NPD: disorder, disease, medical condition, syndrome?

Continuing the discussion from Moderation policy change: unfounded assumptions:

With that as the context, NPD isn’t a medical condition is the distinction that I find important.

I won’t get mad at a diabetic for having low blood sugar, or a schizophrenic for acting in response to a hallucination. That does not involve agency or choice. There is no illness that causes anyone to maniplulate others when they could -not- fabricate a sympathetic story to cause emotional trauma in other humans.

We may never see eye to eye on this, but NPD is not a medical condition, it is a behavior pattern with no one cause, and not in the way a medical syndrome is, as even syndromes are about physical manifestations.

I don’t think it deserves to be lumped in with medical conditions. Many don’t. That’s the controversy as I see it, and it rhymes, to me, with the accidentally/accitentionally divide that those familiar with NPD understand very well.

We don’t need to agree, vive la difference!

I tried to have this conversation here previously, but a whole lotta name-calling happened.

Fortunately those users won’t be partaking in my thread here today, you know who you are.

From what I can see the psychiatric community is still debating that. The rule of thumb for those who make the distinction seems to be that if the symptoms can be mitigated or eliminated by medication or surgery (e.g. Schizotypal Personality Disorder) then it’s a disease but otherwise it’s not. It looks like that point of view is driven by those MDs who associate disease and illness with physiological causes. It seems a little binary to me.

Another group thinks that view is outmoded and that all personality disorders should be considered mental illnesses. I can see where they’re coming from but it strikes me as a little too broad ranging at this stage of our medical knowledge, despite all the new brain scanning technology and such.

It all goes very much to the mind-body problem. I personally think that the distinction between personality disorder and mental illness is a useful one, so we’re in more agreement then you think. The difference may be that I’m willing to allow based on the evidence that there are physiological factors involved in some personality disorders where you may believe they’re all only about behaviour (and thus can only be effectively addressed via behavioural and talk therapy).

I’m not sure to which users you’re referring but anyone can read and join this thread.


there is that ‘all’ creeping in again… for example, If I am asking about the NY Yankees, am I asking about all baseball teams? I think not, and I think that matters, as I don’t believe the SPD you brought up is considered a character disorder. That one may well have a medical cause. But it isn’t NPD, and it isn’t in Cluster B. So to continue my baseball metaphor, your response strikes me as talking about a team in another league, maybe even another sport?

This user asked me to not comment on their threads, I assume the respect will be paid that was sought.

they are defined by behaviors, and not by causes. It’s not a matter of what I believe. It’s observational and documentary, strictly so.

and there is that weird ‘all’ again, like I may be the one of the two of us conflating them when I specially ask you to please not conflate them?

I agree: a personality disorder that, based on observations of treatments, has a physiological disorder.

Correct. That’s a different personality disorder. I never said it was a mental illness or a subset of mental illness or conflated NPD with mental illness (quite the opposite, in fact – my point is that labelling every behavioural issue including all personality disorders as generic “mental illness” is unhelpful.).

That is less than clear, based on this quote of yours (from the other thread)

It’s the difference between saying “The ‘president’ displays many signs of NPD” (easily supported) and “The ‘president’ behaves this way because he’s mentally ill.”

Can you see where you explaining two different ways to say ‘the same thing’, and now it seems they are different things, not the same thing? It’s a bit confusing. Hard to parse.

If you don’t mean to state that NPD is a mental illness, then whats the distinction you made in the first place, because that there reads like you DO think NPD is a mental illness, but no you didn’t say that, however your argument there in the original thread appears to rely on that being your position, that NPD is a mental illness.

Otherwise what were you comparing?

You may have trouble parsing it, but my point is that they were two separate things. The first (per my three criteria stated in this comment, which you might have missed) as specific (is in making ontological distinctions), can be backed up by evidence, and doesn’t attempt a diagnosis; the second is none of those things.

of NPD

but is about “mental illness”

I’ll dare to use another baseball metaphor here. Less charged topic.

The first reads as “the second baseman appears to not play by the rules in the following ways”, and the latter as “the second baseman is a cheater”.

I do see the the difference, I don’t see the distinction

nice conversation, btw. Can i pat us both on the back for talking pleasantly about a deeply unpleasant topic?

It is about “mental illness” in that over-broad labelling using that term, sometimes to explain or even excuse Il Douche’s behaviour, prompted the change in policy here. That was my starting point. I used NPD because it is more relevant to the case of Il Douche.

To extend on your sports metaphor, people were talking about someone as definitively being a generic football player (read: mentally ill) when it would be more accurate to describe him as meeting the criteria to play on the Cleveland Indians (read: NPD). Either way both are agreeing he’s still an athlete (read: displays abnormal or extreme psychological behaviours, whatever their cause), but one way of describing him is more accurate.

If you want to insist on reading more into it that’s your business. I’m leaving it there.

Ah, that makes more sense of it - however, unless he has self-identified as an athlete, is that fair game either way? Both strike me as out of bounds, but I drew the distinction because as football isn’t baseball, and many football coaches (read: MD therapists) and many football players don’t think baseball is even a real athletic endeavor, however they do acknowledge that some athletes do play it, but being a baseball player does not make one an athlete, just a sportsman. While behaving like a football player, without being an athlete will get you killed, or at least benched forever, because that game requires athleticism.

I don’t see remotely diagnosing NPD or a more “generic mental illness” as being all that different. I do see keeping a distinction between character disorder and physical disorder as important, both for those who suffer, and those who suffer them.

If you want to insist that someone asking clarifying questions is actually reading into a thing, and insists on reading more into it, I mean heck, you’re free to pursue that project of yours, and I thank you for addressing my questions.

Seems a bit like a forward, nay, aggressive assertion of someone else’s motivations, tho.

Unless this is a private discussion, I’d like to throw in my two cents. Though I haven’t been able to put my hands on them again in the last five minutes and insert them here, there now seem to be respectable studies to the effect that (a) there are chemical substrates for empathy, (b) the lack of these substrates is genetic and © is characteristic of sociopaths and psychopaths. Might this not also be so of those suffering from NPD? If it is so, or if something like it is so, would that not go far to remove the onus from hard-core narcissists?

That being said, you can’t run a human society without individual responsibility. And that includes the responsibility of those who are physically incapable of optimal citizenship. Understanding always that the default position is full moral responsibility. Mental illness, whether physically or functionally defined, should never be a “get out of jail free” card.

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