The Trouble with Armchair Diagnosing.


We human beings have a tendency to polarize everything...drifting to extremes on one end or the other of the spectrum for whatever we're measuring. I don't usually do anything other than notice, but for a few years, and in ever more absolute terms, people are co-opting mental health diagnoses or just plain making them up. This is not good...for anyone.

Take empaths and narcissists. These two terms are now tossed around by John and Jane Q. Public as if they have some actual, standardized meaning in the general scheme of things.

Not so.

Let's begin with "I am an empath."

Em•path /'em paTH/ noun (chiefly in science fiction) a person with the paranormal ability to apprehend the mental or emotional state of another individual. Empath is a term coined for Star Trek, is not a real psychological term and would not be used in a clinical setting."*

Whenever I read about the observable characteristics of an empath in a blog or book, I sigh. Most recently I read a post in Elephant Journal which described an empath thus...

>> Thinking of other people’s needs before their own

>> Putting other people’s happiness and pleasure first

>> Taking on other people’s problems as though they are their own. In other words, going to all lengths to fix them.

>>Unlike narcissists, empaths obsess more about other people’s requirements and emotional and mental well-being than they do their own. They often place other people on pedestals and can treat them as though they are the centre of the universe—to their own detriment.

Call it "empath" if you want, but the term for this behaviour is 'co-dependent.' Or 'boundary-less.' That is, someone whose internal landscape is almost completely entwined with the emotional state of another. In other words, someone whose sense of Self is externally focused. The I/Thou boundary is non-existent or so blurry that the individual most likely to describe herself ('empaths' are overwhelmingly female) as an 'empath' has little regard for her own internal state, but rather is hyper-attuned to the emotional state of others inevitably " her own detriment." This happens along a continuum from being highly sensitive to being completely overwhelmed by the most intense emotion in the room.

Narcissistic Personality Disorder (NPD) is a defect of personality, manifested as observable behaviour and intractably stable characteristics; furthermore, it is a quantifiable DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) diagnosis. Traits of NPD include grandiosity; entitlement; inability to empathize; chronic envy of others; arrogant or haughty attitude; demand for recognition; exaggerated achievements; relationship difficulties; difficulty regulating emotions/behaviours; major difficulty dealing with stress; angrily reactive to perceived slights, and probably most significantly, anosognosia. This Greek word comes from the root words without, disease, and knowledge. Literally 'a deficit of self-awareness in which a person with some disability is unaware of its existence.' Narcissistic Personality Disorder is rare - only 0.5-1% of the general population, and 50-75% of those diagnosed with NPD are male.

Why does this matter?

  1. Because wrong diagnosis invariably means wrong treatment. What 'empaths' actually need is help to learn how to grow healthy boundaries around a sense of Self. To learn how to separate "I" from "Thou" in ways that acknowledge the integrity of individuality, including their own. Introverts need time apart not because they are necessarily more empathically attuned than Extroverts but because to maintain a healthy and balanced emotional life and psychological equilibrium, they need to be alone to recharge. Peopling costs Introverts a great deal of psychic energy. Individuals characterized as 'empaths' (in my personal and extensive professional experience) commonly have a history of complex or longitudinal trauma. That 'empath' learned early and the hard way that it was dangerous not to be aware of the emotional state of the important people in her life. The resulting habitual hypervigilance is mistakenly labeled as the characteristics of an 'empath' when it's actually safety-making behaviour. Selfish and oblivious individuals aren't helped by being labeled with a personality disorder when, ironically, this behaviour for such men is as much a safety-making behaviour as the women labeled 'empaths' (and for the same reasons). Instead of chronic hypervigilance making them sensitive to every emotional nuance in their orbit, rather they developed a wall which prevented anything from touching - and thus further wounding - Self. The unintended consequence is that in building this wall to protect Self the asshat learned to disregard/ignore his own internal state and by extension the emotional state of others. The result is entitled, oblivious, or self-centered behaviour. This often means for both the 'empath' and the 'narcissist' some form of trauma therapy - to process the reasons why those safety-making behaviours developed, and to develop the skills to navigate life without them - is the solution.

  2. Because it is impossible to end the stigma surrounding mental health when diagnoses are tossed around like bread crumbs for pigeons. Are some individuals more attuned to the moods/emotions of others? Can people (particularly women) accurately empathize, feeling the emotional state of others? Absolutely. Are they empaths? Nope. There is a significant difference between the verb and the noun. The latter is a statement of being and the former an action. 'Empath' is a mashup encompassing characteristics of Introverts, co-dependent individuals, the boundary-less and the traumatized. It is M A D E U P. Instead of recognizing that most of these characteristics resolve or cease to be a defining trait of an individual when the underlying issues are processed, rather we have collectively adopted a 'check box' label from a science-fiction show. Are some individuals such self-centered asshats they make life difficult for the people who love them? Absolutely. Do they have narcissistic traits? Almost certainly. They do not, however, have Narcissistic Personality Disorder. Are some people actual narcissists? Definitely. Are all those men who act selfish and hurtfully oblivious, narcissists? Nope. There is a significant difference between the verb and the noun. Along a continuum as individuals we all may manifest traits and features of almost any disorder depending on the circumstances. Does equal pathology? Not usually. Pathology is a matter of functioning and without meeting ALL the criteria of a specific disorder, a diagnosis is not offered.

  3. Because "Complementary dysfunctions get together."(Virginia Satir) In the case of supposed empaths and supposed narcissists, that translates into, "Caretakers end up with selfish asshats." And why is that, you ask? Because the former feel the need to care for others and the latter feel the need to be cared for, both accepting this dance as "connection." Ironically, the fix for the caretaker/asshat relationship dance is for the caretaker to care less and work to develop an internal sense of Self that is stable and robust, separate and distinct from all others. The fix for the selfish/difficult person is learn to care more, choosing to learn to how acknowledge his impact on others and to take responsibility for the ways in which he is entitled and/or hurtful.

When we measure and pigeonhole others, we act like Prometheus, forcing individuals into the 'bed' of our imagined mold, metaphorically chopping off the bits that don't fit. Someone may act selfishly without be a narcissist. One may be empathic without being an empath (particularly since this applies only to Deanna Troi of Star Trek). Probably more disturbing is the reality that real mental health diagnoses are bandied about willy-nilly, often with a laugh. As if Obsessive-Compulsive Disorder is merely counting stairs or habitually straightening pictures; or feeling blue this morning and excited this afternoon means one is Bipolar, or having more than one romantic partner in a short period of time means one has Borderline Personality Disorder, or feeling bummed this morning because one will miss the season opener of "Game of Thrones" is sufficient reason to moan, "I'm so depressed." The flip side of the careless use of real mental health disorders to describe individuals foibles or quirks is dismissing the real not-so-trivial suffering of individuals with mental health disorders such as Major Depressive Disorder or Generalized Anxiety Disorder - most of whom have experienced the callousness of the advice to "...just get over it.

People hide the state of their mental health because we, as a culture, still don't get it. As "Fast Facts" from the Canadian Mental Health Association indicate, we are ALL touched in some way by mental health. It is impossible to enjoy physical health if one is mentally ill. The reverse is also true - mental health is significantly impacted by physical illness. As a culture we need to stop gratuitous pigeon-holing while at the same time ignoring or dismissing those whose real life diagnosis has a profound impact on quality of life.

The trouble with diagnosing from our metaphorical (and sometimes literal) armchairs, is that when we categorize we also often separate individuals from the connection, support, and help they need to live well. Labels polarize. Let's stop throwing around labels from the comfort of our armchairs and listen to the individuals in our lives who could use some help and support with the realities of a diagnosis offered by a professional who has the training/expertise to make it.


More on this..

Empath - Real or myth?

Science behind Empaths & Empathy (Using science to support the contention that 'empath' is a thing)

The Mirror Neuron Revolution

Pitfalls of Brain Research

The Hype of Mirror Neurons, Empaths and Autism

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