Crimes of the Heartless: Empathy Disorders, Part Two
One of Austen’s major insights about human nature is that people are, as a rule, self-centered. This usually accounts for the moral deficiencies, as well as mistakes in perception and judgment, on the part of Austen’s fictional people. It’s their primary comic-tragic flaw. And so, even though her novels feature characters like Elizabeth and Emma who conquer such deficiencies to find the good within others, and within themselves, Austen isn’t optimistic about the moral aptitude of most people. A multitude of characters with narcissistic tendencies inhabit Austen’s pages.
Yet above and beyond garden-variety narcissism, there are two characters whose thoughts and behavior so far exceed the ordinary self-centeredness of human nature that they can be diagnosed with full-fledged narcissistic personality disorder (NPD): John Thorpe in Northanger Abbey and Sir Walter Elliot in Persuasion. Since personality disorders are on a continuum with personality traits, it’s not surprising that people afflicted with NPD have much in common with those who are simply self-centered, even monstrously so. What makes these fictional people diagnosable is not their selfishness alone, shared by many, but a cluster of symptoms that have been seen to consistently lead to a particular set of impairments that are so pronounced that they render a person incapable of authentic and close relationships with others.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the primary diagnostic tool of therapists and psychiatrists in the United States, describes NPD as “[a] pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts.”* This can lead to boasting; preoccupation with fantasies of unlimited success, power, brilliance, beauty, and so forth; the conviction that she or he is special and can only be understood by, or only associate with, other superior people; a need for excessive admiration; a sense of entitlement; a tendency to exploit others; envy; and arrogance.
Mind-brain scientists have complicated this diagnosis by noting that NPD can take different forms. For instance, neuroscientist Simon Baron-Cohen notes that some narcissists are very outgoing and want to be the center of attention. Others are withdrawn, but still have a sense of entitlement; they expect others to be respectful and compliant, but they lack awareness that they should reciprocate. Psychiatrist James Masterson suggests that there are two kinds of pathological narcissism, exhibitionist (the type described in DSM-5 and above) and closet narcissism. Closet narcissists are still self-obsessed, but they are aware of their sense of deflation and emptiness. They experience the pain of imperfection, which is kept at bay by defenses among exhibitionist narcissists. Still another type of narcissist might be dangerous; it’s been suggested that serial killers are narcissists. This likely describes Raskolnikov in Dostoyevsky’s Crime and Punishment, who kills an old lady just to see what it feels like to kill. What greater sense of entitlement is there than to think that you have the right to take another person’s life? The subtype that appears in Austen’s novels is the outgoing, grandiose narcissist.
NPD shares features with BPD and APD. All three are empathy disorders. But the characteristics of these conditions nevertheless differ in many ways. People with NPD are generally not as violent as dysregulated psychopaths (apart from those serial killers), nor are they as out of control as those with BPD. And unless they’re very high functioning, they’re much less subtle than high machs. With the grandiose, exhibitionist kind of NPD, obnoxious self-preoccupation and inflated sense of importance are there for all to see. In this sense, they’re generally much less dangerous than people afflicted with the other empathy disorders; with most narcissists, you know what you’re dealing with.
MIRROR, MIRROR ON THE WALL
Sir Walter Elliot of Persuasion might be Austen’s most famous narcissist. The novel opens with the narrator’s biting description of Sir Walter’s absorption in his favorite book, the Baronetage, a dictionary of England’s baronets that was periodically updated. The “page at which the favorite volume always opened” is the entry about himself. This is a stunning symbol of the narcissist’s stunted circle of awareness: With all the narratives of history and fiction available in the library of a gentleman’s country estate, Sir Walter focuses on a small dictionary entry that gives his rank and the dates of notable life events, such as his marriage and the birth of his children.
This image of Sir Walter staring at this description of himself evokes the well-known myth of Narcissus (from Ovid’s Metamorphoses) who fell in love with his own reflection in a lake and drowned trying to embrace the image. More literal mirrors abound in Sir Walter’s house, for Sir Walter is just as obsessed with his looks as with his status. When Admiral Croft rents Kellynch Hall from the Elliots, the only change in furnishings he makes is to take down some of the mirrors.
Other characters are well aware of Sir Walter’s narcissism and know they must appeal to it if they’re going to get him to agree to anything. The high mach manipulates others, but narcissists like Sir Walter can easily be the targets rather than the perpetrators of manipulation since they’re so vulnerable to flattery. When it’s clear that Sir Walter needs to rent his estate in order to pay his debts, his lawyer, Mr. Shepherd, appeals to his vanity. He tells Sir Walter that this is a sound course of action because in his financial circumstances, he couldn’t maintain his lifestyle in a manner that accorded with the “ancient dignity” due to his position and his estate. That Sir Walter has a moral obligation to pay his debts and preserve his inheritance for his children has no place in Mr. Shepherd’s reasoning. The lawyer also reassures Sir Walter that moving elsewhere will not compromise the baronet in any way because Sir Walter will set the tone wherever he goes: “In any other place [other than Kellynch], Sir Walter . . . would be looked up to, as regulating the modes of life, in whatever way he might choose to model his household.”
Narcissists need to feel that everything associated with them is the best; their grandiosity extends to their “possessions,” including other people. This need is one path to the distortion of reality we often see in this disorder. When Sir Walter and his equally narcissistic daughter Elizabeth proudly display their rented rooms at Bath, Anne isn’t surprised that her father and sister can be happy with such an obvious descent in status and lifestyle from their estate at Kellynch, because she knows they they’ll gild the lily, no matter how wilted. But she nevertheless “must sigh that her father should feel no degradation in his change; should see nothing to regret in the duties and dignity of the resident land-holder; should find so much to be vain of in the littlenesses of a town.”
This field of distortion often encompasses those associated with narcissists, or those whom they like, because these people also have to be the best. Narcissists idealize those they’re attracted to, just as they exaggerate the value of their own traits, talents, and possessions. As Sir Walter’s liking for his lawyer’s daughter Mrs. Clay increases, he begins to see her differently, observing that her freckles are much diminished. We can bet the family fortune that Mrs. Clay has no fewer freckles than she had when Sir Walter first met her. Sir Walter’s fancy for Mrs. Clay demonstrates that narcissists, like high machs and those who suffer from other forms of APD, can be attracted to others. But they don’t really care in any genuine sense about anyone but themselves. People with NPD have zero empathy, so they view other people as objects. Some of these “objects” are more alluring than others, or redound to their glory; others can be denigrated or ignored.
Anne Elliot’s treatment by her father and sister Elizabeth shows zero empathy in action. Sir Walter is openly scornful and dismissive of Anne. He not only ignores her needs and wishes (indeed, he’s oblivious to them), but he also fails to offer common kindness. And although his favorite daughter, Elizabeth, who also has the disorder, is significantly older than Anne, Sir Walter doesn’t worry that she might have passed her prime marriageable years; it’s Anne who’s treated like the poor spinster, tolerated and exploited because she has nowhere else to go. We can guess that Anne was far too unlike Sir Walter, and far too unwilling to flatter him unduly, to be included in his charmed circle of narcissism (the scenario of three sisters and an old narcissist is reminiscent of King Lear; perhaps Austen had this play in mind). Nevertheless, Sir Walter’s cruelty stems from obtuseness rather than an active desire to inflict pain. People with NPD are unable to take the perspective of others, but they don’t, in general, actively seek to harm others.
The inability to mentalize accounts for much of the bizarre and counterproductive behavior of people with NPD, as well as their slender grasp of reality. They tend to alienate people because, unable to read minds, they can’t understand how their behavior affects others. Mindreading is not only compromised but also avoided because it might be dangerous to know what people really think. Lack of a ToM functions as a very effective defense mechanism that keeps people with NPD from having to face the fact that they’re not perfect, not the best at everything. (They know this deep down, but more of this in a moment.) Most defense mechanisms involve distorting reality for purposes of self-protection, but for those with NPD, this is a continual mandate: They must maintain an unrealistic, grandiose conception of themselves and all those associated with them.
Sir Walter certainly views the world through a distorted lens if he can believe that rented rooms at Bath are as impressive as a well-managed gentleman’s country estate (not to mention his complete failure to recognize Anne’s worth). But the character Austen uses to explore the narcissist’s distortions most fully, especially in the context of relationships, is John Thorpe in Northanger Abbey. John, a bumbling fool who fits the diagnostic criteria for NPD, is a friend of Catherine’s (the heroine’s) brother. He falls for Catherine, who wants nothing to do with him.
As you might recall from Chapter Ten, a lack of a ToM often involves psychic equivalence, the inability to take the context of mind into account. People who think in psychic-equivalence mode might think that what others think and say must be true, or attribute their own thoughts and beliefs to others; both deficits stem from their inability to perceive how feelings and motives, their own and those of other people, might influence perceptions. You need to be conscious of minds as minds, one hallmark of a reflective capacity, to understand this. We see these tendencies, respectively, in Mr. Woodhouse and Miss Bates. Miss Bates hears Emma’s insult as truth rather than the misguided witticism of a haughty and out-of-sorts young woman, and Mr. Woodhouse thinks everyone enjoys a dish of thin gruel. Psychic-equivalence mode translates into very low social intelligence, and so, as we see with these two, a distorted take on reality. Likewise, John projects his own thoughts and wishes onto others to such an extent, and expresses views of events that are so clearly inaccurate, that he appears to have a slim grasp of reality. John reshapes the world to give him the adulation he so desperately needs.
On one occasion, John asks Catherine to accompany him on an outing to Bristol on a day that she has made a date with the Tilneys (Henry Tilney, the man she likes, and his sister Eleanor) to go on a country walk. John comes to Catherine’s lodgings to collect her, and when she reminds him of her prior engagement, he says that he saw Henry and Eleanor driving away in a carriage and overheard Henry say that they were going to a destination sufficiently far away to make an afternoon walk with Catherine out of the question.
Catherine believes John and assumes that Henry and Eleanor have forgotten the appointment. But when she and John drive past the Tilneys, who are walking in the direction of Catherine’s lodgings, she realizes that John hasn’t told the truth. John defends himself by saying that he must have seen a man who looked exactly like Henry, and he refuses to stop the carriage to let Catherine go to her friends. While NPD isn’t usually characterized by violence, this scene conjures the violence that zero empathy makes possible. As noted with respect to Emma’s embarrassing carriage ride with Mr. Elton, Austen’s contemporary readers would have recognized the possibility of rape and abduction associated with a woman’s imprisonment in a carriage from the bestseller Clarissa by Samuel Richardson, one of Austen’s favorite authors.
Catherine reschedules the walk, and John again tries to prevent her from accompanying the Tilneys in order to go on yet another outing. He’s jealous, but rather than admit this vulnerability to himself, he acts out his envy and disappointment. At first, he tries to persuade Catherine to break her appointment. When she stands her ground, he actually goes round to the Tilneys and tells them that Catherine can’t go with them because she has a prior appointment with him. Catherine is furious and quickly goes to see her friends and sets things right.
John’s distortions of the truth account not only for minor mishaps but they also explain the major misunderstanding of the novel. When John still has hopes that Catherine will become his wife, he boasts to General Tilney, Henry’s father, that Catherine will inherit a considerable fortune. At this point, John still considers her part of his charmed circle, and so she must be wealthy, or so the narcissistic logic goes, since all that belongs to a narcissist must be the best. Acting on this information, the general graciously invites Catherine to stay at Northanger Abbey because he would love for his son to marry an heiress.
But when John meets the general in town during this visit, and John is “under the influence of exactly opposite feelings” and “irritated by Catherine’s refusal” of his friendship, which has become obvious even to John himself, he exaggerates the meagerness of Catherine’s financial prospects. At this point, John has lost all hope for a marriage with Catherine, as well as of a match between his sister Isabella and Catherine’s brother James. Catherine now no longer belongs to him in any way. And so she enters the narcissist’s devalued world of outcast others, of those who have nothing to do with me and are therefore worthless. And even worse, he has bad feelings, which also spur him on. After John tells the general that Catherine is not an heiress, the general sends her packing without protection or money for her long journey home.
Well, you might ask, in these instances, is John lying or does he believe what he says? Is he delusional, or just highly manipulative? This is unanswerable. Austen, who usually has no compunctions about eavesdropping on the minds of her characters, doesn’t say.
Nevertheless, Austen strongly hints that John does indeed believe his own lies. Early on in the novel, John takes Catherine for a ride, during which he contradicts himself from moment to moment. With the goal of boasting about the superiority of his own carriage, he tells Catherine that her brother’s carriage is unsafe: “It is the most devilish little rickety business I ever beheld!—Thank God! we have got a better. I would not be bound to go two miles in it for fifty pounds.” Putting others down to elevate oneself is a frequent tactic of people with NPD. When Catherine naturally becomes alarmed for the safety of her brother, John reverses himself: “Oh, curse it the carriage is safe enough, if a man knows how to drive it; a thing of that sort in good hands will last above twenty years after it is fairly worn out. Lord bless you! I would undertake for five pounds to drive it to York and back again, without losing a nail.” For the curious among you, the distance from Bath to York is 186.52 miles, a significantly farther stretch than the two miles of the first statement.
Anyone a bit more sophisticated than Catherine would have seen through John’s contradictions and his boasts, such as his claim that his horse is capable of covering fifty miles a day, or that he had paid too much for his carriage because he pitied the man who was selling it, another untruth. That John can’t remember or avoid contradictions suggests that he’s trapped in psychic-equivalence mode, unable to see beyond the wishes of the moment, and constantly deluding himself in order to ward off untenable truths such as that he was duped by a salesman, and that Catherine would rather be with the Tilneys than with him. You can bet the Elliot estate that Mr. Elliot wouldn’t have been caught contradicting himself. High machs keep track of their lies.
Whether or not John is unable to distinguish desire from reality, or he deliberately lies, his behavior reveals a complete lack of the ability to mentalize. And so he has no idea of how he comes across to other people, of the effects of his statements and actions. How could John possibly think that Catherine would be pleased that he had canceled her appointment with her friends behind her back? Even if she preferred to accompany John rather than the Tilneys (she doesn’t!), she’s certain to resent someone’s tampering with her schedule surreptitiously. In Emma, Mr. Knightley tells Emma, “I have blamed you and lectured you, and you have borne it as no other woman in England would have borne it.” But scold as he might, Mr. Knightley never takes it upon himself to actually interfere with Emma’s plans. Not only does he realize how inappropriate that would be, but he also knows that such interference would be a nearly unforgivable mark of disrespect.
John, mindblind as he is, can’t understand this, or how, more generally, that his behavior drives Catherine away, exactly the opposite of what he means to do. Rather than canceling her appointments, Mr. Elliot, or any other high mach, would have let Catherine go with the Tilneys and found another time to see her. Mr. Elliot would have been so charming that Catherine, who at this point is very naïve and not yet totally in love with Henry, might have begun to find this charismatic older man attractive. Thankfully, she has her own novel, safe from the predatory “high mach-inations” of a Mr. Elliot.
But in case we forget that fully functioning and well-meaning people are subject to blips of narcissism, that very rarely do we entirely get over ourselves, Austen includes a scene showing that Catherine can be almost as insensitive and dull as John. While still in Bath, she visits John’s sister and is looking forward to dining with Eleanor Tilney later in the day. John approaches her in the parlor before she leaves the Thorpe’s lodgings, and he all but declares his love. He goes so far as to ask if he can pay his respects to her parents, a strong indication of his intentions, even to a girl as naïve as Catherine.
This is one of John’s best moments (even if Austen can’t resist telling us that he forces a “foolish laugh”), and we see that he genuinely cares for Catherine to the limited degree that he can care for anyone. But she misses the point entirely. Absorbed as she is in her own feelings and desires, which include her love for Henry and her wish to be close to Eleanor, Catherine fails to understand John’s feelings and rebuffs him in a manner almost as insensitive as his own.
We also need to remember that a little bit of “narcissism” is a good thing. Actually, when narcissism is good, we no longer call it narcissism but rather, healthy self-esteem, a positive self-image based on a realistic assessment of our capabilities and accomplishments. Paradoxically, this is precisely what the narcissist lacks.
ORIGINS OF NPD
I’m going to turn to attachment theorists once again for a psychological account of how NPD develops. According to psychiatrist James Masterson, the conditions that foster NPD likely begin in the second year of life, and they result from the actions of a self-involved caregiver, perhaps one who herself has NPD. Like forms of insecure attachment and the other empathy disorders, NPD results primarily from the caregiver’s failure to provide emotional resonance (attunement) and mirroring, the core behaviors that lead to secure attachment, the ability to regulate emotions, and the capacity for mentalization. This lack of attunement likely begins when the child is ten months old at the earliest, because during roughly the first year of life, a child is incapable of the complex thoughts and behaviors that evoke the failure of attunement on the part of narcissistic caregivers.
In fact, during these early months, if caregiving is “good enough” and not abusive or neglectful, all infants, and not just those who’ll develop NPD, have a grandiose sense of self because in general, their wishes are fulfilled by others. This allows the infant to feel that she’s an all-powerful being who controls her environment; she usually gets what she wants, and so she has little sense of her own limits or imperfections. But this halcyon state of affairs can’t last.
The malattunement that leads to NPD develops when the child begins to participate to a greater extent in the world outside the nursery, and with people other than her primary caregivers. As she ventures out into the world, which means exploring on her own (even if this is only a few feet away from the caregiver), she discovers that she’s not grandiose, that she’s indeed a very little person, not very powerful, who doesn’t always get her way. She feels frustration, fear, and loneliness on these early forays into autonomy. This is known as deflation, and she needs to return to her caregiver, her secure base, for refueling. Here’s where the problem begins.
The danger of narcissism enters when the caregiver not only fails to resonate with the child’s deflated state, but reflects the disappointed grandiosity instead. This might happen despite the best of intentions. Let’s say that the toddler sees a toy he wants to play with and another child picks it up first. Instead of telling the toddler that he must wait his turn, or share, the caregiver says, “You should have had that toy. You’re better than everyone else and deserve to get what you want.” While this is an exaggerated example—although probably not unrealistic treatment for the only son in an eighteenth-century English aristocratic family!—this is the basic pattern. Or a toddler learning to walk might fall down and begin to cry. Instead of acknowledging the baby’s distress, the caregiver tells the child he’s all right and is doing a great job walking. An older child might come to the caregiver upset because he lost a ball game. Instead of saying, “I know how you feel, losing is difficult,” the caregiver says something along the lines of “You just had an off day. I know you’re the best player.” Or “Maybe the others cheated.” Or “You’re smaller than everyone else. In another year, no one will be able to beat you.”
When the caregiver fails to mirror the deflated state and mirrors the grandiose self instead, the child learns that he’s loved and approved only to the extent that he’s successful. This kind of response also prevents the child from developing the necessary coping tools, the procedural schemas, for dealing with deflation—with failure and shame. By mirroring and soothing the child after painful experiences, including the ones she necessarily engenders through socialization, a “good enough” caregiver teaches the toddler to control his impulses and to regulate his negative deflation when he encounters difficulties. The child eventually internalizes the capacity for self-comfort. In short, he learns that disappointments are a part of life, that you can survive them, and that they don’t mean you’re incompetent or unlovable. This is precisely what people with NPD have failed to learn.
A similar process of malattunement occurs in regard to the child’s wishes, dreams, goals, and even his personality. A narcissistic caregiver views the child as an extension of himself. This is true to some extent of all who associate with a person who has NPD, since they must be superior in order to affirm his sense of superiority. But a child functions as an extension in other ways as well. He’s often asked to fulfill the caregiver’s fantasies and dreams, to be what the caregiver would really like him to be. If the child’s desires and temperament don’t match those of the narcissistic caregiver, disapproval will be expressed, often subtly, through tone or facial expression. The child of a narcissistic parent learns that her own wishes and ways of being don’t count compared to those of the caregiver. The child who develops NPD feels he’s nothing but the sum of those accomplishments that please the caregiver, while the child with a healthy sense of self (a “real self”) learns that he has inherent and inalienable worth that doesn’t depend on what he does or doesn’t achieve.
As a result of the caregiver’s need for narcissistic affirmation on the part of the child, seen in the child’s superiority (Everything of mine is the best) and in the projection of her own wishes onto this young person, the child develops a false self, as in BPD. For the person with NPD, the false self takes the form of the grandiose self, the perfect being who fulfills the caregiver’s fantasies and therefore affirms the caregiver’s superiority. (After all, this child is one of her possessions.) The child learns that love and approval depend on maintaining this false self, and that activation of the real self, which includes the child’s realistic appraisal of his accomplishments and knowledge of his own desires, threatens the withdrawal of love and so the ensuing abandonment depression. For the person with NPD, abandonment depression includes feelings of envy as well as feelings of rejection, shame, and worthlessness. The false self protects the child from experiencing these painful effects. As with BPD, the true self remains repressed because whenever the child, and later the adult, self-activates, which means accessing this true self, the abandonment depression also activates. Abandonment depression can also result when the systems that keep grandiosity in place break down, as in a divorce or the loss of a job.
We all have ideal images of what we would like to be and achieve: This is what psychotherapists call the “ego ideal.” But most of us are able treat such standards as goals toward which we strive, and we’re capable of forgiving and accepting ourselves when we fall short. A healthy outlook means that our ideals are likely to be realistic to begin with, even if lofty: We don’t think, I’m going to be the best ballplayer in the world, but rather, I can’t be the best ballplayer in the world, but I can become a good ballplayer. (Perhaps you’re old enough to remember the concept of “personal best,” a bit of common sense addressed to a narcissistic culture.) Accepting an imperfect self and having realistic expectations are important tools for surviving and processing shortcomings and disappointments. But the person with NPD lacks these emotional tools and feels obligated to be perfect. The alternative is too dreadful: a sense of shame and worthlessness and the abandonment depression that makes him feel unfit to be loved.
Some people with NPD, or narcissistic traits, tend to oscillate between grandiosity and shame, or to feel shame most of the time (this applies to Masterson’s closet narcissists). Others maintain the narcissistic grandiose false self by finding ways to devalue those who challenge their inflated self-image, surrounding themselves with those who confirm their superiority, and denying realities that don’t support their grandiosity. We never see Sir Walter or John suffering shame, but we certainly see the lengths to which they go to maintain the false self. Sir Walter surrounds himself with flatterers, devalues (Lear-like) the one daughter who’s honest with him, and fails to note the marks of his own aging as well as the abundance of Mrs. Clay’s freckles. John’s false self is even more deluded, and if he doesn’t have the wealth and standing to attract flatterers, he at least associates with those who tolerate his inconsistencies and boastfulness. Just as Sir Walter rejects Anne, John devalues Catherine once he realizes she’s not interested in him.
But despite the hard work of maintaining defenses, the person with NPD lacks a stable and authentic sense of self-esteem and never really feels good enough, deep down. The search for constant validation of the grandiose self serves to ward off his knowledge of his imperfections and the depression this would bring. But subconsciously, or when defenses falter, the narcissist realizes he’s not absolutely fabulous, that his caregiver’s reassurance was hollow, that there were kids who actually did play a better ball game than he did, or who were smarter, or more handsome, or who had talents that he didn’t have.
When emotions and knowledge are dissociated to this extent, they usually find a way to cause trouble. Because people with NPD can’t recognize their fears and must live the life of the grandiose self, they often feel empty, unfulfilled, and inauthentic (as with BPD), the consequence of living a lie and having a false self. Moreover, a person with NPD can never find genuine support—true attunement and resonance—because he has dissociated from the very feelings that he needs to share with others for refueling: vulnerability and shame. He can’t take the risk of having a real self, which would acknowledge such feelings. And so he avoids true intimacy, which would mean revealing an authentic self in a relationship, a self he can’t allow to emerge. Intimacy also carries the danger that his “fraud” will be discovered, the knowledge that he’s not perfect, and he will then be rejected. The state of crisis in which he constantly lives, often unknowingly, leaves him without the psychological resources to give in return, to be a true friend. He desperately needs people, but no one can get too close.
We get some important clues in Northanger Abbey about John’s childhood that hint at why he developed NPD. His mother, Mrs. Thorpe, has an inflated, grandiose view of all her children, as we learn in her conversation with Mrs. Allen, the family friend who invited Catherine to accompany her to Bath. The narrator tells us, “Mrs. Thorpe, however, had one great advantage as a talker over Mrs. Allen . . . and when she expatiated on the talents of her sons, and the beauty of her daughters,—when she related their different situations . . . and [that] all of them [were] more beloved and respected in their different stations than any three beings ever were, Mrs. Allen had no similar information to give.”
Mrs. Thorpe’s behavior toward John shows that she repeatedly validates his grandiose view of himself, not least by tolerating everything he says, no matter how rude or outrageous. It isn’t much of a stretch to imagine her failures of resonance and her narcissistic expectations throughout John’s life.
THE FAULT LIES IN OUR STARS? GENES? ENVIRONMENT? MORALS?
We’re a species that likes to find fault. It goes with the territory of moral reason and advanced cognitive intelligence. Finding fault is a version of perceiving cause and effect, a capacity we share with many nonhuman animals. It confers a terrific advantage in the struggle for survival. If you understand cause and effect, you can predict events and avoid dangers (If I enter that lion’s den, I’ll probably be killed) and seek benefits (That grove is lush, so there will probably be ripe fruits for me to eat). Among nonhuman animals with significant social intelligence, such as the great apes, the perception of cause and effect often acts as a deterrent: If I steal the dominant chimp’s bananas, I’m sure to be beaten up because that’s what usually happens. Humans take this a step further to internalize rules of right and wrong, and many feel guilt as well as fear at the prospect of wrongdoing. In a basic sense, cause and effect is the foundation of law and ethics, necessary for civil society.
But above and beyond these pragmatic benefits, a sense of cause and effect makes us feel safe, and this response might be specific to humans. If you can find a reason that something bad happens, or something good, you feel more in control. You might say to yourself, “That person got colon cancer because of a poor diet but if I eat well, that won’t happen to me.” And speaking of cancer, John Green’s title for his novel about teens with cancer, The Fault in Our Stars (quoted in my subheading above), makes the point that sometimes bad things happen and no one’s to blame, except the stars—bad luck or, if you’re a believer, some kind of astrological determination. The important point here is that there isn’t a person or some other entity responsible for the tragic plight of Green’s characters.
We can say the same about most instances of cancer. Let’s bracket known risk factors such as smoking and polluted areas where carcinogenic elements can be traced to the actions of a specific person or corporation. (If you’re living in the U.S. in 2017, these are legally the same.) Cancer begins because something goes wrong with the functioning of cells. We don’t blame or punish anyone. We understand that there might be causal factors such as pollutants, or diet, or genetics, but we accept that we aren’t going to hold someone responsible. It’s nobody’s fault.
Many would say that cancer is evil, personifying this frightening disease. But what about literal evil, harm committed by one person against an innocent victim? Is someone who takes a life for no good reason evil? To put this another way, is he to blame? As a consultant on a criminal case, psychiatrist Bruce D. Perry clearly charted the abusive developmental history that enabled a young man to murder two teenage girls, and he writes about this in a wonderful book about childhood trauma, The Boy Who Was Raised as a Dog. But despite the fact that the perpetrator was also a victim, he was legally responsible for his actions.
Most readers will probably agree with the courts in this case, but the answer isn’t always so clear. The legal finding of insanity dictates that someone who commits a crime without understanding what they’re doing isn’t responsible for his actions; he isn’t to blame. We’re willing to say that, in both a legal and moral context, this person isn’t at fault because there’s something wrong with his brain. But our prisons are full of people with APD who’ve committed murders and other heinous crimes. They understand what they’ve done, although their attitude is different from that of most people. And there is indeed something wrong with their brains. The brain of Perry’s subject was terribly damaged.
We can actually refer to areas likely to be damaged or underdeveloped in people with empathy disorders. Neuroscientist Simon Baron-Cohen has identified an empathy circuit within the brain, a loop of ten brain areas with multiple interconnections that are instrumental in generating empathy. Together, these areas control perspective taking, emotional response, emotional expression, and emotional regulation; this last is crucial to empathy and to all positive social connections. Lo and behold, our old friends, the amygdala and the orbitofrontal cortex (OFC) appear on this circuit, contributing in various ways to the experience of empathy. For instance, the OFC activates when a person sees a needle going into another’s hand, and the amygdala prompts us to attend to people’s eyes, which are key in registering emotional expression.
Many studies show compromised empathy circuit areas specifically with regard to Cluster B disorders. For instance, abnormalities of the OFC have been found in the brains of those who exhibit violent and aggressive behavior, characteristic of some forms of APD. This makes sense since the OFC is the braking structure that shuts down the emergency/stress system, which tells a person he’s in danger and should fight. If you can’t quiet your anger over a slight, you’re likely to react with aggression beyond what a situation calls for. Studies have also revealed reductions in the volume of the entire brain of people with APD, and especially in the temporal lobes, where many areas of the empathy circuit are located, and in the frontal lobes, which mediate logic and planning (especially the dorsolateral prefrontal cortex and the ventromedial prefrontal cortex, which often includes a part of the OFC). One patient developed APD traits as a result of damage to the OFC caused by a tumor.
Neurological studies also reveal abnormalities in people with BPD and NPD. One study showed that in subjects with BPD, negative emotion evokes decreased prefrontal activation (logic and planning) and increased amygdala activation (stress and aggression) as compared with the brains of subjects who don’t have this condition. This indicates both greater negative affect and a reduced ability to regulate such affect. Imaging studies investigating the brains of those with NPD compared with healthy control subjects have shown that people with NPD have less gray matter (brain volume) in the areas along the empathy circuit, including the OFC. Also compared with normal control subjects, people diagnosed with NPD have lower activation in the right anterior insula during tasks designed to evoke empathy; this area is on the empathy circuit.
Bear in mind that although studies tend to explore one condition at a time, their findings are relevant to personality disorders other than the one under consideration in any given study because these disorders tend to have many traits in common. This is true to such a great extent that the authors of DSM-5 considered including a general trait-based category called “Personality Disorders,” rather than a listing of specific disorders, separate from one another. The writing committee couldn’t agree to do this, and so the trait-based categorization of the personality disorders appears as an appendix, with the understanding that the next DSM might well revise the section in accord with a trait-based approach. I think this will happen because defining personality disorders as one condition in which impairments don’t necessarily follow specific categories makes sense. Also in line with the tendency to focus on the common denominators of personality disorders, neuroscientists Jean Decety and Yoshiya Moriguchi suggest that interventions that address empathy deficits will likely be useful across a wide array of different clinical conditions, including the Cluster B (empathy) disorders and autism. This is supported by a study that found that when people with psychopathy were asked to deliberately feel the emotions demonstrated in a video clip, brain scans showed increased activity in brain areas associated with empathy, although these people didn’t spontaneously respond in this way. As noted in a previous chapter, Fonagy has formulated a treatment that addresses BPD by encouraging the development of mentalization.
As you know, the environment, especially interactions with primary caregivers, develops the social brain, and a person certainly can’t be held responsible for the environment into which he’s born. We’ve seen repeatedly that interactions determine attachment styles and personalities to a great extent. They also determine pathology, not only in the rather complex ways seen in the Cluster B disorders, but in the simple correlation between neglect and reactive detachment disorder seen in so many orphanages where babies weren’t given the chance to bond with particular caregivers.
The findings on the interaction of genes with attachment experiences are impressive with respect to APD. One study that looked at gene-environment interaction in the development of antisocial personality traits found that abused boys who carried a mutated version of a particular gene were more likely to engage in bullying, violence, cruelty, and other antisocial behaviors that fit the profile for APD than those who didn’t have this version of the gene. This gene determines how much of the neurochemical monoamine oxidase-A (or MAOA) is produced; low levels of MAOA have been linked to aggression.
However, the tendency to antisocial behavior, including violence and cruelty, was more likely only when those who possessed the gene had also suffered childhood abuse (neglect or maltreatment). Of the fifty-five men studied, low MAOA levels alone did not produce a greater likelihood of developing antisocial behaviors. Abusive or inadequate caregiving was necessary to elicit the potential effects of the gene. Men who came from homes with “good enough” caregiving didn’t have an increased risk of developing these negative traits. This finding was corroborated by another study that found that teenagers who possessed this gene but had a secure attachment style (as teens) were able to successfully regulate aggression.
The more we know about the mind-brain, the more difficult it gets to distinguish psychological-neurological factors from moral ones. Why isn’t a person whose brain is damaged because of genetics or an abusive environment just as worthy of exoneration, and forgiveness, as the person who literally doesn’t realize what he’s doing? The person with APD is mindblind in moral terms, unable to feel that his actions are monstrous. His case is certainly different to that of someone capable of feeling empathy and guilt who ignores or suppresses such feelings—signals that tell us to do the right thing. When we punish people with APD, we’re drawing a line in the sand between criminals and victims.
This might appear to be a contemporary problem, but I believe that Austen, prescient and ahead of her time in her astuteness about people, saw this difficulty as well. To begin with, she appears to be aware that some people have abnormalities in thinking and feeling. Take Mr. Woodhouse, for instance, whose capacity to take the perspective of others is clearly limited. When a deficit is harmless, as in this case, Austen treats the character as a beloved eccentric, a course followed for the most part by the fictional people in her pages. And when limitations clearly wreak havoc, as in Mr. Elliot’s treatment of Mrs. Smith, she isn’t inclined to be charitable.
But what about someone like John Thorpe, whose behavior certainly puts others in uncomfortable predicaments? He certainly isn’t as malevolent as Mr. Elliot. And unlike Mr. Elliot, he is himself constantly victimized by petty indignities such as buying inferior merchandise because the seller appeals to his need to have the best. Thorpe is a bumbling fool rather than a clever villain. And a bumbling fool suits Austen’s exploration of the ethical question as to whether people with malfunctioning mind-brains should be held accountable for their behavior. This is a question that we have yet to answer.
Austen was moralistic and created a moralistic fictional world. But because she had a sense that some people have cognitive and emotional limitations that account for their behavior, she faced the same ethical difficulty we face today in determining whether those with damaged mind-brains should be treated as criminals or victims. I believe that she articulates the difficulty in her characterization of John Thorpe. Austen can afford to investigate the finer points of assigning blame to a character whose evil has limits because she’s dealing with minor infractions rather than outright and cruel crimes. John’s lies might have placed Catherine in danger (the long ride home without an escort or money), but this wasn’t an outcome he could have anticipated. Conversely, Mr. Elliot understands the difficulties he creates for Mrs. Smith. Note also that Mr. Elliot’s behavior leads him to break with the ideal world of Austen’s provincial communities at the end of the novel, and although he chooses his banishment, he’s excluded from the circle nevertheless. John gets no such banishment. He doesn’t get the girl in the end, but he never really had a chance of that to begin with.
Earlier, I noted a quirk on Austen’s part, that she doesn’t tell us whether John believes his lies or not, although this defies her usual tendency to clarity with her readers. I think that leaving this issue ambiguous is her solution to the dilemma posed by damaged people who nevertheless damage others. It’s a clever move on Austen’s part. If John were truly delusional, he’d be exonerated to some extent. And Austen believes that people should be held responsible for their actions, so she doesn’t want to excuse him. But she also understands that there’s something very wrong with him. She wants to hold him responsible for his actions, but also say he’s not to blame. So Austen wisely leaves it up to her readers to judge. Or not to judge, as the case may be.
Before leaving these empathy disorders, I’d like to return to the mirror as a symbol of narcissism. Unlike Sir Walter, John isn’t obsessed with his looks, and mirrors aren’t symbolically significant in his story. Northanger Abbey is one of Austen’s earliest complete novels, and perhaps early in her career Austen purposely veered away from using the mirror as a symbol of narcissism because she thought it was a cliché. Everyone in Austen’s day who was educated, even if they hadn’t gone beyond primary (elementary) school, would have known the story of Narcissus; the famous poet John Dryden had translated Ovid’s Metamorphoses into English from Latin, and the myth of Narcissus is one of that work’s most popular and enduring stories. It’s still familiar, even today. But by the time Austen came to write Persuasion, her last completed novel, she understood that this familiar icon, the mirror as an emblem of narcissism, could convey meanings beyond the obvious. The mirror was a perfect symbol for embodying several different aspects of the pathology of narcissism, and not merely the self-love that distinguishes the disorder.
The narcissist looks into the world but sees only himself—either through projections of his own psyche (as in idealizing others) or in the confirmation of grandiosity that he extracts from others. He’s always looking in the mirror in one way or another, seeing himself when he looks outward. In addition, the physical properties of mirrors as surface rather than depth renders them an apt symbol of the narcissist’s psychological limitations; he’s doomed to live with surfaces in emotional and social terms, entering into relationships that lack depth and that never truly connect him to others. And this is ultimately a lonely existence, for even when you see others in the mirror standing next to you, you don’t see real people. Sir Walter never sees Anne for who she truly is, nor even his favorite daughter Elizabeth.
Sir Walter is fortunate in being surrounded by tolerant people, like Lady Russell, who is kind and devoted out of loyalty to the Elliot family and respect for Sir Walter’s position, as well as those who jolly him along in order to manage him, like Mr. Shepherd (Sir Walter’s lawyer) and Mrs. Clay. Sir Walter’s daughters also shield him from the truth: Anne is too respectful to challenge her father. Mary, the youngest daughter, too self-absorbed. And Elizabeth and Sir Walter are complicit in bolstering one another’s grandiosity. Although Sir Walter likely possesses the inner emptiness of the person with NPD, he’s well protected from ever having to confront the abandonment depression. Perhaps as he ages, his changing looks will bring on a crisis that he can no longer avoid. Or perhaps his defenses are so strong that he’ll never be forced to confront his real self, not even in the mirror. He lives a diminished life, but he might well be protected from ever discovering this lack.
Poor John Thorpe isn’t so lucky. He’s not in a position, financially or socially, to command confirmation of his grandiosity from any but his own family. His friends tolerate him because they’re good-natured. But I have a feeling that Thorpe’s failure to win Catherine’s heart will be one in a series of disappointments that will be painful. If he’s lucky, this will prompt a transformation that leads to a better life, as with Darcy. But given what we know of him, this is highly unlikely. If only John had been born a century later, when such checks to his grandiose self-image might have brought him to the newly created analyst’s couch.
* American Psychological Association, DSM-5, 669.