Narcissistic Rage and the Sense of Entitlement

While the manic phase in what is commonly known as ‘bipolar disorder’ usually involves manic flight into grandiose fantasy and impulsive behavior, on occasion it leads to rage, violence, suicide and even murder.  The DSM-IV refers to this as “dysphoric mania” or a mixed state, where manic and depressive symptoms occur simultaneously.  Outbursts of rage also occur in other disorders:  they feature in Intermittent Explosive Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder and various types of narcissistic behavior; anyone dominated by feelings of shame may be prone to occasional outbursts of rage, which are often an intense form of blaming, one of the primary defenses against shame.  While the DSM-IV defines these disorders as unique categories of mental illness, with individual diagnosis codes, they actually exist along a spectrum and have much in common.  Most of the clients I’ve seen who demonstrated features of Borderline Personality Disorder or presented with Bipolar Disorder symptoms also displayed features of narcissistic behavior, often involving outbursts of rage.

In other posts, I’ve talked about the function of hatred and anger as a kind of psychic glue in the face of disintegration anxiety; I’ve tried to make room for the idea that rage, as destructive as its external effects may be, sometimes serves a positive psychic function when the alternative is the terror of a kind of psychic death.  Likewise, rage may function as a defense against shame that feels unbearable.  These two are connected:  shame, as I discussed in my early post on basic or toxic shame, is the emotional expression of our sense that we are damaged; that sense of damage can mean that the self is felt to be in pieces, in danger of collapse.  Hatred, anger and rage serve a defensive and cohesive function for these conditions, especially when there has been a narcissistic injury to one’s sense of self that stirs up unbearable shame.

Narcissistic rage may also express a frustrated sense of entitlement, by which I mean the feeling that one has a right to be given something which others believe should be obtained through effort, and unrealistic expectations of favorable treatment or automatic compliance with one’s expectations.  While this is a characteristic feature of Narcissistic Personality Disorder, I’ve seen it in every borderline client I’ve treated, and in many clients with Bipolar Disorder symptoms, as well.  A sense of entitlement reflects an inflated view of one’s own importance and rights, which features intermittently  in many psychological states of mind.  No doubt you’ve known people who express this sense of entitlement, whether or not they fit into any of the diagnostic categories with which we’ve all become familiar.

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The Role of Helplessness in PTSD Symptoms and Other Disorders

As you may know, many people who experience traumatic events do not subsequently develop post-traumatic stress disorder (PTSD).  One of the determining factors seems to be the feeling of extreme helplessness at the time the trauma occurred:  people who don’t feel helpless are able to process the experience in their usual way.  In language I’ve used elsewhere on this site, they are better able to “contain” their experience.  When someone is overtaken unaware by a traumatic event, however, they can’t rely on their usual resources to process or contain the flood of fear, anxiety, pain, etc. aroused by the event.  To protect itself from this overwhelming experience, the mind erects a barrier against the memory, segregating it from other memories and emotions in a process of defense against it.  The defense fails as the memory can’t be entirely excluded but continues to exert an extremely powerful effect.  The paradoxical result of this effort to ward off an overwhelming experience is to give it a lasting power to cause pain.

It was Sigmund Freud and Josef Breuer, of course, who first theorized about the power of unintegrated traumatic memories.  In their Studies on Hysteria (1895), the authors presented a theory that women who exhibited conversion (hysterical) symptoms suffered from “reminiscences” or memories — and in particular, memories of childhood sexual abuse.  They believed that these memories retained a lasting effect because, at the time the trauma occurred, these children were helpless and unable to protect themselves from the assault or react to it in a normal fashion.  As a result, the memory of that traumatic experience becomes walled off, segregated from other experiences and memories; it “acts like a foreign body” in the mind because it hasn’t been subjected to normal mental processing like other experiences (p. 6).

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“Psychiatric Meds Are Like Insulin for Diabetes” (Big Lie #3)

In Part One of my discussion of Robert Whitaker’s Anatomy of an Epidemic, we learned that there is no  scientific basis for the theory that mental illness results from an imbalance in brain chemistry; Part Two showed how, in the main, patients who were never given psychiatric meds have far better outcomes than people exposed early on to such drugs.  In this third and final part, I’ll discuss what these medications actually do to your brain chemistry and why they lead to a worse prognosis in the long run.

In order to understand these processes, we need a bit of basic neurology.  I’ll try to keep it simple.  As you probably know, the brain is made up of billions of neurons; each one of these neurons is connected to many other neurons.  Messages travel along the neurons, to and from the brain, moving from one neuron to another across a tiny gap called a neural synapse or the synaptic cleft.  One neuron releases a chemical messenger  called a neurotransmitter into the synapse; the molecule then travels across that tiny gap and bonds to the next neuron on the other side, thereby delivering its message.  The message subsequently continues along this second neuron until the next synapse, and so on.  Here’s a diagram of a typical neural synapse; you can ignore most of the labels:


So the message travels down the yellow neuron, releasing neurotransmitters into the synaptic cleft.  On the other side, the green neuron has receptors (the red ovals) where the neurotransmitter bonds, thereby sending  a message which then travels down the green neuron to the next synapse, and so on.  After the message has been sent, the neurotransmitter is released from the receptor back into the synapse where one of two things occurs:  either another chemical agent, an enzyme, goes to work on the neurotransmitter and dissolves it, or the (yellow) neuron re-absorbs it for later use.

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The Misuses of Sexual Excitement

In an early post on neediness, I discussed some psychological strategies people use when they can’t bear the experience of dependency.  Denial of need, a delusion of self-sufficiency or a fantasized merger with the object of need are some of the ways to avoid feeling separate and dependent.  When it comes to our sex life, an intensified kind of excitement is another.  By relating to sex partners in an almost pornographic way, where a stereotyped excitement replaces particular desire for a specific person, one treats other people as if they were interchangeable and therefore easily replaced.  I’m not dependent on you as my particular object of desire because I can easily find someone else to make me feel exactly the same way.

So-called “sex addicts” use this defense, although I object to the way our culture has adapted the language of addiction to describe virtually everything, including an absurd “addiction to self-esteem,” as I described in an earlier post.  This kind of sex may indeed function as a heady drug, sometimes warding off depression, but describing the behavior as an addiction tells us nothing about its defensive function; it shifts our subject to the biological realm of medical syndromes and cures, deleting meaning in the process.  Men and women with serial partners seek the heated thrill of a completely new sexual encounter in order to avoid true intimacy, especially the feelings of need and dependency that go with it.  They may idealize those sex partners for a brief time, but once the excitement begins to wane, the sex addict devalues the other person and moves on, as I discussed in my post on love junkies.

Fetishism can work in a similar but more stable way.  By reducing the sexual relationship to one of body parts (e.g., a foot) instead of whole people, the fetishist depersonalizes the individual.  I don’t desire you as a complete person; it’s your foot that gets me going … and other people’s feet, as well. Stereotyped fantasies of a fetishistic nature can work in the same way.  There’s usually an important unconscious meaning to these fantasies that must be understood, but in addition, they replace personal and intimate desire with an excited fantasy that predates the relationship and will continue after it’s over.  I’ve had
clients, both men and women, who consistently wanted to be degraded in a sexual manner, across their relationships and with no particular reference to their partners. All of these individuals had difficulty sustaining those relationships once they became aware of feeling needy and vulnerable.

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The Cycle of Crime and Punishment in Psychotherapy

I’m sure my fellow psychotherapists have had this same experience:  a client comes into session after having done or said something that they previously vowed not to do, or which they feel somehow damages them; they are burdened with horrible guilt.  Maybe she was trying hard not to use drugs and slipped the night before, or maybe he slept with his old girlfriend even though he knows she’s bad for him.  It could be something as simple as going off a diet.  During session, they go on about how guilty they feel and spend a lot of time berating themselves in a punitive way.  As therapists, we may try to help them understand the reasons for their behavior, or make a connection to some emotional stress that played a role.  We may feel compassion for their suffering, bringing real insight to their psychological and emotional motivations.  Several weeks later, they repeat the same behavior and return to session in the same guilty and self-punitive mindset, as if the previous session had never taken place.

My own therapist referred to this as “the cycle of crime and punishment.”  I find it a very useful concept that helps to explain why some clients don’t benefit from insight and understanding.  It’s as if they view their backsliding as a crime that must be severely punished in a self-flagellating way; once they have undergone said punishment, however, they feel that they’ve expunged all guilt for their crime and regard the subject as closed, in the past.  It is exactly analogous to our penal system, which inflicts punishment on those who commit crimes but regards them as completely free once they have paid their debt to society. The psychological cycle of crime and punishment prevents people from learning from their experience and condemns them to repeat the past, just as the over-emphasis on retribution (as opposed to rehabilitation) in our penal system does little to help incarcerated criminals avoid returning to a life of crime after their release.

Such clients are trapped in their cycle of crime and punishment because they don’t know how to learn from their experience.  They usually come from extremely impoverished backgrounds.  You might think the parents would have been harsh and perfectionistic, and sometimes this is the case; often it’s simply that they have few psychological resources and little to pass along in the way of wisdom or emotional capacity.  They generally model primitive reactions to turmoil — rage, denial, projection, etc. — and the emotional environment feels dangerously confusing to their children.  For some people who come from such families, a harsh, exacting conscience pulls them out of the chaos, painting some very black-and-white lines in order to alleviate the confusion about what’s good and what’s bad in their world.  Sometimes they can be sharply moralistic because it is their “morality” that saves them from the mess of their childhood.

While this kind of morality has its emotional survival value, people burdened with it lack the genuine capacity to bear with and understand their own experience.  They only know how to condemn it, keeping it under lock and key.  Eventually, under extreme pressure, the forbidden impulse slips out:  crime inevitably leads to punishment.  I think you can see how Catholicism might complicate this picture.  With its system of sins and penance, that religion leaves little room for an understanding of the emotional factors that might lead people to “sin” and simply specifies the means to atone for those sins, regarded as inevitable.

In working with such clients, it’s crucial to help them see and understand this dynamic.  They need to see how they allow themselves only two options:  complete success or utter failure.  No gray areas, no step-by-step growth.  That’s actually the easier part.  Then the work must help them to develop the capacity to learn from experience.  As that’s a rather large subject in itself, I’ll save it for another post.

Finding Your Own Way:

Are you the sort of person who beats yourself up when you make a mistake or slip in some way?  Do you find yourself getting extremely angry with yourself for things you do but then committing the same “crimes” again and again?  Examine your system of personal expectations.  You might find that your particular standards reflect very little understanding of the psychological and emotional reasons for doing what you do.  You probably expect yourself simply to “be different” or “stop behaving that way.”  Even if you do have some insight and understanding, you may have no idea how to make use of it; you may simply expect that insight = change and you’re a failure if it doesn’t.

As I’ve discussed in my piece on self-criticism, this kind of conscience reflects an expectation that one shouldn’t have to struggle in order to learn and grow.  To break free of this cycle, you’ll need (for starters) to confront your unrealistic expectations and come to terms with the difficulty of genuine growth. While it’s painful to suffer from this kind of self-punishment, it’s also extremely difficult to take small steps, to recognize and value little changes along the way.  It may take years to grow the kind of emotional capacity you need, possibly in therapy.  Instead, you may simply insist that you “get over” your problem rather than growing slowly and imperfectly over time.

Think again about the penal system analogy.  It’s not enough to do your time; you have to develop some new skills in there or you’ll simply repeat the same crimes once you’ve paid off your debt to society.