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incurvatus in se- The Neuroscience of Narcissistic Personality Disorder, Part I

Posted Jun 23 2009 6:54pm

Oie_mans_brain_2 "Amazing grace, how sweet the sound that sav'd  a wretch like me!  I once was lost, but now am found, was blind, but now I see" 

        How do we separate out from sight, that which we cannot see?

Back in the day, that would be a summer's day somewhere ca. 386 or so, the soon-to-be Bishop of Hippo, battling his own long-standing sexual demons, concubine indulgences, and out-of-wedlock dalliances, decided that Adam's narcissism (of Adam and Eve infamy) was to blame for all the worlds debauched struggles.  Not only was Adam's, shall we say, indiscretion, with Eve to blame for the Bishop's own cravings of the flesh, but Adam it seems, was to blame for all mankind's sexual thoughts, feelings, and behavior, until the end of time - the sins of the father, if you were to believe the tale, would indeed be visited upon the sons in a never-ending intergenerational nightmare of unbridled sexual upheaval and death.  According to Augustine, and backed to this very day without hesitation by the Roman Catholic Church, Adam, at the very moment of his great lapse in restraint, turned himself from what was considered man's natural inclination of outward focus (toward God), to that of the wholly unholy incurvatus in se - a life curved inward (and away from God) - and right smack into the dark and dank nebulous crevices of his narcissistic soul.  It was there, in that one forever frozen moment in time that humanity's assumed prelapsarian existence would cease forever - wherein Adam's fall from his apparent state of grace, would doom all of mankind to carnal chaos and certain death.  So saith Augustine and the Roman Catholic Church.  That Adam utterly objectified Eve, thought only of his own earthly desire without care of consequence, and certainly banished any trace of "God" or "Godliness" for that matter, from consideration, goes a long way toward the modern Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of narcissistic personality disorder (NPD) - not to mention sexual addiction.  It has, unfortunately, taken us a mere couple thousand years or so, to grasp the part about genetics, or said another way, the neurobiological connection and intergenerational legacy of NPD, but more on this exceedingly important point a little later.  I like stories.  And I like allegories.  As allegories go, this one is up there among my favorites.  The bit about Pelagious's banishment (the one dissenting lone voice in the crowd - a veritable humanist that believed man has choice of whether or not to engage in good or evil) and any of his documents or evidence voicing objection to Augustine's morbidly skewed view of original sin and hereditary doom, promptly destroyed by the Roman Catholic Church notwithstanding, it is certainly central to the origins of narcissism and its place in the bowels of human suffering.  After all, it is the narcissistic incurvatus in se, and not sexual desire and temptation per se, that is said to be the Original Sin, is it not - depending I suppose, upon which side of the alter one is standing. And then there was Ovid...

Unlike Augustine's Confessions, Ovid's Metamorphosis, cleverly told in  dactylic hexameter, tells the story of the son of Leirope of Thespia and Cephisus the river god.  We all know the story of the handsome Narcissus, doomed to love only his shallow reflection, and the poor little nymph, Echo, equally doomed to love the reflection of a man incapable of loving her back.  The literature is filled with religious, psychological, and artistic interpretations of the myth of Narcissus.  For the psychologists and psychiatrists that diagnose and (albeit very seldom) treat it, and the lay persons that live with those afflicted with it, NPD by anybody's standards is certainly more Greek tragedy than myth.  While I whole-heartedly disagree with Augustine's (and the Roman Catholic Church in general) fanciful if not delusional fable of Original Sin, I do agree with the genetic legacy and the bit about the sins of the father (or mother for that matter) as it pertains to incurvatus in se, and having nothing whatsoever to do with sin, original or otherwise.  As we shall shortly see, while it is certainly possible, and more often than not is the case, that one can have a NPD without also being sexually addicted, it is only the case that if one is sexually addicted, then by diagnostic definition, they have NPD.  Treating the sex addicted individual is to treat their narcissistic personality disorder.  Nowhere can I think of a more fitting application of incurvatus in se, then those that are sexually addicted.

What does narcissistic personality disorder have to do with sexual addiction?  To the sex addict, they are one and the same.   

In psychiatric terms, we diagnose a personality disorder separate from any other mental disorder.  We do this, like we do everything else, by virtue of its operational definition.  A personality disorder is defined in large part as an enduring and inflexible, long-standing pervasive pattern of thinking and behaving that significantly impacts and impedes an individual's cognitive, affective, and interpersonal world, and one in which is deviant or abnormally different, from the basic cultural expectations of society.  A personality disorder will exacerbate and or skew any other presenting problem, perception, thought or feeling, about themselves, others, and the world at large, the individual may have or hold.  The old thinking was that personality disorders were immutable and unchangeable and the best that was hoped for would be a temporary gross symptom stabilization, otherwise known as a band-aid during flare-ups.  While personality disorders are among the most researched, written about, and discussed of the mental disorders, and while they continue to be fodder for many a lay person, media talking head, and most freshman psych-101 class, they remain the minority of actual psychological and psychiatric clinical cases.  Why?  Because generally speaking, and herein lies the awful rub, those with personality disorders do not see themselves as disordered - au contrare.  Because personality is so entrenched and tied to our very identity (go ahead, try and separate out the two, and while you are at it, do tell me what traits you are putting into which column), most of us cannot ferret out what is normal versus what is abnormal about who we are and how we see ourselves.  How does a personality become disordered in the first place?  The answer?  Not easily.  Unless of course we are talking the Cluster "B" personality disorders which include the "antisocial", "borderline", "histrionic", and "narcissistic" PDs.  This cluster, particularly the "borderline" and "narcissistic" PDs, the two I work with extensively, are more often than not, acquired during early childhood trauma.  These PDs in particular, are severe but protective reactions to equally severe and debilitating traumatic events (for more on this, you might want to refer to one of the earlier posts in this blog).  Although the following example pertains to psychosis and not personality, there is a rather poignant scene in the movie A Beautiful Mind, wherein the chief character, the real-life Nobel prize laureate and paranoid schizophrenic played by Russell Crowe, is sitting with his wife and psychiatrist, debating the demerits of going back to the psychiatric institution for further help (read: electro shock treatment).  Crowe says to the psychiatrist played by Christopher Plummer, "I can fix this thing" referring to his progressively disorganized and schizophrenically ill mind.  The psychiatrist says "no".  "No you can't".  "Why not, why can't I" says Crowe.  "Because" says Plummer, "it is your mind that is broken"...  Just exactly how does a broken mind fix itself let alone perceive itself as broken in the first place? 

Please stay tuned for Part II... 

 

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