BEING IN RELATIONSHIP WITH A narcissist

 BEING IN RELATIONSHIP WITH A NARCISSIST

Reflective Paper

By

Pavan M Srivatsa

Founder – Chakshu Foundation,

Consulting Psychologist 

How the room looks like

The four pillars of narcissistic people are – 

1. Lack of empathy

2. Grandiosity

3. Sense of entitlement

4. Seeking admiration and validation.

The roof under which they live is – lack of self-esteem.

The windows of deep relationship attachment are closed completely with lack of light of empathy. 

The door of acceptance is closed and are locked with multiple locks.

Outside painting of this room is so colourful – meaning, the nar projects oneself to be innocent and great but, victim and gains sympathy.

The floor is filled with sharp nails and glass pieces that prick your feet but the nar knows where there is a proper flooring and keeps the leg there and there only. 

Charm and intelligence-coloured light bulbs change their colours gradually to lack of compassion, one way communication, lying and being judgemental – wanting the power to make every decision and thereby putting others in bad light. 

Victims often feel unheard, not being noticed, being criticised, wrongly judged, picked on negative traits only, rejected. The victim runs out of hope because, they are being treated hopelessly by the narcissistic partner. The nar partner installs balloons of hope and burst it when the other person starts believing the nar. These balloons used to decorate the room is conditional – as in, the nar will decorate the room with balloons of hope and happiness if and only if things are going according to the nar’s expectation only. 

Nar plays the role of being a prince. If not, he turns to a beast and becomes abusive – in most cases, verbally and emotionally. 

Nar imposes and assigns rules and roles to be played to fulfill the nar’s expectations. The opinions and needs of person/ people in relationship with a nar is never heard or understood or considered. 

Pleasing the nar is next to impossible which makes the other people give up hope on relationship. This make re – rendering of hope is impossible. When calling off the relationship, the nar uses the victim card to make the others in relationship feel more guilty, more hopeless and more worthless than staying in the relationship. 

The partner needs to build up on one’s own identity, skills and social circle to make sure that their future is secure, present is safe and thereby develop oneself – go through to grow through shift in attitude rather than denial of what has happened to them because of staying in relationship with a nar. The impact of being in relationship with nar makes you perceive everyone to be nar or conditionally staying with you. This further makes the person feel emotionally exhausted and their social battery drains quickly because, the nar’s shadow is being carried everywhere you go. 

Pleasing a nar is difficult. Your efforts went in vain. That doesn’t mean that your efforts go in vain everywhere with everyone. Your efforts give results on the outside. This is because of faulty generalisation.

HISTORY

Male aged about 53 years walks in to the OPD with complaints of acute gastritis and chest pain. He meets the Physician seeking medical help. He was advised for the following investigation as the physician suspected cardiac arrest.

1.     Echocardiogram

2.     2 – D Echo – heart and

3.     2 – D Echo – abdomen.

Reports read that his heart was healthy and functional. While his 2 – D echo abdomen reports read acidic reflex. He was prescribed appropriate medication by the same physician.

During his second visit to the hospital, he came up with two more symptoms added to his previous set of complaints which include frequent nausea and irritable bowel movement. He was assessed again and the reports were compared. The comparison reports made the physician understand that the patient was into irritable bowel syndrome – IBS and was prescribed medications for the same. Physician suggested the patient to meet a psychologist to take further treatment and specified to the patient that his mental health condition was not in the state of equilibrium as a result of which he had been facing the issues. The patient neglected the doctor’s advice.

 

 

 

VISIT TO THE THERAPIST

The patient calls CCPC founder Pavan M Srivatsa to book an appointment as per the advice of the physicians he consulted (as many as 12 physicians, gastrointestinal specialists and cardiology specialists in the span of 3 months). He, in the first call specified that he had been taking prescribed medication which includes “lyster 0.5mg” (PSEUDO NAME) for his sleep.

 

 

SOCIO DEMOGRAPHIC DATA

AGE: 53 YEAR

GENDER: MALE

MARITAL STATUS: MARRIED

FAMILY: WIFE, PARENTS AND A DAUGHTER

OCCUPATION: MANAGER – FINANCE @ PVT. LTD.

 

 

PRESENTING COMPLAINTS

1.     Irritability since 1 year.

2.     Disturbed sleep since 1 year.

3.     Nightmares since 5 months.

4.     Aggression and inability to express it because of the family situation since 3+ years.

5.     Work stress since 5 years.

6.     Excessive worrying about his daughter since 4 years.

7.     Inability to handle home situation because of 3 generation population under the same roof since 7 years.

8.     Irregular food habits since 1 year.

9.     Excessive worrying about personal health due to pandemic and otherwise since 5 years.

10.   Pain in the chest since about 1 year.

11.   Irritation in the stomach and chest since 2 years increased since about 5 months.

12.   Shivering since 3 weeks.

13.   Excessive medication since 2 years.

14.   Hypertension and hypothyroidism since 12 years and 2 months

 

 

HISTORY OF PRESENTING COMPLAINTS

            Client explained that he had been visiting doctors for proper medication and satisfactory treatment for his hypertension and hypothyroidism since the day he was diagnosed (since 12 years and 2 months). He explained that he had visited homeopathy, Ayurveda and allopathy for treatment while his health has been worsening over a period of time. On probing it was understood that he had been irregular with his medication as he was not convinced with the treatment plan. He added to it that he had been changing doctors frequently as he thought that the doctors were not understanding him properly. “The doctors saw me as a patient with those problems and never saw me as a human being. They labelled me as a mentally ill person and asked me to visit mental health care hospitals.”

            On probing it was evident that he had considered taking help from mental health care hospitals. On probing, he explained that he had visited the following mental health care hospitals for treatment. Which include:

1.     NIMHANS, Bangalore.

2.     St. John’s Hospital, Bangalore.

3.     Manipal, Udupi.

4.     Metro hospital, Shimoga.

5.     Dr. Sridhar Hospital, Shimoga.

 

“Treatments were not up to my expectations. They only prescribed medication. Also, they asked me to visit them frequently (2 months once on an average) which was not possible. So, I gave up on medications too. Now, I don’t know whom to consult and what treatment to take.” the client said. On probing, the client explained about the medications he had been taking presently. He also explained that his thyroid and hypertension are under control because of the medicines. He added to it that his sleep is better because of the medicine “lyster 0.5mg” and would worsen if he has no “lyster” in his daily medicine. He also explained about his past history.

 

            He started with his experience as an adolescent. He was angry and sad when he was talking about the situation where his friends committed suicide – hanging himself as he was mentally ill. “I started smoking cigarettes after this incident. I don’t know why I started it. I was addicted to smoking. I used to smoke at least a pack a day. I had to quit smoking after my marriage was settled. Because, I didn’t want my wife to call me a smoker.”

He continued saying that he was not able to cope up with the withdrawal symptoms (anger, palpitation and muscle tension) and had started smoking again after confessing it in front of his family (mother, father and wife). “I smoke about 12 cigarettes a day. To be honest with you, when I hear my family members fighting, I feel like smoking cigarettes. (puts his head down)”

            Client got married when he was 25 years old (as per the norms of his culture) and is having a satisfactory relationship with his wife. He explained that his mother and his wife were and are still, having a few issues as a result of which they fight verbally.

            “I don’t know whom to support. I don’t know what makes them fight over such small issues.”

He then gave an example of the food menu where the wife prepares food which the client’s mother isn’t satisfied for. According to the wife – as the client said, was a balanced diet wherein, the mother wanted the stapled food according to their culture and tradition. 

            Client has a daughter who is now in her 3^rd year engineering. He explained that his mother and his wife are having issues with the daughter for the dresses she wears, the attitude and the behavior of the daughter. “She is appropriate to her age and present generation. These people haven’t understood and accepted her for this. As a result of which there are fights between these three people which makes me more stressed.” the client said. Client was angry at the mother, her wife and his daughter.

 

            Client then started explaining about his physiological illness. He explained that he was diagnosed with hypertension at an early age of 41. It was then, he realized that he was having thyroid issues. The then physician prescribed him medications for the same. As he was not satisfied with the treatment plan, he had been visiting different doctors and had been changing his medicines since then.

 

            Presently, as the client explains, he has been experiencing difficulty concentrating on his work and sleep (disturbed sleep). He further explained that he had been getting nightmares which are contributing to his deteriorating health and disturbed sleeping patterns. He mentioned that his occupational efficiency has decreased, his relationship with his wife has been affected, his relationship with his parents has been affected and his relationship with himself has been affected while, his relationship with his daughter has not been affected at all. He continued saying “my daughter is my best friend. We make sure that we spend some quality time with each other forgetting everything.”

            

            Client explained that his father is active and a peaceful person who has understood the meaning of life. He further explained that his father was his role model. 

            “My dad never gets annoyed when my wife or his wife shouts at him or makes a scene. He keeps himself calm and continues doing his work without being affected.” 

 

 

CONTENTS OF DREAM

 

            “I am walking on the sea shore. The tides are heavy and dangerous. There are two puppies in my hand and another puppy draining in the tide. I don’t know if I have to leave these two people and save that puppy or to save these two puppies I already have in my hands.”

            “I am at my home sipping my coffee. I suddenly hear a lady screaming my name. I got scared. I get up and turn back to see what happened. I then see nobody in that direction. They are just shadows.”

 

 

 

MENTAL STATUS EXAMINATION

1.     General appearance – Well kempt and tidy. Was wearing a white scarf around his right wrist. Wore a Rado watch on his left hand. A ring on his right-hand ring finger which, as the client said, was an antique. 

2.     General behavior – Gentle and reserved. Was on the edge of the seat during the first quarter of the session and was comfortable expressing himself as the time passed by. Client’s level of involvement in the therapy/ with the therapist increased gradually. Eye contact was well maintained since the beginning of the session and was cutting the eye contact appropriately and when the client felt uncomfortable.

3.     Memory – Intact. (Immediate, recent and remote memory).

4.     Judgement – Intact.

5.     Intelligence – Seems normal (no psychometric tests administered.)

6.     Thought content – Helplessness, confusion, dilemma and dissatisfaction. (that the client labelled as problems).

7.     Emotions – Sad, anger, frustration, anxiety, helpless, happy, excited and disturbed.

8.     Speech – High pitch/ volume, normal tempo.

9.     Orientation towards time, place and person – intact.

10.   Leve of consciousness – alert.

11.   Insight – level 4 – present.

12.   Suicidality or homicidally – not present. 

13.   Attribution to physiological illness – Present.

14.   Readiness to take treatment – present (as the client walked in to the therapist to take therapy after being referred to – by the physician and psychiatrists).

 

NEGATIVE HISTORY

1.     Loss of Consciousness – not reported.

2.     History of seizures – absent.

3.     History of suicide attempts or thoughts – absent.

4.     History of surgery – has undergone a surgery for his appendix.

5.     Drug abuse – present.

6.     Psychiatric history (client) – absent.

7.     Psychiatric history in the family – present (Explained that his father’s younger brother had been admitted to the hospital due to some psychological illness. He further explained that his uncle was a chronic alcoholic.

 

DRUG HISTORY

Smoking Tobacco

Started – 33 years ago.

Had quit smoking about 28 years ago (showed minimum withdrawal symptoms)

Started smoking again about 22 years ago and continued. Presently, the client is smoking a minimum of 7 units per day.

No other drugs used/ abused.

Also takes lyster 0.25mg for his sleep (NOT PRESCRIBED).

 

PERSONAL HISTORY

Birth – normal

Developmental milestones – normal

h/o childhood disorders or illnesses – not reported

academic performance – adequate

social relationship – presently strained

personal relationship – strained

interpersonal relationship – strained – associated with helplessness

premorbid personality – balanced – had issues with spouse and mother for their conflicts.

 

PLAN OF ACTION

1.     Dream analysis.

2.     Assessing ADL and medication.

3.     Referral to pharmacologist for revising prescription.

4.     Psychoanalysis – catharsis.

5.     UPR and PAS.

6.     LOC therapy, LOI therapy and adjustment therapy.

7.     Relapse prevention and psychoeducation.

8.     Client focused family therapy with the client’s daughter and wife. As the stress is because of circular causality.

 

PRESENT CONDITION OF THE CLIENT (AFTER TERMINATION)

            Client aged about 53 years who had issues with how to manage stress in the family situation and his inability to handle the circumstances, who had disturbed sleep and poor interpersonal relationship, personal and social relationship had come to take therapy at CCPC. Presently the client has been completely functional and is aware about the root cause of his stress and causes of the problem situation. Also, the client’s awareness about his previous way of response to stress situation has made him aware about the other choices available to choose to respond to stress situation. The client has resumed with his work and is showing intact performance. Adding to this, the client has hired 4 farmers to farm his land in his native which adds to his present economical income. Client has reported that his sleeping pattern is adequate and normal as a result of which his days are going comparatively better than before (prior to the therapy). Client reported that he has been gradually reducing the counts of cigarettes he has been smoking and presently, he has been smoking only 3 units per day. He added to it that he wanted a couple of months’ time to quit smoking as he is using tapering method to quit his addiction.

 

As kids, we denied visiting the doctor. Our parents and guardians used to just pick us up, put us on the shoulder and walk to the doctor. Our behavior was generally temper tantrums and anger outburst. The reason is, as kids, our experience with the doctor is having a pattern which built a belief.

Stimulus 1: Visiting the doctor.

Stimulus 2: Doctor injects vaccine.

Emotion 1: Before injection – uncertain.

Emotion 2: After injection – sad and angry, shame.

Cause (injection – unpleasant stimulus) leads to effect (negative impression on the doctor).

            This impression will be evidently proved by the doctors during the first 7 to 10 visits to the doctor – because vaccines. It is after this, when the kid is taken to the doctor, when the doctor doesn’t give injections and prescribes medications instead, the impression on the doctors according to the child changes. This shift in the impression proves to the child that previous belief what he/she believed was wrong. Thus, the child feels free to walk in to the clinic with minimum hesitation. 

            Similarly, our beliefs towards “talking to therapists” is unreal because of the first impression on the therapist or therapy as a process. This is because of the social media, movies and serials that show these mental health professionals to be behaving reserved with a loaded syringe in hand and staring the mind through the patient’s eyes, giving electro convulsive therapy, hypnotizing, etc. on the other hand, they show the people who approach the psychologist or a psychiatrist to be an antisocial element or into severe psychiatric conditions like schizophrenia or a criminal or a mentally retarded. 

            

Here is a fact. Nether of them are true. Media has wrongly educated the general population as a result of which there is a social stigma. Like how a kid understood with experience, we too should. Your experience is your best teacher. The only way to experience is either witnessing it directly or by listening to experiences from people who have witnessed it without preconceived notions.

Please feel free to meet a professional therapist because, your mental health matters.

Pavan M Srivatsa Counselling Psychologist and Consultant Psychotherapist Chakshu Counselling and Psychotherapy Centre, Rajajinagar Bangalore, Karnataka, Republic Of India. pavanmsrivatsa@gmail.com +919886622309

Dad, Mom, Cira Doe and Jane Doe.

                  Anashku, aged about 41 years had called Cullinan – the psychologist by 3:30 P.M on a Saturday seeking an appointment. They knew each other for 8 years and this was the first time, Anashku asked Cullinan for a help. It was later understood that it was for Anashku’s son Jane Doe.

                  Anashku was working as a waiter in one of the oldest hotels in Democratic Republic of Bingle while his wife was working in a garment’s factory as a tailor. They were earning a decent income by struggling hard day in and day out. This couple had a couple of children. Cira Doe, aged about 17 years, doing her under graduation in one of the recognized colleges in Democratic Republic of Bingle while Master Jane Doe was studying his 10^th grade.

                  Mr. and Ms. Anashku got Jane Doe to the hospital to talk to Cullinan. Cullinan investigated and assessed the patient and advised Anashku “Jane Doe needs intense, frequent and long-term therapy to be as functional.” The father was devastated to listen to the treatment plan and questioned Cullinan “What is the reason behind my son’s present condition? Can it be cured? Will my son be fine? I love Jane Doe. I want him to be normal – like other guys of his age.” 

Ms. Anashku asked if there are any medicines for Jane Doe instead of therapy. She added to it that she was ready to give him medicines secretly without the knowledge of the patient. They were educated about the pros and cons of drugs on the client’s body and mind.

Story of Jane Doe

Pre-Birth – the mother’s psychological health

During this phase, as the mother was fed with healthy and nutritious food but the environment was emotionally contaminated because of her father’s alcoholism and frequent fights between her parents. This had an impact on the emotional state of Mrs. Anashku. She had been in this environment during the 6^th, 7^th, 8^th and 9^th month of pregnancy.

“I was scared almost all day – every day and I have spent many sleepless nights because of my parents. It was almost every day, my parents used to fight.” Said the patient’s mother.

On the day of delivery

“My parents threatened me saying that they would kill the baby if the baby is a girl again. I was into labor pain and these people talked to me this way.”
She also reported that her mother was in the labor room during the procedure. 

“No woman would have faced this kind of situation in their life. I was so near to death.” She added.

Mrs. Anashku passed out because of excessive bleeding and intolerable pain. After she became conscious, she understood that she had given birth to a male child.

Jane Doe’s infancy and early childhood

Jane Doe had been with his mother in her parents’ house as Mr. Anashku had no parents to take care of infant Jane Doe. It was also understood that Mr. Anashku was working two shifts to make money. During this period, Cira Doe was put in a day care.

“Fights were still going on and things started worsening.” Reported Mrs. Anashku. She also added to it that Jane Doe had a delay in achieving developmental milestones. She specified that Jane Doe started speaking when he was 2 years and 6 months old.

On probing, it was understood that Jane Doe had limited linguistic abilities. Also, Jane Doe was finding it difficult to maintain eye to eye contact with others. “He never spent time with anybody except his grandfather.” Said the mother. Mother was going to work in the garments during this time.

She explained that she left her parents with Jane Doe when he was around 3 years old.

Jane Doe’s schooling

Jane Doe started his schooling and was observed to be comfortable staying in school from the very first day. Jane Doe was spending time with Cira Doe was, by this time, a passive aggressive child with issues with mother, father and younger brother. Sibling rivalry and bullying started at a very young age for Jane Doe. Cira Doe used to make Jane Doe starve till the late evening. As a result of which Jane Doe was underweight or into malnutrition. It was evident because, it was understood that his academic achievements were below average and was having frequent physiological illness during his 10 – 12 years of age. The patient’s mother also reported that he had been cared by his grandmother when he was hospitalized. Parents also reported that they have never spent quality time with the Jane Doe. Jane Doe started bullying others after he came to 7^th grade. It was understood that the teachers had been calling the parents with a list of complaints  about Jane Doe’s problematic behavior, attendance shortage, vulgarity and physical fights.

“We four are staying together since about 2 years now. I am shocked to see my son behaving this way. He doesn’t respect elders, he doesn’t listen to anything we say, he doesn’t talk to us. All he does is – hanging out with friends, smoke, drink, pick up fights with neighboring area people and play games on mobile phone till late night. No seriousness at all.”

When probed about the negative history of Jane Doe, his mother remembered an incident which she thought was not important to present in front of the therapist. “I don’t know if it is important for you to know about this or not, but, he had galloped from the house and was away from us for a week. We lodged a missing complaint. He came back after a week. He said that he was in his friend’s house during this period. We were so scared during this time. His behavior completely changed after this incident.”

Recent history – Even during lockdown, Jane Doe was not wearing masks while going out, was going out to buy and sell pigeons, dogs and cats, was not maintaining social distance. It was also understood that Jane Doe and his friends were into cannabis use every day during the lockdown period (60 days). Mr. Anashku reported that he had been finding it difficult to arrange money for essentials as Jane Doe was robbing money from home for his cigarettes and cannabis. This resulted in a fight between the father and son which ended after Jane Doe slapped Mr. Anashku for questioning him about money. This made Mr. Anashku call Cullinan for an appointment.

Problematic behavior of Jane Doe that leads to a classic diagnosis are as mentioned below:

·       Drug abuse (explained below).

·       Steeling money.

·       Physical and verbal aggression (initiating fights)

·       Serious violation of rules and getting into arguments with others.

·       Gambling.

·       Limited prosocial emotions (Callous).

·       Selective mutism associated with passive aggression.

·       Excessive lying for materialistic gain like cannabis, cigarettes and alcohol or money to buy these.

·       Truancy.

·       Lack of guilt for his behaviors, decisions and outcomes.

·       Attention and concentration distortion associated with partial impairment in immediate memory which is not explained by any other conditions.

A part of verbatim when Cullinan was with Jane Doe and his parents:

Father: I don’t know if I have been expressing love or not expressing love to my son. I love my son from the bottom of my heart.

Mother: Yes sir, I too love my son. I wish I spent time with him, sharing some stories and incidents. I never observed how my son grew up. I am feeling guilty now. I wish we could go back in time and make things right.

Jane Doe: Sir, I don’t want them (pointing at the parents). They don’t deserve to be parents. (walked out of the room).

Mr. and Mrs. Anashku were devastated after listening to Jane Doe’s words before he left the hospital. 

Jane Doe had his own vehicle in which he went to meet his friends while his parents were sobbing in front of Cullinan.

Diagnosis: Conduct Disorder with Childhood-Onset type Associated with Limited Pro-social Emotions.

Co-Existing - Substance Use Disorder because of Child Neglect and Upbringing Away from Parents.

Line of treatment:

1.          Lack of insight – with problematic external locus of control.

2.          Mutism during therapy with minimum/ no eye to eye contact and communication.

3.          Denial to take personal therapy.

4.          Apathic state of emotion and affect.

5.          Addiction to cannabis, alcohol and cigarettes.

·       Jane Doe is advised to be under surveillance of medical experts for further investigation.

·       Jane Doe’s father was also referred to a rehabilitation centre for his Substance Use Disorder.

·       Family therapy and Psychoeducation to family members to make them understand how to minimize Jane Doe’s problem behavior.

·       Individual therapy for both the parents as they were observed to be neurotic.

A gentle note to readers:

Dear all, the money you save and the property are your assets you own for your children’s secured future. Make sure that you are not too busy to ignore or neglect your children’s present. If they don’t have parents in their house, they find parents outside.