Sam Vaknin's Blog
Posted by Sam Vaknin
Notes of first therapy session with Dale G., male, 46, diagnosed with Paranoid Personality Disorder (PPD)
Dale's first enquiry is whether I am in any way associated either with the government or with his former employer. He doesn't seem reassured by my negative response. He eyes me skeptically and insists that I inform him if things change and I do become entangled with his persecutors. Why do I treat him pro bono? He suspects some ulterior motives behind my altruism and inexplicable generosity. I explain to him that I donate 25 hours a month to the community. "It's good for your image, gives you access to local bigwigs, I bet." - he retorts, accusingly. He refuses to allow me to tape record our conversation.
I set some boundaries by reminding him that the therapy session is about him, not me. He nods sagely: it's all part of an intricate scheme to "subdue" him and place him "under firm control". Why would "they"want to do that? Because he knows too much, having exposed fraud, lies,and deceit in the highest places. He has done all this from his position as a sanitary worker at the municipality? - I enquire. He is visibly offended: "There are more secrets in people's trash than in the CIA!" - he exclaims - "You think that your academic degree makes you more clever than I am or somehow superior to me?"
I remind him that therapy was more or less forced on him by his long-suffering wife. Is she one of "them"? He sniggers. Well? "Yes," - he rages - "they got to her, too. She used to be on my side." His phones are tapped, his mail intercepted and inspected, there was a mysterious fire in his apartment only days after he complained against a senior law enforcement officer. Wasn't it the antiquated television set that burst into flames? "If you care to believe such nonsense." - he eyes me with pity.
When was the last time he went out with friends? He has to think hard to come up with an answer: "Four years ago." Why so long? Is he a recluse by nature? Not at all, he is actually gregarious. So, why the social isolation? Part of his defense.You never know when something you have said in company will be used against you. His so-called friends have been asking him too many intrusive questions lately. They insisted on meeting in new venues at odd times and he got suspicious.
So, what is he doing all alone at home? He laughs bitterly: "Won't they love to know my next moves!" He isn't going to give them the pleasure of evincing his strategy. All he is willing to say is that "they" will pay dearly for having underestimated him and for having turned his life "into a long nightmare in hell". Who are "they"? His superiors at the sanitary department. They reassigned him to a dangerous part of town, working night shifts, effectively demoting him from team foreman to "common janitor". He will never forgive them. But wasn't this a temporary arrangement owing to manpower shortages? "That's what they said at the time"- he admits reluctantly.
At the end of the session he insists on inspecting my phone jacks and the under-surfaces of my desk. "You can never be too careful." - he half apologizes.
Posted by Sam Vaknin
Notes of first therapy session with Ani Korban, male, 46, diagnosed with Antisocial Personality Disorder (AsPD), or Psychopathy and Sociopathy
Ani was referred to therapy by the court, as part of a rehabilitation program. He is serving time in prison, having been convicted of grand fraud. The scam perpetrated by him involved hundreds of retired men and women in a dozen states over a period of three years. All his victims lost their life savings and suffered grievous and life-threatening stress symptoms.
He seems rather peeved at having to attend the sessions but tries to hide his displeasure by claiming to be eager to "heal, reform himself and get reintegrated into normative society". When I ask him how does he feel about the fact that three of his victims died of heart attacks as a direct result of his misdeeds, he barely suppresses an urge to laugh out loud and then denies any responsibility: his "clients" were adults who knew what they were doing and had the deal he was working on gone well, they would all have become "filthy rich." He then goes on the attack: aren't psychiatrists supposed to be impartial? He complains that I sound exactly like the "vicious and self-promoting low-brow" prosecutor at his trial.
He looks completely puzzled and disdainful when I ask him why he did what he did. "For the money, of course" - he blurts out impatiently and then recomposes himself: "Had this panned out, these guys would have had a great retirement, far better than their meager and laughable pensions could provide." Can he describe his typical "customer"? Of course he can - he is nothing if not thorough. He provides me with a litany of detailed demographics. No, I say - I am interested to know about their wishes, hopes, needs, fears, backgrounds, families, emotions. He is stumped for a moment: "Why would I want to know these data? It's not like I was their bloody grandson, or something!"
Ani is contemptuous towards the "meek and weak". Life is hostile, one long cruel battle, no holds barred. Only the fittest survive. Is he one of the fittest? He shows signs of unease and contrition but soon I find out that he merely regrets having been caught. It depresses him to face incontrovertible proof that he is not as intellectually superior to others as he had always believed himself to be.
Is he a man of his word? Yes, but sometimes circumstances conspire to prevent one from fulfilling one's obligations. Is he referring to moral or to contractual obligations? Contracts he believes in because they represent a confluence of the self-interests of the contracting parties. Morality is another thing altogether: it was invented by the strong to emasculate and enslave the masses. So, is he immoral by choice? Not immoral, he grins, just amoral.
How does he choose his business partners? They have to be alert, super-intelligent, willing to take risks, inventive, and well-connected. "Under different circumstance, you and I would have been a great team" - he promises me as I, his psychiatrist, am definitely "one of the most astute and erudite persons he has ever met." I thank him and he immediately asks for a favor: could I recommend to the prison authorities to allow him to have free access to the public pay phone? He can't run his businesses with a single daily time-limited call and this is "adversely affecting the lives and investments of many poor people." When I decline to do his bidding, he sulks, clearly consumed by barely suppressed rage.
How is he adapting to being incarcerated? He is not because there is no need to. He is going to win his appeal. The case against him was flimsy, tainted, and dubious. What if he fails? He doesn't believe in "premature planning". "One day at a time is my motto." - he says smugly - "The world is so unpredictable that it is by far better to improvise."
He seems disappointed with our first session. When I ask him what his expectations were, he shrugs: "Frankly, doctor, talking about scams, I don't believe in this psycho-babble of yours. But I was hoping to be able finally communicate my needs and wishes to someone who would appreciate them and lend me a hand here." His greatest need, I suggest, is to accept and admit that he erred and to feel remorse, This strikes him as very funny and the encounter ends as it had begun: with him deriding his victims.
Posted by Sam Vaknin
Notes of first therapy session with Sam V., diagnosed with Narcissistic Personality Disorder (NPD)
Sam presents with anhedonia (failure to enjoy or find pleasure in anything) and dysphoria bordering on depression. He complains of inability to tolerate people's stupidity and selfishness in a variety of settings. He admits that as a result of his "intellectual superiority" he is not well placed to interact with others or even to understand them and what they are going through. He is a recluse and fears that he is being mocked and ridiculed behind his back as a misfit and a freak. Throughout the first session, he frequently compares himself to a machine, a computer, or a member of an alien and advanced race, and talks about himself in the third person singular.
Life, bemoans Sam, has dealt him a bad hand. He is consistently and repeatedly victimized by his clients, for instance. They take credit for his ideas and leverage them to promote themselves, but then fail to re-hire him as a consultant. He seems to attract hostility and animosity incommensurate with his good and generous deeds. He even describes being stalked by two or three vicious women whom he had spurned, he claims, not without pride in his own implied irresistibility. Yes, he is abrasive and contemptuous of others at times but only in the interests of "tough love." He is never obnoxious or gratuitously offensive.
Sam is convinced that people envy him and are "out to get him" (persecutory delusions). He feels that his work (he is also a writer) is not appreciated because of its elitist nature (high-brow vocabulary and such). He refuses to "dumb down". Instead, he is on a mission to educate his readers and clients and "bring them up to his level." When he describes his day, it becomes clear that he is desultory, indolent, and lacks self-discipline and regular working habits. He is fiercely independent (to the point of being counter-dependent - click on this link: http://samvak.tripod.com/faq66.html ) and highly values his self-imputed "brutal honesty" and "original, non-herd, outside the box" thinking.
He is married but sexually inactive. Sex bores him and he regards it as a "low-level" activity practiced by "empty-headed" folk. He has better uses for his limited time. He is aware of his own mortality and conscious of his intellectual legacy. Hence his sense of entitlement. He never goes through established channels. Instead, he uses his connections to secure anything from medical care to car repair. He expects to be treated by the best but is reluctant to buy their services, holding himself to be their equal in his own field of activity. He gives little or no thought to the needs, wishes, fears, hopes, priorities, and choices of his nearest and dearest. He is startled and hurt when they become assertive and exercise their personal autonomy (for instance, by setting boundaries).
Sam is disarmingly self-aware and readily lists his weaknesses and faults - but only in order to preempt real scrutiny or to fish for compliments. He constantly brags about his achievements but feels deprived ("I deserve more, much more than that"). When any of his assertions or assumptions is challenged he condescendingly tries to prove his case. If he fails to convert his interlocutor, he sulks and even rages. He tends to idealize everyone or devalue them: people are either clever and good or stupid and malicious. But, everyone is a potential foe.
Sam is very hypervigilant and anxious. He expects the worst and feels vindicated and superior when he is punished ("martyred and victimized"). Sam rarely assumes total responsibility for his actions or accepts their consequences. He has an external locus of control and his defenses are alloplastic. In other words: he blames the world for his failures, defeats, and "bad luck". This "cosmic conspiracy" against him is why his grandiose projects keep flopping and why he is so frustrated.