22Jun

Narcissism and Hell

Narcissistic Personality Disorder (NPD) has been described as “the last station on the train to hell” (Payson, The Wizard of Oz and Other Narcissists: Coping with the One-Way Relationship in Work, Love, and Family, (2002)). Some would go further: It is hell. Anyone who has dealt with a relative or friend afflicted with Narcissistic Personality Disorder (NPD) is aware of the damage done by these malignant people upon those around them. Very rarely do they have insight or any willingness to change.

The features of narcissistic Personality Disorder, according to the most recent
Diagnostic and Statistical Manual of Mental Disorders (DSM 5) include the following:

Significant impairments in personality functioning manifest by:
Impairments in self functioning (a or b):

Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

Impairments in interpersonal functioning (a or b):

Empathy: Impaired ability to recognize or identify with the

feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

Pathological personality traits in the following domain: 1. Antagonism, characterized by:

a. Grandiosity: Feelings of entitlement, either overt or covert;

self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.

b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

The central defect of narcissism is not putting oneself first, though this is a prominent feature of the disorder. The central defect is rather the wholesale embrace of a lie–the embrace and promotion of the “false self”, a distorted image which is protected ruthlessly. It should be noted, that the lie is first and foremost directed to oneself. The embrace of the lie is also at the root of the ill promulgated by narcissists.

A view from the inside can be found in this “letter from a narcissist’s true self” (available from an online forum at Psych Forums):

You can never get through to my true self because the lies I tell are nearly impenetrable. I have lied so often and for so long that I myself have come to believe my own lies. I am a walking lie. That is the truth.

Psychiatrist and famed author M. Scott Peck shocked many when he wrote, “I now know that Satan is real. I have met it.” He dealt with a subset of people with NPD in his book People of the Lie, in which he proposed that a certain subcategory of them be termed “evil”. He has related that one can define “evil” as “live” spelled backwards–“evil” is the opposite of “live”, or it is that which kills life.

Among the many tales in this book he recounted how a set of parents gave the grieving brother of a suicide victim a grisly present one Christmas–the very gun used in the suicide. They either didn’t care how this would affect him, or wanted to send him a message. For the most part in Peck’s encounters, evil people are of the banal sort, harming only those around them. They may appear normal, often even poised and highly successful. They go to church (and are often leaders there). But they can devastate the lives of those who are around them.

Whereas “God is love”, the malignant narcissist offers only a pretense of love. As Peck says:

Those who are evil are masters of disguise; they are not apt to wittingly disclose their true colors–either to others or to themselves. (p 104)
Because they are such experts at disguise, it is seldom possible to pinpoint the maliciousness of the evil. The disguise is usually impenetrable. (p 76).
Naturally, since it is designed to hide its opposite, the pretense chosen by the evil is most commonly the pretense of love. (p 106)

Victims of narcissism aren’t the only ones to taste Hell. The pain comes around to the person with NPD as well. Narcissism is a double edged sword. The lie is first directed at oneself. It is rare to hear a narcissist complain, but I did run across this post, from a self aware person with NPD:

Here is a comment from the other side. I have narcissistic personality disorder and have lost just about everything important. My adult children have distanced themselves. My wife has filed for divorce. Yes, I have screwed up just about everything. Fortunately, only 1% of the population has NPD. I wish I didn’t.
(From “Lament of a Lonely Narcissist” in a Psychology Today blog by Randi Kruger).

Among the pictures of Hell that have been proffered, one that intrigues me comes from Tim Keller:
We know how selfishness and self-absorption leads to piercing bitterness, nauseating envy, paralyzing anxiety, paranoid thoughts, and the mental denials and distortions that accompany them. Now ask the question” “What if when we die we don’t end, but spiritually our life extends on into eternity?”
Hell, then, is the trajectory of a soul, living a self-absorbed, self-centered life, going on and on forever. (Keller, Reason to Believe p.79)

May God free us from such a trajectory. Let us shun evil and embrace life. As Jesus taught: “I came that they might have life, and have it more abundantly”.

18Apr

Deception at Duke

It should not shock or surprise that an occasion of great malfeasance on the part of one may be the impetus to heroism in another. I was recently informed of a situation that shows both the darkness and light that resides within us.

First, let us examine the darkness. More tha 117 patients were enrolled in clinical trials at Duke University, conducted by Dr. Anil Potti. His work had offered the hope of using cDNA microarrays to individualize cancer treatments. Sadly, it has turned out that much of the work by Dr. Potti was falsified. After investigations by the Institute of Medicine, Potti’s collaborator, Dr. Joseph Nevins was forced to take a closer look at the data. CBS News reported in a “60 Minutes” segment:

Fearing that reality, Joseph Nevins, whose own reputation was at stake, reviewed the original data which had justified the clinical trials for 112 patients. Dr. Nevins discovered that when the underlying data disproved Dr. Potti’s theory, the data were changed.

Nevins: “It became clear that there was no explanation other than there was a manipulation. A manipulation of the data, a manipulation of somebody’s credentials and a manipulation of a lot of people’s trust.”

The bright spot in this story is the courage of a young man who stood up for the truth. In 2008 a medical student named Bradford Perez, who was doing research in Potti’s lab exposed these misdeeds in a report that he presented to administrators at Duke University Medical School. He decided to take his name off all papers published by Potti, and repeat his research year at Duke in a different lab. His concerns apparently were initially covered up, and it took two additional years before the clinical trials were halted.

An outside reviewer had high praise for Perez:

“The medical student was very brave,” said Arthur Caplan, director of the Division of Medical Ethics at the NYU Langone Medical Center, who was asked to review the materials cited in this story. “That was quite an act of courage.

“I have a feeling his lowly status made him someone that they would be able to hope would just go away,” Caplan said. “There was a little bit of don’t-let-the-door-hit-you-on-the-way-out.

“Perez can look at himself in the mirror. Every day. But he paid the price.”

You can read more about Anil Potti and Bradford Petez at Cancer Letter.

16Apr

The Icepick Cometh: A Case Study in Hubris

(Dr. Walter Freeman, left, and Dr. James W. Watts study an X ray before a psychosurgical operation, in public domain image by photographer Harry Ewing).

On a memorably pleasant spring day day some years ago I was privileged to be given a tour of an old mental health institution in the Midwest. The hulking and late Victorian era stone building (complete with mansard roof and turrets) looked like something straight out of a horror movie. Once housing thousands of patients, this facility is now home to little over a hundred severely mentally ill individuals, along with some offices and outpatient clinics. Most of the remaining space sits vacant, full of dust and memories. Of these memory-filled spaces perhaps the creepiest on the tour were the surgical suites, once used for a variety of “psychosurgeries”. The most popular and notorious of these was the prefrontal lobotomy.¹

The lobotomy is a prime example of the hubris of mid 20th century medicine. It is estimated that this technique was performed on over 40,000 Americans, mostly in the 1940s and 50s, although it persisted even into the late 1970s. A crude and imprecise surgery, the lobotomy had a high mortality rate, and caused such complications as seizures and behavior changes–it left many people drooling and docile. The procedure was sometimes performed by non-surgeons, and even by non-physicians. In that era of paternalism in medicine, informed consent was not always obtained. Often the procedure was done for what we would now say is no very good reason. A man named Howard Dully has the distinction of being among the youngest of patients to receive this procedure, when he was only twelve, essentially for being unruly and hostile toward his abusive stepmother. His story has been recounted in a book called My Lobotomy, and also in this article from The Guardian.

One aspect of the lobotomy story that has piqued my interest is the personal and professional rise and fall of the lobotomy’s most enthusiastic proponent, Dr. Walter Freeman. A Yale grad and University of Pennsylvania trained Neurologist, hailing from a prominent family, he was present at the 1930s international meeting where Portuguese Neurologist (and future Nobel Prize winner) Egas Moniz described the earliest cases of lobotomy performed on humans. Freeman soon modified the procedure so that the brain could be entered by hammering an ice pick into the medial aspect of the orbits. A natural showman, he toured the country in a van he called “the lobotomobile”; It is said that he performed 3500 lobotomies in his lifetime.

An Ohio physician, Dr. Wolfgang Baumgartel, later recounted to NPR his recollection of a 1956 visit by Walter Freeman to his facility:

As far as I remember, he probably did between 15 or 20 on that particular day. Dr. Freeman did not leave the operating room after each procedure — the patient went out, the next patient was ready to come in, had his procedure done, went out again, and then the next patient came in…

I remember that he was relaxed. He was very calm while he was operating. He made it look easy to do it. I think he had an extremely self-confident personality. He didn’t have any qualms. He wanted to prove that he was right, he was convinced that he was right. I thought, “How can a man be relaxed just going blindly into a brain ?!” But of course, I didn’t have the authority to say, “Stop that!”

Even in its heyday, the procedure was not without its detractors. His own partner, Dr. James Watts, disapproved of the new “icepick” procedure, and parted ways with him in 1950. Other physicians were appalled as well. As the Wall Street Journal reported: In 1948, one senior VA psychiatrist wrote a memo mocking Dr. Freeman for using lobotomies to treat “practically everything from delinquency to a pain in the neck.”

Dr. Freeman could be reckless. Elizabeth Day wrote, He had a buccaneering disregard for the usual medical formalities – he chewed gum while he operated and displayed impatience with what he called ‘all that germ crap’, routinely failing to sterilise his hands or wear rubber gloves.

From the earlier cited WSJ article: One patient in Iowa in 1951 died when the doctor chose an inopportune moment to stop for a photo and the surgical instrument penetrated too far into the patient’s brain, Freeman biographer Jack El-Hai wrote.

Freeman famously lobotomized Rosemary Kennedy, leaving her in a permanently infantile state. According to Lisa Waller Rogers, lobotomized patients often had to be retaught how to eat and use a toilet.

Although the discovery of Thorazine and a growing public horror of the effects of the procedure pushed the lobotomy out of vogue, Walter Freeman continued to perform them. Jack El-Hai states:

He refused to stop his support of lobotomy when common sense and medical expediency demanded that he do so. His stubborn advocacy of lobotomy during the 1950s and 1960s, and the many patients who were drawn in by his championing of the procedure, is a large part of the tragedy of the first era of psychosurgery.
(Jack El-Hai (2008), p. 138)

His personal life unravelled in tandem with his professional life, or perhaps drove his strange zeal. It is reported that he had a terrible relationship with his mother, and his marriage was troubled as well. Youngson and Schott related the following in an article for The Independent:

All emotion, all anger, and the blind, black rage that many suspected was within Freeman were turned inwards, and when they emerged, it was in strange and grotesque fashion. … Twelve years earlier, Freeman had experienced a nervous breakdown, brought on by overwork. He had been particularly scared by this experience, and ever since had taken at least three capsules of Nembutal every night to guarantee sleep. Nembutal also gave him a dreamless sleep. Freeman did not like his dreams.

Dr. Freeman was forced to retire in 1967, when his last patient died of a brain hemorrhage, and he was banned from operating. He had already become a bit of a pariah in the medical community, operating out of a private clinic because he had been pushed out of the hospitals. He remained defensive, writing bitter limericks about his professional enemies. His last years were spent touring the country on a quest to interview his former patients and revive his legacy. He died of cancer in 1972.

I used the word hubris” earlier, which well fits the good doctor Freeman’s refusal to turn aside from the procedure he loved. As the Good Book says: “Pride goeth before a fall.”

For further reading:

Mashour, Walker, and Martuza. “Psychosurgery: Past, Present, and Future”, Brain Research Reviews, 45 (2005): pp 409-419; Accessed online at Stanford University site.
Elizabeth Day (2008), “He was bad, so they put an ice pick in his brain…” accessed online at theguardian.com.
“Top Ten Fascinating and Notable Lobotomies”, at listverse.
NPR, “Walter Freeman’s Lobotomies: An Oral History”; accessed online at http://www.npr.org/templates/story/story.php?storyId=5014594.
Wall Street Journal, “The Lobotomy Files”, accessed at http://projects.wsj.com/lobotomyfiles/?ch=two.
Jack El-Hai, “Lessons of the First Era of Psychosurgery.” Clinical Neurosurgery, 55 (2008): 138-139, online here.
Youngson and Schott, (1996) “Adventures With an Ice Pick”, in The Independent, available online here.

^1. In my remembrance, although the lights were off and the doors locked, these suites appeared sterile, clean, and stocked; They seemed almost as if they had just been closed up for the day, rather than abandoned decades ago. They gave an eerie impression of being ready to go back into service if needed by a new crop of doctors.

10Apr

It isn’t only the VA…

It appears that the British health system and the U.S. Veterans Administration, have been plagued with the same kind of institutional corruption. The venerable New England Journal of Medicine printed an editorial entitled “Scandal as a sentinel event: Recognizing Hidden Cost–Quality Trade-offs.”

A government-commissioned inquiry by Sir Robert Francis revealed how these circumstances combined to create a major health care scandal.4 Francis’s report describes how Mid-Staffordshire’s leaders imposed cuts without assessing risks, then intimidated staff into suppressing their concerns. Overwhelmed clinicians, Francis concluded, couldn’t remain conscientious and still keep up. Receptionists performed emergency department triage. Meals were left out of reach of bedridden patients. Drug doses were missed. Incontinent patients weren’t cleaned. And impossibility engendered emotional disconnection. One physician told Francis, “What happens is you become immune to the sound of pain” — or “you walk away. You cannot . . . continue to want to do the best you possibly can when the system says no to you.”

Meanwhile, management insisted that NHS performance targets be met, punishing breaches even when compliance did more harm than good. Emergency department nurses told of delaying the start of antibiotics, pain medication, and other needed treatment to attend to less-needy patients within the 4-hour wait-time limit. Staff who missed targets feared being fired. This fear, Francis found, led to premature discharges and falsification of records.

caregivers will move from frustration to insensitivity to corruption when put in an impossible bind between demands for frugality and demands for excellence.

A bit further on we get to the really interesting quote:

“There’s a defined pot of money,” Francis told me last year. “But there’s a public expectation — there’s also a professional expectation — I should be allowed to do everything that’s in my patient’s interest . . . . Politicians promise the same. When that doesn’t work, it’s the fault of the [institution’s] leadership.” The result is a “toxic atmosphere” that “prevents those who are running the show from telling the truth” — and signals caregivers to keep quiet.

This analysis doesn’t let clinicians off the hook for dishonesty or neglect. But it underscores that these scandals are sentinel events — indicators of the risk that caregivers will move from frustration to insensitivity to corruption when put in an impossible bind between demands for frugality and demands for excellence.

Filed under “Reflections of the Fall”.

21Feb

Reflections on the Selfie Stick

(photo by “R4vi” from London, UK, obtained from Wikimedia Commons and used in accordance with Creative Commons 2.0 license)

“Would you like me to take a picture for you?” I asked a group of 20 somethings, who seemed to be struggling to get a picture. I was at the Grand Canyon, snapping photos with my family. “No thanks,” one replied, “we’ve got a selfie stick.”

At every turnout, the magnificent colors and jagged contours of the canyon were a backdrop for people who seemed to be standing, alone or in groups, wielding their telescopic wands with smartphones stuck on the end. It looks goofy to my old fashioned eyes (I still lug a cumbersome DSLR around when I go to places like the Grand Canyon). But I must grant that it is simple and effective. It’s a brilliant invention. I will probably own one at some point.

The selfie stick has exploded in popularity in the past couple years. “Invented” in 2014 (though similar devices date from many years ago), it is now ubiquitous. The selfie is ubiquitous. According to Travel Weekly, 300 million selfies have been uploaded to Instagram as of June 2015. Never has snapping a pic of yourself been easier.

And just like that, one more way of interacting with others is gone. No one needs an outside person to stop and do an act of kindness–“no thank you, we have a selfie stick.”

As a society this may be seen as emblematic of a fundamental problem with our growing addiction to mobile technology: as individuals we are self absorbed (these tools have apparently been dubbed “narcissticks” according to this New York Times editorial), and some would say that we now have a “selfie culture”. Technology has allowed us to become increasingly disengaged from others, even as ironically we are addicted to the facebook posts and Twitter feeds of countless “friends” scattered across the globe. Unless we fight it, our focus is ever drawn down into our devices, into an endless reverberation of our own likes, thoughts, and desires.

By the way, I mean it when I say “we”–I am no cyber saint here. I must cry “mea culpa” as well: I take selfies. I have had dates with my wife in which I can’t resist the urge to get out my iPhone–and that isn’t because she is not lovely and interesting (she is!). My own kids tend to spend most of their vacation days looking at their devices regardless of how breathtaking the scenery around them may be.

If this self absorption is a problem, it is not new. Self-centeredness is a primordial element of the human story (recall the tale of that wretched apple seized by a man who wanted God’s knowledge for himself). The selfie is but a new and more democratic iteration of the time honored self portrait, or the bust, or the thrill of being on-stage. Although, given its intentional impermanence and nonchalance, it might be more accurate to say that the selfie is reminiscent more of “Kilroy was here”, scratched on pixels rather than walls (variants of this sort of thing can be found in antiquity). It is humans saying, “look! I was here! I matter!”

This brings suddenly to my recollection the fallen statue of King Ozymandias, whose decaying selfie was powerfully memorialized by poet Percy Bysshe Shelley:

I met a traveller from an antique land
Who said: `Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies, whose frown,
And wrinkled lip, and sneer of cold command,
Tell that its sculptor well those passions read
Which yet survive, stamped on these lifeless things,
The hand that mocked them and the heart that fed.
And on the pedestal these words appear —
“My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!”
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.’

Most of us (fortunately) aren’t tyrants. We know that our selfies are destined for nowhere glorious. Our “friends” will glance past them in a microsecond, or maybe linger long enough to click the “like” button. If really fortunate maybe someone will pause and comment, perhaps just to say, “OMG I was at the Canyon a week ago!” Then they will move on. It will take seconds, not centuries, for the significance of the selfie moment to fade. We know this but can’t resist the urge to keep doing it. It is the way of the self absorbed. It is our way. “Look, I was here. I matter!”

This is why Christians have a story to tell. Have you become a Christian? Have you been adopted into God’s family? If so, you matter, because you have God as an audience. When you become a Christian, your cosmic portrait will never fade. Unlike your snapshot of yourself against the Grand Canyon, you won’t disappear from God’s in-basket in a few minutes. Your name won’t be blotted from the great Book of Life.

But, the next time you are at the Grand Canyon or Niagara Falls or wherever, if you see a handsome bearded 40-something with a charming family approach you at a scenic overlook, don’t run. Instead take pity on us and agree to snap our picture. I’ll show you how my clunky DSLR camera works.

03Feb

Alberta Embraces Gender Identity Craziness

The new socialist government in Alberta, Canada has put forth new “guidelines” (really mandates) on gender identity that must be enforced in all schools. Rules include gender neutral speech codes, and insist that children have the right to decide their own gender identity, and which washroom to use. The mandates are binding upon all schools, including (apparently) church run parochial schools. Boards that don’t comply could be dissolved by the ruling government.
(The guidelines can be read in entirety here).

The bishop of Calgary did not mince words with his reaction to this, as posted below. Let’s hope and pray that our Canadian brethren can successfully fight back against this madness.

Calgary’s Roman Catholic bishop has denounced as “totalitarian” and “anti-Catholic” the province’s new guidelines for respecting students’ gender identity.

“This approach and directive smack of the madness of relativism and the forceful imposition of a particular narrow-minded anti-Catholic ideology,” Bishop Fred Henry wrote in a blog post on the website of the Catholic diocese of Calgary.

“Such a totalitarian approach is not in accordance with [Canadian law] and must be rejected,” he added, in a post titled “Totalitarianism in Alberta.”

(Read more at CBC News)

28Jan

An Inglorious Death

I was sad to read of a Detroit motorist who went out of life in a rather inglorious way. The 56 year old man died as his car flipped and partially ejected him through his sunroof; he was found to be not wearing pants and had been watching porn on his phone. Naturally this has reverberated around the web with poor taste puns like “this man was really beating traffic”. For reasons of respect, I omit the driver’s name. More can be found at various news outlets, including Detroit Free Press.

Aside from one obvious conclusion–don’t drive while watching porn–it struck me that for many, death is inglorious in a more cosmic sense. No matter how dignified our deaths may seem to fellow mortals, unless we are clothed with the white robes given by Christ, we will all be found pants-less and ashamed before the throne of God.

26Jan

Travesty in Houston

The sad tale of aborted fetuses for sale has taken another wicked turn. A grand jury acquitted Planned Parenthood and decided to go after the activists who exposed them.

HOUSTON — A grand jury here that was investigating accusations of misconduct against Planned Parenthood has instead indicted two abortion opponents who made undercover videos of the organization.

Religious Violence

The old adage “Man is wolf to man” was gruesomely punctuated last week by terrorist attacks in France and elsewhere. It is especially disturbing when such beastliness is performed in the name of religion. Of course Christians are right to condemn such attacks, but we have to address our own credibility problem on this issue. When nonbelievers look in from outside, they don’t distinguish between the Islamic call to Jihad, and the Crusades.

Logically, most “Christian” violence can be dealt with fairly easily by noting that the perpetrators were failing to live up to the tenets of their own faith. The prescription for this is better faith, not less faith.

A harder issue, and one which has come up for me recently in discussions with fellow Christians, is the violence that appears to be sanctioned in the Old Testament.

We have addressed this in our Q and A section: “Christians believe that God is good, and yet why did God order the slaughter of all Canaanites? Isn’t that a contradiction? Isn’t killing the Canaanites a violation of God’s own Law in the Ten Commandments?”

23Oct

When a Church Goes Bad–Abuse at Word of Life Church

Several stories have recently outlined a chilling culture of abuse that had developed at the Word of Life Christian Church in upstate New York. 19 year old Lucas Leonard was beaten to death during a “counseling session” because he was planning to leave the church. His 17 year old brother, Christopher, was also beaten and had to be hospitalized. The boy’s parents and several church members were present and took part in the beatings. Witnesses have described the boy’s mother whipping him with a black cord.

A picture has emerged of a church that was secretive, whose pastor had become paranoid and controlling, driving away many members. Today’s New York Times describes it as a “lethal sect”. Apparently it was not always so. Somewhere along the way an ordinary church took a dark turn.

ALBANY, N.Y. (AP) — Former members of the upstate New York church where two teens were viciously beaten paint a picture of a once vibrant and joyous house of worship that declined into a place of fear and intimidation under new leadership.

“When I first arrived, it was warm and welcoming. It was encouraging. It was helpful,” said Chadwick Handville, a massage therapist in Phoenix, Arizona, who left the Word of Life Christian Church in June 2000 after 10 years that included a stint as a worship leader and trustee. Things went downhill after founder Jerry Irwin returned from some time away and reclaimed his position as pastor, Handville said. (from Yahoo News).

Brother James’ Airs

Category: Reflections of the Fall