Thursday, September 6, 2012

The Gratitude Journal

I gave a client of mine the assignment to write in a gratitude journal for a week.  He's not a particularly negative person, but he's struggling with some minor depression related to his life situation.  When I asked how he copes with it he says that sometimes he writes in a journal, just as a way of getting his thoughts and feelings out.

I recalled my time in Brazil when, as a missionary, I spend most of my entire first year either with non English-speaking companions or companions I disliked.  Sometimes both.  During this time I filled pages and pages of a personal journal.  A few months later when I had filled my journal I shipped it home and gave my family permission to read it.  I was rather surprised when my Mom said she hadn't realized how unhappy I had been.  Unhappy?  I was having the time of my life!  I could barely recall the frustrations of that first year and yet that was nearly all I had written about.

So I told my client to write a gratitude journal instead.  I didn't want to patronize him so I was very straightforward:  This was to help him focus his attention on more positive aspects of his life in hopes that by doing so he might feel a shift in his attitude.  I told him I would do the same (because I could use such a shift myself right about now).  We were not to ignore those things that weren't making us happy, but we were to focus especially on the bigger picture and recognize those things which we are lucky to have.

So tell me, dear reader, would this intervention work for you?  How important is attitude in our overall mood?  Is that something we can control with something as simple as keeping a gratitude journal?

I'll find out this week.

Sunday, August 12, 2012

Malignant Narcissism

There seems to be some cross over in public perception as to what words like "psycho" "sociopath" "antisocial" mean.

Today's entry will introduce a new term which might describe someone who fits the public definition of the above 3, but deserves its own categorical definition.

Malignant Narcissism.

In a film review: American Psycho; Malignant Narcissism on the Screen, some of the most prominent characteristics of this diagnosis are explored (Tylim, 2001).  Unlike beloved psychopathic/sociopathic antisocial killer, Dexter, Christian Bale's character in American Psycho is not driven by a desire to murder.  Murder, instead, becomes part of his plan for perfection.  Dexter might be a neat-freak as Christian-Bale is, but Dexter's lust for blood is an end unto itself, not a means to an end the way Bale's character sees it.

Adolph Hitler has also been classified as a Malignant Narcissist.  I know because I did a paper on him for my undergrad.  He was not obsessed with blood, but he was obsessed with perfection, power, and control.  Dexter doesn't think he's anything special.  He is just responding to impulse.  But not so for the narcissist.  Their drive is grandeur and perfection.

I know that in general we don't care why a murderer murders, and want to spend little time trying to understand, but I do think it's interesting that as we understand more about motives and circumstances, we might better be able to avoid, or spot trouble before it becomes too troublesome.

Friday, August 3, 2012

What It Is and What It Isn't

I used to think Narcissism was the same as vanity.  Y'know, the guy was so vain that he couldn't stop gazing at his own reflection.  Wow, that guy must have been hot, right?

Well, not quite.  W. H. Auden said:  "Narcissus does not fall in love with his reflection because it is beautiful, but because it is his. If it were his beauty that enthralled him, he would be set free in a few years by its fading."

So if a Narcissistic self-love is not motivated by vanity, what then?

To better help understand this disorder, I am highlighting some of the most prevalent diagnostic criteria which are highly distinctive to Narrcissistic Personality Disorder (Shedler, 2004):

  • Has an exaggerated sense of self-importance (e.g., feels special, superior, grand, or envied)
  • Appears to feel privileged and entitled; expects preferential treatment
  • Tends to be critical of others
  • Tends to get into power struggles
  • Tends to blame own failures or shortcomings on other people or circumstances; attributes his or her difficulties to external factors rather than accepting responsibility for own conduct or choices
  • Tends to be controlling, manipulative, dismissive, haughty, or arrogant
  • Has little empathy; seems unable or unwilling to understand or respond to others' needs or feelings
  • Seeks to be the center of attention
  • Is Articulate; can express self well in words

Other criteria, which are highly descriptive of the disorder, but not necessarily characteristic, include:

  • Is articulate; can express self well in words
  •  Tends to feel misunderstood, mistreated, or victimized
  • Tends to hold grudges; may dwell on insults or slights for long periods
  • Lacks close friendships or relationships
  • When upset, has trouble perceiving both positive and negative qualities in the same person at the same time (e.g., may see others in black or white terms, shift suddenly from seeing someone as caring to seeing him or her as malevolent or intentionally hurtful, etc.)
  • Tends to feel anxious
And finally, these criteria are specific of the disorder, but not necessarily characteristic:

  • Seems to treat others primarily as an audience to witness own importance, brilliance, beauty, etc.
  • Has fantasies of unlimited success, power, beauty, talent, brilliance, etc.
  • Takes advantage of others; has little investment in moral values (e.g, puts own neds first, uses or exploits others; has little regard for their feelings or welfare, etc.)
  • Tends to seek power or influence over others (whether in beneficial or destructive ways)
  • Tends to elicit dislike or animosity in others
  • Tends to be emotionally intrusive
  • Tends to show reckless disregard for the rights, property, or safety of others
  • Tends to be oppositional, contrary, or quick to disagree
*In writing this, I do not condone nor condemn the pathologization of these behaviors.  These are simply criteria which have been developed by observing reoccuring patterns.

I feel like this paints a pretty vivid picture of true narcissism which is more than a vanity in the physical, but a deep feeling of self importance.  


Shedler J, Westen D: Refining personality disorder diagnosis: integrating science and practice. Am J Psychiatry 2004; 161: 1350–1365  

Sunday, July 29, 2012

Be [exactly] Like Jesus

So I'm reading this journal article called "Pastoral Care for Shame Based Perfectionism" by Pembroke (2012), and a few scriptures spring to mind:

Matthew 5:48
48 Be ye therefore perfect, even as your Father which is in heaven is perfect.

2 Corinthians 7:1
1 Having therefore these promises, dearly beloved, let us cleanse ourselves from all filthiness of the flesh and spirit, perfecting holiness in the fear of God. 

Doctrine and Covenants 98:15
15 For if ye will not abide in my covenant ye are not worthy of me.

If you don't recognize that third one, it is part of scriptural cannon in the LDS (mormon) faith.

The journal felt like a call to repentance, if you will, to pastoral psychologists who largely ignore research surrounding shame-based perfectionism. Shame-based perfectionism is associated with inferiority shame, and such perfectionists never reach satisfaction because they are constantly reaching for the next level of achievement.  It's all the rage in China right now.

As a shame-based perfectionist, I guess this article hit home with me a bit as I thought about what role my devout religious upbringing may have played in this aspect of my personality. I think the possible religious influence for this is the idea that: a) you CAN be perfect (as the scriptures above imply), and b) if you're not, you're doing something wrong (sinful) or failing to do something required (also sinful).
Doctrines include that of eternal progress and a goal of perfection while believers have embraced the notion that if you are not rising, you are falling; there is no standing still.  I'm not the least bit interested in assigning blame- I'm actually quite happy with a life that always looks for ways to better itself. I think if more people looked critically inward, targeted areas for improvement, and then concentrated some effort in modifying those behaviors, the world might be a better place. The word shame is quite heavy in this sense, but it's true that if I am not striving for a new level of achievement I feel an anxiety associated with waste of time/talents or inferiority to others.

While I do see positive aspects to shame-based perfectionism, the ideal is to be motivated by an excitement about whatever project one is working on rather than a comparative need to tirelessly climb. One way I can see to alter unhealthy motivations is through Bradshaw's (1988) approach to self-acceptance. He suggests that a person identifies 5 people that you hate, and then list the trait that you most dislike in that person. He then suggests that each of these traits represents parts of the "disowned self." Bradshaw affirms that it is important to find our darker sides, then rather than disavow them, accept that they are okay.

Pembroke (2012) finds Bradshaw's approach useful in areas of personal achievement, but expects that when it comes to issues of personal morality, abhorrent traits such as sloth, rudeness, or dishonesty should not be accepted as okay. I diverge a little from Pembroke's criticism in this last aspect as I feel like it smacks a bit of Christian judgement or intolerance. I don't disagree with him, except that I think there is an acceptable step in self-improvement (even if it falls under the category of repentance) during which one accepts his or herself as flawed and imperfect. It becomes paradoxical to try to improve while clinging to the idea that there is something wrong with ones self.

So what do you think? Is there something wrong with striving for perfection? Or is it all about the attitude we have while doing it and what our motivations are? Is it better to accept those dark sides of ourselves, or should we improve without self-acceptance in morally reprehensible areas?

Pembroke, Neil (2012). Pastoral Care for Shame-Based Perfectionism. Pastoral Psychology 61 (2012), pp. 245-258.