Dysmorphophobia

Has the narcissism of the market destroyed our sense of collective identity? Psychiatrist Trevor Turner argues that a preoccupation with self has spawned a new syndrome: malignant self-actualization.

THERE is something mad about the modern world. It's as if there is a collective neurosis where the delights of personal convenience have, paradoxically, created intolerable sensitivities. Or maybe it's that our collective unconscious (as outlined by Carl Jung) is in fact fragmenting. Jung believed that we share a sense of symbols, dreams and feelings that go back to primitive times and reflect memories of our ancestors' experiences. There seems to be a rising tide of mental illnesses, a rising demand for 'lifestyle' medications and even several new 'conditions'. Common 'shyness' is now a 'social phobia'; screwing around is 'sexual-addiction syndrome'; and bad-tempered people now have 'emotionally unstable personality disorders'.

So why not 'malignant self-actualization' syndrome' (MSA) defined as a disabling condition which elevates personal choice into the highest arbiter of everything? It's not yet in the standard psychiatric disease classifications but maybe it should be.

The signs of MSA are all around us. Let's take personal living arrangements. In Western countries there are now often less than two children per marriage. And more than half of households in the 1980s contained just one or two people. Most of our elderly, more than 80 per cent, now live alone or with a spouse, compared to 25 per cent a century ago. Some 60 per cent of households used to have children, now only 12 per cent do. Most old people are looked after by other people's children. Your own flat, your own car, your own space and your own 'personal' computer are the sacred must-haves of today. Yet loneliness can make you sick. Increased illness and in particular 'somatization'--the tendency to turn worry and stress into a physical symptom--is associated with people living alone.

Likewise the future looks set for an increasingly privatized lifestyle. By 2021 it is expected that over 40 per cent of men and a third of women will be living on their own. During the last 30 years the number of divorces has trebled and the number of marriages halved while 'cohabiting' (living together without marriage) has doubled. Half the children of 'cohabitees' see their parents separate before their fifth birthday. Single-parent families are poorer, the kids find it harder to trust and relate... and so on. On the other hand, successful long-term partners have better health and more money; they feel more confident and they deal better with problems and insecurities.

Even so, the pursuit of loneliness seems to be winning out. We have a society obsessed by obsolescence and perfection, throwing away used goods faster than we can buy new ones. 'Shopping therapy' is a typical modem habit, invented by salespeople to latch on to MSA sufferers.

But what are the roots of this obsession with the self? Psychiatrists have long described a range of personality disorders characterized by the inability to think more than a few moments ahead and the dominance of uncontrolled impulse. ('Psychopath' was the old term, but deliberately harming other people isn't the main problem now.)

Today a rising tide of narcissism is spreading like a toxic social algae. Narcissism derives from the Greek myth of the beautiful boy Narcissus who so liked his looks he spent all day staring at his reflection in a pond -- until eventually he fell in and drowned. The modern dominance of the camera and the importance of image over language maybe one of the culprits. Comic books, films, mobile phones that take pictures -- all value the look of things much more than the meaning of things. This obsession with appearance has created two enormous and increasingly profitable industries -- cosmetics and food. A recent advertisement announced proudly that 1,200 researchers were striving night and day to get new products on to the shelves. At the same time fast-food franchises and instant meals are generating rising levels of obesity and further profits in the diet industry. And cosmetic surgery, for the not-quite-right nose or the flabby gut, drains medical resources from the needy to the greedy.

In fact, MSA is a bottomless pit of potential demand on the healthcare system. Conditions like 'air rage', 'road rage' and dysmorphophobia (the conviction that you don't quite look right) all reflect the triumph of individual desire over a commitment to the world outside oneself. Drug marketing has played its part in this; large pharmaceutical companies are happy to provide treatments for every little discomfort or inconvenience.

Bad behaviour

The latest new 'disorder' is 'female sexual dysfunction' and apparently 43 per cent of women in America are suffering from it! That's a big market, just like the one for erection-enhancers and hormonal supplements that uses the 'male menopause' as its catch-phrase. We've already seen the brilliant campaigns for Prozac and friends -- antidepressants that deal with even the mildest of depressions as well as obsessions and anxiety, shyness, bad temper... and whatever.

And where does all this narcissism-cum-MSA come from? Is it the way we are brought up -- as psychoanalysts would have us believe? Or is it all in our genes? Both versions, nurture or nature, unfortunately lead all too easily to excuse-making. Psychoanalysis demands that you talk about yourself -- usually at your own expense -- for up to an hour, four or five times a week, for years. Genetics provides a ready excuse for saying: 'it's not my fault' and demanding to be let off from the consequences of bad behaviour. The next step will be someone suing their parents for not taking proper genetic advice. The answer is probably much simpler, as Sir Michael Russell has pointed out in his book, Developing Minds. Studying how people grow up, Russell found that there are regular opportunities for change, especially if you have a sense of the future. A woman with a difficult childhood talked about her husband of 20 years as someone who 'made me think about tomorrow'. We've all been dealt a mixed hand of parents and gen es, some better than others, but no-one has to go on just looking at themselves in the mirror.

Perhaps the most important ingredient fuelling MSA is, our addictive society. If we take drug and alcohol addicts as the ultimate example of those serving their own needs to the detriment of others -- ranting, robbing or ruining so as to ease their personal pain -- we can also see how subtler addictions are fiercely reinforced by our highly controlled society. George Orwell's paranoid world of 1984-- published in 1948 -- was bad enough, but we have gone way beyond that. Who are we fighting this year? Mr Bush and Mr Blair will tell us. What's the right beer to drink? Bud have a great ad and that Mexican stuff with a lemon in the top still looks cool. We are so hooked on a thousand creature comforts, in the West at least, that we do not see the dependency downsides of coffee (anxiety), sugar (obesity), cars (heart disease) or additives (tantrums).

The demand for cosmetics, cosmetic surgery, pain relievers, tranquillizers, therapy, sleep control, sex-like-in-the-movies and one perfect baby has already distorted health services worldwide. They simply can't keep up. And the more choices you have, the easier it is to be dissatisfied. So medical litigation is rising. The private health-insurance system in Australia temporarily crashed last year, having gone broke -- and in some parts of the US it's hard to find a doctor to deliver your baby because of the costs of malpractice insurance. People walk into hospital emergency departments in London at two in the morning complaining of back pain that's been niggling for months. Why then? 'Because I couldn't sleep,' they say. 'And the baby was crying! Oh, by the way, can you do anything for a crying baby?' But on-and-off back pain and crying babies are not illnesses: they are part of the business of being human. This medicalization of discomfort has been well explored in the writings of Ivan Illich. But we need t o rediscover how to educate ourselves into accepting, embracing even, inconvenience.

Living alone

How do we get out of this? The only reasonably effective treatment for addiction is a group approach -- for example Alcoholics Anonymous -- and there may be some mileage in getting youngsters to talk to stable married couples about how to make relationships work. But if we aren't all going to be living alone by the year 2050 then something big needs to be done soon. Perhaps if we could interest a drug company we could have a cure for MSA, or a vaccination against egotism? Perhaps the fault is with our education system. It's supposed to teach people to think for themselves -- though it rarely does. Maybe, in addition, we need to teach them to think about themselves.

Personally I blame too much counselling and chat shows. The urge to talk over every minor upset or half-baked relationship has become a modern shibboleth. It may be unfashionable to say so but the age of private therapy hasn't exactly been a success -- two world wars, weapons of mass destruction and global pollution. Let's get back to working and playing with other people rather than talking about ourselves. What about compulsory team sports? What about tax breaks for not living alone, for not owning a car, for not having cosmetic surgery? What about abolishing TV? What about conversation over meals? What about 'others before self as my mother used to say?

Trevor Turner is a psychiatrist and an occasional contributor to the NI.

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