I’ve always aimed to be completely honest on this blog and hold back nothing, but there’s something I’ve been avoiding talking about for about a week. Now is the time, and I doubt (and hope!) no one judges me negatively for it.
As most of you probably know, I started this blog because I decided I had NPD (covert, fragile type). It was self-diagnosed and I set about a nutty regimen of self therapy (some of the stuff worked, some did not). I got stuck and stopped progressing, and decided to see a therapist. I found a very good trauma and attachment therapist, who works with people with personality disorders and Complex PTSD (C-PTSD). Still, he hates labels and refused to give me one. He prefers treating symptoms over “disorders.”
When I told him I thought I had NPD he said there was no way and he even doubted I had BPD anymore or if I even ever had it at all (I beg to differ and have an official diagnosis for that). He based this on the fact that I don’t play mind games with him, I don’t manipulate him, and I’m not “difficult.” I don’t overstep his boundaries or act high maintenance or entitled. In fact, he’s told me several times that he looks forward to our sessions. I realize there may be a little counter-transference on his part (which is pretty normal as long as it’s not acted on by the therapist), but I also think I do present myself as someone who’s fairly easy to get along with (and truth be told, I am easy to get along with these days and most people seem to like me, even if I still avoid close contact or deep relationships with anyone).
Finally, insisting on having SOME kind of diagnosis (for some reason, this helps me feel less crazy), he toted out his never-used looking copy of the DSM and we looked through it together. He told me I didn’t fit the criteria for any personality disorder, but PTSD might be a good fit. He wasn’t aware of Complex PTSD because it’s not a recognized diagnosis, but when I explained what it was, he said that sounded like what I probably had. So I got a kind of/sort of diagnosis. I let him borrow my copy of Pete Walker’s wonderful book about C-PTSD, which he is reading now. (For the record, Walker believes personality disorders are complications of C-PTSD, which provides a kind of template for their development).
That was several months ago.
During our last session, he told me something that sent me back down the rabbit hole, at least for a few days. As long as I’ve had this blog, I’ve suspected I have covert narcissism, because I feel like there’s this very thin false self I’ve developed–a false self as thin as a piece of aluminum foil, as a friend of mine put it–over my BPD. This thin veneer of narcissism kept my BPD rages and lack of control at bay, and also kept me emotionally numb. Of course, mindfulness training helped me maintain control, but I suspected my lack of being able to feel much of anything and this way I have of shutting people out or even rejecting them when they try to get too close was definitely pathological and indicated something a bit worse than PTSD. Like all cluster B people, I’m all too aware of this vast black hole inside that I’ve built many layers of defense over to avoid having to confront.
So we were talking about my “many layers of defenses” and I asked him again if he had changed his mind and did he think I really had NPD. This time, he didn’t laugh or deny it. My heart started to hammer away and felt like it was stuck in my throat. He stayed silent for a few moments, and finally said something that rocked me to my core. What he said was he didn’t think I qualified for NPD, but because he knew me better now and had a clearer idea of the defensive structures I’d built over time, he thought the top layer was a narcissistic defense developed to protect myself from the pain of BPD craziness.
He went on to explain the difference between healthy narcissism and pathological narcissism. While he thinks my healthy narcissism (self esteem) has increased (which is definitely good), he thinks my pathological narcissism is beginning to disappear. That was good news (and I think he’s right), but his admission that I did in fact have a narcissistic defense (and therefore am on the N spectrum) just confirmed what I already knew. Even though I’ve known it all along. hearing him say it still upset me so much I burst into tears (this was the first and only time I actually shed more than a few tears in session). Even though I’ve come to realize not all people with narcissism–even NPD– are terrible, unredeemable people, I still can’t help but associate the term “narcissism” with something bad and evil. The stigma is pervasive. Even “healthy narcissism” has a pejorative feel to it.
I tearfully asked him if he was saying this because he thought less of me than he used to and did he think I was a bad, terrible, evil person. Was this his way of rejecting me? Did he think I was hopeless and incurable? My abandonment terror was definitely triggered.
He smiled sympathetically, and then assured me he absolutely did not think any of those things and his feelings toward me had not changed. He just knew me better now and could see the way my defensive structures were arranged, which was actually a good thing because it meant he had a better idea of how to conduct our sessions. He also told me he’d seen a lot of progress in me in the year I’ve been seeing him and that I was one of the most motivated and courageous patients he’s ever had. “Whatever kind of defenses you have,” he told me, “it’s not a judgment against you. I have no doubt you are going to be successful in working through them, no matter how painful things might get, because I can see that you don’t give up easily and I can see how much you desire to reconnect with your authentic self, and i can see you are already doing so.” He also told me that he saw no problems with my level of empathy, and probably even had an excess of it.
That made me feel better, but I spent a few days depressed anyway, mostly because he no longer thought I was “perfect” (as in not having a personality disorder) and even placed me on the N spectrum. I guess that in itself shows my narcissism, because one thing I’ve noticed about myself in therapy (and that might hinder it to some degree) is that I’m always trying to “impress” my therapist with my good behavior and easy to get along with personality (charm).
I hope no one judges me for this, but I’ve never regretted being truthful here, and this is no exception.
At the end of the day, the labels are just labels and don’t define an entire person or their ability to become whole, if they want to badly enough and don’t give up the fight for wellness.