The thing about smoking cigarettes is that the behavior is something we wanted to stigmatize, in order to decrease its frequency in people. At its height in the 1950s and 1960s, two out of every five people smoked in the U.S. It’s a huge health hazard, decreasing lifespans and increasing health problems in smokers.
But smoking doesn’t just impact the person who smokes. Through decades’ worth of research, we now understand the smoking also affects the people around smokers, causing health problems and decreasing lifespans through secondhand smoke. Secondhand smoke, therefore, is also something people seek to stigmatize.
So I find it a bit curious and disconcerting when a well-meaning psychologist compares someone with a mental disorder to someone who smokes. And the people around them as suffering from secondhand smoke.
MedCircle and Dr. Ramani Durvasula recently released a video series focusing on narcissism and narcissistic personality disorder (NPD). NPD is a mental disorder, specifically one of the ten personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013).
All personality disorders are long-term ways an individual has learned to understand and cope with the world around them with problematic, dysfunctional thoughts and behaviors. Narcissistic personality disorder is currently in vogue, given the popularity of social media that reinforce narcissistic behaviors.
Dr. Ramani Durvasula is a licensed clinical psychologist in Los Angeles who, among other things, does video series for MedCircle. The series caught my attention since it was titled, “Narcissism: The ‘Secondhand Smoke’ of Mental Health.”
The idea is explained beginning around the 3:30 mark in the second video of the series (even though the first video is labeled “Secondhand smoke”).
Dr. Durvasula: And you know what, the pattern of narcissism is awful. They may be fine with it. But you, as a recipient of that pattern, it’s not… you’re going to struggle with it. It’s uncomfortable. It’s one of those patterns that’s really unhealthy for the people around it. I call it the “second-hand smoke” of psychiatry. Like being near a person who’s narcissistic, it’s as unhealthy as doing it yourself.
Klye Kittleson (the host): Whoa. That is a great metaphor. NPD is the second-hand smoke of psychiatry.
Dr. Durvasula: And I’d say, narcissism is the second-hand smoke of our time. You stand close enough to it, you’re going to get sick.
Kittleson: That’s a huge deal for people because somebody might not get the diagnosis, but they still have all of these toxic behaviors that are affecting you.
Dr. Durvasula: Oh, absolutely. And you know what, in some ways the diagnosis is irrelevant. All that’s doing is saying that the person is having problems because of it. But if they’re lying, manipulating, exploiting, raging at you, who cares if they have a diagnosis? That’s not good for you to be in the presence of.
Let’s break this down…
Is this an Accurate or Helpful Comparison?
As I mentioned in the introduction, there was a reason to target second-hand smoke — to help reduce deaths and serious health problems that shorten a person’s length and quality of life. Stigmatizing those who smoke serves a very real public health benefit.
For a metaphor to be helpful (not to mention accurate), it should reflect the same kind of outcome. Are we going to save lives by doing it, or increase the quality of life not just for those who inhale the secondhand smoke, but for the smokers themselves? What’s the benefit or purpose of stigmatizing those who engage in narcissistic behaviors or have narcissistic personality disorder?
In the latter case, clearly that’s the last thing we want to do. You can’t cajole someone with a mental disorder into changing their behaviors because we label them as “toxic.” That’s not how psychological change works, especially for personality disorders.
It also goes against everything professionals and advocates are trying to do when it comes to helping people better understand mental disorders. We don’t want to demonize a specific disorder, or make it sound like people who have that diagnosis are bad people. Because they’re not. A person with narcissistic personality disorder is no better or worse than someone with clinical depression or schizophrenia. They are someone who often struggles with their thoughts and behaviors. It’s not all sunshine and roses for these individuals.
What About Stigmatizing Narcissism?
It’s less clear whether we should be seeking to stigmatize narcissistic behaviors — or what we generally just call narcissism. When such behaviors are so intricately intertwined and reinforced in modern social media usage, it’s hard to say where the line is anymore and when people are crossing it.
I’d also have to ask, would we also seek to stigmatize symptoms of other disorders we find toxic, problematic, or unhealthy to others? For example:
Depression: “Jim’s always sad and it’s a bummer to be around him. Why do I need such people in my life? Every time I’m around him, I just feel down, too.”
Borderline personality disorder: “I can never tell whether I’m on Karen’s good side or bad side. She’s can flip on me in a second if she thinks I’m betraying her. I feel like I have to walk on eggshells around her.”
Panic disorder: “We’re going out tonight with Louisa. I hope she doesn’t have another one of her freak-outs while we’re standing in line, it’s so embarrassing and upsetting to be around her!”
I could go on, but you see the point. Do we dump everyone from our life who’s struggling with a psychological, emotional, or mental health concern, just because they’re not always easy to be around?
What About Narcissistic Abuse?
Nobody should stay in a relationship that involves abuse of any kind, whether it be emotional, psychological, physical, sexual, or some other kind of abuse. Abuse, by definition, is harmful — cruel and violent — to the person on the receiving end. If the abuser can’t or won’t change, then it’s of the utmost benefit for the person who’s being abused to remove themselves from that relationship as soon as realistically possible. This may mean gathering resources and making a plan, with the help of friends, family, or a support organization.
All abuse is bad. Period.
Describing the characteristics of “narcissistic abuse” can help a person identify what abuse might look like when someone is in a relationship with an individual with narcissistic personality disorder. It’s going to look different if a person is in a relationship with someone with borderline personality disorder, or antisocial personality disorder, or any other disorder.
But let’s be clear — not everyone with narcissism or narcissistic personality disorder engages in abuse. You’re not going to automatically get “sick” if you have a person with a personality disorder in your life.
Let’s Stop the Stigma
I’m all for awareness and better understanding setting good, healthy boundaries with people in our lives.
I’m against stigma, prejudice, and discrimination that is reinforced — even unintentionally — for any mental disorder or mental illness. Personality disorders are a form of mental illness and should not be held to a different standard or talked about in a way that makes it sound like those who have them are “toxic” people. It is helpful to leave judgments about people based upon their diagnosis at the door, especially if we are trying to help people understand and be empathetic to others with these problems.
Which isn’t to say that you shouldn’t be careful and aware if you’re in a romantic relationship, working relationship, or friendship with such an individual. You absolutely should be, just as you should be aware of all of your relationships and how others interact with you, keeping clear boundaries with each person as needed.
But a person with a personality disorder isn’t going to cause you to develop health problems or shorten your life. I find that comparing narcissism or narcissistic personality disorder to secondhand smoke to be hyperbole, and unhelpful in forwarding our understanding and ongoing conversations around mental illness.
Watch the video and share your thoughts in the comments: