My first encounter with a narcissistic, sociopathic patient – a very rare kind – is a kind of gaslighting, and I didn’t believe it. I thought I could get through it because I bent down to a patient’s eye level in scrubs with four public safety officers with pepper spray behind, and I said to the lost boy who ‘should be over it now because he’s 30 and saw genocide at 10 and has every possible service here.’ You are a black man in Rochester who is tall and strong and I am trying to protect you; I think. I can get through this because, as it happens, I did read all the literature the attending psychiatrist is quoting. I use the word ‘misanthropy’ in a full sentence during treatment planning. My first narcissist was psychotic.
Psychotic patients were routine for me. If I speak with my eyes and look where the pain is – not in their eyes, but in the halo of a person – then there is a thin line I draw from me to them, and I can roll medicines or hope or calming words down that line until the phenomenon collapses, and keep doing so until they are well. When I was alone in Rochester, New York and broke and at risk in a foot of snow, my mother said, ‘I know you will be safe because everyone will see the good shining from you’. Most people do shine in extremis, or, at any rate, that’s how I saw it. What took me unaware was that the line was jerked back, and the patient was not a core of fundamental humanistic values, distorted by psycho-social developmental factors. The patient wasn’t psychotic, not really – he just lived in a monstrous world where there was only him and things that fed or starved him. He was never full. After convincing an elder with impaired mobility and rumpled hair to take his medicine, I found myself pinned by this same man, now transmogrified into a mean curmudgeon in a wheelchair, between the kitchen door and his steel machine.
It took a lot more … a lot more. The world is fucking good. The world is good, the system is bad. The system is narcissistic. The nurses are bad, I am bad. The nurses who are good with the patients are narcissistic – or, no, really, it was the system that was a sociopath. I suppose Trump winning was a gift, or some version of Pema Chodron saying ‘nothing goes away until it teaches us what we need to know.’
There is fundamental, there is elemental, and there is us. If narcissists have a function, it is to strengthen the world, and remove walls that are invisible.
I’m still a nurse, but in an outpatient setting. A narcissist leads America and spins people into anger, placation, division and rage. ‘Svetlana is annoying and weird and thinks she’s better than me.’ ‘Mary is clueless.’ These assertions make more sense than ‘nobody is fairer, everyone is afraid’. Friends who see me, pull me out of the abyss. Then, I do that for them, and find myself saying ‘life’s short’ and ‘TGIF’ with absolutely nothing that is avoidant about it. I don’t work night shift anymore, but the ghosts stagger out at midday from the forest buried beneath the highway.
