The notion of newness and change for the sake of newness and change is a chimera—an empty concept that offers only momentary confetti-type excitement with unknown final outcomes. And no, the ends do not justify the means, especially if people get hurt along the way.
Surprisingly (perhaps) often, when change is applied in efforts to improve existing systems or concepts, the change-makers (because they are perceived as outside the system or concept they are trying to improve or else are viewed as a non-representative part of that system) make changes that are seen as “off.” They just don’t meet the mark and grumbling ensues. (Hey, it’s a tough job they’ve got).
This is why systems (economies, nations, societies, cultures—even cities and towns) have often evolved naturally, over time.
In order for imposed changes to work, the change-makers must take into consideration generations of knowledge and wisdom that are so internalized they are reflexive. Even in non-communal systems, such as a science or art, deep cultural wisdom (perhaps not recognized or acknowledged) is intricately woven into the fabric of the discipline.
To respect that there is wisdom in what the “ordinary Joe or Josephine” knows, those whose families, sub-cultures, people, etc. have survived for centuries, is something that we need to learn to do more of. It’s not blanket, but we still have to cultivate a respect for wisdom of what some view as the non-elite. Respect for tribal wisdom, if you will.
Naturally, every time there is a defining change imposed on a discipline, especially a top-down change that’s being applied by a select group, members kick. And the response to the new DSM-5 is no exception. There’s a lot of kicking going down.
Everyone in the field of mental health brings his or her own knowledge to the table, built not only upon scholarship and evidence-based studies but also upon his/her professional experience, personal history, culture and beliefs. In the “social” sciences, unlike the “hard” sciences where this historical, cultural belief-structure tends to be more hidden, this makes for interesting debate, to say the least.
We may not be ecstatic about several changes in the DSM-5 just as many of us weren’t happy with changes to the previous editions (not that debate accomplishes much, we can’t be perfectionists and survive; one person’s “perfect” is another’s “flawed”). But, one DSM change that seems to be for the best in a larger sense is the deeper insights offered about individuals with narcissistic personality disorder.
Our experience is that NPD exists along a spectrum and is more treatable than it was once thought to be. In truth, the “cluster B” personality disorders often overlap and there can be a fine line which varies at different points in time between histrionic, anti-social, borderline, and narcissistic personality disorders. Although differentials in diagnosis are desirable for insurance-company coding, they can frustrate treatment plans. (In addition to our new book on addiction, we’re working on another project about the overlap).
The standard DSM descriptions of cluster B personality disorders was that people who had them exhibited dramatic, emotional, and/or erratic expressions of personality or behaviors. This described observations from a very “outside” perspective. There have been some excellent attempts to explore what the inner experiences of people with cluster B personality disorders are like, illustrated by writers like Alice Miller. She and others have revealed and explored the process of developing such a personality, but previous editions of the DSM have offered only some commentary on this subject. Granted, the role of the DSM is not to explore each disorder in depth.
Perhaps it’s because narcissistic traits are so generally felt to be repellent that people studying this disorder find it’s hard for them to connect with the inner life of the narcissist (and cluster B personality disorders in general). After all, it is hard to empathize with someone who you know is incapable of caring about others. It is far easier to maintain the emotional distance generally present with a narcissist.
Also, narcissists especially find it difficult to articulate their inner experience. Many of them lack the sensory-language to explain emotional states and experiences. When asking some people with NPD to describe their inner life or emotions, it sounds like someone sight-impaired trying to explain the delightful blue of the Caribbean or someone hearing-impaired the bright golden sound of a trumpet.
The good thing about the new description in the DSM-5 for one such disorder, narcissistic personality disorder, is that it does attempt to describe the inner life. This is positive not only in general for diagnosis or treatment plans but also for the therapist.
He or she will get an authoritative peek into the emotional turmoil many narcissists actually feel, their fears, their pain, what conscience means to them. It gives therapists a chance to more deeply empathize with them. Perhaps by empathizing more fully, by maintaining a connection and entering the NPD fortress, the client will see their reflection in our connection and be able to add warmth to their bleak emotional landscape.
The new narcissist might improve more quickly.
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Last reviewed: 17 Aug 2012