ADHD and Narcissism…Or Something Else Entirely?

(3 minute read)

I once had a client who knew something was terribly wrong with him. It took him hours to get out of bed to go to work. Writing a report for his boss, something that other people could knock out in ten minutes, took him half a day. Packing for a business trip could only be done if his girlfriend helped him. Writing emails were agony, and he could barely force himself to do his expenses. He found himself combative and sullen in the office, and resentful of authority. He hated his own behavior and had diagnosed himself as having ADHD and narcissistic tendencies. Plus, he thought he was downright lazy.

For the first few sessions I bought into my client’s view of himself, and we started looking at his upbringing and his thought patterns to see what was at the root of this, and what we could change. But then he told me that things weren’t always this difficult for him: When he’d been given a work project where he had complete control and was starting things from scratch, he was the model of efficiency and effectiveness. And he had no problem packing for himself when he was going on holiday. Nor did he have any problem reading books, which he devoured in droves, focusing intently for hours at a time.

I suggested to him that he didn’t have ADHD, or Narcissistic Personality Disorder (NPD), or Major Depressive Disorder (MDD). Rather, he had CED: Chronic Entrepreneurial Disorder. He didn’t like working for other people, and wanted to be his own boss. “This is a very serious condition,” I said. “You might end up like Richard Branson or Michael Dell. Even if you have a mild case, you will probably end up being your own boss, making your own hours and doing things you like to do. There’s no treatment for this Disorder, and so I’m afraid you’re condemned to having an independent, happy and exciting life.”

OK, the truth is there is no such thing as Chronic Entrepreneurial Disorder, and I didn’t actually say those things. I did, however, suggest to him that maybe he didn’t have a problem, but rather, trying to fit himself into a role in society that didn’t suit made it LOOK like he had a problem. His reply: “It feels like I’ve been waiting my whole life for someone to say that to me.” Once he stopped trying to cram his entrepreneurial self into a corporate environment, his mood improved and everything else in his life began working better too.

Human beings love to see patterns, which enables us put things into categories and attach labels to them. On the whole, that works very well: It’s useful to categorize things as different as medical illnesses and bank accounts, weather systems and sub-atomic particles. An ordered world is one we know how to deal with.

But our bias toward seeing patterns and attaching labels can lead us astray when it comes to how people think, feel and behave. We try to cram an enormous variety of human activity across some 7 billion unique individuals into a few hundred pages of the Diagnostic and Statistics Manual of the American Psychiatric Association.

And then we try to develop procedures to fix problems with that behavior. We tick off a checklist and say “You have Alcohol Use Disorder — you’re an alcoholic — and you have to go to rehab, then Alcoholics Anonymous (AA) and never touch alcohol again.” Never mind that AA makes him feel terrible, or that his drinking is a result of unhappy marriage.

Or we say “You hear voices that aren’t there, so you have Schizophrenia, and you have to take these drugs for the rest of your life.” Never mind that the voices are soothing and pleasant and she knows full well that they’re not real. And that her life is perfectly normal in all other respects. And that the side effects of the drugs will eventually ruin her life and perhaps kill her.

Or — getting back to my client at the beginning of this article — we say “You can’t get things done at work, you resent your boss for telling you to do things and you’re so distracted that you can’t even pack your own suitcase — you have ADHD and Narcissistic Personality Disorder.” Never mind that simply having more autonomy at work will make those symptoms disappear and reveal the intelligent, capable, caring individual beneath.

The Helping Profession is, I fear, too focused on fitting our clients to the Procrustean bed of our diagnostic categories. We see our clients through the pathology that is described for us in our manuals, and we administer treatments that are prescribed by the Powers That Be of our profession. We should, instead, see our clients as unique individuals, heroes of their own story, whose courage and determination we should encourage so that they can find their own solutions to the problems that beset them.