Thanks Nathalie. This is a thoughtful piece of work that aligns well with my clinical experience over recent years. Clinical and research understanding of personality disorders has developed massively. What we call it is a different question. But there has never been more concensus about what people with these problems need in order to function better. And one of the things they need is accountability. In a culture of identity shopping, neuro divergence and cPTSD are easier to accept or adopt as self applied labels. But diagnosistic systems are not intended to offer identity. They are intended to signpost towards help with functioning better.
I really appreciate you reading this piece, Simon! It gives me a wave of relief to know it aligns with what you’re seeing clinically. All roads keep coming back to accountability as the path to better functioning. It’s just unfortunate when those in your profession (and others) get recruited to hand out identities rather than support true accountability.
Its hard i think for people with developmental trauma which presents mainly interpersonally. Being given accountability for their behavior strategies can feel a bit too much like being scape goated or shamed all over again. Its not. Noone thinks the trauma was their fault. But thats what someone with developmental trauma will be vigilent for.
It's true, which makes it difficult to hold someone in their position accountable. I can see why so many limit the scope of their work or interactions to validating them.
Asking for validation-only therapy is like asking for therapy for arachnophobia, with a “no spiders please” caveat. Its understandable. But its not going to lead to change.
This is really well done, and you know I agree that this is what's going one. Thank you for putting it out there. Many, many people know that what you're writing is true, but they will pretend they don't know it.
There's one point on which I'd add something, or perhaps disagree a bit.
You wrote:
"While there is truth in these patterns in specific populations of women6, this framing makes it incredibly difficult for those who recognise narcissistic traits in themselves to seek help."
My view? That's too bad. The behavior is stigmatized because it *deserves to be stigmatized.* Sympathy-first for the one with a personality disorder (as compared to sympathy-first for the person affected by her Cluster B behavior) is where we're already at. That's why we're here.
I don't care if the narcissist finds it "stigmatizing." I want them to find it stigmatizing. Why? Because most Cluster Bs-not all, but most-are not ever going to change. We're not going to get an appreciable number of narcissists to suddenly see themselves for who they are by "avoiding stigma."
Avoiding stigma is what has allowed Cluster Bs to normalize their behavior and to abuse with abandon. Not only are they not recognized as abusive, their abuse itself is validated and praised as "authenticity."
I care first about helping people avoid the effects of Cluster Bs, because I think that will help more people than (what I believe is) a vain hope that "offering palatable terms" will make a Cluster B suddenly realize she's the problem.
Thanks, Josh. I agree that you’re raising something really important here.
You’re right that stigma exists for a reason and harmful behaviour should carry social consequence. When someone’s fear of being stigmatised outweighs their desire to stop being harmful to others, we’re not going to see change and it becomes a self-reinforcing dynamic: denial, projection, blame.
Your point about stigma as a behavioural intervention is also important. It’s about setting limits and enforcing them rather than shaming for shame's sake. Stigmatise first. If change doesn’t follow, then restrict access to people, opportunities, and environments where harm is likely. And if the behaviour persists, there should be pathways to behavioural rehab.
We already do this with substance abuse. We don’t say “but this person has trauma, so we’ll just let them drink and drive.” We create consequences, treatment pathways, and draw hard lines. Why not treat relational and social abuse the same way?
Good read and thanks for treating the issue with all the care it deserves.
Something also of note: it’s possible to have autism and narcissistic traits (or even full blown NPD). Autism can be misattributed to narcissism because people with ASD can lack the social awareness to be polite, and I’m not talking about that phenomenon specifically, but rather how the two can co-exist and reinforce one another in a different way. This is the phenomenon of childhood bullying and social ostracism creating a narcissistic wound — where the autistic person feels insecure about their social status and feel the need to prove themselves as an adult by competing with or knocking others down. I think one is especially at risk of this if they have savantism or any kind of intellectual or creative gift in addition to autism.
Personally, I don’t think you can force people to look inward and change (what they do have control to change), but you don’t have to put up with bad behavior either. For myself, I turn to religion to examine and work on my more selfish inclinations (that we all have), not therapy. As someone who has been in therapy since I was a very young child (thanks to neurodivergence!), I find most therapists are just kind of dialing it in and aren’t able to create the trusting relationship needed for vulnerable inner work to be supported. Belief in a higher power has helped me do this the most, but I realize it’s not for everyone!
Thank you for speaking about the ASD and narcissism crossover. It’s a nuance I didn’t explore and it adds something important to the conversation. These dynamics can get tangled, especially when early exclusion or a need to prove worth through performance goes unexamined.
I also respect what you shared about your healing path, and the role of therapy in it. The path isn’t one-size-fits-all. What matters most is that it actually supports self-honesty, disruption of old patterns, and accountability whether that’s through therapy, faith, or something else entirely.
Thanks again for sharing your perspective Christina!
One of the things I love about your writing is that you talk about the ways everyone can participate in narcissistic or unhealthy relational systems, and so I think it's important to remember that people with disabilities aren't immune to this phenomenon either. And in some ways, overcoming a degree of self-centeredness is just a normal developmental task of becoming adult, so these conversations are relevant to us all.
However, I do think if you've got relational wounds specifically to do with social exclusion and ostracization, acceptance and love need to be part of the equation when you look inward and constructively criticize yourself, because you most likely have been dealing with criticism from others your whole life. For me, I found that acceptance and love through a higher power (what I call God), but I often use framing from psychology to analyze my own patterns. I like family systems a lot and that's why I find a lot of what you write about to be relevant. I quite like philosophy too. And I agree -- whatever works, works!
I think it's amazing that you've been able to find and use your relationship to God to help you with your healing, complimented by your inner work using psychological frameworks. Whatever works!
Thank you again for your thoughtful insights and for reading this piece!
Thanks so much for this incredibly well-written piece, Nathalie. It’s particularly timely for many conversations I’m having with leaders who feel powerless to address character issues that are causing harm to people and performance, because workplace DEI policies accept self-reported neurodivergence without question and taking action is seen as too politically risky. Sadly, it’s often these leaders who are left to placate team members, absorb the emotional fallout, and hold teams together with little support.
Thank you so much for reading it Sarah and for naming the issues leaders are having. I’m also hearing similar stories from leaders who are trying to hold systems together while navigating real harm. The emotional burden often falls on those tasked with preserving stability, but in doing so, many end up reinforcing the very dynamics that need to change. Instead of strategically dissenting, they’re trying to save a system that’s hurting people.
Is this a question of leaders not having enough backbone?
Great question! The short answer is yes. For me, the longer and more nuanced answer is about why and how. Often, it’s less a lack of backbone and more a lack of scaffolding — leaders need help strengthening their backbone in ways that allow them to dissent strategically without risking relationships, reputation, or results. To that end, I’m focused on how I can help the leaders I’m fortunate to work with become more assertive (your book is on my recommended reads 🤩). What leadership competencies do they need to develop? Do they have a toolkit for strategic dissent? I’m keen to have a longer conversation with you sometime — I have so much to learn from you!
Ah it sounds like what you’re describing is leaders developing relational intelligence. There are a few competences that I outlined in one of my LinkedIn posts, and that I’ll be writing more about soon.
Yes — thanks for sharing this and for picking up on my hasty earlier reply about leaders feeling powerless ‘because of’ workplace policies. There are always multiple perspectives worth considering.
Thanks for the mention Nathalie! I think another aspect is the lack of meaningful treatment options for diagnoses such as NPD and BPD. There's a persistent assumption that personality disorders are "untreatable", which is patently untrue (the true bit is that many are averse to believing there's anything wrong with them). While you can't change someone's core way of being in the world (the way in which they "do something" with their suffering) there's plenty that can be done to reduce the intensity of symptoms and reach a healthy level of functioning. But it tends to require the building of a very robust, secure therapeutic relationship over time alongside behavioural and emotional regulation skills like DBT (and this is hard and expensive). If someone is motivated and believes they can improve, there's a lot that's possible.
I think the discourse around both neurodiversity and personality disorders reflects a broader trend away from valuing meaningful therapeutic treatment. "You're not unwell, the system is unwell" and "this is just the way you are" have a kernel of something useful and perhaps true in them, but they do people an incredible disservice by suggesting that trying to do anything on a personal level is pointless or even morally wrong ("reinforcing oppressor dynamics"). As I think I mentioned in another comment, ADHDers need MORE accountability to live well, not less, and accepting a neurodiversity diagnosis should be an invitation to think creatively about how you're going to get by in the world and where you do/don't function well.
Absolutely! The idea that personality disorders are untreatable has led to cultural resignation that’s inaccurate and unhelpful. Support, structure, and accountability can go a long way but they all require time, skill, and consistency, which most systems aren’t built to deliver. I also agree that the overcorrection toward "the system is the only problem" erases the role of personal responsibility entirely. I’d bet the psychedelic-assisted medical community will eventually carve out an angle for Cluster B...exclusive meds to cool the behaviours, rebranded as relational dysregulation or nervous system overwhelm.
It's funny, but a lot of the clinical literature suggests that BPD is treatable but NPD is not, whereas some professionals I've spoken to have said their experience is the opposite -- NPD is treatable, but people with BPD tend to refuse to accept that they could be part of the problem.
When the community of clinicians can't agree...no wonder there are problems.
This also highlights clinical skill, depth of understanding about the patient's presentation and context, and mastery in their application in treatment.
Ha, clear as mud right? I think so much also depends what people mean by "treatable". Your average criminally antisocial person is unlikely to develop a conscience (though credible case studies suggest it's not unheard of). But even a 5% reduction in acting out behaviours across a lifespan can mean a lot fewer victims.
So much depends on the individual and this is why I like the PDM as a guide over the DSM, it does well on the "level of functioning" bit within individual categories with a scale that goes from healthy through to psychotic. From memory NPD tends to present (on average) higher up the scale so the kind of reality distortion that makes therapy really tricky is more prevalent.
Then there's the whole other thing about how much overlap there is between externalised cPTSD and BPD, how BPD has been used as a lazy "difficult woman" diagnosis...
Excellent and well researched. I appreciate how you tie the threads from various thinkers. I’ve thought for at least the last three years that there’s much overlap between mental illness and leftism, and of course you know I had both mental illness and was a leftist. I also was abused by a “toaster mother” who was warm but unpredictable. She said she loved me, but then she beat me. My father was absent. As a result, I developed a lot of these traits and behaviors. I think everyone could tend toward narcissism but it takes effort not to regress to the mean on that. Separately, I think you’re onto something about the reticence to diagnose people with cluster B disorders because we’ve collectively decided that shame is to be eradicated, and no woman can ever be allowed to feel it or that she’s done anything wrong because she’s too fragile or assumed too morally upright to be faced with a mirror. We need to bring shame back. I’m not saying religion tinged sexual shame but just shame in general.
Thank you Anuradha for your thoughts and for reading this! I'd never heard the term "toaster mother" and I'm glad you explained it (not that you experienced it).
You said something that really stuck with me: “we’ve collectively decided that shame is to be eradicated.” That clicked something into place. It goes a long way in explaining the moral licensing often extended to leftist women as if any attempt to hold them accountable is too cruel, too patriarchal, or too unsafe. The framing protects their fragility over others' wellbeing.
We do need to bring shame back to regulate ourselves and to maintain social cohesion.
I deeply agree with this reflection — we’re at a point where the lines between diagnostic utility, social identity, and personal narrative have become so intertwined that addressing the misuse or overextension of certain labels can feel almost untouchable. In my own clinical practice, I try to speak openly about this complexity with patients, but it’s increasingly clear that doing so — even gently — risks being perceived as invalidating or even oppressive. For some, any questioning of their self-understanding feels like a threat not just to their diagnosis, but to their belonging and legitimacy in a broader cultural ecosystem.
What makes this even more difficult is the generational divide among providers themselves. Between Gen X, Millennials, and Gen Z, there’s a wide range of lived experience around what terms like “mental illness,” “neurodivergence,” or even “healing” mean — and whether we should be using them at all. These aren’t just semantic disagreements; they reflect different worldviews about suffering, responsibility, power, and identity. So even within mental health disciplines — let alone across psychiatry, psychology, therapy, coaching, and peer support — having a coherent conversation has become incredibly challenging.
I have long been searching for a more public forum to have these conversations openly.
It's a relief to read your words Amit. You've described the tension so well, especially the part about how even gentle questioning can be seen as invalidating. The generational split around language and meaning adds another layer that makes honest and real conversation feel almost impossible. Your sentiment also echoes what Freya India just published about her generation and the meaninglessness of therapy language that reduces being human to symptoms and labels. You might be interested in reading it if you haven't already:
That is an excellent piece - thank you for the recommendation. Have you come across online or other types of spaces where this conversations is being had among professionals in mental health space and/or between professionals and folks utilizing mental health services? I want to engage more publicly in this dialogue so that as attention continues to increase on the construct of mental health (especially in the current moment of our global geopolitical climate), some reorientation towards this framing can make its way into the next iteration of how the larger population and next generations engage with these vital questions/considerations for daily life and living.
I see professionals (mainly psychotherapists) discussing related topics on X. Jonathan Shedler, JD Haltigan (on this platform and X) are a few I’ve seen.
re: Why more ADHD/autism, but not more Cluster B, your thoughts on the complex etiological nature of this is certainly on the right track. I might add:
- progressively lowering of the diagnostic threshold as a result of Pharma influence (e.g., more Ritalin sales);
- feminist influence, especially in the early education system, to pathologize generally healthy and normal behaviour amongst boys
- increasing childhood vaccine schedule and associated neurotoxic load (wondering if the more inflammatory APO-E4 allele cohort are more vulnerable 🤔)
- if covert/vulnerable narcissism is a feminine form as I suspect (i.e., more prevalent amongst women than men), the cultural metastization of it would result in increasing thaumaturgical mirroring as being victims of something else health related.
These are awesome and important additions and I'm glad you raised them. One other point that came up but I thought including would blow out the article is metabolic issues. Our metabolic system is completely screwed up by our lifestyles. There are so many Cluster B vegans, for example. It's amazing what animal products and healthier lifestyle can do for mental and emotional function.
Madame Dr. Nathalie, I do thank you for your kind words and find myself further in agreement with you. Physical health and psychoemotional health are intrinsically linked..
This is such an important distinction. When we start framing emotional immaturity or manipulative behavior as fixed traits or identities, we blur the line between explanation and excuse. As I wrote in The Cost of Comfort: Why Hard Truths Matter for Our Kids, the more we protect people from discomfort, the more we stunt their ability to grow. There is a cost to confusing compassion with avoidance, and we are seeing it now across entire systems.
The crisis is not just cultural. It runs through the psychology field itself. In a rush for legitimacy and relevance, too much of the profession has traded long-term development for short-term validation. We have softened our standards, moralized distress, and started calling adaptation a form of oppression. But growth requires friction. And truth still matters.
Thank you for articulating this so clearly. It is a hard but necessary conversation.
Thank you so much for reading the piece and for your thoughts, highlighting the importance of discomfort and friction for character development and growth.
I'd start with search engines and ChatGPT/Grok. Ask it to provide high quality peer reviewed references on the origins of neurodivergence or on ADHD or ASD. There are also a few references at the end of this article.
Side note (and personal note) I'm so grateful I got a TOVA as a requirement of my ADHD diagnosis, even though the process of doing it was so painful I considered just leaving without finishing it.
It's so helpful having a clear diagnostic tool that shows "how effectively and consistently can you pay attention for, and how long, compared to the norm". Something tangible that isn't a self-report. It should be standard and I don't think it is.
I had to look up what the TOVA is and I hadn't come across the term before. After reading a bit on it, I can imagine how challenging that experience must have been yet can also see how having something that objectively tracks attention and functioning would be incredibly helpful. Thank you for sharing that and for adding to the conversation on what meaningful diagnosis and support can look like.
My apologies for the vagueness! I can fall into the trap of over-explaining things to people who are at least as qualified as me and often far more so. It's a really handy diagnostic tool, and I'm mostly joking about how bad it was it. A great example of a measurability in diagnostics.
There are many things about the modern World that One can notice as an overall pattern of disfunction, rot, and all this.
One of those is how adaptable Human Beings are, and how People can recognise "quick and easy" paths to "success".
It is often said that "the fish rots from the head down".
Many of today's "leaders", and those held out as "elite" in some way are, in fact, fraudulant, psychopathic, and sociopathic. Add to that the prevalence of gutless cowardice masquerading as "going along to get along".
We live in the Age of the Preposterous, where many of the so-called "elite" believe Themselves to be the authors and editors of reality. This "trickles down" to everyday People, who apply a "monkey see / monkey do" tactic to Their personal Life, and it is reinforced by the fear of the gutless coward.
It has all been foretold.
The Hopi word for the modern world is "Koyanisqatsi". ( Koy-onn-iss-kot-see ) This translates to "World upside-down", or "Life upside-down".
Anyhoo, to the Hopi, Life in the modern world will continue to dissolve into chaos, until it destroys itself by fire. They will survive as an intact People, just as They survived the Great Flood. To Them, this is the Fourth World, the fourth time Humans have reached high technology, and ultimately destroyed Themselves.
I appreciate this. I’ve heard similar themes in Indian traditions too. In Kali Yuga, the world is said to turn upside down, where power disconnects from wisdom, and truth is hard to find. Some say it ends in fire, and eventually, the sun consumes it all. These patterns echo across so many cultures, and with every end a new cycle begins.
Also, in case it helps: I predict you're going to get unreasonable comments. Some will accuse you of "painting with a broad brush," and they will personalize, and accuse you of "attacking them." I hope you can sweep these aside and not pay attention to them. There's no way to avoid "triggering" people who are immature enough that they cannot handle a frank conversation like this.
Is there a distinction between those who have grown up with the label since early childhood, versus those who acquire an acceptable neurodivergent label as an adult?
How susceptible are diagnosticians to manipulative behaviors in ascribing labels?
I can't really comment on the difference between those who have been diagnosed as children vs those diagnosed as adults because the pathways are so different, as are the drivers and incentives for diagnoses in these populations.
I think many diagnosticians want to do the right thing, can't always detect manipulation, and feel they don't have a choice when someone comes through the door ready to pay to be assessed for neurodivergent label.
Most people are susceptible to manipulative behaviours when someone is perceived to be in suffering and in a position to offer help.
Great paper. I recently wrote a piece about how I feel the real issue that needs more examination is the idea of an underdeveloped sense of self which becomes a breeding v ground for exactly this kind of cluster b behavior. I contrast this theory against adhd and autism to see why it’s not autism or adhd but rather an identity schism.
Thanks Nathalie. This is a thoughtful piece of work that aligns well with my clinical experience over recent years. Clinical and research understanding of personality disorders has developed massively. What we call it is a different question. But there has never been more concensus about what people with these problems need in order to function better. And one of the things they need is accountability. In a culture of identity shopping, neuro divergence and cPTSD are easier to accept or adopt as self applied labels. But diagnosistic systems are not intended to offer identity. They are intended to signpost towards help with functioning better.
I really appreciate you reading this piece, Simon! It gives me a wave of relief to know it aligns with what you’re seeing clinically. All roads keep coming back to accountability as the path to better functioning. It’s just unfortunate when those in your profession (and others) get recruited to hand out identities rather than support true accountability.
Its hard i think for people with developmental trauma which presents mainly interpersonally. Being given accountability for their behavior strategies can feel a bit too much like being scape goated or shamed all over again. Its not. Noone thinks the trauma was their fault. But thats what someone with developmental trauma will be vigilent for.
It's true, which makes it difficult to hold someone in their position accountable. I can see why so many limit the scope of their work or interactions to validating them.
Asking for validation-only therapy is like asking for therapy for arachnophobia, with a “no spiders please” caveat. Its understandable. But its not going to lead to change.
Great example!
This is really well done, and you know I agree that this is what's going one. Thank you for putting it out there. Many, many people know that what you're writing is true, but they will pretend they don't know it.
There's one point on which I'd add something, or perhaps disagree a bit.
You wrote:
"While there is truth in these patterns in specific populations of women6, this framing makes it incredibly difficult for those who recognise narcissistic traits in themselves to seek help."
My view? That's too bad. The behavior is stigmatized because it *deserves to be stigmatized.* Sympathy-first for the one with a personality disorder (as compared to sympathy-first for the person affected by her Cluster B behavior) is where we're already at. That's why we're here.
I don't care if the narcissist finds it "stigmatizing." I want them to find it stigmatizing. Why? Because most Cluster Bs-not all, but most-are not ever going to change. We're not going to get an appreciable number of narcissists to suddenly see themselves for who they are by "avoiding stigma."
Avoiding stigma is what has allowed Cluster Bs to normalize their behavior and to abuse with abandon. Not only are they not recognized as abusive, their abuse itself is validated and praised as "authenticity."
I care first about helping people avoid the effects of Cluster Bs, because I think that will help more people than (what I believe is) a vain hope that "offering palatable terms" will make a Cluster B suddenly realize she's the problem.
What do you think?
Thanks, Josh. I agree that you’re raising something really important here.
You’re right that stigma exists for a reason and harmful behaviour should carry social consequence. When someone’s fear of being stigmatised outweighs their desire to stop being harmful to others, we’re not going to see change and it becomes a self-reinforcing dynamic: denial, projection, blame.
Your point about stigma as a behavioural intervention is also important. It’s about setting limits and enforcing them rather than shaming for shame's sake. Stigmatise first. If change doesn’t follow, then restrict access to people, opportunities, and environments where harm is likely. And if the behaviour persists, there should be pathways to behavioural rehab.
We already do this with substance abuse. We don’t say “but this person has trauma, so we’ll just let them drink and drive.” We create consequences, treatment pathways, and draw hard lines. Why not treat relational and social abuse the same way?
Good read and thanks for treating the issue with all the care it deserves.
Something also of note: it’s possible to have autism and narcissistic traits (or even full blown NPD). Autism can be misattributed to narcissism because people with ASD can lack the social awareness to be polite, and I’m not talking about that phenomenon specifically, but rather how the two can co-exist and reinforce one another in a different way. This is the phenomenon of childhood bullying and social ostracism creating a narcissistic wound — where the autistic person feels insecure about their social status and feel the need to prove themselves as an adult by competing with or knocking others down. I think one is especially at risk of this if they have savantism or any kind of intellectual or creative gift in addition to autism.
Personally, I don’t think you can force people to look inward and change (what they do have control to change), but you don’t have to put up with bad behavior either. For myself, I turn to religion to examine and work on my more selfish inclinations (that we all have), not therapy. As someone who has been in therapy since I was a very young child (thanks to neurodivergence!), I find most therapists are just kind of dialing it in and aren’t able to create the trusting relationship needed for vulnerable inner work to be supported. Belief in a higher power has helped me do this the most, but I realize it’s not for everyone!
Thank you for speaking about the ASD and narcissism crossover. It’s a nuance I didn’t explore and it adds something important to the conversation. These dynamics can get tangled, especially when early exclusion or a need to prove worth through performance goes unexamined.
I also respect what you shared about your healing path, and the role of therapy in it. The path isn’t one-size-fits-all. What matters most is that it actually supports self-honesty, disruption of old patterns, and accountability whether that’s through therapy, faith, or something else entirely.
Thanks again for sharing your perspective Christina!
One of the things I love about your writing is that you talk about the ways everyone can participate in narcissistic or unhealthy relational systems, and so I think it's important to remember that people with disabilities aren't immune to this phenomenon either. And in some ways, overcoming a degree of self-centeredness is just a normal developmental task of becoming adult, so these conversations are relevant to us all.
However, I do think if you've got relational wounds specifically to do with social exclusion and ostracization, acceptance and love need to be part of the equation when you look inward and constructively criticize yourself, because you most likely have been dealing with criticism from others your whole life. For me, I found that acceptance and love through a higher power (what I call God), but I often use framing from psychology to analyze my own patterns. I like family systems a lot and that's why I find a lot of what you write about to be relevant. I quite like philosophy too. And I agree -- whatever works, works!
I think it's amazing that you've been able to find and use your relationship to God to help you with your healing, complimented by your inner work using psychological frameworks. Whatever works!
Thank you again for your thoughtful insights and for reading this piece!
Thanks so much for this incredibly well-written piece, Nathalie. It’s particularly timely for many conversations I’m having with leaders who feel powerless to address character issues that are causing harm to people and performance, because workplace DEI policies accept self-reported neurodivergence without question and taking action is seen as too politically risky. Sadly, it’s often these leaders who are left to placate team members, absorb the emotional fallout, and hold teams together with little support.
Thank you so much for reading it Sarah and for naming the issues leaders are having. I’m also hearing similar stories from leaders who are trying to hold systems together while navigating real harm. The emotional burden often falls on those tasked with preserving stability, but in doing so, many end up reinforcing the very dynamics that need to change. Instead of strategically dissenting, they’re trying to save a system that’s hurting people.
Is this a question of leaders not having enough backbone?
Great question! The short answer is yes. For me, the longer and more nuanced answer is about why and how. Often, it’s less a lack of backbone and more a lack of scaffolding — leaders need help strengthening their backbone in ways that allow them to dissent strategically without risking relationships, reputation, or results. To that end, I’m focused on how I can help the leaders I’m fortunate to work with become more assertive (your book is on my recommended reads 🤩). What leadership competencies do they need to develop? Do they have a toolkit for strategic dissent? I’m keen to have a longer conversation with you sometime — I have so much to learn from you!
Thank you as well for recommending my book and applying it in your work with clients! Happy to have a longer conversation with you too Sarah!
Ah it sounds like what you’re describing is leaders developing relational intelligence. There are a few competences that I outlined in one of my LinkedIn posts, and that I’ll be writing more about soon.
https://www.linkedin.com/feed/update/urn:li:activity:7341041993587838976?commentUrn=urn%3Ali%3Acomment%3A%28activity%3A7341041993587838976%2C7341064140834119683%29&dashCommentUrn=urn%3Ali%3Afsd_comment%3A%287341064140834119683%2Curn%3Ali%3Aactivity%3A7341041993587838976%29
Yes — thanks for sharing this and for picking up on my hasty earlier reply about leaders feeling powerless ‘because of’ workplace policies. There are always multiple perspectives worth considering.
Thanks for the mention Nathalie! I think another aspect is the lack of meaningful treatment options for diagnoses such as NPD and BPD. There's a persistent assumption that personality disorders are "untreatable", which is patently untrue (the true bit is that many are averse to believing there's anything wrong with them). While you can't change someone's core way of being in the world (the way in which they "do something" with their suffering) there's plenty that can be done to reduce the intensity of symptoms and reach a healthy level of functioning. But it tends to require the building of a very robust, secure therapeutic relationship over time alongside behavioural and emotional regulation skills like DBT (and this is hard and expensive). If someone is motivated and believes they can improve, there's a lot that's possible.
I think the discourse around both neurodiversity and personality disorders reflects a broader trend away from valuing meaningful therapeutic treatment. "You're not unwell, the system is unwell" and "this is just the way you are" have a kernel of something useful and perhaps true in them, but they do people an incredible disservice by suggesting that trying to do anything on a personal level is pointless or even morally wrong ("reinforcing oppressor dynamics"). As I think I mentioned in another comment, ADHDers need MORE accountability to live well, not less, and accepting a neurodiversity diagnosis should be an invitation to think creatively about how you're going to get by in the world and where you do/don't function well.
Absolutely! The idea that personality disorders are untreatable has led to cultural resignation that’s inaccurate and unhelpful. Support, structure, and accountability can go a long way but they all require time, skill, and consistency, which most systems aren’t built to deliver. I also agree that the overcorrection toward "the system is the only problem" erases the role of personal responsibility entirely. I’d bet the psychedelic-assisted medical community will eventually carve out an angle for Cluster B...exclusive meds to cool the behaviours, rebranded as relational dysregulation or nervous system overwhelm.
It's funny, but a lot of the clinical literature suggests that BPD is treatable but NPD is not, whereas some professionals I've spoken to have said their experience is the opposite -- NPD is treatable, but people with BPD tend to refuse to accept that they could be part of the problem.
When the community of clinicians can't agree...no wonder there are problems.
This also highlights clinical skill, depth of understanding about the patient's presentation and context, and mastery in their application in treatment.
Ha, clear as mud right? I think so much also depends what people mean by "treatable". Your average criminally antisocial person is unlikely to develop a conscience (though credible case studies suggest it's not unheard of). But even a 5% reduction in acting out behaviours across a lifespan can mean a lot fewer victims.
So much depends on the individual and this is why I like the PDM as a guide over the DSM, it does well on the "level of functioning" bit within individual categories with a scale that goes from healthy through to psychotic. From memory NPD tends to present (on average) higher up the scale so the kind of reality distortion that makes therapy really tricky is more prevalent.
Then there's the whole other thing about how much overlap there is between externalised cPTSD and BPD, how BPD has been used as a lazy "difficult woman" diagnosis...
Thank you for adding more depth to the notion of 'treatable'. It's a bloody mess!
Excellent and well researched. I appreciate how you tie the threads from various thinkers. I’ve thought for at least the last three years that there’s much overlap between mental illness and leftism, and of course you know I had both mental illness and was a leftist. I also was abused by a “toaster mother” who was warm but unpredictable. She said she loved me, but then she beat me. My father was absent. As a result, I developed a lot of these traits and behaviors. I think everyone could tend toward narcissism but it takes effort not to regress to the mean on that. Separately, I think you’re onto something about the reticence to diagnose people with cluster B disorders because we’ve collectively decided that shame is to be eradicated, and no woman can ever be allowed to feel it or that she’s done anything wrong because she’s too fragile or assumed too morally upright to be faced with a mirror. We need to bring shame back. I’m not saying religion tinged sexual shame but just shame in general.
Thank you Anuradha for your thoughts and for reading this! I'd never heard the term "toaster mother" and I'm glad you explained it (not that you experienced it).
You said something that really stuck with me: “we’ve collectively decided that shame is to be eradicated.” That clicked something into place. It goes a long way in explaining the moral licensing often extended to leftist women as if any attempt to hold them accountable is too cruel, too patriarchal, or too unsafe. The framing protects their fragility over others' wellbeing.
We do need to bring shame back to regulate ourselves and to maintain social cohesion.
I deeply agree with this reflection — we’re at a point where the lines between diagnostic utility, social identity, and personal narrative have become so intertwined that addressing the misuse or overextension of certain labels can feel almost untouchable. In my own clinical practice, I try to speak openly about this complexity with patients, but it’s increasingly clear that doing so — even gently — risks being perceived as invalidating or even oppressive. For some, any questioning of their self-understanding feels like a threat not just to their diagnosis, but to their belonging and legitimacy in a broader cultural ecosystem.
What makes this even more difficult is the generational divide among providers themselves. Between Gen X, Millennials, and Gen Z, there’s a wide range of lived experience around what terms like “mental illness,” “neurodivergence,” or even “healing” mean — and whether we should be using them at all. These aren’t just semantic disagreements; they reflect different worldviews about suffering, responsibility, power, and identity. So even within mental health disciplines — let alone across psychiatry, psychology, therapy, coaching, and peer support — having a coherent conversation has become incredibly challenging.
I have long been searching for a more public forum to have these conversations openly.
It's a relief to read your words Amit. You've described the tension so well, especially the part about how even gentle questioning can be seen as invalidating. The generational split around language and meaning adds another layer that makes honest and real conversation feel almost impossible. Your sentiment also echoes what Freya India just published about her generation and the meaninglessness of therapy language that reduces being human to symptoms and labels. You might be interested in reading it if you haven't already:
https://www.freyaindia.co.uk/p/nobody-has-a-personality-anymore
Thank you for the kind words.
That is an excellent piece - thank you for the recommendation. Have you come across online or other types of spaces where this conversations is being had among professionals in mental health space and/or between professionals and folks utilizing mental health services? I want to engage more publicly in this dialogue so that as attention continues to increase on the construct of mental health (especially in the current moment of our global geopolitical climate), some reorientation towards this framing can make its way into the next iteration of how the larger population and next generations engage with these vital questions/considerations for daily life and living.
I see professionals (mainly psychotherapists) discussing related topics on X. Jonathan Shedler, JD Haltigan (on this platform and X) are a few I’ve seen.
Thought-provoking; thank you.
re: Why more ADHD/autism, but not more Cluster B, your thoughts on the complex etiological nature of this is certainly on the right track. I might add:
- progressively lowering of the diagnostic threshold as a result of Pharma influence (e.g., more Ritalin sales);
- feminist influence, especially in the early education system, to pathologize generally healthy and normal behaviour amongst boys
- increasing childhood vaccine schedule and associated neurotoxic load (wondering if the more inflammatory APO-E4 allele cohort are more vulnerable 🤔)
- if covert/vulnerable narcissism is a feminine form as I suspect (i.e., more prevalent amongst women than men), the cultural metastization of it would result in increasing thaumaturgical mirroring as being victims of something else health related.
These are awesome and important additions and I'm glad you raised them. One other point that came up but I thought including would blow out the article is metabolic issues. Our metabolic system is completely screwed up by our lifestyles. There are so many Cluster B vegans, for example. It's amazing what animal products and healthier lifestyle can do for mental and emotional function.
Madame Dr. Nathalie, I do thank you for your kind words and find myself further in agreement with you. Physical health and psychoemotional health are intrinsically linked..
This is such an important distinction. When we start framing emotional immaturity or manipulative behavior as fixed traits or identities, we blur the line between explanation and excuse. As I wrote in The Cost of Comfort: Why Hard Truths Matter for Our Kids, the more we protect people from discomfort, the more we stunt their ability to grow. There is a cost to confusing compassion with avoidance, and we are seeing it now across entire systems.
The crisis is not just cultural. It runs through the psychology field itself. In a rush for legitimacy and relevance, too much of the profession has traded long-term development for short-term validation. We have softened our standards, moralized distress, and started calling adaptation a form of oppression. But growth requires friction. And truth still matters.
Thank you for articulating this so clearly. It is a hard but necessary conversation.
Thank you so much for reading the piece and for your thoughts, highlighting the importance of discomfort and friction for character development and growth.
What should I read to understand Neurodivergance? It's a new term for me.
I'd start with search engines and ChatGPT/Grok. Ask it to provide high quality peer reviewed references on the origins of neurodivergence or on ADHD or ASD. There are also a few references at the end of this article.
Side note (and personal note) I'm so grateful I got a TOVA as a requirement of my ADHD diagnosis, even though the process of doing it was so painful I considered just leaving without finishing it.
It's so helpful having a clear diagnostic tool that shows "how effectively and consistently can you pay attention for, and how long, compared to the norm". Something tangible that isn't a self-report. It should be standard and I don't think it is.
I had to look up what the TOVA is and I hadn't come across the term before. After reading a bit on it, I can imagine how challenging that experience must have been yet can also see how having something that objectively tracks attention and functioning would be incredibly helpful. Thank you for sharing that and for adding to the conversation on what meaningful diagnosis and support can look like.
My apologies for the vagueness! I can fall into the trap of over-explaining things to people who are at least as qualified as me and often far more so. It's a really handy diagnostic tool, and I'm mostly joking about how bad it was it. A great example of a measurability in diagnostics.
Excellent.
There are many things about the modern World that One can notice as an overall pattern of disfunction, rot, and all this.
One of those is how adaptable Human Beings are, and how People can recognise "quick and easy" paths to "success".
It is often said that "the fish rots from the head down".
Many of today's "leaders", and those held out as "elite" in some way are, in fact, fraudulant, psychopathic, and sociopathic. Add to that the prevalence of gutless cowardice masquerading as "going along to get along".
We live in the Age of the Preposterous, where many of the so-called "elite" believe Themselves to be the authors and editors of reality. This "trickles down" to everyday People, who apply a "monkey see / monkey do" tactic to Their personal Life, and it is reinforced by the fear of the gutless coward.
It has all been foretold.
The Hopi word for the modern world is "Koyanisqatsi". ( Koy-onn-iss-kot-see ) This translates to "World upside-down", or "Life upside-down".
Anyhoo, to the Hopi, Life in the modern world will continue to dissolve into chaos, until it destroys itself by fire. They will survive as an intact People, just as They survived the Great Flood. To Them, this is the Fourth World, the fourth time Humans have reached high technology, and ultimately destroyed Themselves.
Check it out;
https://fartbackpack.substack.com/p/the-wierdest-conspeewuhssee-you-have
I appreciate this. I’ve heard similar themes in Indian traditions too. In Kali Yuga, the world is said to turn upside down, where power disconnects from wisdom, and truth is hard to find. Some say it ends in fire, and eventually, the sun consumes it all. These patterns echo across so many cultures, and with every end a new cycle begins.
Also, in case it helps: I predict you're going to get unreasonable comments. Some will accuse you of "painting with a broad brush," and they will personalize, and accuse you of "attacking them." I hope you can sweep these aside and not pay attention to them. There's no way to avoid "triggering" people who are immature enough that they cannot handle a frank conversation like this.
You've been there too so this advice is helpful. Reactions, yes. Accusations, not yet (it's still early). Thank you!
What are the reasons someone would want to be labeled as neurodivergent?
Are there motivations that go beyond just self-acceptance?
Is there a distinction between those who have grown up with the label since early childhood, versus those who acquire an acceptable neurodivergent label as an adult?
How susceptible are diagnosticians to manipulative behaviors in ascribing labels?
I can't really comment on the difference between those who have been diagnosed as children vs those diagnosed as adults because the pathways are so different, as are the drivers and incentives for diagnoses in these populations.
I think many diagnosticians want to do the right thing, can't always detect manipulation, and feel they don't have a choice when someone comes through the door ready to pay to be assessed for neurodivergent label.
Most people are susceptible to manipulative behaviours when someone is perceived to be in suffering and in a position to offer help.
Great paper. I recently wrote a piece about how I feel the real issue that needs more examination is the idea of an underdeveloped sense of self which becomes a breeding v ground for exactly this kind of cluster b behavior. I contrast this theory against adhd and autism to see why it’s not autism or adhd but rather an identity schism.