Saturday, November 04, 2006

Social Workers assess, diagnose and treat NPD?

I myself could probably diagnose your broken arm. But of course only an MD is allowed to diagnose or treat one. Only an MD can diagnose or treat a disease like diabetes or even one like fibromyalgia, which there is no reproducible medical test for. But guess who is out there disgnosing and treating mental illness like NPD. Not just psychiatrists, but also psychologists and even social workers!

No wonder!

The science of psychology amazes me yet again with practices that fall far short scientific standards. This is as ridiculous as estimating the prevalence of NPD from the numbers of people presenting themselves for treatment. As ridiculous as conducting "experiments" without controlling the variables.

Why are even mere social workers allowed to diagnose NPD? Is it because a diagnosis of mental illness is so much guesswork that no one can come along later and prove the diagnosis wrong?

To the contrary, precisely BECAUSE of that only a psychiatrist should be able to diagnose and treat the disease. He or she should monitor and supervise any additional treatment of other health-care providers like psychologists and social workers.

Sheesh. Indeed, if a social worker is good enough to diagnose and treat the disease, why isn't a social worker good enough to prescribe medication or put someone in the hospital? Give me a break.

So some snobby debutante walks in the door and gets diagnosed (perhaps without even knowing it) as suffereing from NPD, and then some malignant narcissist walks in the door and passes for normal.

So that's why malignant narcissists aren't malignant. There is no such thing as a bad person, you see. They are just suffering victims.

Not one thought in the do-gooder about the vast swath of pain and destruction that malignant narcissist is leaving in his or her wake.

Insurance companies are partly to blame. It's time they woke up and started calculating the cost of the collateral damage. They would find it much cheaper to fork over for a psychiatrist and quit forcing patients to see social workers instead.

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4 Comments:

At 4:52 PM, Anonymous Anonymous said...

I can see your point of view, but also the other. On your side, you're right -- there is no way for a social worker (or anyone else who is not a psychatrist) to make a certifiable diagnosis, at least not one that would hold up in a court of law. Neither can such people treat NPD.
On the other hand, NPD and so many other illnesses run rampant, to the point that people who work in the fields of social work, counseling, psychology, etc. cannot help but run into folks who have it. So they should at least be skilled in sniffing it out, so they can help people who are victims of NPDs (and at least be aware of NPDs!).

 
At 4:39 PM, Blogger Louise said...

Essentially we are "diagnosing" our Ns here as well. The difference is that we are NOT doing that as part of deciding whether or not a medically recognized mental illness exists within the individual for the purpose of treatment. We're not "Monday morning quarterbacking" either: we are trying to make sense of a person whose very way of LIFE flies in direct contrast with what we consider a person to be, and the effect it is having on US. It's not clinical- it is VERY personal.

As for TREATMENT: let me ask. How many of our "suspected" Ns would ever seek treatment, let alone BELIEVE that there is anything wrong of them? How many would (or have already tried) try to twist the conversation to make US look like the one with the problem?

If people within our own families and circles of friends who KNOW the N don't necessarily see the evil in the N for what it is, then the N is camouflaging themselves very well. How the HELL can someone "trained" in broad base NPD diagnosis REALLY get it right? And then TREATMENT? Oh, c'mon...social workers do a variety of good in some cases, but this doesn't pass the laugh test.

I agree with KK's concern here in many ways. "Alpha males, prima donnas, drama queens"- these phrases may INDICATE NPD, but not necessarily. It IS an attempt to acknowledge the issue, but I think it needs to be thought out better before put into practice.

 
At 9:02 AM, Anonymous Anonymous said...

Hmmm, I've seen NPDs fool actual psychiatrists too. They are very good at painting themselves as the victims. It's only when you look at the broader picture and start talking to others in their lives that the pattern of using and abusing becomes clear.

Interestingly though, the courts will administer psychiatric exams in criminal trials and sometimes in child custody hearings. The questions are designed to be a foil to people who are trying to give the "right" answer instead of the truthful one. But very religious people often come out as NPD, because they are so sure of their own rightness and goodness.

As far as I've ever heard though, there is no treatment for NPD, so I can't imagine what treatment social workers would be handing out. NPDs will work the system to get sympathy from the mental health care provider, while continuing to do whatever they can get away with in their personal lives.

 
At 6:24 AM, Anonymous Anonymous said...

I have first hand exerience having to deal with someone with NPD. Four of my family members including myself have seen a counselor regarding my husbands ex-wife. Two people in our town have gone to a therapist also because of her causing turmoil in their lives. Our lives are in turmoil. My three stepchildren are in constant turmoil. My stepdaughter has lived with us going on three years now. We have tried to get a psychological evaluation through the courts, but they denied it. Her husband is an attorney and we live in a small town. We feel there is some politics going on. After all, she convinces the courts that she is the victim. We are all very stressed and don't know what to do. Why is it so hard to get the court to see a potential mental health issue especially when there are kids involved?

 

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