In looking at interpersonal health from another angle, we might consider the many statistics that suggest that contemporary Western culture has gravitated toward destruction, death, and violence. For instance, between 1950 and 1970, there was a doubling of the murder rate in the United States.41 The murder rate among boys aged 14 and 17 doubled between 1985 and 1995.42 Increasingly we hear of children under 10 years of age who murder other children, sometimes for a few dollars, sometimes for no apparent reason other than boredom. Over 2 million Americans are currently in jail, and many American states opt for the death penalty out of general frustration with the burgeoning problem of violent crime.
Medical practitioners in many urban hospital emergency rooms compare their work to that of doctors who mop up on the front lines of battle during war. Murder has become the single most common cause of death in some age groups. In the United States, the leading cause of death for women in the workplace is murder; for men it is the third most common cause of death. Each year in America, the number of murders is more than half of the number of American lives lost in the combined years of the Vietnam War. More than 2,000 murders are committed annually in the city of
Los Angeles. Not long ago, 34,000 wreaths were laid out near the White House, each representing a child or adolescent who had been murdered in the preceding few years. A considerable number of these deaths were the result of the increasingly popular pastime of thrill killing. When interviewed after their crimes, thrill killers speak as if they had done nothing more serious than kill a little time. In most instances, no signs of social conscience can be found.
The motivation for this phenomenon has little to do with achieving the basics of survival. The former correlations between crime and poverty, or crime and unemployment, are disappearing. Acts of brutality are being committed by people who have no excuse on the grounds of need. Rather, they reflect a desensitization to antisocial behavior that stems from a moral code that lacks a social foundation.
Alarmists have begun to speak of the suicidal and necrophilic tendencies of modern Western culture, but this stance is not warranted, for several reasons. It is true that the new cultural conditioning project has replaced public virtue and other-directed empathy with a profit mentality whose primary allegiance is to the market,43 but the vast majority of asocial profiteers continue to operate within a set of cooperative arrangements and self-constraints that maximize their efficiency and adaptability and make for profitable business with others.44 In this way, considerable degrees of dishonesty and deception can be acted out as part of the normal interaction between partakers. The law itself is revamping itself in order to accommodate mutual exploitation practices wherein all parties are both criminal and victim.
Psychological symptoms tended historically to mirror cultural prohibitions that were propounded by mainstream social institutions. For example, obsessive and compulsive symptoms were almost exclusively religious in nature, such as intrusive negative thoughts about God or unstoppable urges to commit some type of sin. Hypervirtuous symptoms, in which the patient symbolically enacted social contrition, were also a feature of premodern madness techniques. When religion faded as the moral purveyor, obsessive-compulsive symptoms still had a distinctly other-related aspect, as when a woman feared that she might hurt her husband or children. Although drawing on more localized themes for pathological structure, they nonetheless continued to echo the inclination of individuals to transcend themselves and to locate meaning in a larger social framework. However, these patterns of symptom formation are becoming less common as cultural wrongs become less salient, fewer in number, and more reflective of infractions against oneself. The symptom constellations that are becoming prevalent today are those that communicate pathological degrees of self-attention. Characterological and self-control symptoms are becoming highly prevalent as a consequence of the social deregulation of madness.
What were once called character disorders are now sometimes classified as personality disorders in the official psychiatric diagnosis manuals. Even so, some mental health professionals still refer to character disorders in an attempt to describe symptoms that are more than, or other than, overtly psychiatric in nature. The diagnosis of character disorder often involves a value judgment that the disturbance somehow relates to deeper flaws at the level of the self. In this regard, an assessment is made that something is wrong with the person, rather than simply with the "mind" of that person. The potential confusion that stems from the diagnosis of a character disorder relates to the possibility that the disorder might be normal (in the sense of being the norm) and also that the afflicted often do not experience suffering. The diagnosis then becomes a matter of what the diagnostician assumes to be acceptable behavior and, more generally, what constitutes human nature.
A grandiose dimension has been added to the private self that curtails social perspective and produces narcissistic individuals who become their own most compelling cause in life. It has been claimed that narcissistic personality disorder (NPD) is the defining characterological disturbance of the contemporary world, and that it is a direct by-product of modernity.45 In support of this claim, there is ample clinical evidence that the diagnosis of pathological narcissism is being made much more frequently than in previous decades.
A similar picture has emerged in relation to borderline personality disorder (BPD), which some scholars believe is simply a more disorganized manifestation of NPD. Research indicates that BPD is far more common in modern, as compared to traditional, societies and also that it is increasing within Western cultural settings.46 BPD is defined officially as a pervasive pattern of instability of interpersonal relationships, self-image, and emotion that is associated with high levels of impulsivity. It is this impulsivity that represents the core element of BPD.
Certain contemporary social structures combine to generate an impulsivity-proneness that predisposes members to personality styles that attract a borderline label. The nebulous and uninformed nature of current cultural institutions leaves members with a similarly ill-defined psychic framework that cannot support social inducements or values that adulterate self-attention. Modern culture has also gravitated toward very broad socialization patterns that emphasize individual preferences rather than the conformity-based behavior that stems from narrow socialization strategies.47
The narrow socialization of traditional societies is usually supported by close living and working relationships between adolescents and adults. The high degree of monitoring and mentoring that this affords inclines the adolescent to adopt the values and beliefs that have social approval, while reducing the likelihood of embarkation on a course of reckless, idiosyn cratic, and whimsical action. Their close physical and mental proximity to respected sources of enculturation augments their motivation to succeed within the historical constraints and guidelines of the culture. They develop and engage impulse control in an effort to accomplish the challenge of repeating prosocial cultural formulas toward the end of locating a recognized role and paving the way for entry into the adult world. The acceptance of prohibitions and responsibilities is typically a part of this process.
Societies employing narrow socialization formats usually have institutionalized methods by which to usher adolescents into the adult world; this structure rewards prosocial conformity and connects self-concept to social harmony and the assumption of adult responsibility. Research demonstrates that cultures that offer adulthood challenges and subsequent initiations for official recognition of adult status have low rates of reckless and antisocial behavior.48 Broad socialization patterns as they exist in the modern age leave the young person undisciplined for an indeterminate period, without any guarantee that this individual will ever achieve much self-control or mastery of primitive impulses. In fact, modernity has stretched the lifespan of adolescence to the extent that it is possible to fend off adulthood almost indefinitely.
This development has been assisted by media socialization that mesmerizes members with youthful advantage, while also inspiring them to entertain continually any private or dissociated urges that could be satisfied through creative consumption. The end product is that the perpetual adolescent of the modern era has become immune to the regulating influence of maturity, while enjoying permission to act impetuously on even the most covert motivations that might be detected. This explains in part the steady increase in the prevalence of various impulsivity disorders that have been documented in recent years. The cultural invention of the temporally arrested adolescent offers choice and fluidity and seduces a titillating exploration of one's fantasies. At the same time, it programs the perpetual adolescent with certain traits, most notably impulsivity and social unconnectedness, that increase the risk that borderline and narcissistic orientations will become dysfunctional.
The narcissism-borderline category is the most frequently diagnosed of all the personality disorders. Looking more closely at NPD, we see a disorder characterized by a preoccupation with unlimited success, a greatly exaggerated sense of self-importance, exhibitionistic appeals for attention, unresponsiveness to social criticism, disturbed interpersonal relations, and a tendency to respond with rage to disappointment or restriction. The terms depressed narcissism and negative narcissism are being used with increasing frequency to emphasize the negative emotion that stems from an oscillation between self-glorification and self-loathing. It is also sometimes referred to as middle-class narcissism, an attempt to identify it as a class of pa thology that is not necessarily defined by abnormality in the sense of deviating from the norm.
In NPD we see a character structure that displays intense feelings of entitlement that permit the person to exploit and control others without much inhibition, anxiety, or guilt. From their highly self-centered perspective, it is difficult to experience motivations that do not relate to immediate benefits to the self, even though they can sometimes manipulate social circumstances to their gain. Their general disregard for others is often accompanied by intermittent cravings for their approval. Narcissistic disorders are associated with a proneness toward hostility, due in part to the pronounced inferiority and diminished frustration tolerance that characterize this personality style.
Modern cultural conditions provide the ideal breeding grounds for personality disorders such as NPD and BPD. Their design is such that there is no longer a place for strategic barriers to unregulated self-expression and self-gratification. Modern culture has also seen a significant depletion of easily identifiable social roles. When that depletion is combined with exceedingly fast social change, the result is an environment wherein members must forge a personal identity that is not structured through community affiliation.49
The full range of personality disorders may be encouraged under conditions of cultural disintegration and rapid change. One reason for this may involve the loss of family cohesiveness, and the failure of children to receive necessary amounts of nurturance and consistent emotional support. Out of this comes a family structure that is virtually opposite to the traditional "Confucian family" that stresses structure, rules, cohesion, and marital stability. Although tensions can arise in a Confucian family, its supports and networks are able to buffer most encounters with adversity. To illustrate this point, cross-cultural research related to antisocial personality disorder shows that this form of psychopathology is rare or is nonexistent in cultures that have a Confucian family structure.50 According to some thinkers, the increasing prevalence of personality disorders and related forms of psychopathology is due to the combined effects of family and community breakdown. Temperamentally vulnerable individuals often collapse under the weight of multiple stressors related to normlessness, depletion of social roles and consensual values, and the general failure of social structures as coping devices.51
With specific reference to narcissistic personality features, modernity has constructed a private sphere that has fragmented away from the constraining institutions that once governed instinctual impulses and thereby discouraged purely selfish gratification.52 This arrangement leaves little room for the installation of ideals and motivational motifs that recognize external authority beyond the bare minimum required for safe operation. As contemporary cultural ideals take people further into the materialistic and purely informational world, there is even less impetus for them to sublimate self-interest. In the absence of perceived prohibitions, modern culture places very few demands on its members to communicate substance, or to develop beyond the level of exhibitionism and the creative scratching of one's consumer itches.
Today both narcissists and normal individuals display a deliberative technique-driven self-structure that demotes the status of sharing relationships. Likewise, both emphasize manipulation and control in order to maximize personal outcomes, simultaneously creating a social veneer designed to mask disinterest. In a paradoxical way, the plague of narcissistic pathology is being cured to some extent by the rapid cultural normalization of narcissism itself. As a product of collective regression, normal narcissism expresses itself in many ways, including enthusiasm for personal achievement, health and fitness, bodily perfection, diet, the ultimate orgasm, spiritual bestowals, and all sorts of self-improvement prescriptions. This is all part of a cultural situation in which radical self-preoccupation is an acceptable, and even admirable, approach to life.
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