We’ve got to talk, y’all. There’s a real problem in our society when it comes to Cluster B diagnoses but before I dig deeper into that, what is Cluster B?
Cluster B is a broad term that encompasses several diagnoses. Most commonly known (and misunderstood) are Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD), along with the lesser known Antisocial Personality Disorder and Histrionic Personality Disorder.
So let’s dive deeper into Narcissistic Personality Disorder because that’s been a major Hot Topic lately and we need to unpack a lot as a community.
The diagnosis is named after Narcissus, who was a hunter in Greek mythology who was so enamored with how gorgeous his own reflection looked that he stopped hunting (and eating) and basically stared at his fine self until he died. So based on their outside perspective from working with folks who have the traits and symptoms that are associated with NPD, the medical community decided they get to define people as what amounts to “self centered at a level that causes harm to self and/or others”.
The very first symptom listed when you go looking for a definition is usually lacking empathy and I have to say, as an Autistic person that particular tidbit has really helped me process that we’ve all been fed a pack of lies about Cluster B, because how many definitions of autism include a lack of empathy that we as Autistics know darn well isn’t true? They (the medical establishment) are doing the same thing to *all of us* with their inaccurate outside perspectives on what it means to have certain traits. So they’re telling us folks with NPD don’t empathize or sympathize, and that they won’t care if/when their actions harm others.
Sounding familiar to any of my fellow Autistics? Where have we heard similar things before? Oh yeah! Our own definition in the same manual, and we know that’s not universally true for us, so why are we taking it at face value when it comes to others? I’m starting to wonder just how much of the DSM is even accurate at all, according to people who have the diagnoses in it.
You know who lacks empathy? DOCTORS. Whatever empathy they had for people that got them into medicine in the first place is *trained out of them* in school and in practice. Just look at their saying, “when you hear hoofbeats think horses not zebras.” It means if your patient shows symptoms that could be more than one thing (hoofbeats come from many sources) to assume it’s something common (like a horse) rather than something rare and exotic/exciting (like a zebra). That’s actually why folks with Ehlers Danlos Syndrome use a zebra for the symbol, because almost all of us get ignored and misdiagnosed with more common things before we find a doctor willing to consider the possibility of rare diagnoses like EDS.
Man, writing this is really bringing into focus how ableist (not to mention racist, classist, and sexist, etc) the medical establishment is, was, and always has been. “Do no harm” my pasty white arse. But I digress.
Anyway, after the establishment is done telling us that NPD means a person doesn’t care about anyone but themselves they move on to how they’re always going to want to be the focus of every conversation and they’ll interrupt, and argue to prove they’re right all the time, and won’t take kindly to correction, what would be considered by most as poor social skills, self entitled, being “fake” or making people think they’re more successful or have a better public image than they actually do…. The list of “symptoms” is long and paints a really harmful image.
So harmful that we’ve gotten to a point in society where the term “narcissist” is synonymous with abuser. I don’t talk about it much in public but I’m an abuse survivor. I’ve been in abusive situations as a very small child, as a teenager, and as an adult. It seems there are quite a lot of Autistics who have similar stories as mine. I’ve been through domestic violence (DV) training and therapy more than once. It’s been well over a decade since I did anything close to a formal program but I still try to stay up to date. To this day, even prominent DV advocates and organizations casually use the term narcissist interchangeably with abuser. In many cases abuse survivors are encouraged to “armchair/keyboard diagnose” their abuser as a narcissist, and when someone is processing trauma and they’re given a definition of something that on the surface they think really fits, they’ll cling to that like a life preserver to keep them afloat. I know I did. I armchair diagnosed my dad, for sure. It helped me process the hurt that his abuse caused my inner child, that it wasn’t my fault. But that doesn’t make it right, and now I’ve had to work hard to unlearn the toxic misinformation, and also to re-process the trauma that I thought was worked through.
But something I’ve realized with age and wisdom or whatever, is that the abusers that we as society are equating with NPD, abusers like my dad, would probably *NEVER* seek out a diagnosis or admit to it if they were diagnosed, and there are thousands of people who are diagnosed who are in therapy and doing their own hard work unlearning internalized ableism and trying to break through the stigma surrounding their diagnosis.
Would my dad have been diagnosed? Possibly. But if he had, he wouldn’t be representative of the entire NPD Community, he would be just one abuser among them. Just like if he were diagnosed Autistic, it wouldn’t mean Autistics are inherently abusive, it would mean that he was an abuser who happened to be Autistic.
The Autistic Community didn’t create the negative rhetoric that surrounds Cluster B diagnoses, we were taught it just like everyone else. We were taught that we have more differences than similarities, and we were taught that we as Autistics are easy targets that the narcissist can hone in on as their prey. And as a community suffering individual and collective traumas, we bought it. Now let’s return it. Let’s unlearn it.
We should be embracing our fellow NeuroKin. Neurodiversity is Neurodiversity. We don’t get to cherry pick who is included or acceptable, especially not based on inaccurate stereotypes pulled from a diagnostic manual we know for a fact isn’t even accurate about our own diagnosis. We all have neurology that differs from what is considered “normal” and if we realized and actualized the true power in numbers that we hold, the abled world would quickly learn that they don’t get to control the narrative over any of us, anymore.
We need to redefine a lot of diagnoses, and change what the process looks like for people who are being diagnosed. We need to own our own narratives. We cannot keep letting society teach people that their abuser was anything other than an abuser. A person’s diagnosis might impact the way that their abuse manifests and affects others, but it isn’t the inherent reason why they’re an abuser.