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.
I don’t know whether the phrase is still in current use, but when I was a young man, people used to say, “He thinks the world owes him a living.” It was highly pejorative and usually said in a tone of irritation. We tend to dislike people who convey a sense of entitlement, in part because they implicitly place themselves above everyone else, as if different standards should apply to them. They may come across as condescending or patronizing; they may feel and express contempt for other people, as if they consider themselves to be superior. They often expect to be taken care of financially and behave in exploitative ways in their relationships.
In my experience, these people have a very limited ability to tolerate frustration; they have trouble sustaining hard work over time and may become enraged when they must take a job or even undertake an onerous chore. As a result, their academic and work histories are inconsistent: they tend to drop out of school, have a hard time holding onto a job and accrue excessive debt because they hate the limitations of reality and spend beyond their means. Behind such behavior lies an unconscious expectation that life should be perfect and ideal, where frustration never occurs and no effort is required to meet one’s needs: the objects of our wishes and desires will simply come to us whenever we want them. Many people with apparently different emotional difficulties harbor such an unconscious wish.
When the expectation is strong but meets with frustration, the response is often narcissistic rage — whether in Narcissistic Personality Disorder, Bipolar Disorder, Borderline Personality or any other superficially discrete category of diagnosis. The person may spew venom at a friend or relation; she may become violent, either destroying objects in her environment or launching a physical assault on someone nearby; he may seek to belittle or destroy someone whom he envies. In these cases, the element of rage is obvious, on the surface.
Sometimes it’s less easy to detect. A person in manic flight may not appear to be enraged but nonetheless expresses hatred for the frustrating limitations of reality by defying them — going on a spending spree; attempting to do something all at once (rather than slowly over time) in order to get the desired benefit right now; behaving in omnipotent ways, as if they held magic powers, because they hate the demands of hard work. In other words, I’m suggesting that most manic episodes in part reflect a hatred of and narcissistic rage against the frustrations of reality.
Behind this hatred lie profound feelings of shame and a sense of psychic damage; manic flight also represents an attempt to cure an internal problem by magic when it is felt to be hopelessly beyond repair.
Finding Your Own Way:
My goal here is to replace the illusion of discrete diagnostic categories constantly promoted by the medical profession and our media and instead to encourage an understanding of common psychological dynamics. In my experience, this feeling of entitlement and the narcissistic rage that goes with it is not uncommon. Can you identify with any of these feelings? I certainly can. In the sticky heat yesterday, as I was mowing the lawn when I had other work I preferred to do, Narcissistic Joe (or maybe Borderline Joe?) was raging. Who exactly did I think I was, that I shouldn’t have to mow my own lawn and should be able to do whatever I wanted instead? Maybe you’ve got a borderline inside of you, too.
Take a look at your friends and family. I’m sure there are people whose life arc you can explain in these terms: people who can’t seem to follow through because they expect life to be much easier and less frustrating than it actually is, who sometimes get very angry when things don’t go their way. If you wanted, you might even be able to assign them a diagnostic label. Physicians and psychiatrists do it all the time, handing out prescriptions that temporarily alleviate symptoms but never address the underlying emotional dynamics.
Don’t think “Narcissistic Personality Disorder”; think about unbearable shame and difficulties in tolerating frustration.
Don’t think “Bipolar Disorder”; consider the expression of rage against limitations that characterizes manic flight.
Don’t think “Borderline Personality Disorder”; look for the sense of entitlement in any of the people you may know.