By Gretchen Gibbs

Recently as I wrote down a diagnosis of Narcissistic Personality Disorder, I realized it might be for the last time. In the last couple of weeks The New York Times, The Wall Street Journal, and Psychology Today have featured articles on the diagnostic system of the American Psychiatric Association and how it’s changing to eliminate some of the personality disorders, defined as “maladaptive patterns of living.” Dropping Narcissistic Personality Disorder seems to be garnering the most attention.

So who cares? Some psychologists, including me, think the diagnostic system is an arbitrary group of categories into which we drop people to provide the illusion that we understand them. Still, the system has shorthand communication value, and some of the diagnoses are linked to effective treatments.  

What interests me is the power of the diagnostic system both to reflect societal shifts and to shape those shifts. While I was in graduate school in 1968, the second APA Diagnostic and Statistical Manual (DSM) came out, still including Homosexuality as a sexual deviation, alongside Sadism and Pedophilia. We learned in our classes the role of the overly involved, seductive mother in producing a homosexual son. Even in 1980, the third edition of DSM had a category for “ego-dystonic homosexuality,” which meant if it made you unhappy to be gay you could still be treated. Homosexuality was finally dropped as a disorder in 1987, reflecting the increased tolerance of our society. What an enormous impact dropping the diagnosis had, as mental health workers all over the country suddenly stopped labeling gays and lesbians as deviant. Without that change, we wouldn’t be talking about gays getting married, adopting children, or serving openly in the military.

Other changes in the diagnostic system reflected the feminist movement and shifting attitudes towards women. Can’t you just hear the disapproval of the male psychiatric establishment in the Hysterical Personality label, used to describe “self-dramatizing, attention-getting and seductive” women? That diagnosis bit the dust, along with Passive-Aggressive Disorder, also used more frequently for women than men. When your access to legitimate power is limited, finding some roundabout ways of getting your way becomes understandable.

What does it mean that the APA is dropping the Narcissistic Personality diagnosis? The label was created in 1980, apparently as our culture became more aware of entitlement and self aggrandizement as problems. Thirty or so years later, we seem to be saying, “Not problems, just the norm.”

Narcissistic Personality Disorder “is a pattern of grandiosity, need for admiration and lack of empathy.” According to The Wall Street Journal, quoting a 2007 Pew Research study, 51 percent of young adults said their first or second goal in life was to become famous.

There is narcissism all around us. I see it in politicians and sports figures and entertainers and the number of young people who want to go into the entertainment industry. I see it in young psychologists, who no longer say they want to help people; they want to “follow their passion.” I see it in reality TV and the endless people on cell phones or texting or twittering about their most mundane activities. I see it in the lack of empathy of American culture when it considers universal health care and minimum wages and giving to charity. Can you imagine how Tom Brokaw’s greatest generation would regard the narcissism of today?

Apparently, narcissism is now so general that the pathological level can’t be distinguished from the “normal” level. I believe, however, that dropping the disorder as a diagnosis will lead to further societal acceptance of the behavior. Removing the label of mental illness for homosexuality made it acceptable, no longer a social problem. We are about to do the same thing for narcissism.

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