layers of functional, maladaptive clothing. This is inordinately painful. The client feels dangerously naked, precariously exposed. He then assimilates the plot offered to him, thus enjoying the benefits emanating from the previous two principles and only then does he develop new mechanisms of coping. Therapy is a mental crucifixion and resurrection and atonement for the sins. It is highly religious with the plot in the role of the scriptures from which solace is gleaned.

Also Read 

The Myth of Mental Illness

The Insanity of the Defense

In Defense of Psychoanalysis

The Metaphors of the Mind - Part I (The Brain)

The Metaphors of the Mind - Part II (Psychotherapy)

The Metaphors of the Mind - Part III (Dreams)

Psychophysics

The Basic Dilemma of the Artist

The Chinese Room Revisited

The Interrupted Self

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