The Credibility of What You Hear About NPD

No informative resource about narcissistic personality disorder is complete without information that enables you to make informed judgments about the credibility of what you read and hear about it. Otherwise you will quickly get lost in a maze of myths, pure guessing, and conflicting assertions, not knowing whom or what to believe.

For many, this information will be a surprise, so this chapter cites references to document this warning that you cannot believe everything you read about NPD. Even when written by an authority with a P, H, and D after his or her name.

And, yes, though I assure you that I am honest, you have no way of knowing that. So don't assume it. Just as you don't close your eyes and let others put stuff in your mouth, don't close your eyes and let others put stuff in your head.

Some authorities are mere parrots, who never use their own heads. Some couldn't care less whether they are right or wrong: they just want your money. Others have political and social agendas: they know they are wrong and are deceiving you. For your own good, of course, because us common folk don't know what's good for us. So, they manipulate our perceptions to manipulate us toward their vision of Utopia (where we just trust them to do our thinking and make our decisions for us).

So, take everything with a grain of salt. Check out the cited references below, and think for yourself when weighing the evidence.

If there is a malignant narcissist in your life, you have much knowledge about NPD gotten through first-hand observation of a narcissist's (often strange) behavior. That is not nothing. Those observations are facts. Provided you aren't trying to deceive yourself, that kind of knowledge is the soundest kind. It's far more reliable than the speculations of people sitting in their ivory towers reading the speculations of others and theorizing about the disease.

Therefore, if something an authority claims doesn't seem to make sense, it probably doesn't. Stop and examine it before swallowing. Again, if something an authority claims doesn't square with your own observations, a healthy dose of skepticism is in order.

Below you will find much evidence undermining the credibility of the mental health profession. Keep in mind, however, that if I had been looking for evidence of credibility, I could have found it. The point is NOT that they are all quacks and pseudoscientists. In fact, you will see that the strongest critics of this crowd come from among their own ranks. So, there is good science going on, and there are therapists who get it about NPD and psychopathy. Unfortunately, they are the politically incorrect minority and are not the ones in the positions of power.

Nonetheless, it seems to me that they are slowly but surely winning.

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The Problem

In general, the professionals fall into two groups: the researchers and the clinicians. There are good guys and bad guys in each category, but the main problem is that the relationship between (legitimate scientific) research and clinical practice has been severed by the American Psychiatric Association (APA).

In other words, if you thought psychiatry and clinical mental health practice are based on science, you have been mislead. Speculation and "clinical studies" abound, while legitimate scientific research is ignored.

What's wrong with reliance on clinical studies? For one thing, there are a billion of them! The chances of any one being reproduced by others to test its claims are very small.

More important, you can't test 10 folks in a North Dakota clinic and call that "evidence." (This is also beginning to happen in pharmacology, because testing standards have been lowered to allow drugs into the market faster.) Even if the study is scientifically perfect, the probability of statistical error due to the small number of people in sample is so high as to make the results worse than worthless.

What's more, these studies are notorious for violating scientific method. They are not randomized. They are not controlled (by control groups to make certain the results aren't being caused by some unknown factor). They often don't even draw logical conclusions.

Their college education no longer adequately prepares clinicians to handle statistics and to conduct scientific research. Which, presumably, is why a biology major like me is astonished by some of the junk science they do. It appears that they don't know much more about how to conduct scientific research than you do, so watch out.

This means, of course, that the academics training clinicians fall largely into the "clinician" group. Yes, they must "publish or perish," but most don't publish legitimate scientific research. Instead of basing their judgments on observational data, they base them on a handful of anecdotes cherry-picked from a mountain of available data. Most publish theoretical musings based on the theoretical musings of their peers (which they treat as "evidence"), in what amount to mere essays that do nothing but pose untested hypotheses and then call them "theories."

In real science, speculation is a hypothesis, not a theory. Quantum Theory, Relativity Theory, the Theory of Evolution — all are "theories" because they explain demonstrable facts and have been abundantly tested with all valid scientific evidence supporting them. Consequently, virtually no one but flat-earther types doubts them anymore. Which doesn't mean that there still don't remain questions as to how these forces of nature actually work. For example, every reasonable scientist knows that E = mc2 and that evolution happens, though they may disagree with some aspects of current explanations on how. Flat-earther types often try to hocus-pocus these disagreeing opinions into valid arguments against the theory itself, claiming that some scientists "dispute the theory" and are on their side. Baloney.

Now my just saying this is worthless unless I back it up. Below you will find evidence to back it up.

Evidence of...
· seriously flawed methodology
· ignoring relevant data
· unsound conclusions
· inappropriate comparative judgments based on pure divination instead of data
· passing off as "evidence" a mere smattering of anecdotes selected from available observational data
· appealing to speculative "theory" as "evidence"
· presuming a consensus of opinion and then calling that "evidence"
· failing to cite references to supportive scientific data they claim exists
· divining questionable inferences regarding others' perceptions with no independent corroboration
· appealing to hypothetical counterfactuals = arguments from a vacuum (a kind of illogic)

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The American Psychiatric Association & Diagnostic Error

So, what's up with the American Psychiatric Association (APA) and the mental health practice in general?

One large and good online source of information is The Scientific Review of Mental Health Practice. It will keep you busy for a long time.

These books will do an even better job of cluing you in:
House of Cards: Psychology and Psychotherapy Built on Myth by Robyn M. Dawes
They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal by Paula J. Caplan
Blaming the Brain: The Truth About Drugs and Mental Health by Elliot Vallenstein
Pharmacracy: Medicine and Politics in America Thomas Stephen Szasz
Bias in Psychiatric Diagnosis by Paula J. Caplan
Destructive Trends in Mental Health by Rogers Wright and Nicolas A. Cummings
Creating Mental Illness by Alan V. Horwitz
The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder by Alan V. Horwitz
Science and Pseudoscience in Clinical Psychology by Scott O. Lilienfeld

See also the book Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders by Herb Kutchins and Stuart Kirk. And this book review by Dr. Ken Livingstone:

The reader of this book comes away with a powerful sense of psychiatry as a profession out of control. Cut off from what ought to be its roots in the basic research community, and at the mercy of the strongest political factions of the moment, psychiatry endlessly expands the range of its diagnostic categories until most ordinary people can be fit into at least one DSM category. Thus does psychiatry seem to be in the business, as the authors contend, of making us all crazy.

For documentation of the unreliability of diagnoses and statistical sampling data, see Jerry McLaughlin, "Reducing diagnostic bias," 01-07-02, Journal of Mental Health Counseling.

One issue in the diagnostic assessment bias literature is errors in applying the diagnostic criteria (Rabinowitz & Efron, 1997). In one demonstration of this bias, Morey and Ochoa (1989) asked 291 psychiatrists and psychologists to complete a symptom checklist for a client whom they had diagnosed with a personality disorder. When the checklists were later correlated with the DSM criteria, nearly three of four clinicians had made mistakes in applying the diagnostic criteria. Kappa coefficients of agreement between clinicians' checklists and the DSM criteria varied from 0.09 to .59, indicating a poor-to-modest level of agreement (Babbe, 1998). These results demonstrate the pervasiveness of errors in applying diagnostic criteria.

Errors in applying the DSM criteria were also reported by Davis, Blashfield, and McElroy (1993). They asked 42 psychologists and 17 psychiatrists to read and diagnose case reports containing different combinations of the DSM-III-R criteria for Narcissistic Personality Disorder (NPD; APA, 1987). They found that 94% of the clinicians made mistakes applying the diagnostic criteria, and nearly one out of four clinicians made a diagnosis of NPD even if fewer than half the DSM criteria were met.

Rubinson, Asnis, Harkavy, and Freidman (1988) found clinicians making more mistakes of omission than of commission in applying the DSM criteria. Researchers sent 113 questionnaires to a random sample of clinicians asking them what criteria they used to make a diagnosis of Major Depression. The 54 questionnaires returned indicated that clinicians' most often erred by failing to use all the diagnostic criteria in their diagnostic decision making.

Broverman, Broverman, Clarkson, Rosendrantz, and Vogel (1970), in probably the most publicized study of criterion bias, demonstrated how clinicians viewed typical male traits (i. e., independent, forceful, domineering) as more closely associated with a healthy adult than they did typical female traits (i. e., nurturing, deferential, reserved). This study demonstrated diagnostic criterion bias by showing how a prejudice towards typical male traits over female traits can cause misdiagnosis.

What causes such widespread ineptitude?

An examination of the literature shows that the amount of sheer quackery, junk science, and obfuscation here is breathtaking. Even the paranormal gets published in supposedly serious peer-reviewed journals!

There is no lack of evidence that psychiatry is indeed "a profession out of control, cut off from what ought to be its roots in the basic research community, and at the mercy of the strongest political factions of the moment." Especially the Dirty Dozen here.

Fourteen men, who call themselves "The Dirty Dozen," have managed to transform clinical psychology. The reference to dirt in their name underscores their willingness to engage in political activism and "all sorts of 'psychologically unseemly acts'" (Wright, p. 2) to advance the professional and financial interests of practicing clinical psychologists.

They even wrote a book about themselves, replete with a gallery of their photographic portraits (Ding!) and appendices reproducing all the awards they've gotten (Ding! Ding!). That's right, they don't even know enough not to brag about what they've done (Ding! Ding! Ding!).

The projection in it is breathtaking too. According to them, "the APA had long been dominated by ivory-tower academic psychologists whose attitudes toward professional psychology ranged from benign neglect to outright contempt." Truth = they are the ivory-tower academic psychologists who have long dominated the APA with attitudes toward professional psychology ranging from benign neglect to outright contempt.

Read them too. Notice the echoing of certain standard lines that get parotted round and round the world like a broken record.

Like this one: How awful, the Dirty Dozen write, that graduate training in APA-approved clinical psychology programs was "biased" toward — of all things — "scientific research." Well, they sure fixed that, didn't they?

And then there's this absurdity uttered with a perfectly straight face: Science is "too logical," you see. How does that groaner fly? What is "too" logical, pray tell? A thing is either logical or it ain't. Any idiot knows that.

They've even invented a new buzzword. Anything resembling real science is "hyperscience" in their eyes. Of course. We'd better watch out for all those "extremists" otherwise known as scientists. Who needs science and logic when you're omniscient and can just DIVINE the truth?

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Follow The Money

I first realized that official doctrine is unreliable when I kept hearing this business that, since mental illness is sometimes found coincident with a chemical "imbalance" in the brain that this chemical "imbalance" causes that mental illness. That was a bridge too far, because I happen to have a degree in biology. I knew that falsehood was no accident.

First, it isn't an "imbalance." It's a difference in the concentration ratio between two chemicals. That ratio is sometimes different in people with a mental illness. But it is probably caused by the mental illness, not the other way around. (For an explanation see Is NPD Caused by Chemical Imbalance?)

I can think of no good reason why the APA crowd keeps forgetting to mention that and stretching this research finding into proof that "chemical imbalances" in the brain cause mental illness.

Which conveniently proves also that DRUGS can cure or at least manage it $$$

See "Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry" (PDF) by Lisa Cosgrove in Psychotherapy and Psychosomatics.

In any other branch of medicine, only an MD can diagnose, but not here, thanks to the "Dirty Dozen." Mere social workers can diagnose mental illness. (Which is probably why up to 94% of diagnoses are in error and agreement of diagnoses ranges from 9-60%.) Now they want these folks to be able to write prescriptions, too $$$

And they want to force health insurance companies to pay for ...
... treatments never proved safe or effective for ...
... patients unreliably diagnosed with ...
... diseases they have never proven exist ...
... never established a cause of ...
$$$$$$$$$$$$$$$$$$

Not credibility.

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Junk Science & Statistics

And then there was "NPA Theory" — junk science masquerading as "Mendelian Genetics" to "prove" that NPD is "genetically caused."

That was no accident: that was a con job preying on the trust of people lacking the scientific background to see what is wrong with it. (For an explanation and debunking, see Is NPD Genetically Inherited?)

This "theory" was but an essay, an untested hypothesis so devoid of anything that could be passed off as evidence that it couldn't even be cited in anything but the "speculative" scholarly literature. Nonetheless, the parrots of the APA didn't mind being convinced by it that NPD is genetically caused.

Then the bogus prevalence statistics set off my bullshit alarm yet again.

You cannot claim to be estimating the prevalence of a personality disorder in the general population unless you survey the general population. It is unbelievable that any highly educated expert could fail to know that. Yet the American Psychiatric Association (APA) has done it for decades.

Therefore the "official" estimate of the prevalence of NPD (under 1% of the general population) by the APA in its Diagnostic and Statistical Manual of Mental Disorders (DSM, current version DSM-IV-TR) isn't even scientifically legitimate.

Not until 2004 did any researchers even get around to conducting a survey of the general population to determine the prevalence of personality disorders. And, surprise, it wasn't the American Psychiatric Association: it was the National Institute of Health.

"The first-time availability of prevalence information on personality disorders at the national level is critically important," said Dr. Ting-Kai Li, M.D., Director, National Institute on Alcohol Abuse and Alcoholism.

Result? This survey doubled the APA's "estimate" of 6-9% in its Diagnostic and Statistical Manual, estimating that 15% of Americans meet the APA's own diagnostic criteria for at least one of seven personality disorders — not counting borderline, schizotypal, and narcissistic disorders.

Presumably then, when they get around to developing instruments (questionnaire questions) for those other 3 personality disorders, the overall prevalence rate will rise to more than 20%. That's 1 in every 5 people has the serious mental illness of a personality disorder — IF the APA's diagnostic criteria are worth the paper they're written on.

Has the APA corrected its estimates in the light of this, the only relevant statistically valid data? No.

And one must ask why the NIH couldn't survey for borderline, schizotypal, and narcissistic disorders too. Could it be because the APA's DSM criteria are so blurry and redundant that there was no way to distinguish these personality disorders from the others in any objective manner? How much do you wanna bet?

In addition, for information about how this first legitimate survey showed how misleading the APA's clinical statistics are, see "Personality Disorder Prevalence Surprises Researchers" in Psychiatric News, September 3, 2004, Volume 39 Number 17.

Since Grant conducted the study among a randomly selected population-based sample, the prevalence rates from her study diverged from those presented in the DSM-IV-TR in some cases.

For instance, according to the DSM-IV-TR, dependent personality disorder is "among the most frequently reported personality disorders encountered in mental health clinics," the study report pointed out. However, Grant's study found it to be the least common in the population.

In addition, the DSM-IV-TR estimates that the prevalence of avoidant personality disorder in the general population is between 0.5 percent and 1 percent, yet Grant found it to be 2.36 percent.

Grant explained that prevalence estimates of various personality disorders in the DSM are based on relatively small, clinical studies of patients who are receiving mental health services on an inpatient or outpatient basis.

"You can run into problems if you rely solely on clinical samples," she said. "If you want to know the true prevalence of a certain disorder, you have to get out of the clinic."

For an explanation of why psychiatry is such a mess, you can download "Chapter 12 - Personality Disorders" of Abnormal Psychology at by Nietzel, Speltz, McCauly, and Bernstein (PDF, 595 KB).

Here are some excerpts:

For example, 25 to 85 percent of people diagnosed with one personality disorder also meet the criteria for another one (Widiger & Rogers, 1989; Zimmerman & Coryell, 1989). In terms of Axis I comorbidity, anywhere from 27 to 65 percent of patients with panic disorder or generalized anxiety disorder show a coexisting personality disorder (Brown & Barlow, 1992). Because of this comorbidity, it is often difficult to determine whether a client suffers two or more disorders or whether the problems attributed to an Axis I condition are actually the result of a pervasive personality disorder. [...] The prevalence of personality disorders in the United States is difficult to estimate, in part because many people with these disorders refuse to acknowledge their problems and avoid contact with clinicians. Another complication stems from the fact that the diagnosis of a personality disorder requires establishing a chronic pattern of problems, which is usually more difficult than diagnosing the acute symptoms of an Axis I disorder. [...] By placing personality disorders on Axis II, the DSM-IV encourages clinicians to diagnose personality disorders in addition to any Axis I disorders that are present. However, clinicians often find it difficult to distinguish Axis I and Axis II disorders, and they are uncertain how best to think about clients with diagnoses on both axes.

Comorbidity between Axis I and Axis II disorders can be understood in several ways (Klein, 1993). First, an Axis I disorder and a personality disorder may simply coexist at the same time....It is also possible that one of the disorders predisposes a person to develop the other. ...Another interpretation of comorbidity is that it is an artifact of the criteria used for various diagnoses. ...For example, Comorbidity may simply be the result of definitional similarity. ...A personality disorder and an Axis I disorder may represent different levels of severity along the same basic dimensions of disturbance. [...] At least three other problems make reliable diagnosis of personality disorders difficult. First, as suggested in the discussion of comorbidity, the criteria used to define different personality disorders often overlap considerably. ...A second obstacle to reliable diagnosis of personality disorders is that, by definition, they refer to long-standing behavior patterns rather than acute, current symptoms....Finally, the problems associated with the DSMIV's categorical approach to classification are particularly difficult in the case of personality disorders. As noted in Chapter 2, the DSM-IV requires the clinician to assign a diagnosis if a client meets a particular number out of a fixed set of criteria. If this number is met (for example, five out of nine for narcissistic personality disorder) the diagnosis is made. But there is little or no evidence to support a particular cutoff (such as five of nine instead of six of nine criteria) as being the "true" boundary between normal and abnormal personality (Widiger & Trull, 1991). Furthermore, if the rule requires that five of nine criteria be met, two people could be diagnosed as displaying narcissistic personality disorders even though they share only one defining feature. And two other people who share four defining features might receive different diagnoses because they do not share a fifth criterion.

Absurd. Nietzel also points out that women get diagnosed with Antisocial Personality Disorder far less frequently than men and with Histrionic Personality Disorder far more frequently than men. He cautions that the reason may be cultural factors affecting the mere expression of a personality trait so that it manifests itself in different actions by men than by women but is due to the same underlying personality disorder in both. He also cites evidence of a sexual bias in clinicians diagnosing the disorder. Finally, he notes that the overall rate of diagnosis for any personality disorder may be faddish, following trends of popular interest in one personality disorder or another over time. Notice that he is using the APA's invalid statistics of how common Histrionic Personality Disorder is in the general population:

Histrionic personality disorder occurs in about 2 to 4 percent of the U.S. population (Weissman, 1993), and it appears to be diagnosed more often in females than in males. The reasons for this gender difference remain controversial. It may reflect cultural influences that lead females, especially, to believe that physical beauty is necessary for a satisfying life, or it may be due to the diagnostic biases described in Chapter 2. Recall the study by Maureen Ford and Tom Widiger in which clinicians were asked to diagnose fictitious cases. One case involved a typical description of antisocial personality disorder for which the person was said to be either a man or a woman; the other described a histrionic personality disorder, again presented as either a man or woman. The results showed that clinicians were more likely to diagnose a female with histrionic personality disorder even when she met the criteria for antisocial personality disorder. Likewise, histrionic behavior attributed to a female increased clinicians' use of the histrionic diagnosis. On the other hand, being identified as a male had a smaller effect on the differential use of the two diagnoses. Researchers' interest in histrionic personality disorder appears to have declined recently; it may be diagnosed less frequently in the future since it overlaps considerably with other personality disorders in the dramatic/emotional/erratic cluster.

More on this from "Narcissistic Personality Disorder" in the Encyclopedia of Mental Disorders.

The high preponderance of male patients in studies of narcissism has prompted researchers to explore the effects of gender roles on this particular personality disorder. Some have speculated that the gender imbalance in NPD results from society's disapproval of self-centered and exploitative behavior in women, who are typically socialized to nurture, please, and generally focus their attention on others. Others have remarked that the imbalance is more apparent than real, and that it reflects a basically sexist definition of narcissism. These researchers suggest that definitions of the disorder should be rewritten in future editions of DSM to account for ways in which narcissistic personality traits manifest differently in men and in women.

So far, all these errors have the effect of making malignant narcissism practically disappear from the general population, at a prevalence rate of only about 1%. (There is no known drug said to treat it.) But how can the APA say that when every psychopath is a malignant narcissist and psychopaths alone are 1% of the population?

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Illegitimate Classification Schemes

My first clue that something is wrong with official doctrine was the diagnostic criteria for NPD in the APA's Diagnostic & Statistical Manual (DSM). They are fuzzy abstractions in which the malignance of malignant narcissism is well camouflaged. It's hidden in the statement that people with NPD "exploit" others.

A statement that goes right through the brain like a neutron.

Only when you stop and think what it means to exploit others, and what narcissists use others for, and how they ab-use others (largely through character assassination and treating them like dirt to dominate, manipulate, and humiliate) — only then does the malignance in NPD hit you.

I wondered why the DSM kept that malignance so well camouflaged. Then, sure enough, I ran across evidence that there are many clinicians out there totally unaware of it. They have narcissism as a mere character trait, confused with the personality disorder (NPD). In other words, they think most people with NPD are non-malignant, that they are just arrogant snobs with inflated self-esteem.

Wrong. You can't class people of inflated self-esteem with malignant narcissists, who have abysmal self-esteem and put on a superiority act to cover it and remain in denial of it. At bottom, this inflated self-esteem and deflated self-esteem are the very opposites of one another. It is only superficially that they resemble each other in some respects.

People with inflated self-esteem really have inflated self-esteem. People with deflated self-esteem only pretend to have inflated self-esteem. (Theirs is a "compensatory" egomania, a psychological "complex.") Therefore, only the second group is pathologically envious and desires to tear others "down off that pedestal" = to dominate, manipulate, and humiliate.

That's a huge and fundamental difference. Therefore, confusing the two groups is like classing bats with birds simply because they both fly, or classing fish with whales simply because they both live in the water. They aren't at all alike.

By putting them in the same class with a much larger group to which they don't belong, you muddy the picture, making the bat seem like just another bird, making the whale seem like just another fish. Which they ain't. Same here: you make malignant narcissists seem non-malignant by dumping them into a much larger group of people who are just full of themselves.

What better way to make NPD seem like no big deal? There are no bad people, you see, so the APA must sweep these bad people under the rug.

Sorry for that inference, but I just can't believe this is an honest mistake by highly educated experts who are supposed to know what they're doing.

And look what they callously did to non-malignant narcissists in order to be so nice to the malignant ones. By inventing diagnostic criteria, some of which apply to non-malignant narcissists, and then (without any research to back the validity of doing so) requiring that only 5 of 9 be present to diagnose NPD, they gave many non-malignant narcissists a personality disorder.

But do non-malignant narcissists really have a personality disorder?

As I noted above in quoting from "Chapter 12 - Personality Disorders" of Abnormal Psychology by Nietzel, Speltz, McCauly, and Bernstein:

As noted in Chapter 2, the DSM-IV requires the clinician to assign a diagnosis if a client meets a particular number out of a fixed set of criteria. If this number is met (for example, five out of nine for narcissistic personality disorder) the diagnosis is made. But there is little or no evidence to support a particular cutoff (such as five of nine instead of six of nine criteria) as being the "true" boundary between normal and abnormal personality (Widiger & Trull, 1991).

So any five will do, eh? Here they are, and notice which ones you needn't have and still be diagnosed with the stigma of personality disorder:
1. has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. requires excessive admiration
5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8. is often envious of others or believes that others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes.

That's a personality disorder? A mental illness so serious that it may affect your employment and career opportunities, not to mention your reputation if word ever gets out? Give me a break.

Apparently the powers that be in the APA need to be reminded of what they say a personality disorder is.

A personality disorder is supposed to be an "extreme and rigid extension of a personality trait." It is supposed to be a pervasive and persistent pattern of fundamentally distorted thinking that affects both feeling and behavior. It's supposed to make a person impulsive and prone to wild mood swings. This distorted way of thinking is so fundamental and so consistent that it preoccupies that person, warping virtually every human interaction and affecting their performance in virtually every area of that person's life. Moreover, a personality disorder originates in childhood and persists throughout life. So, again I ask, do people who are inconsiderate, arrogant, and just full of themselves fit the bill?

Many of these non-malignant narcissists are just people who let fame and fortune go to their heads. When reality brings them crashing back down to earth, they're fine.

This sounds like more of the APA Making Us All Crazy, right? Simply by stretching a personality trait into a personality disorder.

See Our Raison d'Etre by Scott O. Lilienfeld, Ph.D., Editor in Chief of the Scientific Review of Mental Health Practice:

The past several decades have seen a virtual explosion in the use of controversial and poorly studied psychiatric labels, such as codependency, sexual addiction, road rage disorder, infanticide syndrome, parental alienation syndrome, premenstrual dysphoric disorder, and Munchausen's syndrome (factitious disorder) by proxy (see Mart, this issue). Although some of these labels may ultimately be shown to be predictively useful, many are of undemonstrated validity (McCann, Shindler, & Hammond, in press). Nevertheless, such labels are commonly invoked by mental health professionals as scientific explanations of problematic behavior and are introduced by them into courts of law with increasing frequency. In still other cases, there are serious concerns that some psychiatric conditions (e.g., dissociative identity disorder, known formerly as multiple personality disorder) are being substantially overdiagnosed in certain settings.

Then I discovered that the APA are doing the same thing with that other group of bad people — psychopaths — making them disappear into a much larger group with different traits — antisocials, your typical street criminal (i.e., sociopaths, people supposed to have something called Antisocial Personality Disorder, APD/ASPD).

They constitute about 80% of prison inmates, probably because most antisocials will eventually get into trouble with the law.

But 80% of antisocials in prison are not psychopaths. Guess why? Because they aren't malignant narcissists. The only thing imprisoned psychopaths have in common with antisocials is their sociopathic/criminal behavior. (See below.) And the key word there is "imprisoned" psychopaths. Most psychopaths never commit a violent crime and land in prison.

Moreover, antisocials have a much lower rearrest rate than psychopaths. Unlike psychopaths, antisocials can be rehabilitated to go straight. They are also far less dangerous than psychopaths because they aren't perverts going around beating and raping and killing anyone handy just to do it. In other words, antisocials are not predators. In other other words, they are not your serial killer, your serial rapist, and your child molester.

Indeed, anyone can see that there is a world of difference between your typical street criminal (antisocial) and your psychopath.

What's more, like most malignant narcissists, most psychopaths never land in jail. But a small percentage of them ever commit a violent crime, get caught, and sent to prison. Indeed, many are highly successful!

See Snakes in Suits about psychopaths in the corporate world, by Dr. Paul Babiak and Dr. Robert Hare.

See also "Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion" in the Psychiatric Times by Robert D. Hare Ph.D.

In my book, Without Conscience, I argued that we live in a "camouflage society," a society in which some psychopathic traits — egocentricity, lack of concern for others, superficiality, style over substance, being "cool," manipulativeness, and so forth — increasingly are tolerated and even valued. ...Psychopaths have little difficulty infiltrating the domains of business, politics, law enforcement, government, academia and other social structures. It is the egocentric, cold-blooded and remorseless psychopaths who blend into all aspects of society and have such devastating impacts on people around them who send chills down the spines of law enforcement officers.

In other words, if the American Psychiatric Association has you picturing the psychopath as looking like your common street criminal, look out. He or she looks more like your boss, your therapist, your mother-in-law, your English Literature professor, that cop writing you a ticket, your political party's nominee for President of the United States....

Like any predator, well camouflaged, of course.

Now why camouflage NPD's malignance and dump the glaring malignance of the psychopath on those with APD instead?

See "Hollow Men: Ted Bundy Discusses Possession" by forensic psychologist J. Reid Meloy, author of The Psychopathic Mind.

We know from the research that psychopaths have a core, aggressive narcissism that is fundamental to their personality. If you remove that narcissism, you don't have a psychopath.

Doesn't that make you think that NPD and psychopathy could be the same thing? It should. But apparently it has never dawned on the APA that they should investigate the possibility.

See "This Charming Psychopath" in Psychology Today by Robert Hare. How do these personality traits of psychopath differ from those of a malignant narcissist?

Indeed, follows The Psychopathy Checklist. Now, since this checklist is designed for use among the prison population, you must disregard the items included for convicted criminals only (promiscuous sexual behavior, juvenile delinquency, revocation of conditional release). But how much else do you see here that doesn't fit a malignant narcissist to a "T"?

Your typical street criminal (antisocial) scores high in Factor 2 traits only. Your psychopath and other malignant narcissists score way higher in both factors. In fact, if there's a difference between psychopaths and malignant narcissists here, it can't be detected.

Common sense alone tells you that psychopaths and malignant narcissists are very much alike and may be just different labels for the same thing or varying severity of the same disease. It also tells you that both groups are distinct from antisocials. So does the very low rate of suicide among psychopaths/narcissists and the high rate of suicide among antisocials.

But the APA classes and labels psychopaths as antisocials anyway. Good way to make psychopathy disappear, eh? It's like dumping the bats and whales in with the birds and fish again. You thus create the illusion that they're just birds and fish too. Thus you make psychopaths seem much different than they really are.

Much less bad than they really are. For, you take the predatory malice and sadism out of psychopaths by classing them as antisocials. You make it seem as though they can be rehabilitated like antisocials and set free without reoffending like antisocials. You make them seem like antisocials — generally the fruit of social ills like bad homes (or gang environments) and poverty.

How? You just say that people with APD can be helped by therapy, that they are the fruit of social ills like poverty and bad homes or neighborhoods, that they can be rehabilitated and set free without reoffending, and so forth. But you fail to mention that this is true only for the 80% that are not psychopaths. See how insidious this deception is?

What's more, Antisocial Personality Disorder is no personality disorder. It's probably just a lousy attitude and a depressed spirit. Which is why you really can help these people.

How is the APA getting away with this?

See "Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (PDF)," in the Journal of Abnormal Psychology by Robert D. Hare, Stephen D. Hart, and Timothy J. Harpur, University of British Columbia.

In this report, Hare, Hart, and Harpur address criticisms of the current diagnostic criteria for psychopathy, which have wheedled their way into people's heads as a definition of it. The approach focuses on "antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy." Voila, the behaviors/actions themselves become the disease. Hence "psychopathy = committing a violent crime."

Wrong. As we have seen above, only a small percentage of psychopaths ever do that. (Not that they don't commit other crimes like fraud, extortion, bigamy, child abuse, embezzlement, and so forth. And some of the legal things they do are worse than the illegal ones, like driving someone to drink or suicide.) Moreover, when they do break the law, they get away with it far more often than not. Again, just like malignant narcissists.

For a good explanation of what's going on see "Psychopaths Among Us," by Robert Hercz in Saturday Night Magazine.

"There's still a lot of opposition — some criminologists, sociologists, and psychologists don't like psychopathy at all," Hare says. "I can spend the entire day going through the literature — it's overwhelming, and unless you're semi-brain-dead you're stunned by it — but a lot of people come out of there and say, 'So what? Psychopathy is a mythological construct.' They have political and social agendas: 'People are inherently good,' they say. 'Just give them a hug, a puppy dog, and a musical instrument and they're all going to be okay.' "

If Hare sounds a little bitter, it's because a decade ago, Correctional Service of Canada asked him to design a treatment program for psychopaths, but just after he submitted the plan in 1992, there were personnel changes at the top of CSC. The new team had a different agenda, which Hare summarizes as, "We don't believe in the badness of people." His plan sank without a trace.

So why is the APA making mere narcissism (i.e., having a big head) and antisocial behavior (getting into trouble with the law) — why do they hocus-pocus these things into personality disorders and then make NPD and psychopathy virtually disappear into these two different, much larger groups?

Psychopaths are all malignant narcissists. That is known for sure. (What we don't know for sure is whether all malignant narcissists are psychopaths.) Plus, even in the APA's hazy DSM descriptions, psychopaths and other malignant narcissists are far, far more like each other than they are each like the rest of the group they've been dumped into.

And why this stubborn refusal to acknowledge the predatory malignance at the bottom of both NPD and psychopathy? Why do these guys play holier-than-thou bleeding hearts by demonizing (as, of all things, "demonizers") anyone who won't buy what they're selling?

How's that for manipulation?

What? can't the APA admit they were wrong and that some people are bad? That psychopaths/narcissists hurt others because they like hurting others? Just because hurting others makes them feel good? Or is it that, if the APA can't blame an evil on society, they don't believe in it? Or is it just that we commonfolk are too ignorant and reactionary to be trusted with this knowledge? Is this like when the Martians are coming in science fiction and our social nannies must keep it a secret so we don't panic to know that predators stalk easy prey among us?

All the psychopaths and other narcissists in the world thank the APA for keeping their prey so unsuspecting.

Ah, narcissistic elitism. To hell with science: they can just divine the truth.

It was bound to happen. If you took any college courses in the arts, you know that it's cultural: those who consider themselves intellectuals have always felt a compelling need to construe themselves as intellectually superior to "those science types." They just think on a higher plane, you see. So, it's no wonder that there's war in the mental healthcare profession, where they are plagued with science types and must turn up their noses at the research of those "robots."

Notice also that the mainstream of media, social workers, and academia politically exploit the idea of psychopaths in business suits and the analogy of the corporation as a psychopath. That notion goes well with their belief that capitalists are evil.

But they act unaware of the fact that, because of the low risk of accountability and the large audience to show off to, the professions of teaching, writing, acting, and politics swell their own ranks with more psychopaths/narcissists than business attracts. Yes, though the scum may well rise to the top in a corporation, you won't find it as prevalent among the ranks as you do in these "helping" professions.

And here I end where I began. All this evidence undermining the credibility of the mental health profession is just a warning about the true credibility of the prevailing wind in it. There are signs of life in this branch of medicine. The profession's strongest critics come from among its own ranks. There are clinicians who see the light. There are researchers who dare to blow against the wind. And they are slowly but surely winning.

Though I'll bet they feel like Galileo arguing with the Church.

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