‘He’s a narcissistic pervert’ she said. ‘And I should know; my mother was one too!’ Emilia was sober, while the rest of the guests were not. She had just announced to the assembled dinner party that her son had been threatening suicide over the last few weeks and refusing to see his father, Emilia’s ex-husband with whom she shares custody. It was not the moment to engage in a discussion regarding the social construction of mental illness. It was the moment to stop drinking.
Emilia has long described her ex as unreasonably inflexible and self-centred. She’s not the only divorcee who finds her ex-spouse’s behaviour nigh on impossible. When encountered, the ex-husband (of course) looks like an ordinarily quiet middle-aged man rather than a monstrous manipulator.
The next morning as the red wine receded, I pondered the effects of terming the ex’s difficult and perhaps abusive behaviour a case of ‘narcissistic perversion’. Perhaps it relieved Emilia of a sense of responsibility for the break-down of communication between her son and ex-husband? Drained by caring for her son, she had presented the psychiatric label as a total explanation of her complex situation, foreclosing any further discussion.
The arrival of forms of perversion or deviancy in the lexicon of medical diagnoses has allowed, for instance, alcoholism and persistent theft to be seen as illness rather than wickedness. This has, opened up the possibility of therapeutic intervention and attempts to ‘cure’ alcohol dependency and kleptomania among other ‘perversions’. The social and political uses of medicalised diagnoses of ‘deviancy’ have varied over time: a biomedical diagnosis can allow an otherwise unacceptable behaviour to be understood as beyond the individual’s volition, almost involuntary, and therefore in need of treatment. When a perversion becomes a psychiatric diagnosis, a claim is opened up for a medical response and to some extent an individual is held less morally responsible for their actions: a young person with conduct disorder or oppositional defiant disorder needs structured support rather than punishment. The attribution of responsibility and its dependence on diagnoses of mental state can have very high stakes: Anders Behring Breivik’s status as paranoid schizophrenic (and therefore legal insane), or as having a narcissistic personality disorder, possibly paranoid psychosis, but probably not schizophrenic and therefore legally sane, as certified by psychiatrists was widely reported earlier this year.
For Emilia, narcissistic personality disorder plays a key role in attributing responsibility for her unhappy tale, albeit of a different order from what happened in Oslo and on the island of Utøya in July 2011. Emilia’s assessment of her ex-husband as a perverted narcissist is based on remembering her mother’s diagnosis 20 years ago in France. Today her son’s psychiatric social worker is not interested in diagnosis, but rather in attending to the boy’s account of his unhappiness. Nonetheless, for Emilia, the term ‘perverted narcissist’ carries great weight in explaining her troubles, despite the diagnosis coming from her, rather than a psychiatrist.
Emilia’s current spouse, Rukhsana, does not take comfort in labelling the ex-husband a narcissist. For Rukhsana, an official-sounding diagnosis represents absolution of responsibility for the years of emotional upset that she has shared with Emilia. However it is Rukhsana, not Emilia, who is encouraging the son to maintain contact with his father.
If a diagnostic term helps Emilia to tolerate her former husband’s wrongdoings, while nonetheless campaigning against their effects on her son, then perhaps it is a useful technology. Its power though, seems to lie more in Emilia’s family history, than in psychiatric practice in her current context. Rukhsana has less use for medical terminology, but believes that families should maintain contact. This belief persists despite having been abused by members of her extended family, none of whom know that she is gay. No single diagnosis exists to explain the troubled complexities of Rukhsana’s experience of family life.
Details have been changed to conceal identities.